Risk Of Ischemic Cardiovascular Disease Research Articles

Molecular Therapies in Cardiovascular Diseases: Small Interfering RNA in Atherosclerosis, Heart Failure, and Hypertension.

Small interfering RNA (siRNA) represents a novel, fascinating therapeutic strategy that allows for selective reduction in the production of a specific protein through RNA interference. In the cardiovascular (CV) field, several siRNAs have been developed in the last decade. Inclisiran has been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) circulating levels with a reassuring safety profile, also in older patients, by hampering proprotein convertase subtilisin/kexin type 9 (PCSK9) production. Olpasiran, directed against apolipoprotein(a) mRNA, prevents the assembly of lipoprotein(a) [Lp(a)] particles, a lipoprotein linked to an increased risk of ischemic CV disease and heart valve damage. Patisiran, binding transthyretin (TTR) mRNA, has demonstrated an ability to improve heart failure and polyneuropathy in patients with TTR amyloidosis, even in older patients with wild-type form. Zilebesiran, designed to reduce angiotensinogen secretion, significantly decreases systolic and diastolic blood pressure (BP). Thanks to their effectiveness, safety, and tolerability profile, and with a very low number of administrations in a year, thus overcoming adherence issues, these novel drugs are the leaders of a new era in molecular therapies for CV diseases.

Aortic Stenosis Risk in Rheumatoid Arthritis

Although an increased risk of ischemic cardiovascular disease has been associated with rheumatoid arthritis (RA), the risk of aortic stenosis (AS) is unknown. To examine the risk of incident AS, aortic valve intervention, AS-related death, and risk factors for AS development in patients with RA. This cohort study linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services from 2000 to 2019. Patients with RA were matched by age, sex, and VHA enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death. Data were analyzed from August 23, 2022, to March 3, 2023. the primary exposure was the presence of RA, defined using validated RA algorithms. Aortic stenosis was defined as a composite of inpatient or outpatient diagnoses, surgical or transcatheter aortic valve replacement, or AS-related death using diagnostic and procedural codes. Risk of AS development was assessed with multivariable Cox proportional hazards models adjusted for race, ethnicity, smoking status, body mass index, rurality, comorbidities, and health care use. The cohort included 73 070 patients with RA (64 008 [87.6%] males; mean [SD] age, 63.0 [11.9] years) matched with 639 268 patients without RA (554 182 [86.7%] males; mean [SD] age, 61.9 [11.7] years) and 16 109 composite AS outcomes that occurred over 6 223 150 person-years. The AS incidence rate was 3.97 (95% CI, 3.81-4.13) per 1000 person-years in patients with RA and 2.45 (95% CI, 2.41-2.49) per 1000 person-years in the control patients (absolute difference, 1.52 per 1000 person-years). Rheumatoid arthritis was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41-1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04-1.54). In this cohort study, RA was associated with a higher risk of developing AS and the subsequent risks of undergoing aortic valve intervention and suffering from AS-related death. Future studies are needed to confirm whether valvular heart disease, specifically AS, may be an overlooked cardiovascular disease complication in RA.

Association of Neutrophil to High-Density Lipoprotein Cholesterol Ratio with Cardiac Ultrasound Parameters and Cardiovascular Risk: A Cross-Sectional Study Based on Healthy Populations.

