Indicator Of Cardiovascular Disease Risk Research Articles

Relationship Between Renal Function Test Serum and Lipid Profile in Patients with Diabetes Mellitus

The prevalence of diabetes mellitus in the world is increasing. Hyperglycemia in diabetes mellitus can increase the risk of complications in various organs, one of which is chronic renal failure. Diabetic patients with chronic renal failure have an increased risk of cardiovascular disease 10 times higher. Cardiovascular disease is closely related to lipid profile results, one of which is triglycerides as an index of cardiovascular disease risk. In chronic renal failure a decline in kidney function is chronic resulting in glomerular filtration rate falling by more than 50% and will increase the levels of BUN and creatinine in the blood. Levels of BUN and creatinine serum is used as a parameter of kidney function tests. This study aims to determine the relationship between serum BUN and creatinine levels against serum triglyceride levels in patients with diabetes mellitus. This was an observational analytic study with cross sectional design. A sample of 50 was taken selectively at Aisyiyah Siti Fatimah Tulangan Hospital in January 2016 - March 2018. The average BUN was 28.59 mg/dL, the creatinine averaged 2.02 mg/dL and the triglyceride averaged 287.96 mg/dL. Multiple linear regression test results showed significant relationship between BUN with Triglyceride serum (b = -3.73; p = 0.048) and creatinine with Triglyceride serum (b = 83.18; p = 0.002). Based on the results, it is found that there is a significant relationship between BUN and creatinine serum against serum triglyceride in diabetes mellitus patients.

Development of novel aptamers for low-density lipoprotein particle quantification.

Cardiovascular disease (CVD) remains the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) is commonly used for CVD risk assessment; however, recent research has shown LDL particle (LDL-P) number to be a more sensitive indicator of CVD risk than both LDL-C and non-high-density lipoprotein cholesterol (HDL-C). Described herein are five single stranded DNA aptamers with dissociation constants in the low picomolar range specific to LDL-P and its subfractions. Furthermore, a set of antisense sequences have been developed and characterized that are capable of binding to the best aptamers and undergoing displacement by LDL-P for use in a simple, affordable diagnostic assay.

The association between serum sodium concentration, hypertension and primary cardiovascular events: a retrospective cohort study.

The mechanisms underlying the adverse cardiovascular effects of increased salt intake are incompletely understood, but parallel increases in serum sodium concentration may be of importance. The aim of this retrospective cohort study was to investigate the relationship between serum sodium, hypertension and incident cardiovascular disease (CVD). Routinely collected primary care data from the Royal College of General Practitioners Research and Surveillance Centre were analysed. A total of 231,545 individuals with a measurement of serum sodium concentration at baseline were included. Exclusion criteria were: age <40 years; abnormal serum sodium; diabetes mellitus; prior CVD event; stage 5 chronic kidney disease; and liver cirrhosis. The primary outcome was incident CVD (myocardial infarction, acute coronary syndrome, coronary revascularisation, stroke, transient ischaemic attack or new heart failure diagnosis) over 5 years. There was a 'J-shaped' relationship between serum sodium concentration and primary cardiovascular events that was independent of established risk factors, medications and other serum electrolytes. The lowest cardiovascular risk was found with a serum sodium between 141 and 143 mmol/l. Higher serum sodium was associated with increased risk in hypertensive individuals, whereas lower concentrations were associated with increased risk in all individuals. Therefore, alterations in serum sodium concentration may be a useful indicator of CVD risk. Higher serum sodium could have a direct effect on the vasculature, particularly in hypertensive individuals. Lower serum sodium may be a reflection of complex volume and neuroendocrine changes.

Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension: A randomised controlled trial

BackgroundPhysical inactivity is a major modifiable lifestyle risk factor associated with cardiovascular disease. Tai Chi is a safe and popular form of physical activity among older adults, yet direct comparisons are lacking between Tai Chi and brisk walking in their ability to reduce cardiovascular disease risk factors and improve psychosocial well-being. Methods246 adults (mean age = 64.4 ± 9.8 years, age range = 30–91 years, 45.5% men) with hypertension and at least two but not more than three modifiable cardiovascular disease risk factors (diabetes, dyslipidaemia, overweight, physical inactivity and smoking) were randomly assigned to either Tai Chi (n = 82), brisk walking (n = 82) or control (n = 82) groups. The Tai Chi and brisk walking groups engaged in moderate-intensity physical activity 150 min/week for 3 months; daily home-based practice was encouraged for another 6 months. The primary outcome was blood pressure. Secondary outcomes were fasting blood sugar, glycated haemoglobin, total cholesterol, triglycerides, high- and low-density lipoprotein, body mass index, waist circumference, aerobic endurance, perceived stress, quality of life and exercise self-efficacy. Data were collected at baseline, post-intervention at 3 months and follow-up assessments at 6 and 9 months. Generalised estimating equation models were used to compare the changes in outcomes over time between groups. ResultsAt baseline, the participants had an average blood pressure = 141/81 and average body mass index = 26; 58% were diabetics, 61% presented with dyslipidemia and 11% were smokers. No significant difference was noted between groups. Tai Chi significantly lowered blood pressure (systolic −13.33 mmHg; diastolic −6.45 mmHg), fasting blood sugar (−0.72 mmol/L), glycated haemoglobin (−0.39%) and perceived stress (−3.22 score) and improved perceived mental health (+4.05 score) and exercise self-efficacy (+12.79 score) at 9 months, compared to the control group. In the Tai Chi group, significantly greater reductions in blood pressure (systolic −12.46 mmHg; diastolic −3.20 mmHg), fasting blood sugar (−1.27 mmol/L), glycated haemoglobin (−0.56%), lower perceived stress (−2.32 score), and improved perceived mental health (+3.54 score) and exercise self-efficacy (+12.83 score) were observed, compared to the brisk walking group. No significant changes in the other cardiovascular disease risk indicators were observed over time between groups. ConclusionNurses play a key role in promoting exercise to reduce cardiovascular disease risk and foster a healthy lifestyle among adults. Tai Chi is better than brisk walking in reducing several cardiovascular disease risk factors and improving psychosocial well-being, and can be recommended as a viable exercise for building a healthy life free of cardiovascular disease.

Elevated levels of plasma symmetric dimethylarginine and increased arginase activity as potential indicators of cardiovascular comorbidity in rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) patients are at high risk of developing cardiovascular disease (CVD). In RA, chronic inflammation may lead to endothelial dysfunction, an early indicator of CVD, owing to diminished nitric oxide (NO) production. Because l-arginine is the sole precursor of NO, we hypothesized that levels of l-arginine metabolic products reflecting NO metabolism are altered in patients with RA.MethodsPlasma samples from patients with RA (n = 119) and age- and sex-matched control subjects (n = 238) were used for this study. Using LC-MS/MS, we measured plasma levels of free l-arginine, l-ornithine, l-citrulline, l-NG-monomethyl arginine (MMA), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA). We compared global arginine bioavailability ratio (GABR) (i.e., ratio of l-arginine to l-ornithine + l-citrulline) and arginine methylation index (ArgMI) (i.e., ADMA + SDMA/MMA) in patients with RA vs. control subjects. Plasma arginase activity was measured using a sensitive arginase assay kit. The relationship of l-arginine metabolites and arginase activity to CVD risk factors was evaluated using Pearson’s chi-square test.ResultsCompared with healthy control subjects, the RA cohort showed significantly lower levels of plasma l-arginine (46.11 ± 17.29 vs. 74.2 ± 22.53 μmol/L, p < 0.001) and GABR (0.36 ± 0.16 vs. 0.73 ± 0.24, p < 0.001), elevated levels of ADMA (0.76 ± 0.12 vs. 0.62 ± 0.12 μmol/L, p < 0.001), SDMA (0.54 ± 0.14 vs. 0.47 ± 0.13 μmol/L, p < 0.001), and ArgMI (6.51 ± 1.86 vs. 5.54 ± 1.51, p < 0.001). We found an approximately fourfold increase in arginase activity (33.8 ± 1.1 vs. 8.4 ± 0.8 U/L, p < 0.001), as well as elevated levels of arginase-mediated l-arginine catalytic product l-ornithine (108.64 ± 30.26 vs. 69.3 ± 20.71 μmol/L, p < 0.001), whereas a nitric oxide synthase (NOS) catalytic product, the l-citrulline level, was diminished in RA (30.32 ± 9.93 vs. 36.17 ± 11.64 μmol/L, p < 0.001). Patients with RA with existing CVD had higher arginase activity than patients with RA without CVD (p = 0.048).ConclusionsGlobal l-arginine bioavailability was diminished, whereas plasma arginase activity, ADMA, and SDMA levels were elevated, in patients with RA compared with healthy control subjects. Plasma SDMA was associated with hypertension and hyperlipidemia in patients with RA. This dysregulated l-arginine metabolism may function as a potential indicator of CVD risk in patients with RA.

