Framingham 10-year Cardiovascular Disease Risk Research Articles

Sex-specific associations between self-reported sleep characteristics and 10-year cardiovascular disease risk in men and women of African descent living in a low socioeconomic status environment

BackgroundRisk factors for cardiovascular disease (CVD) and sleep health are well-known to be sex- and race-specific. To build on the established relationship between sleep duration and CVD risk, this cross-sectional study aimed to describe sex-specific associations between CVD risk and other sleep characteristics (sleep quality, sleep timing and sleep onset latency) in low-income adults of African descent. MethodsSelf-reported sleep (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]), demographic and lifestyle data were collected in 412 adults (56 % women, 35.0 ± 7.6y, 40 % employed) living in an informal settlement in South Africa. CVD risk was determined using the BMI-modified Framingham 10-year CVD risk formula. ResultsLogistic regression analyses, adjusted for employment, alcohol use and physical activity, indicated that men reporting poor sleep quality (OR: 1.95[95 %CI: 1.07–3.51], p=0.025) and earlier bedtimes (0.54[0.39–0.74], p<0.001) were more likely to belong to a higher 10-year CVD risk score quintile. Women reporting earlier bedtimes (0.72[0.55–0.95], p=0.020) and wake-up times (0.30[0.13–0.73], p=0.007), longer sleep-onset latency (1.47[1.43–1.88], p=0.003), shorter total sleep times (0.84[0.72–0.98], p=0.029), higher PSQI global scores (1.93[1.29–2.90], p=0.001) and more moderate to severe symptoms of insomnia (ISI≥15)(3.24[1.04–10.04], p=0.016) were more likely to belong to higher 10-year CVD risk score quintile. ConclusionIn addition to sleep duration, we found that sleep quality, sleep timing and sleep onset latency are additional risk factors for CVD in adults of African descent. Sex-specific differences in the sleep-CVD-risk relationship observed suggests that future studies and recommendations about sleep health in relation to CVD should take sex into account.

Sex-specific associations between self-reported sleep characteristics and 10-year cardiovascular disease risk in men and women of African descent living in a low socioeconomic status environment

BackgroundRisk factors for cardiovascular disease (CVD) and sleep health are well-known to be sex- and race-specific. To build on the established relationship between sleep duration and CVD risk, this cross-sectional study aimed to describe sex-specific associations between CVD risk and other sleep characteristics (sleep quality, sleep timing and sleep onset latency) in low-income adults of African descent. MethodsSelf-reported sleep (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]), demographic and lifestyle data were collected in 412 adults (56% women, 35.0±7.6y, 40% employed) living in an informal settlement in South Africa. CVD risk was determined using the BMI-modified Framingham 10-year CVD risk formula. ResultsLogistic regression analyses, adjusted for employment, alcohol use and physical activity, indicated that men reporting poor sleep quality (OR: 1.9[95%CI: 1.1-3.5],p=0.025) and earlier bedtimes (0.54[0.39-0.74],p<0.001) were more likely to belong to a higher 10-year CVD risk score quintile. Women reporting earlier bedtimes (0.72[0.55-0.95],p=0.020) and wake-up times (0.30[0.1-0.7],p=0.007), longer sleep-onset latency (1.5[1.4-1.9],p=0.003), shorter total sleep times (0.84[0.7-0.9],p=0.029), higher PSQI global scores (1.9[1.3-2.9],p=0.001) and more moderate to severe symptoms of insomnia (ISI≥15)(3.24[1.04-10.04],p=0.016) were more likely to belong to higher 10-year CVD risk score quintile. ConclusionIn addition to sleep duration, we found that sleep quality, sleep timing and sleep onset latency are additional risk factors for CVD in adults of African descent. Sex-specific differences in the sleep-CVD-risk relationship observed suggests that future studies and recommendations about sleep health in relation to CVD should take sex into account.

