Individual Cardiovascular Risk Factors Research Articles

Effect of an 18-month meditation training on cardiovascular risk in older adults: a secondary analysis of the Age-Well randomized controlled trial.

Cardiovascular risk factors represent an important health issue in older adults. Previous findings suggest that meditation training could have a positive impact on these risk factors. The objective of this study was to investigate the effects of an 18-month meditation-based intervention on cardiovascular health. Age-Well was a randomized, controlled superiority trial with blinded end point assessment, including community-dwelling cognitively unimpaired adults 65years and older enrolled between November 24, 2016, and March 5, 2018, in France. One hundred and thirty-four participants were included in this secondary analysis. Participants were randomly affected to an intervention group that received an 18-month meditation-based program or to comparison groups (active control group i.e. non-native language training or passive control group i.e. no intervention). The main outcome was change in the Framingham Risk Score (FRS); other outcomes were changes in cardiovascular and metabolic risk factors. There was no difference in FRS change after 18months between trial arms (p = .38). When assessing individual cardiovascular or metabolic risk factors, meditation training was associated with a greater reduction in diastolic blood pressure than the comparison group in participants with intermediate to high cardiovascular risk (FRS > 10%) at baseline (p = .03). An 18-month meditation training was not effective to increase overall cardiovascular health in older adults, but improved diastolic blood pressure in a subgroup analysis including at-risk participants. These results suggest a potential benefit of a long-term meditation intervention in older adults at-risk of cardiovascular diseases, and highlights the need for future research in more targeted populations. ClinicalTrials.gov Identifier: NCT02977819.

Trajectories of physical activity among participants of six-month mobile app-based disease management program for cardiovascular risk: a group-based trajectory modelling approach

Abstract Background Mobile app-based health promotion is an emerging preventive intervention for cardiovascular disease that allows for the frequent and longitudinal monitoring of physical activity (PA). Previous studies exploring PA trajectories categorized participants in a limited number of follow-up assessments and did not consider dynamic nature with changes that occur over the intervention period. Purpose This study explored the trajectories of PA during mobile app-based disease management programs in adults with cardiovascular risk using group-based trajectory modelling (GBTM). Methods Participants who completed a six-month disease management program using a mobile app were enrolled. The program promoted behavioural changes for the management of cardiovascular risk factors in individuals with one or more of hypertension, diabetes, or dyslipidaemia. Daily step count was measured using a wrist-worn activity tracker (Fitbit devices). Each participant was encouraged to wear a tracker for the monitoring of exercise and physical activity. To analyse relatively physically inactive participants, we included those with baseline step count <8,000 steps/day. GBTM was conducted to identify distinct patterns of longitudinal step count changes of baseline, 3-22 weeks, and 24 weeks. Participants with PA measurements <4 time points were excluded. The baseline characteristics and indicators related to mobile app usage during the first two weeks were compared among the trajectory groups. Results A total of 1,760 participants were included in the analysis (age: median 55 years; 83.8% men; body mass index (BMI): median 27.0 kg/m²; baseline step count: median 6,118 steps/day). GBTM identified four step count trajectory groups: rapid increase (T1, rapid increase in the first three months; 5%), gradual increase (T2, gradual increase in the first three months; 24%), moderate activity (T3, maintained at around 7,000 steps/day; 45%), and physically inactive (T4, around 4,500 steps/day throughout the program; 26%) (Figure 1). The trajectory groups that showed increasing PA patterns were older (T1: median 57 years; T2: 55 years; T3: 55 years; T4: 54 years; p=0.040) with a lower baseline BMI (T1: median 26.6 kg/m²; T2: 26.4 kg/m²; T3: 27.0 kg/m²; T4: 27.7 kg/m²; p<0.001) and were predominantly men (T1: 89.5%; T2: 87.4%; T3: 82.8%; T4: 81.1%; p=0.028). PA increasing patterns were associated with a longer time of mobile app use (T1: median 8.5 min/day; T2: 5.5 min/day; T3: 5.5 min/day; T4: 4.9 min/day; p=0.012) and more login times (T1: median of daily average 3.9/day; T2: 3.0/day; T3: 3.1/day; T4: 2.9/day; p=0.003) during the first two weeks of the program. Conclusions GBTM showed that 30% of participants in the mobile app-based intervention showed significant PA improvement during the first 12 weeks. Results of this study suggest that the response to PA intervention may be associated with lifestyle prior to the program and willingness to use the mobile app.Figure 1.Step count trajectories