Cardiovascular Risk Assessment and Follow-Up of Women after Hypertensive Disorders of Pregnancy

Objectives: Hypertensive disorders of pregnancy (HDP) are associated with increased risk of cardiovascular disease (CVD) in women and serve as some of the earliest clinical indicators of CVD risk. This study examines the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines in identifying women eligible for assessment and treatment following HDP.

Metabolically Healthy Obesity, Transition to Metabolic Syndrome, and Cardiovascular Risk

BackgroundDebate over the cardiometabolic risk associated with metabolically healthy obesity (MHO) continues. Many studies have investigated this relationship by examining MHO at baseline with longitudinal follow-up, with inconsistent results. ObjectivesThe authors hypothesized that MHO at baseline is transient and that transition to metabolic syndrome (MetS) and duration of MetS explains heterogeneity in incident cardiovascular disease (CVD) and all-cause mortality. MethodsAmong 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) the authors used Cox proportional hazards and logistic regression models to investigate the joint association of obesity (≥30 kg/m2) and MetS (International Diabetes Federation consensus definition) with CVD and mortality across a median of 12.2 years. We tested for interaction and conducted sensitivity analyses for a number of conditions. ResultsCompared with metabolically healthy normal weight, baseline MHO was not significantly associated with incident CVD; however, almost one-half of those participants developed MetS during follow-up (unstable MHO). Those who had unstable MHO had increased odds of CVD (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.14 to 2.25), compared with those with stable MHO or healthy normal weight. Dose response for duration of MetS was significantly and linearly associated with CVD (1 visit with MetS OR: 1.62; 95% CI: 1.27 to 2.07; 2 visits, OR: 1.92; 95% CI: 1.48 to 2.49; 3+ visits, OR: 2.33; 95% CI: 1.89 to 2.87; p value for trend <0.001) and MetS mediated approximately 62% (44% to 100%) of the relationship between obesity at any point during follow-up and CVD. ConclusionsMetabolically healthy obesity is not a stable or reliable indicator of future risk for CVD. Weight loss and lifestyle management for CVD risk factors should be recommended to all individuals with obesity.

