Indicator Of Cardiovascular Disease Risk Research Articles

Management of Atherogenic Dyslipidemia in a Patient with LDL Discordance

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> We review a case of a 43-year-old male referred for optimal management of dyslipidemia and cardiovascular risk reduction. This is intended to highlight key features in diagnosis and management of atherogenic dyslipidemia in the setting of metabolic syndrome. <h3>Objective/Purpose</h3> To review a clinical scenario involving LDL discordance in a patient with atherogenic dyslipidemia and its impact on management. <h3>Methods</h3> Clinical management done at tertiary care lipid program. Advanced lipid testing including LDL particle number and size is ordered through Quest Diagnostics. <h3>Results</h3> A 43-year-old nonsmoker male with metabolic syndrome and recently diagnosed insulin dependent type 2 diabetes mellitus was referred to the lipid clinic for further evaluation. With subclinical atherosclerosis noted with calcium score of 6.6 at age 43 (50-75th percentile) and above-average carotid intimal medial thickness, he was treated with rosuvastatin 20 mg daily. Subsequently, he had a good response of ∼50% LDL reduction with LDL-c of 75 mg/dL. At this point, while most clinicians as well as guideline directed approach may suggest a sufficient management of his dyslipidemia, the advent of advanced lipid testing contrasts this dogma otherwise. LDL discordance noted based on higher-than-expected particle number strongly warrants further aggressive LDL lowering for optimal cardiovascular risk reduction in the setting of metabolic syndrome. <h3>Conclusions</h3> While calculated LDL cholesterol has been well established as a primary target of treatment to reduce cardiovascular risk, in patients with hypertriglyceridemia or metabolic syndrome, this may underestimate the true burden of atherogenic, cholesterol-carrying lipoproteins. Measurements of apoB or LDL particle number by NMR may more closely quantify the atherogenic lipoprotein load and thus prove to be better indices of cardiovascular disease risk than calculated LDL cholesterol or non-HDL cholesterol in such a population. In our clinical case, the patient may not be adequately treated based on a calculated LDL of 75 mg/dL on high intensity statin, however, an advanced lipid panel revealing LDL discordance suggests intensification and more aggressive LDL lowering for optimal cardiovascular risk reduction.

Serum copper-to-zinc ratio is associated with heart failure and improves risk prediction in middle-aged and older Caucasian men: A prospective study

Background and aimsSerum copper (Cu) and zinc (Zn) may play a role in the development of adverse cardiovascular outcomes including heart failure (HF). Serum Cu/Zn-ratio has been shown to be a risk indicator for cardiovascular disease, but its relationship with HF has not been previously investigated. We aimed to assess the association between Cu/Zn-ratio and incident HF risk using a prospective cohort study. Methods and resultsStudy participants were recruited in eastern Finland with baseline examinations carried out between March 1998 and December 2001. Serum levels of Cu and Zn were measured using atomic absorption spectrometry in 1866 men aged 42–61 years without a history of HF at baseline. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident HF. During 26.5 years median follow-up, 365 HF cases occurred. Restricted cubic splines suggested linear relationships of serum Cu/Zn-ratio, Cu and Zn with HF risk. A unit increase in Cu/Zn-ratio was associated with an increased HF risk in analysis adjusted for several potential confounders including nutritional factors such as total energy intake, intake of fruits, berries and vegetables, and red meat (HR 1.63; 95% CI 1.06–2.51). The corresponding multivariable-adjusted HRs (95% CIs) for serum Cu and Zn were 2.42 (1.32–4.44) and 1.34 (0.50–3.63), respectively. Addition of Cu/Zn-ratio to a HF risk prediction model was associated with improved risk prediction. ConclusionIn middle-aged and older Finnish men, increased serum Cu/Zn-ratio is associated with an increased risk of HF in a linear dose-response fashion and might improve HF risk assessment.

Association of Monocyte Count and Monocyte/Lymphocyte Ratio with the Risk of Cardiovascular Outcomes in Patients with CKD.

