Greater Risk Of Cardiovascular Disease Research Articles

Acceptability of data linkage to identify women at risk of postnatal complication for the development of digital risk prediction tools and interventions to better optimise postnatal care, a qualitative descriptive study design

BackgroundPregnancy acts as a cardiovascular stress test. Although many complications resolve following birth, women with hypertensive disorder of pregnancy have an increased risk of developing cardiovascular disease (CVD) long-term. Monitoring postnatal health can reduce this risk but requires better methods to identity high-risk women for timely interventions.MethodsEmploying a qualitative descriptive study design, focus groups and/or interviews were conducted, separately engaging public contributors and clinical professionals. Diverse participants were recruited through social media convenience sampling. Semi-structured, facilitator-led discussions explored perspectives of current postnatal assessment and attitudes towards linking patient electronic healthcare data to develop digital tools for identifying postpartum women at risk of CVD. Participant perspectives were gathered using post-it notes or a facilitator scribe and analysed thematically.ResultsFrom 27 public and seven clinical contributors, five themes regarding postnatal check expectations versus reality were developed, including ‘limited resources’, ‘low maternal health priority’, ‘lack of knowledge’, ‘ineffective systems’ and ‘new mum syndrome’. Despite some concerns, all supported data linkage to identify women postnatally, targeting intervention to those at greater risk of CVD. Participants outlined potential benefits of digitalisation and risk prediction, highlighting design and communication needs for diverse communities.ConclusionsCurrent health system constraints in England contribute to suboptimal postnatal care. Integrating data linkage and improving education on data and digital tools for maternal healthcare shows promise for enhanced monitoring and improved future health. Recognised for streamlining processes and risk prediction, digital tools may enable more person-centred care plans, addressing the gaps in current postnatal care practice.

Modifiable risk factors and metabolic health in risk of cardiovascular disease among US adults: A nationwide cross-sectional study

BackgroundMetabolic syndrome (MetS) could increase the risk of cardiovascular disease (CVD) by 2-fold. Ideal control of modifiable risk factors in Life's Simple 7 (LS7) could reduce the CVD risk among the general population. This study aimed to investigate the effects of controlling modifiable risk factors using LS7 in MetS to prevent CVD. Methods44463 participants in NHANES 1999–2018 were included. The primary endpoint was a composite of CVD, including angina pectoris, coronary artery disease, myocardial infarction, congestive heart failure, and stroke. Multivariable weighted logistic regression analyses estimated the associations. The diagnosis of MetS complied with Harmonized International Diabetes Federation Criteria. Measurement of modifiable risk factors used the 2010 American Heart Association LS7 guideline and was indicated by cardiovascular health (CVH). Results14034 individuals were diagnosed with MetS. 4835 participants had CVD. The weighted mean CVH was 8.06 ± 0.03. Intermediate and poor CVH were associated with increased risk for CVD in participants with similar metabolic states compared to ideal CVH. By taking participants with metabolic health and ideal CVH as health control, participants with MetS and poor CVH were demonstrated to have a 3-fold (adjusted odds ratio, 4.00; 95 % confidence interval, 3.21–4.98) greater risk for CVD. Notably, under the condition of ideal CVH, the risk of having CVD was comparable between metabolic health and MetS after fully adjusted. ConclusionIdeal control of Life's Simple 7 in metabolic syndrome contributes to a comparable risk of cardiovascular disease with healthy subjects. LS7 could be recognized as a guideline for secondary prevention in MetS.

Metabolomics signature of blood pressure salt sensitivity and its link to cardiovascular disease: A dietary salt-intervention trial.

