Incidence Of Coronary Heart Disease Research Articles

Association of demographics, cardiovascular indicators and disability characteristics with 7-year coronary heart disease incident in persons with disabilities

ObjectivePrevious studies had demonstrated that disability increases mortality in patients with coronary heart disease (CHD). However, for people who had been disabled but do not have baseline cardiovascular disease, there is still limited data on how they might develop CHD. This study aimed to investigate the incidence and predictors of CHD in people with disabilities.MethodsWe conducted a 7-year retrospective study utilizing data from the Shanghai Comprehensive Information Platform for Persons with Disabilities Rehabilitation. Subjects aged over 18 years with at least four annual complete electronic health records were included. The primary outcome was CHD, defined as ischemic heart disease or myocardial infarction. Kaplan–Meier analysis and log-rank tests were used to compare cumulative CHD for sub-populations, stratified by age, gender, and the classification of disabilities. Cox regression was used to identify the potentially important factors.ResultsOut of 6419 persons with disabilities, 688 CHD cases (mean age 52.95 ± 7.17 years, male 52.2%) were identified, with a cumulative incidence of 10.72% and an incidence density of 15.15/1000 person-years. The incidence density of CHD is higher in the male gender, people over 45 years, and those with physical disabilities. Male (HR = 1.294, 95% CI, 1.111–1.506), hypertension (HR = 1.683, 95% CI, 1.405–2.009), diabetes mellitus (HR = 1.488, 95% CI, 1.140–1.934), total cholesterol (HR = 1.110, 95% CI, 1.023–1.204), and physical disabilities (HR = 1.122, 95% CI, 1.019–1.414) were independently associated with CHD.ConclusionThe findings indicate that the incidence of CHD differs across disability categories rather than the severity of disability. People with physical disabilities had significantly higher risks for the development of CHD. The underlying physiological and pathological factors need to be further studied.

Systemic immune-inflammation index is associated with coronary heart disease: a cross-sectional study of NHANES 2009-2018.

Inflammation has been linked to the development of coronary heart disease (CHD). The systemic immune inflammation index (SII) is a useful biomarker of systemic inflammation. Our study aimed to explore the correlation between SII and CHD. We conducted a multivariate logistic regression analysis, smoothing curve fitting, and segmented model comparison on 15,905 participants with a CHD prevalence of 3.31% and a mean age of 46.97 years. Adjusting for gender, age, and race, we found a negative association between SII and CHD [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.48, 0.90]. There was an inverse trend where increasing SII was associated with decreasing odds of CHD (p for trend = 0.0017). After further adjustment, the association was strengthened, with a similar trend (p for trend = 0.0639). Smoothing curve fitting demonstrated a gender-specific association between SII and CHD. Our findings suggest that higher SII values may be associated with a higher incidence of CHD, which varies by gender. SII may be a cost-effective and convenient method to detect CHD. Further studies are needed to confirm the causality of these findings in a larger prospective cohort.

Mode of transport, genetic susceptibility, and incidence of coronary heart disease

BackgroundCar use has been associated with higher risk of coronary heart disease (CHD). However, whether the associations of transport modes with CHD vary by genetic susceptibility to CHD are unknown. This study aims to investigate the associations of genetic susceptibility and modes of transport with incidence of CHD.MethodsWe included 339,588 white British participants from UK Biobank with no history of CHD or stroke at baseline or within two years of follow-up (52.3% in work). Genetic susceptibility to CHD was quantified through weighted polygenic risk scores derived from 300 single-nucleotide polymorphisms related to CHD risk. Categories of transport mode included exclusive car use and alternatives to the car (e.g., walking, cycling and public transport), separately for non-commuting (e.g., getting about [n=339,588] excluding commuting for work), commuting (in the sub-set in work [n=177,370] who responded to the commuting question), and overall transport (transport mode for both commuting and non-commuting [n=177,370]). We used Cox regression with age as the underlying timescale to estimate hazard ratios (HR) of CHD (n=13,730; median 13.8-year follow-up) and tested the interaction between genetic susceptibility and travel modes with adjustment for confounders.ResultsCompared to those using alternatives to the car, hazards of CHD were higher for exclusive use of cars for overall transport (HR: 1.16, 95% confidence interval (CI): 1.08-1.25), non-commuting (HR: 1.08, 95% CI: 1.04-1.12) and commuting (HR: 1.16, 95% CI: 1.09-1.23), after adjusting for confounders plus genetic susceptibility. HRs of CHD were 1.45 (95% CI: 1.38-1.52) and 2.04 (95% CI: 1.95-2.12) for the second and third tertile of genetic susceptibility to CHD, respectively, compared to the first. There was, in general, no strong evidence of interactions between genetic susceptibility and categories of overall, non-commuting and commuting transport. Estimated 10-year absolute risk of CHD was lower for the alternatives to the car across strata of genetic susceptibility, compared with exclusive use of cars for overall, non-commuting and commuting transport.ConclusionExclusive use of cars was associated with a relatively higher risk of CHD across all strata of genetic susceptibility. Using alternatives to the car should be encouraged for prevention of CHD for the general population including individuals at high genetic risk.