Heart Failure Among Asian American Subpopulations

Heart failure (HF) is a leading cause of death in the US. The current evidence on the burdens of HF in Asian American populations, especially Asian American subgroups, is limited and inconsistent. To assess and compare the incidence and prevalence of HF in Asian American subgroups. This retrospective cohort study used electronic health record data from patients 40 years or older with health care encounters from January 1, 2015, to December 31, 2019, recorded in the Oracle Electronic Health Record Real-World Data database, which has more than 100 health care systems across the US contributing to the database as of February 2024. For prevalence analysis, the study samples were those who had at least 1 encounter in the study calendar year. For incidence analysis, participants were additionally limited to those without HF before the study year who also had encounter(s) the year before the study year. Data analysis was performed from August 1, 2023, to July 31, 2024. Race and ethnicity were determined using patient self-reported data, which were categorized as Black, East Asian, South Asian, Southeast Asian, other Asian (without specified ethnicity), and White. Outcomes were incidence and prevalence of HF, identified using recorded International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Age- and sex-standardized incidence and prevalence were used to calculate the risk ratio of each racial and ethnic group compared with White patients. Incidence and prevalence analyses were performed for 6 845 791 patients (mean [SD] age, 62.1 [12.5] years; 59.9% female; 2.8% Asian, 6.7% Black, and 90.5% White) and for 13 440 234 patients (mean [SD] age, 61.7 [12.7] years; 57.0% female; 2.9% Asian, 7.1% Black, and 90.0% White), respectively. Using the 2015 population as the standard, age- and sex-standardized HF incidence was 2.26% (95% CI, 2.07%-2.45%) for Southeast Asian patients, 1.56% (95% CI, 1.31%-1.82%) for South Asian patients, and 1.22% (95% CI, 1.06%-1.38%) for East Asian patients compared with 1.58% (95% CI, 1.57%-1.59%) for White patients and 2.39% (95% CI, 2.36%-2.42%) for Black patients. Similarly, heterogeneous rates in Asian American subgroups were also observed in the prevalence analysis. In this study of HF outcomes, the disparities between Southeast and East Asian patients were larger than those between Black and White patients, with the estimates in Southeast Asian patients being similar to those of Black patients. These findings reinforce that individual Asian ethnicities and cardiovascular risk factors should be considered in the assessment of HF risks.

Burden of risk factors in women and men with unrecognised myocardial infarction: a systematic review and meta-analysis.

Unrecognised myocardial infarction (MI) is a MI that remains undetected in the acute phase and is associated with an unfavourable prognosis. With this systematic review and meta-analysis, we evaluated the burden of cardiovascular risk factors in individuals with unrecognised MI. We searched general population-based cohort studies diagnosing unrecognised MI by electrocardiogram or myocardial imaging up to 24 November 2023. Pooled mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI) were determined, and random-effects meta-analyses were performed. Fourteen cohort studies were included involving 200,450 individuals (mean age 62.8±9.9 years, 56.0% women), among which 4,322 (2.2%) experienced unrecognised MI (mean age 66.3±8.2 years, 47.8% women) and 4,653 (2.1%) recognised MI (mean age 68.5±7.3 years, 33.8% women). Compared to individuals without MI, those with unrecognised MI had higher body mass index (MD 0.27, 95% CI 0.16-0.39) and systolic blood pressure (MD 4.48, 95% CI 2.81-6.15), and higher prevalence of hypertension (RR 1.27, 95% CI 1.06-1.51) and diabetes mellitus (RR 1.67, 95% CI 1.36-2.06). Furthermore, individuals with unrecognised MI had lower prevalence of hypertension (RR 0.92, 95% CI 0.88-0.97) and diabetes mellitus (RR 0.80, 95% CI 0.70-0.92). Individuals with unrecognised MI are characterised by a substantial burden of metabolic risk factors. Our findings suggest insufficient recognition and management of cardiovascular risk factors among individuals with unrecognised MI.

Evaluation of the relationship between dietary acid load and cardiovascular risk factors in patients with type 2 diabetes: a case-control study.

Diets high in dietary acid load are thought to be associated with metabolic diseases. However, the number of studies examining the relationship between dietary acid load and metabolic diseases in Turkey is insufficient. The aim of this study was to investigate the relationship between cardiovascular disease risk factors and dietary acid load in individuals with type 2 diabetes. In this case-control study, 51 participants aged 30-65 years with type 2 diabetes and 59 participants in the control group were included. Blood pressure and biochemical findings were measured. Anthropometric measurements and body composition measurements were made. Dietary intake was assessed using a 3-day (1 day on weekends, 2 days on weekdays) food consumption record. Dietary acid load scores, including potential renal acid load (PRAL) and net endogenous acid production (NEAP), were calculated based on dietary intake. NEAP and PRAL scores were categorized as low and high according to the median value. Smoking status, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), trigylceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL), waist-hip ratio (WHR), waist-to- height ratio (WtHR), hemoglobin and fat mass (%) were evaluated as cardiovascular risk factors. The cut-off values of PRAL and NEAP were 3.61 and 44.78 mEq/d, respectively. After adjustment for various covariates, a significant positive association between PRAL and TG levels was observed in the diabetic group [odds ratio (OR), 5.98; 95% CI, 1.45-24.67; p = 0.013]. In contrast, a negative association was found between PRAL and SBP in the control group [odds ratio (OR), 0.21; 95% CI, 0.05-0.83; p = 0.026]. However, these associations were not observed for NEAP values in either group. A higher PRAL value was consistently associated with higher TG level, but other cardiovascular risk factors were not. More longitudinal and interventional studies are needed to better establish a causal effect between dietary acid load and cardiovascular risk factors in individuals with diabetes.

Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity.

In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or how much is due to the various cardiovascular risk factors that often accompany excess weight. Several risk factors, such as hypertension, dyslipidemia, hyperuricemia, glucose intolerance, and type 2 diabetes mellitus, are already present in pediatric age. Therefore, early intervention with the goal of correcting and/or eliminating them is particularly important. In the child and adolescent with obesity, the first approach to achieve weight reduction and correct the risk factors associated with severe excess weight should always be non-pharmacologic and based on changing poor eating habits and unhealthy lifestyles. The purpose of this review is to give an update on non-pharmacological interventions to be implemented for cardiovascular prevention in children and adolescents with obesity, and their effectiveness. In particular, interventions targeting each individual cardiovascular risk factor will be discussed.

Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease patients: a pilot randomized controlled trial

Abstract Background Cardiac rehabilitation is a standard and multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person CR, however, older adults are under-reported with effectiveness, feasibility, and usability of CTR for this population remains unclear . Purpose This study investigates the effects, usability, and feasibility of 12-week CTR on health outcomes of older people with CHD. Design A pilot randomized controlled trial with qualitative process evaluation. Methods The study randomized 43 older adults with CHD to the 12-week CTR intervention or usual care. Guided by Social Cognitive Theory, intervention group participants received individualized in-person assessment and orientation session, followed by CTR usage at home. Participants were encouraged to visit the CR website for self-learning and data uploading, use the pedometer for daily step tracking, and chat with peers and CR nurse via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Results Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β= 23.26, p<.001; T2: β=12.18, p=0.008) across study endpoints. No significant difference was observed regarding self-efficacy, quality of life, psychological symptoms, and body weight and blood pressure. Twenty participants completed the intervention, with 100% used social media for tele-consultation, 90% used the pedometer for tele-monitoring, 40% (n=8) used the website. Improving awareness on rehabilitation and a clear action focus were considered as key enablers while physical discomforts and difficulties in using the technology were described as main barriers. Conclusions The CTR is effective in improving physical activity and healthy behaviors for older adults. Considering the variation in individual cardiovascular risk factors, full-scale RCT with larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life. Strategies to improve user intervention usage is needed.

Triglyceride-Glucose Index as Predictor for Hypertension, CHD and STROKE Risk among Non-Diabetic Patients: A NHANES Cross-Sectional Study 2001–2020

BackgroundCardiovascular disease (CVD) is a leading cause of global mortality. Early intervention and prevention of CVD depend on accurately predicting the risk of CVD. This study aimed to investigate the association between the TyG index and the risk of coronary heart disease (CHD), congestive heart failure (CHF), heart attack (HA), stroke, and hypertension (HTN) among patients without diabetes in the United States.MethodsIn this retrospective, cross-sectional study, we used data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020. We conducted several regression analysis models and calculated the sensitivity and specificity of (TyG) index for predicting the onset of CHD, CHF, HA, stroke, and HTN.ResultsA total of 10,937 individuals without diabetes participated in our study. Individuals with a TyG index greater than 8.96 displayed significant increasing in various parameters, including BMI, systolic/diastolic blood pressure, total cholesterol, LDL, and Apo-B levels (p < 0.001). Almost all regression models ensured that a higher TyGI value was associated with higher odds of having CHD, CHF, HA, stroke, and HTN, which patients with a TyGI value higher than 8.96 have odds ratios of 2.24–5.58 for CHD, 1.68–4.42 for stroke, 2.45–3.77 for HA and 1.75–3.93 for HTN comparing than patients with a TyGI value lower than 8.11 (p-value < 0.05).We evaluated the predictive value of the TyG index for each endpoint, obtaining the following area under the curve (AUC) values: 54.75% for CHF (95% CI: 0.542–0.614), 52.32% for stroke (95% CI: 0.529–0.584), 55.67% for HA (95% CI: 0.595–0.646), 55.59% for HTN (95% CI: 0.574–0.597), and 50.31% for CHD (95% CI: 0.592–0.646).Conclusion The TyG index showed a strong correlation with cardiovascular risk factors in individuals without diabetes, however it was a poor predictor of almost studied cardiovascular diseases.

