Greater Coronary Heart Disease Research Articles

The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study.

Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment.Materials and Methods: Data were from 8,583 White and African American women, 45–64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding.Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1–2 (36.2%), 3–4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1–2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14–2.42) and heart failure risk (1.46, 1.04–2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10–1.52) and hospitalized MI (1.38, 1.13–1.69), after adjustment for baseline characteristics and breastfeeding.Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.

Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study

Cardiovascular fat (CF) is associated with greater coronary heart disease (CHD) risk. Postmenopausal women have greater CF volumes than premenopausal women, and the association between specific CF depot volumes and CHD risk is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact CF volumes. Whether racial differences in CF volumes and in their associations with central (visceral fat [VAT]) and general adiposity (body mass index [BMI]) exist in midlife women have not been addressed before. In all, 524 participants from the Study of Women's Health Across the Nation (mean age: 50.9 ± 2.9 years; 62% White and 38% Black) who had data on CF volumes (epicardial fat [EAT], paracardial fat [PAT], total heart fat, and aortic perivascular fat), VAT, and BMI were studied. In models adjusted for age, study site, menopausal status, comorbid conditions, alcohol consumption, and physical activity, Black women had 19.8% less EAT, 24.5% less PAT, 20.4% less total heart fat, and 13.2% less perivascular fat than White women (all P < 0.001). These racial differences remained significant after additional adjustment for BMI or VAT. Race significantly modified associations between adiposity measures and CF volumes. Every 1-SD higher BMI was associated with 66.7% greater PAT volume in White compared with 42.4% greater PAT volume in Black women (P = 0.004), whereas every 1-SD higher VAT was associated with 32.3% greater EAT volume in Black compared with 25.3% greater EAT volume in White women (P = 0.039). Racial differences were found in CF volumes and in their associations with adiposity measures among midlife women. Future research should determine how race-specific changes in CF volumes impact CHD risk in women.

Use of Different Types and Amounts of Dietary Fats to Redesign Pork

Title: Use of different types and amounts of dietary fats to redesign pork. Background: Using high energy fat-supplemented diets in pork production can offer several economic advantages to producers when fat sources are cost effectively priced. Because of a decreased heat increment, dietary fat supplementation allows a greater proportion of dietary calories to be available for tissue synthesis when pigs are maintained at or above the thermo neutral zone. Previous research has indicated that diets that have increasing dietary saturated fatty acids (SFA) cause hypercholesterolemia, atherosclerosis development, and greater coronary heart disease risk in humans. When dietary polyunsaturated fatty acids (PUFA) are substituted for saturated fatty acids (SFA), decreased blood cholesterol concentration occurs. This information has caused the consumer to question the consumption of meat products, such as pork, which are perceived as being rich in SFAs. The objective of this study was to alter the polyunsaturated (PUFA) to saturated fatty acid (SFA) ratio in pork for better human nutrition. Methods and findings: Pigs were fed either choice white grease or soybean oil at 10, 20, 30, or 40% of total dietary calories. All diets were based on corn and soybean meal. The study used 54 pigs with six pigs per treatment. Initial and slaughter weights were 54 and 110 kg, respectively. Skeletal muscle samples were taken from the longissimus dorsi, biceps femoris, and triceps brachii muscles. Adipose tissue samples were taken from the outer, middle, and inner 10th rib backfat layers, perirenal adipose tissue, and an inter muscular adipose deposit within the ham. Total lipids were extracted; fatty acid methyl esters were formed by trans esterification and quantified by gas chromatography. Adding choice white grease or soybean oil to diets fed growing swine did not alter animal growth rates. The PUFA from the outer 10th rib backfat layer showed linear increases (P < 0.05) when pigs were fed diets with increasingly greater soybean oil content, whereas the backfat from pigs fed diets containing greater choice white grease contents resulted in a linear increase (P < 0.05) of monounsaturated fatty acids (MUFA). Including soybean oil in the low-fat control diet at 30 and 40% increased the PUFA to SFA ratios (P:S) to 0.9 and 1.26 (P < 0.05), respectively, in longissimus muscle. The MUFA content in the longissimus muscle was decreased by 30% (P < 0.05) with the 40% soybean oil diet. Myristate, palmitate, and total SFA in longiIIssimus muscle decreased 27 (P < 0.05), 30 (P < 0.05), and 29% (P < 0.05), respectively, with the 40% soybean oil diet. Conclusions: Including choice white grease in the diet had minimal effects on the unsaturated to SFA muscular lipid ratios. In conclusion, high fat diets rich in unsaturated fatty acids can be used effectively to redesign pork for consumers wanting to decrease their consumption of saturated fatty acids.