Three-dimensional Printing and Modeling in Interventional Cardiology: A Comprehensive Review

Abstract Cardiovascular disease (CVD) is one of the leading causes of death, with an increasing incidence of coronary heart disease, heart failure, and arrhythmias. The significance of surgical interventions across cardiovascular conditions requires modern imaging modalities that better visualize the anatomy of the heart across different patient demographics, aiding in preprocedural planning and intraoperative procedures. We conducted a literature search in databases such as PubMed/Medline and ScienceDirect and included a comprehensive analysis of findings from articles in English related to three-dimensional (3D) printing in the anatomical visualization, preprocedural surgical planning, and therapeutic use for various cardiovascular conditions. With the incorporation of cardiac imaging techniques, 3D models can recapitulate the coronary vasculature to understand the pathophysiology of atherosclerosis and thromboembolisms, as well as diving into its clinical applications in preoperative surgical planning and assisting in interventional procedures for congenital heart defects, valvular disorders, tachyarrhythmias, aneurysms, and cardiomyopathy. We also identified that the integration of scaffolds and biomaterial could assist in regenerative medicine alongside 3D printing and its applications in the treatment of coronary artery disease and ischemic heart conditions. Our review concludes that the literature surrounding 3D-printed models is promising but requires further investigations on its large-scale translational impact on patient care.

Workplace socioeconomic characteristics and coronary heart disease: a nationwide follow-up study

ObjectivesImportant gaps in previous research include a lack of studies on the association between socioeconomic characteristics of the workplace and coronary heart disease (CHD).We aimed to examine two contextual factors...

1222-P: An Examination of Frailty as Measured via Deficit Accumulation in African American Adults with Diabetes and Prediabetes

Type 2 diabetes increases the accumulation of health deficits and has been described to be connected to accelerated biological aging. We utilized a frailty index (FI) in African Americans with prediabetes and diabetes modeled after the deficit accumulation index approach used in the Action for Health in Diabetes (Look AHEAD) Trial. This metric of frailty is comprised of 32 functional, behavioral, and clinical characteristics using the Jackson Heart Study (JHS) public access dataset. JSH is a large, community-based, observational study investigating the causes of cardiovascular disease (CVD) in 5301 African-Americans from Jackson, MS. Our study included 1339 adults aged 40-84 with prediabetes and diabetes who had over 12 years of follow-up for incident CVD events. Obese individuals, older individuals, those with poorer diabetes control, and hypertension had significantly higher mean FI scores than those without these characteristics. Approximately 34% of this sample was frail and 66% not frail. Compared with non-frail participants, stroke, heart failure, and coronary heart disease incidence of frail participants were increased. Frailty was an independent predictor of 12-year stroke (adjusted hazard ratio (HR): 6.84; 95% confidence interval (CI): 3.09 to 15.12), heart failure (adjusted HR: 3.00; 95% CI: 1.77 to 5.09), and coronary heart disease (adjusted HR: 2.48; 95% CI: 1.44 to 4.15) after adjusting for age and gender. Frailty is prevalent among African Americans with diabetes and prediabetes and is a predictor cardiovascular outcome. Frail adults with diabetics have an even higher risk of CVD, compared to non-frail adults with diabetes. Disclosure F.Simpson: None. A.Bertoni: None.

