Identification Of Cardiovascular Disease Risk Research Articles

A bibliometric analysis of studies conducted over the last 10 years on cardiovascular disease risk identification and prevention in primary care

Objective: This bibliometric analysis was conducted to determine the trends of studies on cardiovascular disease risk identification and prevention in primary care from 2013 to 2024 and visualize the latest developments. Methods: The data were collected in February-March 2024 from the database “Web of Science Core Collection,” the analysis was carried out using the VOSviewer program. The change in the number of publications of the published articles by year, author, country, and institution citation analyses, country, institution, and author collaboration analyses, journal and author co-citation analyses, and keyword analyses were evaluated. Results: Five hundred and ninety-two authors from 64 countries and 377 institutions contributed to 443 studies published in 80 journals between 2013 and 2024 on determining and preventing cardiovascular disease risk in primary care. "BMC Family Practice" was the journal in which most articles were published, and "Circulation" was the most cited. The first three countries that support published articles most are the United States, England, and Australia. Focusing on the topics "blood-pressure control", "coronary-artery calcium", "physician-pharmacist collaboration", "low-density lipoprotein cholesterol", "health-risk assessment", "pollution", "primary care", "coronary heart disease", "prevention", "cardiovascular disease" and "mortality" will help fill the gap in the field. Conclusions: This bibliometric analysis has shown increasing interest in studies related to cardiovascular disease risk and prevention in primary care. Primary prevention guidelines are important resources in addressing risk factors. Global collaborations and long-term studies are necessary in this field, led by developed countries with a high disease burden.

Associations Between Risk Factors of Cardiovascular Disease in Young Adults

Introduction Cardiovascular disease (CVD) impacts 50% of U.S. adults although few studies evaluate young adults’ cardiovascular disease risk. Early identification of cardiovascular disease risk may mitigate increased adulthood incidence. We analyzed (CVD) risk factors and their association with cardiovascular fitness ([Formula: see text] o2max) to devise effective strategies to improve cardiovascular health across the lifespan. Methods A cross-sectional study evaluated the effect of a single bout of aerobic exercise on cardiovascular disease risk factors in adults aged 18 to 36 years. Glycemic control (HbA1C), cardiovascular fitness ([Formula: see text]o2max), percent body fat, lean body mass, waist circumference, and body mass index (BMI) were analyzed using correlation analysis and multiple linear regression. Results Statistically significant relationships were observed between percent body fat (r = .83, P < .001) and BMI, and waist circumference (r = .83, P < .001) and BMI. Percent body fat ( P < .001) and race ( P = .018) predicted exercise time, with Asians exercising the longest. Percent fat ( P < .001) and HbA1C ( P = .039) were identified as predictors of cardiovascular fitness which was low in spite of primarily normal average HbA1C levels. Conclusions HbA1C and body fat negatively influence cardiovascular fitness ([Formula: see text] o2max) in young adults increasing adulthood cardiovascular disease risk. Research investigating the effect of HbA1C on cardiovascular health especially in youth is warranted.

Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/Non-COVID-19 Frameworks Using Artificial Intelligence Paradigm: A Narrative Review.

Diabetes is one of the main causes of the rising cases of blindness in adults. This microvascular complication of diabetes is termed diabetic retinopathy (DR) and is associated with an expanding risk of cardiovascular events in diabetes patients. DR, in its various forms, is seen to be a powerful indicator of atherosclerosis. Further, the macrovascular complication of diabetes leads to coronary artery disease (CAD). Thus, the timely identification of cardiovascular disease (CVD) complications in DR patients is of utmost importance. Since CAD risk assessment is expensive for low-income countries, it is important to look for surrogate biomarkers for risk stratification of CVD in DR patients. Due to the common genetic makeup between the coronary and carotid arteries, low-cost, high-resolution imaging such as carotid B-mode ultrasound (US) can be used for arterial tissue characterization and risk stratification in DR patients. The advent of artificial intelligence (AI) techniques has facilitated the handling of large cohorts in a big data framework to identify atherosclerotic plaque features in arterial ultrasound. This enables timely CVD risk assessment and risk stratification of patients with DR. Thus, this review focuses on understanding the pathophysiology of DR, retinal and CAD imaging, the role of surrogate markers for CVD, and finally, the CVD risk stratification of DR patients. The review shows a step-by-step cyclic activity of how diabetes and atherosclerotic disease cause DR, leading to the worsening of CVD. We propose a solution to how AI can help in the identification of CVD risk. Lastly, we analyze the role of DR/CVD in the COVID-19 framework.