Individuals with a high degree of salt sensitivity (SS) have a greater risk of cardiovascular disease (CVD), but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear. This study aimed to reveal the role of the SS-related metabolomics signature in the development of CVDs, based on the MetaSalt study, which was a dietary salt-intervention trial conducted at four centers in China in 2019. A total of 528 participants were recruited and underwent 3 days of baseline observations, a 10-day low-salt intervention, and a 10-day high-salt intervention. Plasma untargeted metabolomics, lipidomics, and BP measurements were scheduled at each stage. Participants were grouped into extreme SS, moderate SS, and salt-resistant (SR) individuals according to their BP responses to salt. Linear mixed models were used to identify SS-related metabolites and determine the relationship between the SS-related metabolomics signature and arterial stiffness. Mendelian randomization (MR) analyses were applied to establish the causal pathways among the SS-related metabolites, BP, and CVDs. Among the 713 metabolites, 467 were significantly changed after the high-salt intervention. Among them, the changes in 30 metabolites from the low-salt to the high-salt intervention differed among the SS groups. Of the remaining nonsalt-related metabolites, the baseline levels of 11 metabolites were related to SS. These 41 metabolites explained 23% of the variance in SS. Moreover, SS and its metabolomics signature were positively correlated with arterial stiffness. MR analyses demonstrated that the SS-related metabolites may affect CVD risk by altering BP, indicating that the increase in BP was the consequence of the changes in SS-related metabolites rather than the cause. Our study revealed that the metabolomics signature of SS individuals differs from that of SR individuals and that the changes in SS-related metabolites may increase arterial stiffness and foster CVDs. This study provides insight into understanding the biology and targets of SS and its role in CVDs.

Resting Beat-to-Beat Blood Pressure Variability in Young, Healthy, Non-Hispanic Black Females

Background: Non-Hispanic Black (BL) individuals are at greater risk for cardiovascular disease and hypertension compared to other racial groups. Beat-to-beat blood pressure variability (BPV) is a known predictor of adverse cardiovascular outcomes. Our laboratory recently reported an augmented resting beat-to-beat BPV in non-Hispanic BL males compared to their White (WH) male counterparts. However, racial differences in beat-to-beat BPV between non-Hispanic BL and non-Hispanic WH females are unknown. Therefore, we tested the hypothesis that young, healthy, non-Hispanic BL females have elevated resting beat-to-beat BPV compared to healthy age and body mass index matched WH females. Methods: We studied 12 young healthy non-Hispanic BL females (20 ± 2 years, 25.2 ± 4 kg/m2, mean ± standard deviation) and 12 young healthy non-Hispanic WH females (22 ± 3 years, 22.7 ± 3 kg/m2; P = 0.13 and P = 0.10, respectively). Beat-to-beat arterial blood pressure (finger photoplethysmography) was continuously recorded during ten minutes of supine rest. Mean, standard deviation (SD), range, coeffcient of variation, and average real variability (ARV) were calculated for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Results: Resting absolute SBP (BL: 113 ± 12 mmHg; WH: 112 ± 7 mmHg; P = 0.98), DBP (BL: 69 ± 7 mmHg; WH: 66 ± 5 mmHg; P = 0.22), and MAP (BL: 83 ± 7 mmHg; WH: 81 ± 4 mmHg; P = 0.48) were not different between groups. Likewise, beat-to-beat SBP SD (BL: 3.5 ± 0.78 mmHg; WH: 4.0 ± 1.16 mmHg; P = 0.21), range (BL: 21 ± 5 mmHg; WH: 24 ± 6 mmHg; P = 0.26), coeffcient of variation (BL: 3.01 ± 0.82%; WH: 3.56 ± 0.96%; P = 0.20), and ARV (BL: 2.02 ± 0.46; WH: 2.26 ± 0.6; P = 0.27) were not different between BL and WH females. There were also no differences in any of the beat-to-beat BPV measures for DBP or MAP between BL and WH females (all P > 0.05). Conclusion: In contrast to our hypothesis and previous work in non-Hispanic BL males, these preliminary data suggest that beat-to-beat BPV is not different between non-Hispanic BL and WH females. This work was supported by the College of Nursing and Health Innovation. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes

BackgroundThe global prevalence of diabetes is similar in men and women; however, there is conflicting evidence regarding sex differences in diabetes-related complications. The aim of this study was to investigate...

