Increased Risk Of Cardiovascular Disease Research Articles

Risk of Adverse Cardiovascular Outcomes in Postmenopausal Women with Inflammatory Bowel Disease

BackgroundIndividuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear.MethodsWe conducted a survival analysis of Women’s Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history, and lifestyle factors (e.g., smoking, alcohol, physical activity, body mass index, etc.).ResultsOf 134,022 WHI participants meeting inclusion criteria, 1367 (1.0%) reported IBD at baseline. Mean baseline age was 63.4 years. After adjusting for age and other confounders, no significant difference was observed between IBD and non-IBD women for the risk of CHD (HR 0.96, 95% CI 0.73–1.24), VTE (HR 1.11, 95% CI 0.81–1.52) or PAD (HR 0.64, 95% CI 0.28–1.42). After adjusting for age, risk of ischemic stroke was significantly higher (HR 1.41, 95% CI 1.06–1.88) in IBD than non-IBD women. With further adjustment, the excess risk of ischemic stroke among IBD women was attenuated and no longer statistically significant (HR 1.31, 95% CI 0.98–1.76).ConclusionsAmong postmenopausal women with IBD, risk of ischemic stroke may be higher than in non-IBD women.

Income variability and incident cardiovascular disease in diabetes: a population-based cohort study.

Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors: A decade-apart study of two nationwide cohorts.

Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks. Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited. To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago. We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample, studying two colon cancer survivor groups for CVD risk factors, mortality rates, and major adverse events like pulmonary embolism, arrhythmia, cardiac arrest, and stroke, adjusting for confounders via multivariable regression analysis. Of total colon cancer survivors hospitalized in 2007 (n = 177542) and 2017 (n = 178325), the 2017 cohort often consisted of younger (76 vs 77 years), male, African-American, and Hispanic patients admitted non-electively vs the 2007 cohort. Furthermore, the 2017 cohort had higher rates of smoking, alcohol abuse, drug abuse, coagulopathy, liver disease, weight loss, and renal failure. Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities, including hypertension, hyperlipidemia, diabetes, obesity, peripheral vascular disease, congestive heart failure, and at least one traditional CVD (P < 0.001) vs the 2007 cohort. On adjusted multivariable analysis, the 2017 cohort had a significantly higher risk of pulmonary embolism (PE) (OR: 1.47, 95%CI: 1.37-1.48), arrhythmia (OR: 1.41, 95%CI: 1.38-1.43), atrial fibrillation/flutter (OR: 1.61, 95%CI: 1.58-1.64), cardiac arrest including ventricular tachyarrhythmia (OR: 1.63, 95%CI: 1.46-1.82), and stroke (OR: 1.28, 95%CI: 1.22-1.34) with comparable all-cause mortality and fewer routine discharges (48.4% vs 55.0%) (P < 0.001) vs the 2007 cohort. Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events (stroke 28%, PE 47%, arrhythmia 41%, and cardiac arrest 63%). It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Plasma Lipidomic Profiles in cART-Treated Adolescents with Perinatally Acquired HIV Compared to Matched Controls.

Children with perinatally acquired human immunodeficiency virus (PHIV) are growing into adulthood with HIV and treatment-associated comorbidities, such as dyslipidemia and insulin resistance. HIV is identified as independent risk factor for cardiovascular disease (CVD). The hypothesis behind increased CVD risk associated with HIV includes vascular inflammation, dyslipidemia and combination antiretroviral therapy (cART) metabolomic toxicity. To investigate differences in lipid profiles and pathophysiological mechanisms of CVD risk in adolescents with PHIV, we compared the plasma lipidome of PHIV adolescents and HIV-negative controls. We additionally investigated the influence of current cART regimens and increased lipoprotein(a) (Lp(a)) levels on the plasma lipidome. We included 20 PHIV-infected adolescents and 20 HIV-negative controls matched for age, sex, ethnic origin and socio-economic status. Plasma lipidome was measured using Thermo Scientific Ultimate 3000 binary high-performance liquid chromatography (HPLC)-mass spectrometry. We evaluated the plasma lipidome in PHIV adolescents using different cART regimens (including those known to be associated with lipid alterations). The median age was 17.5 years (15.5-20.7) and 16.5 years (15.7-19.8) for PHIV adolescents and controls, respectively. Of PHIV adolescents, 45% used a non-nucleotide reverse transcriptase inhibitor (NNRTI)-based (25%) or protease inhibitor (PI)-based (20%) cART regimen. In this pilot study, we observed no significant differences between lipidomic profiles between PHIV adolescents and controls. We observed no differences in the plasma lipidome in participants with increased versus normal Lp(a) levels. Different cART regimens appear to influence chain length differences in the plasma lipidome of PHIV adolescents; however, the significance and causality of this observation remains undetermined. Further research on the influence of cART on lipid composition could further identify these alterations.

