History Of Heart Attack Research Articles

Self-efficacy, Knowledge and Outcomes Expectations Foot Self-care among Diabetic Patients with High-Risk Feet in Jordan

Background: Patients with high-risk feet and diabetes are prone to develop diabetes-related foot ulcers (DFUs). To prevent DFUs and their costs and impacts on diabetes mellitus (DM) patients’ productivity and quality of life, patients’ foot self-care (FSC) practices are essential to screen for DFUs. Our study aimed to assess the self-efficacy and outcome expectations about FSC and evaluate the knowledge about DFUs among patients with DM in Jordan. Methods: A cross-sectional study was conducted with DM patients who attended two diabetes clinical centers in Jordan in the period from October 2022 to April 2023 in which data were collected through a self-administered questionnaire developed to assess patients’ understanding of DFUs, foot care outcomes expectations (FCOE), and self-efficacy about FSC. Results: The final sample included data from 107 patients. Patient awareness of DFUs and FCOE was good, and the level of self-efficacy for FSC was moderate to high. Multiple linear regression revealed that age was negatively associated with lower self-efficacy for FSC (β = -0.22, p = 0.03) and both confidence (self-efficacy) in FSC and living arrangements (i.e., living with family) were positively associated with higher FCOE (β = 0.19, p = 0.04 and β = 0.39, p <0.001, respectively). Diagnosis of renal failure, diagnosis of retinopathy, elevated levels of glycated hemoglobin, and the settings in which the patient is receiving care for DM were positively associated with an understanding of DFUs. Both age and history of heart attacks and coronary artery disease were negatively associated with realizing DFUs (β = -0.26, p = 0.007, and β = -0.18, p = 0.045, respectively). Conclusion: Patients with diabetes mellitus in Jordan have good FCOE, good awareness of DFUs, and a moderate degree of self-efficacy to execute FSC. Health education and self-efficacy programs should focus on older adults with a history of heart attacks to boost their understanding of DFUs and raise their sense of self-efficacy around FSC.

Determining the Relationship Between Sleep Problems, Shock Pain, and Shock Anxiety in Patients With ICD.

This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors. The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40±3.36; the mean FSAS score was 29.98±8.46; the mean PSQI score was 8.02±3.81; the mean ESS score was 7.59±4.10. PSQI had a statistically significant correlation with the total FSAS score (p<0.001) and a statistically insignificant correlation with ESS (p>0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares. It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".

Polygenic prediction of coronary artery disease among 130,000 Mexican adults

Abstract Background Coronary artery disease (CAD) is a leading cause of premature mortality globally. Polygenic risk scores (PRSs) have been reported to enhance CAD prediction in populations of European ancestry but evidence from other populations is limited. We assessed the transferability and relevance of eight different external PRSs to the odds of premature CAD in a Mexican population with high levels of relatedness and ancestry admixture. Methods 128,388 genotyped participants aged 35-74 years who were recruited between 1998 and 2004 into the Mexico City Prospective Study (MCPS) were included. We selected and recreated eight previously-reported CAD PRSs. The number of single nucleotide polymorphism variants included in the PRSs varied from 44 to 6,472,620. Premature CAD was defined as either self-reported history of heart attack or angina at recruitment or death before age 75 with CAD recorded on the death certificate. Age and sex-adjusted logistic regression was used to estimate the ability of each PRS to predict CAD, both overall and separately by age, sex and estimated proportion of Indigenous American ancestry. Analyses were repeated after further adjustment for conventional risk factors (blood pressure, adiposity, smoking, diabetes and highest education achieved). Risk discrimination was assessed using C-statistic. Results Of the 128,388 participants, 68% were women, mean (SD) age was 50.2±10.9 years and the average proportion of Indigenous American ancestry was 67%. CAD was identified for 3,871 (3.0%) participants; prior CAD was reported by 1,669 (1.3%) participants while 2,360 (1.8%) participants died before age 75 years with CAD mentioned on the death certificate. All eight PRSs were positively and approximately log-linearly associated with the odds of CAD, but the strength of association varied between the PRSs, ranging from a 7% increase per 1SD higher PRS (odds ratio [OR] 1.07, 95% CI 1.04-1.11) to a 33% increase (OR 1.33, 95% CI 1.29-1.37). Collectively, age, sex and (any) PRS resulted in a C-statistic of 0.70-0.71. C-statistics were slightly lower among those with a higher proportion of indigenous American ancestry. For four of the eight PRSs (including three of the four multi-ancestry PRSs) the increase in odds of CAD per 1SD higher PRS was significantly greater for men than women (eg, for the PRS with the strongest overall association with CAD the OR per 1SD higher PRS was 1.43 [95% CI 1.36-1.49] in men and 1.25 [1.20-1.31] in women). Further inclusion of conventional vascular risk factors reduced the strengths of associations of each PRS with CAD only slightly but increased the model C statistic to 0.74 in all cases. Conclusions In this population of admixed Mexican adults, existing PRSs predicted CAD reasonably well and independently of conventional vascular risk factors. Ancestry-specific instruments that more closely represent genetic variation in Mexico may further enhance polygenic prediction of CAD risk.Table 1.Baseline characteristicsFigure 1.Main analysis results

