High Cardiovascular Disease Risk Group Research Articles

Evaluating cardiovascular disease risk stratification using multiple-polygenic risk scores and pooled cohort equations: insights from a 17-year longitudinal Korean cohort study.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, caused by a complex interplay of genetic and environmental factors. This study aimed to evaluate the combined efficacy of multi-polygenic risk scores and pooled cohort equations (PCE) for predicting future CVD risks in the Korean population. In this longitudinal study, 7,612 individuals from the Ansan and Ansung cohorts were analyzed over a 17-year follow-up period. The participants were genotyped using the Korea Biobank Array, and quality-controlled genetic data were subjected to imputation analysis. The weighted sum of the PRSs (wPRSsum) was calculated using PRS-CS with summary statistics from myocardial infarction, ischemic stroke, coronary artery disease, and hypertension genome-wide association studies. The recalibrated PCE was used to assess clinical risk, and the participants were stratified into risk groups based on the wPRSsum and PCE. Associations between these risk scores and incident CVD were evaluated using Cox proportional hazards models and Kaplan-Meier analysis. The wPRSsum approach showed a significant association with incident CVD (HR = 1.15, p = 7.49 × 10-5), and the top 20% high-risk genetic group had an HR of 1.50 (p = 5.04 × 10-4). The recalibrated PCE effectively differentiated between the low and high 10-year CVD risk groups, with a marked difference in survival rates. The predictive models constructed using the wPRSsum and PCE demonstrated a slight improvement in prediction accuracy, particularly among males aged <55 years (C-index = 0.640). We demonstrated that while the integration of wPRSsum with PCE did not significantly outperform the PCE-only model (C-index: 0.703 for combined and 0.704 for PCE-only), it provided enhanced stratification of CVD risk. The highest risk group, identified through the combination of high wPRSsum and PCE scores, exhibited an HR of 4.99 for incident CVD (p = 1.45 × 10-15). These findings highlight the potential of integrating genetic risk assessments with traditional clinical tools for effective CVD risk stratification. Although the addition of wPRSsum to the PCE provided a marginal predictive improvement, it proved valuable in identifying high-risk individuals and supporting personalized treatment strategies. This study reinforces the utility of multi-PRS in conjunction with clinical risk assessment tools, paving the way for more tailored approaches for CVD prevention and management in diverse populations.

Abstract P215: Activity Behaviors and Cardiometabolic Health Outcomes in People Living With HIV

Introduction: Physical activity (PA) and sedentary behavior (SB) are independently associated with cardiometabolic health; data on activity behaviors and cardiometabolic health among people living with HIV (PWH) are limited. Hypothesis: Activity behaviors would differ by age and that not meeting PA Guidelines would be associated with an increased risk of cardiometabolic diseases among PWH. Methods: Using NHANES 2007-08 through 2017-18, PWH (n=125; age 44.3 yrs) were characterized as emerging (18-29 yrs), early (30-44 yrs) and middle (45-59 yrs) adulthood. Achieving Guidelines (≥150 min/wk) was derived from self-reported PA across three domains. SB was reported as time spent sitting. Chronic conditions were high cholesterol, obesity, hypertension, and chronic kidney disease. Prevalence estimates of joint high SB (≥8 h/day) and inactivity (&lt;10 min/wk) were calculated, and regression models were used to estimate differences in behaviors by age and investigate the association between achieving Guidelines and chronic conditions. Results: PWH reported 395.8 min/day of SB with 37.5% spending over 8 h/day sitting. There was no significant difference in SB across lifestage. A total of 67.2% achieved Guidelines although 14% were jointly inactive and highly sedentary. Compared with early adult PWH, middle adult PWH spent more time performing transport-related PA (β= 102.7 min/wk, p =0.009) and less time performing leisure-time PA (β= -211 min/wk, p =0.044) ( Figure ). Compared with PWH meeting Guidelines , those that did not meet Guidelines had higher diastolic blood pressure (β= 6.1 mmHg [CI: 2.6, 9.6]) and higher odds of obesity (OR=2.5[CI: 1.0, 6.4]). Conclusions: Domain-specific differences occurred in transportation and leisure time PA among PWH - a high-risk group for cardiovascular disease. Not meeting the Guidelines resulted in greater odds of obesity and higher diastolic blood pressure. Future research should incorporate device-based measures of movement to understand its relation to chronic disease in PWH.