Effects of high-quality protein supplementation on cardiovascular risk factors in individuals with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials

BackgroundUncertainties still existed about the effect of high-quality protein supplementation on cardiovascular disease (CVD) risk factors, although high-quality proteins such as soy and milk proteins have proposed to be beneficial for cardiometabolic health. MethodsA systematic search in PubMed, Web of Science, Cochrane Library, Scopus, and Embase was conducted to quantify the impact of high-quality protein on CVD risk factors. Results63 RCTs on 4 types of high-quality protein including soy protein, milk protein, whey, and casein were evaluated. Soy protein supplementation decreased systolic blood pressure (SBP, -1.42 [-2.68, -0.17] mmHg), total cholesterol (TC, -0.18 [-0.30, -0.07] mmol/L), and low-density lipoprotein cholesterol (LDL-C, -0.16 [-0.27, -0.05] mmol/L). Milk protein supplementation decreased SBP (-2.30 [-3.45, -1.15] mmHg) and total cholesterol (-0.27 [-0.51, -0.03] mmol/L). Whey supplementation decreased SBP (-2.20 [-3.89, -0.51] mmHg), diastolic blood pressure (DBP, -1.07 [-1.98, -0.16] mmHg), triglycerides (-0.10 [-0.17, -0.03] mmol/L), TC (-0.18 [-0.35, -0.01] mmol/L), LDL-C (-0.09 [-0.16, -0.01] mmol/L) and fasting blood insulin (FBI, -2.02 [-3.75, -0.29] pmol/L). Casein supplementation decreased SBP (-4.10 [-8.05, -0.14] mmHg). In the pooled analysis of four high-quality proteins, differential effects were seen in individuals with different health status. In hypertensive individuals, high-quality proteins decreased both SBP (-2.69 [-3.50, -1.87] mmHg) and DBP (-1.34 [-2.09, -0.60] mmHg). In overweight/obese individuals, high-quality proteins improved SBP (-1.40 [-2.22, -0.59] mmHg), DBP (-2.59 [-3.20, -1.98] mmHg), triglycerides (-0.09 [-0.15, -0.02] mmol/L), TC (-0.14 [-0.22, -0.05] mmol/L), LDL-C (-0.12 [-0.16, -0.07] mmol/L), and HDL-C levels (0.02 [0.01, 0.04] mmol/L). According to the benefits on CVD risks factors, whey ranked top for improving cardiometabolic health in hypertensive or overweight/obese individuals. ConclusionOur study supports a beneficial role of high-quality protein supplementation to reduce CVD risk factors. Further studies are still warranted to investigate the effects of different high-quality proteins on CVD risks in individuals with cardiometabolic disorders.

Health guidance intervention mitigates the escalation of predicted comprehensive cardiovascular disease risk: Interrupted time series design

IntroductionMetabolic syndrome increases the risk of cardiovascular events. Despite the Japanese healthcare system's efforts in early detection and intervention, particularly through Specific Health Checkup and Guidance programs, research on their effectiveness is limited. This study evaluated the impact of Specific Health Guidance on the predicted risk of atherosclerotic cardiovascular disease (ASCVD) in working-age Japanese individuals. MethodsEmploying an Interrupted Time Series (ITS) design, this study compared the trends in predicted ASCVD risk and each individual risk factor used for the prediction of ASCVD risk before and after intervention in individuals participating in the guidance. ResultsAnalyses based on the ITS design indicated that participation in Specific Health Guidance programs, specifically the intensive level program, mitigates the increase trend of the predicted ASCVD risk. On the other hand, the impact on the trends of individual cardiovascular risk factors was minimal. ConclusionsThe intensive level Specific Health Guidance appeared to reduce the increasing trend in ASCVD risk, emphasizing the importance of comprehensive risk assessment in evaluating health interventions. However, the results are limited owing to the specific demographics and short evaluation period. Further research is necessary to understand the long-term impacts and broader applicability.

Left Ventricular Trabeculations at Cardiac MRI: Reference Ranges and Association with Cardiovascular Risk Factors in UK Biobank.

Background The extent of left ventricular (LV) trabeculation and its relationship with cardiovascular (CV) risk factors is unclear. Purpose To apply automated segmentation to UK Biobank cardiac MRI scans to (a) assess the association between individual characteristics and CV risk factors and trabeculated LV mass (LVM) and (b) establish normal reference ranges in a selected group of healthy UK Biobank participants. Materials and Methods In this cross-sectional secondary analysis, prospectively collected data from the UK Biobank (2006 to 2010) were retrospectively analyzed. Automated segmentation of trabeculations was performed using a deep learning algorithm. After excluding individuals with known CV diseases, White adults without CV risk factors (reference group) and those with preexisting CV risk factors (hypertension, hyperlipidemia, diabetes mellitus, or smoking) (exposed group) were compared. Multivariable regression models, adjusted for potential confounders (age, sex, and height), were fitted to evaluate the associations between individual characteristics and CV risk factors and trabeculated LVM. Results Of 43 038 participants (mean age, 64 years ± 8 [SD]; 22 360 women), 28 672 individuals (mean age, 66 years ± 7; 14 918 men) were included in the exposed group, and 7384 individuals (mean age, 60 years ± 7; 4729 women) were included in the reference group. Higher body mass index (BMI) (β = 0.66 [95% CI: 0.63, 0.68]; P < .001), hypertension (β = 0.42 [95% CI: 0.36, 0.48]; P < .001), and higher physical activity level (β = 0.15 [95% CI: 0.12, 0.17]; P < .001) were associated with higher trabeculated LVM. In the reference group, the median trabeculated LVM was 6.3 g (IQR, 4.7-8.5 g) for men and 4.6 g (IQR, 3.4-6.0 g) for women. Median trabeculated LVM decreased with age for men from 6.5 g (IQR, 4.8-8.7 g) at age 45-50 years to 5.9 g (IQR, 4.3-7.8 g) at age 71-80 years (P = .03). Conclusion Higher trabeculated LVM was observed with hypertension, higher BMI, and higher physical activity level. Age- and sex-specific reference ranges of trabeculated LVM in a healthy middle-aged White population were established. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kawel-Boehm in this issue.

