Framingham Cardiovascular Disease Risk Score Research Articles

The effect of education based on a health belief model and motivational interviews on cardiovascular disease risk factors and healthy lifestyle behaviour changes in patients with essential hypertension: A randomized controlled trial

ObjectiveTo determine the effects of "Health Belief Model (HBM)-based education" and "education and motivational interviews (MIs)" by comparing the two methods on cardiovascular disease (CVD) risk factors and healthy lifestyle behaviour changes of patients diagnosed with essential hypertension. MethodsThe study was a single-centre, single-blind, parallel-group, 6-month follow-up, randomized controlled trial. It was conducted on 80 individuals (40 in the study group, 40 in the control group). Both groups received HBM-based education and an educational booklet on healthy lifestyle behaviour changes at the beginning of the study. Additionally, the study group underwent a total of 6 MIs. ResultsThe decrease in the study group's 10-year Framingham CVD risk scores (mean difference 5,33) compared to the baseline values was higher than that observed in the control group (mean difference 3,95). Over the six-month follow-up period, the study group's knowledge of CVD risk factors increased, and healthy lifestyle behaviour improved. ConclusionHBM-based education and an educational booklet, either alone or in combination with MI, supported patients with essential hypertension in lowering their CVD risk through lifestyle modifications. Practice implicationsHealthcare professionals within primary healthcare settings can use HBM-based health education and short-term MIs to reduce CVD risk and improve health outcomes.

Abstract 13519: US Population Eligibility and Estimated Impact of Tirzepatide on Obesity Prevalence and Preventable Cardiovascular Disease Events in US Adults

Background: Tirzepatide, a novel GIP-GLP-1 receptor agonist therapy, has been shown to be beneficial for weight loss and reduction of cardiovascular disease (CVD) risk factors in adults with obesity in the SURMOUNT-1 trial. We estimated US population eligibility for tirzepatide and the impact on reduction of CVD events in US adults with obesity. Methods: We applied SURMOUNT-1 eligibility criteria (body mass index [BMI] > 30 kg/m 2 or BMI > 27 kg/m 2 with at least one risk factor or CVD, excluding diabetes) to US adults aged > 18 years in the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 to estimate the US eligible population using NHANES sample weighting. Tirzepatide 15 mg group weight changes in the SURMOUNT-1 trial were applied to estimate the population impact on weight and obesity, and in those aged 30 to 74 years without prior CVD, the estimated 10-year CVD risks utilizing the BMI-based Framingham CVD risk scores. The difference in the estimated risks with and without tirzepatide “treatment” multiplied by the eligible weighted population represented the estimated “preventable” CVD events. Results: We identified 4015 US adults weighted to an estimated population size of 93.4 million [M] (38% of the US adult population) who fit SURMOUNT-1 trial eligibility criteria, of which 51% were female and 89% were without prior CVD. Applying tirzepatide 15 mg SURMOUNT-1 treatment effects on weight loss resulted in an estimated 70.6% (65.9 M) and 56.7% (53.0 M) showing > 15% and > 20% weight reductions, respectively, translating to a 58.8% (55.0 M) reduction in obesity (BMI > 30 kg/m 2 ) prevalence and 36.4% (34.0 M) increase in normal weight (BMI <25 kg/m 2 ) prevalence among the eligible population. Among those without CVD, estimated 10-year CVD risks were 10.1% “before” and 7.8% “after” tirzepatide “treatment” reflecting a 2.3% absolute (and 23% relative) risk reduction (number needed to treat [NNT]=43) translating to an estimated 1.95 million preventable CVD events over 10 years. Conclusions: Tirzepatide treatment in eligible US adults may reduce obesity prevalence nearly 60% representing 55M adults and prevent up to 2M CVD events over 10 years, suggesting a dramatic impact on societal burden and healthcare costs in those with these conditions.

US Population Eligibility and Estimated Impact of Semaglutide Treatment on Obesity Prevalence and Cardiovascular Disease Events.

