Framingham Coronary Risk Score Research Articles

Effects of Age, Metabolic and Socioeconomic Factors on Cardiovascular Risk among Saudi Women: A Subgroup Analysis from the Heart Health Promotion Study.

Background: Cardiovascular disease (CVD) remains the leading cause of death in women. Along with the effect of age on the risk of CVD, the reproductive profile of women can influence cardiac health among women. Objectives: The objective of this study is to investigate the influence of age and reproductive stages on the development and progression of cardiovascular disease risks in Saudi women. Methods: For this study, we included 1907 Saudi women from the Heart Health Promotion Study. The study cohort was divided into five age groups (less than 40 years, 40-45 years, 46-50 years, 51-55 years, and ≥56 years). The cohort stratification was meant to correspond to the social and hormonal changes in women's life, including reproductive, perimenopausal, menopausal, and postmenopausal age groups. The groups were compared with respect to the prevalence of metabolic, socioeconomic, and cardiac risks, and the age group of less than 40 years was considered as the reference group. The World Health Organization stepwise approach to chronic disease risk factor Surveillance-Instrument v2.1 was used in this study to collect the anthropometric and biochemical measurements and the Framingham Coronary Heart Risk Score was used to calculate the cardiovascular risk (CVR). Logistic regression analysis was conducted to assess the independent effect of age on CVD risks after adjustment of sociodemographic factors. Results: Metabolic and CVR increased progressively with the increase in age. There was a sharp increase in obesity, hypertension, diabetes, and metabolic syndrome, from the age group <40 years to 41-45 years and then again between the age groups of 46-50 and ≥56 years. A similar noticeable increase in metabolic risk factors (high cholesterol, high triglyceride, high Low-Density Lipoprotein) was observed between the age group <40 years and 41-45 years, but with a steady increase with the increase in age between the other age groups. The high and intermediate Framingham Coronary Heart Risk Scores showed a progressive increase in prevalence with the increase in age, where the proportion doubled from 9.4% at the age group 46-50 years, to 22% at the age group 51-55 years. It doubled again at the age group ≥56 years to 53%-these sharp inflections in the risk of CVD correspond to the women's reproductive lives. Conclusions: In Saudi women, CVR increases with the increase of age. The influence of pregnancy and menopause is apparent in the prevalence of increased risks for cardiovascular and metabolic diseases.

Cardiovascular Risk Factors amongst the Patient Living with HIV Attending at Anti-Retroviral Therapy Center of Bangladesh

Human immunodeficiency Virus (HIV) seropositive individual is at risk of developing disease of cardiovascular system (CVD). There are scarce of research work regarding this field in Bangladesh. Considering scarcity, this study was conducted at anti-retroviral therapy (ART) center of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh to find out the frequency of the CVD and their common risk factors in HIV seropositive patients from March 2017 to September 2019. Different CVD risk factors were assessed in this study. The demographic data were assessed and World Health Organization STEPS questionnaire were used to collect demographic data. The 10-year CVD risk was calculated by using the Framingham coronary risk score (FRS). Mean age of study population was 38, SD= 9.8. Among them sixty-five (65%) were men and thirty-five (35%) were women. About one third were overweight followed by 5% were obese. High cholesterolemia, high triglyceridemia, high low-density lipoprotein (LDL) and low high-density lipoprotein (HDL) were found in 23%, 58%, 14%. and 63% of the HIV patent, respectively. Hypertension was present in 19% and diabetes in 15% of the patients. In Framingham risk score, 19% of the participants had intermediate to high risk of cardiovascular disease within 10 years. The cardiovascular risk factors were common in HIV patients attending ART center of BSMMU, where base line 10-years CVD risk was low. People living with HIV appear to be an imminent risk to develop CVD. Bangladesh Med J. 2021 May; 50(2) : 40-44

Evaluating the relationship of sleep quality and sleep duration with Framingham coronary heart disease risk score