Predictors of Cardiac Autonomic Dysfunction in Obesity-Related Hypertension.

Cardiac Autonomic Dysfunction (CAD) is an overlooked cardiovascular risk factor in individuals with obesity-related hypertension. Despite its clinical significance, there is a notable lack of clarity regarding the pathophysiological correlates involved in its onset and progression. The present study aimed to identify potential predictors of CAD in obesity-related hypertension. A total of 72 participants (34 men and 38 women) were enrolled. Comprehensive evaluations were conducted, including cardiac autonomic function assessments, body composition estimation and biochemical analysis. Participants were categorized as CAD-positive or CAD-negative based on Ewing's criteria for autonomic dysfunction. Univariate logistic regression analysis was performed to identify potential predictors for CAD. Multivariate logistic regression models were further constructed by adjusting clinically relevant covariates to identify independent predictors of CAD. Multivariate logistic regression analysis revealed that resting heart rate (HRrest), (odds ratio, confidence interval: 0.85, 0.78-0.93; p = 0.001) and percentage body fat (BF%), (odds ratio, confidence interval: 0.78, 0.64-0.96; p = 0.018) were significant independent predictors of CAD. Receiver Operating Characteristic curve analysis depicted optimal cut-off values for HRrest and BF% as >74.1bpm and >33.6%, respectively. Multicolinearity analysis showed variance inflation factors (VIF) below the cautionary threshold of 3. The HRrest and BF% emerged as significant independent predictors of CAD in obesity-related hypertension. Therapeutic strategies should target HRrest<74.1bpm and BF% <33.6% to mitigate CAD risk in this population. Future trials are required to establish causal relationships and may consider additional confounding variables in obesity-related hypertension.

Cardiovascular Disease and Risk Factors in Individuals With a History of Out-of-home Care.

Exposure to childhood out-of-home care (foster family and residential care) is associated with an increased risk of ill-health and disability in adulthood, but the risk for cardiovascular disease has not previously been studied longitudinally. This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 881 731 of whom 26 310 (3.0%) had a history of out-of-home care. The study population, born 1972 to 1981, was followed from age 18 to age 39 to 48 years for hospitalizations and death. After adjusting for year of birth and maternal education, individuals with a history of childhood out-of-home-care experienced a doubling of the risk for coronary disease (hazard ratio; 95% confidence interval: 2.05; 1.74-2.41) and stroke (hazard ratio 1.85; 1.59-2.15), compared with the general population, with similar estimates for men and women. Women with a history of out-of-home care had a more than doubled risk for cigarette smoking in early pregnancy, with a relative risk of 2.26; (2.18-2.34) and a moderately increased risk for gestational diabetes relative risk 1.49 (1.19-1.86). There was marked attenuation (40% to 90%) in effect estimates for disease and risk factors after further control for cohort members educational achievement at age 15-16 years. A history of childhood out-of-home care was associated with a doubled risk of early cardiovascular disease events. Cigarette smoking and educational underachievement were the main identified risk factors.

Investigating the Associations of Cardiovascular Risk Factors, Conditions, and Interventions with Cerebrovascular Diseases: The 90+ study