Abstract 18518: Exploring Sleep's Impact On Sex And Racial/ Ethnic Disparities In Cardiovascular Disease Risk: Leveraging Machine Learning And Precision Insights To Unravel Sleep-cvd Connections In 10-year Sleep Health Health Study

Introduction: The study aimed to explore the connection between insufficient sleep (&lt;7 hrs.) and 10-year cardiovascular disease (CVD) risk levels in black and white individuals, using Framingham risk (FRS) and Reynolds risk (RRS) scores. It also sought to identify and characterize the CVD risk factors associated with heightened or reduced risk profiles. Methods: Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (&lt;5%), low-medium (5% to &lt;10%), medium-high (10% to &lt;20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles. Results: Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups. Conclusions: These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts. Support: R01HL142066, R01AG067523, R01AG075007

Cardiovascular Risk Factors Among Asian Americans: Perspectives on the Role of Acculturation in Cardiovascular Diseases Health Disparities.

The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US.

OA40 Predicting cardiovascular disease risk in children and adolescents with juvenile-onset systemic lupus erythematosus using the APPLE (Atherosclerosis Prevention in Paediatric Lupus Erythematosus) clinical trial cohort

Abstract Background/Aims The risk of developing cardiovascular disease (CVD) through atherosclerosis in juvenile-onset systemic lupus erythematosus (JSLE) patients is significantly increased. This study aimed to stratify and characterise JSLE patients at elevated CVD risk using patient/disease-related factors and metabolomic data from patients recruited to the APPLE (Atherosclerosis Prevention in Paediatric Lupus Erythematosus) clinical trial, designed to assess atherosclerosis development. Methods Unsupervised hierarchical clustering was performed to stratify patients by arterial intima-media thickness (IMT) measurements at baseline (N = 151) and carotid (c)IMT progression over 36 months (placebo arm only, N = 60). Baseline metabolomic profiles (∼250 serum metabolites) were compared between clusters using conventional statistics, univariate logistic regression, sparse Partial Least-Squares Discriminant Analysis (sPLS-DA) and random forest classifier. An independent cohort (UCL-JSLE cohort, N = 89) with matching metabolomics, immunophenotyping and proteomics, was used to validate the discovered CVD risk-related signatures from the APPLE cohort. Results Baseline IMT stratification identified 3 clusters with high, intermediate, and low baseline IMT measurements and progression trajectories over 36 months, each having distinct racial/BMI/household education/income characteristics. Analysis of cIMT progression over 36 months identified 2 patient groups with high and low IMT progression. Unique metabolomic profiles differentiated high and low cIMT progression groups, with a good discriminatory ability (0.81 AUC in ROC analysis) using the top 6 metabolites (total cholesterol esters, total cholesterol, phospholipids in small LDL particles, total cholesterol in small LDL particles, free cholesterol in medium LDL particles, and total lipids in small LDL particles) selected from the analysis. cIMT progression over 36 months in the placebo group correlated positively with baseline disease activity (SLEDAI), damage score (SLICC), white blood cell count, serum complement C3, blood pressure (both systolic and diastolic) and BMI. Metabolomics signatures discovered from the APPLE cohort were applied to stratify JSLE patients in the validation cohort (UCL-JSLE), where 3 groups were identified with distinct metabolomics profiles indicating JSLE patients with high risk (N = 20), intermediate risk (N = 43) and low risk (N = 26) CVD-risk. Significant differences were observed in the frequency of classical monocytes (p = 0.015) and nonclassical monocytes (p = 0.005) when comparing the high and low CVD risk groups in the UCL-JSLE cohort. Conclusion Complex analysis of IMT patterns and progression in the APPLE trial cohort identified novel key determinants that could guide further research for CVD-risk stratification in JSLE. Disclosure J. Peng: None. G.A. Robinson: None. S.P. Ardoin: None. L.E. Schanberg: None. O. Carra: None. E. Jury: None. C. Ciurtin: None.