Semaglutide 2.4mg benefits weight loss and reduction of cardiovascular disease (CVD) risk factors in adults with obesity. We estimated the US population eligibility for semaglutide 2.4mg (based on the weight management indication) and the impact on obesity and CVD events. We applied STEP 1 trial eligibility criteria to US adults aged ≥ 18years in the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 to estimate the US eligible population. Semaglutide weight changes in STEP 1 were applied to estimate the population impact on weight changes and obesity prevalence. We also estimated 10-year CVD risks utilizing the BMI-based Framingham CVD risk scores. The difference in estimated risks with and without semaglutide "treatment" multiplied by the eligible NHANES weighted population represented the estimated "preventable" CVD events. We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3M) and 50.5% (47.0M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0M) reduction in obesity (BMI ≥ 30kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% "before" and 8.34% "after" semaglutide "treatment" reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10years. Semaglutide treatment in eligible US adults may substantially reduce obesity prevalence and CVD events, which may dramatically impact associated healthcare costs.

Cardiovascular Disease Risk Screening for Commercial Drivers Examined in Occupational Practice: Implementing Evidence-Based Practice to Champion the Health of Essential Workers.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States, with 20% of deaths in adults under age 65. Commercial drivers have an increased CVD incidence rate of 50% compared to 30% for the general population, yet one third of drivers will not be screened for risk factors due to a lack of insurance or primary care. With approximately 3.5 million commercial drivers nationally and correlation of CVD to increased motor vehicle accidents, fatalities, and excessive healthcare costs, addressing the care gap for this high-risk population is imperative. An evidence-based practice (EBP) project synthesized the literature and implemented CVD risk screening for commercial drivers examined in an occupational practice setting. Using the non-laboratory Framingham CVD risk score calculator, over 90% of drivers were screened during mandated medical examinations and provided education regarding modifiable risk factors during a 2-month period. Over 40% of commercial drivers were at high risk for CVD with 25% uninsured and 32% without primary care. The average CVD risk score was twice the general population's risk score, with obesity, hypertension, and smoking being the most common risk factors discussed. Incorporating CVD risk screening and education during opportune encounters is logical, efficient, and financially prudent. The EBP change supports occupational professionals' standards, and ongoing review of CVD screening guidelines with integration into practice provides health promotion and promotes public safety for these essential workers.

Clinical utility of liver fat quantification for determining cardiovascular disease risk among patients with type 2 diabetes.

Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are independent risk factors for cardiovascular disease (CVD). To examine the clinical utility of liver fat quantification for determining CVD risk among a well-phenotyped cohort of patients with T2DM. This was a cross-sectional analysis of a prospective cohort of adults aged ≥50 with T2DM. Liver fat was quantified with magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), an advanced imaging-based biomarker. Patients were stratified into a higher liver fat group (MRI-PDFF ≥ 14.6%), and a lower liver fat group (MRI-PDFF < 14.6%). The co-primary outcomes were CVD risk determined by Framingham and Atherosclerotic Cardiovascular Disease (ASCVD) risk scores. High CVD risk was defined by risk scores ≥20%. Of the 391 adults (66% female) in this study, the mean (±SD) age was 64 (±8) years and BMI 30.8 (±5.2) kg/m2 , respectively. In multivariable analysis, adjusted for age, gender, race, and BMI, patients in the higher liver fat group had higher CVD risk [OR = 4.04 (95% CI: 2.07-7.88, p < 0.0001)] and ASCVD risk score [OR = 2.85 (95% CI: 1.19-6.83, p = 0.018)], respectively. Higher liver fat content increases CVD risk independently of age, gender, ethnicity and BMI. These findings raise the question whether liver fat quantification should be incorporated into risk calculators to further stratify those with higher CVD risk.

Advanced glycation end products are associated with cardiovascular risk in the Mexican population

Background and aimsChronic exposure to hyperglycemia is a significant risk factor for cardiovascular disease (CVD). Advanced glycation end products (AGES) result from multiple sugar-dependent reactions interacting with proteins and their receptors, generating endothelial dysfunction and CVD. However, there is little epidemiological data about its impact on CVD risk. We aimed to assess the association between circulating AGES and CVD risk in the Mexican population. Methods and resultsWe used longitudinal data from waves 2004–2006 and 2010–2012 of 1195 participants from the Health Workers Cohort Study. Circulating AGES were assessed by radioimmunoassay, and cardiovascular risk (CVR) was computed with the Framingham risk score. Linear and logistic fixed-effects regression models were used to assess the interest association, adjusting for confounding factors. An increase in 200 μU/ml of AGES was associated with a 0.18% increased risk of CVD (95% CI 0.05–0.31%). After adjusting for physical activity and smoking status, individuals who increased their AGES category had higher odds of middle–high CVR (low to medium AGES: OR 1.83, 95% CI 1.11–3.20; low to high AGES: OR 2.61, 95% CI 1.51–4.50). The associations remained statistically significant when we further adjusted for insulin resistance, dietary intake of AGES, and total daily calorie intake. ConclusionOur data show that circulating AGES are associated with the Framingham CVD risk score, independently of other major risk factors for CVD in the Mexican population.