ABSTRACT Sleep is an important modulator of cardiovascular function and is recognized to play an important role in the pathogenesis and progression of cardiovascular disease. However, results of the studies investigating the relationship between sleep complaints and cardiovascular outcomes are still controversial. This study aimed to investigate the associations of sleep duration and sleep quality with Framingham 10-year hard coronary heart disease (CHD) risk score in Turkish adults. We included a total of 362 participants (mean age: 48.5 ± 9.0 years, 50.6% males) and measured sleep quality and sleep duration using Pittsburgh Sleep Quality Index (PSQI). Framingham risk scoring system was utilized to calculate the 10-year hard CHD risk of participants. Binary logistic regression analysis was performed to determine the association between sleep quality, sleep duration, and CHD risk. Both short sleep duration (<6 hours) (OR = 3.858, 95% CI: 1.245–11.956) and long sleep duration (≥8 hours) (OR = 2.944, 95% CI: 1.087–7.967) were identified as the predictors of 10-year hard CHD risk. However, sleep quality was not associated with 10-year CHD risk even as a categorical or continuous variable (OR = 0.864, 95% CI: 0.418–1.787 and OR = 0.985, 95% CI: 0.868–1.117, respectively). Our findings highlighted previous studies demonstrating the U-shaped relationship, with both short and long sleep durations to be associated with a higher CHD risk. Evaluation of habitual sleeping patterns may provide additional information in clinical cardiovascular risk assessment. Future research should investigate whether interventions to optimize sleep duration may help to prevent coronary events in large population-based cohorts.

Impact of COVID-19 and Associated Preventive Measures on Cardiometabolic Risk Factors in South Korea.

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, preventive measures mandated by government policies have included the closure of exercise facilities and movement restriction, which can lead to an unhealthy lifestyle. We investigated the effect of these preventive measures on metabolic parameters in individuals with cardiometabolic disorders.MethodsIn this retrospective, observational study of patients who visited the hospital at least twice a year for the past 4 years, changes in cardiometabolic factors during the COVID-19 pandemic (2019-2020) were compared with changes in the same cohort at the same annual time points during the previous seasons of 2016-2019.ResultsA total of 1,485 individuals with a mean age of 61.8±11.7 years were included in the analyses. During the COVID-19 pandemic, the number of patients whose metabolic syndrome worsened increased significantly by 21% compared with the 2018-2019 season. Body mass index increased by 0.09±1.16 kg/m2 in the 2019-2020 pandemic period, whereas it decreased by -0.39±3.03 kg/m2 in 2018-2019 and by -0.34±2.18 kg/m2 in 2017-2018 (both P<0.05). Systolic blood pressure increased by 2.6±18.2 mmHg in the COVID-19 pandemic period, while it decreased in the three antecedent seasons (all P<0.05). Lipid profiles worsened in the pandemic period compared with the previous years. Framingham coronary heart disease risk score also increased significantly.ConclusionNationwide strategies to maintain cardiometabolic health are necessary during contagious disease pandemics like COVID-19 to mitigate the adverse health effects of pandemic-preventative strategies.

High Sensitive C Reactive Protein and the Calculated Framingham Coronary Heart Disease Risk Score in a Selected Population of Sri Lanka

Recently, the inammatory marker, high sensitivity C-reactive protein (hsCRP) has attracted clinical attention as a novel risk factor for Coronary Heart Disease (CHD) due to the immerging relationship between inflammation and atheroma.

Performance of the Framingham coronary heart disease risk score for predicting 10-year cardiac risk in adult United Arab Emirates nationals without diabetes: a retrospective cohort study

BackgroundPrimary prevention guidelines recommend the use of the Framingham risk score (FRS) to estimate the 10-year coronary heart disease (CHD) risk in patients without diabetes for statin eligibility. However, the FRS model has never been validated in an Arab population. Therefore, this study aimed to examine the clinical performance of the FRS model for predicting 10-year CHD risk in adult United Arab Emirates (UAE) nationals without diabetes.MethodsThis 10-year retrospective cohort study included patients from the primary care clinics and outpatient specialty departments of a large tertiary care hospital in Al-Ain, UAE. They were aged 30–79 without a baseline history of cardiovascular disease and diabetes. The FRS for each subject was calculated. Follow-up data on hard CHD (hCHD) events (myocardial infarction or coronary death) for each participant were collected from the baseline visit in 2008 until December 31, 2019. The area under the time-dependent receiver operating characteristic (ROC) curve (AUROC) was used to assess the FRS model discrimination. Calibration was measured by using the Hosmer-Lemeshow χ2 test and the calibration curve. The optimal cutoff-point for hCHD risk prediction was determined by ROC curve analysis.ResultsA total of 554 participants were included. The mean age was 48.0 ± 12.8 years and 45% were men. The mean predicted FRS of the study cohort was 5.2% and approximately 7% were classified as high-risk (≥ 20% threshold) by the FRS model. During a median follow-up of 10.2 years (interquartile range, 7.8–11.0 years), 26 hCHD events occurred. The FRS model displayed reasonably good discrimination (time-dependent AUROC value: 0.83) and calibration in predicting hCHD (Hosmer-Lemeshow χ2 statistic 11.2, P = 0.191). Applying the 20% high-risk threshold, the FRS model had a sensitivity of only 37% in identifying patients at high-risk for an hCHD event over 10 years. While a 7.5% optimal cutoff-point improved the sensitivity to 74%.ConclusionsThe FRS can be used in the prediction of coronary risk among UAE nationals without diabetes, however, the recommended hCHD risk threshold for statin eligibility may be too high. Lowering the cutoff-point to 7.5% could improve the identification of patients for preventive treatment.