Health-related quality of life and physical activity in Ukrainian pediatric patients with heterozygous familial hypercholesterolemia

Introduction. Familial hypercholesterolemia (FH) is a genetically determined disease characterized by elevated low-density lipoprotein levels since birth and predisposes a person to develop atherosclerosis-induced cardiovascular disease. Healthcare providers should monitor the health status and physical activity level in pediatric patients with FH, as a high-risk group for cardiovascular disease. Purpose - to investigate the self-reported health-related quality of life (HRQoL) and physical activity energy expenditure based on the questionnaire data (PAEEq) in children with heterozygous FH compared with healthy peers to assess the health status. Materials and methods. The HRQoL scores were assessed using the KINDLR questionnaire in 15 patients with FH and 21 healthy peers. The physical activity level was evaluated using the C(Y)PAQ questionnaire. The KINDLR data together with other variables such as age, weight, height, sex, BMI and the PAEEq scores were analyzed in SAS® OnDemand for Academics. Results. HRQoL scores in FH children were similar to those of the control group (p&gt;0.05). There was no association between PAEEq and the HRQoL scores in the FH (r=0.37, p=0.29) and the control group (r=0.43, p=0.20). The KINDLR Physical well-being score in the 5-9 years age group was significantly higher for FH children than for controls (p&lt;0.01), while the total HRQoL score was not significantly different between FH children and controls. The group of FH children aged 5-9 with an intermediate level of PAEEq was the most physically active among the surveyed children. The controls aged 15-18 with low levels of PAEEq was the least active. All other age groups were characterized by a low intermediate level of PAEEq. Conclusions. Children with FH have HRQoL scores that are comparable to those of healthy peers. The FH and control groups were relatively satisfied with their quality of life. Thus, FH children consider themselves to be healthy, and from this underestimation of their cardiovascular risk they may have low adherence. Most FH children were found to have the low intermediate levels of PAEEq, which may indicate a lack of exercise and poor quality of life later on. Children with FH may have significant health problems in adulthood if they are not treated early and appropriately. In a similar manner, low PAEEq levels were demonstrated by the controls, so they should be also informed about the significance of regular physical activity and properly motivated. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors.

Abstract P3-03-17: The Impact of Cardiovascular Disease Risk on Cancer Progression among Female Breast Cancer Survivors: A Longitudinal Study within The Boss Cohort

Abstract Background Among breast cancer (BC) survivors, cardiovascular disease (CVD) is one of the most common comorbidities contributing to mortality. Data on to what extent CVD risk impacts disease progression and second cancers in younger women is limited. We conducted a prospective cohort study to examine whether CVD risk is associated with disease recurrence or new primary cancer among female BC survivors enrolled in a cohort of women with a family history of BC. Methods The study included 301 females with a first primary diagnosis of BC in the Breast and Ovarian Surveillance Service (BOSS) Cohort, after excluding those who had a history of recurrence or second primary cancer prior to enrollment (N=125), a diagnosis of ductal carcinoma in situ (DCIS) (N=66), and with missing CVD risk factors (N=3). A risk score based on 7 CVD risk factors (age 65 or older, diabetes, hypertension, high cholesterol, body mass index (BMI), smoking status, and physical activity) was assessed at baseline and updated 4 and 8 years after enrollment. Each risk factor was given a score (0, 1, or 2) and was summed and categorized into low (score=0 or 1), intermediate (score=2 or 3), and high (score &amp;gt;3) risk. The primary outcome was either BC progression or all second primary cancers. Analyses limited to BC progression and second BC only were also conducted. Outcomes were ascertained through active follow-up and confirmed by pathology records. Kaplan-Meier graphs and two different Cox regression models were used to compare risk groups: model 1 adjusted for participants’ age, race, BMI, time from diagnosis, education, tumor stage, and estrogen receptor (ER) status; model 2 included further adjustment of cancer treatments (chemotherapy, hormone therapy, radiation), statin use, baby aspirin use, and specifically cardiotoxic treatments. For subgroup analyses, a more parsimonious model was used including age, race, BMI, education, cancer treatments, and cardiotoxic treatment. Results Participants’ mean age of BC diagnosis was 47.4 years and the median follow-up time was 11.5 years. The incidence rate of recurrence or any second cancer was 21 cases per 1000 person-years. At baseline, there were 168, 130, and 84 survivors in the low, intermediate, and high CVD risk groups respectively, and their use of statins increased from 12.7%, 34.5% to 52.7%. In the multivariable model, BC survivors with an intermediate CVD risk score had a 2.23 times greater risk of recurrence or second primary cancer as compared to those with a low CVD risk score (95% CI=1.20- 4.17). After further adjusting for cancer and CVD treatment in model 2, the HR was attenuated but still significant to 2.01 (95% CI = 1.20- 4.17. Interestingly, the association was attenuated and non-significant in the high-risk group (model 2: HR=1.37, 95% CI = 0.54- 3.45). The positive association between intermediate CVD risk score and recurrence or second cancer was also observed among subgroups of BC survivors including those who were postmenopausal (HR = 2.23, 95% CI = 1.01-4.93), with ER-positive BC (HR=2.07, 95% CI=1.08-3.99), regional disease (HR = 2.74, 95% CI = 1.06-7.04), diagnosed 5 years or greater (HR = 4.85, 95% CI = 1.14-20.66). There was a significant interaction between intermediated CVD risk and diagnosis time of 5 years (P interaction = 0.033). Restricting the outcome to disease progression and second BC alone led to similar results. The HR comparing the intermediate risk group and low risk group was 2.65 (95% CI = 1.27-5.55) in model 1 and decreased to 2.28 (95% CI = 1.06-4.89) in model 2. Conclusion There was a significant association between CVD risk and subsequent cancer progression in female breast cancer survivors, particularly among long-term BC survivors. The non-significant results among the women with high CVD risk scores may reflect the fact that a greater proportion of these women compared to women in the intermediate group reported taking cardiac treatments that can favorably impact cancer progression. Citation Format: Xinyi Feng, Zhengyi Deng, Michelle McCollough, Betty May, Erica Selznick, Avonne Connor, Deborah K. Armstrong, Kala Visvanathan. The Impact of Cardiovascular Disease Risk on Cancer Progression among Female Breast Cancer Survivors: A Longitudinal Study within The Boss Cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-17.

