History Of Cardiovascular Disease Events Research Articles

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. ClinicalTrials.gov Identifier: NCT03336255.

Association of the triglyceride glucose index with all-cause and cardiovascular mortality in a general population of Iranian adults

BackgroundThe triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries.PurposeTo examine the association between TyG index and risk of CVM and ACM in Iranians.MethodsThis prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index.ResultsAfter a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality.ConclusionThe predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Abstract 131: Association Between Left Ventricular Injury Detected by Cardiac MRI and Incident Ischemic Stroke: The Multi-Ethnic Study of Atherosclerosis

Background: The association between left ventricular injury (LVI) detected by cardiac magnetic resonance imaging (CMR) and the risk of a subsequent ischemic stroke is unknown. Methods: We studied stroke-free participants in the Multi-Ethnic Study of Atherosclerosis study who underwent a steady-state free precession CMR at Exam 5 (2010-2012). The exposure of interest was LVI defined by either LV ejection fraction (EF) < 50% or circumferential strain > -10 in any LV apical wall. The primary outcome was incident ischemic stroke. We performed Cox proportional hazard analysis to model the association between LVI and incident ischemic stroke, adjusting for demographic and clinical covariates. Results: The analytic sample consisted of 2,584 participants (n=302 or 11.7% with LVI, n=2,282 or 88.3% without LVI). There were a total of 18 ischemic stroke events among those with LVI (6%) and 65 among those without LVI (3%). Participants with LVI were significantly older, male, Black, had higher BMI, and lower HDL. Participants with LVI were more likely to have diabetes, tobacco use, and atrial fibrillation (24% versus 14%, p<0.001). There was no significant difference in history of cardiovascular disease events (6% versus 4%, p=0.143). LVI was significantly and independently associated with incident ischemic stroke (adjusted hazard ratio 1.80, 95% C.I. 1.04-3.12). When participants were stratified into 3 mutually exclusive groups of no LVI, LVEF > 50% and LV apical circumferential strain < -10, and LVEF < 50% and LV apical circumferential strain > -10, the hazard of incident ischemic stroke was significantly higher for each of the two latter groups compared to the no LVI group (log-rank p-value=0.003; Figure 1 ). Conclusion: LVI identified by CMR is a significant, independent predictor of incident ischemic stroke. LV apical circumferential strain > -10% may be a novel and quantitative stroke risk factor. Further studies are needed to validate these CMR biomarkers of stroke risk.

Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India.

The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India. We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.

P684 Increased risk of cardiovascular disease and high risk profiles compatible with metabolic syndrome in patients with Inflammatory Bowel Disease: a cross-sectional analysis of matched cohorts

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased risk of cardiovascular disease (CVD). This probably results from a cumulative effect of chronic inflammation and traditional CVD risk factors. We assessed the CVD risk profile of IBD patients as compared to the general population. Methods In this cross-sectional study, consecutive IBD patients aged ≥45 years were included at the Gastroenterology and Hepatology outpatient clinic. CVD risk profiles wese assessed by anthropometrics (blood pressure, length, weight, waist and hip circumference), serum analyses (nonfasting glucose and lipid spectrum) and self-administered questionnaires (history of CVD events, traditional CVD risk factors, medication use). One to four controls from the Rotterdam Study were matched to each IBD case by sex and age (scope +-5 years). Stratification was applied to asses differences between sex, IBD diagnosis and clinical disease activity (HBI or SCCAI>5). Results 235 IBD patients were included (44% male; median age 59 years (IQR 51–66)) and matched to 829 controls (44% male; median age 62 years (IQR 57–68)). IBD patients were more frequently diagnosed with CVD (OR 2.01, 95%CI 1.23–3.27). IBD patients showed lower odds of overweight defined as BMI ≥25 kg/m2 (OR 0.48, 95%CI 0.35–0.66) and hypercholesterolemia defined as total cholesterol ≥6.2 mmol/L, self-reported diagnosis or use of lipid lowering drugs (OR 0.45, 95%CI 0.31–0.65). The following markers of metabolic syndrome were increased in IBD patients: hypertension defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, self-reported diagnosis or use of antihypertensive drugs (OR 1.67, 95%CI 1.19–2.32), waist circumference (92 cm (SE±10) vs 88 cm (SE±8), p=.006) and triglyceride level (2.7 mmol/L (SE±0.8) vs 2.1 (SE±0.8), p<.001). (Table 1) Male patients had higher waist circumference, less favorable lipid profiles and were more frequently diagnosed with hypertension (OR 1.72, 95%CI 0.99–2.94) as compared to female patients. Patients with ulcerative colitis were more frequently smokers (OR 4.34, 95%CI 1.27–16.66) and showed higher odds of hypercholesterolemia (OR 1.85, 95%CI 1.06–3.33) as compared to patients with Crohn’s disease. Conclusion Patients with IBD are more frequently diagnosed with CVD as compared to age-sex matched controls. The CVD risk profile in IBD patients is characterized by components of the metabolic syndrome, i.e. hypertension, truncal obesity and hypertriglyceridemia, particularly among male IBD patients. The prevalence of other traditional CVD risk factors was comparable or even lower in IBD patients as compared to controls. The exploration of targeted preventive management strategies is required.