Waist circumference cutoff identifying risks of obesity, metabolic syndrome, and cardiovascular disease in men with spinal cord injury.

ObjectivesTo apply spinal cord injury (SCI) specific waist circumference (WC) cutoff point to identify risks of 1) obesity, 2) metabolic syndrome (MetS), 3) cardiovascular disease (CVD).MethodsThirty-six men with chronic SCI underwent anthropometric measurements, dual-energy x-ray absorptiometry (DXA), and magnetic resonance imaging (MRI) to measure total and regional adiposity. An SCI specific WC cutoff point of 86.5 cm was applied to the existing general population criteria. Pearson chi-square (χ2) analyses tested the difference in the number of participants classified as obese using the SCI specific cutoff point compared to the general population criteria. Sensitivity and specificity analyses relative to percentage body fat mass and visceral adipose tissue was used to assess classification performance of this cutoff point. The interrater reliability for three definitions of MetS was assessed using Cohen’s Kappa (κ) values. Linear regression analyses were utilized to propose SCI specific Framingham Coronary Heart Disease Risk Score (FRS) cutoff value.ResultsUsing SCI specific WC cutoff point of 86.5 cm, 36% of participants were classified as obese compared to only 3% when using WC of 102 cm (P < 0.001). Relative to percentage body fat mass, the general population WC cutoff point of 102 cm had a sensitivity of 6.3% and specificity of 100% both which changed to 68.8% and 90%, respectively, with a SCI specific cutoff point of 86.5 cm. Similar results were obtained when using visceral adipose tissue as a reference. The Kappa (κ) values improved substantially after using SCI specific criteria (0.95 ± 0.05) compared to the general population criteria (0.47 ± 0.28) for three definitions of MetS. The SCI specific FRS cutoff value of 6 was predicted after applying a WC cutoff of 86.5 cm.ConclusionsUsing the existing general population criteria underestimated persons with SCI who are at risk of developing obesity, MetS, and CVD. The recommended SCI specific criteria are likely to distinguish those at risks of developing comorbidities and allow healthcare providers to intervene in a timely manner.

Cardiovascular Risk and Hearing Threshold Levels on Disc Jockey Workers

Introduction: Noise-induced hearing loss is a major public health problem. Extended exposure to noisy music can cause not only hearing loss, but also biochemical changes in exposed Disc Jockey (DJ) workers. Aim of work: To study some health hazards; mainly biochemical changes and hearing threshold levels among DJ workers compared with a well-matched control group and the prevalence of using protective measures among this occupational group. Materials and methods: A cross-sectional controlled study was conducted at Benha city, Kalyobiya Governorate, Egypt. Data was collected from the beginning of May till the end of September 2017. Sixty-three DJ workers and well-matched seventy-two office workers were subjected to an interview structured questionnaire, clinical examinations including audiometric hearing threshold assessment, biochemical analysis and Framingham coronary heart disease risk score was calculated. Results: The hearing threshold was affected in 59% of DJ workers. Blood pressure, pulse and lipid profile were statistically significantly higher in DJ workers (except HDL was lower). The difference in audiometric measures starts at 3000 at right ear and 4000 at left ear. The only significant predictor for hearing affection was work duration. Conclusion: Noise is one of the disturbing factors for health. In addition to impairing of hearing, noise affects blood pressure, blood glucose and lipid profiles which acts as risk factor for cardio vascular diseases.

Color Data v2: a user-friendly, open-access database with hereditary cancer and hereditary cardiovascular conditions datasets.