Risk factors associated with consumption of alcohol among Turkish older men and women

ABSTRACT Objectives This study aims to examine the factors associated with alcohol use among individuals aged 60 and above in Türkiye. Methods The microdata obtained from the Türkiye Health Survey conducted by the Turkish Statistical Institute (TSI) in 2019 and 2022 were used in this study. Binary logistic regression analysis was employed to identify variables associated with alcohol use in older adults. Results The analysis revealed that gender, age, education level, employment status, marital status, health condition, lung disease, history of heart attack, kidney disease, Alzheimer’s disease, difficulty in carrying or holding items, and tobacco use significantly influence alcohol use among older individuals. Conclusion The study concludes that older males are at a higher risk of alcohol use. It is recommended to develop preventive health programs tailored to address the specific reasons for alcohol initiation and use among men. Aging is a period characterized by reduced activity in both work and social life due to retirement, leading some older individuals to turn to alcohol consumption as a coping mechanism. To promote active aging, it is suggested that the number of senior clubs and elderly solidarity centers affiliated with municipalities should be increased.

Association between female infertility and stroke mortality: evidence from the PLCO cancer screening trial.

While infertility affects about 15% of women during their reproductive years, its long-term impact on stroke mortality after this period remains unclear. This study aims to investigate the association between infertility and stroke mortality in women using data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. We analyzed data from 75,778 female participants aged 55-74 years with a median follow-up of 16.84 years. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for stroke mortality, adjusting for potential confounders. Among participants, 14.53% reported infertility. During follow-up, 1,159 women died from stroke. Compared to women without infertility, those with infertility had a higher risk of stroke mortality (HR 1.21, 95% CI 1.04-1.41, p = 0.016). This association remained statistically significant after adjusting for age, race, education level, marital status, smoking status, body mass index, history of hypertension, history of heart attack, history of diabetes mellitus, birth control pill use, hormone replacement therapy, endometriosis, first menstrual period and pregnancy history (HR 1.20, 95% CI 1.02-1.42, p = 0.029). Sensitivity and subgroup analyses yielded consistent results. The findings of this study indicate that infertility is associated with an increased risk of stroke mortality in women. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

Alcohol consumption among Iranian population based on the findings of STEPS survey 2021

