Coronary Heart Disease Incidence Rates Research Articles

Abstract P387: FOXO3 Longevity Genotype Mitigates The Risk Of Coronary Heart Disease In Men With Hypertension

Background: We have shown that the FOXO3 longevity genotype moderates the mortality risk in men with hypertension. This study aimed to test whether the FOXO3 longevity genotype moderates the risk of incident coronary heart disease (CHD) in men with hypertension. Methods: The study included 6,312 Japanese American men who were free of CHD at the baseline examination of the Kuakini Honolulu Heart Program (1965-1968, age 53.9±5.4, range 45-68 years), and had been genotyped for the FOXO3 SNP rs2802292 ( FOXO3-292 ). The minor G allele, i.e., TG or GG (TG / GG) genotype is associated with longevity vs. the common TT genotype, which is not . Hypertension was defined as systolic/diastolic BP ≥ 140/90 mmHg or taking antihypertensive medication. Incident CHD was diagnosed from hospital records and follow up examinations to 12/31/2000 (35 years of follow-up). The date of the first coronary event was defined as onset date of CHD, including myocardial infarction, coronary insufficiency, angina, coronary bypass, coronary angioplasty, silent myocardial ischemia, and CHD death. Cox proportional hazard models were used to assess the association of FOXO3-292 genotype and hypertension with incident CHD. Results: During follow-up, 1,629 men developed incident CHD. The age-adjusted incidence rate of CHD was 8.99, 8.31, and 8.62 per 1,000 person-years ( p =0.62) for FOXO3-292 genotypes TT, TG, and GG , respectively. The Cox model, adjusting for age and CVD risk factors, showed hazard ratio (95%CI) for CHD with FOXO3-292 genotypes TG / GG compared to genotype TT was 0.91 (0.82-1.00; p =0.058). The full Cox model, adjusting for age and CVD risk factors, showed a significant interaction effect of FOXO3-292 genotypes TG / GG with hypertension on incident CHD (β= -0.22, p =0.03). After stratifying for hypertension, FOXO3-292 genotypes TG / GG had no effect on incident CHD in those without hypertension HR=1.01 (0.88-1.17; p =0.84) but had a protective effect on incident CHD HR=0.82 (0.74-0.95; p = 0.0064) in those with hypertension. Conclusion: We found the longevity associated FOXO3 genotype may not independently affect the risk of CHD in all men but was associated with protection against incident CHD in men with hypertension.

Risk factors and characteristics of new-onset coronary heart disease in adults with physical disabilities: A retrospective cohort study

ObjectivesThere is limited information about coronary heart disease (CHD) in adults with physical disabilities. This study was performed to assess the incidence and predictors of the new development of CHD in adults with physical disabilities. MethodsA retrospective cohort study was performed on 3902 physically disabled people in Shanghai, China. Baseline information was collected in January 2012, and participants were followed-up with for 7.5 years for CHD events. Risk factors for demographic characteristics, disease history, electrocardiography, and blood biochemical indicators were evaluated using a Cox proportional hazard model. Subgroup analyzes were performed according to gender and level of physical disability. ResultsOut of the total 3902 adults with physical disabilities (average age 55.9 ± 8.5 years), 468 (12.0%) developed CHD, during a median follow-up period of 7 years. Independent predictors of CHD included the following: age (HR = 1.411, 95% CI = 1.255–1.587, p＜0.001), gender (HR = 0.773, 95% CI = 0.637–0.940, p = 0.010), abnormal electrocardiogram(HR = 1.396, 95% CI = 1.088–1.792, p = 0.009), hypertension (HR = 1.657, 95% CI = 1.369–2.006, p＜0.001), diabetes (HR = 1.649, 95% CI = 1.307–2.081, p＜0.001), serum uric acid (HR = 1.001, 95% CI = 1.000–1.002, p = 0.046), and total cholesterol (HR = 1.416, 95% CI = 1.054–1.902, p = 0.021). In addition to the risk factors of the total population with physical disability, triglyceride was also a significant risk factor for CHD in the subgroup with women and mild disability. ConclusionsDuring a 7.5 years period, the CHD incidence rate among physically disabled people was 12.0%. We identified the role of CHD risk factors such as age, gender, hypertension, diabetes, serum uric acid, total cholesterol, and abnormal electrocardiogram.

PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION

Objective: To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice. Design and method: We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events. Results: The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19). Conclusions: In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.

