Higher Framingham Risk Research Articles

Framingham risk score is a useful indicator of posttransplant cardiovascular events and survival among Korean kidney transplant recipients: a nationwide, prospective cohort study.

Cardiovascular disease is an important risk factor for mortality among kidney transplant recipients. In this study, we aimed to investigate the association between cardiovascular risk score at kidney transplantation and long-term outcomes of patients. In this prospective, observational cohort study, we enrolled kidney transplant recipients who participated in the Korean Organ Transplantation Registry and underwent transplantation between April 2014 and December 2019. The cardiovascular risk status of kidney transplant recipients was assessed using the Framingham risk score. All-cause mortality, major adverse cardiovascular events, allograft failure, estimated glomerular filtration rates (eGFRs), and composite outcomes were evaluated after kidney transplantation. Of the 4,682 kidney transplant recipients, 96 died during 30.7 ± 19.1 months of follow-up. The Kaplan-Meier survival analysis results showed that high Framingham risk scores were associated with all-cause mortality, major adverse cardiovascular events, and composite outcomes. According to the multivariable Cox analysis, high Framingham risk scores were associated with an increased risk of mortality (hazard ratio [HR], 3.20; 95% confidence interval [CI], 1.30-7.91), major adverse cardiovascular events (HR, 8.43; 95% CI, 2.41-29.52), and composite outcomes (HR, 2.05; 95% CI, 1.19-3.46). The eGFRs after transplantation were significantly higher among patients in the low Framingham risk score group (p < 0.001). However, Framingham risk scores were not associated with graft loss or rapid decline in eGFRs. The Framingham risk score is a useful indicator of cardiovascular events, mortality, and kidney function after kidney transplantation.

Prevalence, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities

BackgroundWhether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear. MethodsUsing the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity. ResultsA total of 5,841,453 people, representing 23.0% (95% confidence interval [CI] 21.7%-24.2%) of Canadian adults, were hypertensive. The adjusted odds ratio (aOR) of having hypertension treated and controlled was higher in people with the following conditions, as compared to people without these conditions: a prior heart attack or stroke (aOR 3.15; 95% CI 2.31-4.31); dyslipidemia (aOR 2.51; 95% CI 1.96-3.21); obstructive sleep apnea (aOR 1.95; 95% CI 1.19-3.21); overweight or obesity (aOR 1.51; 95% CI 1.18-1.94); chronic kidney disease (aOR 1.49; 95% CI 1.13-1.95); and diabetes (aOR 1.44; 95% CI 1.12-1.86). Individuals without any of these comorbidities were less likely to have BP that is treated and controlled (aOR 0.34; 95% CI 0.25-0.48). Moreover, the prevalence of BP treatment and control was low among many people without prior heart attack or stroke, even those with a moderate (aOR 0.25; 95% CI 0.17-0.37) or high (aOR 0.10; 95% CI 0.06-0.16) Framingham risk. ConclusionsLarge differences in levels of BP control exist across comorbidity profiles, and the greatest gaps are seen in individuals without recognized comorbidities, even those who have a moderate-to-high Framingham risk. Efforts to optimize BP control and narrow care gaps, especially in individuals without recognized comorbidities, are necessary to reduce the burden of cardiovascular disease and premature death in Canada.

Abstract 3072: GDF15 Represses The Interferon Response Early In Vascular Senescence

Senescent cells have been identified as major contributors of the progression of vascular diseases including atherosclerosis by increasing the senescence-associated secretory phenotype (SASP) and dysregulating vascular cells. Notably, senescence and the SASP can contribute to plaque rupture and atherosclerotic progression by promoting inflammation and plaque vulnerability. A time course microarray analysis of vascular smooth muscle cell (VSMC) senescence revealed p53-regulated GDF15 mRNA was increased early and remained elevated throughout senescence. Notably, GDF15 has been implicated as a biomarker for cardiovascular disease mortality and is part of the conserved SASP across cell types and tissues. Interestingly, intracellular or secreted GDF15 protein levels were increased in monkeys fed a high-fat diet or in mice fed a high-fat diet and in individuals with high Framingham risk scores, respectively. We sought to identify the role of GDF15 in senescent VSMCs. Using CRISPRi, we silenced GDF15 during early senescence and performed RNA-sequencing. Pathway analysis revealed a enrichment in interferon signaling with the loss of GDF15. Coinciding with the increase in interferon signaling, phosphorylation of STAT1 and CREB were increased by loss of GDF15 in early senescence, aiding in the elevation of interferon expression. Given the role of interferons in communication and the prominence of macrophages in atherosclerosis, we tested the effects of conditioned media, derived from either proliferating or senescent VSMCs, on the activation and the expression of scavenger receptors on human macrophages. Senescent conditioned media increased expression of ABCG1 , CD36 , LOX-1 , SCARF1 , and GDF15 mRNA as well as TNFα and CCL2 secretion in macrophages. We propose that elevated GDF15 levels in early senescence suppress interferon signaling, thus preventing macrophage chemotaxis and in turn leading to the accumulation of senescent cells in the vasculature. Thus, disrupting the senescent VSMC-macrophage communication through secreted proteins may offer promising avenues of therapeutic development to prevent or improve inflammatory vascular diseases.

