Incidence Of Cardiovascular Disease Risk Factors Research Articles

Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality.

Obstructive sleep apnea is a well-established risk factor for cardiovascular disease (CVD). Recent studies have also linked periodic limb movements during sleep to CVD. We aimed to determine whether periodic limb movements during sleep and obstructive sleep apnea are independent or synergistic factors for CVD events or death. We examined data from 1049 US veterans with an apnea-hypopnea index (AHI) <30 events/hour. The primary outcome was incident CVD or death. Cox proportional hazards regression assessed the relationships between the AHI, periodic limb movement index (PLMI), and the AHI×PLMI interaction with the primary outcome. We then examined whether AHI and PLMI were associated with primary outcome after adjustment for age, sex, race and ethnicity, obesity, baseline risk of mortality, and Charlson Comorbidity Index. During a median follow-up of 5.1 years, 237 of 1049 participants developed incident CVD or died. Unadjusted analyses showed an increased risk of the primary outcome with every 10-event/hour increase in PLMI (hazard ratio [HR], 1.08 [95% CI, 1.05-1.13]) and AHI (HR, 1.17 [95% CI, 1.01- 1.37]). Assessment associations of AHI and PLMI and their interaction with the primary outcome revealed no significant interaction between PLMI and AHI. In fully adjusted analyses, PLMI, but not AHI, was associated with an increased risk of primary outcome: HR of 1.05 (95% CI, 1.00-1.09) per every 10 events/hour. Results were similar after adjusting with Framingham risk score. Our study revealed periodic limb movements during sleep as a risk factor for incident CVD or death among those who had AHI <30 events/hour, without synergistic association between periodic limb movements during sleep and obstructive sleep apnea.

Association of Cardiovascular Diseases With Post-Traumatic Stress Disorder: An Updated Review

The intricate relationship between post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD) has garnered increasing attention due to its bidirectional impact and potential for significant health consequences. Epidemiological evidence suggests that PTSD may serve as a risk factor for incident CVD, while acute CVD events can trigger PTSD, subsequently increasing the risk of recurrent cardiovascular events. This dynamic interplay is characterized by the human stress response, disrupted behavioral and lifestyle factors, and potential physiological mechanisms. Notably, the immediate aftermath of a cardiovascular event presents a critical window for intervention, offering the possibility of preventing the development of PTSD and its associated physiological and behavioral sequelae. However, while candidate mechanisms linking PTSD and CVD have been identified, determining which mechanisms are most amenable to intervention remains a challenge. This article emphasizes the urgency of addressing key unanswered questions in this domain. Despite an evolving understanding of the association between PTSD and CVD, causal relationships remain to be firmly established. Comprehensive investigations into the intricate interplay of behavioral and biological mechanisms are essential for identifying precise targets for intervention. Innovations in research methodologies, including the exploration of PTSD symptom dynamics and their impact on cardiovascular function, hold the potential for identifying crucial intervention points. Drawing parallels from prior challenges in translating identified risk factors into effective interventions, the field must prioritize systematic investigations and early-phase intervention trials. By doing so, researchers and clinicians can potentially develop strategies to mitigate CVD risk in the context of PTSD and improve both cardiovascular and mental health outcomes.

Obesity, cardiovascular risk, and lifestyle: cross-sectional and prospective analyses in a nationwide Spanish cohort.