Abstract W MP67: Non-traditional Serum Lipid Indices and Recurrent Stroke Risk

Background: Expert consensus guidelines recommend low-density lipoprotein (LDL) cholesterol as the primary serum lipid target for recurrent stroke risk reduction. Indeed, emerging evidence suggests that non-traditional serum lipid indices may be better predictors of vascular risk than LDL. Triglycerides (TG)/high-density lipoprotein (HDL) is a powerful independent predictor of all-cause mortality and cardiovascular events. Furthermore, total cholesterol (TC)/HDL ratio, LDL/HDL and non-HDL have all been independently linked with greater coronary heart disease (CHD) risk. Little is known about the effects non-traditional serum lipid indices on recurrent vascular risk after a recent stroke. Method: We analyzed the Vitamin Intervention for Stroke Prevention study database comprising 3680 recent (&lt;120 days) ischemic stroke patients followed up for 2 years. Independent associations of each 4 lipid index (TG/HDL, TC/HDL, LDL/HDL, and non-HDL) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. Each of the 4 groups was stratified into quintiles according to the distribution of lipid indices. Results: Of all indices evaluated only TG/HDL was consistently and independently related to both outcomes: compared with the lowest quintile (≤1.93), the highest TG/HDL quintile (≥6.22) was associated with stroke [adjusted hazard ratio (AHR), 1.56; 95% CI, 1.05–2.32] and stroke/CHD/vascular death (AHR 1.39, 95% CI, 1.05–1.83), including adjustment for lipid modifier use. Compared with the lowest quintile (≤3.50), the highest TC/HDL quintile (≥5.98) was associated with stroke/CHD/vascular death (AHR 1.44, 95% CI, 1.03–2.01). LDL/HDL, non-HDL, elevated TG alone, and low HDL alone, were not independently linked to either outcome. Conclusions: Of various non-traditional serum lipid indices, elevated baseline TG/HDL and TC/HDL predict future vascular risk after a stroke, but only elevated TG/HDL is related to risk of recurrent stroke. Future studies should assess the role of TG/HDL as a potential therapeutic target for global vascular risk reduction after stroke.

Usefulness of Abnormal Heart Rate Recovery on Exercise Stress Testing to Predict High-Risk Findings on Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Men

Abnormal heart rate recovery (HRR) after maximal exercise treadmill testing predicts adverse cardiac outcomes, although whether abnormal HRR on exercise treadmill testing should prompt further diagnostic cardiac testing is unknown. The aim of this study was to determine the prevalence of high-risk stress single-photon emission computed tomography myocardial perfusion imaging (MPI) findings in patients with abnormal HRR. A total of 509 men who had been referred for exercise stress MPI and were without other abnormal exercise treadmill testing findings (ischemic electrocardiographic changes or exercise treadmill testing-induced angina) were included in this study. Abnormal HRR was defined as a decrease in heart rate <or=12 beats at 1 minute after maximal exercise. Overall, 11% had abnormal HRR. Patients with abnormal HRR had significantly more mild or greater coronary heart disease (summed stress score [SSS] >or=4, 49% vs 27%; p = 0.001), severe coronary heart disease (SSS >8, 36% vs 7%; p <0.001), left ventricular (LV) dysfunction (LV ejection fraction <50%; 25% vs 6%; p <0.001), and composite high-risk MPI findings (SSS >8 or LV ejection fraction <40%; 40% vs 9%; p <0.001) compared with those without abnormal HRR. On multivariate logistic regression analysis, abnormal HRR was found to be an independent predictor of mild or greater coronary heart disease (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.4 to 4.3, p = 0.003), severe coronary heart disease (OR 5.5, 95% CI 2.7 to 11.0, p <0.001), and composite high-risk MPI findings (OR 4.3, 95% CI 2.1 to 8.6, p <0.001). In conclusion, abnormal HRR on exercise treadmill testing was associated with a high prevalence of abnormal and high-risk stress MPI findings, even in patients without other exercise treadmill testing findings that traditionally would prompt further testing. These findings suggest that further testing with stress MPI should be considered in patients with abnormal HRR on routine exercise treadmill testing.

Coronary heart disease and hormone replacement therapy after the menopause

The discordance in coronary heart disease (CHD) outcome between randomized, controlled trials and observational studies of hormone replacement therapy (HRT) is likely the result of the dissimilar cohorts studied. This observation led to the formation of the timing hypothesis that benefits and risks of HRT depend upon age of HRT initiation and/or time of HRT initiation in relation to menopause. This hypothesis has been supported with data from large, randomized, controlled trials that have studied HRT and selective estrogen receptor modulators (SERMs) in the prevention of CHD. Initiation of HRT in women <60 years of age and/or within 10 years of menopause reduces both CHD and total mortality; SERMs have been shown to reduce CHD in women <60 years. What has become clear from the cumulated literature is that in young postmenopausal women who initiate HRT in close proximity to menopause, the adverse effects of HRT are rare and no greater than those of other commonly used pharmacological agents and that the primary prevention benefits for CHD are at least equivalent to those of other commonly used therapies. Additionally, the literature indicates that the duration of HRT confers greater CHD benefit especially in women <60 years who initiate therapy. The cumulated literature dispels misperceptions concerning HRT and CHD.

Greater CHD Risk from Diabetes in Women Than Men

Some, but not all, studies suggest that diabetes increases coronary heart disease (CHD) risk more in women than in men. These researchers addressed the