The aortic-femoral arterial stiffness gradient: an atherosclerosis risk in communities (ARIC) study.

The aortic to femoral arterial stiffness gradient (af-SG) may be a novel measure of arterial health and cardiovascular disease (CVD) risk, but its association with CVD risk factors and CVD status, and whether or not they differ from the referent measure, carotid-femoral pulse-wave velocity (cfPWV), is not known. Accordingly, we compared the associations of the af-SG and cfPWV with (i) age and traditional CVD risk factors and (ii) CVD status. We evaluated 4183 older-aged (75.2 ± 5.0 years) men and women in the community-based Atherosclerosis Risk in Communities (ARIC) Study. cfPWV and femoral-ankle PWV (faPWV) were measured using an automated cardiovascular screening device. The af-SG was calculated as faPWV divided by cfPWV. Associations of af-SG and cfPWV with age, CVD risk factors (age, BMI, blood pressure, heart rate, glucose and blood lipid levels) and CVD status (hypertension, diabetes, coronary heart disease, heart failure, stroke) were determined using linear and logistic regression analyses. (i) the af-SG and cfPWV demonstrated comparable associations with age and CVD risk factors, except BMI. (ii) a low af-SG was associated with diabetes, coronary heart disease, heart failure and stroke, whilst a high cfPWV was only associated with diabetes. Although future studies are necessary to confirm clinical utility, the af-SG is a promising tool that may provide a unique picture of hemodynamic integration and identification of CVD risk when compared with cfPWV.

A systematic approach incorporating family history improves identification of cardiovascular disease risk.

Although family history (FH) is an independent predictor of cardiovascular disease (CVD) risk, traditional risk scores do not incorporate FH. Nurse practitioners routinely solicit FH but have no mechanism to incorporate the information into risk estimation. Underestimation of risk leaves clinicians misinformed and patients vulnerable to the CVD epidemic. We examined a systematic approach incorporating FH in CVD risk assessment, validating risk reclassification using carotid intima-media thickness (CIMT), a surrogate measure of atherosclerosis. Of 413 consecutive patients prospectively enrolled in the Integrative Cardiac Health Project Registry, a subgroup of 239 was low or intermediate risk by the Framingham Risk Score. A systematic approach for the assessment of FH was applied to this subgroup of the registry. A positive FH for premature CVD, defined as a first-degree relative having a CVD event before the age of 55 years in men and 65 years in women, conferred reclassification to high risk. Reclassification was validated with CIMT results. Chart audits revealed adherence to the systematic approach for FH assessment in 100% of cases. This systematic approach identified 115 of 239 (48%) patients as high risk because of positive FH. Of the reclassified patients, 75% had evidence of subclinical atherosclerosis by CIMT versus 55% in the patients not reclassified, P < 0.001. Logistic regression identified positive FH for premature CVD (odds ratio, 2.6; P = 0.001) among all variables, as the most significant predictor of abnormal CIMT, thus increasing risk for CVD. The Integrative Cardiac Health Project systematic approach incorporating FH into risk stratification enhances CVD risk assessment by identifying previously unrecognized high-risk patients, reduces variability in practice, and appropriately targets more stringent therapeutic goals for prevention.

Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study.

There is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. Vascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. Carotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction. Measures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D.