Publicly available genetic databases promote data sharing and fuel scientific discoveries for the prevention, treatment and management of disease. In 2018, we built Color Data, a user-friendly, open access database containing genotypic and self-reported phenotypic information from 50 000 individuals who were sequenced for 30 genes associated with hereditary cancer. In a continued effort to promote access to these types of data, we launched Color Data v2, an updated version of the Color Data database. This new release includes additional clinical genetic testing results from more than 18 000 individuals who were sequenced for 30 genes associated with hereditary cardiovascular conditions as well as polygenic risk scores for breast cancer, coronary artery disease and atrial fibrillation. In addition, we used self-reported phenotypic information to implement the following four clinical risk models: Gail Model for 5-year risk of breast cancer, Claus Model for lifetime risk of breast cancer, simple office-based Framingham Coronary Heart Disease Risk Score for 10-year risk of coronary heart disease and CHARGE-AF simple score for 5-year risk of atrial fibrillation. These new features and capabilities are highlighted through two sample queries in the database. We hope that the broad dissemination of these data will help researchers continue to explore genotype–phenotype correlations and identify novel variants for functional analysis, enabling scientific discoveries in the field of population genomics. Database URL: https://data.color.com/

Association between body adiposity index and coronary risk in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

The body adiposity index (BAI) was recently proposed as a better indicator of body adiposity than body mass index in adults. The association between BAI and cardiometabolic risk factors has been widely investigated. However, the strength and magnitude of these associations varied as a function of the endpoint evaluated, the study design, the population investigated, and the cut-off points used. The aim of this study was to investigate the association between BAI and coronary heart disease (CHD) risk in a large sample of Brazilian adults and to propose the most appropriate cut-off points for BAI for the identification of CHD risk in the adult Brazilian population. Data from 15,092 civil servants (54.4% women) from universities and research institutes in six Brazilian states were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All were aged 35-74years at baseline. The Framingham coronary risk score was used to identify a very high risk of CHD (≥20% risk of CHD over the next 10 years) and a high risk of CHD (≥10% risk). BAI cut-off points capable of detecting a risk of CHD were determined using ROC curves and associations were tested using Poisson regression with robust variance, according to sex and age. Three multivariable models were examined. BAI remained positively associated with a very high and high risk of CHD following adjustment for potential confounding factors in all the strata and multivariable models (p<0.05), with the exception of model 3 (adjusted for education level and waist-to-hip ratio) for very a high risk of CHD in younger women (p=0.06). In the adjusted models, the prevalence ratios for a very high and high risk of CHD, irrespective of age group, varied between 1.23 (95%CI: 1.09-1.39) and 1.64 (1.33-2.03) and 1.07 (1.03-1.12) and 1.47 (1.36-1.60) in men; and 1.57 (1.08-2.31) and 2.42 (1.36-4.31) and 1.29 (1.13-1.47) and 1.82 (1.54-2.15) in women, respectively. The optimal cut-off points of BAI to determine a risk of CHD were: 28.0 in men of both age groups, and 34.0 in younger women and 36.0 in older women to determine a very high risk; and 26.0 in younger men and 34.0 in women of both age groups to determine a high risk. BAI showed a reasonable ability to predict coronary risk in participants of the ELSA-Brasil (AUC>60%, except for the group of men of 60-74 years of age). Higher BAI levels were found to be associated with a greater risk of developing CHD in both men and women of different ages participating in the ELSA-Brasil, suggesting that BAI may be a useful tool for screening for CHD risk in Brazilian adults.

Associations between very low concentrations of low density lipoprotein cholesterol, high sensitivity C-reactive protein, and health outcomes in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.