Low income and education are associated with greater ASCVD risk scores among adults in the US

IntroductionSocial determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults. MethodsUtilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999–2018 and included participants aged 40–79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design. ResultsMean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K–<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K–<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education. ConclusionWe found strong graded associations between lower income and lower educational attainment with greater CVD risk.

PCSK9 plasma concentration is associated with epicardial adipose tissue volume and metabolic control in patients with type 1 diabetes

Patients with type 1 diabetes (T1D) have a greater risk of cardiovascular disease. Proconvertase subtilisin-kexin 9 (PCSK9) is involved in the atherosclerosis process. This study aimed to determine the relationship between PCSK9 levels and epicardial adipose tissue (EAT) volume and cardiometabolic variables in patients with T1D. This was an observational cross-sectional study including 73 patients with T1D. Clinical, biochemical and imaging data were collected. We divided the patients into two groups according to their glycemic control and the EAT index (iEAT) percentile. We performed a correlation analysis between the collected variables and PCSK9 levels; subsequently, we performed a multiple regression analysis with the significant parameters. The mean age was 47.6 ± 8.5 years, 58.9% were men, and the BMI was 26.9 ± 4.6 kg/m2. A total of 31.5%, 49.3% and 34.2% of patients had hypertension, dyslipidemia and smoking habit, respectively. The PCSK9 concentration was 0.37 ± 0.12 mg/L, which was greater in patients with worse glycemic control (HbA1c > 7.5%), dyslipidemia and high EAT volume (iEAT > 75th percentile). The PCSK9 concentration was positively correlated with age (r = 0.259; p = 0.027), HbA1c (r = 0.300; p = 0.011), insulin dose (r = 0.275; p = 0.020), VLDL-C level (r = 0.331; p = 0.004), TG level (r = 0.328; p = 0.005), and iEAT (r = 0.438; p < 0.001). Multiple regression analysis revealed that 25% of the PCSK9 variability was explained by iEAT and HbA1c (p < 0.05). The PCSK9 concentration is associated with metabolic syndrome parameters, poor glycemic control and increased EAT volume in patients with T1D.

Abstract P362: Differences in Cardiovascular Health, Physical Activity Determinants, and Desired Intervention Components in Individuals With a History of Hypertensive Disorders of Pregnancy by Activity Level

Introduction: Hypertensive Disorders of Pregnancy (HDP) affects ~16% of pregnancies and is associated with a 2- to 4-fold greater risk of cardiovascular disease (CVD). Physical activity (PA) is a known modifiable risk factor for CVD; however, little is known about the CVD risk factors potentially related to postpartum PA after HDP. More research is also needed examining specific behavioral determinants influencing postpartum PA and a postpartum PA intervention would be desired. Purpose: To assess differences in CVD risk factors, behavioral determinants of PA, and desired PA intervention components among postpartum individuals with HDP, stratified by PA level. Hypothesis: Inactive individuals will have more CVD risk factors, different behavioral determinants and desired PA intervention components compared to active individuals after HDP. Methods: Individuals residing in Iowa who were &lt;1 year postpartum and experienced a HDP were recruited to complete online surveys assessing demographics, PA, CVD risk factors, behavioral determinants of PA (e.g., barriers and facilitators of PA), and desired PA intervention components. Individuals were classified as active or inactive using the 2018 PA guidelines for Americans. Results: Participants (N=72) were 30±6 years old, mostly white (84%), and 54% were sufficiently active. Inactive individuals were more likely to be diagnosed with hypertension after delivery, had lower CVD knowledge, and were 2.9 times less likely to identify facilitators of PA compared to active individuals (Table; p&lt;0.05). All indicated interest in a postpartum PA intervention, with inactive individuals expressing greater interest in information on postpartum PA safety, PA while breastfeeding, and social media interventions compared to active individuals (Table; p&lt;0.05). Preferred communication included text, email, and video call. Conclusions: Development of PA interventions after HDP should consider the unique needs of individuals across current postpartum activity levels.