Abstract P228: Milkfat Consumption, Dyslipidemia, and Body Weight in Children

Background: Dietary guidelines recommend consumption of 1% or skim (i.e. non-fat) milk for children &gt;2 years due to concerns about the role of saturated fat in raising low-density lipoprotein cholesterol (LDL) levels and cardiovascular disease risk. Low- or non-fat milk is also recommended to promote energy balance and reduce obesity risk. While more recent evidence in adults suggests no association between milkfat and cardiovascular disease risk, this association has not been well studied among children who tend to be the highest consumers of milk. No known studies have demonstrated an association between milkfat consumption and lipid levels in children. Our objective was to determine if there is an association between milk fat consumption and risk of dyslipidemia and obesity among U.S. children. Methods: We used cross-sectional data from children 2-19 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 (n=7261). Usual milkfat intake (i.e. never/rare milk consumption, non-fat, 1%, 2%, or whole) was self-reported by parent or child. Lipid levels (12-19 years only) and adiposity (BMI z-score and weight category [underweight, normal, overweight, or obese] in all ages) were assessed by trained staff using standardized methods. Covariates included child age, sex, household income, race/ethnicity, physical activity, dieting, and total energy intake. We used multivariate linear and logistic regression models to examine the association between milkfat consumption and our outcomes and conducted pairwise comparisons to assess differences between different milkfat consumers. Results: Most children consumed 2% milk (42.3%), followed by whole (26.1%), 1% milk (11.7%), never/rare consumption (10.2%), and nonfat (9.7%). We found no significant trends in mean cholesterol (total, HDL, LDL) with consumption of milk with greater fat content. There was a significant trend towards higher triglycerides as milkfat intake increased (p=0.01) though this association was stronger among 2% milk compared to whole fat consumers. We found no significant trend in prevalence of each BMI category across milk fat intake. Pairwise comparisons demonstrated that usual consumption of 1% and 2% milkfat was associated with both higher BMI Z-score and odds of obesity compared to whole milk. Conclusion: We found no significant linear trend between usual %milk fat consumed and indicators of cardiovascular disease (BMI-Z and lipid levels) in children, except for triglycerides which rose as milkfat intake increased. However, triglycerides were higher among the 2% compared to whole milkfat consumers. Overall, whole milk was not associated with increased indicators of cardiovascular disease risk in children.

Abstract MP34: Tai Chi Exercise is More Effective Than Brisk Walking in Reducing Cardiovascular Disease Risk Factors

Background: Physical inactivity is one of the major modifiable lifestyle risk factors associated with cardiovascular disease (CVD). Tai Chi (TC) is safe and popular among older adults; yet direct comparisons between TC and brisk walking (BW) on reducing CVD risk factors are lacking. Methods: A total of 246 adults (mean age=64.4±9.8 years, 45.5% men) with hypertension and two other CVD risk factors (i.e., smoker, diabetic, dyslipidemia, or overweight) were randomly assigned to either TC (n=82), BW (n=82), or control (C, n=82) groups. The TC and BW groups had 150 minutes/week, moderate-intensity physical activity for three months; with home-based practice encouraged for another six months. The primary outcome was blood pressure (BP). Secondary outcomes were: fasting blood sugar (FBS), HbA1c, total cholesterol, triglycerides, high and low density lipoprotein, body mass index (BMI), waist circumference and perceived stress. Data were collected at baseline, post-intervention at 3-month, 6-month and 9-month follow-up assessments. Generalized estimating equations models compared changes in the outcomes over time between groups. Results: At baseline, average BP=141/81, smokers=11%, diabetics=58%, dyslipidemia=61%, average BMI=26; with no significant differences between groups. TC significantly lowered BP (systolic -13.33 mmHg; diastolic -6.45 mmHg), FBS (-0.72 mmol/L), HbA1c (-0.39%), and perceived stress (-3.22 score) at 9-months, compared to C group. Pairwise comparisons indicated significantly greater reductions in SBP (p&lt;0.001), DBP (p=0.049), FBS (p=0.001), HbA1c (p=0.002), and perceived stress (p=0.027) in TC group, compared to BW group. No significant changes in other CVD risk indicators over time between groups were observed. Conclusion: TC was better than BW in reducing several CVD risk factors, and can be recommended as a viable exercise to build a healthier life free of CVD.