Discordance Between Very Low-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol Increases Cardiovascular Disease Risk in a Geographically Defined Cohort.

Clinical risk scores are used to identify those at high risk of atherosclerotic cardiovascular disease (ASCVD). Despite preventative efforts, residual risk remains for many individuals. Very low-density lipoprotein cholesterol (VLDL-C) and lipid discordance could be contributors to the residual risk of ASCVD. Cardiovascular disease-free residents, aged ≥40 years, living in Olmsted County, Minnesota, were identified through the Rochester Epidemiology Project. Low-density lipoprotein cholesterol (LDL-C) and VLDL-C were estimated from clinically ordered lipid panels using the Sampson equation. Participants were categorized into concordant and discordant lipid pairings based on clinical cut points. Rates of incident ASCVD, including percutaneous coronary intervention, coronary artery bypass grafting, stroke, or myocardial infarction, were calculated during follow-up. The association of LDL-C and VLDL-C with ASCVD was assessed using Cox proportional hazards regression. Interaction between LDL-C and VLDL-C was assessed. The study population (n=39 098) was primarily White race (94%) and female sex (57%), with a mean age of 54 years. VLDL-C (per 10-mg/dL increase) was significantly associated with an increased risk of incident ASCVD (hazard ratio, 1.07 [95% CI, 1.05-1.09]; P<0.001]) after adjustment for traditional risk factors. The interaction between LDL-C and VLDL-C was not statistically significant (P=0.11). Discordant individuals with high VLDL-C and low LDL-C experienced the highest rate of incident ASCVD events, 16.9 per 1000 person-years, during follow-up. VLDL-C and lipid discordance are associated with a greater risk of ASCVD and can be estimated from clinically ordered lipid panels to improve ASCVD risk assessment.

Investigating the interplay of smoking, cardiovascular risk factors, and overall cardiovascular disease risk: NHANES analysis 2011–2018

BackgroundThis study explores the intricate relationship between smoking, cardiovascular disease (CVD) risk factors and their combined impact on overall CVD risk, utilizing data from NHANES 2011–2018.MethodsParticipants were categorized based on the presence of CVD, and we compared their demographic, social, and clinical characteristics. We utilized logistic regression models, receiver operating characteristics (ROC) analysis, and the chi-squared test to examine the associations between variables and CVD risk.ResultsSignificant differences in characteristics were observed between those with and without CVD. Serum cotinine levels exhibited a dose-dependent association with CVD risk. The highest quartile of cotinine levels corresponded to a 2.33-fold increase in risk. Smoking, especially in conjunction with lower HDL-c, significantly increases CVD risk. Combinations of smoking with hypertension, central obesity, diabetes, and elevated triglycerides also contributed to increased CVD risk. Waist-to-Height Ratio, Visceral Adiposity Index, A Body Shape Index, Conicity Index, Triglyceride-Glucose Index, Neutrophil, Mean platelet volume and Neutrophil to Lymphocyte ratio demonstrated significant associations with CVD risk, with varying levels of significance post-adjustment. When assessing the combined effect of smoking with multiple risk factors, a combination of smoking, central obesity, higher triglycerides, lower HDL-c, and hypertension presented the highest CVD risk, with an adjusted odds ratio of 14.18.ConclusionSmoking, when combined with central obesity, higher triglycerides, lower HDL-c, and hypertension, presented the highest CVD risk, with an adjusted odds ratio of 14.18.