AbstractBackgroundIn the oldest‐old (those &gt;90 years) cerebrovascular diseases are highly prevalent and independently associated with dementia. Although cardiovascular risk factors like hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM) are thought to be major contributors to the development of cerebrovascular diseases, autopsy studies in the oldest‐old show weak associations with HTN, no association with DM, and HLD remains understudied. We expanded upon existing studies by investigating the associations of cardiovascular risk factors, conditions, interventions, and APOE genotype with the presence of cerebrovascular diseases in participants &gt;90‐years‐old.MethodsParticipants are from The 90+ study, a population‐based epidemiology study of dementia and aging whose participants were survivors of the Leisure World cohort (n = 267). The self‐reported cardiovascular risk factors were DM, HLD, and HTN. Cardiovascular conditions were arrhythmia, coronary artery disease, congestive heart failure (CHF), heart valve disease, myocardial infarction, stroke, and transient ischemic attack. Cardiovascular interventions were coronary artery bypass, pacemaker placement, and statin use. Cerebrovascular diseases were arteriolosclerosis, atherosclerosis, cerebral amyloid angiopathy (CAA), and microvascular lesions (MVLs) on autopsy. Neuropathologic evaluation followed NIA‐AA guidelines. We investigated the association between individual cardiovascular risk factors, conditions, interventions, and APOE genotype with individual cerebrovascular pathologies using logistic regressions adjusted for age of death, sex, and education.ResultsParticipants were on average 98.1 years at death and 75% were female (Table 1). None of the cardiovascular features were associated with arteriolosclerosis or atherosclerosis (Figure 1). APOE‐ε4 was positively associated with CAA [OR = 3.62] while DM [OR = 0.23] and statin use [OR = 0.57] were negatively associated (Figure 2). CHF was negatively associated with the likelihood of MVLs [OR = 0.39] (figure 2).ConclusionsCardiovascular risk factors were not associated with cerebrovascular pathologies in our age group, leading to three potential interpretations: 1) they are not risk factors for cerebrovascular pathologies, 2) they have been mitigated through treatment, or 3) they are not associated due to survival bias, as these conditions reduce life expectancy. Associations of APOE‐ε4, DM, and statin use with CAA may relate to β‐amyloid metabolism while CHF’s negative association with MVLs may relate to decreased blood pressure variability. These initial findings on the limited associations warrant further exploration.

Glycated Hemoglobin (HbA1c) and Thrombotic Risk in Polycythemia Vera and Essential Thrombocythemia

BACKGROUND: Essential thrombocythemia (ET) and polycythemia vera (PV) are BCR::ABL1 negative myeloproliferative neoplasms (MPNs) characterized by overproduction of one or more mature myeloid cell lineages and high thrombotic risk. Diabetes mellitus (DM) is a rare cardiovascular (CV) comorbidity in MPNs and the optimal treatment target levels of glycated hemoglobin (HbA1c) in MPNs remain unknown. OBJECTIVE&amp;METHODS: This multicenter study was conducted in Croatia and Serbia in the period between 01/1997 and 01/23 and investigated clinical correlations of HbA1c in ET and PV patients whose diagnoses were reassessed according to 2016 WHO criteria. We retrospectively collected data regarding diabetic ET and PV patients with available HbA1c at disease diagnosis, stratified them according to HbA1c levels, and compared their clinical outcomes to a control group of 93 non-diabetic ET and PV patients. Outcomes of interest were time to thrombosis (TTT; death as a censoring event) and overall survival (OS). Survival analyses were based on Kaplan-Meier method and performed with log-rank test and the Cox-regression analysis. The study was approved by Ethics Committees from all participating centers. RESULTS: We included 109 MPN patients (33 ET and 76 PV) with DM (all type II); median age was 69 years (range 37-86), 60 (55%) were females, 81 (74.3%) were JAK2- and 10 (9.2%) CALR-positive. Ninety-two (84.4%) patients were classified as high-risk (age&amp;gt;60 years or prior thrombosis), 68 (62.4%) received hydroxyurea (HU), 91 (83.5%) had arterial hypertension, 44 (40.4%) hyperlipidemia, and 36 (33%) were smokers. The median follow-up time was 38 months; 16 (14.7%) thrombotic (13 arterial and 3 venous) events and 25 deaths (22.9%) occured during this time. Median HbA1c in diabetic MPN patients was 6.8% (range 4.8-16.2%). There were no associations of HbA1c with disease phenotype, age, sex, mutational status, prior thrombosis, presence of individual CV risk factors, or any of the blood cell count components (p&amp;gt;0.050 for all analyses). ROC curve defined the optimal HbA1c cut-off level of ≥7.2% for the best discrimination of thrombotic events in MPN patients with DM. Diabetic MPN patients with low HbA1c (&amp;lt;7.2%) had similar TTT (median 182 months) as non-diabetic MPN patients (median 197 months) whereas those with higher HbA1c (≥7.2%) had significantly worse TTT (median 124 months; HR 3.76, p=0.012), as presented in Figure 1A. The detrimental effect of high HbA1c was evident in high-risk (HR 3.2, p=0.031) but not in low-risk diabetic MPN patients (p=0.115). Also, JAK2-negative diabetic MPN patients with higher HbA1c had inferior TTT when compared to their counterparts (HR 28.17, p&amp;lt;0.001), with no difference among JAK2-positive patients (Figure 1B). There were significant interactions between high HbA1c, thrombotic risk, and advanced age (p=0.026), higher leukocytes (p=0.028), higher erythrocytes (p=0.007), higher platelets (p=0.034), higher hematocrit (p=0.007) and higher hemoglobin (p=0.013), with older age and higher blood counts favoring higher thrombotic risk associated with high HbA1c. There was no difference in OS when comparing non-diabetic to diabetic MPN patients with respect to HbA1c (p=0.209). In the multivariate Cox regression model, high HbA1c (HR 5.04, p=0.013) remained as the only variable associated with inferior TTT among diabetic MPN patients when additionally controlling for age, sex, history of thrombosis, presence of JAK2 mutation, HU treatment, baseline leukocyte counts, and the presence of at least one other CV risk factor. DISCUSSION: This study demonstrated that diabetic MPN patients with low (&amp;lt;7.2%) HbA1c had similar TTT as non-diabetic patients suggesting that stringent control of DM in MPNs is extremely important; this effect was most evident in JAK2-negative diabetic MPN patients. Also, significant interactions with high trombotic risk were found between high HbA1c, older age, and different myeloid cell lineages, suggesting that uncontrolled DM acts synergistically with MPN clone and underlies CV development. However, no correlations between HbA1c and blood cell counts were detected, indicating that HbA1c measurements may not be accurrate in MPNs for DM diagnosis. The lack of association of high HbA1c with OS is probably related to optimal post-thrombotic management. Future studies are needed to elucidate optimal HbA1c values for the diagnosis and treatment of DM in MPNs.