Abstract 12620: Effects of Financial Status on Engagement in Self-care in Rural Caregivers With Cardiovascular Risk Factors

Introduction: Caring for adults with chronic illnesses increases the risk of developing cardiovascular disease (CVD). Engaging in self-care of healthy behaviors is critical for caregivers, but it may be more difficult due to financial hardship and psychological distress among those living in socioeconomically distressed rural areas. The study's purpose was to examine the association of financial status with engagement in self-care and whether this association is mediated by depressive symptoms in rural caregivers. Methods: We used baseline data from 300 rural caregivers (mean age 55 years, 76% female) with at least 2 CVD risk factors participating in a CVD risk reduction intervention trial. They provided data on financial status (3 groups: more than enough, enough, and not enough to make ends meet), depressive symptoms (Patient Health Questionnaire), self-care engagement (MOS-Specific Adherence Scale), caregiving time/difficulty (Oberst Caregiving Burden Scale), and physical assessments for estimating Framingham CVD risk score. Mediation analysis with a multi-categorical antecedent was conducted controlling Framingham risk score and caregiving time/difficulty. Results: Those with more than enough (27%), enough (56%), and not enough (56%) to make ends meet had similar Framingham risk scores (M = 12.3, P = .61). Compared to the more than enough group (Figure 1), the not enough group had lower self-care engagement scores (direct effect = -6.48) that were reduced further by the influence of depressive symptoms (indirect effect = -1.19). The results were similar for the enough to make ends meet group (direct effect= - 2.67; indirect effect = -.70). Conclusion: Poor financial status was directly associated with decreased engagement in self-care and indirectly associated through increased depressive symptoms. Promoting self-care strategies should include managing depressive symptoms for rural caregivers with a high risk of CVD who report financial hardship.

Updating Framingham CVD risk score using waist circumference and estimated cardiopulmonary function: a cohort study based on a southern Xinjiang population

PurposeTo explore the association between waist circumference (WC), estimated cardiopulmonary function (eCRF), and cardiovascular disease (CVD) risk in southern Xinjiang. Update the Framingham model to make it more suitable for the southern Xinjiang population.MethodsData were collected from 7705 subjects aged 30–74 years old in Tumushuke City, the 51st Regiment of Xinjiang Production and Construction Corps. CVD was defined as an individual's first diagnosis of non-fatal acute myocardial infarction, death from coronary heart disease, and fatal or non-fatal stroke. The Cox proportional hazards regression analysis was used to analyze the association between WC, eCRF and CVD risk. Restricted cubic spline plots were drawn to describe the association of the two indicators with CVD risk. We update the model by incorporating the new variables into the Framingham model and re-estimating the coefficients. The discrimination of the model is evaluated using AUC, NRI, and IDI metrics. Model calibration is evaluated using pseudo R2 values.ResultsWC was an independent risk factor for CVD (multivariate HR: 1.603 (1.323, 1.942)), eCRF was an independent protective factor for CVD (multivariate HR: 0.499 (0.369, 0.674)). There was a nonlinear relationship between WC and CVD risk (nonlinear χ2 = 12.43, P = 0.002). There was a linear association between eCRF and CVD risk (non-linear χ2 = 0.27, P = 0.6027). In the male, the best risk prediction effect was obtained when WC and eCRF were added to the model (AUC = 0.763((0.734,0.792)); pseudo R2 = 0.069). In the female, the best risk prediction effect was obtained by adding eCRF to the model (AUC = 0.757 (0.734,0.779); pseudo R2 = 0.107).ConclusionIn southern Xinjiang, WC is an independent risk factor for CVD. eCRF is an independent protective factor for CVD. We recommended adding WC and eCRF in the male model and only eCRF in the female model for better risk prediction.