Alcohol production and consumption have been prohibited in Iran for over four decades, leading to a typical underestimation of its consumption. This study aimed to assess the prevalence of alcohol consumption, its associated factors, and estimate per capita alcohol consumption among Iran’s adult population. In this population-based survey, 27,874 adults from across Iran were selected using systematic proportional-to-size cluster sampling. Alcohol consumption was evaluated through a modified Persian version of the STEPS questionnaires from previous studies, applied over different timespans. Per capita consumption was calculated using the quantity-frequency method, expressed in liters of pure alcohol. Adjusted odds ratios were reported for associates of alcohol consumption concerning metabolic risk factors, sociodemographic elements, and lifestyle variables. The prevalence of lifetime alcohol consumption was 6.9% (95% CI 6.5–7.2) in the adult population, with a notable sex difference (males: 13.7% [95% CI 13–14.4]; females: 1.4% [95% CI 1.1–1.6]). The 12 month prevalence was 3.8% (95% CI 3.6–4.1). For individuals aged 18 and older, the per capita alcohol consumption in Iran was 0.12 L. Factors such as being a lifetime smoker, younger, wealthier, and having 7–12 years of education were significantly linked to higher alcohol consumption. Significant associations were also observed between alcohol consumption and having a history of heart attacks (OR = 2.04, 95% CI 1.44–2.89), and physical injuries (OR = 1.88, 95% CI 1.34–2.64). The estimated lifetime and 12-month prevalence of alcohol use in our study were higher among some of the subpopulations. The findings also revealed a complex relationship between alcohol consumption, behavioral risk factors, and metabolic profiles. Consequently, immediate preventive measures tailored to each factor’s association with alcohol use are recommended.

Risk of cardiovascular diseases among young adults: a cross-sectional study in Malaysia

BackgroundCardiovascular disease (CVD) is the major cause of mortality worldwide. Recent studies showed that there is increasing CVD incidence at younger ages. Therefore, this study aimed to estimate the risk...

Comparing screening based on the NHS Health Check and Polypill Prevention Programmes in the primary prevention of heart attacks and strokes.

To compare the NHS Health Check Programme with the Polypill Prevention Programme in the primary prevention of heart attacks and strokes. Use of published data and methodology to produce flow charts of the two programmes to determine screening performance and heart attacks and strokes prevented. The UK population. The NHS Health Check Programme using a QRISK score on people aged 40-74 to select those eligible for a statin is compared with the Polypill Prevention Programme in people aged 50 or more to select people for a combination of a statin and three low-dose blood pressure lowering agents. In both programmes, people had no history of heart attack or stroke. In 1000 people, the number of heart attacks and strokes prevented in the two programmes. In the hypothetical perfect situation with 100% uptake and adherence to the screening protocol, in every 1000 persons, the NHS Health Check would prevent 287 cases of a heart attack or stroke in individuals who would gain on average about 4 years of life without a heart attack or stroke amounting to 1148 years in total, the precise gain depending on the extent of treatment for those with raised blood pressure, and 136 would be prescribed statins with no benefit. The corresponding figures for the Polypill Prevention Programme are 316 individuals who would, on average, gain 8 years of life without a heart attack or stroke, amounting to 2528 years in total, and 260 prescribed the polypill with no benefit. Based on published estimates of uptake and adherence in the NHS Health Check Programme, in practice only 24 cases per 1000 are currently benefitting instead of 287, amounting to 96 years gained without a heart attack or stroke. The Polypill Prevention Programme is by design simpler with the potential of preventing many more heart attacks and strokes than the NHS Health Check Programme.