Impact of health practice index and cardiovascular health metrics on incident cardiovascular disease according to glucose tolerance status.

To evaluate and compare the association of incident cardiovascular disease (CVD) with the Health Practice Index (HPI) reflecting only lifestyle habits and Ideal Cardiovascular Health Metrics (ICVHMs) consisting of lifestyle habits and factors targeted for control in the same population according to glucose status. This retrospective cohort study included 1,28,162 participants aged 18-72years with no history of CVD followed for ≥ 3years between 2008 and 2016. Participants were classified according to normal glucose tolerance (86,174), prediabetes (36,096), or diabetes (5892). HPI and ICVHMs scores were classified into three groups (high/medium/low). Multivariate Cox regression hazard analysis examined CVD risk. During a mean follow-up of 5.2years, 1057 CVD events occurred. In prediabetes, CVD risk was significantly higher in groups with both medium and low HPI scores and ICVHMs scores compared to high scores for normal glucose tolerance (hazard ratios [HRs] for high/medium/low HPI scores were 0.95 [0.78-1.17], 1.56 [1.29-1.89], and 2.41 [1.74-3.34] and for ICVHMs scores were 0.74 [0.50-1.11], 1.58 [1.26-1.98], and 2.63 [2.10-3.31], respectively). Regarding diabetes, compared with high HPI/ICVHMs scores in the normal glucose tolerance group, a significantly increased CVD risk was observed in the high-score HPI group, but not in the high-score ICVHMs group (HPI high/medium/low HR, 1.63 [1.22-2.18], 2.19 [1.69-2.83], and 2.26 [1.34 -3.83]; ICVHMs high/medium/low HR, 1.14 [0.47-2.81], 2.38 [1.75-3.23], and 3.31 [2.50-4.38], respectively). In diabetes, ideal lifestyle practices alone were insufficient for primary prevention of CVD but had a greater impact on primary prevention of CVD in prediabetes. The online version contains supplementary material available at 10.1007/s13340-024-00708-7.

Associations of Regional Body Fat with Risk of Cardiovascular Disease and Mortality among Individuals with Type 2 Diabetes.

We aimed to prospectively examine the association between regional body fat and risk of cardiovascular disease (CVD) in individuals with type 2 diabetes (T2D), who often exhibit changes in relative fat distribution and have increased CVD risk. The main analysis included 21,472 participants with T2D from the UK Biobank. Regional body fat was measured by bioelectric impedance assessment. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median of 7.7 years of follow-up, 3,976 CVD events occurred. After multivariable adjustment, upper and lower body fat were independently and oppositely associated with CVD risk among patients with T2D. Higher arm fat percentage was linearly associated with increased CVD risk (P nonlinear >0.05), while higher trunk fat percentage was nonlinearly associated with increased CVD risk (P nonlinear <0.05). In contrast, higher leg fat percentage was nonlinearly associated with lower CVD risk (P nonlinear <0.05). When comparing extreme quartiles, the multivariable-adjusted HR (95% CI) of CVD was 0.72 (0.58, 0.90) for leg fat percentage, 1.63 (1.29, 2.05) for arm fat percentage, and 1.27 (1.06, 1.52) for trunk fat percentage. Similar patterns of associations were observed for all-cause and CVD mortality. In addition, leg fat percentage, but not other regional fat percentage, was associated with CVD risk independently of traditional measures of obesity. Among people with T2D, arm fat and trunk fat were positively, whereas leg fat was inversely, associated with the risk of CVD and mortality. These findings highlight the importance of considering both the amount and the location of body fat when assessing CVD and mortality risk among individuals with T2D.