To assess whether overweight and obesity are independently associated with cardiometabolic health [as categorized based on the presence/absence of cardiovascular disease (CVD) risk factors (diabetes, hypercholesterolaemia, or hypertension)], and the role of lifestyle on this association. A nationwide cohort of Spanish adults (18-64 years) was studied using a cross-sectional design and prospective observational design. Lifestyle-related factors (physical activity, sleeping characteristics, alcohol drinking, and smoking) were registered, and participants were classified as having an 'unhealthy' or 'healthy' cardiometabolic status attending to the presence or absence, respectively, of ≥1 CVD risk factor. A number of 596 111 participants (44 ± 9 years, 67% male) were studied at baseline, with prospective analyses in a subcohort [n = 302 061; median follow-up, 2 years (range, 2 to 5)]. Compared to normal weight, overweight and obesity were associated with a higher prevalence [odds ratio, 1.67 (95% confidence interval, 1.61-1.67) and 2.70 (2.69-2.78), respectively] and incidence [1.62 (1.59-1.67) and 2.70 (2.63-2.78)] of an unhealthy cardiometabolic status. Meeting physical activity guidelines reduced the odds of an unhealthy cardiometabolic status at baseline [0.87 (0.85-0.88)] among individuals with overweight/obesity, as well as of transitioning from a healthy status to an unhealthy status during the follow-up [0.87 (0.84-0.94)]. No significant associations were found for the remainder of lifestyle factors. Overweight and obesity are independently associated with an unhealthy cardiometabolic status. Regular physical activity attenuates not only the prevalence but also the incidence of CVD risk factors.

The rs579459 ABO gene polymorphism and risk of incident cardiovascular events in obstructive sleep apnea: a pilot study.

We have previously shown that the TT genotype (rs579459 location of the ABO gene) is significantly associated with circulating levels of e-selectin in patients with suspected obstructive sleep apnea (OSA). We hypothesized that this genotype would be associated with incident cardiovascular disease (CVD). Patients with suspected OSA who had a full diagnostic polysomnogram from 2003 to 2011 were recruited; CV events occurring within 8years of polysomnography were identified by linkage to provincial health databases. Cox proportional hazards models were used to evaluate the incidence of first CV events as a function of the rs579459 genotype. In this targeted study, 408 patients were studied, and 39 incident events were identified. A larger proportion of patients with the TT genotype had an event (31/247; 12.6%) than the CT and CC genotypes (8/161; 5.0%); in univariate analysis, the TT genotype was significantly associated with CV events (HR = 2.53; 95% CI = 1.16-5.51, p = 0.02). After adjustment for age, AHI, sex, smoking, diabetes, statin use, and BMI, the TT genotype remained a significant predictor (HR = 2.35; 95% CI = 1.02-5.42, p = 0.046). No events were found in patients with an absence of both OSA and the TT genotype (N = 30). The effect of the SNP was partially (16.2%) mediated by e-selectin levels. This is the first study to examine genetic variants as a risk factor for incident CVD in the context of OSA. Although these results are preliminary and in need of replication, it suggests that genetic markers may become useful in helping to guide precision clinical care.

Association of Exposure to Abuse, Nurture, and Household Organization in Childhood With 4 Cardiovascular Disease Risks Factors Among Participants in the CARDIA Study.

BackgroundWe investigated associations of childhood abuse with 4 cardiovascular disease risk factors in adulthood, and whether exposure to nurturing and household organization in childhood mitigated these associations.Methods and ResultsThe CARDIA (Coronary Artery Risk Development in Young Adults) study (baseline examination, 1985–1986) was used to examine associations of childhood exposures (measured retrospectively at the year 15 examination) with incident obesity, type 2 diabetes, hypertension, and hyperlipidemia (assessed from baseline to year 30). Race‐ and sex‐stratified Cox proportional hazards models were used to examine associations of exposure to childhood abuse with incident cardiovascular disease risk factors. Interaction terms between exposure to abuse and exposure to nurturing relationship and household organization were included to test for effect modifications. Exposure to occasional/frequent abuse (versus no abuse) was associated with incident type 2 diabetes among White men (hazard ratio [HR], 1.81; 95% CI, 1.06–3.08). Exposure to low versus no abuse was associated with incident hyperlipidemia among White men (HR, 1.35; 95% CI, 1.09–1.67) and White women (HR, 1.26; 95% CI, 1.01–1.56). Risks of incident hyperlipidemia were higher for White women who experienced abuse and lived in dysfunctional households (HR, 3.61; 95% CI, 1.62–8.05) or households with low levels of organization (HR, 2.05; 95% CI, 1.25–3.36) compared with White women who experienced abuse but lived in well‐organized households (HR, 0.66; 95% CI, 0.41–1.06). Similar patterns were seen for Black men who lived in dysfunctional households (HR, 3.62; 95% CI, 1.29–10.12) or households with low organization (HR, 2.01; 95% CI, 1.08–3.72).ConclusionsWe identified race‐ and sex‐specific associations of childhood exposures with incident cardiovascular disease risk factors. The associations of household organization and dysfunction with cardiovascular disease risks merits further investigation.

