Framingham Cardiovascular Risk Score Research Articles

Cardiovascular disease risk exacerbates brain aging among Hispanic/Latino adults in the SOL-INCA-MRI Study.

Cardiovascular disease (CVD) risk factors are highly prevalent among Hispanic/Latino adults, while the prevalence of MRI infarcts is not well-documented. We, therefore, sought to examine the relationships between CVD risk factors and infarcts with brain structure among Hispanic/Latino individuals. Participants included 1,886 Hispanic/Latino adults (50-85 years) who underwent magnetic resonance imaging (MRI) as part of the Study of Latinos-Investigation of Neurocognitive Aging-MRI (SOL-INCA-MRI) study. CVD risk was measured approximately 10.5 years before MRI using the Framingham cardiovascular risk score, a measure of 10-year CVD risk (low (<10%), medium (10- < 20%), and high (≥20%)). MR infarcts were determined as present or absent. Outcomes included total brain, cerebral and lobar cortical gray matter, hippocampal, lateral ventricle, and total white matter hyperintensity (WMH) volumes. Linear regression models tested associations between CVD risk and infarct with MRI outcomes and for modifications by age and sex. Sixty percent of participants were at medium or high CVD risk. Medium and high CVD risk were associated with lower total brain and frontal gray matter and higher WMH volumes compared to those with low CVD risk. High CVD risk was additionally associated with lower total cortical gray matter and parietal volumes and larger lateral ventricle volumes. Men tended to have greater CVDRF-related differences in total brain volumes than women. The association of CVD risk factors on total brain volumes increased with age, equal to an approximate 7-year increase in total brain aging among the high-CVD-risk group compared to the low-risk group. The presence of infarct(s) was associated with lower total brain volumes, which was equal to an approximate 5-year increase in brain aging compared to individuals without infarcts. Infarcts were also associated with smaller total cortical gray matter, frontal and parietal volumes, and larger lateral ventricle and WMH volumes. The high prevalence of CVD risk among Hispanic/Latino adults may be associated with accelerated brain aging.

Evaluation of the relation between subclinical systolic dysfunction defined by four-dimensional speckle-tracking echocardiography and growth differentiation factor-15 levels in patients with acromegaly.

In patients with acromegaly, the long-term presence of elevated GH and IGF-1 levels is associated with an unfavorable cardiovascular risk profile. We aimed to assess the relationship of four-dimensional speckle tracking echocardiographic (4DSTE) measurements with growth differentiation factor-15 (GDF-15) levels and the Framingham Cardiovascular Risk Score (FRS) in patients with acromegaly. A single-center, cross-sectional study was conducted. The study included 40 acromegaly and 32 age- and gender-matched controls. Anthropometric, biochemical, and echocardiographic assessments were performed. GDF-15 levels were measured using ELISA. In the controlled acromegaly group, global longitudinal (GLS), circumferential (GCS), area (GAS), and radial (GRS) strain measurements identified by 4DSTE were lower than those of the controls (p < 0.05). Moreover, strain parameters were lower in active acromegaly patients than in controls, but the difference was not statistically significant. The GLS was negatively correlated with age, the estimated disease duration, and FRS. Serum GDF-15 levels showed no significant difference between the acromegaly and control groups. In patients with acromegaly, serum GDF-15 levels were positively correlated with age, waist-to-hip ratio, systolic and diastolic blood pressure, FRS, fasting plasma glucose, and HbA1c, but not with strain parameters. The multiple regression analysis revealed that FRS was an independent factor associated with serum GDF-15 levels in patients with acromegaly and the overall cohort (p < 0.001). Our study demonstrates that while LVEF was within normal limits, global strain parameters (GLS, GCS, GAS, and GRS) measured by using a novel imaging technique, 4DSTE, were lower in patients with acromegaly, suggesting the presence of subclinical systolic dysfunction in patients with acromegaly. GDF-15 can be a potential predictor of cardiovascular risk in patients with acromegaly.