Adherence to antihypertensive medications for secondary prevention of cardiovascular disease events: a dose-response meta-analysis

ObjectivesThe aim of the study was to explore the association between adherence to antihypertensive medications (AHMs) and the risk of recurrence of cardiovascular disease (CVD) events in patients with a history of CVD events from cohort studies. Study designThis is a dose-response meta-analysis. MethodsPubMed and Embase databases were searched up to March 4, 2021, to identify English-language reports of cohort studies that assessed the association of AHM adherence with risk of recurrence of CVD events. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association. ResultsWe included nine cohort studies (54,349 patients) in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.54–0.78) for the highest versus lowest AHM adherence category. We did not find any evidence of non-linearity association between AHM adherence and risk of CVD events (Pnon-linearity = 0.534); for patients with a history of CVD events, the risk of CVD events was reduced by 9% for each 20% increase in AHM adherence (RR, 0.91; 95% CI, 0.85–0.97). The results of sensitivity analysis and subgroup analysis were virtually unchanged. ConclusionsThe high level of adherence to AHM is an effective strategy for preventing recurrence of CVD events. Patients with a history of CVD events should adhere to AHM.

Genetic variants associated with inherited cardiovascular disorders among 13,131 asymptomatic older adults of European descent

Genetic testing is used to optimise the management of inherited cardiovascular disorders that can cause sudden cardiac death. Yet more genotype–phenotype correlation studies from populations not ascertained on clinical symptoms or family history of disease are required to improve understanding of gene penetrance. We performed targeted sequencing of 25 genes used routinely in clinical genetic testing for inherited cardiovascular disorders in a population of 13,131 asymptomatic older individuals (mean age 75 years) enrolled in the ASPREE trial. Participants had no prior history of cardiovascular disease events, dementia or physical disability at enrolment. Variants were classified following ACMG/AMP standards. Sudden and rapid cardiac deaths were clinically adjudicated as ASPREE trial endpoints, and assessed during mean 4.7 years of follow-up. In total, 119 participants had pathogenic/deleterious variants in one of the 25 genes analysed (carrier rate of 1 in 110 or 0.9%). Participants carried variants associated with hypertrophic cardiomyopathy (N = 24), dilated cardiomyopathy (N = 29), arrhythmogenic right-ventricular cardiomyopathy (N = 22), catecholaminergic polymorphic ventricular tachycardia (N = 4), aortopathies (N = 1), and long-QT syndrome (N = 39). Among 119 carriers, two died from presumed sudden/rapid cardiac deaths during follow-up (1.7%); both with pathogenic variants in long-QT syndrome genes (KCNQ1, SCN5A). Among non-carriers, the rate of sudden/rapid cardiac deaths was significantly lower (0.08%, 11/12936, p < 0.001). Variants associated with inherited cardiovascular disorders are found in asymptomatic individuals aged 70 years and older without a history of cardiovascular disease.