Elevated lipoprotein(a) and genetic polymorphisms in the LPA gene may predict cardiovascular events

Elevated lipoprotein(a) [Lp(a)] is a risk factor for coronary heart disease (CHD), but there are few studies on the prediction of future cardiovascular events by Lp(a) and its LPA single nucleotide polymorphisms (SNPs). The aim of this study was to investigate whether elevated Lp(a) and its SNPs can predict cardiovascular events. We evaluated whether Lp(a) and LPA SNPs rs6415084 and rs12194138 were associated with the incidence rate and severity of CHD. All participants were followed up for 5 years. Elevated Lp(a) is an independent risk factor for the risk and severity of CHD (CHD group vs. control group: OR = 1.793, 95% CI: 1.053–2.882, p = 0.043; multiple-vessel disease group vs. single-vessel disease group: OR = 1.941, 95% CI: 1.113–3.242, p = 0.027; high GS group vs. low GS group: OR = 2.641, 95% CI: 1.102–7.436, p = 0.040). Both LPA SNPs were risk factors for CHD, and were positively associated with the severity of CHD (LPA SNPs rs6415084: CHD group vs. control group: OR = 1.577, 95% CI: 1.105–1.989, p = 0.004; multiple-vessel disease group vs. single-vessel disease group: OR = 1.613, 95% CI: 1.076–2.641, p = 0.030; high GS group vs. low GS group: OR = 1.580, 95% CI: 1.088–2.429, p = 0.024; LPA SNPs rs12194138: CHD group vs. control group: OR = 1.475, 95% CI: 1.040–3.002, p = 0.035; multiple-vessel disease group vs. single-vessel disease group: OR = 2.274, 95% CI: 1.060–5.148, p = 0.038; high GS group vs. low GS group: OR = 2.067, 95% CI: 1.101–4.647, p = 0.021). After 5 years of follow-up, elevated Lp(a) and LPA SNPs rs6415084 and rs12194138 can independently predict cardiovascular events. The increase of serum Lp(a) and LPA SNPs rs6415084 and rs12194138 are associated with increased prevalence and severity of CHD, and can independently predict cardiovascular events.

Does the Encounter Type Matter When Defining Diabetes Complications in Electronic Health Records?

Electronic health records (EHRs) and claims records are widely used in defining type 2 diabetes mellitus (T2DM) complications across different types of health care encounters. This study investigates whether using different EHR encounter types to define diabetes complications may lead to different results when examining associations between diabetes complications and their risk factors in patients with T2DM. The study cohort of 64,855 adult patients with T2DM was created from EHR data from the Research Action for Health Network (REACHnet), using the Surveillance Prevention, and Management of Diabetes Mellitus (SUPREME-DM) definitions. Incidence of coronary heart disease (CHD) and stroke events were identified using International Classification of Diseases (ICD)-9/10 codes and grouped by encounter types: (1) inpatient (IP) or emergency department (ED) type, or (2) any health care encounter type. Cox proportional hazards regression was used to estimate associations between diabetes complications (ie, CHD and stroke) and risk factors (ie, low-density lipoprotein cholesterol and hemoglobin A1c). The incidence rates of CHD and stroke in all health care settings were more than twice the incidence rates of CHD and stroke in IP/ED settings. The age-adjusted and multivariable-adjusted hazard ratios for incident CHD and stroke across different levels of low-density lipoprotein cholesterol and hemoglobin A1c were similar between IP/ED and all settings. While there are large variations in incidence rates of CHD and stroke as absolute risks, the associations between both CHD and stroke and their respective risk factors measured by hazard ratios as relative risks are similar, regardless of alternative definitions.

1487-P: Comparison of the Framingham Risk Score, SCORE, and UKPDS Risk Engine for Predicting Cardiovascular Disease Complications in People with Diabetes