A Cross-Sectional Evaluation of Cardiovascular Risk Assessment in Type 2 Diabetes Mellitus Patients Using the Framingham Risk Score.

The global burden of type 2 diabetesmellitus (T2DM) is continuously increasing, particularly in India. The risk of cardiovascular disease (CVD) is higher in T2DM individuals when compared to non-diabetics, which imposes significant morbidity and mortality. The main aim of the present study was to assess the risk factorsfor CVD in T2DM patients. The secondary aim was to assess the association between cardiovascular risk profile and10-year cardiovascular risk using theFramingham risk score. This was a cross-sectional study conducted on 110 T2DM patients, and the anthropometric and biochemical parameters were analyzed. The Framingham cardiovascular risk prediction model was used to calculate the 10-year risk for CVD. The CVD risk factor was compared among the genders. Further, the association between the Framingham cardiovascular risk and the various categories of risk factors was also analyzed. Based on the Framingham cardiovascular risk score, 23 (20.9%) were at low risk, 39 (35.5%) were at moderate risk, and 48 (43.6%) were at low risk. A higher proportion of males had hypertension (55.2 vs. 17.3%; p=0.007), elevated cholesterol levels (48.3% vs. 23.1%; p=0.008), and smoking or tobacco use (31% vs. 7.7%; p=0.006) as compared to females. The significant risk factors for high 10-year CVD risk were hypertension (p=0.001), elevated total cholesterol (p=0.03), smoking or tobacco use (p=0.007), and glycemic control (p=0.04). The Framingham cardiovascular risk score estimates reveal that male gender, hypertension, smoking, and uncontrolled diabetes are the important risk factors for CVD progression among diabetic patients. Therefore, it is imperative to generate awareness regarding the potential risks and then implement suitable interventions during the early phases at the primary healthcare level.

Comparative Analysis of Three Atherosclerotic Cardiovascular Disease Risk Prediction Models in Individuals Aged 75 and Older.

To evaluate the performance of the Framingham cardiovascular risk score (FRS)/pooled cohort equations (PCE)/China prediction for atherosclerotic cardiovascular disease (ASCVD) risk (China-PAR model) in a prospective cohort of Chinese older adults. We assessed 717 older adults aged 75-85 years without ASCVD at the baseline from the Sichuan province of China. The participants were followed annually from 2011 to 2021. We obtained the participants' information through the medical records of physical examination and evaluated their 10-year ASCVD risk using FRS, PCE, and China-PAR. We further evaluated the predictive abilities of three assessment models. During the 10-year follow-up, 206 participants developed ASCVD, with an incidence rate of 28.73%. The FRS and China-PAR moderately underestimated the risk of ASCVD (22.1% and 12.4%, respectively), but while PCE overestimated the risk (36.1%). FRS and China-PAR were found to underestimate the risk of ASCVD (26% and 63%, respectively) for men, while PCE overestimated the risk by 8%; For women, FRS and China-PAR were found to underestimate the risk of ASCVD (14% and 35%, respectively), while PCE overestimated the risk by 88%. The 10-year ASCVD risk was found to be overestimated by PCE. China-PAR had the most accurate predictions in women, while FRS was particularly well-calibrated in males. All three risk models have good discrimination, with FRS and PCE being well-calibrated in men and all three being well-calibrated in women. Therefore, accurate risk models are warranted to facilitate the prevention of ASCVD at the baseline among Chinese older adults.

No Evidence for an Association of HIV and Antiviral Treatment With Changes in Framingham Cardiovascular Risk Score in the Ndlovu Cohort Study.

HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high-income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle-income country. This longitudinal analysis of the NCS (Ndlovu Cohort Study), South Africa used baseline to 36-month follow-up data. Demographics, HIV, ART status, and cardiometabolic measures were obtained. FRS was used as a CVD risk measure. Through linear mixed models, FRS trends over time and the association with HIV were studied. Analysis included 1136 participants, with 609 (54%) having HIV, and 495 (81%) taking ART. At baseline, 9.8% of participants had a high FRS. People living with HIV (PLHIV) had a 3.2% lower FRS than HIV-negative participants (P<0.001). FRS increased similarly for both groups over time. Other factors associated with FRS were secondary and higher education (ß value: -0.075, P<0.001; ß value: -0.084, P<0.001) and alcohol consumption (ß value: 0.011, P<0.001). CVD risk increased for all participants over 36 months, suggesting classic risk factors rather than HIV status or ART to be drivers of CVD risk. People living with HIV had a significantly lower FRS than their HIV-negative counterparts, possibly related to HIV itself or a more frequent interaction with healthcare services. No association of HIV and ART with changes in FRS over 36 months was observed, suggesting the need for research using clinical endpoints to elucidate the effects of HIV and ART on CVD risk. Population-based prevention of CVD risk factors in sub-Saharan Africa is warranted, regardless of HIV status.

Pakistani Ankylosing Spondylitis Cohort with modifiable cardiovascular risk factors (PAS-CVD) study.

To determine the frequency of modifiable cardiovascular risk factors in the Pakistani cohort with Ankylosing Spondylitis (AS). After IRB approval, a cross-sectional study was conducted among patients of AS, at the Department of Rheumatology Indus Medical College, Tando Mohammad Khan, from 15th March to 15th September, 2022. After obtaining demographic data, other parameters such as blood pressure (BP) and body mass index were recorded. In addition, a 5 ml blood sample was collected to assess their serum lipid profile, and fasting blood sugar levels. Using the laboratory data, the Framingham cardiovascular risk score was calculated for each patient and they were categorized into low, intermediate, or high-risk categories. Total 131 cases of ankylosing spondylitis: frequency of modifiable risk factors were: obesity (75.6%), high TG level (62.6%), high risk FRS score (40.5%), high LDL level (38.1%), low HDL (34.4%), hypertension (30.5%), diabetes mellitus (26.7%), high cholesterol level (17.6%), smoking (16%). In univariate analysis AS cases shows that increasing disease duration was associated with more risk of modifiable risk factors (p<0.05), on multivariate analysis, a positive association of age, diastolic blood pressure, smoking, diabetes mellitus, DMARDS, herbal medication-but not statistically significant (p>0.05). In chronic AS there's higher prevalence of modifiable cardiovascular risk factors, earlier recognition and effective management helps in prevention of future cardiovascular events.

Cognitively healthy Indians with higher Framingham Cardiovascular Risk Scores have higher WMH burden with lesser grey matter, white matter and hippocampal volumes