Recent findings have demonstrated the important contribution of inflammation to the risk of cardiovascular disease (CVD) in individuals with optimally managed low density lipoprotein cholesterol (LDL-C). We explored relationships between LDL-C, high sensitivity C-reactive protein (hs-CRP), and clinical outcomes in a free-living US population. We used data from the REasons for Geographical And Racial Differences in Stroke (REGARDS), and selected individuals at 'high risk' for coronary events with a Framingham Coronary Risk Score of ≥10% or atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% in order to explore relationships between low LDL-C [<70 mg/dL (1.8 mmol/L) in comparison to ≥70 mg/dL (1.8 mmol/L)]; hs-CRP <2 compared with ≥2 mg/L and clinical outcomes [all-cause mortality, incident coronary heart disease (CHD), and incident stroke]. To assess the association between the LDL-C and hs-CRP categories and each outcome, a series of incremental Cox proportional hazards models were employed on complete cases. To account for missing observations, the most adjusted model was used to interrogate the data using multiple imputation with chained equations (MICE). In this analysis, 6136 REGARDS high-risk participants were included. In the MICE analysis, participants with high LDL-C (≥70 mg/dL) and low hs-CRP (<2 mg/L) had a lower risk of incident stroke [hazard ratio (HR) 0.69, 0.47-0.997], incident CHD (HR 0.71, 0.53-0.95), and CHD death (HR 0.70, 0.50-0.99) than those in the same LDL-C category high hs-CRP (≥2 mg/L). In participants with high hs-CRP (≥2 mg/dL), low LDL-C [<70 mg/dL (1.8 mmol/L)] was not associated with additional risk reduction of any investigated outcome, but with the significant increase of all-cause mortality (HR 1.37, 1.07-1.74). In this high-risk population, we found that low hs-CRP (<2 mg/L) appeared to be associated with reduced risk of incident stroke, incident CHD, and CHD death, whereas low LDL-C (<70 mg/dL) was not associated with protective effects. Thus, our results support other data with respect to the importance of inflammatory processes in the pathogenesis of CVD.

Abstract P164: Cognitive Impairment Among Adults With Incident Heart Failure

Background: Cognitive impairment is as high as 70% among adults with heart failure (HF) and its prevalence increases with the duration and severity of HF. However, little is known about the prevalence of cognitive impairment early in the course of HF. This is important, as high cognitive impairment at diagnosis would suggest that earlier screening would be warranted. We examined the prevalence and correlates of cognitive impairment among adults with incident HF. Methods: We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, an observational, longitudinal cohort study of 30,239 community-dwelling adults &gt; 45 recruited from 2003 to 2007. Blacks and residents of the stroke belt were oversampled. Global cognitive status was assessed annually by telephone with the Six-item Screener (SIS) and the diagnosis of incident HF was validated by physicians using medical records and standard clinical criteria. Participants who were hospitalized for incident HF from 2004 until 2016 with a SIS completed &gt; 1 month but &lt; 18 months before the index hospitalization were included. After determining the prevalence of cognitive impairment among this cohort, we identified which of their baseline characteristics were independently associated with cognitive impairment using multivariable logistic regression. We then compared the prevalence of cognitive impairment among adults with incident HF to the prevalence of cognitive impairment among age, sex, and race matched participants without HF, stratifying by 10-year Framingham Coronary Heart Disease Risk Scores (FRS) (&lt;10%, 10-20%, and &gt; 20%). Results: Of the 436 participants with incident HF, 14.9% had cognitive impairment. In an age-adjusted model, older age (OR 1.04 [95% CI 1.01 - 1.08], black race (OR 1.88 [95% 1.08-3.28]), &lt; high school education (OR 1.89 [95% 1.02-3.51]), and anticoagulation (OR 3.01 [95% 1.05 - 8.63]) were independently associated with higher odds of cognitive impairment, whereas female sex (OR 0.54 [95% 0.31 - 0.94]) was associated with lower odds of cognitive impairment. The prevalence of cognitive impairment among participants with incident HF was higher than the prevalence of cognitive impairment among controls with low FRS (9.4%) but was less than the prevalence of cognitive impairment among controls with high FRS (21.9%). Conclusion: The prevalence of cognitive impairment among adults with incident HF was greater than the prevalence of cognitive impairment among matched participants with low CHD risk, but less than the prevalence of cognitive impairment among matched participants with the highest CHD risk. This suggests that the majority of cognitive decline in HF may occur later in the course of the disease. Increased awareness of cognitive impairment among newly diagnosed patients, as well as ways to mitigate cognitive decline in the context of HF management, are warranted.