Early life cardiovascular risk factor trajectories and vascular aging in midlife: a 30-year prospective cohort study

Abstract Background Vascular aging, as assessed by structural and functional arterial properties, is an independent predictor of cardiovascular outcomes. We aimed to explore the associations of individual cardiovascular risk factors from childhood to midlife and their accumulation over a 30-year span with vascular aging in midlife. Methods Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 2180 participants aged 6 to 18 years at baseline were followed for over 30 years. Distinct trajectories of systolic blood pressure (SBP), body mass index (BMI), and heart rate (HR) from childhood to midlife were identified by group-based trajectory modeling. Vascular aging was assessed by carotid intima–media thickness (cIMT) or brachial-ankle pulse wave velocity (baPWV). Results We identified 4 distinct SBP trajectories, 3 distinct BMI trajectories and 2 distinct HR trajectories from childhood to midlife. Persistently-increasing SBP, high-increasing BMI, and high-stable HR were all shown to have a positive association with baPWV in midlife. For cIMT, similar associations were observed for persistently-increasing SBP and high-increasing BMI. After further adjustment for SBP, BMI and HR at the time of vascular assessment in 2017, associations were also observed for cardiovascular risk factor trajectories accumulation with baPWV (β=0.656 (95%CI, 0.265-1.047)] and with cIMT [β=0.045 (95%CI, 0.011-0.079)] in adulthood. Conclusions Longitudinal exposure to individual cardiovascular risk factors from childhood to midlife and cardiovascular risk factor accumulation were associated with an increased risk of vascular aging in midlife. Our study lends support for early targeting of risk factors in order to prevent cardiovascular disease later in life.Long-term SBP, BMI, HR trajectories

Identifying patients' cardiovascular vulnerability against atmospheric parameters and air pollution

Abstract Background Atmospheric parameters are direct environmental factors on the human body. There is a growing concern that atmospheric parameters might have a potential cardiovascular (CV) effect and increase morbidity and mortality. The health effects of climate change and air pollution are already major public health issues. In the future, the growing concern about unfavorable atmospheric situations and air pollution can further increase this problem. Despite the importance of different atmospheric parameters’ CV risks, there are few studies about identifying vulnerable populations against atmospheric parameters and air pollution. Purpose We aimed to explore vulnerable populations against atmospheric parameters. Methods The study comprised 7230 hospitalized patients with acute CV diseases (ACVDs). Demographic and individual CV risk factor data were collected for each patient. We examined the relationship between demographic characteristics (age, sex) and CV risk factors (hypertension, hyperlipidemia, diabetes, previous CV diseases) and meteorological and air pollution parameters on a day-to-day basis in a 5-year time period (2017-2021) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross-validation. Results Patients with diabetes were detected as the most vulnerable group against atmospheric parameters. The interaction between temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) showed a positive association with daily diabetic patients’ hospitalization counts (p&amp;lt;0.001). The relative strength of the association with demographic characteristics was the largest between daily temperature variation (5°C≤) and patients with age 55 or more (p=0.002). The effect of temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) was positively associated with the daily hospitalization counts of male patients (p&amp;lt;0.001). Conclusions In our study, we can identify vulnerable subpopulations that have increased CV risk during specific atmospheric conditions. The importance of our findings is growing in the context that extreme atmospheric conditions and air pollution are likely to become more common in the future. In conclusion, a better understanding of vulnerability could help establish new CV prevention strategies.