TYPE 2 DIABETES MELLITUS PATIENTS WITH AND WITHOUT HYPERTENSION: XANTHINE OXIDASE ACTIVITY AND URIC ACID CONCENTRATION

A metabolic condition known as type 2 diabetes mellitus (T2DM) has spread all over the world. Pancreatic insulin resistance and β-cell dysfunction are its defining features. In 2021, almost 537 million people worldwide had diabetes. The prevalence of hypertension (HTN) in T2DM more than 50% result from uncontrolled blood glucose. The prevalence of microvascular and macrovascular complications in T2DM with HTN, more common than in those without HTN. Hyperglycemia is related to overproduction of reactive oxygen species (ROS) and oxidative stress (OS). The etiology of metabolic disorders is associated with OS. On the other hand, OS increases the risk of cardiovascular disease (CVD) by causing endothelial dysfunction. An important source of ROS is xanthine oxidase (XOD), while uric acid (UA) has two properties: pro- oxidant and antioxidant. Sixty T2DM patients with and without hypertension participated in this research. These patients were compared to a control group of thirty people. Lipid profile, XOD and UA were determined in this research. The results of the study showed a significant increase in XOD and UA values in T2DM patients compared to controls. The elevated OS agents and lipids biomarkers mainly in T2DM group could contribute to increasing cardiometabolic risks and weakening the overall health status of the participants. Triglyceride (TG), total cholesterol (TC), LDL-c and HDL-c abnormalities are risk factors of CVD. Dyslipidemia and elevated HbA1c in diabetic patients can be considered as a very high-risk group for CVD.

Do statins benefit low-risk population for primary prevention of atherosclerotic cardiovascular disease: A retrospective cohort study.

The reported beneficial effects of statins on cardiovascular outcome based on risk assessment are inconsistent. Therefore, we investigated statin therapy effectiveness for the primary prevention of cardiovascular disease (CVD), according to the Korean Risk Prediction Model (KRPM). Subjects aged 40-79 years with low density lipoprotein cholesterol (LDL-C) of < 190 mg/dL and without CVD history were categorized as statin users or non-users using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database, Korea, 2002-2015. The 10-year atherosclerotic CVD (ASCVD) risk was calculated using the validated KRPM and categorized as low, borderline, intermediate, or high-risk groups; the incidence of major adverse cardiovascular events (MACEs) was compared over a mean follow-up period of 5.7 years using Cox proportional hazard models. The MACE incidence risk was decreased in statin users [hazard ratio (HR) 0.90, 95% confidence interval (CI) (0.84-0.98)]. However, there was an increased risk of MACE incidence in low-risk statin users [HR 1.80, 95% CI (1.29-2.52)], and no significant relationship was identified between statin use and MACE in the borderline [HR 1.15, 95% CI (0.86-1.54)] and intermediate-risk [HR 0.94, 95% CI (0.85-1.03)] groups. The risk of MACE incidence decreased only in the high CVD risk group among statin users. Statin use is not associated with MACE reduction in low- to intermediate-risk participants. Therefore, individuals with LDL-C level of < 190 mg/dL and low ASCVD risk should consider statin therapy only when CVD risk is proved obvious using an appropriate ASCVD risk tool.