Abstract 45: Elevated Long-Term Triglyceride-Glucose Index Variability From Childhood is Linked to Poorer Midlife Cognitive Function: The Bogalusa Heart Study

Background: Insulin resistance has been linked to a higher risk of cardiovascular events and cognitive impairment in older adults. Recently, an elevated triglyceride-glucose (TyG) index, a noninvasive marker of insulin resistance, has been linked to a greater risk of cardiovascular disease. Whether long-term TyG index variability from childhood to midlife impacts midlife cognitive function (CF) is unclear. Hypothesis: We hypothesized that elevated TyG index variability from childhood to midlife is associated with poorer midlife CF. Aim: We aimed to identify the impact of elevated TyG index variability from childhood to midlife on midlife CF. Methods: We studied 1,100 midlife Bogalusa Heart Study participants (age at enrollment: mean 9.5 years +/- standard deviation(SD) 3.5 years; age at midlife: 48.1 +/- 5.2 years; 60.3% women(663 of 1100), 34% Black(374 of 1100)) with ≥ 3 lipid and glucose measurements across follow-up. Participants with Type 2 diabetes mellitus were excluded. TyG index levels were calculated as ln [(serum fasting triglyceride in mg/dL x serum fasting glucose in mg/dL)/2]. TyG index measures of each individual were fitted into random-effects models stratified by race and sex, and individual growth curves were obtained. Visit-to visit TyG index variability from childhood to midlife was calculated by the deviation from age-predicted values (DEV) and residual SD (RSD) from these models. Midlife CF was measured from 10 neuropsychological (NP) tests, which were categorized into 3 distinct NP profiles (optimal, average, and mixed-low) using cluster analysis. Associations between TyG index variability and NP profiles were analyzed using multinomial logistic regression models, adjusting for education status and the mean of TyG index levels from childhood to midlife. DEV and RSD were standardized to z-scores according to race and sex before regression analysis. Interactions according to race and sex were performed. Results: Every 1 SD increase in DEV increased the odds of having a mixed-low CF by 48.9% (95% CI 1.201, 1.847) and an average CF by 22.9% (95% CI 1.046, 1.443) compared to optimal CF, after adjusting for education status and mean TyG levels. Every 1 SD increase in RSD increased the odds of having a mixed-low CF by 51% (95% CI 1.217, 1.873) and an average CF by 25.4% (95% CI 1.068, 1.472) compared to optimal CF, adjusting for education status and mean TyG levels. Neither race nor sex modified the effects of DEV nor RSD on CF. Conclusions: Greater long-term TyG index variability was linked with poorer midlife CF. Further studies are needed to elucidate the brain effects of higher long-term variability in insulin resistance from childhood to midlife.

Association between diabetic status and risk of all-cause and cause-specific mortality on dialysis following first kidney allograft loss.

Diabetes mellitus (DM) is associated with a greater risk of mortality in kidney transplant patients, primarily driven by a greater risk of cardiovascular disease (CVD)-related mortality. However, the associations between diabetes status at time of first allograft loss and mortality on dialysis remain unknown. All patients with failed first kidney allografts transplanted in Australia and New Zealand between 2000 and 2020 were included. The associations between diabetes status at first allograft loss, all-cause and cause-specific mortality were examined using competing risk analyses, separating patients with diabetes into those with pre-transplant DM or post-transplant diabetes mellitus (PTDM). Of 3782 patients with a median (IQR) follow-up duration of 2.7 (1.1-5.4) years, 539 (14%) and 390 (10%) patients had pre-transplant DM or developed PTDM, respectively. In the follow-up period, 1336 (35%) patients died, with 424 (32%), 264 (20%) and 199 (15%) deaths attributed to CVD, dialysis withdrawal and infection, respectively. Compared to patients without DM, the adjusted subdistribution HRs (95%CI) for pre-transplant DM and PTDM for all-cause mortality on dialysis were 1.47 (1.17-1.84) and 1.47 (1.23-1.76), respectively; for CVD-related mortality were 0.81 (0.51-1.29) and 1.02 (0.70-1.47), respectively; for infection-related mortality were 1.84 (1.02-3.35) and 2.70 (1.73-4.20), respectively; and for dialysis withdrawal-related mortality were 1.71 (1.05-2.77) and 1.51 (1.02-2.22), respectively. Patients with diabetes at the time of kidney allograft loss have a significant survival disadvantage, with the excess mortality risk attributed to infection and dialysis withdrawal.

Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study.

To examine whether vasomotor symptoms (VMS) and migraine headaches, hypothesized to be vasoactive conditions, are associated with greater risk for cardiovascular disease (CVD) events including strokes. We performed a secondary data analysis of a subset of women (n = 1,954) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort, which began data collection at 18 to 30 y of age. We examined whether migraine headaches and VMS trajectories (characterized as minimal, increasing, and persistent) at CARDIA year 15 examination were associated with higher risk of CVD events and stroke (both ischemic and hemorrhagic) using Cox proportional hazards regression models and adjustment for traditional CVD risk factors (age, cigarette use, and levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides) and reproductive factors. Among women with minimal VMS (n = 835), increasing VMS (n = 521), and persistent VMS (n = 598), there were 81 incident CVD events including 42 strokes. Women with histories of migraine and persistent VMS had greater risk of CVD (hazard ratio [HR], 2.25; 95% CI, 1.15-4.38) after adjustment for age, race, estrogen use, oophorectomy, and hysterectomy compared with women without migraine histories and with minimal/increasing VMS. After adjustment for CVD risk factors, these associations were attenuated (HR, 1.51; 95% CI, 0.73-3.10). Similarly, women with histories of migraine and persistent VMS had greater risk of stroke (HR, 3.15; 95% CI, 1.35-7.34), but these associations were attenuated after adjustment for CVD risk factors (HR, 1.70; 95% CI, 0.66-4.38). Migraines and persistent VMS jointly associate with greater risk for CVD and stroke, although risk is attenuated with adjustment for traditional CVD risk factors.

Clinical characteristics and degree of cardiovascular risk factor control in patients with newly-diagnosed type 2 diabetes in Catalonia.

Women with type 2 diabetes mellitus (T2DM) face a greater risk of cardiovascular disease (CVD) and encounter challenges in managing cardiovascular risk factors (CVRF); however, limited data are available in individuals with newlydiagnosed T2DM. This study aimed to examine differences between women and men at the onset of T2DM in terms of clinical characteristics, glycaemic status, and CVRF management. This was a retrospective cohort study including subjects with newly-diagnosed T2DM from the System for the Development of Research in Primary Care (SIDIAP) database in Catalonia (Spain). Sex differences (Dif) were assessed at baseline and 1-year post-diagnosis, by calculating the absolute difference of means or proportions. A total of 13,629 subjects with newly-diagnosed T2DM were analyzed. Women were older and had a higher BMI than men. At baseline, women had higher total cholesterol [Dif (95%CI) 10 mg/dL (9.1/10.8)] and low-density lipoprotein cholesterol (LDL-c) [Dif (95%CI) 7 mg/dL (6.3/7.7)], while men had higher rates of smoking and alcohol intake. Lipid target achievement was lower in women, in both primary prevention (LDL-c < 100 mg/dL) [Dif (95%CI) -7.3 mg/dL (-10.5/-4.1)] and secondary prevention (LDL-c < 70 mg/dL) [Dif (95%CI) -8.3 mg/dL (-17.3/0.7)], along with lower statin and antiplatelet prescriptions, especially one year after diagnosis. Changes in clinical and laboratory data one year post-diagnosis revealed that, in the primary prevention group, men experienced greater improvements in total cholesterol, LDL-c and triglycerides, while women had less success in achieving CVRF control targets compared to men. Additionally, cardiovascular events, such as coronary artery disease and peripheral artery disease increased more in men than in women within the first year of diagnosis, especially in primary prevention subjects. Differences between men and women CVRF are already apparent at the onset of T2DM, particularly in primary prevention, with notable differences in lipid profile and target level attainment.

