Incidence Of Non-fatal Cardiovascular Disease Research Articles

Dietary inflammatory potential and the risk of nonfatal cardiovascular diseases in the China Health and Nutrition Survey

BackgroundTo our knowledge, no evidence exists to link dietary inflammatory potential to cardiovascular disease (CVD) in China. Furthermore, the precise mechanisms underlying the link between a pro-inflammatory diet and CVD remain incompletely understood. ObjectiveWe aimed to investigate the relationship between dietary inflammatory potential and nonfatal CVD in the Chinese population and to explore the mediating role of insulin resistance. MethodsA total of 4822 adults who participated in the China Health and Nutrition Survey (CHNS) were included in this analysis. The dietary inflammatory index (DII) was used to assess dietary inflammatory potential. Cox proportional hazards models and restricted cubic spline were applied to assess the longitudinal associations. The triglyceride-glucose (TyG) index was calculated to measure insulin resistance. Mediation analysis using a two-stage regression method for survival data was employed to explore the mediating effects of the TyG index on the association between DII score and nonfatal CVD. ResultsDuring a median follow-up of 18 y, 234 incident cases of nonfatal CVD, including 136 strokes and 114 myocardial infarctions (MIs), were observed. For each standard deviation of the DII score, nonfatal CVD incidence increased by 15% (hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.01–1.31), and stroke incidence increased by 22% (HR = 1.22, 95% CI: 1.03–1.45). DII score displayed a linear association with nonfatal CVD and stroke (P for nonlinearity = 0.250 and 0.238, respectively). No significant association was found between the DII score and MI. Mediation analyses showed that the TyG index mediated 5.90% and 9.35% of the total association between DII score and nonfatal CVD and stroke, respectively. ConclusionsThis study provides evidence that dietary inflammatory potential is positively associated with nonfatal CVD and stroke in Chinese adults, and the association was partly mediated by insulin resistance.

Indoor solid fuel use for cooking and the risk of incidental non-fatal cardiovascular disease among middle-aged and elderly Chinese adults: a prospective cohort study.

ObjectivesThe harm of indoor air pollution to health has gradually attracted attention, but the effect of indoor air pollution from burning solid fuels on incidental non-fatal cardiovascular disease (CVD) is not well understood. Under these circumstances, this study examined the association between solid fuel use and incidental non-fatal CVD.DesignThe prospective cohort study was conducted in 2011, 2013, 2015 and 2018.SettingThe nationally representative survey was conducted in 28 provinces of China.ParticipantsThis study included 13 544 middle-aged and elderly adults without CVD in the baseline survey, and they were followed for 7 years.Outcome measuresFirst incidence of non-fatal CVD (heart disease or stroke).MethodsBased on longitudinal data, Cox proportional hazards models were used to assess the effects of solid fuel use and persistent use on incidental CVD events.ResultsDuring the 7-year follow-up period, there were 1533 non-fatal CVD cases. A total of 7310 (54%) participants used solid fuel for cooking at the baseline survey, and 2998 (41%) users continued to use solid fuel. Solid fuel use was associated with incidental non-fatal CVD (HR: 1.18; 95% CI: 1.05 to 1.32) compared with clean fuel, and persistent solid fuel use might lead to a higher risk of incidental non-fatal CVD (HR: 1.38; 95% CI: 1.18 to 1.61) and heart disease (HR: 1.49; 95% CI: 1.24 to 1.81). In the subgroup analysis, the relationship remained significant in the female, elderly, rural and hypertensive groups. However, we found no significant interaction between these risk factors and fuel use (all p<0.05).ConclusionsThis cohort study provides evidence for the effects of solid fuel use on incidental non-fatal CVD in middle-aged and elderly Chinese adults. Advocating for the use of clean energy and ventilation stoves is important to cardiovascular health.

Reduced cardiovascular morbidity in patients with hemophilia: results of a 5-year multinational prospective study

AbstractHemophilia is a congenital bleeding disorder caused by low levels of clotting factor VIII or IX. The life expectancy of people with hemophilia (PWH) has increased with the availability of clotting factor concentrates. At the same time, the incidence of cardiovascular disease (CVD) has increased; in retrospective studies, there are conflicting data regarding if, despite this increase, the incidence is still lower than in the general population. We prospectively compared the incidence of CVD in PWH vs the predicted incidence. This prospective, multicenter, observational study included adult PWH (aged >30 years) from The Netherlands and United Kingdom. They were followed up for a 5-year period, and CVD incidence was compared with a predicted event rate based on the QRISK2-2011 CVD risk model. The primary end point was the observed fatal and nonfatal CVD incidence after 5 years compared with the estimated events and in relation to severity of hemophilia. The study included 709 patients, of whom 687 (96.9%) completed 5 years' follow-up or reached an end point. For 108 patients, the QRISK score could not be calculated at inclusion. For the remaining 579, fewer CVD events were observed than predicted: 9 vs 24 (relative risk, 0.38; 95% confidence interval, 0.18-0.80; P = .01), corresponding with an absolute risk reduction of 2.4%. Severe hemophilia treated on demand had the highest risk reduction. There was no statistically significant relation between severity of hemophilia and incidence of CVD. In hemophilia, a lower-than-predicted CVD incidence was found, supporting the theory that hemophilia protects against CVD. The study is registered at www.clinicaltrials.gov as #NCT01303900.