Evaluation of treatment effectiveness and 10-year cardiovascular disease risk level in hypertensive outpatients

Hypertension represents a substantial risk factor for the development of cardiovascular disease (CVD), stroke, and chronic kidney disease. CVD stands as the primary cause of global mortality. This study employed a prospective cross-sectional design spanning 4 weeks. Data were collected using a pro forma designed to capture patients’ sociodemographic and clinical information. Prescribers’ adherence to anti-hypertensive prescription guidelines, as per the JNC8 guideline, and patients’ attainment of target blood pressure (BP) goals were assessed. Framingham 10-year CVD risk score estimation was employed to estimate patients’ 10-year CVD risk levels. Among the patients, 51 (59.3%) had anti-hypertensive prescriptions that adhered to the JNC8 guidelines. However, a majority, 54 (62.8%), failed to achieve their JNC8 target BP goals, and 44 (51.2%) exhibited intermediate 10-year CVD risk levels. Furthermore, 71 (98.6%) of the patients did not receive the recommended statin and/or aspirin therapy, despite its necessity. An association was found between patients’ achievement of JNC8 target BP goals and their 10-year CVD risk levels. The majority of patients received anti-hypertensive prescriptions that aligned with JNC8 guidelines. Nonetheless, most of them did not attain their JNC8 target BP goals and exhibited intermediate to high 10-year CVD risk levels.

Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys.

Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. To provide current picture and future trend of CVD risk in the adult Iranian population. Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention.

Ten-Year Cardiovascular Disease Risk Score and Cognitive Function Among Older Adults: The National Health and Nutrition Examination Survey 2011 to 2014.

Background The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non-Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test-specific and global cognition Z scores. Each incremental 5% in Framingham 10-year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (β=-0.06 [95% CI, -0.09 to -0.03]), delayed memory (β=-0.05 [95% CI, -0.08 to -0.01]), immediate memory (β=-0.07 [95% CI, -0.10 to -0.03]), and global cognition (β=-0.05 [95% CI, -0.09 to -0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers.

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Association of triglyceride/high-density lipoprotein cholesterol ratio with subclinical inflammation and 10-year cardiovascular disease risk as determined by Framingham risk scores in Korean male smokers.

Various risk factors and the multifactorial pathophysiology of cardiovascular disease (CVD) have been studied. We focused on the interaction between insulin resistance and inflammatory processes. Thus, we analyzed the association of triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio with subclinical inflammation and CVD risk in male smokers. We retrospectively reviewed medical records from the Health Promotion Center of Severance Hospital in Korea between 2015 and 2017. Subjects were currently smoking men aged 30 to 59, with leukocyte counts within the normal range, for a total of 1,566. We grouped participants into four groups using the median TG/HDL ratio and the median leukocyte count. The odds ratio (OR) of high Framingham 10-year CVD risk (≥10%) was calculated using multiple logistic regression. The median Framingham 10-year CVD risk increased significantly from Group 1 (low leukocyte count, low TG/HDL ratio) to Group 4 (high leukocyte count, high TG/HDL ratio). The OR for Group 4 was 2.46 compared with Group 1 after adjusting for various CVD risk factors. In subgroup analysis, the OR of the highest leukocyte group was 1.57 compared to the lowest leukocyte group after adjusting for other variables. In conclusion, TG/HDL ratio and subclinical inflammation were positively related to CVD risk in Korean male smokers.

Fatty Liver Index as a Simple and Useful Predictor for 10-year Cardiovascular Disease Risks Determined by Framingham Risk Score in the General Korean Population.

The fatty liver index (FLI) is a simple and non-invasive method for the diagnosis of fatty liver disease with an increased risk of cardiovascular disease (CVD) as well as liver-related mortality. We examined the association between FLI and 10-year CVD risk as determined by the Framingham risk score. This cross-sectional study included 7,240 individuals aged 30 to 69 years who underwent a health examination between 2015 and 2017. The FLI was calculated using an algorithm based on triglyceride, γ-glutamyltransferase, body mass index (BMI), and waist circumference. Multiple linear and logistic regression analyses were performed to assess independent relationships between the FLI and Framingham risk score after adjusting for confounding variables. The overall prevalence of fatty liver disease among study participants as assessed by an FLI ≥ 60 was 19.7%. Compared with non-hepatic steatosis (FLI < 30), the odds ratio (95% confidence interval) for a high Framingham 10-year CVD risk ≥ 10% in individuals with hepatic steatosis (FLI ≥ 60) was 2.56 (1.97-3.33) after adjusting for age, gender, fasting plasma glucose, high-density and low-density lipoprotein cholesterol, blood pressure, C-reactive protein, regular exercise, alcohol-drinking, and current smoking. The FLI was positively and independently associated with a Framingham 10-year CVD risk in the general Korean population. Our findings suggest that the FLI, a simple, useful, and economical index, may be an indicator of CVD events.