Emerging evidence suggests an association of higher monocyte count and monocyte/lymphocyte ratio (MLR) with the risk of cardiovascular disease (CVD) in individuals without chronic kidney disease (CKD); however, limited studies have examined if this association translates to the CKD population. This study examined whether monocyte count and MLR are associated with the risk of CVD, CVD death, and all-cause death in patients with nondialysis CKD who participated in the Chronic Renal Insufficiency Cohort observational study. Baseline monocyte count and MLR were categorized into tertiles and also modeled continuously. Cox proportional hazards models were used to examine the association between monocyte count (primary predictor) and MLR (secondary predictor) at baseline and time to a composite of CVD events, including heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease (primary outcome). Secondary outcomes were time to CVD death and all-cause death. The median follow-up time was 9 years for CVD events and 11.7 years for death. In the fully adjusted model, participants with a higher monocyte count and MLR had a greater risk of CVD events (hazard ratio [HR] per doubling of monocyte count=1.2 [95% CI, 1.1 to 1.31]; HR per doubling of MLR=1.26 [95% CI, 1.16 to 1.36]), CVD death (HR=1.18 [95% CI, 0.99 to 1.41]; HR=1.27 [95% CI, 1.1 to 1.48]), and all-cause death (HR=1.17 [95% CI, 1.06 to 1.3]; HR=1.18 [95% CI, 1.09 to 1.29]). These results suggest that monocyte count and MLR may have the potential to be cost-effective, clinically available indicators of CVD risk in the CKD population.

PATIENTS' PERCEPTION OF RECOVERY AFTER CARDIOVASCULAR INTERVENTIONS: AN IMPORTANT INDICATOR OF LIFESTYLE CHANGE

Cardiovascular disease (CVD) is one of the leading causes of premature death in the world.1 Recent advances in medical technology have led to lower mortality and better relative recovery in CVD patients. Today, various invasive procedures are used in cardiovascular interventions such as percutaneous coronary interventions (PCIs), which have led to improvements in the outcomes of CVD patients. However, despite the benefits of cardiovascular interventions, patients need to change their lifestyles. Therefore, patients with CVD need rehabilitation after cardiovascular interventions for complete recovery, which is often overlooked.2 Meanwhile, patients' perception of recovery after cardiovascular interventions is one of the key factors in predicting lifestyle changes in CVD patients. These patients should have a full awareness of a healthy lifestyle about physical activity, alcohol and tobacco use, and diet, as well as a proper perception of recovery after cardiovascular interventions.3 Hence, the results of a randomized controlled trial in the UK that assessed the impact of educational and rehabilitation programs on patients 'perceptions after myocardial infarction (MI) showed that educational and rehabilitation programs can lead to positive changes in patients' perceptions of recovery after cardiovascular interventions and lifestyle after MI, especially after three months of intervention. Also, patients in the intervention group reported fewer symptoms of angina compared to patients in the control group. Overall, educational and rehabilitation programs were effective in changing the perception of CVD patients and improving the functional outcome of patients after MI.4 In contrast, the results of another study in the Netherlands that evaluated the effect of a lifestyle intervention on CVD risk indicators in patients with familial hypercholesterolemia showed that there was no significant improvement between the intervention and control groups (usual care).5 The importance of this issue becomes clearer when these patients undergo invasive cardiovascular interventions. Despite the benefits of cardiovascular interventions, patients need to change their lifestyles. On the other hand, there is a link between patients' perceptions of recovery after cardiovascular interventions and lifestyle changes. Therefore, there is a need for serious attention to patients' perception of recovery after cardiovascular interventions. Obviously, patients' perceptions of recovery after cardiovascular interventions can be an important predictor of their lifestyle changes. However, to our knowledge, studies in this field are very limited. Therefore, it is suggested that researchers in future studies pay special attention to the perception of CVD patients of recovery after cardiovascular interventions as an important predictor of lifestyle changes in them after cardiovascular interventions.