Cardiovascular disease and mortality in people with schizophrenia or antipsychotic treatment: A cohort study in primary care

People with schizophrenia (SZ) or under treatment with antipsychotic drugs (TAD) are considered to be at high risk of cardiovascular (CV) morbidity and mortality, but the reasons are not fully understood. In addition, no longitudinal studies in the setting of primary care in Spain have been performed. We aimed at analysing the incidence of cardiovascular disease (CVD) and CV mortality in the population with SZ and in the population without SZ but under TAD (NS-TAD). MethodsRetrospective cohort study in primary care in Spain, based on data from computerized medical records and mortality recorded in the National Statistics Institute. Three groups were generated: SZ, NS-TAD and control group, with a 4-year follow-up period (2008 to 2011). ResultsIn an adjusted model, SZ was established as an independent risk factor for CV mortality although not with non-fatal CVD incidence. The NS-TAD group was an independent risk factor for mortality of any cause and CVD, but not CV mortality. ConclusionsDifferences between SZ and NS-TAD support that SZ has an increased risk of CVD independently of TAD. Further studies to evaluate the origin and management are needed. The detection of CVD and the consequent secondary CV prevention in these high-risk populations should be prioritized. Herein, a greater interaction between primary care and mental health services is eagerly needed.

Omega-3 fatty acids and risk of cardiovascular disease in Inuit: First prospective cohort study

Background and aimsNo prospective study have ever assessed if marine n-3 polyunsaturated fatty acids protect Inuit against cardiovascular disease as claimed. It is highly relevant as cardiovascular disease (CVD) incidence rates are rising concurrent with a westernization of diet. We aimed to assess the association between blood cell membrane phospholipid content of eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA) on CVD risk in Inuit. MethodsWe used data from a cohort of adult Greenlanders with follow-up in national registers. The main outcome was fatal and non-fatal CVD incidence among participants without previous CVD. The continuous effect of EPA + DHA was calculated as incidence rate ratios (IRRs) using Poisson regression with age as time scale, adjusting for age, sex, genetic admixture, lifestyle and dietary risk factors. ResultsOut of 3095 eligible participants, 2924 were included. During a median follow-up of 9.7 years, 216 had their first CVD event (8.3 events/1000 person years). No association between EPA + DHA and CVD risk was seen, with IRR = 0.99 per percentage point EPA + DHA increase (95% CI: 0.95–1.03, p = 0.59). No association was seen with risk of ischemic heart disease (IHD) (IRR = 1.03, 95% CI: 0.97–1.09) and stroke (IRR = 0.98, 95% CI: 0.93–1.03) as separate outcomes or for intake of EPA and DHA. ConclusionsWe can exclude that the CVD risk reduction is larger than 21% for individuals at the 75% EPA + DHA percentile compared to the 25% percentile. We need a larger sample size and/or longer follow-up to detect smaller effects and associations with IHD and/or stroke.

Identification of Dietary Patterns Related to Metabolic Diseases and Their Association with Cardiovascular Disease: From the Korean Genome and Epidemiology Study.

Using data from the community-based cohort of the Korean Genome and Epidemiology Study (KoGES), we evaluated the dietary patterns (DPs) related to metabolic diseases and their associations with the incidence of non-fatal cardiovascular disease (CVD). After excluding those with a history of CVD or cancer, we analyzed the data of 8352 subjects aged 40–69 years. Based on their daily intake of 26 food groups at baseline, the DPs of the subjects with metabolic diseases (n = 1679, 20.1%) were analyzed using principal component analysis. Due to regional differences in the effect of DPs on CVD, we performed analyses stratified by region. The association between DPs and the incidence of non-fatal CVD was evaluated by calculating the hazard ratio (HR) and 95% confidence interval (CI) using the Cox proportional hazards model. During the 12-year follow-up, the incidence of non-fatal CVD was 5.4 per 1000 person-years (n = 431). An animal-based DP made the greatest contribution to the total variance and was characterized by a high intake of pork, beef, chicken, fish, and shellfish. The effect of DP on CVD differed by region (industrial/rural regions, p < 0.05) and was dominant in industrial regions, irrespective of metabolic disease status. In industrial regions, subjects in the top quintile of DP had a 0.42-fold (95% CI = 0.24–0.74) lower risk of incident CVD than those in the bottom quintile, even after adjusting for various covariates. In addition, the risk of CVD was high in individuals with a history of metabolic disease in both regions (HR = 1.74, 95% CI = 1.24–2.43 in industrial regions; HR = 1.88, 95% CI = 1.42–2.48 in rural regions). DP and a history of metabolic diseases, but not their interaction, were independently associated with incident CVD. In our study, an animal-based DP related to metabolic disease was independently associated with incident CVD, and this effect was noticeable only in industrial regions.