Public knowledge of risk factors and warning signs of heart attack and stroke

BackgroundKnowledge of the predisposing risk factors and prompt recognition of the warning signs for heart attack and stroke is fundamental in modification of lifestyle behaviors and an imperative precursor to health-seeking behavior. In view of an existing knowledge gap amidst increasing incidence of heart attack and stroke in Tanzania, we conducted this community-based cross-sectional study among residents of Dar es Salaam city.ResultsA total of 1759 respondents were enrolled in this study. The mean age was 45.4 years, females constituted over a half of participants and over two-thirds had attained at least secondary school education. Regarding risk factors, just over 2% of participants displayed satisfactory awareness and only stress was recognized by at least half of participants. With regard to warning signs, barely 1% of participants had satisfactory knowledge for either of the conditions while nearly three-quarters of participants failed to mention even a single warning sign for heart attack. Recognized by about two-thirds of respondents, sudden numbness or weakness in face, arm or leg was the most acknowledged stroke symptom; however, other symptoms were familiar to less than a third of participants. Although over a half of respondents acknowledged going to a hospital as their first resort, over one-tenth of respondents expressed inappropriate reactions towards heart attack and stroke victims. Old age, higher level of education, positive history of heart attack or stroke, high blood pressure and history of dyslipidemia showed association with both risk factors and warning signs knowledge during bivariate analyses.ConclusionsPublic knowledge of common risk factors and typical warning signs for heart attack and stroke was critically suboptimal. These findings herald an utmost need for public health efforts to increase community awareness of risk factors and typical signs of the two conditions to curb the rising prevalence and associated morbimortality.

Cardiovascular disease screening in homeless individuals-a feasibility study

Abstract Background The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals. Purpose (i)To investigate feasibility of dedicated mobile CVD screening for homeless individuals; and (ii)To estimate prevalence of risk factors and burden of CVD Methods With patients, health professionals and researchers, we co-developed and implemented a 15-minute CVD assessment for homeless individuals as an add-on service to the Find&amp;Treat service (a peer-led, multi-disciplinary outreach team across London) during scheduled, routine visits to homeless hostels. We included a questionnaire (demographic, past medical history and symptom data) as well as clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF). Results Among 656 individuals screened in 75 routine visits between May 2019 and January 2023, we recruited 524 (79.9%) individuals. Mean age was 47 (SD 13.1) years (range 18-87). Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (stroke, myocardial infarction, or peripheral arterial disease) (15%) and family history of heart attack in a 1st degree relative&amp;lt;60 years (27%) were common. Although only 2% reported previously diagnosed hypercholesterolaemia, 24% of screened individuals had total cholesterol&amp;gt;5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (7/57, 12.3%). Asian and British Asian individuals had highest prevalence of raised HbA1C levels (&amp;gt;6%) (8/33, 24.2%), compared to black and black British (22/120, 18.3%) and white (15/283, 5.3%) individuals. Among individuals aged 25 – 84 with no previous CVD, one third had a 10-year QRISK score of ≥10% (120/362, 33.1%), consistent across different ethnic groups: white (75/233, 32.2%), black (24/77, 31.2%) and Asian (6/17, 35.3%). Conclusions A simple, pragmatic CVD assessment for homeless individuals was feasible and acceptable, and identified gaps in diagnosis and prevention. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks.

Abstract 14954: Disaggregating the Burden of Cardiovascular Risk Factors and Disease Among Asian Subpopulations in the United States

Background: Asian Americans are the fastest growing racial group in the US, and represent a highly heterogeneous population. However, little is known about how the burden of all cardiovascular risk factors and diseases varies among Asian American subgroups on a national scale. Methods: We identified all Asian adults in the National Health Interview Survey (NHIS) database from 2013 to 2018, and fit survey-weighted logistic regression models to examine the association between each Asian subgroup (Chinese, Asian Indian, Filipino, Other Asian) and outcomes after adjustment for age and sex. We also evaluated how social determinants (education, insurance status, poverty) contributed to any observed associations. NHIS survey weights were used to generate nationally representative estimates. Results: The weighted study population included 12,984,588 Asian adults. After adjustment for age and sex, Filipino, Asian Indian, and Other Asian adults were all significantly more likely to have hypertension, diabetes, hyperlipidemia and obesity than Chinese adults (Figure). For cardiovascular diseases, Filipino adults were significantly more likely to have a history of heart attack (2.76% vs 0.51%; adjusted RR 2.73, 95% CI 1.42-5.22), coronary artery disease (5.00% vs. 1.37%; RR 2.16, 95% CI 1.30-3.55), and stroke (2.71% vs. 0.90%; RR 2.41, 95% CI 1.35-4.26) than Chinese adults, while prevalence rates were similar for other groups (Asian Indian, Other Asian). Differences across Asian subgroups were not attenuated after also including social determinants in our models. Conclusions: In this national study, the burden of cardiovascular risk factors and diseases varied significantly across Asian subpopulations. These findings highlight the importance of disaggregating Asian adults in national public health surveillance efforts, to inform targeted initiatives that address inequities in cardiovascular health.