Prevalence and management of dyslipidemia in primary care practices in Canada.

To estimate the prevalence of dyslipidemia and to describe its management in Canadian primary care. Retrospective cohort study using primary care electronic medical record data. Canada. Adults aged 40 years or older who saw a Canadian Primary Care Sentinel Surveillance Network contributor between January 1, 2018, and December 31, 2019. Presence or absence of dyslipidemia as identified by a validated case definition and the treatment status of patients identified as having dyslipidemia based on having been prescribed a lipid-lowering agent (LLA). In total, 50.0% of the 773,081 patients 40 years of age or older who had had a primary care visit in 2018 or 2019 were identified as having dyslipidemia. Dyslipidemia was more prevalent in patients 65 or older (61.5%), in males (56.7%) versus females (44.7%), and in those living in urban areas (50.0%) versus rural areas (45.2%). In patients with documented dyslipidemia, 42.8% had evidence of treatment with an LLA. Stratifying patients by Framingham risk score revealed that those in the high-risk category were more likely to have been prescribed an LLA (65.0%) compared with those in the intermediate-risk group (48.7%) or the low-risk group (22.8%). The strongest determinants of receiving LLA treatment for dyslipidemia include sex, with males being 1.95 times more likely to have been treated compared with females (95% CI 1.91 to 1.98; P<.0001); and body mass index, with those with obesity having a significantly increased likelihood of being treated with an LLA (adjusted odds ratio of 1.36, 95% CI 1.32 to 1.41; P<.0001). This study provides an updated look at the prevalence and treatment of dyslipidemia among Canadians. Half of patients aged 40 years or older have dyslipidemia, with an even higher prevalence observed among adults aged 65 years or older, males, and those with obesity or other chronic conditions. There are still gaps in treatment among those with documented dyslipidemia, principally among those calculated to have high or intermediate Framingham risk scores. Particular attention should also be paid to those at higher risk for not receiving treatment, including female patients and those within normal body mass index ranges.

Incidental Coronary Arterial Calcification for Cardiovascular Risk Assessment in Men With Prostate Cancer Undergoing PET/CT Imaging

BackgroundCardiovascular (CV) disease is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting. MethodsConsecutive patients who underwent positron emission tomography/computed tomography (PET/CT) for recurrent prostate cancer at a single institution from 2012 to 2017 were identified retrospectively. Clinical data and coronary calcification on nongated CT imaging were obtained. The primary outcome was major adverse CV event (MACE; myocardial infarction, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality) occurring within 5 years of PET/CT. ResultsAmong 354 patients included in the study, there were 98 MACE events that occurred in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%). Coronary calcification was predictive of MACE (HR = 1.9, 95% CI: 1.1-3.4, P = .03) using adjusted Kaplan-Meier analysis. As a comparator, the Framingham risk score was calculated for 198 patients (56%) with complete clinical and laboratory data available. In this subgroup, high baseline Framingham risk (corresponding to 10-year risk of CV disease > 20%) was not predictive of MACE. ConclusionsMACE was common (21%) in men with recurrent prostate cancer undergoing PET/CT over 5 years of follow-up. Incidental coronary calcification on PET/CT was associated with increased risk of MACE and may have utility as a CV risk predictor that is feasible to implement among all prostate cancer providers.