Abstract MP68: Association Of Multiparity With Carotid Artery Plaque Prevalence: The Multi-Ethnic Study Of Atherosclerosis (MESA)

Background: Multiparity may be associated with an increased risk of cardiovascular disease (CVD); however, responsible mechanisms are incompletely understood. Carotid artery plaque is a marker of subclinical atherosclerosis and an indicator of CVD risk. We hypothesized that multiparity would be independently associated with greater atherosclerosis, as measured by carotid plaque. Methods: We included women in MESA free of CVD who had data on parity ascertained by questionnaire and carotid plaque measured by B-mode ultrasound at baseline. Parity was categorized as nulliparity (ref), 1-2, 3-4 and ≥5 live births. Multivariable logistic and linear regression were performed to evaluate the association of parity categories with carotid plaque presence (yes/no) and extent [carotid plaque score (CPS)], respectively. Results: Of 2789 women included, 38% were White, 29% Black, 12% Chinese, and 22% Hispanic with a mean (SD) age of 62±10 yrs. Carotid plaque prevalence increased with greater parity ( Figure) . Compared to nulliparity, a history of 1-2 live births, 3-4 live births, and grand multiparity (≥5 live births) were significantly associated with carotid plaque presence after adjustment for demographics ( Table, Model 1 ) . Grand multiparity remained significantly associated with carotid plaque presence after full covariate adjustment [OR 1.42 (95% 1.01-2.01), Model 2]. In addition, a history of 1-2 live births and grand multiparity was associated with a greater CPS compared to nulliparity after adjustment for demographics (Model 1). The association of parity with CPS was attenuated and no longer significantly associated with CPS after further adjustment for lifestyle and CVD risk factors (Model 2). Conclusion: In a multiethnic cohort of US women, grand multiparity was independently associated with carotid plaque presence. Further studies are needed to understand the increased risk and prognostic significance of subclinical atherosclerosis among parous women.

A novel operator-independent noninvasive device for assessing arterial reactivity.

BackgroundEndothelial dysfunction is associated with increased risk of cardiovascular disease (CVD). Currently available noninvasive methods of measuring endothelial function have limitations. We tested a novel device that provides an automated measurement of the difference between baseline and post-ischemic, hyperemia-induced, brachial arterial compliance, a phenomenon known to be endothelium-dependent. The association between the calculated index, Flow-mediated Compliance Response (FCR), and established CVD risk indices was determined.MethodsAdults with CVD risk factors or known coronary artery disease (CAD) were enrolled. Framingham Risk Score (FRS) was calculated and presence of metabolic syndrome (MetSyn) was assessed. Carotid artery plaques were identified by ultrasound. Cardiorespiratory fitness was assessed by 6-minute walk test (6MWT). FCR was measured using the device.ResultsAmong 135 participants, mean age 49.3 +/- 17.9 years, characteristics included: 48% female, 7% smokers, 7% CAD, 10% type 2 diabetes, 34% MetSyn, and 38% with carotid plaque. Those with MetSyn had 24% lower FCR than those without (p < 0.001). Lower FCR was associated with higher FRS percentile (r = -0.29, p < 0.001), more MetSyn factors (r = -0.30, p < 0.001), more carotid plaques (r = -0.22, p = 0.01), and lower 6MWT (r = 0.34, p < 0.0001).ConclusionFCR, an index of arterial reactivity obtained automatically using a novel, operator-independent device, was inversely associated with established CVD risk indices, increased number of carotid plaques, and lower cardiorespiratory fitness. Whether measuring FCR could play a role in screening for CVD risk and assessing whether endothelial function changes in response to treatments aimed at CVD risk reduction, warrants further study.

Evaluation of Aortic Elasticity Parameters in Survivors of COVID-19 Using Echocardiography Imaging

Objective: While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects lung tissue, it may cause direct or indirect damage to the cardiovascular system, and permanent damage may occur. Arterial stiffness is an early indicator of cardiovascular disease risk. The aim of our study was to establish the potential effects of SARS-CoV-2 on the vascular system evaluated by transthoracic echocardiographic examination. Subjects and Methods: This study compared arterial stiffness between the survivors of COVID-19 and those without a history of COVID-19 infection. The difference in aortic diameter was examined using echocardiography. Results: The study included 50 patients who survived COVID-19 in the last 3–6 months and 50 age- and gender-matched healthy volunteers. In surviving COVID-19 patients, aortic diastolic diameter in cm ([3.1 ± 0.2] vs. [2.9 ± 0.1], p < 0.001), pulse pressure (PP) ([43.02 ± 14.05] vs. [35.74 ± 9.86], p = 0.004), aortic distensibility ([5.61 ± 3.57] vs. [8.31 ± 3.82], p < 0.001), aortic strain ([10.56 ± 4.91] vs. [13.88 ± 5.86], p = 0.003), PP/stroke volume index ([1.25 ± 0.47] vs. [0.98 ± 0.28], p = 0.001), and aortic stiffness index ([2.82 ± 0.47] vs. [2.46 ± 0.45], p < 0.001) were statistically significant compared to the control group. Conclusion: SARS-CoV-2 may cause reduced or impaired aortic elasticity parameters linked to impaired arterial wall function in COVID-19 survivors compared with controls.

