Future Development Of Cardiovascular Disease Research Articles

The Potential Cardiovascular Benefits of Physical Exercise in Early Onset Psychosis and Bipolar Disorder

IntroductionEarly onset psychosis (EOP) and bipolar disorder (EOBP), occurring before the age of 18, have been linked to early signs of atherosclerosis and an elevated risk of cardiovascular disease (CVD). Physical exercise is a well-established factor in reducing the risk of developing CVD. However, it remains unclear whether regular physical activity can mitigate cardiovascular risk factors and signs of atherosclerosis in individuals with EOP and EOBP.ObjectivesThis study aimed to explore the impact of physical exercise on cardiovascular risk factors in these populations.MethodsWe assessed the physical exercise habits of 71 individuals, including 22 with EOP, 21 with EOBP, and 28 age-matched healthy controls. Participants’ physical exercise routines were categorized as 0, 1, 2, or 3 or more times per week, with each session lasting at least 30 minutes. Our analysis included adjustments for conventional CVD confounders. Additionally, we used high-frequency ultrasound (22 MHz) to evaluate different layers of the arterial wall in the left common carotid artery (LCCA).ResultsCompared to the control group, adolescents with EOP and EOBP exhibited significantly thicker LCCA intima thickness (0.132 vs. 0.095 mm, p<0.001) and intima/media ratio (0.24 vs. 0.17, p<0.001). Remarkably, adolescents with EOP and EOBP who engaged in physical exercise three times or more weekly (n=13) displayed significantly less intima thickness (0.142 vs. 0.116 mm, p<0.01). However, we did not observe a significant association between exercise and other CVD risk factors. Even when considering factors such as the extent of antipsychotic medication use or the severity of the disorders in our regression analysis, the significant association between exercise and reduced intima thickness persisted (p<0.05).ConclusionsAmong adolescents with EOP or EOBP, those who engaged in physical exercise three or more times weekly exhibited less pronounced LCCA intima thickness compared to their less active counterparts, although it remained thicker than that of healthy controls. These findings, if replicated, suggest that regular physical exercise, specifically three or more times a week, could potentially offer protection against the future development of CVD in individuals with EOP and EOBP. Further research is warranted to confirm and expand upon these promising results.Disclosure of InterestNone Declared

Abstract P239: Association of Presence of Non-Specific Physical Complaints With Future Development of Cardiovascular Disease in Middle-Aged Japanese Workers: Finding From the Aichi Workers Cohort Study

Introduction: Stress responses to work-related stressors often manifest in non-specific physical complaints, by monitoring it may provide early indications of underlying health issues. Hypothesis: We hypothesized that there is a significant association between non-specific physical complaints and the subsequent incidence of cardiovascular diseases (CVD) in middle-aged Japanese. Methods: A cohort of 4820 Japanese workers (3876 male, 944 female) ages 35 to 65 years were followed from 2007 to 2019 for CVD incidence (stroke and acute coronary artery diseases). Non-specific physical complaints were assessed as a domain of stress response in the 57-item brief job stress questionnaire and consisted of 11 items: felt dizzy; experienced joint pains; experienced headaches; had stiff neck or shoulders; had lower back pain; had eyestrain; had heart palpitations or shortness of breath; had stomach or intestine problems; lost appetite; had diarrhea or constipation; couldn’t sleep well. Each item had four possible responses from never, sometimes, often, to always, corresponding scores of which are 1, 2, 3, and 4, respectively. The presence of non-specific physical complaints was defined as a sum score of 27-44 for males and 30-44 for females according to the recommended standard values. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) of non-specific physical complaints for CVD were estimated and adjusted for age, sex, smoking status, alcohol consumption, regular exercise, sleep duration, body mass index, systolic blood pressure, total cholesterol, and histories of hypertension, hyperlipidemia, and diabetes. Results: During a median of 10.4 years of follow-up, 90 CVD cases were identified. The presence of non-specific physical complaints was significantly associated with the incidence of CVD independent of confounding variables (HR: 2.04, 95% CI: 1.02-4.07). Conclusion: The present study revealed that the presence of non-specific physical complaints was associated with a higher risk of developing CVD.