#3296 ADVERSE MUSCLE COMPOSITION ASSESSED BY MRI ASSOCIATES TO POOR FUNCTIONAL PERFORMANCE AND METABOLIC COMORBIDITIES IN CKD

Abstract Background and Aims CKD is associated with alterations in body composition, such as reduced muscle mass, increased amount of fat or both simultaneously. Furthermore, both sarcopenia and sarcopenic obesity are associated with worse physical functioning, poor quality of life, increased morbidity and mortality in CKD. Magnetic resonance imaging (MRI) is considered an accurate method for the study of body composition. A water/fat separated MRI scan with automated image analysis can quantify the skeletal muscle volume and allows a quantitative measure of muscle quality by assessing muscle fat infiltration. The combined observation of low muscle volume and high muscle fat infiltration, i.e. adverse muscle composition (AMC), has been shown to be linked to poor function and metabolic comorbidities within subjects with non-alcoholic fatty liver disease. The aim of this study was to investigate the prevalence of AMC and its association with poorer muscle function and metabolic comorbidity within CKD in the large UK Biobank imaging study. Method This is a cross-sectional and prospective study including a total of 647 UK Biobank participants with eGFR cystatin C < 60 ml/min/1,73 m2. A control group was created by selecting participants (matched on sex, age, and BMI) with an eGFR cystatin ≥ 60 ml/min/1,73 m2. Fat-tissue free muscle volume and muscle fat infiltration (MFI) were quantified using a rapid whole-body water and fat separated MRI protocol and automated image analysis (AMRA® Researcher). For each participant, a personalized muscle volume z-score (sex- and body size-specific) was calculated and combined with muscle fat infiltration for AMC detection. AMC was defined as having low muscle volume in combination with high muscle fat infiltration. Sarcopenia was calculated according to the last published recommendation by the European Working Group on Sarcopenia in Older People. Data describing muscle function (hand strength, walking test, stair climbing and number of falls) and metabolic comorbidity (coronary heart disease (CHD) and type 2 diabetes (T2D) have been included and obtained from the study database linked to the study participants' electronic health records. A Cox proportional hazards ratio model, corrected for age, sex, BMI, low hand grip strength, T2D, smoking, and alcohol consumption, was used to assess the association between AMC and CHD incidence. Results • The prevalence of AMC was 1,4x higher in CKD participants compared with the control group without CKD (27.7% vs 20.4%, p<0.001). CKD participants had significantly higher prevalence of sarcopenia (7.2% vs 4.4%, p = 0.004), low hand grip strength (16.0% vs 11.8%, p = 0.006), slow walking pace (17.3% vs 9.9%, p <0.001), CHD (17.4% vs 8.9%, p <0.001) and T2D (13.7% vs 9.2%, p = 0.001) compared with the control group without CKD (Fig. 1). • CKD participants with AMC (179 out of 647) had a significantly higher prevalence of sarcopenia (17.3% vs 3.5%, p<0.001), low hand grip strength (22.8% vs 13.4%, p = 0.006), slow walking pace (27.0% vs 13.6%, p <0.001), as well as prevalence of CHD (23.6% vs 15.0%, p = 0.014) and T2D (18.6% vs 11.8%, p = 0.033) compared with CKD participants without AMC (Fig. 2). • CKD participants with prevalent CHD at the study had higher prevalence of AMC (37.5% vs 25.5%, p = 0.014) compared to CKD participants without CHD. • AMC was associated with 1.9x higher incidence of CHD (95% confidence interval 1.15–3.15, p = 0.012) compared to those without AMC. Conclusion AMC, as determined by MRI with automated image segmentation, is highly prevalent within CKD and associates with poor function, high prevalence of metabolic comorbidities and an increased risk for CHD. CKD patients with poor muscle health is a highly vulnerable group and this technique enables them to be targeted for accurate interventions in order to improve outcomes.