Racial and rural-urban disparities in cardiovascular risk factors among patients with head and neck cancer in a clinical cohort.

Evidence on distribution of cardiovascular disease (CVD) risk factors in patients with head and neck squamous cell carcinoma (HNSCC) is limited. We assessed disparities in prevalence and incidence of CVD risk factors in patients with HNSCC. Electronic health records (EHR) data on 2262 patients with HNSCC diagnosed between 2012 and 2018 at a NCI-designated cancer center were included. Prevalence of CVD risk factors at baseline and incidence at 1-year post HNSCC diagnosis were assessed using logistic and robust Poisson regression, respectively. At baseline, 31.72% white patients with HNSCC had dyslipidemia, compared to 24.29% blacks (p < 0.008); diabetes was more prevalent in blacks (p < 0.027). Odds of ≥1 prevalent CVD clinical risk factor at baseline was lower in blacks (OR, 95%CI: 0.71, 0.54-0.93) and in rural patients (OR, 95%CI: 0.70, 0.58-0.85). At 1year, risk of incident diabetes was higher in rural patients (RR, 95%CI: 1.63, 1.21-2.19). Demographic disparities were observed in distribution of CVD risk factors in patients with HNSCC.

Multi-use physical activity trails in an urban setting and cardiovascular disease: a difference-in-differences analysis of a natural experiment in Winnipeg, Manitoba, Canada

ObjectiveTo determine if expansion of multi-use physical activity trails in an urban centre is associated with reduced rates of cardiovascular disease (CVD).MethodsThis was a natural experiment with a difference in differences analysis using administrative health records and trail-based cycling data in Winnipeg, Canada. Prior to the intervention, each year, 314,595 (IQR: 309,044 to 319,860) persons over 30 years without CVD were in the comparison group and 37,901 residents (IQR: 37,213 to 38,488) were in the intervention group. Following the intervention, each year, 303,853 (IQR: 302,843 to 304,465) persons were in the comparison group and 35,778 (IQR: 35,551 to 36,053) in the intervention group. The natural experiment was the construction of four multi-use trails, 4-7 km in length, between 2010 and 2012. Intervention and comparison areas were based on buffers of 400 m, 800 m and 1200 m from a new multi-use trail. Bicycle counts were obtained from electromagnetic counters embedded in the trail. The primary outcome was a composite of incident CVD events: CVD-related mortality, ischemic heart disease, cerebrovascular events and congestive heart failure. The secondary outcome was a composite of incident CVD risk factors: hypertension, diabetes and dyslipidemia.ResultsBetween 2014 and 2018, 1,681,125 cyclists were recorded on the trails, which varied ~ 2.0-fold across the four trails (2358 vs 4264 counts/week in summer months). Between 2000 and 2018, there were 82,632 CVD events and 201,058 CVD risk events. In propensity score matched Poisson regression models, the incident rate ratio (IRR) was 1.06 (95% CI: 0.90 to 1.24) for CVD events and 0.95 (95%CI: 0.88 to 1.02) for CVD risk factors for areas within 400 m of a trail, relative to comparison areas. Sensitivity analyses indicated this effect was greatest among households adjacent to the trail with highest cycling counts (IRR = 0.85; 95% CI: 0.75 to 0.96).ConclusionsThe addition of multi-use trails was not associated with differences in CVD events or CVD risk factors, however the differences in CVD risk may depend on the level of trail use.Trial registrationTrial registration number: NCT04057417.

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

Hepatic Fibrosis Associates With Multiple Cardiometabolic Disease Risk Factors: The Framingham Heart Study.