Prediction of incident atherosclerotic cardiovascular disease with polygenic risk of metabolic disease: Analysis of 3 prospective cohort studies in Korea

Background and aimsStudies have demonstrated that the risk of atherosclerotic cardiovascular disease (ASCVD) can be assessed by polygenic risk score (PRS) using common genetic variants. Because metabolic syndrome is a well-known, robust risk factor of ASCVD, we established PRS of metabolic disease and analyzed whether this PRS could predict incident ASCVD. MethodsWe constructed PRSs for eight quantifiable metabolic phenotypes—systolic/diastolic blood pressure, body mass index (BMI), four blood lipid components, and fasting blood glucose—by genome-wide association studies of two prospective Korean cohorts (n = 37,285). We conducted a grid search of combinations of metabolic PRSs to identify the most optimal weighted score for incident ASCVD (PRSMetS-ASCVD). The utility of PRSMetS-ASCVD was validated in an independent prospective cohort (n = 4333). ResultsThe individuals in the highest PRS quintile demonstrated a 1.4–2.0-fold increased risk of incident hypertension, obesity, hyperlipidemia, and diabetes. Using the PRSMetS-ASCVD, we identified 6.7% of the population as a high risk group demonstrating a 3.3-fold (95% confidence interval 1.7–6.1, p < 0.001) higher risk for incident ASCVD. The model combining the PRSMetS-ASCVD demonstrated a better performance for predicting ASCVD than that consisting of only conventional risk factors, such as age, sex, BMI, smoking, hypertension, diabetes and hyperlipidemia. The population with high PRSMetS-ASCVD minimally overlapped with that of high Framingham risk score, thus suggesting the additive independent benefits beyond the Framingham risk score, especially in younger individuals. ConclusionsThe polygenic risk of metabolic disease independently predicts those at an increased risk of ASCVD, identifying those at a genetically high risk of incident ASCVD.

Abstract 13035: A Potent Protective Vascular Endothelium Property of Garcinia mangostana L. Extract in High-Risk Framingham Score Patients With Type 2 Diabetes: A Prospective Randomized Control Trial

Background: Endothelial dysfunction is the hallmark of vascular complications in cardiovascular disease with type 2 diabetes as the comorbid. Garcinia mangostana L., or mangosteen, has been known as the queen of fruits from Southeast Asia that owns anti-inflammatory and anti-oxidant properties for years. Objective: This study was aimed to evaluate the role of G. mangostana extract as a potent protective vascular endothelium in patients with type 2 diabetes and high-risk Framingham score. Method: This is a prospective, randomized, single blind, placebo-controlled trial in subjects with type 2 DM and high-risk Framingham score. Subjects were randomly divided into two groups: the treatment group of G. mangostana extract, administered 2,175 mg/day in divided dosage for 90 days, and control group receiving placebo. The primary endpoint was the changes in endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) levels. We also evaluated the levels of NO, IL-1, IL-6, TNF-α, fasting blood glucose and HbA1c. Study had been approved by local ethics committee. Statistical analysis was done and p&lt;0.05 was considered significant. Results: From 90 subjects with high-risk Framingham score, there were 49 (54.4%) subjects with type 2 diabetes, which randomly divided into two groups. The treatment group (n=23) received G. mangostana extract and control group (n=26) received placebo. Statistical analysis showed that increase of EPC and decrease of CEC levels were significant in treatment group, compared to control (p=0.000 and p=0.002, respectively). The levels of NO increased significantly (p=0.027) and levels of IL-1, IL-6, TNF-α decreased significantly in comparison to placebo (p=0.003, p=0.002, p=0.000, respectively). Analysis also showed that HbA1c decreased significantly (p=0.002) compared to placebo; however, it was insignificant for fasting blood glucose reduction (p=0.336). Conclusion: Garcinia mangostana L. extract, as an adjuvant therapy, plays a role in improving endothelial dysfunction by significant increase in EPCs and decrease in CECs, in patients with type 2 diabetes and high-risk Framingham score.

Metabolic syndrome and its determinants among professional drivers: a systematic review and meta-analysis.