Evaluation of Common Factors of Periodontitis and Cardiovascular Disease in Patients with the Acute Coronary Syndrome.

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases.

Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study.

BackgroundAlthough hypothyroidism is associated with various comorbidities, its relationship with increased all-cause mortality remains controversial. The aim of this nationwide retrospective cohort study was to investigate whether hypothyroid patients treated with levothyroxine had increased mortality compared to controls.MethodsHypothyroid subjects were identified through the Korean National Health Insurance Service Claims database between 2008 and 2017. Hypothyroidism in this study was defined as overt hypothyroidism treated with long-term prescription of levothyroxine (>6 months). After 1:3 age-, sex- and index year-matching, 501,882 patients with newly diagnosed hypothyroidism and 1,505,646 controls without hypothyroidism were included.ResultsDuring a mean follow-up of 6 years, 25,954 (5.2%) hypothyroid patients and 59,105 (3.9%) controls died. Hypothyroidism was significantly associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI] 1.12–1.16) even with levothyroxine treatment. When stratified by age, sex, and cardiovascular disease risk, independent associations between hypothyroidism and mortality remained significant in all subgroups. The risk of mortality was higher in the < 65 age group (HR: 1.25, 95% CI: 1.22–1.29), men (HR: 1.28, 95% CI: 1.25–1.31), and the high cardiovascular disease risk group (HR: 1.31, 95% CI: 1.29–1.34). The mortality rate of hypothyroid patients was highest within 1 year of treatment and decreased with time.ConclusionThis nationwide, population-based cohort study showed that all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls. This association remained significant regardless of age, sex, and cardiovascular disease risk.

Competing mortality risks: predicted cardiovascular disease risk versus predicted risk of breast cancer mortality in patients receiving adjuvant chemotherapy in a single Irish center

BackgroundDue to advances in care, most women diagnosed with breast cancer do not die from the disease itself. Instead, cardiovascular disease (CVD) remains the most frequent cause of death. Many breast cancer patients are older and have established CVD risk factors. They are at further risk due to exposure to anthracyclines, HER2 targeted agents, endocrine therapy and radiotherapy. In this study, we compared the 10-year predicted risk of breast cancer mortality versus that of cardiovascular (CV) morbidity/mortality in breast cancer patients receiving adjuvant chemotherapy using online predictive risk calculators. Furthermore, we evaluated the predicted outcome of CV risk factor optimisation on their overall CV risk.MethodsThis was a cross sectional study. All patients with resected Stage I-III breast cancer who received adjuvant chemotherapy at our centre from September 2015 to November 2016 were identified. Data recorded included demographics, tumor characteristics, treatments and CV risk factors. To calculate predicted 10-year risk of CVD and impact of lifestyle changes, we used the JBS3 (Joint British Society) online risk calculator. To calculate the predicted 10-year risk of breast cancer mortality, we used the PREDICT calculator. Biostatistical methods included Wilcoxon signed rank test for predicted CVD risk pre and post cardiovascular risk optimization.ResultsWe identified 102 patients. Of this cohort, 76 patients were ≥ 50 years & 26 were < 50 years of age. The group had significant baseline cardiovascular risk factors: increased BMI (68 %, n = 70), ex-smoking (34 %, n = 35), current smoking (13 %, n = 13), hypertension (47 %, n = 47) and dyslipidemia (57 %). Of the total group, 48 % had a high (> 20 %) and 37 % had a moderate (10–20 %) 10-year predicted breast cancer mortality risk. Regarding 10-year predicted risk of CVD, 11 % and 22 % fell into the high (> 20 %) and moderate (10–20 %) risk categories, respectively. Assuming CV risk factor optimisation, there was a predicted improvement in median 10-year CV risk from 26.5 to 9.9 % (p = .005) in the high CVD risk group and from 14.0 to 6.6 % (p < .001) in the moderate CVD risk group.ConclusionsBenefits predicted with a CVD risk intervention model indicates that this should be incorporated into routine breast oncology care.