Visit-to-visit variability in multiple biological measurements and cognitive performance and risk of cardiovascular disease: A cohort study

BackgroundVisit-to-visit variability in single biological measurements has been associated with cognitive decline and an elevated risk of cardiovascular diseases (CVD). However, the effect of visit-to-visit variability in multiple biological measures is underexplored. We investigated the effect of visit-to-visit variability in blood pressure (BP), heart rate (HR), weight, fasting plasma glucose, cholesterol, and triglycerides on cognitive performance and CVD. MethodsData on BP, HR, weight, glucose, cholesterol, and triglycerides from study visits in the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial were used to estimate the association between visit-to-visit variability, cognitive performance (Mini Mental State Examination (MMSE) score) and CVD (non-fatal stroke, non-fatal myocardial infarction, or cardiovascular death). Visit-to-visit variation for each measurement was estimated by calculating each individuals visit-to-visit standard deviation for that measurement. Participants whose standard deviation was in the highest quarter were classified as having high variation. Participants were grouped into those having 0, 1, 2, 3, or ≥ 4 high variation measurements. Regression and survival models were used to estimate the association between biological measures with MMSE and CVD with adjustment for confounders and mean measurement value. ResultsAfter adjustment for covariates, higher visit-to-visit variability in BP, HR, weight, and FPG were associated with poorer MMSE and a higher risk of CVD. Effect sizes did not vary greatly by measurement. The effects of high visit-to-visit variability were additive; compared to participants who had no measurements with high visit-to-visit variability, those who had high visit-to-visit variability in ≥4 measurements had poorer MMSE scores (-0.63 (95 % CI -0.96 to -0·31). Participants with ≥4 measurements with high visit-to-visit variability compared to participants with none had higher risk of CVD (hazard ratio 2.46 (95 % CI 1.63 to 3.70). ConclusionVisit-to-visit variability in several measurements were associated with cumulatively poorer cognitive performance and a greater risk of CVD.

Abstract 18787: Rural Intervention for Caregivers’ Heart Health: A Randomized Controlled Trial

Background: Informal caregivers are at greater risk for cardiovascular disease (CVD) than non-caregivers. This risk is higher for older caregivers who often have chronic illnesses, especially those living in a rural environment. Yet caregivers, particularly rural caregivers, are usually “hidden patients” in a caregiver-patient dyad as they commonly ignore their own health. We developed a CVD-risk reduction intervention (RICHH) that promoted self-care in the context of the demands of caregiving. Our aims were to test the impact of RICHH on adherence to CVD risk reduction behaviors and to determine whether age moderated intervention effects on outcomes. Methods: Rural informal caregivers (N=311; 76% female, age=55±14 years) at CVD risk were randomized to intervention or usual care groups. The intervention group completed a 12-week self-care intervention using video conferencing. Outcomes were assessed at 4 and 12 months. Adherence to CVD risk reduction behaviors and adherence to healthy diet was assessed using the Medical Outcome Scale-CVD Specific Adherence Scale and the Healthy Eating Index-2015 (HEI). Piecewise linear mixed-effect modeling determined intervention effects and age moderation. Results: Compared to the usual care group, adherence to CVD risk reduction behaviors increased in intervention at 4 months (b = 2.02, p &lt; 0.001), and the improvement was maintained at 12 months (b = 4.17, p &lt; 0.001; Figure). Total diet quality was improved in intervention versus control at 4-months (b = 0.95, p &lt; 0.001) and was maintained at 12 months (b = 3.05, p = 0.024). Consumption of fruits, vegetables, and whole grains increased in intervention, while intake of sugar and saturated fats decreased. Age did not moderate intervention effects. Conclusion: The intervention was effective in improving adherence to CVD risk reduction behaviors, including heart-healthy eating, regardless of caregiver age, showing its effectiveness for all ages of caregivers.

Sleep is Essential for Cardiovascular Health: An Analytic Review of the Relationship Between Sleep and Cardiovascular Mortality.