Cardiovascular Risk Screening and Pregnancy Complications: A Comparison of Two Canadian Maternal Health Clinic Populations.

This study compared pregnancy-related cardiovascular disease risk indicators between women who attended 2 different postpartum screening and education clinics: 1 at an urban tertiary care centre and 1 at a northern, rural community hospital. Risk differences associated with ethnicity were also examined. We conducted a retrospective record review that compared data from an urban clinic in Kingston, Ontario (n=675) with those from a rural clinic in Prince Rupert, British Columbia (n=65). Patients who had a hypertensive disorder of pregnancy, gestational diabetes, intrauterine growth restriction, idiopathic preterm birth, or placental abruption attended the clinics at 6 months postpartum. Demographic information, personal and family history, physical examination findings, and laboratory results were collected and used to generate cardiovascular risk estimates using validated scoring systems. These estimates were compared between clinic populations and between ethnic subsets. Fifty-five percent of the Prince Rupert cohort were Indigenous, while 87% of the Kingston cohort were White (P < 0.001). A greater proportion of the Kingston cohort had experienced hypertensive disorders of pregnancy (P=0.002), while a greater proportion of the Prince Rupert cohort had developed gestational diabetes (P=0.010). The Prince Rupert population had higher lifetime and 30-year cardiovascular disease risk scores (P=0.008 and P=0.005, respectively). Indigenous patients had more major cardiovascular risk factors as well as higher lifetime and 30-year cardiovascular risk scores (P=0.001 and P=0.008, respectively) than White and Asian patients. The increased cardiovascular disease risk in both rural and Indigenous women supports the need for better postpartum care, long-term follow-up, and early promotion of cardiovascular health in these populations.

Abstract 14353: Feminizing Hormone Therapy and Subclinical Indicators of CVD Risk in Transgender Women With HIV

Introduction: Transgender women (TW) are at higher risk of HIV infection compared to cisgender groups and HIV is associated with accelerated cardiovascular disease (CVD) complications. A high proportion of TW use feminizing hormone therapy (FHT), particularly estrogen. However, there is a scarcity of data about the cardiovascular impact of FHT in TW with HIV (TWH). Subclinical indicators of CVD risk, arterial stiffness and endothelial progenitor cells colony forming units (EPC-CFUs), were examined in TWH with and without FHT. Hypothesis: Estrogen use in FHT reduces arterial stiffness and induces EPC proliferation. Methods: This pilot included adults 20-60 years old, identifying as TW, with a documented HIV-1 diagnosis, stable ART ≥ 6 months, and without history of CVD. Sociodemographic questionnaire was completed prior to an in-person blood collection and applanation tonometry assessment. Groups were stratified by estrogen levels (normal: 1-82pg/ml vs high: &gt;82pg/ml) and relationships with EPC-CFUs and arterial stiffness were examined using t-test and Pearson’s correlation. Results: Median age was 42 yrs. (IQR 34-52) with mean glucose 105.70 mg/dl (± 58.07), triglycerides 138.52 mg/dl (± 69.61), LDL 82.38 mg/dl (± 35.01), and CRP 3.45 mg/L (±3.57). TW with high (n=5) and normal (n=12) estrogen levels had similar values in EPC-CFUs counts (p=0.99), central augmentation index (cAIx; p=0.27), carotid to radial pulse wave velocity (CR-PWV; p=0.20), and carotid to femoral PWV (CF-PWV; p=0.87). A positive trend appeared in log-transformed estradiol across cAIx (r=0.32, p=0.21); negative trends in CR-PWV (r=-0.11, p=0.70) and CF-PWV (r=-0.19, p=0.48), and no relationship with EPC-CFUs (r=0.05, p=0.86). There were non-significant negative weak trends between EPC-CFUs and cAIx (r=-0.32, p=0.21), CR-PWV (r=-0.2, p=0.48), and CF-PWV (r =-0.29, p=0.27). Conclusions: An inverse correlation between EPC-CFUs and arterial stiffness measurements was observed. Considering these test modalities have a strong correlative potential with CVD risk, FHT does not appear to confer higher CVD risk through these mechanisms. Further research to understand the mechanisms underlying HIV related CVD pathophysiology is critically needed especially in TWH.