Study of Correlation Between Glycated Hemoglobin (Hba1c) and Serum Lipid Profile in Type 2 Diabetic Patients

Introduction: Diabetic mellitus is a chronic metabolic disease characterized by hyperglycemia. Type 2 diabetes mellitus accounts for more than 90% of cases worldwide. Elevated HbA1c and dyslipidemia proportionately increases the risk of development of cardiovascular disease (CVD) which is the major cause of morbidity and mortality worldwide. Aims: To Study the correlation between glycated hemoglobin (HbA1c) and serum lipid profile in type 2 diabetic patients. Methods: This is a hospital based cross sectional study conducted at Nepalgunj medical college teaching hospital, which included 104 type 2 diabetic patients (54 males and 50 females).Venous blood samples were collected from all patients and serum was used for analyzing HbA1c, lipid profile panel and fasting blood glucose (FBG). DM was defined as per American diabetic association (ADA) criteria. Dyslipidemia was defined as per the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guidelines. The data were analyzed using standard statistical methods, including SPSS 21. Results : Abnormal lipid parameters were demonstrated with increased Total Chloseterol (TC), Triglyceride (TG), Low density lipoprotein (LDL),Very low density lipoprotein (VLDL) and low High density lipoprotein (HDL) suggestive of dyslipidemia.HbA1c showed direct and significant correlation with TC,LDL,TG and VLDL. Patients with HbA1c &gt; 7.0% had a significantly higher value of TC, LDL, TG and VLDL as compared to patients with HbA1c ≤7.0%.However, the significant difference in value of HDL-C was not found between two groups. Conclusion: Due to the strong correlation with lipid profile, HbA1c could be the ideal marker for predicting dyslipidemia in type 2 DM . Patients with higher HbA1c value and dyslipidemia should be considered as a very high risk group for CVD.

The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies.

BackgroundWhether hyperthyroidism is an independent risk factor for cardiovascular events remains controversial. We aimed to evaluate the association of overt and subclinical hyperthyroidism with the risk of ischemic heart disease (IHD), stroke, heart failure, and cardiovascular mortality.MethodsStudies regarding the association between hyperthyroidism and cardiovascular events were searched on PubMed and Embase databases. The cardiovascular disease (CVD) risk was classified as high and low, based on pre-existing diseases, including history of coronary, cerebral, or peripheral artery disease; heart failure; atrial fibrillation; diabetes mellitus; or chronic kidney disease.ResultsThirty-seven cohort studies were included in this meta-analysis. The pooled hazard ratio for subjects with overt hyperthyroidism compared with the control group was 1.11 (95% confidence interval [CI], 1.03 to 1.19) for IHD, 1.35 (95% CI, 1.03 to 1.75) for stroke, and 1.20 (95% CI, 1.00 to 1.46) for cardiovascular mortality. For subjects with subclinical hyperthyroidism, the pooled hazard ratio was 1.24 (95% CI, 1.07 to 1.45) for IHD, when compared with the control group. Subgroup analysis by CVD risk showed that the risk of stroke in overt hyperthyroidism was increased in the low CVD risk group; however, these association was not observed in the high CVD risk group. Similarly, the risk of IHD in subjects with subclinical hyperthyroidism was significantly increased in the low CVD risk group.ConclusionOvert hyperthyroidism is associated with increased risk of IHD, stroke, and cardiovascular mortality, and subclinical hyperthyroidism is associated with increased risk of IHD. These associations were particularly observed in the low risk CVD group without underlying CVD.

Management of dyslipidaemia and hypertension in patients with rheumatoid arthritis in 19 countries

Abstract Background/Introduction The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. Purpose To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment. Methods The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP &amp;gt;140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP &amp;lt;140/90 mmHg. The 10-year risk of a fatal CVD event was calculated by the European CVD risk calculator, the Systematic COronary Risk Evaluation (SCORE), and was thereafter multiplied with 1.5 as recommended by the European League Against Rheumatism. Patients were classified in a high or very high CVD risk group according to the 2012 European Society of Cardiology guidelines, with low density lipoprotein cholesterol (LDL-c) goal at &amp;lt;2.6 and &amp;lt;1.8 mmol/L, respectively. Results In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, most of whom (74%) were female. Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8–43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these only 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%). Conclusion(s) This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Only one half of subjects were at blood pressure goals, and achievement of lipid goals was even poorer at one third of those eligible for treatment, which is lower than what is reported for subjects with coronary heart disease. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted research collaboration with Lilly

The association between walking speed and risk of cardiovascular disease in middle-aged and elderly people in Taiwan, a community-based, cross-sectional study.