Gestational diabetes mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies—a scoping review

BackgroundGlobally, gestational diabetes mellitus complicates 1 in 6 pregnancies and increases future risk of type 2 diabetes and cardiovascular disease in the affected women. There is a lack of consensus on the optimal follow-up of these women. eHealth is emerging as a health care tool, but its practical utility and advantages over standard care in the follow-up after pregnancy complications remains to be determined. Our aim was to systematically review the existing literature on cardiovascular follow-up after gestational diabetes, the utility of eHealth technology for this purpose, and to identify research gaps.MethodsWe performed a systematic scoping review following a published protocol and the Joanna Briggs methodology for studies up until May 2022. Four databases were searched: Ovid MEDLINE, Embase, Maternity and Infant Care, and Cochrane Database of Systematic Reviews. Primary research articles and systematic reviews were included in the final analyses. Two reviewers independently screened abstracts and performed full text assessment. Data was extracted using a data charting form. In all stages of the process, if consensus was not reached, a third reviewer was consulted. The findings from the data charting process provided the basis for summarizing the findings from the included studies.ResultsThe search of the databases generated 2772 hits. After removing duplicates and manually adding a total of 19 studies, reviews, and guidelines, a total of 2769 titles and abstracts were screened, and 97 papers underwent full-text review. In the final analyses, 15 articles and 12 systematic reviews were included, whereas guidelines are presented as supplementary material.No studies were identified that examined follow-up regarding long-term overall cardiovascular risk after gestational diabetes. Various lifestyle interventions were tested for individual cardiovascular risk factors, with diverging effects. eHealth technologies were found acceptable by participants but had no consistent, statistically significant effect on relevant health outcomes.ConclusionsThis scoping review of the existing literature revealed neither an established systematic cardiovascular follow-up strategy for women after gestational diabetes nor evidence that eHealth technologies are superior to conventional follow-up. Further research into the utility of eHealth in cardiovascular follow-up after complicated pregnancies should include longer-term follow-up and core cardiovascular outcomes.Systematic review registrationThe protocol for this scoping review was published at Open Science Framework (osf.io/p5hw6)

Optimization of cardiovascular risk factor management in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms, current knowledge, and perspectives.

The exact prognostic role of cardiovascular (CV) risk factors in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms (MPNs) remains unknown as it is often masked by other MPN-related features that bear strong prognostic impact on thrombotic risk. Therefore, current MPN treatment is not primarily guided by presence of CV risk factors. Treatment of CV risk factors in MPN patients usually mirrors that from the general population, despite the fact that CV risk factors in MPNs have their own specificities. Moreover, the optimal target levels for different metabolic deflections in MPNs (i.e., low-density lipoprotein, serum uric acid, or glycated hemoglobin levels) have not been defined. In the current review, we separately discuss the most important aspects of every individual CV risk factor (arterial hypertension, hyperlipidemia, chronic kidney disease, smoking, diabetes mellitus, hyperuricemia, and obesity and cachexia) in MPNs, summarize recent advances in the field, and propose future directions and research areas which may be needed to appropriately manage CV risk factors in MPNs.

Effect of Cardiovascular Risk Factors on 30-Day All-Cause Mortality in Cardiogenic Shock.

Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from 2019 to 2021. The prognosis of patients with "low CVR" (i.e., 0-1 CVR factors) was compared to patients with "high CVR" (i.e., 2-4 CVR factors) according to presence or absence of arterial hypertension, diabetes mellitus, hyperlipidaemia or smoking. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier and Cox proportional regression analyses. 273 consecutive patients with CS were included. 28% presented with low CVR and 72% with high CVR. Within the entire study cohort, the risk of 30-day all-cause mortality did not differ between patients with high and low CVR (55% vs. 57%; log rank p = 0.727; HR = 0.942; 95% CI 0.663-1.338; p = 0.738). Even after multivariable adjustment, high CVR was not associated with an elevated risk of 30-day all-cause mortality (HR = 1.039; 95% CI 0.648-1.667; p = 0.873). The presence of arterial hypertension (55% vs. 58%; log rank p = 0.564; HR = 0.906; 95% CI 0.638-1.287; p = 0.582), diabetes mellitus (60% vs. 52%; log rank p = 0.215; HR = 1.213; 95% CI 0.881-1.671; p = 0.237) and a history of smoking (56% vs. 56%; log rank p = 0.725; HR = 0.945; 95% CI 0.679-1.315; p = 0.737) did not significantly influence short-term prognosis.. Only the absence of hyperlipidaemia significantly decreased the risk of all-cause mortality (65% vs. 51%; log rank p = 0.038; HR = 0.718; 95% CI 0.516-0.998; p = 0.049), which was no longer observed after multivariable adjustment (HR = 0.801; 95% CI 0.536-1.195; p = 0.277). In conclusion, neither the overall CVR nor individual CVR factors were associated with the risk of 30-day all-cause mortality in patients with CS.