Association of Arterial Stiffness Indices with Framingham Cardiovascular Disease Risk Score

Purpose: The new non-invasive arterial stiffness indices, arterial velocity pulse index (AVI) and arterial pressure volume index (API) are known to be associated with cardiovascular disease risk. The present study aimed to examine the “dose-response” associations between AVI, API and Framingham cardiovascular disease risk score (FCVRS). Methods: This survey included individuals with arterial stiffness indices collected at age 18 years and older. We used Pearson’s correlation coefficients and multivariate linear analyses to evaluate associations of AVI and API to other variables. The associations between FCVRS and AVI, API were analyzed by restrictive cubic spline. Results: 4311 people were included in the full study population, including 2091 males and 2220 females. In restricted cubic spline regression models, AVI or API had significant U-shaped associations with FCVRS, with the lowest risk score of cardiovascular disease was 8 units or 18 units, respectively. After AVI increased to 12 units, FCVRS increased rapidly until AVI was 27 units, and the FCVRS increased relatively flat afterward. For API, results were similar. When API increased to 23 units, the FCVRS increased rapidly, and after API was 52 units, FCVRS increased relatively flat. Conclusions: AVI or API had U-shaped associations with FCVRS. The associations may provide a new perspective for early treatment or lifestyle modifications to prevent cardiovascular diseases.

Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.

BACKGROUND:Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference—Individual Participant Data Collaboration.METHODS:One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared.RESULTS:We analyzed 53 172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm Hg systolic BP thresholds (both P<0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all P<0.001). Higher arm BP models better predicted cardiovascular events with Framingham and atherosclerotic cardiovascular disease risk scores (both P<0.001) and reclassified 4.6% and 3.5% of participants respectively to higher risk categories compared with lower arm BPs).CONCLUSIONS:Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: CRD42015031227.

Low-Plasma Insulin-Like Growth Factor-1 Associates With Increased Mortality in Chronic Kidney Disease Patients With Reduced Muscle Strength

Chronic kidney disease (CKD) leads to metabolic and nutritional abnormalities including resistance to insulin-like growth factor-1 (IGF-1) action, and reduced muscle mass and strength. Low IGF-1 as well as low hand-grip muscle strength (HGS) are independent predictors of increased mortality in CKD patients. In 685 patients (CKD Stage 3-5, median age 58years; 62% men), baseline measurements of IGF-1, HGS, subjective global assessment (SGA), lean body mass index (LBMI), and metabolic and inflammatory biomarkers potentially linked to IGF-1 were analyzed in relation to mortality during 5years of follow-up. We compared survival in 4 groups with high or low (cut-offs defined by receiver operating characteristic curve analysis) levels of IGF-1 and HGS. Patients with low IGF-1 were older; had lower BMI, HGS, and LBMI, were more likely to have diabetes, cardiovascular disease (CVD), and malnutrition (SGA >1); and had high-sensitivity C-reactive protein levels. During 5years of follow-up, 208 patients died. The mortality rate was highest among patients with Low IGF-1+Low HGS. In competing-risk regression analysis, Low IGF-1+Low HGS was independently associated with 2.8 times higher all-cause mortality risk than Low IGF-1+High HGS, after adjusting for Framingham's CVD risk score, presence of CVD, SGA, dialysis status, high-sensitivity C-reactive protein, albumin, LBMI, and sample time in freezer. Low IGF-1 was associated with increased all-cause mortality in patients who also had low HGS but not in those with high HGS, suggesting that the association of IGF-1 with survival in CKD patients depends on nutritional status.