NAFLD is increasing in prevalence and will soon be the most common chronic liver disease. Liver stiffness, as assessed by vibration-controlled transient elastography (VCTE), correlates with hepatic fibrosis, an important predictor of liver-related and all-cause mortality. Although liver fat is associated with cardiovascular risk factors, the association between hepatic fibrosis and cardiovascular risk factors is less clear. We performed VCTE, assessing controlled attenuation parameter (CAP; measure of steatosis) and liver stiffness measurement (LSM) in 3,276 Framingham Heart Study adult participants (53.9% women, mean age 54.3±9.1years) presenting for a routine study visit. We performed multivariable-adjusted logistic regression models to determine the association between LSM and obesity-related, vascular-related, glucose-related, and cholesterol-related cardiovascular risk factors. The prevalence of hepatic steatosis (CAP≥290dB/m) was 28.8%, and 8.8% had hepatic fibrosis (LSM≥ 8.2kPa). Hepatic fibrosis was associated with multiple cardiovascular risk factors, including increased odds of obesity (OR, 1.82; 95% CI, 1.35-2.47), metabolic syndrome (OR, 1.49; 95% CI 1.10-2.01), diabetes (OR, 2.67; 95% CI, 1.21-3.75), hypertension (OR, 1.52; 95% CI, 1.15-1.99), and low high-density lipoprotein cholesterol (OR, 1.47; 95% CI, 1.09-1.98), after adjustment for age, sex, smoking status, alcohol drinks/week, physical activity index, aminotransferases, and CAP. In our community-based cohort, VCTE-defined hepatic fibrosis was associated with multiple cardiovascular risk factors, including obesity, metabolic syndrome, diabetes, hypertension, and high-density lipoprotein cholesterol, even after accounting for covariates and CAP. Additional longitudinal studies are needed to determine if hepatic fibrosis contributes to incident cardiovascular disease risk factors or events.

Metabolic syndrome is associated with reduced flow mediated dilation independent of obesity status.

Data suggest that metabolic health status, incorporating components of metabolic syndrome (MetS), predicts cardiovascular disease (CVD) risk better than BMI. This study explored the association of MetS and obesity with endothelial function, a prognostic risk factor for incident CVD. Forty-four participants were phenotyped according to BMI as non-obese vs obese (<30 or >30 kg/m2) and according to the International Diabetes Federation criteria of MetS: ≤2 criteria MetS (MetS-) vs ≥3 criteria MetS (MetS+); (1.)non-obese MetS- vs (2.) non-obese MetS+ and (3.) obese MetS- vs (4.) obese MetS+. Flow-mediated dilation (FMD), body composition including liver fat (MRI and spectroscopy), dietary intake, intensities of habitual physical activity and cardio-respiratory fitness were determined. Variables were analysed using a one-factor between-groups ANOVA and linear regression; mean (95% CI) are presented. Individuals with MetS+ displayed lower FMD than those with MetS-. For non-obese individuals mean difference between MetS+ and MetS- was 4.1% ((1.0, 7.3); P = 0.004) and obese individuals had a mean difference between MetS+ and MetS- of 6.2% ((3.1, 9.2); P < 0.001). Although there was no association between BMI and FMD (P = 0.27), an increased number of MetS components was associated with a lower FMD (P = 0.005), and after adjustment for age and sex, 19.7% of the variance of FMD was explained by MetS, whereas only 1.1% was explained by BMI. In this study cohort, components of MetS, rather than obesity per se, contribute to reduced FMD, which suggests a reduced bioavailability of nitric oxide and thus increased risk of CVD.

Prediction of cardiovascular health by non-exercise estimated cardiorespiratory fitness

ObjectiveTo estimate the incidence of major biological cardiovascular disease (CVD) risk factors in adults using non-exercise estimated cardiorespiratory fitness (eCRF).Methods200 039 healthy people (99 957 women), aged ≥18 years (38.5±12.1...