New Approaches to the Management of Cardiovascular Risk Associated with Sleep Respiratory Disorders in Pediatric Patients.

Exposure to risk factors in youth can exacerbate the development of future cardiovascular disease (CVD). Obstructive sleep apnea (OSA), characterized by repetitive episodes of airway obstructions, could trigger said CVD acting as a modifiable risk factor. Measurements from echocardiography have shown impairments in the anatomy and function of the heart related to the severity of OSA. Therefore, the aim of this review was to propose a new clinical approach to the management of cardiovascular risk (CVR) in children based on treating OSA. The review includes studies assessing echocardiographic parameters for cardiac function and structure in pediatric OSA diagnosed using the apnea-hypopnea index (AHI) ≥ 1/h using polysomnography (PSG) and conducted within a year. Based on the reviewed evidence, in addition to PSG, echocardiography should be considered in OSA children in order to indicate the need for treatment and to reduce their future CVR. A follow-up echocardiography after treatment could be performed if impairments in the anatomy and function were found. Prioritizing parameters intimately connected to comorbidity could propel more effective patient-centered care. In conclusion, a reevaluation of pediatric OSA strategies should be considered, emphasizing comorbidity-related parameters in the cardiovascular field. Further studies are needed to assess this approach, potentially leading to enhanced protocols for more effective pediatric OSA treatment and CVR prevention.

Too Loud to Handle? Transportation Noise and Cardiovascular Disease.

The World Health Organization reported that more than 1.6 million healthy life-years are lost yearly from traffic-related noise in western Europe. In addition, the number of studies on health side effects in response to traffic noise is steadily growing, mainly cardiovascular disease, such as acute and chronic ischemic heart disease, heart failure, arrhythmia, and stroke. Pathophysiologically nighttime noise has been shown to cause sleep disturbances, including too short sleep periods and frequent interruption of sleep leading to an increase in the levels of circulating stress hormones and subsequently to a significant increase in the production of reactive oxygen species (oxidative stress) and inflammation in the vasculature and the brain. The consequence is arterial hypertension and vascular (endothelial) dysfunction, which might increase the risk of cardiovascular disease. With the present review, we give an overview of the "so-called" nonauditory cardiovascular health effects of noise, which have been proposed to be responsible for the future development of cardiovascular disease. We present epidemiological evidence but also evidence provided by translational human and experimental noise studies. Finally, we discuss manoeuvres to mitigate noise effectively.

Trend of risk factors for cardiovascular diseases among young and middle-aged indians: Insights from a nationally representative survey

BackgroundIndia, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states. MethodsThe present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same. ResultsA declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019–21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey. ConclusionThe present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.

Abstract P335: Prognostic Cut Point of Fasting Insulin in Apparently Healthy Young Adults for the Development of Future Cardiovascular Disease