The epidemiology of cardiovascular disease (CVD) complications in people with diabetes is changing with the increasing prevalence of presentations other than coronary heart disease (CHD) (e.g., heart failure (HF), cardiomyopathy (CM)). Existing CVD risk estimators such as the Framingham Risk Score (FRS), SCORE, and UKPDS Risk Engine primarily assess CHD risk. Our goal was to assess the prediction accuracy of HF and CM from these risk equations. We evaluated FRS, SCORE, and UKPDS to predict 1-year risk of CHD, HF, and CM from electronic health records of 469 diabetes patients seen at Emory Healthcare. Only adults without a prior history of CVD at baseline were included. A patient was denoted as a case if s/he had a subsequent ICD-9 code of HF, CHD, or CM at the next visit within a year, and if not, s/he was denoted as a control. We calculated the C-statistic of each score for each disease type. Our population had an average age of 71 with 47% females and 58% Caucasian. CHD, HF, and CM annual incidence rates were 54%, 44%, and 38%, respectively. Across FRS, SCORE, and UKPDS, CHD had the highest C-statistic (0.589-0.608) with HF the next highest (0.547-0.578). CM (0.369-0.426) performed worse than chance. Moreover, UKPDS performed the best across the three CVD complications. These results suggest that CVD risk estimators need to be calibrated for variations in disease presentation. Disclosure J.C. Ho: None. L.R. Staimez: None. K. Narayan: None. R.L. Simpson: None. V.S. Hertzberg: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024); National Library of Medicine (1K01LM012924-01)

Coexistence effect of hypertension and angiotensin II on the risk of coronary heart disease: a population-based prospective cohort study among Inner Mongolians in China

Objective: To investigate the coexistence effect of hypertension and angiotensin II on the risk of coronary heart disease based on a prospective study in an Inner Mongolian population of China.Methods: The participants were categorized into four subgroups according to hypertension status and median of angiotensin II level. Incident coronary heart disease (CHD) was defined as study outcome. A Cox proportional hazard model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) of CHD across the four subgroups after adjusting for important confounding factors.Results: During an average 9.2 years of follow-up, a total of 75 incident CHD cases were observed. The cumulative incidence rates of CHD among normotensives with angiotensin II ≤49 pg/mL, normotensives with angiotensin II >49 pg/mL, hypertensives with angiotensin II ≤49 pg/mL and hypertensives with angiotensin II >49 pg/mL were 1.76%, 1.50%, 4.71% and 5.62%, respectively (log-rank test, p < .001). Compared to the normotensives, the multivariable adjusted HRs (95% CI) of CHD with hypertensives and Ang II >49 pg/mL were 2.43 (1.41–4.17) and 1.30 (0.81–2.07), respectively. Furthermore, compared to normotensives with angiotensin II ≤49 pg/mL, the multivariate-adjusted HRs (95% CIs) of CHD for normotensives with angiotensin II >49 pg/mL, hypertensives with angiotensin II ≤49 pg/mL and hypertensives with angiotensin II >49 pg/mL were 1.33 (0.60–2.91), 2.35 (1.16–4.76) and 3.00 (1.52–5.92), respectively (p for trend <.05). The hypertensives with angiotensin II >49 pg/mL were at the highest risk of CHD.Conclusions: Hypertension not angiotensin II was an independent risk factor for incident CHD, but the coexistence of both hypertension and high angiotensin II level further increased risk of incident CHD among the Inner Mongolians.

Increased Subsequent Risk of Coronary Heart Disease in Primary Cesarean Delivery Women: A Population-Based Cohort Study.

Impacts of delivery modes on the subsequent risk of coronary heart disease (CHD) in pregnant women have not been elucidated. Data of women who had undergone cesarean delivery (CD cohort) or vaginal delivery (VD cohort) between January 2000 and December 2012 from Taiwan Health Insurance Database were analyzed. All subjects were tracked until December 31, 2013. For women with multiple deliveries, only the first delivery data were included. Study end point was the diagnosis of new-onset CHD after delivery. In total, 51,765 subjects (CD cohort: n = 17,839; VD cohort: n = 33,926) were included. During 1-14 years of follow-up, the incidence rate of new-onset CHD in the CD cohort was significantly higher than in the VD cohort (1.3% [231/17,839] vs. 0.8% [257/33,926], p < 0.001; effect size: 0.30). Analysis revealed that the subsequent risk of CHD in the CD cohort was significantly higher than in the VD cohort (adjusted hazard ratio [HR] = 1.28, 95% confidence intervals [CI]: 1.06-1.55, p = 0.012). We performed sensitivity tests by excluding subjects who had undergone CD due to nonmedical reasons from the CD cohort. The remaining subjects were named as the *CD cohort. Analysis also revealed a higher subsequent risk of CHD in the *CD cohort than in the VD cohort (adjusted HR = 1.32, 95% CI: 1.08-1.60, p = 0.006). Women who had undergone primary CD, especially those who had undergone CD due to medical reasons, were associated with an ∼30% higher risk of CHD than those who had undergone VD.

A sialoadenectomy is associated with an increased risk of coronary heart disease: A three-year follow-up study.