1655-P: Genetic Risk Factors for Incident Cardiovascular Disease in Type 2 Diabetes Patients

Patients with type 2 diabetes (T2D) are at two-fold increased risk of cardiovascular disease (CVD). CVD is the leading cause of T2D morbidity and mortality. The aim of this study was to identify genetic risk factors associated with incident CVD in patients with T2D. We performed survival genome-wide association study (GWAS) with patients with T2D in the UK Biobank (UKBB), Partners HealthCare Biobank (PBB), and Korean Genome and Epidemiology (KoGES) studies. The primary outcome of the study was a composite of myocardial infarction and stroke that occurred at least one year after the diagnosis of T2D. We conducted survival GWAS using ’GWASTools’ R package adjusting for age, and sex. The results of the three cohorts were meta-analyzed using inverse variance weighted method. A total of 19,121 participants were included in the analyses (15,643 from UKBB, 1,161 from PBB and 2,317 from KoGES). The incidence rate of CVD was higher in the hospital-based study of PBB (33.5%) compared to population-based studies of UKBB (9.5%), and KoGES (8.0%). Although there was no genetic association reaching genome-wide significance, there were four genomic loci that had suggestive association evidence for incident CVD with P&amp;lt;1.0x10-6. These include distinct variants in rs113067014 (intergenic) on chromosome 1 (chr1), rs1367414 (intron in PAX3) on chr2, rs11762253 (intron in AC004160.1) on chr7, and rs2837174 (intron in IGSF5) on chr21. When we investigated 184 previously validated coronary artery disease loci, 17 reached nominal significance of P&amp;lt;0.05 with consistent direction of association. A polygenic score (PS) comprised of these 184 variants was significantly associated with risk of CVD in T2D patients (HR 1.20 per s.d. increase in PS, P=6.6x10-16). In summary, we have implemented survival GWAS analysis to investigate genetic risk factors for incident CVD in patients with T2D. However, further increase in sample size is required to identify molecular features leading to increased CVD risk among individuals with T2D. Disclosure S. Kwak: None. J.M. Mercader: None. A. Leong: None. B. Porneala: None. P. Wu: None. J.B. Cole: None. J. Merino: None. K. Park: None. N.H. Cho: None. J. Dupuis: Consultant; Self; Merck Sharp &amp; Dohme Corp. J.C. Florez: Advisory Panel; Self; Doris Duke Charitable Foundation. Other Relationship; Self; Novo Nordisk Inc., Park Street School. J.B. Meigs: Consultant; Self; Quest Diagnostics.

Onset of cardiovascular disease risk factors in women with and without a history of breast cancer: The Pathways Heart Study.

12017 Background: Women with a history of breast cancer (BC) are at increased long-term risk of dying from cardiovascular disease (CVD). However, the onset of CVD risk factors in women with BC has not been well-described. We compared risk of incident CVD risk factors in women with and without BC enrolled in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records. All invasive BC cases diagnosed between 2005-2013 were identified and matched 1:5 with controls on birth year, race/ethnicity and KPNC membership at the date of BC diagnosis. Cox regression models assessed the hazard of incident hypertension (based on diagnosis codes and filled prescriptions), dyslipidemia (based on diagnosis codes, filled prescriptions, and lab values), and diabetes (KPNC Diabetes Registry). Models were adjusted for baseline BMI, menopausal status, smoking status, neighborhood median household income, education, prevalent CVD conditions, and other baseline CVD risk factors. Subgroups of women who received chemotherapy, radiation therapy, and endocrine therapy were compared with controls. Results: A total of 14,942 women with a new diagnosis of invasive BC were identified and matched to 74,702 controls. On average, women were 62.0 years, 28.3 kg/m2BMI, 64.9% non-Hispanic white. Overall, cases were more likely to develop hypertension (HR: 1.18, 95% CI: 1.13, 1.24) and diabetes (HR: 1.23, 95% CI: 1.16, 1.31). Across the board, receipt of any of the three therapies (chemotherapy, radiation therapy and endocrine therapy) was associated with increased risk of hypertension and diabetes, compared to controls. Risk-factor specific hazard ratios for receipt of chemotherapy were (HR 1.18, 95% CI: 1.10, 1.27) and (HR 1.38, 95% CI: 1.26, 1.51), for hypertension and diabetes, respectively. For receipt of radiation therapy, risk-factor specific hazard ratios were (HR: 1.17, 95% CI: 1.09, 1.26) and (HR: 1.15, 95% CI: 1.04, 1.27), for hypertension and diabetes, respectively. Risk-factor specific hazard ratios for receipt of endocrine therapy were (HR: 1.22, 95% CI: 1.14, 1.30) and (HR: 1.16, 95% CI: 1.06, 1.27), for hypertension and diabetes, respectively. Conclusions: The risk of developing hypertension and diabetes is increased in women with BC who received chemotherapy, radiation therapy, and/or endocrine therapy. Future studies should examine the roles of CVD risk factor diagnosis and management on cardiometabolic risk in women with a BC history.