Drivers are one of the trade unions that are most exposed to various health-related risks, especially metabolic diseases. The present study aimed to systematically assess the overall prevalence of metabolic syndrome and its determinants among drivers in the world. All retrospective, cross-sectional, or prospective studies evaluating the prevalence and risk for metabolic syndrome and its main components among male professional drivers were eligible for the initial assessment. PRISMA guideline was used. Two blinded reviewers independently screened the titles and abstracts of the manuscripts followed by a deep assessment of the full texts for determining the inclusion appropriateness. In the final, 12 articles were eligible for the final analysis. Overall, 19,350 professional male drivers with a total average age of 43.06years (ranged from 35.5 to 51.1years) were included in the study. The prevalence of metabolic syndrome was estimated to be 32.8% (95%CI: 32.1% to 33.5%), and the major determinants of appearing this syndrome among professional drivers were advanced age, years of driving experience, higher body mass index, smoking, high cholesterol dietary regimen, high Framingham risk score, low regular exercising, history of diabetes mellitus, history of gout, and shift work pattern. According to the 32.8% prevalence rate of metabolic syndrome among drivers, managerial measures are needed to prevent and control metabolic disturbances among professional drivers are recommended.

The Prevalence, Distribution, and Extent of Subclinical Atherosclerosis and Its Relation With Serum Uric Acid in Hypertension Population.

Background: Data are limited on the prevalence, distribution, and extent of subclinical atherosclerosis (SCA) in populations with primary hypertension and an in-depth evaluation is required to explore the impact of elevated serum uric acid (SUA) levels on the systemic extent of SCA.Methods: A total of 1,534 individuals with blood pressure-controlled primary hypertension registered from January 1, 2015 to May 31, 2018 were included. The systemic extent and risk factors of SCA in the carotid, coronary, thoracic, and renal territories were investigated by Doppler ultrasound and computed tomography.Results: SCA was present in 85.9% of patients. The proportion of focal, intermediate and generalized SCA was 17.9, 21.3, and 46.6%. Plaques were most common in the thoracic aorta (74%), followed by the coronary (55.3%), carotid (51.6%), and renal (45.8%) arteries, respectively. Participants were stratified into quartiles based on gender-specific SUA levels. Compared with patients in the first quartile, the Odds Ratio (OR) [95% confidence interval] for SCA in the second, third and fourth quartile were 1.647 (1.011–2.680), 3.013 (1.770–5.124), and 5.081 (3.203–10.496), respectively. Patients with elevated SUA levels at high 10-year Framingham risk had a higher likelihood of a more severe risk of SCA (95.8%). However, extensive SCA was also present in a substantial number of low 10-year-Framingham risk patients at the higher quartiles of SUA (53.8%).Conclusions: SCA was highly prevalent in the hypertension population and the thoracic aorta was the most frequently affected vascular site. Elevated SUA concentration was significantly associated with the prevalence and severity of SCA regardless of territories.

The Role of Garcinia Mangostana Pericarp Extract as Antioxidant to Inhibit Atherosclerosis Process in High Risk Framingham Score Patient; Original Article

Atherosclerosis is the pivotal role of cardiovascular disease (CVD) involving oxidative stress dan inflammation. Garcinia has anti-oxidant property for years. This study was performed to explore the role of α-Mangostin of Garcia Mangostana Pericarp Extract as an antioxidant in inhibiting atherosclerotic process in patients with high-risk Framingham score. Methods: This prospective cohort design was led in 90 grown-ups with high hazard cardiovascular score which were resolved dependent on Framingham criteria, age 50–70 years of age. The patients were divided into two groups. One group was administered 2520 mg/day Garcinia mangostana Linn extracts (GMLE) in 3 divided doses for 90 days and the other group was administered a placebo. Parameters were Nitric Oxide (NO), Superoxide Dismutase (SOD) and Malondialdehyde (MDA), measured at baseline and after 90 days of treatment. An Independent T-test was performed for normally distributed data and the Mann-Whitney test was performed for abnormally distributed data with a significance level of p≤0.05. Results: Among the 77 subjects, we found that the plasma, MDA, concentration was significantly decreased compared with placebo 0,29±0.5 vs -0.04±0.25, respectively p = 0.011). SOD level significantly decreased in GMLE patients compared with placebo patients (0,17±0.79 vs -0.27±0.67, respectively, p=0.010) and we found that there was slightly increased in nitric oxide (NO), but no significantly compared with placebo 4.34±10.01 and 2.35±7.39, respectively, p = 0.37). Conclusion: Garcinia mangostana pericarp extract has an antioxidant effect that significantly inhibit atherosclerosis process in high-risk Framingham score patients

Low‐grade albuminuria is associated with high cardiovascular risk in CVD‐free and normoalbuminuric Chinese adults: Results from the REACTION study