Little is known regarding the long-term adverse effects of a sialoadenectomy. The purpose of this study was to estimate the risk of coronary heart disease (CHD) among patients receiving a sialoadenectomy procedure by utilizing a cohort study based on a population-based database in Taiwan. This study retrieved data of the study sample from the Longitudinal Health Insurance Database 2005. This retrospective cohort study included 608 patients who underwent a sialoadenectomy and 1824 propensity score-matched comparison patients. We individually tracked each sampled patient for a 3-year period from their index date to discriminate those who subsequently received a diagnosis of CHD during the follow-up period. We found that respective incidence rates of CHD during the 3-year follow-up period were 3.87 (95% confidence interval (CI): 3.01–4.91) and 1.79 (95% CI: 1.45–2.18) per 100 person-years for patients who did and those who did not undergo a sialoadenectomy. The stratified Cox proportional analysis revealed that the hazard ratio of CHD during the 3-year follow-up period was 2.43 (95% CI: 1.77–3.33) than comparison patients. This study demonstrates an association between sialoadenectomy and CHD.

Impact Of Hypertension versus Diabetes on Cardiovascular and All-cause Mortality in Iranian Older Adults: Results of 14 Years of Follow-up

To evaluate the joint effect of hypertension (HTN) and diabetes (DM) on coronary heart disease (CHD), and stroke event, all-cause, and cardiovascular disease (CVD) mortality in Middle Eastern older adults, 2747 people (1436 women) aged ≥ 50 years, free of CVD at baseline, were categorized into four groups (HTN−/DM−, HTN+/DM−, HTN−/DM+, HTN+/DM+). Multivariate Cox proportional hazard models were run for different outcomes. To compare the impact of HTN versus DM, HTN+/DM− was considered as reference. In a median of 13.9 years, incidence rate of CHD, and stroke event, all-cause and CVD mortality in total population were 19.0, 4.7, 13.5, and 6.4 per 1000 person-years, respectively. The multivariate sex-adjusted hazard ratios (HRs) of HTN−/DM+ for CHD, stroke, all-cause mortality and CVD mortality were 1.19 (confidence interval (CI): 0.9–1.57), 1.07 (CI: 0.63–1.82), 1.62 (CI: 1.2–2.18), and 1.28 (CI: 0.83–1.97); the corresponding HRs for HTN+/DM+ were 1.96 (CI: 1.57–2.46), 1.66 (CI: 1.1–2.52), 2.32 (CI: 1.8–2.98), and 2.6 (CI: 1.85–3.65) respectively. The associations between HTN/DM status with stroke incidence and all-cause mortality were stronger among men than in women (P for interaction <0.05). Compared to HTN+/DM−, HTN−/DM+ increases all-cause mortality by 62%, however, they are not considerably different regarding CHD, stroke incidence and CVD mortality.

Association between hemorrhoid and risk of coronary heart disease: A nationwide population-based cohort study.

The purpose of the study was to address the association between hemorrhoid and the subsequent risk of coronary heart disease (CHD) development.This retrospective cohort study used reimbursement claims data from the Longitudinal Health Insurance Database 2000 in Taiwan. Thirty-three thousand thirty-four patients with hemorrhoids and 132,136 age-, gender-, and index year matched controls between 2000 and 2010 were identified. Cox model was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of CHD development for the hemorrhoid cohort compared with the nonhemorrhoid cohort.During a follow-up period of 12 years, the overall incidence rate of CHD was 9.91 per 1000 person-years in the hemorrhoid patients and was 1.36-fold higher than in the nonhemorrhoid cohort (7.28 per 1000 person-years) with an adjusted hazard ratio (aHR) of 1.27 (95% CI = 1.21–1.34). Moreover, compared with the nonhemorrhoid patients without these comorbidities, among patients with hemorrhoids, those with any 2 comorbidities were at a significantly increased risk of CHD (HR = 7.12, 95% CI = 6.61–7.67; P < .001), followed by those with any 1 comorbidity (HR = 3.23, 95% CI = 2.94–3.54; P < .001).We found that hemorrhoid patients had a 1.27-fold higher risk of CHD compared with those without hemorrhoids after adjusting for the potential confounding factors.

Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study

Objective To examine the association of long term intake of gluten with the development of incident coronary heart disease.Design Prospective cohort study.Setting and participants 64 714 women in the Nurses’...