Clinical Significance of the Cardio-Ankle Vascular Index in Postmenopausal Women With Hypercholesterolemia

Background: The cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia. Methods: A total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined. Results: A significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI. Conclusion: The present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients. J Clin Med Res. 2021;13(5):276-282 doi: https://doi.org/10.14740/jocmr4509

Clinical Significance of the Cardio-Ankle Vascular Index in Postmenopausal Women With Hypercholesterolemia.

BackgroundThe cardio-ankle vascular index (CAVI) is a physiological indicator of arterial elasticity. However, limited information regarding the clinical significance of the CAVI in patients with hypercholesterolemia is available. This cross-sectional study aimed to elucidate the clinical significance of the CAVI for the primary prevention of cardiovascular disease (CVD) among postmenopausal women with hypercholesterolemia.MethodsA total of 168 untreated postmenopausal hypercholesterolemic women (low-density lipoprotein cholesterol levels ≥ 140 mg/dL, mean age ± standard deviation, 63 ± 10 years) with no history of CVD events were enrolled. The CAVI was measured using commercial devices, after which, its relationships with various clinical parameters, such as carotid artery ultrasonography findings and CVD biomarkers, were examined.ResultsA significant positive correlation was observed between the CAVI and maximum intima-media thickness of the common carotid artery (max-C-IMT), which was evaluated using carotid artery ultrasonography (r = 0.49, P < 0.001). Regarding CVD biomarkers, the CAVI was significantly correlated with estimated glomerular filtration rate (r = -0.18, P < 0.001), high-sensitivity C-reactive protein (r = 0.36, P < 0.001), whole blood passage time as a marker of blood rheology (r = 0.41, P < 0.001), and skin autofluorescence as a marker of advanced glycation end products in tissues (r = 0.46, P < 0.001), although no significant correlation was noted between serum lipid parameters and the CAVI. Multiple regression analysis identified max-C-IMT (β = 0.35, P < 0.001), whole blood passage time (β = 0.18, P = 0.007), skin autofluorescence (β = 0.17, P = 0.011), and age (β = 0.16, P = 0.018) as variables independently associated with CAVI.ConclusionThe present study indicated that the CAVI is an essential CVD risk factor among postmenopausal women with hypercholesterolemia. Moreover, impaired blood rheology and increase of skin autofluorescence were associated with elevated CAVI in such patients.

Risk of cardiovascular events in men on abiraterone or enzalutamide combined with GnRH agonists: nation-wide, population-based cohort study in Sweden

Background Men with prostate cancer (PCa) on gonadotropin-releasing hormone agonists (GnRH) have an increased risk of cardiovascular disease (CVD) compared to men with PCa not on GnRH as well as compared with PCa-free men. Whether the addition of androgen receptor targeted (ART) drugs to GnRH further increases CVD risk, remains to be fully elucidated. Material and methods We investigated risk of CVD for men with castration resistant PCa (CRPC) on GnRH plus ART; abiraterone or enzalutamide vs 5,127 and 12,079 respective matched comparator men on GnRH in Prostate Cancer data Base Sweden (PCBaSeTraject) 4.1 between 1 June 2015 and 31 December 2018. PCBaSeTraject links National Prostate Cancer Register of Sweden to other healthcare registries and demographic databases. We conducted multivariable Cox proportional hazard models adjusting for PCa risk category, Charlson comorbidity index (CCI), insulin or statin use, civil status, level of education, history of CVD events and number of CVD drugs, with any incident or fatal CVD as the outcome. Results and conclusion 1,310 men were treated with abiraterone and 3,579 with enzalutamide. In multivariable analysis, CVD risk was increased in men on abiraterone (hazard ratio (HR): 1.19; 95% confidence interval (CI): 1.03–1.38) and in men on enzalutamide (HR: 1.10; 95% CI: 1.01–1.20). Men with a recent CVD (<12 months) including both men on ART as well as comparators had a much higher probability of a new CVD vs men with no prior CVD. CVD risk was mildly increased in men with PCa on GnRH plus abiraterone or enzalutamide vs comparator men on GnRH. Residual confounding and detection bias may at least partly explain this association.

Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly.

High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08-1.70]; P=0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04-2.33]; P=0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07-2.79]; P=0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04-1.54]; P=0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration- URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01038583; URL: https://www.isrctn.com; Unique identifiers: ISRCTN83772183.

Association of Disease Progression With Cardiovascular and Limb Outcomes in Patients With Peripheral Artery Disease: Insights From the EUCLID Trial.

Patients with peripheral artery disease have a high risk of future cardiovascular disease events and mortality. Little is known about the changes in symptom classification over time in patients with peripheral artery disease and the association of changes in symptom classification with subsequent cardiovascular disease events. In this analysis of the EUCLID trial (Examining Use of Ticagrelor in Peripheral Artery Disease), we examined the changes in Rutherford classification (RC) of patients over 12 months. We examined the baseline characteristics of patients by change in symptom classification at 12 months (improved=decreased RC, no change, or worsened=increased RC), and the association between changes in symptom classification (RC) at 12 months and subsequent cardiovascular disease events. Among 12 759 patients, 3240 (25%) were classified as improved by RC at 12 months, 8132 (64%) as no change, and 1387 (11%) as worsened. At 12 months, many patients who were asymptomatic or had mild/moderate claudication at enrollment had no change in symptom classification over 12 months (73.7% and 70.9%). Patients who worsened over 12 months were more likely to have comorbidities (diabetes mellitus and prior myocardial infarction) and more events (myocardial infarction, amputation, and major bleeding) by 12 months postrandomization, all P<0.001. Worsened symptom classification over 12 months was associated with increased risk of all-cause death (adjusted hazard ratio, 1.29 [95% CI, 1.03-1.62]), major amputation (adjusted hazard ratio, 4.12 [95% CI, 2.46-6.88]), and a composite of cardiovascular death, myocardial infarction, or stroke (adjusted hazard ratio, 1.30 [95% CI, 1.05-1.62]), all P<0.05 after 12 months postrandomization. Patients with comorbidities and prior history of cardiovascular disease events at baseline and within the first 12 months of the trial were more likely to have worsened symptom classification at 12 months. Worsening symptom classification over 12 months was associated subsequently with an increased risk of all-cause death, amputation, and a composite of cardiovascular death, myocardial infarction, or stroke. Graphic Abstract: A graphic abstract is available for this article.

Untreated hypertension in Russian 35-69 year olds - a cross-sectional study.

The Russian Federation has among the highest rates of cardiovascular disease (CVD) in the world and a high rate of untreated hypertension remains an important risk factor. Understanding who is at greatest risk is important to inform approaches to primary prevention. 2,353 hypertensive 35-69 year olds were selected from a population-based study, Know Your Heart, conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015-2018. The associations between untreated hypertension and a range of co-variates related to socio-demographics, health, and health behaviours were examined. The age-standardised prevalence of untreated hypertension was 51.1% (95% CI 47.8-54.5) in males, 28.8% (25.4-32.5) in females, and 40.0% (37.5-42.5) overall. The factors associated with untreated hypertension relative to treated hypertension were younger ages, self-rated general health as very good-excellent, not being obese, no history of CVD events, no evidence of diabetes or chronic kidney disease, and not seeing a primary care doctor in the past year as well as problem drinking for women and working full time, lower education, and smoking for men. The study found relatively high prevalence of untreated hypertension, especially, in men. Recent initiatives to strengthen primary care provision and implementation of a general health check programme (dispansarisation) are promising, although further studies should evaluate other, potentially more effective strategies tailored to the particular circumstances of this population.

Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians

Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ2 statistic to assess the model discrimination and calibration, respectively. The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.