Data are limited with regard to the association between low-grade albuminuria (below the threshold of microalbuminuria) and high cardiovascular risk in normoalbuminuric Chinese adults free of cardiovascular disease (CVD). A total of 32 650 participants aged over 40 years from seven regional centers in China were included in this study. The single-void first morning urine sample was collected to measure the urinary albumin to creatinine ratio (UACR) and the data were divided into sex-specific quartiles. The Framingham Risk Score (FRS) was used to identify participants at high risk of developing coronary heart disease (CHD) over the next 10 years and the association between low-grade albuminuria and high 10-year Framingham risk for CHD (FRS ≥20%) was investigated. Among males and females, the prevalence of cardiometabolic risk factors (diabetes, hypertension, and dyslipidemia) increased markedly with the elevation of UACR quartiles. Logistic regression analysis showed that the odds ratios (ORs) for high 10-year risk of CHD increased significantly from the second quartile in males (UACR: 4.78 ~ 7.53 mg/g, OR=1.21, 95% confidence interval [CI]: 1.05-1.40) and the third quartile in females (UACR: 9.13 ~ 15.04 mg/g, OR=3.07, 95% CI: 1.75-5.40). Stratified analysis showed that in males, the association was especially pronounced in elderly, overweight/obese participants and those without diabetes and hypertension whereas in females, the association was especially pronounced in elderly, overweight/obese participants and those without diabetes and with hypertension. Low-grade albuminuria was significantly associated with high 10-year cardiovascular risk among CVD-free and normoalbuminuric Chinese adults.

A Randomized Crossover Intervention Study on the Effect a Standardized Maté Extract (Ilex paraguariensis A. St.-Hil.) in Men Predisposed to Cardiovascular Risk.

(1) Background: Due to its richness in chlorogenic acids (CGAs), Maté (Ilex paraguariensis A. St.-Hil.) could be of interest in the prevention of cardiometabolic diseases, however clinical evidence are lacking. This trial aimed to evaluate the impact of maté CGAs, consumed in a daily dose achievable through traditional maté beverages, on parameters related to cardiometabolic risk. (2) Design: Thirty-four male volunteers aged 45–65 years and with at most one criteria of metabolic syndrome, were recruited for a randomized, double-blind, placebo-controlled, and crossover study. The volunteers were assigned to consume an encapsulated dry maté extract for four-weeks, providing 580 mg of caffeoyl quinic acid derivatives (CQAs) daily, or a placebo, with a two weeks washout between intervention periods. Anthropometric variables, blood pressure, plasma glucose, lipids, endothelial, and inflammatory biomarkers were measured in overnight-fasted subjects and after a glucose load. (3) Results: We found no significant effects of treatment on these parameters and the response to the glucose load was also similar between the two interventions. However, a significant decrease in fasting glucose was observed between day 0 and day 28 for the maté group only (−0.57 ± 0.11 mmol/L, p < 0.0002). In subjects with an intermediate to high Framingham risk score, consumption of maté extract induced a 10% increase of high-density lipoprotein (HDL)-c from baseline. In a subgroup representative of the study population, significant decreases in the C-reactive protein (CRP) (−50%) and interleukin-6 (IL-6) (−19%) levels were observed. (4) Conclusions: These clinical observations suggest that maté, naturally rich in CGAs, could improve some cardiometabolic markers in subjects with a higher predisposition to metabolic syndrome, even if that remains to be confirmed in new trials specifically targeting this population.

Statin Use and Major Adverse Cardiac Events among High Cardiac Risk Patients with Lung Cancer Receiving Radiotherapy