Compared to serum triglyceride alone, the association between serum triglyceride to high-density lipoprotein cholesterol ratio and 10-year cardiovascular disease risk as determined by Framingham risk scores in a large Korean cohort

BackgroundThe incidence of cardiovascular disease (CVD) has gradually increased to the extent that it has become the most common cause of mortality worldwide, and triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, a surrogate marker of insulin resistance, has emerged as an independent predictor of CVD. Additionally, several recent studies have reported an independent association between triglyceride-rich lipoproteins and CVD risk. The present study was conducted to investigate the association between the CVD risk determined by the Framingham risk score and the TG alone and TG/HDL ratio in a large Korean cohort. MethodsThis cross-sectional study included 6,995 participants aged 30 to 69 years that participated in a health examination program. TG/HDL ratio quartiles and TG quartiles were categorized as follows: Q1: ≤ 1.25, Q2: 1.26–2.07, Q3: 2.08–3.48, and Q4: ≥3.49; Q1: ≤ 71, Q2: 72–105, Q3: 106–159, and Q4: ≥160, respectively. Odds ratios (ORs) and 95% confidence intervals (CI) for high Framingham 10-year CVD risk (≥10%) were calculated across TG/HDL ratio quartiles and TG quartiles using multiple logistic regression analysis after adjusting for confounding variables. ResultsThe mean values of most cardiometabolic variables including body mass index, blood pressure, fasting plasma glucose levels, leukocyte count, median CRP levels, and Framingham 10-year CVD risk scores increased gradually with TG/HDL ratio quartiles. The OR (95% CI) of the highest TG/HDL ratio quartile and TG quartile as compared with the lowest TG/HDL ratio quartile and TG quartile for high Framingham 10-year CVD risk was 9.27 (6.68–12.86) and 0.97 (0.69–1.36) after adjusting for confounding variables, respectively. ConclusionCompared to TG, the TG/HDL ratio was found to be positively and independently associated with Framingham 10-year CVD risk in a large Korean cohort.

Agreement between laboratory-based and non-laboratory-based Framingham risk score in Southern Iran

The Framingham 10-year cardiovascular disease risk is measured by laboratory-based and non-laboratory-based models. This study aimed to determine the agreement between these two models in a large population in Southern Iran. In this study, the baseline data of 8138 individuals participated in the Pars cohort study were used. The participants had no history of cardiovascular disease or stroke. For the laboratory-based risk model, scores were determined based on age, sex, current smoking, diabetes, systolic blood pressure (SBP) and treatment status, total cholesterol, and High-Density Lipoprotein. For the non-laboratory-based risk model, scores were determined based on age, sex, current smoking, diabetes, SBP and treatment status, and Body Mass Index. The agreement between these two models was determined by Bland Altman plots for agreement between the scores and kappa statistic for agreement across the risk groups. Bland Altman plots showed that the limits of agreement were reasonable for females < 60 years old (95% CI: −2.27–4.61%), but of concern for those ≥ 60 years old (95% CI: −3.45–9.67%), males < 60 years old (95% CI: −2.05–8.91%), and males ≥ 60 years old (95% CI: −3.01–15.23%). The limits of agreement were wider for males ≥ 60 years old in comparison to other age groups. According to the risk groups, the agreement was better in females than in males, which was moderate for females < 60 years old (kappa = 0.57) and those ≥ 60 years old (kappa = 0.51). The agreement was fair for the males < 60 years old (kappa = 0.39) and slight for those ≥ 60 years old (Kappa = 0.14). The results showed that in overall participants, the agreement between the two risk scores was moderate according to risk grouping. Therefore, our results suggest that the non-laboratory-based risk model can be used in resource-limited settings where individuals cannot afford laboratory tests and extensive laboratories are not available.