Incident CHD and ischemic stroke associated with lipoprotein(a) by levels of Factor VIII and inflammation

Inflammation and coagulation may contribute to the increased risk for atherosclerotic cardiovascular disease (ASCVD) associated with high lipoprotein(a). The association of lipoprotein(a) with ASCVD is stronger in individuals with high versus low high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation. Determine the association of lipoprotein(a) with incident ASCVD by levels of coagulation Factor VIII controlling for hs-CRP. We analyzed data from 6,495 men and women 45 to 84 years of age in the Multi-Ethnic Study of Atherosclerosis (MESA) without prevalent ASCVD at baseline (2000-2002). Lipoprotein(a) mass concentration, Factor VIII coagulant activity, and hs-CRP were measured at baseline and categorized as high or low (≥75th or <75th percentile of the distribution). Participants were followed for incident coronary heart disease (CHD) and ischemic stroke through 2015. Over a median follow-up of 13.9 years, there were 390 CHD and 247 ischemic stroke events. The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) (≥40.1 versus <40.1 mg/dL) including adjustment for hs-CRP among participants with low and high Factor VIII was 1.07 (0.80-1.44) and 2.00 (1.33-3.01), respectively (p-value for interaction 0.016). The hazard ratio (95%CI) for CHD associated with high lipoprotein(a) including adjustment for Factor VIII was 1.16 (0.87-1.54) and 2.00 (1.29-3.09) among participants with low and high hs-CRP, respectively (p-value for interaction 0.042). Lp(a) was not associated with ischemic stroke regardless of Factor VIII or hs-CRP levels. High lipoprotein(a) is a risk factor for CHD in adults with high levels of hemostatic or inflammatory markers.

Body Weight in Adolescent Men in Sweden and Risk of an Early Acute Coronary Event: A Prospective Population-Based Study.

Background Coronary heart disease remains the dominant cause of death worldwide. To improve cardiovascular disease prevention, knowledge of early key risk factors, especially those that are modifiable, is essential. The ongoing global obesity epidemic is of particular concern. We aimed to determine whether body mass index at conscription predicts early acute coronary events among men in Sweden. Methods and Results This was a population-based Swedish cohort study of conscripts (n=1 668 921; mean age, 18.3 years; 1968-2005), with follow-up through linkage to the nationwide Swedish patient and death registries. Risk of a first acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow-up (1-48 years) was calculated with generalized additive models. Objective baseline measures of fitness and cognition were included in the models in secondary analyses. During follow-up, there were 51 779 acute coronary events, of which 6457 (12.5%) were fatal within 30 days. Compared with men at the lowest end of the normal body mass index spectrum (body mass index, 18.5 kg/m2), an increasing risk for a first acute coronary event was observed, with hazard ratios (HRs) peaking at 40 years of age. After multivariable adjustments, men with a body mass index of 35 kg/m2 had an HR of 4.84 (95% CI, 4.29-5.46) for an event before the age of 40 years. Conclusions An increased risk of an early acute coronary event was detectable within normal levels of body weight at the age of 18 years, increasing to almost 5-fold in the highest weight category at 40 years of age. Given increasing levels of body weight and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future.

Lung function indices do not affect the incidence of coronary heart disease in patients with sleep-disordered breathing

BackgroundCurrently, it's unclear whether sleep-disordered breathing (SDB) and reduced lung function could synergistically increase the incidence of coronary heart disease (CHD). Furthermore, the predictive value of different lung function indices for the incidence of CHD remains unknown. MethodsWe enrolled 3749 participants from the Sleep Heart Health Study (SHHS) to conduct a retrospective study. The individuals were divided into the SDB and non-SDB subgroups according to Apnoea–Hypopnoea Index (AHI). Cox regression models were used to evaluate the association between lung function and CHD. We also conducted a ROC analysis to assess the predictive value of different lung function indices. Results512 cases of CHD were identified during an average of 10.40 years of follow-up in participants without CVD at baseline. We observed that lung function was a better predictor of CHD in non-SDB participants compared with SDB participants. Reduced lung function was associated with a higher risk of CHD in participants without SDB, while the inverse association became non-significant in participants with SDB. Furthermore, the incremental contribution of lung function to CHD diminished with increasing severity of SDB. ConclusionWe need to focus more on the lung function of individuals without SDB rather than those with SDB to reduce the risk of CHD.