AbstractBackgroundIncreasing evidence indicates the important role of cardiovascular risk factors in dementia risk, particularly in Indians. It is known that cardiovascular risk factors tend to cluster together, and a widely used multivariable risk scoring is the Framingham Cardiovascular Risk Score (FRS). However, very little is known about the association between FRS and structural brain MRI parameters in cognitively healthy Indians.MethodBaseline clinical and brain MRI data of 487 cognitively healthy Indians (Clinical Dementia Rating score of ‘0’), who are part of two ongoing, large, aging cohort studies in India – Srinivaspura Aging, Neuro Senescence and COGnition study (SANSCOG) study (n = 200) and Tata Longitudinal Study of Aging (TLSA, n = 289) were utilized. FRS was calculated using clinical and blood biochemistry data, whereas brain MRI scans were performed on 3T MRI scanners. White matter hyperintensity (WMH) lesion segmentation was performed using Lesion Segmentation Toolbox (LST) and brain volumes (total grey matter, total white matter, 3rd ventricle, right and left hippocampus) were derived using FreeSurfer software and normalized according to total intracranial volumes of the respective subjects. Linear regression analysis was performed with FRS as independent variable and various structural MRI parameters as dependent variables. A p value of &lt;0.05 was considered significant.ResultUrban subjects with higher FRS had significantly higher WMH volume (β = 0.00011, p&lt;0.001, R2 = 0.130), lower grey matter (β = ‐0.00285, p&lt;0.001, R2 = 0.206), white matter (β = ‐0.00180, p&lt;0.001, R2 = 0.106), right hippocampal (β = ‐0.00004, p&lt;0.001, R2 = 0.180), left hippocampal (β = ‐0.00003, p&lt;0.001, R2 = 0.156) volumes and higher 3rd ventricle volumes (β = 0.00003, p&lt;0.001, R2 = 0.150). Rural subjects higher FRS had lower grey matter (β = ‐0.00166, p&lt;0.001, R2 = 0.118, white matter (β = ‐0.0011, p&lt;0.001, R2 = 0.060), right hippocampal (β = ‐0.00002, p&lt;0.001, R2 = 0.087), left hippocampal (β = ‐0.00002, p&lt;0.001, R2 = 0.084) volumes and higher 3rd ventricle volumes (β = 0.00004, p&lt;0.001, R2 = 0.264) but no significant association was seen with WMH volume.ConclusionThese findings indicate that cardiovascular risk is associated with structural brain changes in cognitively healthy Indians. Since cardiovascular risk can be reduced through cost‐effective community level strategies, such as lifestyle‐based interventions, promptly addressing this risk in Indians could be an important part of dementia prevention strategies.

Sleep health and subjective cognitive decline in the Vanderbilt Memory and Aging Project

AbstractBackgroundIdentifying modifiable risk factors for Alzheimer’s disease (AD) and related dementias (ADRD) may reveal critical evidence for early prevention. It is commonly believed that poor sleep is an early symptom of neurodegeneration and ADRD. However, distinct neurobiological processes occur during sleep, and dysfunction of these processes may also contribute to AD pathogenesis. Less is known about poor sleep and associations with subjective cognitive decline (SCD), a clinical symptom occurring before overt cognitive impairment due to early pathological AD. This study investigated associations between objective and self‐reported measures of sleep health and SCD in a community‐based cohort of older adults.MethodParticipants from the Vanderbilt Memory and Aging Project (n = 220; 74±7 years; 34% female) completed 7‐days of wrist actigraphy and self‐report measures for SCD [Everyday Cognition Scale (ECog)] and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Actigraphy data was processed to estimate average nightly sleep duration, sleep efficiency, and wake after sleep onset. Linear regressions related objective and self‐report sleep health measures with total ECog score adjusting for age, sex, race/ethnicity, education, body mass index, depressive symptoms, Framingham cardiovascular risk score, and apolipoprotein E‐e4 carrier status.ResultIn main effect models, longer sleep duration was associated with greater SCD (b = 0.05, p&lt;0.01). In models adjusted for age, sex, race/ethnicity, and education, higher PSQI (indicative of poorer sleep quality) was associated with greater SCD (b = 1.06, p = 0.01); however, the association was no longer statistically significant in the fully adjusted model. No associations were observed between sleep efficiency or wake after sleep onset and SCD.ConclusionIn this community cohort of older adults, longer nightly sleep duration and self‐reported poor sleep quality were linked with higher SCD. Findings could suggest that abnormal sleep duration and poor sleep quality increase the earliest clinical symptoms of AD. Further investigations are needed to evaluate the potential pathways connecting sleep health to ADRD development.