Effects of Structured Lifestyle Education Program for Individuals With Increased Cardiovascular Risk Associated With Educational Level and Socioeconomic Area.

Background. Differences in socioeconomic status contribute to inequalities in lifestyle habits and burden of noncommunicable diseases. We aimed to examine how the effects of a 1-year structured lifestyle education program associate with the participant’s educational level and socioeconomic area (SEA) of residence. Methods. One hundred individuals (64% women) with high cardiovascular risk were included. Education level (nonuniversity vs university degree) was self-reported and SEA (low vs high) defined by living in different SEAs. Lifestyle habits and quality of life were self-reported, cardiovascular risk factors and Framingham 10-year cardiovascular disease risk were measured at baseline and after 1 year. Results. Sedentary behavior decreased in both nonuniversity degree and low SEA group over 1 year, with a significantly greater improvement in daily activity behavior in low- compared with high-SEA group. Abdominal obesity decreased significantly more in the nonuniversity compared with the university degree group. Cardiovascular risk and quality of life improved in all groups, however, with greater discrimination when using educational level as the dichotomization variable. Conclusion. The results are clinically and significantly relevant, suggesting that low socioeconomic status measured both as educational level and SEA are no barriers for changing unhealthy lifestyle habits and decreasing cardiovascular risk after participation in a lifestyle program.

Higher monocyte count with normal white blood cell count is positively associated with 10-year cardiovascular disease risk determined by Framingham risk score among community-dwelling Korean individuals.

The cardiovascular disease (CVD) has been identified as a leading cause of premature mortality among middle-aged and elderly individuals globally. Inflammation plays an important role in aging and age-related diseases, such as atherosclerosis and CVD. White blood cell (WBC) count is an inexpensive, simple biomarker of systemic inflammations and includes several cell subtype counts, such as neutrophils, monocytes, lymphocytes, basophils, and eosinophils. However, which component of a WBC count has the ability to predict CVD remains controversial. The objective of this study was to assess the association between monocyte counts and 10 year-CVD risk among community-dwelling Korean individuals using the Framingham risk score (FRS). We studied a total of 627 participants aged over 30 years who underwent routine health examinations. The mean age of the study population was 48.1 ± 11.7 years, and 56.9% were male. In the multiple regression analysis, the independent contribution of monocyte count to Framingham 10-year CVD risk was 0.217 ± 0.092 (P = .018) after adjusting for confounding variables. We found that of the various WBCs, monocyte count is an independent predictor of CVD risk. Further larger-scale prospective cohort studies are warranted to determine these associations in the future.

Racial and sex differences in biological and chronological heart age in the Coronary Artery Risk Development in Young Adults study

PurposeCalculation of a biological heart age offers an alternative to absolute risk for characterizing cardiovascular risk by describing risk relative to an individual with normal health. We examined risk factors contributing to differences between biological and chronological heart age in young adults. MethodsThe Coronary Artery Risk Development in Young Adults study included 2264 Black and White men and women who attended examination years 10 through 25. We estimated biological heart age using the nonlaboratory-based Framingham 10-year cardiovascular disease risk calculator. Trends in risk factors were examined cross-sectionally and longitudinally. ResultsBiological heart ages for Black participants were 5.6 years older than their chronological ages over 15 years (P < .001). In longitudinal analyses, urinary albumin–creatinine ratio and alcohol intake were statistically significantly related to higher biological compared with chronological heart age, whereas physical activity and education were statistically significantly related to negative heart age differences (P < .001). Trends were similar in cross-sectional analyses at all time points. ConclusionsMost risk factors driving biological heart age, including race, education, physical activity, and urinary albumin–creatinine ratio, contributed to heart age differences cross-sectionally and longitudinally suggesting that risk factors related to adverse biological aging are important at younger and older ages.