Statin use is recommended in patients with high Framingham risk or established coronary heart disease (CHD). Patients with lung cancer have a high prevalence of pre-existing CHD and face excess cardiac risk following thoracic radiotherapy (RT). We sought to characterize statin use by cardiac risk in a large cohort of patients with locally advanced non-small cell lung cancer (NSCLC) treated with RT. Retrospective analysis of 748 locally advanced NSCLC patients treated with thoracic RT. Patients were stratified by 10-year Framingham risk. High cardiac risk was defined as either high (≥20%) Framingham risk or pre-existing CHD or CHD risk equivalent. The cumulative incidence of major adverse cardiac events (MACE; unstable angina, heart failure, myocardial infarction [MI], coronary revascularization, and cardiac death) was estimated and Fine and Gray regressions were performed (non-cardiac death as a competing risk). The median follow-up was 20 months overall and 48 months in patients alive. Among CHD-negative patients (64.2%), 27.9% were low Framingham risk, 25.0% moderate and 47.1% high risk. At the time of RT, statin use by Framingham risk group (low, moderate, or high) or known CHD was 15.7%, 25.8%, 37.2%, and 63.1%, respectively. Among all high cardiac risk patients (66%, n = 496), only 51.2% were on a statin at the time of RT. High cardiac risk patients on statins (compared to no statin) were more likely to have a history of hypertension (73.3% vs. 51.4%, P<.001), hyperlipidemia (83.4% vs. 29.2%, P<.001), diabetes (28.1% vs. 11.5%, P<.001), former smoking (62.1% vs. 49.4%, P = .017), peripheral vascular disease (17.1 vs. 7.4%, P = .001), stroke (4.4% vs. 1.2%, P = .032), coronary artery disease (52.2% vs. 32.5%, P<.001), MI (49.6% vs. 26.0%, P = .001), and congestive heart failure (17.8% vs. 6.6%, P<.001), with no significant difference in age, sex, performance status, cancer stage, chemotherapy use, RT prescription dose, or cardiac or coronary RT dose exposure (P>.05). Statin use was associated with increased risk of MACE in high cardiac risk patients on univariable analysis (hazard ratio [HR] 1.76; 95% CI: 1.06-2.90; P = .027) with 2-year MACE estimates of 10.9% vs. 4.5%, but not when adjusted for known cardiac prognostic factors (P = 0.4). Only half of statin-eligible high cardiac risk patients with locally advanced NSCLC are on a statin at the time of RT. Even among high cardiac risk patients, those on statins harbored significantly more cardiac risk factors than those not on statins, suggesting only those of highest cardiac risk are on anti-lipid therapy at the time of RT. These results highlight that NSCLC patients represent a distinctly high cardiac risk population due to elevated baseline risk factors and cardiac radiation exposure with an unmet need for improved cardiac risk reduction, including optimization of medical therapy.

Eligibility of the Systolic Blood Pressure Intervention Trial (SPRINT) to the Chinese Adults.

Objective To explore the proportion and characteristic of Chinese adults meeting The Systolic Blood Pressure Intervention Trial (SPRINT) eligibility criteria and assess its generalizability. Method Our study was based on a cross-sectional, population-based survey with a sample of 26,093 participants aged over 20 years. The SPRINT eligibility criteria were age ≥ 50 years, elevated SBP of 130 to 180 mmHg depending on the number of antihypertensive medication classes being taken, and increased cardiovascular disease (CVD) but without diabetes, history of stroke and estimated glomerular filtration rate < 20 ml/min/1.73 m2, or receiving dialysis. Results Overall, we estimated that 4,036 (15.5%) participants would meet the SPRINT eligibility criteria. They were generally older, likely to be female, lower educational level, tended to be more overweight, and had higher Framingham risk score compared with overall population or subjects aged ≥ 50 years. Of participants eligible for SPRINT, most (56.2%) of them were not treated for hypertension, and 542 (13.4%) were not previously considered to have hypertension or need for antihypertension therapy. Among the 11,637 adults with hypertension, 3,494 (30.0%) would potentially benefit from treatment intensification. The most common antihypertensive medication class being taken was diuretic agents. Conclusion A substantial percentage of Chinese subjects meet the SPRINT eligibility criteria. Further studies are needed to assess the cost-effectiveness from treatment intensification in Chinese setting.

Children First Study II: an educational programme on cardiovascular prevention in public schools can reduce parents' cardiovascular risk.

The aim of this study was to analyze whether the implementation of a multidisciplinary educational programme for cardiovascular prevention in public schools can contribute to reducing the FramINGHAM CARDIOVASCULAR RISK SCORE OF THE CHILDREN'S PARENTS AFTER ONE YEAR. This was a prospective, community-based, case-control study carried out in public schools in Sao Paulo, Brasil. Students were randomized to receive healthy lifestyle recommendations by two different approaches. The control group received written cardiovascular health educational brochures for their parents. The intervention group received the same brochures for the parents, and the children were exposed to a weekly educational programme on cardiovascular prevention with a multidisciplinary health team for one year. Clinical and laboratorial data were collected at the onset and end of the study. We studied 265 children and their 418 parents. At the baseline, the rate of parents with intermediate or high Framingham scores (risk of cardiovascular disease over the next 10 years greater than 10%) was 6.9% in the control group and 13.3% in the intervention group. After one year, the rate of parents with intermediate or high Framingham risk score was reduced by 22.2% in the intervention group and increased by 33.3% in the control group (p=0.031). The cardiovascular risk factors that improved in the intervention group were blood pressure, LDL-cholesterol (low-density lipoprotein cholesterol), and glucose levels. An educational programme on cardiovascular prevention for school-age children in public schools can reduce the cardiovascular risk of their parents.