Association of Post-Traumatic Stress Disorder Symptoms Following Hurricane Katrina With Incident Cardiovascular Disease Events Among Older Adults With Hypertension

ObjectiveTo determine the association of post-traumatic stress disorder (PTSD) symptoms following Hurricane Katrina with incident cardiovascular disease (CVD) events in older, hypertensive, community-dwelling adults both overall and stratified by age, sex, and race. MethodsThis was a prospective cohort study performed in Southeastern Louisiana 12–24 months following Hurricane Katrina through February 2011. Participants were community-dwelling older adults (n = 2,073) enrolled in the Cohort Study of Medication Adherence Among Older Adults with no known history of CVD events. PTSD symptoms were assessed via telephone interview 12–24 months following Hurricane Katrina using the PTSD CheckList-Specific Version. The presence of PTSD symptoms was defined by scores greater than or equal to 37. Incident CVD events (stroke, myocardial infarction, hospitalization for congestive heart failure, or CVD death) were identified and adjudicated over a median 3.8-year follow-up period. ResultsOverall, 8.6% of participants screened positive for PTSD symptoms, and 11.6% had an incident CVD event during follow-up. PTSD symptoms were associated with an adjusted hazard ratio (aHR) for CVD events of 1.7 (95% confidence interval [CI], 1.1, 2.6). The association was present among blacks (aHR, 3.3, 95% CI, 1.7, 6.3) but not whites (aHR, 0.9, 95% CI, 0.4, 1.9); the interaction of PTSD symptoms and race on CVD events was statistically significant. ConclusionPTSD symptoms following Hurricane Katrina were associated with a higher risk of incident CVD in older adults with hypertension, with a stronger association in blacks compared with whites.

Sex-specific incidence rates and risk factors of premature cardiovascular disease. A long term follow up of the Tehran Lipid and Glucose Study

ObjectivesTo investigate the risk factors for premature cardiovascular disease (CVD) and to quantify their population attributable fractions (PAFs) among an Iranian population during a median follow-up of 12years. MethodsA total of 2235 men and 3703 women, aged ≥30years, free of CVD at baseline were entered into the study. Premature CVD was defined as having a history of CVD events before the age of 55 and 65 for men and women, respectively. Multivariate Cox proportional hazard regression models were used to determine the risk factors associated with premature CVD events. ResultsDuring the study, incident rates of premature CVD were 4.8 and 3.9 per 1000 person years for men and women, respectively. Low HDL-C [Hazard ratio: 1.74, 95% confidence interval: 1.11–2.74], hypercholesterolemia [3.01: 2.02–4.49], current smoker [1.68: 1.12–2.51], family history of premature CVD [2.04: 1.36–3.07], hypertension [1.65: 0.97–2.81, P=0.06] and type 2 diabetes(T2D) [1.98: 1.16–3.40] were significant predictors among men; the corresponding PAFs were 32.7, 29.4, 19.4, 14.9, 8.7 and 7.9%, respectively. Among women, T2D [3.02: 2.08–4.39], hypercholesterolemia [1.65: 1.19–2.29], being overweight [1.79: 1.01–3.17], hypertension [1.54: 1.01–2.34], family history of premature CVD [1.65: 1.19–2.29], high physical activity [0.67: 0.46–0.96] and prediabetes [1.48: 1.00–2.18] were significant predictors; the corresponding PAFs were 25.4, 22.5, 18.5, 16.8, 11.4, −10.3 and 9.1%, respectively. ConclusionsConsidering the high burden imposed on health system by cardio-metabolic risk factors, dietary, behavioral and pharmacological interventions are need to be initiated early to prevent premature CVD, taking into account the sex-related differences between risk factors.

Predictors of all-cause and cardiovascular disease mortality in type 2 diabetes: Diabetes Heart Study.