Abstract P456: Examining Framingham Coronary Heart Disease 10-year Risk Reduction in Individuals Treated With Lorcaserin, a Selective 5HT 2C Receptor Agonist for Weight Management

Introduction: Obesity contributes significantly to cardiovascular disease (CVD) risk and weight management is associated with CVD risk reduction. Lorcaserin, a selective 5HT 2C receptor agonist, is indicated as an adjunct to a reduced-calorie diet and increase physical activity for weight management in adults with obesity (BMI≥30) and overweight (BMI 27-29.9 and ≥1 weight-related comorbidity). This analysis used the Framingham 10-year CVD risk to examine the impact of lorcaserin treatment on CVD risk and risk reduction. Method: Pooled data from two randomized, double-blind studies (BLOOM &amp; BLOSSOM) investigating the efficacy of lorcaserin vs. placebo among non-diabetic patients with overweight or obesity, were used in this analysis. Framingham CVD risk was calculated for those whose lipid values were available at baseline and at one year. A Framingham CVD risk of &lt;5% was classified as low risk. Patients were stratified by cohort, lorcaserin (LOR) vs. placebo (PBO) and response at week 12 (≥5% weight loss vs. &lt; 5%) for calculating the 10-year CVD risk at one year. Logistic regression was used to adjust for baseline risk and determine if proportional differences in risk reduction were significant. Results: A total of 5,658 patients were evaluated, 51% treated with LOR. Among the LOR-treated patients, 43% achieved ≥5% weight loss at week 12 (compared to 19% treated with PBO). At one year, more patients in the LOR cohort had reduced CVD risk (from high to low risk, 21% vs. 15%, respectively). The regression analysis showed LOR-treated patients were 34% more likely to have low CVD risk (p&lt;0.001). Similarly, for patients who lost ≥5% baseline body weight at 12 weeks, more patients in the LOR cohort had reduced CVD risk (from high to low risk, 26% vs. 16% respectively) at one year. The regression showed LOR-treated patients were 23% more likely to have low CVD risk (p&lt;0.05). Conclusion: The analysis suggests that patients treated with LOR are more likely to have low CVD risk at one year than those treated with PBO. The effect is magnified if patients have ≥5% weight loss at 12 weeks.

A 13-week low glycemic load diet and lifestyle modification program combining low glycemic load protein shakes and targeted nutraceuticals improved weight loss and cardio-metabolic risk factors.

An open-label, randomized, exploratory study of 44 healthy overweight subjects with cardio-metabolic syndrome (CMS) risk factors was conducted to assess the safety, tolerability, and efficacy of a proprietary lifestyle modification program without (DIET) and with (PROG) targeted nutraceutical supplementation, including phytosterols, antioxidants, probiotics, fish oil, berberine, and soy, pea, and whey proteins over 13 weeks. Key metrics were recorded at baseline and weeks 9 and 13. For the DIET and PROG groups, compliance was 85% and 86%, respectively, with no adverse events related to the diet or supplements. Twelve subjects discontinued participation before week 9 for reasons unrelated to the study. PROG subjects experienced greater decreases (p < 0.05) than DIET in body mass, fat mass, total cholesterol, LDL cholesterol, TG, cholesterol / HDL ratio, TG/HDL ratio, apolipoprotein B / apolipoprotein A1 ratio, and hs-CRP. The Framingham 10-year cardiovascular disease risk score decreased by 40% (p < 0.01) in the PROG arm versus no change for the DIET arm. As a pilot study, it was not possible to state whether the observed effects were the result of nutraceutical supplementation alone or the result of additive or synergistic interactions among diet, lifestyle modifications, and nutraceutical supplementation. Moreover, individuals with CMS risk factors following a lifestyle modification program received additional health benefits from targeted nutraceutical supplementation.