A Low Omega-3 Index and High AA/EPA Ratio in American College Football Players are Both Improved Following 5 Weeks of DHA-Rich Algae Oil Supplementation

Abstract Purpose Many athletes are deficient in long chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA). A consequent low Omega-3 Index (O3I) and high arachidonic acid/eicosapentaenoic acid (AA/EPA) ratio increase cardiovascular disease risk and inflammation. Algae oil is a plant-based, sustainable source of LC n-3 PUFA, suitable for vegans and vegetarians. Effects of algae oil supplementation on whole blood fatty acids among athletes has not been previously reported. This study evaluated the effects of 5 weeks of DHA-rich algae oil supplementation on the whole blood fatty acid profile, O3I and AA/EPA ratio of omnivorous Division I American College Football (ACF) players. Methods: Data, including a spot blood sample, were collected at baseline for all participants (n = 47), then for a subset of players (n = 22) following a 5-week control period (usual diet) and 5 weeks of algae oil supplementation (usual diet + 1575 mg docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA) 5 days/week; average 1125 mg/day). Results: Baseline O3I was 4.3% ± 0.1% and AA/EPA ratio was 45.6 ± 23.8. After 5 weeks of algae oil supplementation, the O3I was 6.1% ± 1.0% and the AA/EPA ratio was 25.1 ± 11.6. The O3I was significantly higher and the AA/EPA ratio was significantly lower (P &lt; 0.0001 for both) compared with both baseline and the end of the control period. The increase in O3I from baseline was correlated with calculated DHA + EPA dose per unit body mass (R = 0.641, P = 0.001). Conclusions: Algae oil supplementation for 5 weeks improved both the low baseline O3I and high AA/EPA ratio among ACF players, with body mass specific dose effects.

Abstract 24: Actigraphy-Measured Sleep Irregularity Increases the Risk of Incident Cardiovascular Disease and Cardiovascular Mortality in Older Women

Background: Cardiovascular disease (CVD) is the leading cause of death for U.S. women. Our understanding of how poor sleep health contributes to CVD is limited by reliance on cross-sectional studies, self-reported sleep measures, and predominately non-Hispanic white samples. Our objective was to prospectively investigate actigraphy-measured sleep health and incident CVD and CVD mortality in a cohort of older multiethnic women. Methods: Women (n=3,992; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in May 2012-April 2014 and were followed through February 2022 for physician-adjudicated incident CVD (definition in Table footnote) and CVD mortality. Sleep duration, timing, efficiency, irregularity, and continuity were derived from accelerometers (definition in Table footnote). Women with prior CVD at baseline were excluded from analyses. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Minimally adjusted models included age, race and ethnicity. Models were additionally adjusted for education, smoking, alcohol consumption, comorbid conditions, self-rated health, and CVD risk factors. Results: Over a median of 8.3 years of follow-up, 636 incident CVD cases occurred, including 395 CVD deaths. In minimally adjusted models, longer sleep duration, greater sleep irregularity, and more wake after sleep onset were associated with increased CVD risk (Table 1). In models further adjusted for CVD risk factors, the HR (95% CI) for a 60-minute increase in sleep irregularity was 1.18 (1.01-1.37) for incident CVD and 1.30 (1.07-1.58) for CVD mortality. Conclusions: Greater sleep irregularity was associated with higher risk of incident CVD and CVD mortality in a diverse cohort of older women. These results support the importance of maintaining regular sleep for cardiovascular health.

Abstract P169: Cardiovascular Disease Incidence Among Male Veterans by Sexual Orientation and Race

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk ( Table ). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.

Abstract 27: Chronotype, Life’s Essential 8, and Risk of Cardiovascular Disease: A Prospective Cohort Study in UK Biobank