Burden of Cardiovascular Disease Risk Factors Over 13.5 Years in a Rural and Urban South Indian Cohort in Comparison with Global Data

Background: India has high mortality rates from cardiovascular disease (CVD). Understanding the trends and identifying modifiable determinants of CVD risk factors will guide preventive strategies and support policy making. Methods: We estimated the prevalence and incidence of CVD risk factors (overweight, obesity, central obesity, type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) in 962 (male 519) non-migrant adults from Vellore, South India, studied in i) 1998-2002 (baseline, mean age 28.2 years) and ii) 2013-2014 (follow-up, mean age 41.7 years). Prevalence was compared with the Non-Communicable Disease Risk Collaboration (global) data. Incidence was compared with another Indian cohort from New Delhi (NDBC). Regression analysis was used to test baseline predictors of incident CVD risk factors. Findings: The prevalence of CVD risk factors at 28 and 42 years was 17% and 51% for overweight/obesity, 19% and 59% for central obesity, 3% and 16% for type 2 diabetes, 2% and 19% for hypertension and 15% and 30% for hypertriglyceridemia. The prevalence of type 2 diabetes at baseline and follow-up and hypertension at follow-up was comparable with or exceeded that in high income countries despite lower obesity rates. The incidence of most risk factors was lower in Vellore than in the NDBC. Weight gain from 15 to 28 years, and 28-year waist circumference, strongly predicted incident type 2 diabetes, hypertension and hypertriglyceridemia. After adjusting for these, rural residents had a higher incidence of type 2 diabetes and hypertension. Interpretation: A high prevalence of CVD risk factors is evident at a young age among Indians compared with high and upper-middle income countries. The rural prevalence is catching up with urban rates. Adiposity predicted higher risk factors, but the prevalence of hypertension and T2D is higher than expected given a relatively low obesity prevalence in global terms. This suggests greater sensitivity to adiposity and/or other unmeasured causal factors, among Indians. The increasing burden of CVD risk factors in India reinforces the need for strengthening CVD risk-prevention strategies, particularly in rural India and starting from a young age. Funding Statement: British Heart Foundation, UK and Christian Medical College, Vellore, India Declaration of Interests: None. Ethics Approval Statement: The study was approved by the institutional ethics committee of the Christian Medical College, Vellore and all participants provided informed consent.

Association of prescription opioids and incident cardiovascular risk factors among post-9/11 Veterans

Reports indicate that long-term opioid therapy is associated with cardiovascular disease (CVD). Using VA electronic health record data, we measured the impact of opioid use on the incidence of modifiable CVD risk factors. We included Veterans whose encounter was between October 2001 to November 2014. We identified Veterans without CVD risk factors during our baseline period, defined as the date of first primary care visit plus 365 days. The main exposure was opioid prescriptions (yes/no, long-term (i.e. ≥90 days) vs no opioid, and long-term vs short-term (i.e. <90 days)), which was time-updated yearly from the end of the baseline period to February 2015. The main outcome measures were incident CVD risk factors (hypertension, dyslipidemia, diabetes, obesity, and current smoking).After excluding prevalent CVD risk factors, we identified 308,015 Veterans. During the first year of observation, 12,725 (4.1%) Veterans were prescribed opioids, including 2028 (0.6%) with long-term exposure. Compared to patients without opioid use, Veterans with opioid use were more likely to have CVD risk factors. Those with long-term exposure were at higher risk of having hypertension (adjusted average hazards ratio [HR] 1.45, 99% confidence interval [CI] 1.33–1.59), dyslipidemia (HR 1.45, 99% CI 1.35–156), diabetes (HR 1.30, 99% CI 1.07–1.57), current smoking status (HR 1.34, 99% CI 1.24–1.46), and obesity (HR 1.22, 99% CI 1.12–1.32). Compared to short-term exposure, long-term had higher risk of current smoking status (HR 1.12, 99% CI 1.01–1.24).These findings suggest potential benefit to screening and surveillance of CVD risk factors for patients prescribed opioids, especially long-term opioid therapy.