Cardiovascular Risk Assessment and Follow-Up of Women After Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) are associated with increased risk of cardiovascular disease (CVD) in women and serve as some of the earliest clinical indicators of CVD risk. This study examines the utility of CVD risk models proposed in the 2016 Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines in identifying women eligible for assessment and treatment following HDP.

Oxidative DNA Damage and Carotid Intima Media Thickness as Predictors of Cardiovascular Disease in Prediabetic Subjects.

Prediabetes is considered as a risk factor for the development of diabetes mellitus and cardiovascular disease. The present study was conducted with the aim of finding out the relationship between oxidative DNA damage and carotid intima media thickness for the prediction of cardiovascular disease in prediabetic subjects. The study included 100 prediabetic subjects and 100 normal individuals as controls. In both cases and controls, 8-OHdG was measured by ELISA, and CIMT was measured by B mode ultrasonography. Both 8-OHdG and CIMT were significantly higher in subjects with prediabetes as compared to controls (185.80 ± 10.72 pg/mL vs. 126.13 ± 16.01 pg/mL, p < 0.001 and 0.70 ± 0.04 mm vs. 0.57 ± 0.03 mm, p < 0.001, respectively). There was significant and positive correlation of IGT with 8-OHdG (r = 0.783; p < 0.001) and CIMT (r = 0.787; p < 0.001) in prediabetic subjects. Moreover, 8-OHdG showed significant positive correlation with CIMT (r = 0.704; p < 0.001) in prediabetic subjects. In conclusion, increased 8-OHdG and CIMT in prediabetic subjects indicate that biochemical changes of atherosclerosis start even before the onset of diabetes mellitus. Hence, 8-OHdG and CIMT could be used as indicators of cardiovascular disease risk in these subjects.

Changes in the Blood Components Caused by Water Intake

Although water is an essential component of the human body and is involved in many physiological processes, the effect of a steady and sufficient water intake on blood components has not well elucidated. Therefore, we investigated the changes in hematological parameters, high-sensitivity C-reactive protein (hs-CRP), and immunoglobulin G (IgG) after water intake in 13 healthy adults. They were divided into two groups: The control group (N=4), which consumed water ad libitum, and the experimental group (N=9), which consumed 2 L of water per day. Two weeks later, blood cell counts, hematocrit, and hemoglobin content had increased in the experimental group, although not significantly (p>0.05); however, there was a significant increase in the mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) (p<0.05; and p<0.01, respectively), and a significant decrease in the mean platelet volume (MPV) (p<0.05). Of the immunologic parameters, a non-significant decrease in the concentration of hs-CRP, an indicator of cardiovascular disease risk, was observed (p>0.05). However, there was a dramatic and significant increase in the concentration of IgG (p<0.05). In conclusion, a steady and sufficient water intake may contribute to alleviate anemia by increasing hemoglobin. Additionally, it may decrease the risk of cardiovascular disease by decreasing platelet activation and concentration of hs-CRP. Furthermore, a steady intake of water may improve immune function by increasing the concentration of the components of humoral immunity.

Visceral adiposity index and 10-year cardiovascular disease incidence: The ATTICA study