Body composition measures and cardiovascular risk in high-risk ethnic groups

Cardiovascular disease (CVD) is highly prevalent in Suriname, a middle-income country with predominantly people of African and Asian ancestry. We examined whether the more comprehensive body composition measures determined by bioelectrical impedance analysis (BIA) are superior to the more traditional BMI and waist measures in relation to cardiovascular risk. Data from the cross-sectional Healthy Life in Suriname (HELISUR) study were used to calculate BMI, waist-hip ratio, waist-to-height ratio, and waist circumference. BIA was used to estimate fat percentage, fat-free mass index, and fat-to-fat-free mass ratio. High cardiovascular risk was defined as 1) a 10-year Framingham coronary heart disease risk score ≥10% in African-Surinamese and ≥12% in Asian-Surinamese, and 2) an increased arterial stiffness (pulse wave velocity >10m/s). Using logistic regression analysis, we pre-selected the strongest correlate (i.e. lowest p-value below 0.05) of all body composition items for both outcomes of cardiovascular risk separately, and subsequently, used forward logistic regression modelling to determine whether other measures added value to the initial model with the strongest correlate (-2 log-likelihood (-2LL) of initial model minus-2LL of new model, χ-square statistic >3.841, 1 df). Analyses were adjusted for sex, age and ethnicity. We examined 691 participants (65% women; 48% African-Surinamese) with a mean age of 42 (SD 14) years. Waist circumference was the strongest correlate for high 10-year CVD risk in the total group, in men and African-Surinamese. In Asian-Surinamese, fat-free mass index was the strongest correlate of high 10-year CVD risk. Increased arterial stiffness was most strongly related with waist-to-height ratio in the total group and in African-Surinamese, and with BMI in men. None of the measures were significantly associated in women (for both outcomes) and Asian-Surinamese (for increased arterial stiffness). Forward selection showed that only BMI added value next to waist-to-height ratio in the total group in relation to increased arterial stiffness. Waist measures, in particular waist circumference and waist-to-height ratio, and BMI should be used in African and Asian-Surinamese to identify who is at increased cardiovascular risk. Overall, we found little advantage in using BIA measures rather than simple anthropometric measures.

Abnormal levels of vascular endothelial biomarkers in schizophrenia.

Schizophrenia is associated with chronic low-grade inflammation, which has been linked to increased vascular risk and rates of cardiovascular disease. Levels of vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) have been related to aging and neurodegeneration, but their role in schizophrenia remains uncertain. Using a cross-sectional, case-control design, this study included 99 outpatients with schizophrenia and 99 healthy comparison subjects (HCs). Sociodemographic and clinical data were collected, and plasma levels of VEGF, ICAM-1, and VCAM-1 were assayed. A "vascular endothelial index" (VEI) was computed using logistic regression to create a composite measure that maximally differed between groups. General linear models were conducted to examine the possible role of demographic, physical, and lifestyle factors. A linear combination of ICAM-1 and VCAM-1 levels best distinguished the groups, with significantly higher levels of this composite VEI in persons with schizophrenia than HCs. Group differences in the VEI persisted after adjustment for BMI and cigarette smoking. Neither age nor gender was significantly related to the VEI. Schizophrenia patients with higher VEI had earlier age of disease onset, higher systolic and diastolic blood pressure, lower high-density lipoprotein cholesterol, higher insulin resistance, lower levels of mental well-being, and higher Framingham Coronary Heart Disease Risk scores. Schizophrenia is characterized by an elevation of vascular endothelial biomarkers, specifically cell adhesion molecules poised at the intersection between inflammatory response and vascular risk. Interventions aimed at reducing vascular risk may help reduce vascular endothelial abnormalities and prevent cardiovascular morbidity and mortality in schizophrenia.

P627Associations between very low concentrations of LDL-cholesterol and health outcomes in the reasons for geographical and racial differences in stroke (REGARDS) Study