CARDIOVASCULAR RISK SCORE MAY BE USEFUL IN STRATIFY DEATH RISK IN HOSPITALIZED COVID19 PATIENTS

Objective: COVID–19 induce a robust systemic inflammation. Patients with cardiovascular disease (CVD) present an increased death risk. Many efforts are spent to identify possible predictors of negative outcomes. CVD score are useful tools in evaluation of risk of cardiovascular events Aim: We evaluated oxygenation and characteristics in COVID–19 according to cardiovascular risk stratification performed using Framingham (FRS) and Atherosclerotic cardiovascular disease (ASCVD) risk scores. Design and method: We evaluated retrospectively 155 COVID–19 patients (110 males, aged 67.43 ± 14.72 yrs). All patients underwent to a complete physical examination, chest imaging, laboratory tests, and blood gas analysis at the time of diagnosis. Seventeen patients died (10 males and 7 females, aged 74.71 ± 7.23 yrs) while the remaining 138 patients (100 males, aged 66.07 ± 15.16 yrs) were alive at discharge. Results: No differences there were in Hb, C–reactive protein nor in d–dimers between the two groups. Compared to alive, died group presents a significant increase in white blood cells (p &lt; 0.05) and d–dimers (p &lt; 0.05). No difference there were in pCO2, SO2, and in alveolar arteriolar oxygen difference (A–aDO2). On the contrary, in died patients there is an increased pO2 (p &lt; 0.05) and a decreased ratio between oxygen inspired and pO2 (P/F; p &lt; 0.05). Died patients have increased both in FRS (27.37 ± 5.03 vs 21.33 ± 9.49, p &lt; 0.05) and ASCVD (40.18 ± 20.36 vs 21.47 ± 17.23, p &lt; 0.05). FRS, but not ASCVD, presents a negative correlation to P/F (r–0.42, p &lt; 0.05) in died while no correlation was found in alive. No other correlation has been found with blood gas parameters or in the phlogosis parameters evaluated in the two groups. ROC curve analysis showed a good performance in prediction of death for both scores (AUC FRS 0.71, ASCVD 0.77) with a good sensitivity (FRS 76.92%, ASVCD 75.00%) and specificity (FRS 65.00%, ASCVD 81.13%). Conclusions: CVD is a major risk factor for death in COVID–19 patients. The increase risk relates to a reduced lung capacity but it is not related to alteration in gas exchange. CV risk results independent from inflammatory state we found. CVD risk score may be useful to stratify patients at admittance for a better treatment.

P365 CARDIOVASCULAR RISK SCORE MAY BE USEFUL IN STRATIFY DEATH RISK IN HOSPITALIZED COVID19 PATIENTS

BackgroundCOVID–19 induce a robust systemic inflammation. Patients with cardiovascular disease (CVD) present an increased death risk. However, many efforts are spent to identify possible predictors of negative outcomes in order to have a more specific clinical setting. CVD score are useful tools in evaluation of risk of cardiovascular events Aim: We evaluated oxygenation and characteristics in COVID–19 according to cardiovascular risk stratification performed using Framingham (FRS) and Atherosclerotic cardiovascular disease (ASCVD) risk scores.Material and MethodsWe evaluated 155 COVID–19 patients (110 males and 45 females, aged 67.43±14.72 yrs). All patients underwent to a complete physical examination, chest imaging, laboratory tests, and blood gas analysis at the time of diagnosis. Seventeen patients died (10 males and 7 females, aged 74.71±7.23 yrs) while the remaining 138 patients (100 males and 38 females, aged 66.07±15.16 yrs) were alive at discharge.ResultsNo differences there were in Hb, C–reactive protein nor in d–dimers between the two groups. Compared to alive, died group presents a significant increase in white blood cells (p < 0.05) and d–dimers (p < 0.05). No difference there were in pCO2, SO2, and in alveolar arteriolar oxygen difference (A–aDO2). On the contrary, in died patients there is an increased pO2 (p < 0.05) and a decreased ratio between oxygen inspired and pO2 (P/F; p < 0.05). Died patients have increased both in FRS (27.37±5.03 vs 21.33±9.49, p < 0.05) and ASCVD (40.18±20.36 vs 21.47±17.23, p < 0.05). FRS, but not ASCVD, presents a negative correlation to P/F (r–0.42, p < 0.05) in died while no correlation was found in alive. No other correlation has been found with blood gas parameters or in the phlogosis parameters evaluated in the two groups. ROC curve analysis showed a good performance in prediction of death for both scores (AUC FRS 0.71, ASCVD 0.77) with a good sensitivity (FRS 76.92%, ASVCD 75.00%) and specificity (FRS 65.00%, ASCVD 81.13%).DiscussionCVD may be considered as a major risk factor for death in COVID–19 patients. The increase risk relates to a reduced lung capacity but it is not related to alteration in gas exchange. Similarly, CV risk results independent from inflammatory state we found. CVD risk score may be useful to stratify patients at admittance for a better treatment