Introduction: Individuals with evening chronotype often experience circadian misalignment, which may disrupt health behaviors and circadian regulation of cardiometabolic functions such as blood pressure and heart rate. However, the association of chronotype with cardiovascular disease (CVD) and the interplay with other CVD risk factors are not fully understood. Hypothesis: We assessed the hypothesis that individuals with an evening chronotype, compared to those with a morning chronotype, have a poorer cardiovascular health as measured by the Life’s Essential 8 (LE8), and consequently an increased CVD risk. We further explored if the associations differed by sex. Methods: We conducted a prospective study in the UK Biobank among 477,878 adults aged 39-74 years and free of CVD at baseline in 2006-2010. Chronotype was self-reported using a single representative question from the Morningness-Eveningness Questionnaire. The LE8 score was calculated based on 8 modifiable CVD risk factors, and ranged from 0 to 100 with higher scores indicating better cardiovascular health. Incident CVD was defined as first myocardial infarction (MI) or stroke leading to hospitalization or death, identified via validated algorithms that mapped national medical records and death certificates to ICD-10 codes until May 2022. We used Cox proportional hazards models to estimate the association between chronotype and CVD risk. Models were adjusted for demographics, shift work, and family history of CVD. We applied causal mediation framework to decompose the total chronotype-CVD effect into estimated natural direct effect (i.e., independent of LE8) and natural indirect effect (i.e., mediated by LE8; NIE). Results: Participants with a “definite evening” chronotype were 75% more likely to have a low LE8 score (&lt;50) compared to “intermediate” type (prevalence ratio 95% CI: 1.67, 1.84). This association was notably stronger among women ( P -interaction: 0.0001). Over 12.7 years of follow-up, there were 27,346 documented incident CVD events (17,180 MI; 11,329 stroke). The hazard ratio (HR) for total CVD was 1.03 (95% CI: 1.00, 1.06) for the “definite morning” and 1.15 (95% CI: 1.10, 1.20) for “definite evening” compared with “intermediate” chronotype ( P -trend: 0.06). This association was stronger in women ( P -interaction: 0.05), and similar for MI and stroke. The NIE of the chronotype-CVD association comparing “definite evening” to “intermediate” was 1.11 (95% CI: 1.09, 1.13), equivalent to 95% of the association being mediated by LE8. Conclusions: Evening chronotype was associated with a modest increase in CVD risk, compared to intermediate chronotype, which appeared to be mainly explained by overall poor cardiovascular health. Our results suggest potential benefits of targeted interventions in evening chronotype for CVD prevention. Ongoing work is exploring potential effect modification by night shift work.

Abstract P350: Increased Trunk Fat and Decreased Limb Fat Linked to Elevated Cardiovascular Risk in Hong Kong Chinese Women

Introduction: Despite known links between overall body fat and cardiovascular disease (CVD) risk, the relationship involving regional body fat (arm, trunk, and leg) remains underexplored in Chinese populations. This study examined the associations between overall and regional body fat percentage (BFP) and CVD risk in Hong Kong Chinese women. Hypothesis: We hypothesized that higher overall and trunk BFP were associated with increased CVD risk, whereas higher arm and leg BFP predicted decreased risk. Methods: This study used baseline data of 3616 women (mean age 56.12±8.51) from an ongoing cohort named ‘MECH-HK’ (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women). The recruitment was conducted between October 2019 and October 2021. BFP was measured using the bioelectrical impedance analysis device of Inbody 270 model. Framingham 10-Year Risk Score (FRS) was calculated to present the CVD risks. Multivariate linear models were used to estimate the BFP-FRS associations. Potential non-linear relationships were assessed with restricted cubic spline models. Results: Mean overall BFP was 32.55%, and regional BFP for arm, trunk and leg were 4.59%, 15.38% and 10.76%, respectively. Non-linear associations between overall BFP and FRS were observed (P for non-linear = 0.03). After adjustment for age, education level, monthly family income, smoking and drinking status, physical activity level, family history of CVD and BMI, the overall BFP was associated with increased FRS (β: 0.04, 95% CI: 0.00 to 0.08, P = 0.03) when overall BFP &lt; 35%. However, no significant association was observed when overall BFP &gt;= 35% (β:-0.07, 95% CI: -0.16 to 0.02, P = 0.13). Higher trunk BFP was associated with increased FRS (β: 0.30, 95% CI: 0.21 to 0.38, P &lt; 0.001), while higher arm (β: -0.69, 95% CI: -0.98 to -0.40, P &lt; 0.001) and leg (β: -0.38, 95% CI-0.50 to -0.25, P &lt; 0.001) BFP were associated with decreased FRS. Conclusions: Increased overall (when &lt; 35%) and trunk BFP and decreased arm and leg BFP are associated with elevated CVD risk.