The Relationship Between the Incidence of Coronary Heart Disease and Ethnic Minorities

Abstract The study aimed at the determination of risk factors, their relationship with the development of stenosing lesions of the coronary arteries in different ethnic groups in Kazakhstan. Primary coronary angiographies of n=640 patients diagnosed with coronary heart disease (CHD) (2017-2019) have been analysed (Almaty, Kazakhstan). The patients were subdivided into: Kazakhs (n=338) and Russians (n=302). In the Russian group, the chance of arterial hypertension incidence was higher (44% and 33%, p&lt;0.05). In the Russian group, the percentage of obstructive CHD was higher than in the Kazakhs (66% and 57%, p&lt;0.05). There was association between obstructive CHD and risk factors such as male sex, diabetes, smoking, and diastolic blood pressure (DBP) in the Kazakhs (p&lt;0.05). In the Russian group, the relationship between development of CHD and age, level of total cholesterol and high-density lipoprotein (HDL) was higher (p&lt;0.05). There is an association between smoking, diabetes, sex, DBP and the development of CHD in Kazakhs. In the Russian group, CHD was associated with risk factors such as older age, dyslipidaemia and arterial hypertension. There were significant ethnic differences in the risk factors and CHD, in the Russian group the probability of development of obstructive CHD was higher. There was an association between smoking, diabetes, sex, DBP and the development of CHD in Kazakhs. In the Russian group, CHD was associated with risk factors such as older age, dyslipidaemia and arterial hypertension. These finding indicate the need to develop differentiated programmes for the screening, preventive measures for different ethnic groups.

PROGNOSTIC VALUE OF MICRORNA-126-3P FOR CARDIOVASCULAR EVENTS IN A GENERAL POPULATION

Objective: Endothelial dysfunction is a forerunner of atherosclerosis, leading to cardiovascular disease, and albuminuria is a marker of endothelial dysfunction. Measurement of circulating levels of microRNAs is emerging as potential biomarkers for cardiovascular disease. We aimed to estimate the predictive value of a plasma microRNAs signature associated with albuminuria in the incidence of cardiovascular events. Design and method: The first study phase was to identify the plasma miRNAs associated with albuminuria in patients with HTN and controls. In a second step, a predictive model of miRNAs to assess the risk to develop CV events was analyzed in a retrospective study of the general population (HORTEGA Follow-up Study), on those who did not have previous CVD and had complete basal information on relevant covariates. Plasma miRNAs quantified in hypertensive patients by next generation sequencing were validated in a cohort of patients and controls by real-time quantitative PCR. The microRNAs associated with albuminuria were tested and their prognostic value for cardiovascular event incidence were analyzed on a retrospective, population-based study using Cox proportional hazard models. Results: A plasma microRNA profile was identified in the discovery cohort (n = 48) associated with albuminuria and three microRNAs (miR-126-3p, miR-1260b and miR-374a-5p) were confirmed in the validation cohort (n = 98). The microRNA signature discriminates urinary albumin excretion at baseline (n = 1025), and predicts the incidence of cardiovascular events and coronary heart disease and stroke in a general population retrospective study within a 14-year follow-up (n = 926). Thus, high miR-126-3p levels were associated with a shorter time free of both cardiovascular events (HR = 1.48, (1.36–1.62), p &lt; 0.0001), as well as coronary artery disease and stroke combined (HR = 2.49, (2.19–2.83), p &lt; 0.0001) (Figure). Conclusions: An increased plasma microRNAs profile was identified in hypertensive patients with albuminuria. Increased miR-126-3p emerges as a prognostic marker for cardiovascular events in a long-term general population. Further studies will assess the potential role of miR-126-3p as a guide for the status of endothelial dysfunction.

Association between Residential Exposure to Air Pollution and Incident Coronary Heart Disease Is Not Mediated by Leukocyte Telomere Length: A UK Biobank Study.