Cohort heterogeneity and AD biomarkers in older adults without significant cognitive impairment: A comparison of U.S. POINTER and ADNI

AbstractBackgroundA key focus of the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is recruitment of unimpaired older individuals at risk for cognitive decline with heterogeneous characteristics (under‐represented racial and ethnicity groups (URG), family history of cognitive decline, hypertension, geographic diversity), and a subset of individuals undergo PET and MRI.MethodTo examine effects of heterogeneity on relationships between risk factors, AD biomarkers (Aß and entorhinal tau PET, hippocampal volume (HV)) and cognition (global, executive function, and memory) were examined from U.S. POINTER neuroimaging participants (N = 602, about 65% of the anticipated total sample) and a subset of Alzheimer’s Disease Neuroimaging Initiative participants (N = 503). Neuroimaging data were processed and analyzed using harmonized methods across studies. Some cohort‐specific measurements were standardized using a within‐cohort reference group (Aß‐negative individuals &lt;70yrs and with global CDR = 0).ResultU.S. POINTER imaging participants are younger than those in ADNI (68.6+/‐5.0yrs vs 70.7+/‐4.4yrs), more likely to be female (65% vs 58%) and from URG (27% vs 15%), and had lower education (14.7+/‐3.3yrs vs 16.7+/‐2.3yrs) and higher Framingham Cardiovascular Risk scores (9.9+/‐8.3 vs 7.7+/‐5.3). The groups differed on several AD biomarkers and cognitive measures (Table). In regression models, AD biomarkers were stronger predictors of cognitive performance in ADNI compared to POINTER. Specifically, Aß+ individuals with elevated tau had disproportionately poorer cognitive performance in ADNI, and this relationship remained consistent across cognitive measures (Figure). Conversely, demographic/risk variables were stronger predictors in POINTER. Demographic/risk predictors (age, sex, education, race, and FRS) together explained twice as much variance in global cognition in POINTER compared to ADNI (Adjusted R2 = 29% vs 14%). The addition of AD biomarkers to the model further increased the amount of variance in global cognition explained from 14% to 34% in ADNI, but addition of AD biomarkers did not increase variance explained in the POINTER model.ConclusionHeterogeneity among study participants appears to influence baseline biomarker‐cognition relationships such that AD biomarkers explain more variability in cognitive performance in ADNI than POINTER. These findings further suggest that cohort characteristics may affect the potential influence of amyloid‐ and tau‐modifying treatments on cognition.

Cohort heterogeneity and AD biomarkers in older adults without significant cognitive impairment: A comparison of U.S. POINTER and ADNI

AbstractBackgroundA key focus of the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is recruitment of unimpaired older individuals at risk for cognitive decline with heterogeneous characteristics (under‐represented racial and ethnicity groups (URG), family history of cognitive decline, hypertension, geographic diversity), and a subset of individuals undergo PET and MRI.MethodTo examine effects of heterogeneity on relationships between risk factors, AD biomarkers (Aβ and entorhinal tau PET, hippocampal volume (HV)) and cognition (global, executive function, and memory) were examined from U.S. POINTER neuroimaging participants (N = 602, about 65% of the anticipated total sample) and a subset of Alzheimer’s Disease Neuroimaging Initiative participants (N = 503). Neuroimaging data were processed and analyzed using harmonized methods across studies. Some cohort‐specific measurements were standardized using a within‐cohort reference group (Aβ‐negative individuals &lt;70yrs and with global CDR = 0).ResultU.S. POINTER imaging participants are younger than those in ADNI (68.6+/‐5.0yrs vs 70.7+/‐4.4yrs), more likely to be female (65% vs 58%) and from URG (27% vs 15%), and had lower education (14.7+/‐3.3yrs vs 16.7+/‐2.3yrs) and higher Framingham Cardiovascular Risk scores (9.9+/‐8.3 vs 7.7+/‐5.3). The groups differed on several AD biomarkers and cognitive measures (Table). In regression models, AD biomarkers were stronger predictors of cognitive performance in ADNI compared to POINTER. Specifically, Aβ+ individuals with elevated tau had disproportionately poorer cognitive performance in ADNI, and this relationship remained consistent across cognitive measures (Figure). Conversely, demographic/risk variables were stronger predictors in POINTER. Demographic/risk predictors (age, sex, education, race, and FRS) together explained twice as much variance in global cognition in POINTER compared to ADNI (Adjusted R2 = 29% vs 14%). The addition of AD biomarkers to the model further increased the amount of variance in global cognition explained from 14% to 34% in ADNI, but addition of AD biomarkers did not increase variance explained in the POINTER model.ConclusionHeterogeneity among study participants appears to influence baseline biomarker‐cognition relationships such that AD biomarkers explain more variability in cognitive performance in ADNI than POINTER. These findings further suggest that cohort characteristics may affect the potential influence of amyloid‐ and tau‐modifying treatments on cognition.