Introduction: Recent findings have demonstrated the important contribution of inflammation to the risk of cardiovascular disease (CVD) in individuals with optimally managed low density lipoprotein cholesterol (LDL-C). We explored relationships between LDL-C, high sensitivity C-reactive protein (hsCRP) and clinical outcomes in a free-living US population. Methods: We used data from the REasons for Geographical And Racial Differences in Stroke (REGARDS), and selected individuals at “high risk” for coronary events with a Framingham Coronary Risk Score of >10% or atherosclerotic cardiovascular disease (ASCVD) risk >7.5% in order to explore relationships between low LDL-C ( 70 mg/dl [1.8 mmol/L]); hs-CRP <2 compared to ≥2 mg/L and clinical outcomes (all-cause mortality, incident coronary heart disease [CHD] and incident stroke). To assess the association between the LDL-C and hs-CRP categories and each outcome, a series of incremental Cox proportional hazards models were employed on complete cases. To account for missing observations, the most adjusted model was used to interrogate the data using multiple imputation with chained equations (MICE). Results: In this analysis, 6136 REGARDS high risk participants were included. In the MICE analysis, participants with high LDL-C (>70 mg/dl) and low hs-CRP (<2 mg/L) had a lower risk of incident stroke (hazard ratio [HR] 0.69, 0.47-0.997) incident CHD (HR 0.71, 0.53- 0.95) and CHD death (HR 0.70, 0.50-0.99) than those in the same LDL-C category high hs- CRP (≥2 mg/L). In participants with high hsCRP (≥2 mg/dL), low LDL-C (<70 mg/dL [1.8 mmol/L]) was not associated with additional risk reduction of any investigated outcome, but with the significant increase of all-cause mortality (HR 1.37, 1.07-1.74). Conclusions: In this high-risk population, we found that low hsCRP (<2mg/L) appeared to be associated with reduced risk of incident stroke, incident CHD and CHD death, whereas low LDL-C (<70 mg/dL) was not associated with protective effects. Thus, our results support other data with respect to the importance of inflammatory processes in the pathogenesis of CVD.

Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors

BackgroundDietary recommendations emphasize increased consumption of fruit, vegetables, and whole grain cereals for prevention of chronic disease. ObjectivesThis study assessed the effect of dietary advice and/or food provision on body weight and cardiovascular disease risk factors. MethodsHealthy overweight men (n = 209) and women (n = 710), mean age 44.7 years, body mass index [BMI] 32.4 kg/m2, were randomized between November 2005 and August 2009 to receive Health Canada’s food guide (control, n = 486) or 1 of 3 interventions: dietary advice consistent with both Dietary Approaches to Stop Hypertension (DASH) and dietary portfolio principles (n = 145); weekly food provision reflecting this advice (n = 148); or food delivery plus advice (n = 140). Interventions lasted 6 months with 12-month follow-up. Semiquantitative food frequency questionnaires and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, 6 months, and 18 months. ResultsParticipant retention at 6 and 18 months was 91% and 81%, respectively, after food provision compared to 67% and 57% when no food was provided (p < 0.0001). Test and control treatments showed small reductions in body weight (−0.8 to −1.2 kg), waist circumference (−1.1 to −1.9 cm), and mean arterial pressure (0.0 to −1.1 mm Hg) at 6 months and Framingham coronary heart disease risk score at 18 months (−0.19 to −0.42%), which were significant overall. Outcomes did not differ among test and control groups. ConclusionsProvision of foods increased retention but only modestly increased intake of recommended foods. Current dietary recommendations showed small overall benefits in coronary heart disease risk factors. Additional dietary strategies to maximize these benefits are required. (Fruits, Vegetables, and Whole Grains: A Community-based Intervention; NCT00516620)

The relation of protein C and protein S levels with cardiovascular risk in patients with diabetic neuropathy

BackgroundThis study was conducted to determine the clinically significance of protein C and protein S levels as a cardiovascular risk marker in patients with diabetic neuropathy. MethodsWe included 71 subjects. 50 of them were diabetics, 27 of them also had diabetic neuropathy(DN), 21 subjects were non diabetic. We evaluated these 3 group subjects’ protein C, protein S, fibrinogen, prothrombine time (PT), activated partial thromboplastine time (aPTT), total cholesterol, levels and Framingham Coronary Risk Score (FCRS). ResultsNon diabetic group’s protein C levels were higher than patients with DN (p<0.05) and diabetic patients without DN (p<0.05). But there were no difference in terms of protein C levels between patients with DN and diabetic patients without DN. FCRS of control group was lower than diabetic subjects(p<0.01). ConclusionsWe found that protein C and S levels were much lower in diabetic patients than non diabetics.There was no difference between diabetic patients with DN and diabetic patients without DN in terms of protein C and protein S levels. Further, we couldn’t detect any finding that we can say protein C and Protein S levels can be used as a cardiovascular risk assessment marker in diabetic neuropathic patients.