Abstract 11323: Improving Risk Assessment With Generalized Cardiovascular Disease Risk Score

Introduction: Clinical practice usually divides cardiovascular (CV) disease prevention patients into distinct primary (1 o ) and secondary (2 o ) prevention groups. Hypothesis: That a generalized CVD risk prediction model will find overlap in risk between primary and (2 o ) prevention patients and variation within them, allowing better targeting of interventions for CV risk. Methods: We followed all patients aged 40-75 who visited a Veterans Affairs outpatient clinic during the year 2010. The primary outcome was having a new ASCVD event in 5 years of follow-up. We used one risk score based on existing risk scores (traditional model) and developed a second using elastic net logistic regularization that with over 100 variables from the electronic health record (VARS+). All models were assessed for predictive accuracy. Models were developed on an 80% sample of the dataset and tested on the remaining 20%. Results: The sample had 742,787 patients, over 20,000 of whom were women. 7.7% had a history of heart attack, 5.2% stroke, and 27% had diabetes. 30% of male participants and 23% of women an event during follow-up. The c-statistic is 0.75 for the traditional model and 0.77 for the VARS+ model, with good calibration in both. There was substantial overlap between 1 o and 2 o prevention (Figure). There was a wide range of risk, such that secondary prevention patients in the 25 th and 75 th percentiles for overall risk had 5-year event rates of 14.1% and 32.1%, respectively. Discussion: CV disease prevention could be better targeted in some cases by reducing the distinction between 1 o and 2 o prevention in favor of a focus on generalized risk.

Chronic comorbid conditions and asthma exacerbation occurrence in a general population sample

Chronic comorbid conditions are common in adults with asthma, and some may influence a patient’s asthma exacerbation risk. We explored associations between eighteen chronic comorbid conditions and asthma exacerbation occurrence in adults with asthma in a cross-sectional study nested within a cohort study using data from the two-yearly US National Health and Nutrition Examination Survey (NHANES) program. Data of 2387 adults with self-reported doctor-diagnosed current asthma from the 2007 to 2018 NHANES surveys were selected. Investigated chronic comorbidities were: angina pectoris; congestive heart failure; coronary heart disease; depression; diabetes mellitus; soft and hard drug use; gastroesophageal reflux; gout; history of heart attack; history of stroke; hypercholesterolemia; hypertension; kidney failure; liver conditions; obesity; rheumatoid arthritis; and thyroid problems. Outcome was defined as asthma exacerbation category: no, moderate, or severe exacerbation(s) in the past year. Ordinal logistic regression analysis with correction for potential confounders was used to estimate odds ratios (OR) for moderate or severe exacerbations. Observed associations with increased severe asthma exacerbation occurrence were: obesity (OR = 1.67; 95% confidence interval 1.24, 2.26), and rheumatoid arthritis (OR = 1.55; 1.04, 2.30). History of stroke (OR = 1.95; 1.22, 3.11) and rheumatoid arthritis (OR = 1.33; 1.00, 1.75) showed associations with increased moderate exacerbation occurrence. Age-stratified analysis showed soft drug use, obesity, depression, thyroid problems, and rheumatoid arthritis to be associated with moderate and/or severe exacerbation occurrence in one or more 10-year age strata. In conclusion, several chronic comorbid conditions were associated with asthma exacerbation occurrence, which confirms but also complements previous studies. Our observations contribute to understanding exacerbation risk estimation and, ultimately, personalized asthma management.

Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020

Wearable devices may be able to improve cardiovascular health, but the current adoption of these devices could be skewed in ways that could exacerbate disparities. To assess sociodemographic patterns of use of wearable devices among adults with or at risk for cardiovascular disease (CVD) in the US population in 2019 to 2020. This population-based cross-sectional study included a nationally representative sample of the US adults from the Health Information National Trends Survey (HINTS). Data were analyzed from June 1 to November 15, 2022. Self-reported CVD (history of heart attack, angina, or congestive heart failure) and CVD risk factors (≥1 risk factor among hypertension, diabetes, obesity, or cigarette smoking). Self-reported access to wearable devices, frequency of use, and willingness to share health data with clinicians (referred to as health care providers in the survey). Of the overall 9303 HINTS participants representing 247.3 million US adults (mean [SD] age, 48.8 [17.9] years; 51% [95% CI, 49%-53%] women), 933 (10.0%) representing 20.3 million US adults had CVD (mean [SD] age, 62.2 [17.0] years; 43% [95% CI, 37%-49%] women), and 5185 (55.7%) representing 134.9 million US adults were at risk for CVD (mean [SD] age, 51.4 [16.9] years; 43% [95% CI, 37%-49%] women). In nationally weighted assessments, an estimated 3.6 million US adults with CVD (18% [95% CI, 14%-23%]) and 34.5 million at risk for CVD (26% [95% CI, 24%-28%]) used wearable devices compared with an estimated 29% (95% CI, 27%-30%) of the overall US adult population. After accounting for differences in demographic characteristics, cardiovascular risk factor profile, and socioeconomic features, older age (odds ratio [OR], 0.35 [95% CI, 0.26-0.48]), lower educational attainment (OR, 0.35 [95% CI, 0.24-0.52]), and lower household income (OR, 0.42 [95% CI, 0.29-0.60]) were independently associated with lower use of wearable devices in US adults at risk for CVD. Among wearable device users, a smaller proportion of adults with CVD reported using wearable devices every day (38% [95% CI, 26%-50%]) compared with overall (49% [95% CI, 45%-53%]) and at-risk (48% [95% CI, 43%-53%]) populations. Among wearable device users, an estimated 83% (95% CI, 70%-92%) of US adults with CVD and 81% (95% CI, 76%-85%) at risk for CVD favored sharing wearable device data with their clinicians to improve care. Among individuals with or at risk for CVD, fewer than 1 in 4 use wearable devices, with only half of those reporting consistent daily use. As wearable devices emerge as tools that can improve cardiovascular health, the current use patterns could exacerbate disparities unless there are strategies to ensure equitable adoption.

A History of Heart Attack and Experiencing Frequent Mental Distress Among US Veterans and Adult Civilians: A 2019 National Level Cross-Sectional Study.

Frequent mental distress (FMD) is poor mental health for ≥14days in the past month. Prevalence and risk for depression and suicide are higher among US veterans (USV) than US civilians (USC). Limited research has been done among USV regarding FMD. Anyone can experience mental distress without being clinically depressed-examining FMD more broadly captures health burden of poor mental state. This study's purpose was to examine the association between having a history of heart attack (HHHA) and FMD among USV vs USC. This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (n = 274 352) data. Weighted and adjusted logistic regression models were conducted overall and by USV/USC status. HHHA increases weighted adjusted odds (WAO) of FMD. Among insured not obese USV with HHHA, the WAO of FMD were 1.4x significantly greater (P < .05) than among insured not obese USV without HHHA. Among uninsured obese USC with HHHA, the WAO of FMD were 3.2x significantly greater (P < .0001) than among uninsured obese USC without HHHA, and significantly lower among USV. Study findings suggest a distinction in FMD among USV/USC with HHHA. Understanding this association can inform policy for FMD screening post-heart attack as another potential intervention to prevent/reduce suicide among USV/USC.

Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study

ObjectiveElectronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known...

Abstract P129: Age at Menarche Associated With Cardiovascular Disease Risk Factors and History Among African American Women: The Jackson Heart Study

Menarche is the onset of menstruation and is a definitive indication of female puberty. The average age at menarche has steadily declined worldwide over the past century. While many cardiovascular conditions have their start during youth, age at menarche may also play a role in predicting the risk for cardiovascular disease (CVD). Of particular importance is the disproportionately high number of CVDs that affect African Americans, which contributes greatly to the disparities in life expectancy between African Americans and Whites. This study aims to address a gap in knowledge about African American women’s health by examining the association between age at menarche and CVD. We assessed the hypothesis that an earlier age at menarche is associated with increased odds of CVD risk factors and history for women in the Jackson Heart Study. This study was a secondary analysis of baseline data from 2,458 females in the Jackson Heart Study, a longitudinal cohort study of African Americans in the Jackson, MS metropolitan area. Early menarche was defined as menarche occurring at less than 12 years of age. Cardiovascular disease risk factors included hypertension, diabetes, obesity, and abdominal obesity (waist circumference &gt;88cm). Cardiovascular disease history included coronary heart disease, heart attack, and stroke. The association between early menarche and CVD risk factors and history was examined using multivariable logistic regression models, controlling for physical activity, nutrition, smoking, alcohol use, education, income, and oral contraceptive use. The prevalence of CVD risk factors and CVD history was higher for women with an early age at menarche (&lt;12 years) than for other women. After adjusting for covariates, early age at menarche was associated with greater odds of hypertension (OR, 1.47 [95% CI, 1.17-1.84]), obesity (OR, 1.77 [95% CI, 1.43, 2.19]), abdominal obesity (OR, 1.87 [95% CI, 1.44, 2.41)], history of coronary heart disease (OR, 1.98 [95% CI, 1.33, 2.94]), and history of heart attack (OR, 1.76 [95% CI, 1.09, 2.84]). Early age at menarche was not significantly associated with diabetes or stroke history. In conclusion, in this large sample of African American women in the Jackson Heart Study, we observed that menarche before 12 years of age was associated with increased odds of CVD risk factors and CVD history compared to those with menarche after 12 years of age. These findings highlight the importance of exposures during youth and childhood which may contribute to poor health outcomes in later life.

Abstract P581: Body Mass Index Variability in Relation to Heart Failure and Outcomes

Introduction: Heart failure (HF) is a disease with high morbidity and mortality, and affects an estimated total of 6.2 million HF patients in the US. Obesity is an established risk factor for HF, and fluctuation in body mass index (BMI) has shown a negative effect in health. Hypothesis: We assessed the hypothesis that BMI variability is associated with incident HF. Methods: This study used data from the UK Biobank, which is a prospective cohort study with a median follow-up of 12.5 years. After excluding prevalent HF or cancer at enrollment, a total of 99,368 White participants with ≥ 3 BMI measures from primary care records within &gt; 2 years before and at enrollment were included. The within-participant variability of BMI was evaluated using standard deviation (SD) and coefficient of variation (CV), which were converted to z scores for further analysis. HF prevalence and incidence were ascertained based on in-patient Hospital Episode Statistics using ICD-9 and -10 codes and self-report at enrollment. The association of BMI variability with incident HF was assessed using Fine and Gray's competing risk model, treating death events obtained from the National Death Registry as competing risk. Two multi-variate models were used: Model 1 adjusted for age, sex, smoking history, alcohol consumption, diabetes, hypertension, history of heart attack or stroke, lipids, estimated glomerular filtration rate; Model 2 additionally adjusted for mean BMI across multiple measures per individual. Sex-stratified analyses were also conducted. Results: The cohort was 43% male, with mean age 57.5 (SD 7.8) years. A total of 3,406 incident HF cases were observed during the follow-up. Per SD higher in BMI variability measured in SD and CV were associated with higher risk in HF incidence, with stronger associations observed among females, Figure 1 . Conclusions: BMI fluctuation is linked with HF incidence. Future studies are warranted to explore the mechanisms in changes of BMI such as body composition, and the possible causal pathways leading to HF.