BackgroundMany studies evaluated the best predictors for cardiovascular disease (CVD) events in individuals with type 2 diabetes (T2D), but few studies examined the factors most strongly associated with mortality in T2D. The Diabetes Heart Study (DHS), an intensively phenotyped family-based cohort enriched for T2D, provided an opportunity to address this question.MethodsAssociations with mortality were examined in 1022 European Americans affected by T2D from 476 DHS families. All-cause mortality was 31.2 % over an average 9.6 years of follow-up. Cox proportional hazards models with sandwich-based variance estimation were used to evaluate associations between all-cause and CVD mortality and 24 demographic and clinical factors, including coronary artery calcified plaque (CAC), carotid artery intima-media thickness, medications, body mass index, waist hip ratio, lipids, blood pressure, kidney function, QT interval, educational attainment, and glycemic control. Nominally significant factors (p < 0.25) from univariate analyses were included in model selection (backward elimination, forward selection, and stepwise selection). Age and sex were included in all models.ResultsThe all-cause mortality model selected from the full DHS sample included age, sex, CAC, urine albumin: creatinine ratio (UACR), insulin use, current smoking, and educational attainment. The CVD mortality model selected from the full sample included age, sex, CAC, UACR, triglycerides, and history of CVD events. Beyond age, the most significant associations for both mortality models were CAC (2.03 × 10−4 ≤ p ≤ 0.001) and UACR (1.99 × 10−8 ≤ p ≤ 2.23 × 10−8). To confirm the validity of the main predictors identified with model selection using the full sample, a two-fold cross-validation approach was used, and similar results were observed.ConclusionsThis analysis highlights important demographic and clinical factors, notably CAC and albuminuria, which predict mortality in the general population of patients with T2D.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-015-0055-y) contains supplementary material, which is available to authorized users.

Prevalence of cardiovascular disease (CVD) risk factors and preventive care among U.S. cancer survivors.

9592 Background: CVD is a major cause of mortality in cancer survivors. Prior claims-based studies suggested underutilization of preventive care in cancer survivors, but most CVD preventive care items are not available in claims data. We directly examined the prevalence of CVD risk factors and receipt of care in survivors compared to the non-cancer general population (control) using the National Health Interview Survey. Methods: 32,934 cancer survivors interviewed between 1999 and 2011 were matched to 65819 controls based on age, race, and history of CVD events (angina, myocardial infarction, stroke). Statistical analysis accounted for population sampling weight. Results: CVD risk factors were prevalent among cancer survivors (Table), and 33% continued to smoke. Primary care visits were reported more often among survivors compared to controls (83% vs 74%, p&lt;0.001). A high proportion of survivors and controls received monitoring for diagnosed CVD risk factors, while rates of interventions to modify the risk factors were more modest. On multivariable logistic regression models, having a general doctor visit was associated with increased monitoring for all CVD risk factors examined (hypertension, hyperlipidemia, diabetes, obesity, smoking), but there was no significant difference between cancer vs control. Conclusions: Cancer survivors in the US receive comparable monitoring and interventions for CVD risk factors compared to non-cancer individuals. Survivorship care involving a general doctor was associated with improved monitoring of CVD risk factors. [Table: see text]

Abstract P262: Comparison of Contemporary, Highly-sensitive and Supersensitive Troponin Assays as Predictors of Incident Cardiovascular Events - A Prospective Analysis of the Finrisk 1997 Cohort