Higher air pollution exposure and shorter leukocyte telomere length (LTL) are both associated with increased risk of coronary heart disease (CHD), and share plausible mechanisms, including inflammation. LTL may serve as a biomarker of air pollution exposure and may be intervened with to reduce the risk of CHD. To the best of our knowledge, we are the first to test the mediation effect of LTL in the relationship between air pollution exposure and incident CHD. Using the UK Biobank (UKB) data (n = 317,601), we conducted a prospective study linking residential air pollution exposure (PM2.5, PM10, NO2, NOx) and LTL to incident CHD during a mean follow-up of 12.6 years. Cox proportional hazards models and generalized additive models with penalized spline functions were used to model the associations of pollutant concentrations and LTL with incident CHD. We found non-linear associations of air pollution exposure with LTL and CHD. Pollutant concentrations in the lower range were decreasingly associated with longer LTL and reduced risk of CHD. The associations between lower pollutant concentrations and reduced risk of CHD, however, were minimally mediated by LTL (<3%). Our findings suggest that air pollution influences CHD through pathways that do not involve LTL. Replication is needed with improved measurements of air pollution that more accurately assesses personal exposure.

Incidence and risks of coronary heart disease and heart failure in Japanese patients with type 2 diabetes mellitus: The Fukuoka diabetes registry

AimsWe prospectively investigated the incidence of coronary heart disease (CHD) and heart failure (HF), risk factors and prognosis in Japanese patients with type 2 diabetes. MethodsA total of 4,874 outpatients with type 2 diabetes (mean age 65 years, male 57%, previous CHD 14%) were registered at multicenter diabetes clinics of a prefecture in 2008–2010 and followed for the development of CHD and HF requiring hospitalization for a median of 5.3 years (follow-up rate 98%). Risk factors were evaluated using multivariable adjusted Cox proportional models. ResultsThe incidence rates per 1,000 person-years were 12.3 for CHD (silent myocardial ischemia 5.8, angina pectoris 4.3, myocardial infarction 2.1) and 3.1 for hospitalized HF, respectively. New-onset CHD was significantly associated with higher serum adiponectin [the highest quartile vs. the lowest quartile HR 1.6 (95%CI 1.0–2.6)]. HF was significantly associated with higher serum adiponectin [the highest quartile vs. the lowest quartile HR 2.4 (95%CI 1.1–5.2)], and lower serum creatinine/cystatin C ratio, a surrogate marker for sarcopenia [lowest quartile vs. the highest quartile HR 4.6 (95%CI 1.9–11.1)]. ConclusionsThe incidence of heart disease was low and circulating adiponectin and sarcopenia may predict the development of heart disease in Japanese patients with type 2 diabetes.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country

IntroductionCardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10–15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.MethodsA nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.ResultsOf 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8–57.4), P < 0.001). There was no correlation between education and health literacy levels.ConclusionThe inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Coronary Artery Calcium Score and Polygenic Risk Score for the Prediction of Coronary Heart Disease Events

Coronary artery calcium score and polygenic risk score have each separately been proposed as novel markers to identify risk of coronary heart disease (CHD), but no prior studies have directly compared these markers in the same cohorts. To evaluate change in CHD risk prediction when a coronary artery calcium score, a polygenic risk score, or both are added to a traditional risk factor-based model. Two observational population-based studies involving individuals aged 45 years through 79 years of European ancestry and free of clinical CHD at baseline: the Multi-Ethnic Study of Atherosclerosis (MESA) study involved 1991 participants at 6 US centers and the Rotterdam Study (RS) involved 1217 in Rotterdam, the Netherlands. Traditional risk factors were used to calculate CHD risk (eg, pooled cohort equations [PCEs]), computed tomography for the coronary artery calcium score, and genotyped samples for a validated polygenic risk score. Model discrimination, calibration, and net reclassification improvement (at the recommended risk threshold of 7.5%) for prediction of incident CHD events were assessed. The median age was 61 years in MESA and 67 years in RS. Both log (coronary artery calcium+1) and polygenic risk score were significantly associated with 10-year risk of incident CHD (hazards ratio per SD, 2.60; 95% CI, 2.08-3.26 and 1.43; 95% CI, 1.20-1.71, respectively), in MESA. The C statistic for the coronary artery calcium score was 0.76 (95% CI, 0.71-0.79) and for the polygenic risk score, 0.69 (95% CI, 0.63-0.71). The change in the C statistic when each was added to the PCEs was 0.09 (95% CI, 0.06-0.13) for the coronary artery calcium score, 0.02 (95% CI, 0.00-0.04) for the polygenic risk score, and 0.10 (95% CI, 0.07-0.14) for both. Overall categorical net reclassification improvement was significant when the coronary artery calcium score (0.19; 95% CI, 0.06-0.28) but was not significant when the polygenic risk score (0.04; 95% CI, -0.05 to 0.10) was added to the PCEs. Calibration of the PCEs and models with coronary artery calcium and/or polygenic risk scores was adequate (all χ2<20). Subgroup analysis stratified by the median age demonstrated similar findings. Similar findings were observed for 10-year risk in RS and in longer-term follow-up in MESA (median, 16.0 years). In 2 cohorts of middle-aged to older adults from the US and the Netherlands, the coronary artery calcium score had better discrimination than the polygenic risk score for risk prediction of CHD. In addition, the coronary artery calcium score but not the polygenic risk score significantly improved risk discrimination and risk reclassification for CHD when added to traditional risk factors.