Physical activity is important for cardiovascular health and cardiorespiratory fitness in patients with psoriasis.

SummaryBackgroundPatients with psoriasis have a level of physical activity below that recommended for cardiovascular health, which is significantly limited by disease severity and other psoriasis‐specific barriers. We hypothesized that physical activity is important for cardiovascular health in patients with psoriasis and that its objective measurement could have clinical utility.AimTo explore whether physical activity influences the risk of cardiovascular disease (CVD) in patients with psoriasis.MethodsIn total, 242 patients with chronic plaque psoriasis were recruited. History, examination and physical activity were assessed and arteriography, the noninvasive measurement of arterial function, was performed for each participant.ResultsWe observed a significant relationship between volume of physical activity and the likelihood of future CVD as measured by pulse wave velocity (PWV; P < 0.02). We identified a significant relationship between the diastolic reflection area (DRA) and health‐promoting levels of physical activity (P < 0.001), in addition to a significant correlation between DRA and the likelihood of future CVD (P < 0.001). The DRA is a complex, dimensionless variable that describes the intensity of diastolic wave reflection and the duration of diastole, which are key determinants of the blood supply to the left ventricle. Our data suggest that DRA may represent a surrogate marker for cardiorespiratory fitness.ConclusionOur study describes a significant relationship between exercise, cardiorespiratory fitness and PWV, a preclinical indicator of future CVD risk, in patients with psoriasis. The DRA offers a noninvasive, objective measurement of exercise adherence, which could have clinical utility in the future.

Natural menopausal age and cardiovascular disease risk factors in older Chinese women: Guangzhou Biobank Cohort Study.

To examine the associations of natural menopausal age with cardiovascular disease risk factors and whether the associations varied by parity in older Chinese women. Information of demographic characteristics, lifestyles, and reproductive factors was collected by face-to-face interview. Framingham Risk Score was used as an indicator of cardiovascular disease risk, with a score ≥ 10% considered as high cardiovascular disease risk (vs low, dichotomous). Multivariable logistic and linear regressions were used to examine the associations of menopausal age with cardiovascular disease risk factors. Of 18,339 women aged 50+ years, the average (standard deviation) age was 61.8 (6.9) years. Compared with women with menopausal age of 45 to 54 years, after adjustment for multiple potential confounders, women with menopausal age <45 years or ≥55 years had higher Framingham Risk Score (0.93%, 95% confidence interval: 0.40-1.46, and 0.69%, 95% confidence interval: 0.18-1.20, respectively). Women with menopausal age <45 or ≥55 years had higher odds of high cardiovascular disease risk (vs low) (odds ratio [95% confidence interval]:1.26 (1.10-1.44) and 1.17 (1.02-1.33), respectively). The associations of menopausal age with the Framingham Risk Score varied by parity (P for interaction ≤0.001). The Framingham Risk Score was higher in those with one to three parity (<45 y: 1.01 [0.43-1.59]; ≥55 y: 1.14 [0.60-1.68]) and lower for parity ≥4 (<45 y: -0.33 [-1.84 to 1.18]; ≥55 y: -2.02 [-3.82 to -0.22]). In nulliparous women, the Framingham Risk Score was highest in menopausal age <45 years (3.97 [1.67-6.26]), but the differences were nonsignificant in menopausal age ≥55 years (0.66 [-1.38 to 2.71]). Both early and late natural menopausal ages were associated with a higher cardiovascular disease risk, and the associations were stronger in those with lower parity.