ASGARD risk scores for long-term, individualized cardiovascular surveillance of low-risk patients with asymptomatic non-severe aortic valve stenosis: development and internal validation

Abstract Background Routine echocardiography of asymptomatic patients with non-severe aortic valve stenosis (AS) mainly focuses on the valve condition at 1-2 year intervals but has limited ability to predict the risk of other cardiovascular comorbidities. Thus, there is a compelling need to replace routine echocardiography for low-risk patients with more individualized cardiovascular surveillance for a safe period. Aim First, to develop and validate separate risk stratification models for AS-related events (AVE) and major cardiovascular events (MCE) to identify low-risk AS patients who can safely postpone routine echocardiography replaced by tailored risk stratification and adequate risk factor management. Second, to estimate optimal follow-up intervals according to risk stratification for each outcome. Methods We analyzed serial measurements from 69% of 1579 patients with mild-to-moderate AS who were asymptomatic and event-free one year after inclusion in the randomized, multicenter Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial. We developed two ASGARD risk scores using multivariable Cox proportional hazard regression analyses, designed as landmark analyses starting at year-1 and with a clinically relevant 2-year follow-up. The ASGARD scores estimated the risk of AVE (composite of aortic valve replacement or hospitalization with heart failure) and MCE (composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke, and all-cause mortality). We estimated the prognostic models with backward elimination, selecting the lowest Akaike information criterion values and p&amp;lt;0.05. There were 7 predictors for AVE and 6 for MCE among current demographic, electrocardiograms, laboratory data, and echocardiographic measures one year earlier (baseline) (Figures 1A, 2A). We defined optimal follow-up for risk score quartiles at rates ≤5% visualized on Kaplan-Meier plots. We assessed model performance in 31% of patients held out for internal validation. Results ASGARD development models for both AVE and MCE risk demonstrated overall consistent predictive performance in the internal validation cohort, as evidenced by c-statistics, calibration-in-the-large, calibration slope, Brier score, and goodness-of-fit (all p&amp;gt;0.05) (Figure 1B-C, 2B-C). ASGARD predicted AVE risk similar to a new Vmax measurement (area under the curve [95% CI], 0.82 [0.78-0.87] vs. 0.85 [0.82-0.89) (Figure 1B), and MCE risk better than Framingham cardiovascular risk score (0.76 [0.70-0.82] vs. 0.68 [0.62-0.75]) (Figure 2B). The one-year event rates were ≤5% for the 2 lowest risk score quartiles (Figure 1D, 2D). Conclusion The ASGARD risk scores show promise for long-term, individualized cardiovascular surveillance of low-risk patients with non-severe AS without unnecessary echocardiography. Further studies are warranted for external model validation, continuous optimization, and exploring the potential for implementation in clinical practice.Figure 1Figure 2

Relationship between Framingham Cardiovascular Risk Score and cognitive performance among ageing rural Indian participants: a cross-sectional analysis

ObjectiveThe burden of cardiovascular risk factors is increasing in India, which, in turn, can adversely impact cognition. Our objective was to examine the effect of cardiovascular risk factors measured by...

Accuracy of visceral adiposity indices and lipid accumulation products in the identification of adults at high cardiovascular risk

IntroductionThe lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients. MethodsA cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score. ResultsNo significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity. ConclusionOur results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.

Vitamin D Deficiency and Its Association With Cardiovascular Diseases Among Patients Attending a Private Tertiary Sector Cardiovascular Heart Clinic in Nairobi.