Diabetes and number of years of life lost with and without cardiovascular disease: a multi-state homogeneous semi-Markov model.

We quantified the impact of type 2 diabetes on incidence of non-fatal cardiovascular disease (CVD) and mortality, considering CVD as a continuum from occurrence of diabetes to the end point, and estimated the 15-year life expectancy with and without CVD. A total of 7239 Iranian adults (3246 men), aged ≥30years, were followed from 1999 to 2014. We applied a multi-state semi-Markov model with three transitions including CVD-free to non-fatal CVD, CVD-free to death and non-fatal CVD to death, and studied the influence of diabetes on each transition rate, stratifying by sex and adjusting for confounders. Diabetes was significantly associated with increased risk of non-fatal CVD in men [hazard ratio, 1.70 (1.36-3.53)] and women [2.19 (1.74-2.77)], and of all-cause death [2.72 (2.03-3.63) and 1.92 (1.37-2.67) in men and women, respectively]. An increased risk of mortality was found only among diabetic men, when non-fatal CVD was occurred [2.19 (1.36-3.53)]. Men with diabetes experienced first non-fatal CVD and death without CVD 1.7 and 1.4years, respectively, earlier than those without diabetes; the corresponding values were 1.4 and 0.7years for women. Moreover, diabetic men lived 1.3years less than non-diabetic counterparts when non-fatal CVD was occurred. Diabetes increased the risk of non-fatal CVD events and all-cause mortality and consequently decreased the number of years lived without CVD. A decrease in LE was found only among diabetic men compared to non-diabetics after non-fatal CVD occurred.

Comparison of Machine Learning Approaches Toward Assessing the Risk of Developing Cardiovascular Disease as a Long-Term Diabetes Complication.

The estimation of long-term diabetes complications risk is essential in the process of medical decision making. Guidelines for the management of Type 2 Diabetes Mellitus (T2DM) advocate calculating the Cardiovascular Disease (CVD) risk to initiate appropriate treatment. The objective of this study is to investigate the use of sophisticated machine learning techniques toward the development of personalized models able to predict the risk of fatal or nonfatal CVD incidence in T2DM patients. The important challenge of handling the unbalanced nature of the available dataset is addressed by applying novel ensemble strategies. Hybrid Wavelet Neural Networks (HWNNs) and Self-Organizing Maps (SOMs) constitute the primary models for building ensembles following a subsampling approach. Different methods for combining the decisions of the primary models are applied and comparatively assessed. Data from the 5-year follow up of 560 patients with T2DM are used for development and evaluation purposes. The highest discrimination performance (Area Under the Curve (AUC): 71.48%) is achieved by taking into account both the HWNN- and SOM- based primary models' outputs. The proposed method is superior to the Binomial Linear Regression (BLR) model justifying the need to apply more sophisticated techniques in order to produce reliable CVD risk scores.

Cardiovascular disease and death associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA)

Cardiovascular disease (CVD) and death may be associated with depression and antidepressants, but published findings remain equivocal. The authors aimed to determine the risk of CVD incidence and death associated with several classifications of depression. A prospective cohort study was conducted (1994-2006) in a regionally representative sample of 1000 non-institutionalised older Australians age 65+ years (47% men). Endpoints were non-fatal CVD incidence and death over 10 and 12-years, respectively. Depression incidence was assessed at 2-years. Depression related predictors were defined by symptoms (Psychogeriatric Assessment Scales, depression scale) and/or antidepressants to determine independent and/or joint effects on endpoints. Cox regressions determined unadjusted and multiple-adjusted (for significant covariates) hazard ratios (HR). Baseline response rate was 70.3%. Aggregate dropout rate was approximately 24% for survivors at biennial follow-ups, but death status was ascertained for all participants. Several classifications of depression predicted death in unadjusted analyses (39-60% >1), but effects disappeared in multiple-adjusted analyses (in which all HRs became <1 and non-significant). Depression related predictors were thus not associated with CVD incidence; or death after accounting for confounding mostly by CVD, diabetes and poor functional health covariates. Prevalent arthritis, respiratory disease and daily pain were predictors (P < 0.05) of depression incidence. Depression related predictors were not independently associated with CVD incidence or death in older people. Antidepressants were not associated with CVD or premature death, accounting for whether participants' remained symptomatic or not. Depression co-occurs with and might be partly caused by chronic disease and poor functional health.