Atherosclerosis is Evident in Treated HIV-Infected Subjects With Low Cardiovascular Risk by Carotid Cardiovascular Magnetic Resonance

Premature atherosclerosis has been observed among HIV-infected individuals with high cardiovascular risk using one-dimensional ultrasound carotid intima-media thickness. We evaluated the assessment of HIV-infected individuals with low traditional cardiovascular disease risk using cardiovascular magnetic resonance, which allows three-dimensional assessment of the carotid artery wall. Carotid cardiovascular magnetic resonance was performed in 33 HIV-infected individuals (cases) (19 male, 14 female), and 35 HIV-negative controls (20 male, 15 female). Exclusion criteria included smoking, hypertension, hyperlipidemia (total cholesterol/HDL ratio > 5) or family history of premature atherosclerosis. Cases were stable on combination antiretroviral therapy with plasma HIV-1 RNA <50 copies per milliliter. Using computer modeling, the arterial wall, lumen, and total vessel volumes were calculated for a 4-cm length of each carotid artery centered on the bifurcation. The wall/outer-wall ratio (W/OW), an index of vascular thickening, was compared between the groups. Cases had a median CD4 cell count of 690 cells per microliter. Mean (±SD) age and 10-year Framingham coronary risk scores were similar for cases and controls (45.2 ± 9.7 years versus 46.9 ± 11.6 years and 3.97% ± 3.9% versus 3.72% ± 3.5%, respectively). W/OW was significantly increased in cases compared with controls (36.7% versus 32.5%, P < 0.0001); this was more marked in HIV-infected females. HIV status was significantly associated with increased W/OW after adjusting for age (P < 0.0001). No significant association between antiretroviral type and W/OW was found-W/OW lowered comparing abacavir to zidovudine (P = 0.038), but statistical model fits poorly. In a cohort of treated HIV-infected individuals with low measurable cardiovascular risk, we have observed evidence of premature subclinical atherosclerosis.

Optimal Cutoff Points of Anthropometric Parameters to Identify High Coronary Heart Disease Risk in Korean Adults.

Several published studies have reported the need to change the cutoff points of anthropometric indices for obesity. We therefore conducted a cross-sectional study to estimate anthropometric cutoff points predicting high coronary heart disease (CHD) risk in Korean adults. We analyzed the Korean National Health and Nutrition Examination Survey data from 2007 to 2010. A total of 21,399 subjects aged 20 to 79 yr were included in this study (9,204 men and 12,195 women). We calculated the 10-yr Framingham coronary heart disease risk score for all individuals. We then estimated receiver-operating characteristic (ROC) curves for body mass index (BMI), waist circumference, and waist-to-height ratio to predict a 10-yr CHD risk of 20% or more. For sensitivity analysis, we conducted the same analysis for a 10-yr CHD risk of 10% or more. For a CHD risk of 20% or more, the area under the curve of waist-to-height ratio was the highest, followed by waist circumference and BMI. The optimal cutoff points in men and women were 22.7 kg/m2 and 23.3 kg/m2 for BMI, 83.2 cm and 79.7 cm for waist circumference, and 0.50 and 0.52 for waist-to-height ratio, respectively. In sensitivity analysis, the results were the same as those reported above except for BMI in women. Our results support the re-classification of anthropometric indices and suggest the clinical use of waist-to-height ratio as a marker for obesity in Korean adults.

Nutritional, metabolic and cardiovascular correlations of morning cortisol in health care workers in a gastroenterology service.

Workplace stress has been associated with obesity. Diminished body weight has also been anticipated in some contexts. In a cohort of healthcare personnel, morning cortisol was compared to nutritional and metabolic variables, aiming to identify the correlates of such marker. Population n=185, 33.8 ± 9.8 years, 88.1% females, body mass index (BMI) 25.6 ± 4.4 kg/m2, included nurses and other nosocomial professionals, the majority with high social-economic status (75.2%). Participants were stratified according to BMI, fasting blood glucose (FBG) and metabolic syndrome (MS). Fasting plasma cortisol and the Framingham Coronary Risk Score was calculated. Mean cortisol was acceptable (19.4 ± 7.9 µg/dL) although with elevation in 21.6%. No correlation with FBG or MS occurred, and nonobese persons (BMI <25) exhibited the highest values (P=0.049). Comparison of the lowest and highest cortisol quartiles confirmed reduced BMI and waist circumference in the former, with unchanged Framingham Coronary Risk Score. Cortisol correlated with reduced BMI. Despite low BMI and waist circumference, Framingham Coronary Risk Score was not benefitted, suggesting that exposure to cardiovascular risk continues, besides psychological strain. Initiatives to enhance organizational and staff health are advisable in the hospital environment.