Vitamin D deficiency is a common condition that affects approximately 30-50% of the worldwide population. Vitamin D deficiency is associated with an increased risk of cardiometabolic diseases and is considered a cardiovascular risk factor globally. Methods: This is a retrospective cross-sectional study that aimed to identify the prevalence of vitamin D deficiency and its associations with the cardiovascular disease (CVD) risk profile of patients presenting for cardiac evaluation at Primecare Heart Clinic, a private heart clinic in Nairobi, Kenya, between January 1, 2020 and January 31, 2022. Females with vitamin D deficiency composed 58.87% of the study participants. The average 10-year Framingham CVD risk level of the vitamin D-deficient participants was 7.09%. Participants with vitamin D deficiency that were older and had low serum high-density lipoprotein C (HDL-C) levels and high systolic blood pressure (BP) had a higher risk of CVDs. Male participants were at five times higher risk of CVDs.Vitamin D-deficient patients who were older and had a low HDL cholesterol level and high systolic BP are at a high risk of CVDs. The two-way analysis of variance (ANOVA) test value was 345.6992, and the p-valuewas 0.002884. Our study demonstrated that a low level of vitamin D was associated with a higher Framingham cardiovascular risk score and cardiovascular risk in patients. Nonetheless, this is a retrospective study, which is a major limitation of this study.

Fixed dose combination therapies in primary cardiovascular disease prevention in different groups: an individual participant meta-analysis

ObjectiveTo evaluate the effects of fixed dose combination (FDC) medications on cardiovascular outcomes in different age groups in an individual participant meta-analysis of three primary prevention randomised trials.MethodsParticipants at intermediate...

Accuracy of visceral adiposity indices and lipid accumulation products in the identification of adults at high cardiovascular risk

IntroductionThe lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients. MethodsA cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score. ResultsNo significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity. ConclusionOur results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.

Effects of clinical, comorbid, and social determinants of health on brain ageing in people with and without HIV: a retrospective case-control study.

Neuroimaging reveals structural brain changes linked with HIV infection and related neurocognitive disorders; however, group-level comparisons between people with HIV and people without HIV do not account for within-group heterogeneity. The aim of this study was to quantify the effects of comorbidities such as cardiovascular disease and adverse social determinants of health on brain ageing in people with HIV and people without HIV. In this retrospective case-control study, people with HIV from Washington University in St Louis, MO, USA, and people without HIV identified through community organisations or the Research Participant Registry were clinically characterised and underwent 3-Tesla T1-weighted MRI between Dec 3, 2008, and Oct 4, 2022. Exclusion criteria were established by a combination of self-reports and medical records. DeepBrainNet, a publicly available machine learning algorithm, was applied to estimate brain-predicted age from MRI for people with HIV and people without HIV. The brain-age gap, defined as the difference between brain-predicted age and true chronological age, was modelled as a function of clinical, comorbid, and social factors by use of linear regression. Variables were first examined singly for associations with brain-age gap, then combined into multivariate models with best-subsets variable selection. In people with HIV (mean age 44·8 years [SD 15·5]; 78% [296 of 379] male; 69% [260] Black; 78% [295] undetectable viral load), brain-age gap was associated with Framingham cardiovascular risk score (p=0·0034), detectable viral load (>50 copies per mL; p=0·0023), and hepatitis C co-infection (p=0·0065). After variable selection, the final model for people with HIV retained Framingham score, hepatitis C, and added unemployment (p=0·0015). Educational achievement assayed by reading proficiency was linked with reduced brain-age gap (p=0·016) for people without HIV but not for people with HIV, indicating a potential resilience factor. When people with HIV and people without HIV were modelled jointly, selection resulted in a model containing cardiovascular risk (p=0·0039), hepatitis C (p=0·037), Area Deprivation Index (p=0·033), and unemployment (p=0·00010). Male sex (p=0·078) and alcohol use history (p=0·090) were also included in the model but were not individually significant. Our findings indicate that comorbid and social determinants of health are associated with brain ageing in people with HIV, alongside traditional HIV metrics such as viral load and CD4 cell count, suggesting the need for a broadened clinical perspective on healthy ageing with HIV, with additional focus on comorbidities, lifestyle changes, and social factors. National Institute of Mental Health, National Institute of Nursing Research, and National Institute of Drug Abuse.