Introduction: Early metabolic imbalance (EMI) is insidiously prevalent in the U.S., especially among teens and young adults. It includes markers of insulin resistance, inflammation and oxidative stress, but does not meet the criteria for metabolic syndrome. Individuals with EMI have compensatory hyperinsulinemia, an independent risk factor for CVD. Yet, fasting insulin is an underutilized prognostic marker, partly due to a lack of calibrated cut points for this population. Hypothesis: The prognostic value of insulin for CVD risk is associated with an optimum cut point, which can be calibrated using a time-dependent receiver operator characteristic (timeROC) analysis of CARDIA: Coronary Artery Risk Development in Young Adults. Methods: The parent CARDIA study began in 1985, enrolling 5,114 participants ages 18-30 at baseline, with 35-year follow-up. In our retrospective cohort analysis, the exclusion criteria were hyperglycemia, hypertriglyceridemia, low HDL, pregnancy, diabetes, CVD, or fasting < 8 hours, all at baseline; n=3,292. The primary outcome was time to incident CVD (or censor), defined as fatal/nonfatal MI, coronary revascularization, acute coronary syndrome, CHF, stroke, TIA, carotid or peripheral artery disease. Survival data were analyzed using the ‘timeROC’ package in R v.4.2.1, with/without adjustment for the 2019 ACC/AHA risk factors for CVD. For validation, a conventional ROC (logROC) analysis was performed, with incident CVD as the outcome. For timeROC and logROC, the cut point optimum was determined using minimum distance to the [0, 1] coordinate; predictive accuracy was summarized by area under the curve (AUC). The prognostic value of insulin at its optimum was determined using Cox regression for insulin alone and with risk factors, using Stata v.17.0. Cox results are summarized with hazard ratio (HR) and Harrell’s c-statistic (c). Results: The cut point optimum for baseline fasting insulin was 9.1 mIU/L (60.5 percentile), with AUC 0.583 (95% CI: 53.6, 62.9), sensitivity 54.8% and specificity 61.7%. The results were unchanged with/without covariate adjustment in timeROC, and with logROC. Using the optimum, the unadjusted Cox HR for high vs. low insulin was 1.9 (95% CI 1.4, 2.6, p<0.0001); c=0.580. Cox model 2 included a variable with both high insulin and high waist circumference (WC); HR for both vs. neither condition was 2.6 (95% CI 1.8, 3.8, p<0.0001); c=0.606. Cox model 3 added ACC/AHA risk factors to model 2: HR 2.2 (95% CI 1.5, 3.4, p<0.0001) for high insulin and WC vs. neither; c=0.716. Conclusion: For young adults in CARDIA without metabolic syndrome or prediabetes, the cut point optimum for fasting insulin is near the top tertile. Insulin has a high prognostic value for CVD, especially when combined with WC. Though useful, insulin suffers from modest sensitivity. Better markers of EMI are needed for assessing hidden CVD risk in apparently healthy young adults.

Study the association of body mass index and obesity in MBBS students with their family health status in a Tertiary Care Hospital, Puducherry

Background: Overweight-obesity has turned into a worldwide epidemic due to sedentary lifestyle with more eating and less physical activity. The overweight and obesity rising among young people give alarm which may cause the formation link to the rise of other non-communicable diseases such as hypertension, diabetes, myocardial infarction, and stroke are the most important concern. Medical students are exposing lot of stress in their education and this stressful condition leads to irregularity in diet, lack of exercise, and their family health history, each being considered an independent factor leading to obesity. Aims and Objectives: The aim of the study was to estimate the prevalence of overweight and obesity among 2nd year MBBS students and find the association between family history with body mass index (BMI). Materials and Methods: This study included 150 MBBS students’ BMI survey from SVMCHRC, Puducherry The height and weight of the students were be measured and BMI was calculated using formula. Students parents health status data were collected and the association of BMI and family history was established. Results: Based on student BMI details, the study found that overweigh was 18% and obese was 38%. Student parents health details obtained and studied possible future risk for obese student. Conclusion: Students are overweight-obese that particular students family history was collected. They are susceptible to the future development of cardiovascular disease, Type II diabetes, hypertension, osteoarthritis, anesthesia risks, and menstrual abnormalities as well as some types of cancers including those of colon and breast. So that students necessary health promotional activities are suggested to adopt healthy life style including regular physical exercises, yoga, and good dietary habits that are advised for healthy life style.

Decrease serum anti-oxLDL antibody is an independent marker of peripheral arterial disease in peritoneal dialysis patients

Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients.Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group.Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients.Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients. Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients. Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group. Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients. Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients.

Utilizing Patient Characteristics to Predict the Likelihood of Heart Condition

As primary care providers deal with a multitude of chronic conditions, cardiovascular disease may often be overlooked. Finding cardiovascular disease early in a patient increases treatment options and reduces the likelihood of further complications. Thus, it is important that providers have tools at their disposal to assess patients’ odds of heart disease, given past medical histories and vital signs in clinic. Utilizing patient data from the Cleveland Heart Clinic, we developed a predictive model for assessing the odds that a patient evaluated in clinic may have an underlying heart condition. We selected each variable based on its relative capacity for prediction of heart condition, then further analyzed the contributes of this feature in the model. The final model includes the sex of the patient, their self-reported experience of exercise-induced angina, and resting ECG results. This model can be used in the clinic to estimate a patient’s odds of heart disease. Unlike current models used in primary care clinics, this model uses fewer variables and specifically assesses the odds of a current condition, as opposed to the future development of cardiovascular disease. Testing directly for heart disease is costly and time-consuming, so it’s useful to build a predictive diagnostic model.