Abstract P298: Cross-Sectional and Longitudinal Associations Between Fast Food Outlet Access and Inflammatory Markers in the US-Based Nurses’ Health Study II

Background: Access to fast food outlets (FFO) has increased in recent years and may decrease diet quality and increase cardiovascular disease risk. Inflammation is a well-established cardiovascular disease risk factor, but it remains unclear whether inflammation is one of the pathways explaining associations between the food environment and inflammatory markers. Methods: We included 6,609 participants from the US-based Nurses’ Health Study II (NHS-II), a prospective cohort of registered female nurses. Counts of FFO were obtained from the Infogroup US Historical Business Data within 1500-meter circular buffers and assigned to participants’ residential addresses from 1998 to 2011. Biomarkers included C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor necrosis factor α receptor 2 (TNFαR2, in a subset), and adiponectin. We evaluated cross-sectional associations between counts of FFO (1998) and inflammatory markers (1999) in linear regression models and evaluated longitudinal associations by the change in counts of FFO between 1998 and 2010 and the change in inflammatory markers between 1999 and 2011 using linear mixed models. Models were adjusted for age, race/ethnicity, partners’ education level, smoking, neighborhood socioeconomic status, and population density. Interaction terms were included to explore effect modification by baseline neighborhood socioeconomic status and population density. Results: Our study comprised women with a mean age of 45.3 (+/- 4.4) years at 1998. A one-unit higher count of FFO within a 1500m buffer was not cross-sectionally associated with CRP (β: 0.004, 95%CI: -0.004, 0.010), IL-6 (β: 0.001, 95%CI: -0.001, 0.004), TNFR2 (β: 0.051, 95%CI: -1.495, 1.597), or adiponectin (β: -6.054, 95%CI: -14.576, 2.468). No associations were found in longitudinal models (CRP (β: 0.000, 95%CI: -0.007, 0.008), IL-6 (β: 0.001, 95%CI: -0.002, 0.003), or adiponectin (β: -1.127, 95%CI: -11.889, 14.3152)). No significant effect modification was found between count of FFO and neighborhood socioeconomic status, or population density (P-for-interaction &gt;0.1). Conclusions: While several previous studies have found an association between frequency of consumption of food at fast food restaurants and biomarkers of cardiovascular risk, at the community level, we did not find associations between the count of FFO and several inflammatory markers in a population of US female nurses.

Cardio-rheumatology: the cardiovascular, pharmacological, and surgical risks associated with rheumatological diseases in women.

Cardiovascular disease (CVD) remains the number one cause of death worldwide. Women are at increased risk of death from CVD, but the mechanisms for how and why this occurs remain elusive. One subset of women who are exceptionally vulnerable to CVD are those with rheumatic diseases (RDs). Indeed, women account for 80% of all RDs, disorders that encompass a broad range of autoimmune and autoinflammatory diseases that lead to chronic inflammation and pathology. The clear association of increased CVD risk in women with RD is thought to be mediated by a number of factors, including RD pathology itself, pharmacological induction of CVD, and/or as yet unidentified mechanisms. As such, elucidation of the causes and treatments of these pathologies has given rise to a new subspecialty of cardiology: cardio-rheumatology. Here, we review and discuss the CVD risks in patients with RDs, the associated sex disparities in RD and CVD care, as well as the current therapeutic and interventional options available to specifically help women with RDs. We hope this discussion will provide guidance and support to patients, as well as to cardio-rheumatologists, as these groups are the most uniquely positioned to radically improve CVD care in these individuals. Moreover, we are hopeful this discussion may lead to better, more efficacious approaches to treating these disorders in women in the near future.