Central obesity as assessed by conicity index and a-body shape index associates with cardiovascular risk factors and mortality in kidney failure patients.

Anthropometric indices of central obesity, waist circumference (WC), conicity index (CI), and a-body shape index (ABSI), are prognostic indicators of cardiovascular (CV) risk. The association of CI and ABSI with other CV risk indices, markers of nutritional status and inflammation, and clinical outcomes in chronic kidney disease (CKD) stage 5 (CKD5) patients was investigated. In a cross-sectional study with longitudinal follow up of 203 clinically stable patients with CKD5 (median age 56 years; 68% males, 17% diabetics, 22% with CV disease, and 39% malnourished), we investigated CI and ABSI and their associations with atherogenic index of plasma (AIP), Framingham CV risk score (FRS), Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC), handgrip strength (HGS), high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). CV events (CVE) and all-cause mortality during up to 10-years follow up were analyzed by multivariate survival analysis of restricted mean survival time (RMST). Chronic kidney disease patients with middle and highest CI and ABSI tertiles (indicating greater abdominal fat deposition), compared to those with the lowest CI and ABSI tertiles, tended to be older, more often men and diabetic, had significantly higher levels of hsCRP, IL-6, AIP, FRS, CAC and AVC scores. CI and ABSI were positively correlated with CAC, FRS, AIP, hsCRP and IL-6. Both CI and ABSI were negatively correlated with HGS. In age-weighted survival analysis, higher CI and ABSI were associated with higher risk of CVE (Wald test = 4.92, p = 0.027; Wald test = 4.95, p = 0.026, respectively) and all-cause mortality (Wald test = 5.24, p = 0.022; Wald test = 5.19, p = 0.023, respectively). In RMST analysis, low vs. high and middle tertiles of CI and ABSI associated with prolonged CVE-free time and death-free time, and these differences between groups increased over time. Abdominal fat deposit indices, CI and ABSI, predicted CV outcomes and all-cause mortality, and were significantly associated with the inflammatory status in CKD patients.

Relationship of Arterial Stiffness and Central Hemodynamics With Cardiovascular Risk In Hypertension.

Hypertension is becoming a serious public health problem and noninvasive estimation of central hemodynamics and artery stiffness have been identified as important predictors of cardiovascular disease. The study included 4,311 participants, both sex and aged between 20 and 79 years. Arterial velocity pulse index, arterial pressure-volume index (AVI, API, and the index of artery stiffness), central systolic blood pressure, central artery pulse pressure (CSBP, CAPP, and estimated via oscillometric blood pressure monitor), and 10-year risk score of cardiovascular disease in China (China-PAR) and Framingham cardiovascular risk score (FCVRS) were assessed at baseline. Regression model was performed to identify factors associated with high cardiovascular disease risk stratification. The relationships between CSBP, CAPP and China-PAR, and FCVRS were analyzed by restrictive cubic spline functions. The uncontrolled hypertension group showed the highest values of AVI, API, CSBP, and CAPP. In the regression analysis, CAPP and hypertension subtypes were identified as significant predictors of high cardiovascular risk stratification, and CAPP was strongly correlated with API in this cohort. Finally, CSBP and CAPP showed significant J-shaped relationships with China-PAR and FCVRS. Subjects with uncontrolled hypertension present with elevated values of CAPP, CSBP, API, AVI, China-PAR, and FCVRS scores. CAPP was independently associated with high cardiovascular risk stratification, and there was a significant J-shaped relationship with China-PAR and FCVRS that may identify people with higher cardiovascular risk.

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.