976-P: Cardiovascular Risk Predicts Severe Respiratory Failure in Patients Hospitalized with COVID-19

Cardiometabolic disease is associated with mortality and requirement for ventilation in COVID-19. Symptomatic atherosclerotic cardiovascular disease (CVD) implies the presence of significant endothelial dysfunction and is a risk factor for severe COVID-19. However, many patients with no history of CVD exhibit severe COVID-19. We hypothesised that CVD risk calculators could serve as a proxy for significant endothelial dysfunction and predict COVID-19 outcomes in those without symptomatic CVD. We reviewed 230 patients aged 35 to 65 years, hospitalized with COVID-19 at our institution. 190 patients with no history of symptomatic CVD were included. 23% developed severe respiratory failure (RF, requiring mechanical or non-invasive ventilation), while 4% (7/164) of those without prior end-stage renal disease required renal replacement therapy (RRT). In univariate analysis, age (β = 0.057 ± 0.02, p= 0.02), BMI (β = 0.05 ± 0.03, p = 0.049) and T2DM (β = 0.81 ± 0.41, p = 0.048) predicted RF. In keeping with a link between insulin resistance and severe COVID-19, an association was observed between triglycerides and RF (β = 0.26 ± 0.14, P = 0.058). CVD risk indices QRISK3 (0.07 ± 0.02, P &amp;lt;0.001), a CVD Risk Algorithm that predicts the risk of a CV event in next 10 years, and CHADS2VASC (0.53 ± 0.20, P=0.01) were both associated with RF. Age and QRISK3 were associated with a requirement for RRT and length of stay. We observed a threshold effect for QRISK3: when 10 year risk of a CV event was &amp;gt; 5% the risk of RF markedly increased (OR: 6.86 (95% CI: 2.30 - 20.5, P&amp;lt;0.001). The risk of RF was similar across all strata of QRISK3 &amp;gt;5%. A similar trend was observed when analysis was limited to those with T2DM (Ventilatory support in T2DM: QRISK&amp;lt;5% - 0/8, QRISK&amp;gt;5%: 11/30). All cases of RRT occurred in those with QRISK &amp;gt;5%. CVD risk calculators predict severe COVID-19, supporting a role for subclinical CVD in severe COVID-19. Patients hospitalized with QRISK3 &amp;gt;5% may be candidates for early intervention and enhanced monitoring. Disclosure S. Lockhart: None. A. Sheikh: None. H. Griffiths: None. J. Calvo latorre: None. A. B. Daly: None. L. Sibal: None. Funding National Institute for Health Research

Self-reported alcohol consumption, carbohydrate deficient transferrin and risk of cardiovascular disease: The PREVEND prospective cohort study

BackgroundSelf-reported alcohol consumption is an established risk factor for cardiovascular disease (CVD). Carbohydrate deficient transferrin (CDT) is an established objective marker of excessive alcohol consumption, but data on its prospective association with CVD are lacking. We aimed to evaluate the associations of self-reported alcohol consumption and CDT (expressed as %CDT, a more reliable marker than absolute CDT levels) with CVD risk. Materials and methodsIn the PREVEND prospective study of 5,206 participants (mean age, 53 years; 47.7% males), alcohol consumption by self-reports, absolute CDT measured using the Siemens nephelometric assay and %CDT calculated as the percentage of total transferrin concentrations, were assessed at baseline. Alcohol consumption was classified into 5 categories: abstention (reference), light, light–moderate, moderate and heavy alcohol consumption.Hazard ratios (HRs) (95% confidence intervals [CI]) for first CVD events were estimated. ResultsMean (SD) of %CDT was 1.59 (0.54) %. During a median follow-up of 8.3 years, 326 first CVD events were recorded. Compared with abstainers, the multivariable-adjusted HRs (95% CIs) of CVD for light, light–moderate, moderate and heavy alcohol consumption were 0.66 (0.46–0.95), 0.83 (0.62–1.11), 0.83 (0.61–1.14) and 0.80 (0.48–1.36), respectively. Light alcohol consumption was associated with reduced coronary heart disease risk 0.62 (0.40–0.96), whereas light-moderate alcohol consumption was associated with reduced stroke risk 0.45 (0.24–0.83). The association of %CDT with CVD risk was not significant. ConclusionsOur findings confirm the established association between self-reported light to moderate alcohol consumption and reduced CVD risk. However, %CDT within the normal reference range may not be a risk indicator for CVD.