The association between job strain, depressive symptoms, and cardiovascular disease risk: results from a cross-sectional population-based study in Québec, Canada.

Job strain (high psychological demands and low decision control) has been associated with cardiovascular disease (CVD). It is unclear if job strain is associated with CVD risk score independently of depression, an established risk factor for CVD. This study investigated whether there is an association between job strain and CVD risk score, when depressive symptoms are controlled for. Sex differences were examined. Data came from the CARTaGENE study, a community health survey of adults in Québec, Canada (n = 7848). Participants were working adults aged 40-69years. CVD risk was estimated using the Framingham risk score. Job strain was measured as the ratio of job demands to control using the Job Content Questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression analyses were conducted to examine the association between job strain and CVD risk score controlling for depressive symptoms. There was no interaction effect between job strain and depressive symptoms in the association with CVD risk score. High job strain was reported in approximately 21% of participants, high Framingham risk score was observed in approximately 9%. Job strain was associated with the Framingham risk score (B = 0.73, p < 0.001, adjusted for age, sex, and education) and controlling for depressive symptoms did not significantly change the association (B = 0.59, p < 0.001). The results suggest that the job strain is associated with CVD risk score and that this association is not explained by depressive symptoms. Similar associations were observed for males and females.

Natural course of coronary artery calcium progression in Asian population with an initial score of zero

BackgroundWe aimed to investigate the natural course of coronary artery calcium progression in an Asian population with a baseline coronary artery calcium (CAC) score of zero, and to determine subclinical coronary atherosclerosis.MethodsFour hundred fifty-nine subjects with at least two CAC scans with an initial score of zero were included. CAC progression (+) was defined by the development of any CAC (i.e., CAC > 0) during subsequent CT scans. Clinical characteristics and Framingham risk profiles were also recorded.ResultsAmong 459 subjects, 106 (23.09%) experienced CAC progression during the average follow-up period of 5.71 ± 2.68 years. Older age, male gender, HDL-C, total cholesterol and higher Framingham risk score were independently associated with CAC progression. Framingham risk score had the better discriminative ability (AUC = 0.660) to predict CAC progression compared to the other parameters with a sensitivity of 75.24% and specificity of 53.95%. For the double zero score with coronary artery atherosclerosis prediction, older age, triglycerides, hypertension, and Framingham risk score were significantly associated with these events. Among these parameters, Framingham risk score may be a relatively acceptable parameter with high negative predictive (NPV = 96.4%) value to rule out double zero score with obstructive coronary artery atherosclerosis scenario with an optimum cut-off value of <16.9 (AUC =0.652, sensitivity of 57.69%; specificity of 68.82%).ConclusionsA baseline zero CAC score in asymptomatic Chinese population with low to intermediate risk have a low incidence for CAC progression within the 5-years period. For CAC progression prediction, Framingham risk score with the cutoff < 11.1 may help confirm subjects at low risk to improve cardiovascular risk stratification and reclassification in the field of preventive cardiology.

The Effect of Add-on Garcinia mangostana L. Extract on Endothelial Dysfunction in Type 2 Diabetes Mellitus Subjects with High Risk Framingham Score: A Cohort Study

Background : Garcinia mangostana L. has been extensively used for years as antioxidant and anti-inflammation. However, its role in the context of endothelial disease was lacking. Objectives : To assess the effect of add-on G. mangostana L. extracts on endothelial dysfunction in type 2 diabetes subjects with high-risk Framingham score, compared to placebo. Methods : This was a prospective cohort study conducted in type 2 diabetes subjects with high-risk Framingham score. Subjects were randomized into two groups. The first group received 2,520 mg/day of G. mangostana L. extract. The second group was given a placebo for 90 days. The outcome measure of our study was the levels of endothelial progenitor cell (EPC), circulating endothelial cell (CEC), nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), Superoxide dismutase (SOD) and fasting blood glucose. Multiple linear regression was used to determine the correlation and effect estimate. Results: A total of 49 patients were included in our study. Of those, elevated levels of EPC and SOD were observed in treatment group compared to placebo. On the other hand, the level of CEC, IL-1, Il-6, NO, MDA, TNF-α, fasting blood glucose and HbA1c was found significantly lower than placebo. Conclusion: Garcinia mangostana L. extract is associated with an increased levels of EPC and SOD, and it is also correlated with a decreased levels of CEC, IL-1, Il-6, NO, MDA, TNF-α, fasting blood glucose and HbA1c.