Noise annoyance and cardiovascular disease risk: results from a 10-year follow-up study

The relationship between noise annoyance and risk of cardiovascular disease (CVD) still needs to be fully elucidated. Thus, we examined the relationship between noise annoyance and CVD risk in a large population-based cohort study. Cross-sectional (N = 15,010, aged 35–74 years, baseline investigation period 2007–2012) and prospective data (5- and 10-year follow-up from 2012 to 2022) from the Gutenberg Health Study were used to examine the relationship between noise annoyance due to different sources and risk of prevalent and incident CVD comprising atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and venous thromboembolism. In cross-sectional analyses, noise annoyance was an independent risk factor for prevalent CVD, with the strongest associations seen for noise annoyance during sleep (e.g., neighborhood noise annoyance: odds ratio 1.20, 95% confidence interval 1.13–1.27, p < 0.0001). While in the 10-year follow-up, mostly positive associations (although not significant) between noise annoyance and incident CVD were observed, no indication of increased CVD risk was observed after 5 years of follow-up. Noise annoyance due to different sources was associated with prevalent CVD, whereas only weak associations with incident CVD were found. Further large-scale studies are needed to establish the relationship between noise annoyance and risk of CVD.

Animal-derived foods: consumption, composition and effects on health and the environment: an overview

Consumption of animal-derived foods (ADFs), particularly red meat, is declining in high-income countries because of concerns over health and the effects on climate change but is increasing in low- and middle-income countries. As a group of foods, ADFs are high in good-quality protein and several key vitamins and minerals (notably vitamin B12, iron and zinc). There is evidence, though, that processed red meat poses risks of cardiovascular disease (CVD) and colorectal cancer and the same risks, although not so strong, are apparent for unprocessed red meat. Milk and milk products generally have a neutral disease risk and there is evidence of reduced risks of CVD and colorectal cancer. Similarly, white meat (chicken and fish) is not associated with disease risk whilst eggs have been linked with increased CVD risk because of their cholesterol content. The risks of chronic disease seem higher in high-income than in low- and middle-income countries, possibly due to different levels of consumption. Production of ADFs results in high greenhouse gas emissions per unit of output compared with plant proteins. Ruminant meat production has particularly high costs but wide variation between farms in different regions of the world suggests costs can be significantly lowered by changes to production systems. Reducing ADF consumption to benefit health and the environment has been proposed but in low-income countries, current levels of consumption of ADFs may be compatible with health and climate targets.

Body size, insulin sensitivity, metabolic health and risk of cardiovascular disease in Chinese adults: Insights from the China Cardiometabolic Disease and Cancer Cohort (4C) study.

To assess the excess risk of cardiovascular disease (CVD) associated with different criteria for metabolic health, and the interplay of body size, insulin sensitivity and metabolic health with CVD risk. We conducted a prospective study involving 115 638 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study. Metabolic health was defined using three different definitions: (1) insulin sensitivity defined by homeostatic model assessment of insulin resistance index; (2) absence of metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria; and (3) simultaneous absence of metabolic abnormalities (diabetes, hypertension, dyslipidaemia). The primary endpoint was a composite of incident CVD events comprising the first occurrence of myocardial infarction, stroke, heart failure, or cardiovascular death. During a mean 3.61-year follow-up period, obese individuals with insulin sensitivity (multivariable-adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.37-2.08), or without metabolic syndrome (HR 1.46, 95% CI 1.13-1.89) still exhibited increased CVD risks, when compared to their normal-weight counterparts. Otherwise, those with obesity but simultaneous absence of metabolic abnormalities demonstrated similar CVD risk compared to normal-weight individuals (HR 0.91, 95% CI 0.53-1.59). CVD risk increased with the number of abnormalities across body mass index categories, regardless of insulin sensitivity. This study emphasizes the need for refined definitions of metabolic health and advocates for meticulous screening for metabolic abnormalities to reduce cardiovascular risks, even in individuals with normal weight and insulin sensitivity.