Student Debt and Cardiovascular Disease Risk Among U.S. Adults in Early Mid-Life

Student loan debt has become common for young adults in the U.S. and is correlated with poor physical and mental health. It is unclear how the accumulation or repayment of student debt is associated with longer-term cardiovascular risks and chronic inflammation. Nationally representative data collected between 1994 and 2018 from >4,000 participants of a U.S. cohort study were analyzed in 2021 to assess the associations among change in student debt between young adulthood and early mid-life, 30-year Framingham cardiovascular disease risk scores, and C-reactive protein levels. Ordinary least squares regression revealed higher cardiovascular disease and C-reactive protein risks among those in households who became indebted or were consistently in debt between young adulthood and early mid-life than among those in households who were either never in debt or repaid their loans. This pattern persisted after adjustments for degree completion, socioeconomic measures, and other sources of debt. These findings provide a benchmark for widening health inequalities among a cohort bearing more student debt than any other in U.S. As student debt accumulates, within-cohort disparities in cardiovascular disease and related morbidities may undermine the health benefits of postsecondary education.

A community based cross sectional study on the prevalence of dyslipidemias and 10\xa0years cardiovascular risk scores in adults in Asmara, Eritrea

Despite the contribution of dyslipidemia to the high and rising burden of arteriosclerotic cardiovascular disease (CVD) in Sub-Saharan Africa; the condition is under-diagnosed, under-treated, and under-described. The objective of this study was to explore the prevalence of dyslipidemias, estimate a 10-year cardiovascular disease risk and associated factors in adults (≥ 35 to ≤ 85 years) living in Asmara, Eritrea. This population-based cross-sectional study was conducted among individuals without overt CVDs in Asmara, Eritrea, from October 2020 to November 2020. After stratified multistage sampling, a total of 386 (144 (37%) males and 242 (63%) females, mean age ± SD, 52.17 ± 13.29 years) respondents were randomly selected. The WHO NCD STEPS instrument version 3.1 questionnaire was used to collect data. Information on socio-demographic variables was collected via interviews by trained data collectors. Measurements/or analyses including anthropometric, lipid panel, fasting plasma glucose, and blood pressure were also undertaken. Finally, data was analyzed by using Statistical Package for Social Sciences version 26.0 for Windows (SPSS Inc., Chicago, IL, USA). All p-values were 2-sided and the level of significance was set at p < 0.05 for all analyses. The frequency of dyslipidemia in this population was disproportionately high (87.4%) with the worst affected subgroup in the 51–60 age band. Further, 98% of the study participants were not aware of their diagnosis. In terms of individual lipid markers, the proportions were as follows: low HDL-C (55.2%); high TC (49.7%); high LDL (44.8%); high TG (38.1%). The mean ± SD, for HDL-C, TC, LDL-C, non-HDL-C, and TG were 45.28 ± 9.60; 205.24 ± 45.77; 130.77 ± 36.15; 160.22 ± 42.09 and 144.5 ± 61.26 mg/dL, respectively. Regarding NCEP ATP III risk criteria, 17.6%, 19.4%, 16.3%, 19.7%, and 54.7% were in high or very high-risk categories for TC, Non-HDL-C, TG, LDL-C, and HDL-C, respectively. Among all respondents, 59.6% had mixed dyslipidemias with TC + TG + LDL-C dominating. In addition, 27.3%, 28.04%, 23.0%, and 8.6% had abnormalities in 1, 2, 3 and 4 lipid abnormalities, respectively. Multivariate logistic regression modeling suggested that dyslipidemia was lower in subjects who were employed (aOR 0.48, 95% CI 0.24–0.97, p = 0.015); self-employed (aOR 0.41, 95% CI 0.17–1.00, p = 0.018); and married (aOR 2.35, 95% CI 1.19–4.66, p = 0.009). A higher likelihood of dyslipidemia was also associated with increasing DBP (aOR 1.04 mmHg (1.00–1.09, p = 0.001) and increasing FPG (aOR 1.02 per 1 mg/dL, 95% CI 1.00–1.05, p = 0.001). Separately, Framingham CVD Risk score estimates suggested that 12.7% and 2.8% were at 10 years CVD high risk or very high-risk strata. High frequency of poor lipid health may be a prominent contributor to the high burden of atherosclerotic CVDs—related mortality and morbidity in Asmara, Eritrea. Consequently, efforts directed at early detection, and evidence-based interventions are warranted. The low awareness rate also points at education within the population as a possible intervention pathway.