Abstract 16685: Depletion of Circulating CD34+/KDR+ Cells in Type 2 Diabetes is Associated With Glycemic Control

Background and Hypothesis: Circulating levels of endothelial progenitor cells have been found to be predictive of cardiovascular events and mortality. Although the levels of these cells reflect overall cardiovascular disease (CVD) risk, studies assessing their association with major CVD factors - hypertension, dyslipidemia and diabetes have yielded inconsistent results and the mechanisms contributing to EPC depletion remain unknown. We hypothesized that EPC depletion occurring in diabetes is mediated in part by hyperglycemia or insulin resistance. Methods: Circulating levels of progenitor cells were measured by flow cytometry in 108 diabetic or non-diabetic subjects recruited from the University of Louisville Health System. Reactive hyperemia index (RHI) was measured by the EndoPAT. Demographic information was acquired and blood, plasma and urine were used for biochemical analyses. Subjects were divided into high and low EPC count groups using the median split. Data was analyzed using a Chi-square test, a two-sample rank sum test, and univariable and multivariable logistic regressions. Results: Levels of CD34 + /KDR + /CD14 − /CD16 − cells (EPCs) were associated with the diagnosis of diabetes (p=0.04), but not with other demographic covariates, hypertension or dyslipidemia. Levels of CD34 + , AC133 + and CD34 + /AC133 + /CD45 + cells also displayed significant association with diabetes (p=0.038, 0.014 and 0.038 respectively). RHI was strongly associated with diabetes (p&lt;0.0001) hypertension and dyslipidemia, however, no significant associations were observed between RHI and EPCs. EPC levels were inversely associated with HbA1C (p=0.047) and fasting blood glucose, but not with insulin levels or the HOMA-IR score. In the complete model, the association between EPCs and diabetes was strengthened by the inclusion of RHI, indicating more robust EPC depletion in those with endothelial dysfunction. Conclusion: Circulating EPC levels are a robust index of long-term glycemic control and are associated with hyperglycemia rather than contemporaneous insulin levels or endothelial dysfunction. These findings may help in prognosis and early identification of CVD risk in patients with diabetes, independent of other risk estimates.

O105 Effect Of A Multi-Faceted Quality Improvement Intervention To Improve Cardiovascular Disease Risk Identification And Management In Australian Primary Health Care: The Torpedo Cluster-Randomised Trial

O105 Effect Of A Multi-Faceted Quality Improvement Intervention To Improve Cardiovascular Disease Risk Identification And Management In Australian Primary Health Care: The Torpedo Cluster-Randomised Trial

Cardiovascular Disease Risk in Young People with Type 1 Diabetes

Cardiovascular disease (CVD) is the most frequent cause of death in people with type 1 diabetes (T1D), despite modern advances in glycemic control and CVD risk factor modification. CVD risk identification is essential in this high-risk population, yet remains poorly understood. This review discusses the risk factors for CVD in young people with T1D, including hyperglycemia, traditional CVD risk factors (dyslipidemia, smoking, physical activity, hypertension), as well as novel risk factors such as insulin resistance, inflammation, and hypoglycemia. We present evidence that adverse changes in cardiovascular function, arterial compliance, and atherosclerosis are present even during adolescence in people with T1D, highlighting the need for earlier intervention. The methods for investigating cardiovascular risk are discussed and reviewed. Finally, we discuss the observational studies and clinical trials which have thus far attempted to elucidate the best targets for early intervention in order to reduce the burden of CVD in people with T1D.

Waist circumference as screening instrument for cardiovascular disease risk factors in schoolchildren

To propose cutoff points for waist circumference of schoolchildren for the identification of cardiovascular disease risk factors. This school-based cross-sectional study surveyed 1,413 schoolchildren aged 7 to 12 years old, selected by random cluster sampling. Waist circumference, total cholesterol and systolic and diastolic pressures were measured. Reference values for cardiovascular disease risk factors were developed from measures of total cholesterol and systolic and diastolic blood pressures. The receiver operating characteristic (ROC) curve and bivariate analysis, followed by calculation of sensitivity, specificity and odds ratio, were used in data analysis. The cutoff points had area values under the ROC curve ranging between 0.603 and 0.949, while sensitivity and specificity ranged between 0.500 and 1.00. Among all proposals analyzed, the one presented by this study best balanced sensitivity and specificity values. Bivariate analysis followed by odds ratios calculation indicated that subjects with waist circumference above the proposed cutoff points have increased chances of presenting cardiovascular disease risk factors. The cutoff points proposed in the present study seem to be a valid alternative and better balance sensibility and specificity than other proposals for screening students with increased chances of presenting cardiovascular disease risk factors.