Dietary Polyphenol Intake Is Associated with Biological Aging, a Novel Predictor of Cardiovascular Disease: Cross-Sectional Findings from the Moli-Sani Study.

Biological aging, or the discrepancy between biological and chronological age of a subject (Δage), has been associated with a polyphenol-rich Mediterranean diet and represents a new, robust indicator of cardiovascular disease risk. We aimed to disentangle the relationship of dietary polyphenols and total antioxidant capacity with Δage in a cohort of Italians. A cross-sectional analysis was performed on a sub-cohort of 4592 subjects (aged ≥ 35 y; 51.8% women) from the Moli-sani Study (2005–2010). Food intake was recorded by a 188-item food-frequency questionnaire. The polyphenol antioxidant content (PAC)-score was constructed to assess the total dietary content of polyphenols. Total antioxidant capacity was measured in foods by these assays: trolox equivalent antioxidant capacity (TEAC), total radical-trapping antioxidant parameter (TRAP) and ferric reducing-antioxidant power (FRAP). A deep neural network, based on 36 circulating biomarkers, was used to compute biological age and the resulting Δage, which was tested as outcome in multivariable-adjusted linear regressions. Δage was inversely associated with the PAC-score (β = −0.31; 95%CI −0.39, −0.24) but not with total antioxidant capacity of the diet. A diet rich in polyphenols, by positively contributing to deceleration of the biological aging process, may exert beneficial effects on the long-term risk of cardiovascular disease and possibly of bone health.

Assessment of vascular function in formerly pre-eclamptic women as a novel marker of future cardiovascular risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Women with a history of pre-eclampsia (PE) are at increased risk of cardiovascular disease (CVD). The association between PE and CVD in later life may be explained by vascular dysfunction, either pre-existing or elicited by PE. Several small studies have shown that vascular dysfunction may persist for years in some patients, indicator of future CVD risk, while other studies could not confirm these findings. Purpose In this longitudinal prospective cohort study, we aim to comprehensively assess vascular function in previously pre-eclamptic women (early (&amp;lt;34 weeks) and late (&amp;gt;34 weeks)) and healthy controls. We hypothesize that vascular dysfunction is both more persistent and pronounced in early PE compared to late PE since different pathophysiologic mechanisms underlie both subtypes of PE. Methods For this first analysis, 63 PE patients were compared to 16 non-pregnant healthy controls. Endothelial function was determined by flow-mediated dilatation (FMD), modified FMD (mFMD) and low-flow mediated constriction (L-FMC). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) and augmentation index using pulse wave analysis of the brachial artery, and corrected for heart-rate (Aix75). Results Average post-partum period was 11 months (1.4-111.5 months). Thirty-five presented with early PE, 28 with late PE. In the total PE group, FMD was significantly decreased compared to healthy controls (7.1 ± 2.8 vs 8.9 ± 3.8; p = 0.037), but no difference between early and late PE was observed. Likewise, Aix75 remained elevated after PE (16.5 ± 11.5 vs 5.8 ± 10.1; p &amp;lt; 0.001), again, without difference between early and late PE. cfPWV was not different after PE compared to healthy controls (p &amp;gt; 0.05) but was significantly higher in the early PE group compared to the late PE group (6.9 ± 1.0 vs 6.4 ± 1.0; p = 0.045). Conclusion Even in the postpartum, PE is characterized by overt and persisting endothelial dysfunction and arterial stiffness. Arterial stiffness is more pronounced in early PE compared to late PE. This reaffirms that PE has consequences beyond placental impairment and that the persisting vascular impairment in the postpartum could reflect the risk of CVD later in life.

Urinary Levels of the Acrolein Conjugates of Carnosine Are Associated with Cardiovascular Disease Risk.