The aim of this study was to investigate the association between walking speed and cardiovascular disease (CVD) risk among community-dwelling middle-aged and elderly populations in Taiwan. This was a cross-sectional and community-based study with 400 participants aged 50 years and over recruited from a community health promotion project in 2014 in Guishan district, Taoyuan city. We excluded 91 people, and a total of 309 participants were eligible for analysis. The statistical methods used in this study were one-way ANOVA and the Chi-square test, Pearson's correlation test and logistic regression model. In total, 309 participants (98 males and 211 females) aged 50 to 74 (62.05 ± 6.21) years without a CVD history were enrolled in this study. The walking speed gradually decreased from the low CVD risk group to the high CVD risk group (p < 0.05). A significant inverse association between walking speed and CVD risk was confirmed with a Pearson's correlation coefficient of-0.143 (p < 0.05) in middle-aged people, but this significant inverse association was not shown in elderly people. The multivariate logistic regression model for predicting CVD risk and walking speed with an adjusted odds ratio (OR) was 0.127 (95% CI = 0.021-0.771) in middle-aged people with adjustment for sex, age, waist circumference (WC), hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (p < 0.05). Our study clearly shows that slow walking speed is associated with an increased risk of CVD in middle-aged people rather than in elderly people.

Longitudinal association between adolescent negative emotions and adulthood cardiovascular disease risk: an opportunity for healthcare quality improvement

PurposeWhile cardiovascular disease (CVD) is the leading cause of death globally, over 80% of the cases could be prevented through early lifestyle changes. From the perspective of quality management in healthcare, this may offer an effective prevention window if modifiable CVD risk factors are identified and treated in adolescence. The purpose of this research is to examine the negative emotions in adolescents and determine if it independently increases CVD risk later in life.Design/methodology/approachLongitudinal data from 12,350 participants of the Add Health study, which conducted a multi-wave survey for 14 years from adolescence (Wave 1) through adulthood (Wave 4), were used to test the research hypothesis. Four items (perception of life, self-reported depression, perceived loneliness and fearfulness) reflective of adolescent negative emotion were identified from the Wave 1 questionnaire, and factor analysis was conducted to confirm the hypothesized structure. The outcome variable, 30-year adulthood CVD risk category (high or low risk), was estimated using biomarkers, biological data and other factors collected during the 14-year follow-up in Wave 4. A logistic regression analysis was employed to assess the impact of adolescent negative emotions on adulthood CVD risk after adjusting for common risk factors such as sociodemographic characteristics, socioeconomic status and medical conditions in adolescence.FindingsThe results indicated adolescent negative emotion to be significantly associated with CVD risk category (p-value < 0.0001), even after controlling for common risk factors. A unit increase in the level of adolescent negative emotion increased the chance of being in the high CVD risk group in adulthood by 8% (odds ratio = 1.08 ± 0.03).Practical implicationsHealthcare providers and organizations could capitalize on the research findings by screening for negative emotions early in life through individual and societal interventions. The findings also provide an opportunity for implementing quality improvement initiatives to deliver robust preventive care, which, in turn, could improve the overall population health, reduce healthcare costs and improve care quality.Originality/valueAlthough previous studies showed a strong link between adolescent physiological factors (e.g. obesity) and adulthood cardiovascular disease (CVD), the association between adolescent outlook/attitude (negative emotion) and CVD risk has not been examined.