Background and aimsVisceral adiposity index (VAI) has been proposed as a marker of visceral adipose tissue accumulation/dysfunction. Our aim was to evaluate potential associations between the VAI and the 10-year cardiovascular disease (CVD) incidence. Methods and resultsDuring 2001–2002, 3042 Greek adults (1514 men; age: ≥18 years) without previous CVD were recruited into the ATTICA study, whilst the 10-year study follow-up was performed in 2011–2012, recording the fatal/non-fatal CVD incidence in 2020 (1010 men) participants. The baseline VAI scores for these participants were calculated based on anthropometric and lipid variables, while VAI tertiles were extracted for further analyses. During the study follow-up a total of 317 CVD events (15.7%) were observed. At baseline, the participants' age and the prevalence of hypertension, diabetes, hypercholesterolemia and metabolic syndrome increased significantly across the VAI tertiles. After adjusting for multiple confounders, VAI exhibited a significantly independent positive association with the 10-year CVD incidence (OR = 1.05, 95%CI: 1.01, 1.10), whereas the association of the body mass index (HR = 1.03, 95%CI: 0.99, 1.08), or the waist circumference (HR = 1.01, 95%CI: 0.99, 1.02) was less prominent. Sex-specific analysis further showed that VAI remained significantly predictive of CVD in men alone (HR = 1.06, 95%CI: 1.00, 1.11) but not in women (HR = 1.06, 95%CI: 0.96, 1.10). ConclusionsOur findings show for the first time in a large-sample, long-term, prospective study in Europe that the VAI is independently associated with elevated 10-year CVD risk, particularly in men. This suggests that the VAI may be utilized as an additional indicator of long-term CVD risk for Caucasian/Mediterranean men without previous CVD.

Zinc and Selenium Co-supplementation Reduces Some Lipid Peroxidation and Angiogenesis Markers in a Rat Model of NAFLD-Fed High Fat Diet

Studies have shown that non-alcoholic fatty liver disease (NAFLD) patients are more prone to cardiovascular disease (CVD). Zinc and selenium deficiency are common in NAFLD. But the effects of zinc and selenium co-supplementation before and/or after disease progression on CVD markers are not clear in NAFLD patients. This study aimed to compare the effects of zinc and selenium co-supplementation before and/or after disease progression on some of the CVD markers in an experimental model of NAFLD. Forty male Sprague Dawley rats (197±4g) were randomly assigned into four dietary groups: control group (C; received 9% of calorie as fat), model group (M; received 82% of calorie as fat), and supplementation before (BS) or after (AS) disease progression. Animals were fed diets for 20weeks in all groups. Fasting plasma glucose (FPG), insulin, HOMA-IR, ALT, AST, lipid profile, malondialdehyde (MDA) and vascular endothelial growth factor (VEGF) levels were measured as CVD indices. Serum ALT, AST, FPG, insulin, MDA, VEGF and HOMA-IR were significantly higher in the M than C group. Co-supplementation reduced serum ALT and AST levels in the BS and AS groups compared with the M group. FPG, insulin, HOMA-IR, VEGF, MDA, LDL/HDL-c and TC/HDL-c ratio were significantly reduced in the AS compared with the M group. TG/HDL-c ratio was significantly reduced in the BS and AS compared with the M group. Serum MDA, VEGF, Insulin and HOMA-IR were significantly lowered in the AS than BS group (p<0.05). Zinc and selenium co-supplementation after NAFLD progression reduced CVD risk indices in an experimental model.

Abstract P019: Family History of Cardiovascular Disease is Associated With Cognitive Function: The Emory Healthy Aging Study