Risk Factors of Cardiovascular Diseases on Patients with Cardiovascular Diseases

Cardiovascular diseases (CVD) are the leading cause of death globally and the main problem of non-communicable diseases. Prevention is part of cardiovascular disease treatment because it breaks the chain of management and subsequent complications from the disease. Its foundation is based on the promotion of a healthy lifestyle, as well as appropriate identification and treatment for cardiovascular risk factors. This study aimed to identify risk factors for cardiovascular diseases in patients with cardiovascular diseases. A descriptive study was performed with proportionate stratified random sampling and 88 patients with cardiovascular diseases participated in this study. Data were collected in one of general hospitals in Pekanbaru, Indonesia. The risk factors of cardiovascular disease patients were assessed using a questionnaire. Descriptive analysis statistic was used to describe risk factors of cardiovascular disease. Moreover, 80% of patients completed the questionnaire. The results showed that the majority of respondents (56.8%) had hypercholesterolemia. The results showed that most respondents (73) had a smoking history (83%). The result showed that most of the patients (64.8%) with cardiovascular disease have no family history of heart attacks. The result showed that the majority of the respondents (69.3%) had a family history of hypertension. Over 92% of respondents were unable to do strenuous activities and 79.5% were unable to do moderate activities even once a week. Early assessment and education about risk factors of cardiovascular diseases are important for the prevention and promotion of health.&#x0D; Keywords: cardiovascular disease, cardiac patients, activity patterns

Assessing and predicting the trend of cardiovascular risk factors in 40-80-year population based on the Ira-PEN program as an integrated service in primary health care.

In Iran, half of all mortalities and 79% of those induced by noncommunicable diseases are attributed to cardiovascular diseases. In Iran, due to the high rate of noncommunicable diseases, a modified program (PEN) called Ira-PEN was integrated into the primary care program in health centers. The Ira-PEN program is adapted from the comprehensive WHO-PEN program to estimate the 10-year risk of cardiovascular diseases to control the main risk factors of noncommunicable diseases nationally. This study was conducted to investigate the process of service provision to determine the information needs and the necessary interventions in the comprehensive health service centers of Ardabil Province. The present descriptive and analytical study was conducted in the Ardabil University of Medical Sciences. It used the data available in the registration system of the Health Network. The research population consisted of all people aged between 40 and 80 who visited the comprehensive health service centers to perform risk assessment of cardiovascular strokes in the province from 2018 to the end of 2021. The collected data were added to Excel. FORCAST function was used to predict the future through a linear regression analysis. To compare the final results, which is actually a reduction in mortality due to cardiovascular diseases, the difference test of two mortality rates due to cardiovascular diseases was used in 2018 and 2021. Test of two death proportions was performed through z test and Minitab21 Software. The prevalence of cardiovascular disease risk factors was as follows: history of heart attack (0.59%), history of stroke (0.51%), history of diabetes (7.9%), history of high blood pressure (15.7%), and history of prediabetics (12.8%). The probability of suffering from lipid disorder was 26.4% and BMI > 30 was 32.4%. The risk factors of hypertension, abdominal obesity, and smoking showed a decrease in the measurement of disease risk factors during 4 years. Identification of the common risk factors in the region helps to focus interventions on effective prevention and treatment measures and adopt evidence-based policies in order to reduce these risk factors. Since the investigated risk factors are rooted in inappropriate behaviors and lifestyles, by modifying these behaviors and changing lifestyles, their prevalence can be reduced and reducing these risk factors will lead to a reduction in the prevalence of cardiovascular diseases.