Association of High Sensitive C-Reactive Protein and Obesity in Thais

Background: Obesity, a public health problem in many countries, was related to cardiovascular risk. High sensitive C-reactive protein (hs-CRP) was a predictor of cardiovascular disease (CVD) risk and elevated in inflammatory diseases. Objective: To investigate the association between hs-CRP and obesity among Thais. Materials and Methods: The present study was cross-sectional study. One hundred eleven adults were randomly recruited, and the anthropometric parameters were measured. Obesity indices, such as body mass index (BMI), body adiposity index (BAI), and waist to hip ratio (WHR) were calculated to estimate the obesity. Spearman’s correlation was used to evaluate the association between hs-CRP and obesity indices. The subjects were divided into three CVD risk groups according to hs-CRP levels. The hs-CRP less than 1 mg/L (n=31), the hs-CRP 1 to 3 mg/L (n=54), and the hs-CRP more than 3 mg/L (n=26) determined the low, intermediate, and high CVD risk groups, respectively. One-way ANOVA was used to determine the significant differences of obesity indices among the low, intermediate, and high CVD risk groups. Results: The present study showed a positive correlation between hs-CRP and obesity indices such as waist circumference (p&lt;0.001, r=0.416), weight (p=0.001, r=0.311), hip circumference (p&lt;0.001, r=0.376), WHR (p=0.024, r=0.214), BMI (p&lt;0.001, r=0.383), and BAI (p&lt;0.001, r=0.334). The results demonstrated that values of all obesity indices were elevated in intermediate and high CVD risk groups. BMI, waist circumference, and WHR expressed significant differences among low, intermediate, and high-risk groups (p&lt;0.05). In addition, hs-CRP was significantly elevated in obese people compared with non-obese people. Conclusion: The hs-CRP positively correlated with obesity indices indicating the association between high level of hs-CRP and obesity. Keywords: Cardiovascular disease, High sensitive C-reactive protein, Obesity, Obesity indices

Inflammatory properties of diet mediate the effect of depressive symptoms on Framingham risk score in men and women: Results from the National Health and Nutrition Examination Survey (2007-2014)

Depression is common in patients with cardiovascular disease (CVD) and associated with inflammation. Inflammation contributes to the development of CVD and can be modulated by diet. However, the role of inflammatory properties of diet in the relationship between depressive symptoms and CVD risk is not well understood. We hypothesized that the inflammatory properties of diet mediate the relationship between depressive symptoms and CVD risk in men and women. Cross-sectional data collected by the National Health and Nutrition Examination Survey (2007–2014) were used for the study. Depressive symptoms scores, inflammatory properties of diet, and CVD risk were measured by the Patient Health Questionnaire-9 (PHQ-9), the Dietary Inflammatory Index (DII), and the Framingham risk score (FRS), respectively. Generalized linear models were used for the mediation analysis. There were significant differences in the proportions of men and women in the depressed group (PHQ-9 ≥ 10; 5.24 ± 0.65% vs 9.36 ± 0.87%, P < .001) and high CVD risk group (FRS >20%; 16.47 ± 0.79% vs 6.03 ± 0.32%, P < .001). The DII partially mediated the relationship between depressive symptoms and CVD risk in men (indirect effect: 0.06, P = .010) but fully mediated the relationship between depressive symptoms and CVD risk in women (indirect effect: 0.10, P < .001). These findings confirmed our hypothesis that inflammatory properties of diet at least partially mediate the relationship between depressive symptoms and CVD risk in men and women. Our findings suggest that interventions designed to reduce depressive symptoms should contain strategies to reduce pro-inflammatory and increase anti-inflammatory properties of diet to decrease CVD risk.

Physical health burden of PTSD, depression, and their comorbidity in the U.S. veteran population: Morbidity, functioning, and disability

ObjectiveAlthough it is well-established that posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are associated with physical health difficulties among U.S. veterans, the incremental burden of having both disorders relative to either one alone remains largely unknown. The goal of this study was to provide the first population-based characterization of the burden of medical illness associated with PTSD, MDD, and their comorbidity among U.S. veterans. MethodsData were from National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 2732). Analyses (a) examined the magnitude of medical comorbidity and disability associated with PTSD, MDD, and co-occurring PTSD/MDD; and (b) compared physical functioning by PTSD/MDD status. ResultsAfter adjusting for sociodemographic characteristics and substance use disorders, veterans with comorbid PTSD/MDD were more likely to be diagnosed with heart disease, migraine, fibromyalgia, and rheumatoid arthritis compared to those with MDD-only. Conversely, they were at greater odds of being diagnosed with hypercholesterolemia and hypertension relative to those with PTSD-only. Comorbid PTSD/MDD status was associated with approximately three times greater odds of disability compared to MDD alone. Veterans with co-occurring PTSD/MDD and PTSD-only exhibited worse physical functioning than those with MDD-only. ConclusionFindings indicate that veterans with co-occurring PTSD/MDD represent a high-risk group for cardiovascular disease and other health problems, and therefore deserve careful attention from healthcare systems. Further research is needed to investigate mechanisms underlying associations between PTSD/MDD and physical health morbidities, as well as whether treatment of PTSD/MDD can reduce risk for comorbid medical conditions.