Abstract P239: Clinical Risk Factors Related to Biological versus Chronological Heart Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Recent analysis of BRFSS data used the non-laboratory-based Framingham 10-year cardiovascular (CVD) risk calculator to derive biological heart age in older adults. . This calculator utilizes cardiovascular disease (CVD) risk factors sex, age, BMI, systolic blood pressure (SBP), diabetes status, smoking status and antihypertensive medication use. We examined which risk factors drove differences between biological and chronological heart age in young adults. Methods: CARDIA examined 2674 black and white men and women who attended Year 10 (mean age 34) and Year 25 (mean age 49) exams and had complete data for heart age components. Biological heart age was calculated using the non-laboratory-based Framingham 10-year CVD risk calculator. Heart age difference was defined as the difference between biological and chronological heart age, with higher values representing poorer heart age. Heart age difference was categorized into three levels, ≤-5 years, -5 to +5 years, or ≥+5 years. Differences between levels were assessed using linear regression, with heart age difference coded as an indicator variable referenced against a heart age difference of -5 and +5 years. Results: Race, smoking status, BMI and SBP were statistically significantly different from the reference in those whose heart age differences were lower (≤ -5) and higher (≥ 5) at exam years 10 and 25. Sex differed from the reference only in the lower heart age difference groups at both exams. Diabetes status differed from the reference only in the higher heart age difference groups at both exams. Conclusions: Most risk factors driving biological heart age, including race, smoking status, diabetes status, antihypertensive medication use, BMI and SBP, drive both favorable and unfavorable heart age differences at years 10 and 25 with the notable exceptions of female sex with favorable and diabetes with unfavorable heart age difference. This suggests that risk factor management at both younger and older ages impacts vascular aging.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis

IntroductionAlthough testosterone deficiency has a well-known association with increased risk of cardiovascular disease (CVD), the threshold remains to be determined. AimTo investigate whether there is a discriminatory testosterone level below which the CVD risk increases. MethodsThe study included 876 men 45 to 74 years old who underwent a general health checkup. The Framingham Risk Score was used to estimate the 10-year CVD risk; a high-sensitivity C-reactive protein (hsCRP) level of at least 1 mg/L was considered an indicator of increased CVD risk. Aging symptoms and sexual function were evaluated with the Aging Males’ Symptom Scale. Main Outcome MeasuresLocally weighted regression was performed to determine the testosterone threshold for Framingham CVD risk and increased hsCRP. ResultsThe mean age was 56.6 ± 7.0 years. The mean total testosterone level was 394.3 ± 115.7 ng/dL. The mean 10-year Framingham CVD risk was 16.6 ± 10.7%, and 169 (19.3%) had increased hsCRP. The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk. Their risk appeared to increase at a relatively higher testosterone level, and it reached a plateau at a testosterone level of 300 to 350 ng/dL. In contrast, the risk in those with no or less sexual dysfunction remained low at a higher testosterone level, and a threshold level of 425 to 475 ng/dL was associated with increased CVD risk. A similar pattern and threshold were identified in the analyses of the relation between testosterone and hsCRP. ConclusionThese data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

Where to Sit? Type of Sitting Matters for the Framingham Cardiovascular Risk Score.

BackgroundCurrent evidence on associations of type-specific sedentary behavior with cardiovascular disease (CVD) is limited to mainly screen-time sedentary behavior (SB). We aimed to study the associations of type-specific and total time spent sitting with the Framingham 10-year cardiovascular disease risk score (Framingham score) in Finnish adults.MethodsData comprise the National FINRISK 2007 and 2012 health examination surveys with 10,185 participants aged 25–74 years, apparently free of CVD. Participants reported average daily time spent sitting in different locations: work-related sitting, at home in front of television (TV), at home in front of computer, in a vehicle, and elsewhere. Total SB time was calculated from these context-specific self-reports. Accelerometer-based sedentary time was assessed in 988 FINRISK 2012 participants. Framingham score was calculated using information on blood pressure and its medication, cholesterol levels, age, diabetes status, and smoking. Analyses were adjusted for age, study year, education, employment status, leisure time physical activity, and body mass index.ResultsOut of several type-specific sitting behaviors, only TV sitting showed systematic associations with the Framingham score in both genders. The lowest Framingham risk was found for TV sitting from 6 minutes to less than 1 hour daily. Of other types of sitting, computer sitting was inversely associated with the Framingham risk in men only. Total self-reported sitting time did not show significant associations with the Framingham score, but instead higher objectively assessed sedentary time showed higher Framingham risk in men.ConclusionsTV sitting showed most systematic associations with CVD risk score. This suggests that of all types of SB, reducing TV sitting should be targeted for reducing CVD risk.

SPRINT Trial Results: Latest News in Hypertension Management.