Oral Health Care Professionals' Identification of Cardiovascular Disease Risk Among Patients in Private Dental Offices in Sweden

The authors conducted a study to investigate whether general private dental practitioners in Sweden could identify patients at risk of experiencing a fatal outcome of cardiovascular disease (CVD) within a set time frame and to what extent those practitioners' findings would result in medical interventions. The authors enrolled 200 patients who met the following inclusion criteria: age of 45 years or older; no history of or use of medications for hypertension, hypercholesterolemia or diabetes; and having had no visits to a health care professional during the preceding 12 months during which glucose levels, total cholesterol levels or blood pressure had been assessed. The participating dentists and their staff members used a computerized system, HeartScore (European Society of Cardiology, Sophia Antipolis, France), to calculate the risk, in percentages, of a patient's dying as a result of a CVD event within the next 10 years. Dentists advised patients with HeartScores of 10 percent or higher to seek medical advice. After six to 12 months, one of the authors conducted structured telephone interviews to ascertain the results of the medical referrals. Six percent of the participants, all men (n = 12), had HeartScores of 10 percent or higher. No woman had a HeartScore higher than 5 percent. Fifty percent of the identified patients (n = 6) with a HeartScore of 10 percent or higher received prescriptions for antihypertensive medications after undergoing an evaluation by a medical care provider. For three patients, the physician was not able to confirm the dentists' assessment and took no further action. Oral health care professionals can identify patients who are unaware of their risk of developing serious complications as a result of CVD and who are in need of medical intervention. The authors' findings suggest the need for more studies with larger sample populations.

Are definitions of adiposity appropriate for identification of cardiovascular disease risk in South Asian populations?

Summary South Asian populations living in the UK have a high prevalence of the metabolic syndrome, cardiovascular disease (CVD) and type 2 diabetes which impacts greatly on the morbidity and mortality of this ethnic group. The identification of ‘at risk’ individuals is essential to initiate preventative treatment. However, this is considerably hindered by the lack of appropriate cut‐off values for anthropometric measures. CVD risk is significantly higher at a lower body mass index (BMI) in many Asian groups compared with Caucasians and adiposity (particularly central deposition) is higher at similar BMI levels. The definition of adiposity in Asians needs to be firmly established and appropriate lower BMI and waist circumference cut‐offs implemented in ethnic subpopulations to facilitate appropriate treatment strategies.

LIFECHECK: a successful, low touch, low tech, in-plant, cardiovascular disease risk identification and modification program.

LIFECHECK, a voluntary, in-plant cardiovascular risk identification and modification program, was developed to complement Coors Wellness Center-based programs. LIFECHECK was offered to the 1,320 employees located at the Coors Engineering Center and Can Manufacturing Complex at the Coors Brewing Company. The initial 30-minute screening included height, weight, blood pressure, cholesterol, smoking history, weekly Kcal expenditure, self-rating of health, and health effects of stress. Participants concluded the screening session with a wellness counselor who reviewed results and referred them to the appropriate intervention activities. The eight-week intervention was provided at the worksite and was available to all shifts. The intervention included an activity competition and activity classes; nutrition, hypertension, smoking, and lipid classes; a smoke-out day; one-on-one counseling; exercise equipment at four worksites; posters; traymats; table tents; and electronic messages. A total of 692 employees, 52% of those eligible, participated in the initial screening. Of these, 91% had one or more risk factors, and 33% had three to five cardiovascular disease risk factors. A total of 499 employees, 72% of those eligible, completed the follow-up screening. Thirty-two percent of the employees who participated in LIFECHECK had not used the Wellness Center in the eight years it had been open. There were significant changes in employees who completed the eight-week program for systolic blood pressure, total cholesterol, weight, physical activity, and risk of ischemic heart disease within eight years as measured by the Framingham score (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)