Stratifying the Risk of Cardiovascular Disease in Obstructive Sleep Apnea Using Machine Learning.

Obstructive sleep apnea (OSA) is associated with higher risk of morbidity and mortality related to cardiovascular disease (CVD). Due to overlapping clinical risk factors, identifying high-risk patients with OSA who are likely to develop CVD remains challenging. We aimed to identify baseline clinical factors associated with the future development of CVD in patients with OSA. Retrospective analysis of prospectively collected data. We performed a retrospective analysis of 967 adults aged 45 to 84 years and enrolled in the Multi-Ethnic Study of Atherosclerosis. Six machine learning models were created using baseline clinical factors initially identified by stepwise variable selection. The performance of these models for the prediction of additional risk of CVD in OSA was calculated. Additionally, these models were evaluated for interpretability using locally interpretable model-agnostic explanations. Of the 967 adults without baseline OSA or CVD, 116 were diagnosed with OSA and CVD and 851 with OSA alone 10 years after enrollment. The best performing models included random forest (sensitivity 84%, specificity 99%, balanced accuracy 91%) and bootstrap aggregation (sensitivity 84%, specificity 100%, balanced accuracy 92%). The strongest predictors of OSA and CVD versus OSA alone were fasting glucose >91 mg/dL, diastolic pressure >73 mm Hg, and age >59 years. In the selected study population of adults without OSA or CVD at baseline, the strongest predictors of CVD in patients with OSA include fasting glucose, diastolic pressure, and age. These results may shape a strategy for cardiovascular risk stratification in patients with OSA and early intervention to mitigate CVD-related morbidity. 3 Laryngoscope, 132:234-241, 2022.

Cardiology, Research and Training: An Interview With Professor Eugene Braunwald

Professor Eugene Braunwald, often referred to as the 'Father of Modern Cardiology', has contributed significantly to medicine and cardiology. He is best known for the acclaimed textbook Braunwald's Heart Disease and for being the founding chairman of the Thrombolysis in Myocardial Infarction (TIMI) Study Group. Our primary aim is to highlight his experiences and the guidance that he has to offer to future generations of medical trainees and professionals. An interview with Prof. Braunwald provided the authors with an insight into his journey in medicine. A range of questions were posed pertaining to his struggles and accomplishments in cardiology, his perspectives on the future of cardiology and research, as well as his advice to current and future medical professionals.1 Positive role models are an inspiration to all, regardless of the stage in their career. With hard work, unwavering dedication and a strong desire to make a positive difference to patients and the field, the opportunities are endless. Whether it is clinical or bench research, advances in clinical cardiology and research usually go hand-in-hand. Although primary and secondary prevention of cardiovascular disease remain of critical importance, it is now time to focus on primordial prevention to step back and reduce the development of the risk factors for the future development of cardiovascular disease in the first place. There have been significant advances in cardiology over the past two-thirds of the century during which Prof. Braunwald trained and then led the field. However, there is still much work to be done. Mentors and medical institutions alike must work towards a common goal of 'igniting the fire' within the new generation of clinicians and investigators who will then propel this important specialty to ever greater heights.

Fatty Liver Index and Development of Cardiovascular Disease: Findings from the UK Biobank.

Nonalcoholic fatty liver disease is common and is associated with rising morbidity and mortality in the UK. Cardiovascular disease is the main cause of death in people with nonalcoholic fatty liver disease. To determine the association between baseline cardiovascular risk factors with fatty liver index, and to investigate the association between fatty liver index and the incidence of cardiovascular disease in the UK. This study is a population-based retrospective cohort study using the UK Biobank database. The mean fatty liver index in the study cohort was 44.9, and 33.7% met the criteria for nonalcoholic fatty liver disease. Fatty liver index was significantly associated with a wide range of cardiovascular risk factors at baseline. During a mean follow-up of 7.86years, the combined incidence of cardiovascular disease was 6.92 per 1000-person years at risk. We found significant association between fatty liver index and incident cardiovascular disease in the fully adjusted model. We found significant association between fatty liver index and incident cardiovascular disease in subgroups stratified by BMI as well as subgroups with fatty liver index < 30, < 60, and ≥ 60. Fatty liver index not only predicts NAFLD diagnosis, but also indicates baseline and future development of cardiovascular disease on long-term follow-up across weight categories and fatty liver index spectrum. These findings can inform clinicians and other stakeholders on cardiovascular disease management and preventive efforts. Patients with high fatty liver index should be counseled on the increased future risk of developing cardiovascular disease.

Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age.

Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.

Habitual cannabis use is associated with altered cardiac mechanics and arterial stiffness, but not endothelial function in young healthy smokers.

Cigarette smoking is among the most detrimental behaviors to cardiovascular health, resulting in arterial stiffening, endothelial dysfunction, and structural/functional alterations to the myocardium. Similar to cigarettes, cannabis is commonly smoked, and next to alcohol, is the most commonly used recreational substance in the world. Despite this, little is known about the long-term cardiovascular effects of smoking cannabis. This study explored the associations of cardiovascular structure and function with cannabis use in ostensibly healthy young participants (n = 35). Using echocardiography, carotid-femoral pulse wave velocity (cfPWV), and brachial flow-mediated dilation (FMD), we performed a cross-sectional assessment of cardiovascular function in cannabis users (n = 18) and controls (n = 17). There were no differences in cardiac morphology or traditional resting measures of systolic or diastolic function between cannabis users and controls (all P > 0.05), whereas cannabis users demonstrated reduced peak apical rotation compared with controls (cannabis users: 5.5 ± 3.8, controls: 9.6 ± 1.5; P = 0.02). Cannabis users had higher cfPWV compared with controls (cannabis users: 5.8 ± 0.6 m/s, controls: 5.3 ± 0.7 m/s; P = 0.05), whereas FMD was similar between cannabis users and controls (cannabis users: 8.3 ± 3.3%, controls: 6.8 ± 3.6%; P = 0.7). Young, healthy, and cannabis users demonstrate altered cardiac mechanics and greater aortic stiffness. Further studies should explore causal links between cannabis smoking and altered cardiovascular function.NEW & NOTEWORTHY Recreational cannabis is the most widely used substance in the world, other than alcohol. Yet, the effects of cannabis use on cardiovascular function and health are not well understood. Our cross-sectional data demonstrate that young, ostensibly healthy cannabis users have greater arterial stiffness and altered cardiac mechanics compared to nonusers. These findings suggest that cannabis users may be at greater risk of the development of future cardiovascular disease.

Impact of preventive screening and lifestyle interventions in women with a history of preeclampsia: A micro-simulation study.

Preeclampsia is a female-specific risk factor for the development of future cardiovascular disease. Whether early preventive cardiovascular disease risk screenings combined with risk-based lifestyle interventions in women with previous preeclampsia are beneficial and cost-effective is unknown. A micro-simulation model was developed to assess the life-long impact of preventive cardiovascular screening strategies initiated after women experienced preeclampsia during pregnancy. Screening was started at the age of 30 or 40 years and repeated every five years. Data (initial and follow-up) from women with a history of preeclampsia was used to calculate 10-year cardiovascular disease risk estimates according to Framingham Risk Score. An absolute risk threshold of 2% was evaluated for treatment selection, i.e. lifestyle interventions (e.g. increasing physical activity). Screening benefits were assessed in terms of costs and quality-adjusted-life-years, and incremental cost-effectiveness ratios compared with no screening. Expected health outcomes for no screening are 27.35 quality-adjusted-life-years and increase to 27.43 quality-adjusted-life-years (screening at 30 years with 2% threshold). The expected costs for no screening are €9426 and around €13,881 for screening at 30 years (for a 2% threshold). Preventive screening at 40 years with a 2% threshold has the most favourable incremental cost-effectiveness ratio, i.e. €34,996/quality-adjusted-life-year, compared with other screening scenarios and no screening. Early cardiovascular disease risk screening followed by risk-based lifestyle interventions may lead to small long-term health benefits in women with a history of preeclampsia. However, the cost-effectiveness of a lifelong cardiovascular prevention programme starting early after preeclampsia with risk-based lifestyle advice alone is relatively unfavourable. A combination of risk-based lifestyle advice plus medical therapy may be more beneficial.