Frailty as Cardiovascular Risk Factor (and Vice Versa).

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.

Sense of Purpose in Life and Cardiovascular Disease: Underlying Mechanisms and Future Directions.

In this review, we synthesize recent research that has reported associations of a higher sense of purpose in life with reduced risk of developing cardiovascular disease (CVD), and then explore mechanisms that might underlie these associations. Accumulating observational and experimental evidence suggests that having a higher sense of purpose might influence CVD risk through three pathways: (1) enhancement of other psychological and social resources that buffer against the cardiotoxic effects of overwhelming stress; (2) indirect effects through health behaviors; and (3) direct effects on biological pathways. A sense of purpose in life is emerging as an independent risk factor for incident CVD. A key remaining question is whether purpose causally effects CVD risk; in the "Future Research Directions" section, we focus on work needed to establish causality and provide suggestions for next steps.

Increasing Liver Fat Is Associated With Incident Cardiovascular Risk Factors

Nonalcoholic fatty liver disease (NAFLD) is associated with increased liver- and cardiovascular disease (CVD)-related morbidity and mortality. In cross-sectional analyses, NAFLD clusters with several cardiometabolic traits including obesity,1,2 hypertension,3 diabetes,1 and dyslipidemia.3 However, liver fat is dynamic and changes over time. Aside from limited prior studies evaluating diet or exercise interventions, little is known about the association between changes in liver fat and the incidence of CVD risk factors. Additionally, previous studies often have limited follow-up; evaluate only select populations, such as individuals with obesity4,5 or diabetes6-8; and may not account for changes in weight or body mass index (BMI). The aim of the present study was to examine, in a longitudinal cohort, the natural history of liver fat change and the association with the incidence of multiple CVD risk factors.

Gestational diabetes mellitus in mothers and long term cardiovascular disease in both parents: Results of over a decade follow-up of the Iranian population

Background and aimsWe aimed at evaluating whether the presence of gestational diabetes mellitus (GDM) in mothers is associated with increased risk of incident cardiovascular disease (CVD) in both mothers and fathers. MethodsIn this population-based study, 4308 Iranian women, aged 18–64 years, with at least 1 live-birth delivery, and free of CVD at baseline, were followed. Corresponding spouses were identified in 2547 cases. The association between history of GDM and incident CVD was assessed using multivariate Cox's proportional hazard in 3 models: model 1, unadjusted; model 2, adjusted for age, body mass index, smoking (for men), maternal parity, miscarriage, physical activity, hypertension and hypercholesterolemia, and model 3, further adjusted for diabetes mellitus. ResultsAfter a median follow-up of 14.1 years, 314 mothers and 424 fathers experienced CVD. Women with history of GDM had an adjusted hazard ratio (HR), 95% CI of 1.85 (1.38–2.48) and 1.29 (0.96–1.75) for CVD in models 1 and 2, respectively. Furthermore, an independent association with CVD was observed in fathers with an adjusted HR of 1.35 (1.02–1.79) in the confounder adjusted model and even after further controlling for diabetes [1.36 (1.03–1.80)]. Moreover, all traditional risk factors, excluding BMI, showed an independent risk for CVD in both genders. ConclusionsWomen with prior GDM showed an increased risk of CVD that was not independent of important CVD risk factors. However, among men, spousal history of GDM was an independent risk factor for incident CVD, even after considering important traditional risk factors, including diabetes.

Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults

ObjectivesWe examined the dose–response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan.MethodsThis study included 1 98 919 participants, aged 18–97 years,...