The American Heart Association recently included sleep health as one of eight factors that define cardiovascular health. Restorative sleep is a pillar of lifestyle medicine influenced by sleep duration, quality, and disorders. Short and long sleep duration are associated with greater risk of cardiovascular disease. Short sleep appears causally related to cardiovascular risk. Long sleep is more strongly predictive of cardiovascular risk, which may be due to comorbidities and other risk factors. Good-quality sleep appears to protect against the increased risk and is independently associated with risk of cardiovascular disease (CVD). Insomnia, particularly difficulty falling asleep and non-restorative sleep, is associated with an increase in cardiac events. Obstructive sleep apnea (OSA) is associated with cardiac risk and outcomes, which is typically observed in the context of contributing comorbidities. However, treating OSA with continuous positive airway pressure (CPAP) may not improve prognosis. Further research is needed to understand the causal mechanisms connecting sleep health with CVD and whether modifying sleep can improve outcomes. Sleep health should be considered as part of a holistic approach to improving cardiovascular health, as reflected in the scoring of LE8 and as one of the interrelated components of lifestyle medicine.

The association between sleep deprivation and the risk of cardiovascular diseases: A systematic meta‑analysis.

Globally, sleep deprivation is a concerning health issue associated with an increased risk of cardiovascular diseases (CVDs). The present study aimed to explore the association between short-term sleep and the risk of CVDs, taking into consideration sex and age groups. A comprehensive review was conducted by assembling cohort studies that are available in the PubMed, Cochrane Library, and Embase databases. Individuals with ≤5 or ≤6 h of sleep per day were considered as sleep-deprived subjects. To minimize potential bias, two reviewers thoroughly evaluated the selected articles. Relevant data were extracted, and pooled odds ratios (ORs) or relative risks (RRs) were calculated using a random-effects model. In total, 18 cohort studies involving adult subjects were included in the present analysis. The pooled results strongly indicated that sleep deprivation was associated with a greater risk of CVDs [RR: 1.09, 95% confidence interval (CI): 1.02-1.16, P=0.009]. However, when the pooled analysis was stratified by sex and age, the following results were observed: short-term sleep women (RR: 1.06, 95% CI: 0.96-1.17, P=0.27), short-term sleep men (RR: 1.07, 95% CI: 0.97-1.17, P=0.17); ≥18 years-old sleep-deprived population (RR: 1.09, 95% CI: 1.00-1.17, P=0.04), ≥40 years-old sleep-deprived population (RR: 1.09, 95% CI: 0.98-1.22, P=0.11), and subjects with co-existing diseases, such as diabetes and hyperlipidemia (RR: 1.06, 95% CI: 0.94-1.20, P=0.32). In conclusion, short-term sleep is associated with the increased risk of CVDs. Among subjects who were aged ≥18 years-old, there was a strong association with the development of CVDs compared with those who were aged ≥40 years-old. Furthermore, men were at a higher risk of CVDs than women. Adequate sleep (7-8 h per day) may play a role in improving cardiac health. The results of the present study may provide valuable support for further research in public health, highlighting the correlation between sleep deprivation and the risk of CVDs.

Protein Biomarkers of Early Menopause and Incident Cardiovascular Disease.

Background Premature and early menopause are independently associated with greater risk of cardiovascular disease (CVD). However, mechanisms linking age of menopause with CVD remain poorly characterized. Methods and Results We measured 71 circulating CVD protein biomarkers in 1565 postmenopausal women enrolled in the FHS (Framingham Heart Study). We examined the association of early menopause with biomarkers and tested whether early menopause modified the association of biomarkers with incident cardiovascular outcomes (heart failure, major CVD, and all-cause death) using multivariable-adjusted linear regression and Cox models, respectively. Among 1565 postmenopausal women included (mean age 62 years), 395 (25%) had a history of early menopause. Of 71 biomarkers examined, we identified 7 biomarkers that were significantly associated with early menopause, of which 5 were higher in women with early menopauseincluding adrenomedullin and resistin, and 2 were higher in women without early menopauseincluding insulin growth factor-1 and CNTN1 (contactin-1) (Benjamini-Hochberg adjusted P<0.1 for all). Early menopause also modified the association of specific biomarkers with incident cardiovascular outcomes including adrenomedullin (Pint<0.05). Conclusions Early menopause is associated with circulating levels of CVD protein biomarkers and appears to modify the association between select biomarkers with incident cardiovascular outcomes. Identified biomarkers reflect several distinct biological pathways, including inflammation, adiposity, and neurohormonal regulation. Further investigation of these pathways may provide mechanistic insights into the pathogenesis, prevention, and treatment of early menopause-associated CVD.