Association of Cardiovascular Mortality and Deep Learning-Funduscopic Atherosclerosis Score derived from Retinal Fundus Images

The prediction of atherosclerosis using retinal fundus images and deep learning has not been shown possible. The purpose of this study was to develop a deep learning model which predicted atherosclerosis by using retinal fundus images and to verify its clinical implications by conducting a retrospective cohort analysis. Retrospective cohort study. The database at the Health Promotion Center of Seoul National University Hospital (HPC-SNUH) was used. The deep learning model was trained using 15,408 images to predict carotid artery atherosclerosis, which was named the deep-learning funduscopic atherosclerosis score (DL-FAS). A retrospective cohort was constructed of participants 30-80 years old who had completed elective health examinations at HPC-SNUH. Using DL-FAS as the main exposure, participants were followed for the primary outcome of death due to CVD until Dec. 31, 2017. For predicting carotid artery atherosclerosis among subjects, the model achieved an area under receiver operating curve (AUROC) and area under the precision-recall curve (AUPRC), accuracy, sensitivity, specificity, positive and negative predictive values of 0.713, 0.569, 0.583, 0.891, 0.404, 0.465, and 0.865 respectively. The cohort consisted of 32,227 participants, 78 cardiovascular disease (CVD) deaths, and 7.6-year median follow-up visits. Those with DL-FAS greater than 0.66 had an increased risk of CVD deaths compared to those with DL-FAS <0.33 (hazard ratio: 8.33; 95% confidence interval [CI], 3.16-24.7). Risk association was significant among intermediate and high Framingham risk score (FRS) subgroups. The DL-FAS improved the concordance by 0.0266 (95% CI, 0.0043-0.0489) over the FRS-only model. The relative integrated discrimination index was 20.45% and net reclassification index was 29.5%. A deep learning model was developed which could predict atherosclerosis from retinal fundus images. The resulting DL-FAS was an independent predictor of CVD deaths when adjusted for FRS and added predictive value over FRS.

Systolic Time Interval (STI) in Hypothyroid Patients Receiving High Dose L-Thyroxine

Introduction: Systolic Time Interval (STI) is a simple,noninvasive and precise technique to assess left ventricular (LV) function. It measures aortic Pre-Ejection Period (PEP) over Left Ventricular Ejection Time (LVET) from echocardiogram. Thyrotoxicosis will enhance LV function and cause reduction of STI. This study was perform to measure the changes of STI after administration of high dose L-thyroxine and to determine the correlation between high dose L-thyroxine administration and STI. Materials and Method: A Total of 22 patients were screened. Those with cardiac diseases and high Framingham risk score were excluded. Nine patients were started on high dose L-thyroxine (7x their usual dose) once a week during the month of Ramadan.Thyroid hormones ( T3,T4,TSH)Â and STI (PEP/LVET) were measured at baseline and within 24 hrs after high dose L-thyroxine ingestion. Results: All patients have normal thyroid hormones level and normal cardiac function at baseline. The median dose (mcg) of L-thyroxine was 600 (437.5,700) while the median level of fT4 (pmol/L) was 17.43(12.38,20.8). Despite the significant increment of fT4 after Lthyroxine ingestion [baseline 13.21(8.19,14.63) vs high dose 17.43(12.38,22.55) p; 0.011] there was no significant change in STI [baseline 0.3(0.2,0.4) vs high dose 0.28(0.26,0.45) p; 0.513]. There was no correlation found between the dose of Lthyroxine and STI (r=0.244 , p;0.526). Conclusion: Administration of high dose Lthyroxine did not significantly alter STI despite significant increment of fT4 level unlike the naturally occurring thyrotoxicosis.Therefore ‘exogenous’ administration of high dose L-thyroxine is cardiac safe.