Background: Family history of cardiovascular disease (CVD) is a readily available risk indicator of future CVD, combining the influence of shared genetic, environmental and behavioral risk factors. Though CVD risk factors have been associated with an increased risk of cognitive impairment and decline, less is known about the association between family history of CVD and cognitive function. Evaluating this association may further elucidate the role of cardiovascular health in cognitive health. Methods: The Emory Healthy Aging Study isan ongoing prospective cohort study aimed at identifying predictors of healthy aging and age-related diseases. Participants are primarily residents of the Atlanta area, at least 18 years old, who completed an online baseline health survey. Multiple recruitment forums were used, including clinic waiting rooms, informational letters and emails, community events and online recruitment. Baseline information about demographic (age, race, gender), socioeconomic (education, household income), and health behavior factors (physical activity, smoking) as well as personal health (diabetes, hyperlipidemia, and hypertension) and family health history were collected by online survey. Family history of CVD was defined as self-reported history for any parent or sibling of coronary artery disease, myocardial infarction, or stroke. Cognitive function was measured using the validated Cognitive Function Instrument (CFI) with scores ranging between 0-14 (lower is better). The association between family history of CVD and CFI score was assessed using multivariable linear regression, adjusting for demographic, socioeconomic, lifestyle and CVD risk factors, as well as family history of mild cognitive impairment (MCI) or Alzheimer’s disease (AD). Results: We studied 3801 participants (75% female, 85% white, 10% black, and 5% other), recruited between October 2015 and October 2016. Mean age was 59±13 years and 61% reported a family history of CVD. Adjusting for age, gender, race, education, household income, exercise habits, smoking status and family history of MCI or AD, family history of CVD was associated with poorer cognitive performance (β=0.26; 95% CI (0.12, 0.41)). Additional adjustment for hypertension, hyperlipidemia, diabetes and BMI only slightly attenuated estimates (β=0.22; 95% CI (0.08, 0.41)). In the same model, the estimated β for family history of cognitive impairment was similar: 0.22 (0.07, 0.37). Conclusion: In this cross-sectional study of people from the community, family history of CVD was associated with poorer cognitive function, and this association was of the same magnitude as having a first-degree family member with a history of cognitive impairment. Although longitudinal data are needed, these results underscore the link between cardiovascular and neurocognitive health and potential role of shared genetic and behavioral factors.

Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients.

BackgroundIn hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex.MethodsSeventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively.ResultsThe mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio.ConclusionsHemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.

Correlation of metabolic syndrome severity with cardiovascular health markers in adolescents

Background and ObjectivesThe presence of metabolic syndrome (MetS) in childhood is a significant risk factor for later cardiovascular disease (CVD). Recent data showed temporal decreases in a sex- and race/ethnicity-specific MetS severity z-score among U.S. adolescents. Our goal was to characterize the relationship of this MetS z-score with other CVD risk indicators and assess their temporal trends and lifestyle influences. MethodsWe analyzed 4837 participants aged 12–20years from the National Health and Nutrition Examination Survey by 2-year waves from 1999 to 2012. We used linear regression to compare MetS z-score and dietary factors with serum levels of low-density lipoprotein (LDL), apolipoprotein-B (ApoB), high-sensitivity C-reactive protein (hsCRP) and uric acid. ResultsMetS severity z-score was positively correlated with LDL, ApoB, hsCRP, and uric acid measurements (p<0.0001 for all). These correlations held true among individual racial/ethnic groups. LDL, ApoB, and hsCRP measurements decreased over time among U.S. adolescents (p=0.002, p<0.0001, and p=0.024, respectively). Saturated fat consumption was positively correlated with LDL (p=0.005) and ApoB (p=0.012) and inversely related to serum uric acid (p=0.001). Total caloric intake was inversely related to LDL (p=0.003) and serum uric acid (p=0.003). Unsaturated fat, carbohydrate, and protein consumption were not related to LDL, ApoB, hsCRP, or serum uric acid. ConclusionsThere is a positive correlation between MetS severity and all four CVD risk indicators studied. LDL, ApoB, and hsCRP showed favorable temporal trends, which could be related to similar trends in MetS z-score. These data support the importance of considering multiple inter-related factors in clinical CVD risk assessment.

Smoking cessation reduces ratio of total cholesterol/high density lipoprotein (HDL) cholesterol levels on adult people in Yogyakarta Special Region

Cigarette smoking is a major cause of cardiovascular disease due to elevation of free radical substances as well impairment in lipid metabolism. Smoking cesation has been linked with reduced risk of mortality. However, data regarding cardiovascular disease (CVD) risk factor in former smoker is limited. The aim of the study was to evaluate the CVD risk factor among smoker, non-smoker and former smoker in Yogyakarta Special Region, Indonesia. A cross-sectional design from 86 apparently healthy male, aged between 25-50 years old was performed for this study. From total subjects, 45 subjects are smokers, 26 are non-smokers and 15 are former smokers. Body weight, height, and blood pressure were also measured from the subjects. Blood was drawn for assessment of total cholesterol (TC), triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL) and C-reactive protein (CRP) concentrations. We found significant difference in the level of HDL, cardiovascular risk index (LDL/HDL ratio), atherogenic index (TC/HDL ratio) and also in systolic blood pressure among groups (p<0.05). Smoking person had significantly low HDL level with high CVD risk index and atherogenic index (p<0.05). The CVD risk index was not different between former smoker and smoker groups. Serum CRP level was not different among the groups. In conclusion, smoking is associated with increased risk of CVD. Smoking cessation slightly decrease the CVD risk.