American Indian young adults display diminished cardiovascular and cortisol responses to acute psychological stress

American Indian adults are at an increased risk for cardiovascular disease compared with non-Hispanic white adults. Scant research exists examining the underlying physiological and psychological mechanisms associated with these risks. This study aimed to examine possible psychological and physiological stress-related mechanisms related to cardiovascular disease risk in healthy American Indian and non-Hispanic white adults. Forty American Indian (60% female, Mean age = 19.93, SD = 2.08 years) and 45 non-Hispanic white (70% female, Mean age = 20.18, SD = 2.22 years) participants attended an in-person laboratory session. Salivary cortisol and cardiovascular activity were measured before (baseline), during, and after exposure to a 10-minute mental arithmetic task. Compared to non-Hispanic white participants, American Indian had diminished salivary cortisol (p < .001), blood pressure (p’s < .001), and heart rate (p = .041) responses to acute psychological stress. These effects could not be accounted for by differences in task performance or self-reported engagement. Previous research has shown that exaggerated responses to stress are associated with increased risk of cardiovascular disease. However, diminished responses to stress are associated with early childhood stress and future adverse behaviors (e.g., addiction, obesity). Diminished reactivity may influence behaviors that can impact future development of cardiovascular disease in American Indian populations.

Early onset neurocirculatory response to static handgrip is associated with greater blood pressure variability in women with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a psychiatric illness that is more prevalent in women, and accumulating evidence suggests a link between PTSD and future development of cardiovascular disease. The underlying mechanisms are unclear, but augmented sympathetic reactivity to daily stressors may be involved. We measured muscle sympathetic nerve activity (MSNA), blood pressure (BP), and heart rate responses in 14 women with PTSD and 14 healthy women (controls) during static handgrip (SHG) exercise to fatigue at 40% of maximal voluntary contraction (MVC). Two minutes of postexercise circulatory arrest (PECA) was followed immediately after SHG to fatigue. MVC and the time to fatigue during SHG did not differ between groups (both P > 0.05). At the first 30 s of SHG, women with PTSD showed augmented sympathetic neural [mean ± SD, ∆MSNA burst frequency (BF): 5 ± 4 vs. 2 ± 3 bursts/30 s, P = 0.02 and ∆MSNA total activity (TA): 82 ± 58 vs. 25 ± 38 arbitrary units/30 s, P = 0.004] and pressor (∆systolic BP: 10 ± 5 vs. 4 ± 3 mmHg, P = 0.003) responses compared with controls. However, MSNA and BP responses at fatigue and during PECA were not different between groups. More interestingly, the augmented initial neural and pressor responses to SHG were associated with greater awake systolic BP variability during ambulation in women with PTSD (MSNA BF: r = 0.55, MSNA TA: r = 0.62, and SBP: r = 0.69, all P < 0.05). These results suggest that early onset exercise pressor response in women with PTSD may be attributed to enhanced mechano- rather than metaboreflexes, which might contribute to the mechanisms underlying the link between PTSD and cardiovascular risk.NEW & NOTEWORTHY The novel findings of the current study are that women with posttraumatic stress disorder (PTSD) exhibited augmented sympathetic neural and pressor responses at the first 30 s of submaximal isometric muscle contraction. More interestingly, exaggerated neurocirculatory responses at the onset of muscle contraction were associated with greater ambulatory awake systolic blood pressure fluctuations in women with PTSD. Our findings expand the knowledge on the physiological mechanisms that perhaps contribute to increased risk of cardiovascular disease in such a population.