Evaluation of HOMA IR in perimenopause patients with abnormal uterine bleeding

Introduction: Perimenopause as a clinical entity is characterized by a series of symptoms that occur due to estrogen deficiency in multiple organs and systems. Obesity is a risk factor that favors all these changes, especially hyperplasia. Glucose homeostasis is often impaired in these patients, insulin levels are increased, and HOMA IR is increased. Goals: to detect hyperplasia in obese perimenopausal patients with abnormal uterine bleeding to determine insulin levels, HOMA IR, to determine the association between hyperplasia and HOMA IR. Material and Methods: This was a prospective cohort study, performed at the OB/GYN Clinic, over 1 year. 100 patients with abnormal uterine bleeding during the perimenopause were involved, aged 45–50, divided into two groups based on BMI. 1-patients with a BMI above 30, 2-patients with a BMI under 30, and the control group consisted of 40 asymptomatic patients. Results: The average value of glycemia in the first group was higher and was 5.7 mmol/l, the cut-off value was 5,5. The average value of the HOMA-IR insulin resistance index in the first group was highest - 2.8 (the cut-off value was 1.8). Endometrial hyperplasia was registered in the first group at 40.9%. Discussion: The first group registered a significant association between HOMA IR and hyperplasia, the risk of endometrial hyperplasia occurring was eight times higher. The first group registered a significant association between glycemia and endometrial hyperplasia. High levels of glycemia increase the risk of endometrial hyperplasia occurring three times. Conclusion: In menopausal transition patients with abnormal uterine bleeding there is an increased incidence of endometrial hyperplasia, hyperglycemia, and increased HOMA IR. There is a strong association between these changes and the risk of cardiovascular disease increases. Menopause is a period in a woman’s life that requires a multidisciplinary approach to diagnostics and treatment. Keywords: HOMA IR, perimenopause, abnormal bleeding, hyperplasia.

Cardiovascular Outcomes with Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Patients with Diabetes: A Real-World Data Analysis.

Anti-vascular endothelial growth factor (anti-VEGF) therapy is commonly used intravitreally for diabetic proliferative retinopathy, but when used systemically for treating cancers, an excess of cardiovascular disease (CVD) events has been noted. The latter is of concern for people with diabetes, who are at higher risk of CVD. This study aims to explore the relationship between incident CVD and intravitreal anti-VEGF therapy in patients with diabetes, compared to other therapies, using a large real-world global federated dataset. Data were analysed using TriNetX, a global electronic medical real-world ecosystem. The study included adults with diabetes and excluded those with a history of CVD prior to the time window of data extraction. Patients were categorised into two cohorts: anti-VEGF therapy or control cohort (laser or steroid therapies). The cohorts were 1:1 propensity score-matched for age, sex, ethnicity, body mass index, systolic blood pressure, HbA1c, and cardiovascular medications. Outcomes analysed at 1, 6 and 12months were: (1) mortality; (2) acute myocardial infarction (MI); (3) cerebral infarction; and (4) heart failure. Relative risk analyses were performed using the built-in R statistical computing platform on TriNetX. In patients with diabetes (n = 2205; mean age 58.8 ± 15.8, Stddiff 0.05; 56% male), anti-VEGF therapy was associated with a numerical but non-statistically significant increased CVD risk over 1, 6, and 12months: Mortality over 1month (RR 1; 95%CI 0.42, 2.40), 6months (RR 1.46; 95%CI 0.72, 2.95) and 12months (RR 1.41; 95%CI 0.88, 2.27). There was no excess of acute MI over 1 (RR n/a: not applicable; 0/0: 0 events in the anti-VEGF group/0 events in the control group), 6 and 12months (RR n/a; 0/10 events); cerebral infarction over 1, 6months (RR n/a; 0/0 events), and 12months (RR n/a; 0/10); and heart failure over 1month (RR n/a; 0/0 events), 6months (RR 1; 95%CI 0.42, 2.40) and 12months (RR 1; 95%CI 0.42, 2.34). There was no statistically significant risk of cardiovascular-related events in the short or medium term in patients with diabetes who received intravitreal anti-VEGF therapy, despite a small increase in the number of CVD events. Our study supports the real-world safety of intravitreal anti-VEGF therapy in patients with diabetes free of baseline CVD.