Carnosine is a naturally occurring dipeptide (β-alanine-L-histidine) which supports physiological homeostasis by buffering intracellular pH, chelating metals, and conjugating with and neutralizing toxic aldehydes such as acrolein. However, it is not clear if carnosine can support cardiovascular function or modify cardiovascular disease (CVD) risk. To examine this, we measured urinary levels of nonconjugated carnosine and its acrolein conjugates (carnosine-propanal and carnosine-propanol) in participants of the Louisville Healthy Heart Study and examined associations with indices of CVD risk. We found that nonconjugated carnosine was significantly associated with hypertension (p = 0.011), heart failure (p = 0.015), those categorized with high CVD risk (p < 0.001), body mass index (BMI; p = 0.007), high sensitivity C-reactive protein (hsCRP; p = 0.026), high-density lipoprotein (HDL; p = 0.007) and certain medication uses. Levels of carnosine-propanal and carnosine-propanol demonstrated significant associations with BMI, blood glucose, HDL and diagnosis of diabetes. Carnosine-propanal was also associated with heart failure (p = 0.045) and hyperlipidemia (p = 0.002), but no associations with myocardial infarction or stroke were identified. We found that the positive associations of carnosine conjugates with diabetes and HDL remain statistically significant (p < 0.05) in an adjusted, linear regression model. These findings suggest that urinary levels of nonconjugated carnosine, carnosine-propanal and carnosine-propanol may be informative biomarkers for the assessment of CVD risk—and particularly reflective of skeletal muscle injury and carnosine depletion in diabetes.

Six-month effects of modified Atkins diet implementation on indices of cardiovascular disease risk in adults with epilepsy

ABSTRACT Background/Aims Ketogenic diet therapies (KDTs) offer a needed therapeutic option for patients with drug-resistant epilepsy. The current study investigated biochemical and anthropometric indices of cardiovascular disease (CVD) risk in adults with epilepsy treated with KDT over 6 months. Method 65 adults with epilepsy naïve to diet therapy were enrolled in a prospective longitudinal study and instructed on modified Atkins diet (MAD) use. Seizure frequency, anthropometric measures, blood levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 and B, and lipoprotein sub-fractions were assessed at baseline, 3 months, and 6 months. Results Subsequent to study enrollment, 34 participants were lost to follow-up, elected not to start, or stopped MAD prior to study completion, leaving a total of 31 participants in the study at 6 months. Compared to baseline, participants on MAD showed significant reductions in median seizure frequency/week, weight, body mass index, waist and hip circumference, and percent body fat at 3 and 6 months. Compared to baseline, participants on MAD for 3 months showed significantly increased levels of total, small and medium LDL particles, ApoB and ApoB/A1 ratio. At 6 months, only small LDL particles and ApoB levels remained elevated and levels of ApoA1 had risen, suggesting possible compensatory adaptation over time. Conclusions This study provides evidence demonstrating the efficacy and cardiovascular safety of 6 months of MAD use by adults with epilepsy. It also highlights an index of CVD risk – small LDL particles - that should be closely monitored.. Trial registration: ClinicalTrials.gov identifier: NCT02694094..

Cardiovascular age of workers with different employment categories

Introduction We compared the cardiovascular age (an indicator of cardiovascular disease risk) in workers with different employment status after adjustment for demographic and socioeconomic factors. Methods This cross-sectional study used data collected from 2007 to 2017 for the Korea National Health and Nutrition Examination Survey (KNHANES). Study participants were placed into different employment categories based on employment status and work schedule: regular full-time, regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time. Results Analysis of women indicated that regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time workers were more likely to have an older cardiovascular age (OR = 1.180, 1.238, 1.297, 1.493, and 1.408, respectively) after adjustment for age, marriage, education, income, residence, region, and drinking status. Analysis of men indicated employment status was unrelated to cardiovascular age. Conclusion Female nonstandard Korean workers were more likely to have an increased cardiovascular age. However, most of these workers, especially daily workers, are not currently protected by the Occupational Safety and Health Act (OSHA) of Korea. Collaboration or networking with community-based health care services in Korea is essential to better manage the health of these vulnerable female workers.

Hot Flashes and Cardiovascular Disease Risk Indices Among Women With HIV.

Women with HIV (WWH) transitioning through menopause have heightened cardiovascular disease (CVD) risk. In the general population, hot flash burden relates to CVD risk indices. We found higher hot flash burden among women with vs without HIV. Further, among WWH, hot flash burden related to select CVD risk indices.ClinicalTrials.gov RegistrationNCT02874703.

Nonalcoholic Fatty Liver Disease and Cardiovascular Disease.

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