The effect of Baduanjin exercise on health-related physical fitness of college students: study protocol for a randomized controlled trial

BackgroundLow health-related physical fitness in college students is a risk factor for future development of cardiovascular diseases at later stages in life, but appropriate exercise is one of the main determinant factors of health-related physical fitness. Previous studies have showed that Baduanjin exercise is beneficial in improving sleep quality, mental health, body flexibility, and body physique. However, the evidence is unclear whether Baduanjin exercise can be recommended as an effective exercise to promote health-related physical fitness of college students.Methods/designOne hundred twenty college students will be recruited and randomly allocated to either the Baduanjin exercise or the control group at a ratio of 1:1. The students in the Baduanjin exercise group will receive a 12-week supervised Baduanjin exercise training intervention with a frequency of 1 h each day and 4 days per week, while those in the control group will not receive any specific exercise intervention and will be informed to maintain their original lifestyle for 12 weeks. The primary outcome of health-related physical fitness involving measurements of body flexibility, muscular strength, cardiopulmonary fitness, and body endurance will be measured at baseline and after the 12-week intervention period. Mixed linear models will be used to analyze the effect of the Baduanjin exercise intervention on the health-related physical fitness of college students.DiscussionThis is the first trial to evaluate the effects of Baduanjin exercise on health-related physical fitness in college students. If the results are as expected, they will provide evidence of Baduanjin exercise in promoting health-related physical fitness in young adults.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-17013011. Registered on 17 November 2017.

A study on high prevalence of metabolic syndrome among competitive exam appearing students from Andhra Pradesh

Background: Metabolic syndrome is a pool of risk factors which are indicators of future development of cardiovascular disease and type 2 diabetes mellitus in adults. Stress is strongly associated with metabolic syndrome. Adolescents are more prone to academic stress and leads to development of metabolic syndrome also.Aim & Objectives: A comparative study to determine prevalence of metabolic syndrome among the adolescent students appearing for competitive exams. Methods: A comparative descriptive study was conducted among the intermediate students of 16-19 years age group. Students were selected randomly from students residing at hostel in private junior colleges, Guntur. A sample of hundred students were selected, fifty from exam appearing students and another fifty from non-exam appearing students in the present academic year. Comparison done between both the students groups. Prevalence of metabolic syndrome was measured in both groups based on International Diabetes Federation Criteria. Relevant statistical tests were used to test the statistical significance. Results: In the current study the results reveal that exam appearing students had higher values of waist circumference, blood pressure, fasting plasma glucose and triglycerides and lower values of HDL-Cholesterol. The prevalence of metabolic Syndrome was high among exam appearing students (34%) when compared to non-appearing students (6%). (X2=12.25, P=0.0005) The risk of metabolic syndrome in competitive exam appearing students was eight times higher than in non-exam appearing students (OR=8.07). Conclusion: Finally we conclude that, the prevalence of metabolic syndrome was significantly higher among the students appearing for competitive exams when compared to the students not appearing for competitive exams.

Effects of long-term glycemic variability on incident cardiovascular disease and mortality in subjects without diabetes

Increased glycemic variability (GV) is an independent risk factor for cardiovascular complications in patients with diabetes. We evaluated the risk of future development of cardiovascular disease (CVD) and death according to GV in a general population without diabetes.We used the National Health Insurance Service, providing a population-based, nationwide database of Koreans. We included individuals without diabetes who underwent glucose measurement at least 3 times during 2002 to 2006. GV was calculated as standard deviation (SD) of fasting plasma glucose (FPG) levels. We observed development of CVD or all-cause death from 2007 to 2015, and also evaluated the mortality within 1 year after CVD.Among 3,211,319 people, we found 23,374 incident cases of myocardial infarction (MI), 27,705 cases of stroke, and 63,275 deaths during 8.3 years of follow-up. After multivariate adjustment, GV was found to be a significant predictor of MI, stroke and all-cause death for their highest quartile, with corresponding hazard ratios (HR) of 1.08 (95% confidence interval, CI 1.04-1.11), 1.09 (95% CI 1.06-1.13), and 1.12 (95% CI 1.10-1.15), respectively. The risk of death increased more in those who had both impaired fasting glucose and the highest quartile of GV (HR 1.24 [95% CI 1.21-1.28]). Moreover, early death rate after 1 year of CVD was higher in the highest quartile of GV compared to the lowest quartile (HR 1.21 [95% CI 1.03-1.41]).Long-term FPG variation was independently associated with CVD and mortality in a general population without diabetes.