Menopausal Hot Flashes and Carotid Intima Media Thickness Among Midlife Women.

There has been a longstanding interest in the role of menopause and its correlates in the development of cardiovascular disease (CVD) in women. Menopausal hot flashes are experienced by most midlife women; emerging data link hot flashes to CVD risk indicators. We tested whether hot flashes, measured via state-of-the-art physiologic methods, were associated with greater subclinical atherosclerosis as assessed by carotid ultrasound. We considered the role of CVD risk factors and estradiol concentrations in these associations. A total of 295 nonsmoking women free of clinical CVD underwent ambulatory physiologic hot flash assessments; a blood draw; and carotid ultrasound measurement of intima media thickness and plaque. Associations between hot flashes and subclinical atherosclerosis were tested in regression models controlling for CVD risk factors and estradiol. More frequent physiologic hot flashes were associated with higher carotid intima media thickness (for each additional hot flash: β [SE]=0.004 [0.001]; P=0.0001; reported hot flash: β [SE]=0.008 [0.002]; P=0.002, multivariable) and plaque (eg, for each additional hot flash, odds ratio [95% confidence interval] plaque index ≥2=1.07 [1.003-1.14]; P=0.04, relative to no plaque, multivariable] among women reporting daily hot flashes; associations were not accounted for by CVD risk factors or by estradiol. Among women reporting hot flashes, hot flashes accounted for more variance in intima media thickness than most CVD risk factors. Among women reporting daily hot flashes, frequent hot flashes may provide information about a woman's vascular status beyond standard CVD risk factors and estradiol. Frequent hot flashes may mark a vulnerable vascular phenotype among midlife women.

Cardiovascular risk profiles of world masters games participants.

Increasing evidence indicates adherence to exercise throughout life is concurrent with improved health. World masters games (WMG) have more participants than any other international sporting competition and is under investigated, particularly with regard to indices of cardiovascular disease risk. Therefore, we chose to investigate selected cardiovascular risk factors in WMG participants. This was a cross-sectional, observational study which utilized a web-based questionnaire to survey cardiovascular risk factors of WMG participants. The survey consisted of three sections: basic demographics, medical history and physiological parameters which included Body Mass Index (BMI), waist circumference (WC), resting blood pressure (BP) and lipids (total cholesterol [TC], high density lipoprotein [HDL] and low density lipoprotein [LDL]). A total of 1435 participants, 872 male, aged 27-91 years (mean age 54.99 years) participated in the study. Key findings included significant differences (P<0.05) between genders in BMI (17.7%, P<0.001), WC (10.6%, P<0.001), resting SBP (5.8%, P<0.001) and resting DBP (4.8%, P<0.001). Significant differences were also found between genders in HDLs (15.2%, P<0.001), TC:HDL ratio (17.2%, P<0.001) and LDL:HDL ratio (19.0%, P<0.001). Significant differences (P<0.001) were also identified when comparing WMG lipid results to the Australian general population (TC P<0.001; HDLs P<0.001; LDLs P<0.001). A high percentage of WMG participants demonstrated optimal values in a number of cardiovascular disease (CVD) risk factors when compared to the general population, female WMG participants had better values as compared to males. This reflected a decreased CVD in WMG participants and supports our hypothesis of enhanced health characteristics in an active, but aged cohort.