ECG Abnormalities and Arterial Stiffness by HIV Status among High-Risk Populations in Rakai, Uganda: A Pilot Study.

Background:People living with HIV are at increased risk for cardiovascular disease (CVD). In sub-Saharan Africa, population-based data on major CVD events such as stroke and myocardial infarction are difficult to collect. The use of proxy measures could be a feasible way to better study CVD in such settings. This study aimed to determine the acceptance of incorporating ECG and arterial function measurements into a population-based cohort study and to assess the prevalence of ECG abnormalities and arterial stiffness.Methods:A pilot study was conducted within the Rakai Community Cohort Study in Uganda on two high-risk CVD populations; one determined by age (35–49) and Framingham CVD risk scores and the other by age alone (50+). Data on ECG, arterial function, blood pressure, and HIV status were collected. The acceptability of incorporating ECG and arterial function measurements was established as an acceptance rate difference of no more than 5% to blood pressure measurements.Results:A total of 118 participants were enrolled, 57 participants living with HIV and 61 HIV-negative participants. Both ECG measurements and arterial function were well accepted (2% difference). Left ventricular hypertrophy (LVH) and arterial stiffness (>10 m/s) were common in both participants living with HIV and HIV-negative participants across the two high-risk populations. Prevalence rates ranged from 30% to 53% for LVH and 25% to 58% for arterial stiffness. Arterial stiffness at the 11 m/s cutoff (p = 0.03) was found to be more common among participants living with HIV in the 35–49 population.Conclusions:The incorporation of ECG and arterial function measurements into routine activities of a population-based cohort was acceptable and incorporating these proxy measures into cohort studies should be explored further. LVH and arterial stiffness were both common irrespective of HIV status with arterial stiffness potentially more common among people living with HIV.

Abstract 10699: Predictors of Health Activation in Rural Caregivers with Multiple Cardiovascular Disease Risks

Introduction: Caregivers of patients with chronic conditions are at higher risk for cardiovascular disease (CVD) than their urban counterparts. Despite the burden related to caregiving, caregivers need to be activated for their own health to decrease this risk. Health activation has not been studied in rural caregivers. It is particularly relevant because most rural dwellers live in low-resourced, socioeconomically distressed environments where their health activation may be challenging. The purpose of this study was to identify characteristics of rural caregivers with multiple CVD risk factors who were not considered “activated” in their own health. Methods: Rural caregivers who had at least two CVD risk factors completed surveys on caregiver burden (Zarit Burden Interview), adherence to a healthy lifestyle (MOS Specifical Adherence Scale), perceived health status, and caregiving characteristics, and we calculated the Framingham CVD risk score. Health activation was assessed using the Patient Activation Measure, which categorizes people into four categories: overwhelmed, struggling, taking action, and maintaining levels. A multi-nominal logistic regression model was used to determine predictors of patient activation category. Results: Of the total of 269 rural caregivers (mean age= 54.1 years, 78% female), 36% were in the maintaining level, 42% were in the taking action level, and 22% in overwhelmed/struggling level. There were no significant differences in demographic or caregiving characteristics among the groups. Compared to the maintaining group, caregivers who had high caregiving burden (OR = 1.035, P = .007) and high Framingham CVD risk (OR = 1.061, P = .025), and low adherence to healthy behavior (OR = .917, P &lt; .001) were more likely to be in the overwhelmed/struggling group. Caregivers who had a high burden (OR = 1.026, P = .012) and low adherence to healthy behaviors (OR = .926, P &lt; .001) were more likely to be in the taking action group. Conclusions: Most rural caregivers were not activated on their health management even though they have multiple CVD risk factors. Screening health activation levels are needed for caregivers, and developing tailored intervention based on activation levels is needed.