Cardiovascular risk in long-term testicular cancer survivors.

4533 Background: The aim was to evaluate the incidence of non-fatal cardiovascular disease (CVD) and risk profile in testicular cancer (TC) survivors (TCS). Methods: 990 men treated for unilateral TC (1980-1994) were included in this national follow-up study (2007-2008) including physical examination, blood samples and a questionnaire. Patients were categorized into four treatment groups: Surgery (n=206), radiotherapy only (RT, n=386), cisplatin-based chemotherapy only (chemo, n=364) and combined RT/chemotherapy (RT/chemo, n=34). Age-matched male controls from the general population (NORMs) were recruited from the Tromsø Study (n=990). Men diagnosed with CVD before or within two years after the TC diagnosis were excluded from analyses of CVD endpoints (age-adjusted Cox regression). CVD endpoints were 1) coronary heart disease (CHD) and 2) total CVD. All CVD diagnoses were validated by medical records (TCS). For comparisons to NORMs, the combination of stroke/myocardial infarction (MI) was the endpoint as only these diagnoses were validated. Results: Median observation time was 19 years (range 13-28). Overall 92 TCS (9.9%) experienced CVD events during follow-up. Compared with surgery group, the chemo (HR 2.6, 95% CI 1.0-6.9) and the RT/chemo group (HR 5.3, 95% CI 1.5-18.5) had increased risks for CHD. Increased risks for total CVD were observed after any cytotoxic treatment (RT: HR 2.3, 95% CI 1.1-4.7; chemo: HR 2.4, 95% CI 1.1-5.0; RT/chemo: HR 5.2, 95% CI 2.0-13.5). Compared with NORMs, TCS had 1.7 times higher risk (95% CI 1.0-2.8) for stroke/MI, with the highest risks for the RT (HR 2.0, 95% CI 1.2-3.5) and the RT/chemo group (HR 4.5, 95% CI 1.6-12.8). All treatment groups except surgery group had increased prevalence of antihypertensive medication compared to NORMS (22% vs. 13%), highest for the chemo (OR 3.3, 95% CI 2.4-4.5) and the RT/chemo group (OR 4.1, 95% CI 1.9-8.8). Survivors in the RT and RT/chemo group had higher levels of micro CRP (RT: β=0.38 mg/l, p<.001, RT/chemo: β=0.63 mg/l, p=0.014), and a higher prevalence of diabetes (RT: OR 2.3, 95% CI 1.5-3.6; RT/chemo: OR 3.9, 95% CI 1.4-10.9). Conclusions: Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly when combined, increases the long-term risk for CVD. No significant financial relationships to disclose.

Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population.

White individuals who are on dialysis experience much higher overall and cardiovascular mortality rates than black individuals despite a more favorable risk factor profile, but the incidence of nonfatal cardiovascular disease (CVD) to this racial disparity has not been well studied. A longitudinal study of 16,103 people who had ESRD and were enrolled in the United Renal Data System from 1993 to 1996 was conducted. The incidence of new and recurrent atherosclerotic CVD (ASCVD) events was determined using Medicare claims for hospitalizations and mortality among blacks and whites, stratified by ASCVD at baseline. ASCVD was defined as coronary heart disease, peripheral vascular disease, and cerebrovascular disease. Incidence of new ASCVD in people without ASCVD at baseline was 146.9 per 1000 person-years in whites and 118.7 per 1000 person-years in blacks. Incidence of recurrent ASCVD was 404.1 per 1000 person-years in whites and 317.5 per 1000 person-years in blacks. Whites were 1.35 (95% confidence interval, 1.18 to 1.55) times more likely to develop incident ASCVD compared with blacks and 1.25 (95% confidence interval, 1.14 to 1.36) times more likely to develop recurrent disease after adjusting for traditional CVD and dialysis-related risk factors. Excess risk for recurrent ASCVD in whites compared with blacks was consistently present no matter the duration of dialysis: Hazard ratio 1.42 for 0 to 6 mo and 1.40 for 6 to 12 mo. Whites who are treated with dialysis have a higher incidence of ASCVD than blacks who are on dialysis, both new and recurrent. Although differences in survival before the initiation of dialysis may contribute to the observed difference in ASCVD risk, it is not explained by baseline traditional and dialysis-related ASCVD risk factors.