Lipoprotein(a) and the risk of recurrent coronary heart disease: the Dubbo Study

Objective Elevated Lipoprotein(a) [Lp(a)] has not been firmly established as a risk factor for recurrent coronary heart disease (CHD). The present analysis explored this relationship in senior citizens. Methods This was a longitudinal study in 607 subjects, all with prevalent CHD, mean age 71 years, followed for 16 years. Baseline examinations of lipids and other CHD risk factors were conducted in 1988–89 in Dubbo, Australia. The independent contribution of Lp(a) to a further CHD event was examined in proportional hazards regression models. Results There were 399 incident CHD cases. Median Lp(a) in CHD cases was 130 mg/L (Interquartile range 60–315) and in non-cases 105 mg/L (45–250) (p < .07, U-Test). 26% of CHD cases and 19% of non-cases had Lp(a) 300 + mg/L; 18% of CHD cases and 8% of non-cases had Lp(a) 500 + mg/L. Lp(a) in Quintile 5 of its distribution (355 + mg/L), using Lp(a) Quintile 1 (<50mg/L) as reference, significantly predicted recurrent CHD with Hazard Ratio 1.53 (95% CI 1.11–2.11, p = .01). Prediction was independent of other risk factors. Lp(a) 500 + mg/L versus lower, significantly predicted recurrent CHD with Hazard Ratio 1.59 (1.16–2.17, p < .01). Prediction was similarly significant for Lp(a) 300 + mg/L versus lower, with Hazard Ratio 1.37 (1.09–1.73, p < .01). Conclusion Elevated Lp(a) is an independent and significant predictor of recurrent CHD in senior citizens. Upper reference Lp(a) levels of 500 mg/L (≈125nmol/L) or 300 mg/L (≈75nmol/L) both appear to be appropriate. The clinical benefit of therapy to reduce elevated Lp(a) remains to be confirmed.

Effects of a Primary Care-Based Intervention on the Identification and Management of Patients with Coronary Heart Disease and Mental or Cognitive Comorbidity-A Study Protocol.

Mental and cognitive disorders (MCD) negatively affect the incidence and prognosis of coronary heart disease (CHD). Medical guidelines recommend the appropriate management of comorbid MCD in patients with CHD, yet there is evidence that the implementation in primary care is not always adequate. We present the protocol for a pilot study that aims to develop a minimally invasive intervention and evaluate its feasibility in the primary care setting to improve the identification and management of comorbid MCD in patients with CHD. The study consists of two consecutive parts and will be carried out in Cologne, Germany. Part 1 comprises the development and tailoring of the intervention, which is guided by qualitative interviews with primary care physicians (PCPs, n = 10), patients with CHD and MCD and patient representatives (n = 10). Part II focuses on the implementation and evaluation of the intervention in n = 10 PCP offices. Changes in PCP behaviour will be analysed by comparing routine data in the practice management system six months before and six months after study participation. In addition, we will explore the influence of organisational characteristics and perform a socio-economic impact assessment. The outcomes of this mixed-method study will inform the feasibility of a PCP-based intervention to improve quality of care in patients with CHD and comorbid MCD.

The relationship between polycystic ovary syndrome and coronary heart disease: a bibliometric analysis.

Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine diseases for women of puberty and reproductive age. PCOS can affect women's health for the rest of their lives since the incidence of coronary heart disease (CHD) may increase in the perimenopausal and senile periods among PCOS women compared with non-PCOS women. A literature retrieval based on the Science Citation Index Expanded (SCI-E) database. All obtained records results were downloaded in plain text format for subsequent analysis. VOSviewer v1.6.10, Citespace and Microsoft Excel 2010 software were utilized for analyzing the following terms: countries, institutions, authors, journals, references and keywords. There were 312 articles retrieved from January 1, 2000 to February 8, 2023, and the frequency of citations was 23,587. The United States, England, and Italy contributed the majority of the records. Harvard University, the University of Athens, and Monash University were the top 3 most productive institutions with publications on the relationship between PCOS and CHD. Journal of clinical endocrinology & metabolism ranked first with the highest publications (24 records), followed by Fertility and sterility (18 records). The keywords were divided into six clusters in the overlay keywords network: (1) the correlation between CHD risk factors and PCOS women; (2) the relationship between cardiovascular disease and female reproductive system hormone secretion; (3) the interaction between CHD and metabolic syndrome; (4) the relationship between c-reactive protein and endothelial function and oxidative stress in PCOS patients; (5) the potential positive effect of metformin on reducing CHD risk factors in PCOS patients; (6) the study of serum cholesterol and body-fat distribution in patients with CHD in PCOS. Oxidative stress, genome-wide association, obesity, primary prevention, and sex difference were main hotspots in this field in recent five years according to the keyword citation burst analysis. The article obtained the hotspots and trends and provided a reference for subsequent research on the association between PCOS and CHD. Moreover, it is hypothesized that oxidative stress and genome-wide association were frontier hotspots in studies that explore the relationship between PCOS and CHD, and prevention research may be valued in the future.

“Study of Psychosocial Antecedents to Precipitation of Congestive Heart Failure in Cardiac Patients: A Prospective Observational Study”

Introduction: Psychosocial factors, such as stress, adversity, socioeconomic status, depression, and anxiety, are associated with overall health and with cardiovascular health in particular. Psychosocial risk factors have been frequently studied in relation to coronary heart disease. In observational studies, high levels of depression and anxiety have consistently been associated with incident coronary heart disease, whereas associations with hostility and social support have been mixed. However, psychosocial factors have been examined less often in HF. Among patients with HF, depression is the most commonly researched psychosocial risk factor. Aim of the study: The aim of this study was to determine the psychosocial antecedents to precipitation of congestive heart failure in cardiac patients. Methods: This was a prospective study and was conducted in the Department of Cardiology of Lugansk State Medical University (LSMU), Hospital No-01, Lugansk, Ukraine during the period from November, 2008 to September 2009. We included 120 patients with heart disease in our study. The patients were randomly divided into two groups – HF group (Patients who hadn’t any heart failure, n=60) and No-HF group (Patients who had heart failure, n=60) Result: In total 120 patients from both the groups completed the study. In our study we found majority (35.83%) of our patients were aged 61-70 years and most of our patients were female (62%) compared to male (38%). We found the mean age was 49.73 ± 8.9 years. Among all patients 76.67% were smoker, 70% had DM, 80% had history of hypertension, 31.67% had asthma, 59.17% had previous history of CVD and the mean duration of CVD was 3.29±2.41 years. The mean BMI was 27.67±4.24 kg/m2. TC, HDL &amp; LDL was higher in no-HF group which indicates a lower risk of heart disease while Tg was higher in HF group indicating a great risk of heart disease. We also found CRP , albumin &amp; fibrinogen was higher in HF group that indicates a greater risk of heart disease. Among all psychosocial factors, anger, anxiety, depressive symptoms, hostility and self-reported health were found higher in HF group compared to no-HF group. Conclusion: In our study, we found statistically significant relationships between psychosocial factors and incident HF. However, adverse levels of psychosocial factors played a role to be an indicator of HF development among cardiac patients. We found psychosocial risk factors such as anger, anxiety, depressive symptoms, hostility and self-reported health as an indicator of congestive heart failure among our cardiac patients.