The built environment and cardiovascular disease: an umbrella review and meta-meta-analysis.

To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults. We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e., outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanisation, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect and excess significance bias. Meta-meta analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3,304 initial hits, 51 systematic reviews were included, covering five domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution and urbanisation in relation to CVD were scarce or lacking. Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs, and lack of evidence from LMIC's. PROSPERO CRD42021246580.

Sleep Deprivation and Heart Rate Variability in Healthy Volunteers: Effects of REM and SWS Sleep Deprivation.

Using PSG-guided acute selective REM/SWS sleep deprivation in volunteers, this study examined the effects of sleep deprivation on the cardiovascular and autonomic nervous systems, as well as the relationship between cardiac neuromodulation homeostasis and cardiovascular disease. An experiment was conducted using 30 healthy volunteers (male : female = 1 : 1, aged 26.33 ± 4.5 years) divided into groups for sleep deprivation of SWS and REM sleep, and then, each group was crossed over for normal sleep (2 days) and repeated sleep deprivation (1 day, 3 times). During the study period, PSG and ELECTRO ECG monitoring were conducted, and five-minute frequency domain parameters and blood pressure values were measured before and after sleep deprivation. Changes in VLF, LFnu, LF/HF, HF, and HFnu after SWS sleep deprivation were statistically significant (P < 0.05), but not LF (P = 0.063). Changes in VLF, LF, HF, LF/HF, LFnu, and HFnu after REM sleep deprivation were not statistically significant (P > 0.05). An increase in sympathetic nerve activity results from sleep deprivation and sudden awakening from SWS sleep is associated with a greater risk of cardiovascular disease.

Joint Injury, Osteoarthritis, and Cardiovascular Disease Risk Factors in Former National Football League Athletes: An NFL-LONG Study.

Individuals with lower extremity osteoarthritis (OA) have a 25% greater risk of cardiovascular disease (CVD) than those without OA. The prevalence of traumatic joint injuries among National Football League (NFL) players exposes these athletes to an elevated risk for OA and potentially a greater risk of cardiovascular risk factors (CRFs) and CVD. To examine the associations between a history of lower extremity joint injury, lower extremity OA, and the prevalence of CRFs and CVD among former NFL athletes. Cross-sectional study. Former NFL players completed a comprehensive health questionnaire that was used in an ongoing study, the Neurologic Function Across the Lifespan: A Prospective, Longitudinal, and Translational Study for Former NFL Players (NFL-LONG). A subsample of 1738 former players reported lifetime medical diagnoses including CVD or CRFs. Crude and adjusted prevalence ratios (PRsadj) characterized the associations between CVD or CRFs and injury, OA diagnosis, or both among athletes who reported (1) no history of lower extremity joint injury or surgery and no diagnosed OA, (2) a history of lower extremity joint injury or surgery and no diagnosed OA, and (3) a history of lower extremity joint injury or surgery and diagnosed OA. Neither a history of lower extremity joint injury (PRadj = 1.34; 95% CI = 0.86, 2.07) nor a history of lower extremity joint injury and diagnosed OA (PRadj = 1.41; 95% CI = 0.89, 2.25) was significantly associated with CVD. However, CRFs were 30% and 53% more prevalent in former players with lower extremity joint injury and no diagnosed OA (PRadj = 1.30; 95% CI = 1.12, 1.50) and those with lower extremity joint injury and diagnosed OA (PRadj = 1.53; 95% CI = 1.31, 1.78), respectively, versus athletes with no history of either condition. The prevalence of CRFs was highest among former NFL athletes with a history of lower extremity joint injury and diagnosed OA. These findings provide insight regarding the potential pathways to chronic diseases that may be initiated by joint injury early in life.