Job strain and the incidence of coronary heart diseases: does the association differ among occupational classes? A contribution from a pooled analysis of Northern Italian cohorts

ObjectivesTo assess the association between job strain (JS) and the incidence of coronary heart disease (CHD) in North Italian employed men, adopting a stratified analysis by occupational class (OC).MethodsThe study...

No increased risk of coronary heart disease for patients receiving androgen deprivation therapy for prostate cancer in Chinese/Taiwanese men

The relationship between androgen deprivation therapy (ADT) and coronary heart disease (CHD) remains controversial. Furthermore, the majority of such studies focused on Caucasian populations, and there is still a paucity of studies among Asian populations. This population-based study aimed to investigate the relationship between ADT and CHD in an ethnic Chinese (i.e., Taiwanese) population. We used data sourced from the Taiwan 'Longitudinal Health Insurance Database'. This study included 1278 patients with prostate cancer in the study group and 1278 subjects without prostate cancer in the comparison group. Each patient was individually tracked for a 3-year period to identify those who had subsequently received a diagnosis of CHD. The results showed that the incidence rate of CHD during the 3-year follow-up period was 4.69 (95% CI: 2.99-5.48) per 100 person-years and 2.67 (95% CI: 2.15-3.27) per 100 person-years for the study and comparison cohort, respectively. The Cox proportional hazard regression showed that the hazard ratio for CHD during the 3-year follow-up period for prostate cancer patients was 1.65 (95% confidence interval (CI) = 1.25-2.16) compared with comparison subjects after adjusting for patients' geographic location, monthly income, urbanization level, hypertension, diabetes, hyperlipidemia, and stroke. However, we failed to find a significant difference in the adjusted hazard of CHD during the 3-year follow-up period between prostate cancer patients who did and those who did not receive ADT (hazard ratio = 1.12, 95% CI = 0.79-1.59). We concluded that prostate cancer but not ADT was significantly associated with CHD. In addition, a common cause of prostate cancer and coronary heart disease could exist.

Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age

ObjectivePsychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess...

Comparative Trends in the Incidence of Hospitalized Myocardial Infarction and Coronary Heart Disease in Adults With and Without Diabetes Mellitus in Western Australia From 1998 to 2010

The risk of myocardial infarction (MI) is elevated in people with diabetes mellitus (DM) compared with non-DM counterparts. The aim of this study was to compare population trends in the incidence of hospitalized MI and coronary heart disease (CHD) in adults with and without DM. All incident hospitalized MI and CHD events were identified from whole-population hospital data in Western Australia for 1998 to 2010. Annual age-standardized MI and CHD incidence rates were calculated for people with and without DM aged 35 to 84 years and age-adjusted trends estimated from Poisson regression. There were 26 610 incident MI and 56 142 incident CHD cases during the study period. MI incidence rates fell in men (-2.9%/y; 95% confidence interval [CI], -3.7 to -2.1) and women (-3.8%/y; 95% CI, -4.8 to -2.1) with DM, representing overall reductions of 35% and 43% respectively, with comparable reductions in incident CHD. Downward trends in MI incidence in those with DM were most apparent in 55- to 84-year olds. In adults without DM, there was no decline in MI incidence but a small significant decrease in incident CHD (men, -1.5%/y; 95% CI, -1.8 to -1.2 and women, -1.3%/y; 95% CI, -1.8 to -0.9). Incidence rate ratios for MI in men with versus without DM declined from 4.5 (95% CI, 4.2-4.8) to 3.1 (95% CI, 2.9-3.3) and from 6.0 (95% CI, 5.4-6.6) to 3.8 (95% CI, 3.5-4.1) in women between 1998 and 2010. There have been significant reductions in incidence rates of MI and CHD in adults with DM between 1998 and 2010; however, the excess risk of MI incidence remains 3 to 4× greater in people with DM.

Increased risk of coronary heart disease in patients with chronic osteomyelitis: a population-based study in a cohort of 23 million

ObjectivesChronic inflammatory disease may trigger vascular atherosclerosis. This study aimed to determine whether chronic osteomyelitis (COM) is linked to an increased risk of coronary heart disease (CHD).MethodsA national insurance claim...

A coronary heart disease prediction model: the Korean Heart Study

ObjectiveThe objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk...

Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease

Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease

Age-dependent decline of association between obesity and coronary heart disease: a cohort study in a remote Australian Aboriginal community

ObjectiveTo determine whether the association between obesity and coronary heart disease (CHD) in Aboriginal adults depends on age.Design, setting and participantsA cohort study with up to 20 years of follow-up...