We thank the editors of Hypertension for the invitation to discuss aspects of the recently published Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov identifier NCT01206062) main results.1 This commentary focuses on generalizability of the findings and what is known about serious adverse effects that may be related to the SPRINT intervention. SPRINT compared the effects of antihypertensive treatment with a systolic blood pressure (SBP) target of <120 mm Hg (intensive treatment) versus <140 mm Hg (standard treatment) in 9361 hypertensive adults ≥50 years of age who had an average SBP of 130–180 mm Hg (the acceptable upper limit decreasing as the number of pretrial antihypertensive medications increased) and were at additional risk for cardiovascular disease (CVD).2 SPRINT was designed to recruit study participants with an average CVD risk of ≈2% per year, equivalent to a Framingham 10-year CVD risk score of 20%. The main finding in SPRINT was that a primary composite outcome of myocardial infarction, non–myocardial infarction acute coronary syndrome, stroke, acute decompensated heart failure, and CVD death was reduced by ≈25% in the intensive treatment group compared with the standard treatment group. Similarly, all-cause mortality was reduced by ≈27% in the intensive treatment group. During follow-up, the mean SBP was 121.5 mm Hg in the intensive treatment group and 134.6 mm Hg in the standard treatment group.1 Although many classes of medications were available, emphasis was placed on using classes with the best outcomes in large clinical trials: thiazide-type diuretics, calcium channels blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Other agents, including spironolactone, amiloride, β-blockers, vasodilators, or α-receptor blockers, could be added if necessary. The mean numbers of antihypertensive medications were 2.8 and 1.8 in the intensive treatment and standard treatment groups, respectively. On balance, the intensive intervention was well tolerated. The trial …

Abstract P008: Weight Gain and Cardiovascular Risk Reduction Associated With Tobacco Abstinence in Smokers With Serious Mental Illness

Background: In patients with serious mental illness, high prevalence of smoking and obesity-related risk factors contribute to high rates of cardiovascular disease (CVD) and premature mortality. The impact of smoking cessation on weight gain, obesity-related risk factors, and overall cardiovascular risk among this population is unknown. Methods: We conducted secondary analyses to assess weight gain and change in CVD risk of 87 smokers with serious mental illness (schizophrenia, schizoaffective disorder, and bipolar disorder) who participated in a randomized controlled trial to test the long-term effectiveness of varenicline on smoking cessation. Initially, 203 smokers with serious mental illness were enrolled into an open-label 12-week course of varenicline. Subjects who attained abstinence at the end of the open-label phase were eligible to participate in the randomized phase, and 87 subjects were randomized to continue either varenicline or placebo for the following 40 weeks. Smoking cessation at week 52 (end of treatment) was defined as 21-day point prevalence abstinence. We compared subjects who were abstinent at week 52 (N=33) to subjects who had relapsed to smoking (N=54) on changes in weight and Framingham 10-year CVD risk score over the 52-week trial; outcomes were modeled with repeated measures analyses of variance. Results: At baseline, subjects who achieved week 52 abstinence were older (52 vs. 46 years, p=0.01) and had higher fasting serum glucose (98 vs. 89 mg/dL, p=0.008) than subjects who relapsed, but they did not differ on sex, race, smoking characteristics, blood pressure, lipids, treatment for diabetes, or treatment with antipsychotic medications. Baseline mean body mass index did not differ between abstinent and relapsed subjects (31.4 vs. 32.4, p=0.52), but the baseline mean Framingham risk score was higher for abstinent than relapsed subjects (14.2% vs. 10.8%, p=0.02). Over the 52 week study period, abstinent subjects gained more weight than relapsed subjects (4.8 kg vs. 1.2 kg, p=0.002 for time*abstinence interaction), but the mean Framingham risk score decreased substantially for abstinent subjects and not for relapsed subjects (-7.6% vs. 0.0%, p=0.003 for abstinence effect adjusting for sex, site, varenicline or placebo, and antipsychotic medications). Conclusion: Despite the high prevalence of obesity at baseline and substantial weight gain associated with long-term abstinence, smoking cessation resulted in a large reduction in the Framingham estimated 10-year CVD risk among patients with serious mental illness.