Introduction: Besides the role in diagnosis of acute cardiac events, troponins seem to be powerful biomarkers in terms of risk stratification in the general population. The objective of our study was to compare the performance of three troponin assays with different sensitivities in cardiovascular disease (CVD) risk prediction in a population-based cohort without a history of CVD events. We hypothesized that troponins may predict future CVD events even in healthy individuals and that the predictive power may depend on the sensitivity of the assay. Methods: Troponin I concentrations were measured using a contemporary sensitive (Abbott TnI), a highly sensitive (Abbott hsTnI), and a supersensitive assay (Singulex) in participants aged 25-74 years of the FINRISK 1997 cohort, followed up for 14 years. Individuals with a history of major adverse cardiovascular event (MACE, n=470) and pregnant women (n=76) were excluded and 7,899 persons were included in the analysis. Study endpoints were defined as incident myocardial infarction (MI), coronary heart disease (CHD), CVD (including all of the above plus ischemic stroke), incident heart failure (HF) and MACE (including all of the above). We used Cox proportional hazards regression to determine relative risks per one standard deviation increment in troponin, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Results: During follow-up, we observed 1,074 incident MACE, which included 277 MI events, 529 CHD events, 770 CVD events, and 505 cases of HF. We observed significantly (p&lt;0.001) increased hazard ratios (HR) for the supersensitive troponin assay for incident MI (HR 1.24 [95% confidence interval (CI) 1.11-1.39]), and CVD (HR 1.15 [CI 1.07-1.24]). For HF and MACE, both highly sensitive and supersensitive troponin showed significantly increased HR (HF: 1.19 [CI 1.1-1.3] and 1.28 [CI 1.18-1.39]; MACE 1.12 [CI 1.05-1.19] and 1.18 [CI 1.11-1.25]), respectively. There was no overall improvement in net reclassification (NRI). Focusing on the clinical NRI, which determines reclassification in individuals with an intermediate risk according to the Framingham risk score, the NRI was significantly improved for HF (NRI 10.2%, p&lt;0.001), and MACE (NRI 5.1%, p&lt;0.001), when using the supersensitive troponin assay. Conclusions: In our large population-based cohort high-sensitivity troponin assays improved risk prediction for cardiovascular endpoints. The use of a supersensitive troponin assay led to an improvement of the clinical NRI for MACE, HF, and CHD.

Universal pediatric lipid screening: preventing future cardiovascular disease in high-risk children

Case 1: 11-year-old boy at a routine well-child visit A review of systems is negative. He plays three sports and maintains an optimal diet through his mother’s efforts and, recently, his own volition. His paternal grandfather died at age 40 years in a work-related accident. There is no known family history of lipid disorders. Examination shows normal BMI, normal blood pressure and no other abnormalities. Upon lipid screening, he is noted to have nonfasting non-HDL-C of 255 mg/dl. Upon fasting lipid profile, his LDL-cholesterol (LDL-C) is 240 mg/dl. His parents are subsequently tested and his 33-year-old father is noted to have a LDL-C of 250 mg/dl. In this patient, there were no features that would have triggered concerns for hyperlipidemia, such as a family history of hyperlipidemia or early atherosclerotic events. Despite an optimal lifestyle, he has dramatically elevated LDL-C due to a genetic dyslipidemia, heterozygous familial hypercholesterolemia (FH). The approximately 1 in 500 children born with FH demonstrate persistently elevated LDL-C concentrations of at least 160 mg/dl and typically over 200 mg/dl. Approximately 50% of affected men and 20% of affected women experience coronary heart disease events by the age of 50 [2,3]. Multiple studies have shown that relying on a family history of CVD events or hyperlipidemia to trigger screening is insufficiently sensitive and may miss 30–60% of affected children owing to a lack of knowledge about the family history, lack of In November 2011, after a systematic review of the relevant literature, the National Heart Lung, and Blood Institute (NHLBI) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents published evidence-based, integrated guidelines on preventing cardiovascular disease (CVD) by reduction of athero sclerotic disease risk factors in children and adolescents [1]. These guidelines encourage the broad adoption of healthy behavioral patterns, beginning in childhood, to prevent the development of athero sclerotic CVD risk factors – so-called ‘primordial prevention’. The guidelines endorse a healthy diet and activity patterns at a population level, as well as the individual practitioner–child–family unit as cornerstones of CVD prevention. Predicated upon evidence linking childhood CVD risk factors to adult risk factor prevalence, subclinical athero sclerosis and CVD events, the panel also comprehensively updated and rationally extended a number of previous guidelines advocating individual -level identification and management of CVD risk factors including nutrition, physical activity, tobacco exposure, elevated blood pressure, obesity, diabetes mellitus and metabolic syndrome. One significant extension pertained to lipid disorders, where the panel recommended screening of all children once between 9 and 11 years of age with a nonfasting non-HDL-cholesterol (HDL-C). This recommendation was designed to identify those children with extreme lipid abnormalities, usually due to a genetic dyslipid emia, in whom the risk of early CVD is established and treatment is available. When abnormal values are confirmed, identified children should be treated with targeted nutritional changes, physical activity and, when