Sex Differences in the Relationship Between Arterial Stiffness and Cognitive Function in Older Adults

ObjectiveTo examine potential sex differences in the relationship between arterial stiffness and global cognitive function and executive functions. MethodsBaseline data from 80 older adults were included from two randomized controlled trials (NCT02669394 and NCT02737878). Arterial stiffness was measured by carotid-femoral pulse wave velocity (cf-PWV). Cognitive function assessment included global cognition (Mini-Mental State Examination [MMSE]) and executive functions (set shifting [Trail Making Test Part B minus A], inhibition [Stroop Test], and working memory [Verbal Digit Span Backwards Test]). Separate statistical models were constructed to assess the effect of cf-PWV on each cognitive outcome for females and males. Each statistical model controlled for Framingham cardiovascular disease risk score and education. ResultsHigher cf-PWV was associated with impaired MMSE performance in males (β = -0.48; p = 0.018), but not females (p ≥ 0.389). For executive processes, higher cf-PWV was associated with impaired Trail Making Test Part B minus A (β = 0.56; p = 0.005) and Stroop Test (β = 0.59; p = 0.004) in males, but not in females (ps ≥ 0.108). cf-PWV was not significantly associated with Verbal Digit Span Forward minus Backward Test in males or females (ps ≥ 0.108). ConclusionsArterial stiffness is more strongly associated with cognitive impairment in males than females. These results further elucidate the interplay between vascular health and cognitive function by providing support for sex-specific mechanisms.

Comparing Framingham risk score and cognitive performance in a Mexican American cohort

ObjectiveMexican-Americans have a higher prevalence of modifiable cardiovascular risk factors as compared to Non-Hispanic whites. This study aims to elucidate the utility of the Framingham Cardiovascular Disease Risk Score (FCVDRS) as a predictor of cognitive performance on a cohort of Mexican Americans elders. Participants and Setting429 Mexican-Americans (338 female and 91 male) from a longitudinal study conducted at The University of North Texas Health Science Center were studied. Main outcome measuresDemographic and clinical data relevant to Framingham Cardiovascular Disease 10-year Risk Score (FCVDRS) were assessed. FCVDRS was calculated based on Body Mass Index (BMI) and categorized as Low if <10, Moderate if between 10 and 20, and High if >20. Cognitive performance on Trails B, Wechsler Logical Memory I and II, Mini Mental State Examination (MMSE), and Animal Naming (AN) tests. Demographic data was analyzed using t-tests and chi-square tests as appropriate. Pearson correlation tests and ANOVAs were used to compare FCVDRS, as a continuous variable and as a categorical variable, against cognitive performance. ResultsBoth Pearson correlation tests and linear regression analysis, showed significant correlations between FCVDRS and performance on 4 of the 8 measures of cognitive performance. ANOVAs with Post-Hoc analysis also showed that the difference in cognitive performance was more pronounced between groups with greater differences in FCVDRS. In all analyses, the strength of the relationship was stronger in females. ConclusionThe results show that FCDVRS has high predictive utility in measures of cognitive function. Gender specific analysis between FCVDRS and cognitive performance indicate a stronger association in females.

Cardiovascular risk moderates the effect of aerobic exercise on executive functions in older adults with subcortical ischemic vascular cognitive impairment

Aerobic training (AT) can promote cognitive function in adults with Subcortical Ischemic Vascular Cognitive Impairment (SIVCI) by modifying cardiovascular risk factors. However, pre-existing cardiovascular health may attenuate the benefits of AT on cognitive outcomes in SIVCI. We examined whether baseline cardiovascular risk moderates the effect of a 6-month progressive AT program on executive functions with a secondary analysis of a randomized controlled trial in 71 adults, who were randomized to either: (1) 3×/week progressive AT; or (2) education program (CON). Three executive processes were measured: (1) response inhibition by Stroop Test; (2) working memory by digits backward test; and (3) set shifting by the Trail Making Test. Baseline cardiovascular risk was calculated using the Framingham cardiovascular disease (CVD) Risk Score (FCRS), and participants were classified as either low risk (< 20% FCRS score; LCVR) or high risk (≥ 20% FCRS score; HCVR). A complete case analysis (n = 58) was conducted using an analysis of covariance (ANCOVA) to evaluate between-group differences in the three executive processes. A significant interaction was found between cardiovascular risk group and intervention group (AT or CON) for the digit span backward and the Trail Making Test. AT improved performance compared with CON in those with LCVR, while in those with HCVR, AT did not improve performance compared with CON. Baseline cardiovascular risk significantly moderates the efficacy of AT on cognition. Our findings highlight the importance of intervening early in the disease course of SIVCI, when cardiovascular risk may be lower, to reap maximum benefits of aerobic exercise.