Neutrophils and high-density lipoprotein cholesterol (HDL-C) are significantly linked to cardiovascular disease (CVD). This study investigates the correlation of neutrophil count to HDL-C ratio (NHR) with cardiac ultrasound parameters and cardiovascular risk in healthy populations. Firstly, NHR was calculated based on neutrophils and HDL-C. Then, the differences in basic clinical characteristics and cardiac ultrasound parameters were compared between the high and low NHR groups, males and females. Subsequently, cardiovascular risk was predicted according to the Chinese 10-year ischemic cardiovascular disease (ICVD) risk assessment tool for people aged 35-60 years. Finally, the correlation between NHR and cardiac ultrasound parameters and cardiovascular risk was calculated. A total of 3020 healthy participants, 1879 males and 1141 females, were included. Participants in the high NHR group had significantly increased Aorta (AO), Left Atrium (LA), Right Atrium (RA), Right Ventricle (RV), End Systolic Diameter of Left Ventricle (ESD), End Diastolic Diameter of Left Ventricle (EDD), Main Pulmonary Artery (MPA), Right Ventricular Outflow Tract (RVOT), Interventricular Septum (IVS), Left Ventricular Posterior Wall (LVPW), and cardiovascular risk and decreased E/A values compared to those in the low NHR group. The same results were found in males participants compared to females. A total of 1670 participants underwent ICVD risk assessment tool. Cardiovascular risk was significantly higher in those with high NHR and in males than in those with low NHR and in females. Correlation analysis showed that NHR was positively correlated with AO, LA, RA, RV, ESD, EDD, MPA, RVOT, IVS, LVPW and cardiovascular risk, and negatively correlated with E/A values. Our study demonstrates that NHR is significantly associated with cardiac ultrasound parameters and cardiovascular risk in healthy populations. NHR may serve as a useful indicator for the early diagnosis and treatment of cardiovascular disease among healthy populations.

Increased sympathetic outflow induced by emotional stress aggravates myocardial ischemia-reperfusion injury via activation of TLR7/MyD88/IRF5 signaling pathway.

Emotional stress substantially increases the risk of ischemic cardiovascular diseases. Previous study indicates that sympathetic outflow is increased under emotional stress. We aim to investigate the role of increased sympathetic outflow induced by emotional stress in myocardial ischemia-reperfusion (I/R) injury, and explore the underlying mechanisms. We used Designer Receptors Exclusively Activated by Designer Drugs technique to activate the ventromedial hypothalamus (VMH), a critical emotion-related nucleus. The results revealed that emotional stress stimulated by VMH activation increased sympathetic outflow, enhanced blood pressure, aggravated myocardial I/R injury, and exacerbated infarct size. The RNA-seq and molecular detection demonstrated that toll-like receptor 7 (TLR7), myeloid differentiation factor 88 (MyD88), interferon regulatory factor 5 (IRF5), and downstream inflammatory markers in cardiomyocytes were significantly upregulated. Emotional stress-induced sympathetic outflow further exacerbated the disorder of the TLR7/MyD88/IRF5 inflammatory signaling pathway. While inhibition of the signaling pathway partially alleviated myocardial I/R injury aggravated by emotional stress-induced sympathetic outflow. Increased sympathetic outflow induced by emotional stress activates TLR7/MyD88/IRF5 signaling pathway, ultimately aggravating I/R injury.

Reducing the 10-year risk of ischemic cardiovascular disease to receive early cardiovascular benefits from bariatric surgery for obesity in China.

BackgroundCardiovascular risk due to obesity can be improved greatly by bariatric surgery. However, there is no research involving appropriate model for evaluating cardiovascular disease risk reduction in bariatric surgery for obesity in China. We selected the ischemic cardiovascular disease (ICVD) risk score that accurately predict cardiovascular risk in Chinese adults to evaluate the 10-year risk of ICVD and estimated early cardiovascular benefits of bariatric surgery in obese Chinese patients through its reduction.MethodsFrom 2017 to 2019 we followed up 107 patients 6 months after surgery and measured the ICVD 10-year risk and other cardiovascular factors before and after surgery.ResultsThere were significant reductions in the ICVD total score (p < 0.001) and ICVD 10-year risk (%) (p < 0.001) 6 months post-operation compared with baseline. Furthermore, we found significant reductions in body mass index (BMI), body adiposity index (BAI), low-density lipoprotein (LDL), small dense-low-density lipoprotein (sd-LDL) and triglycerides (TG) 6 months after surgery compared with pre-operation (all p < 0.05). The decrease in ICVD total score was correlated with excess BMI loss (%EBMIL), reduced BAI, reduced LDL, reduced sd-LDL and reduced TG respectively (all p < 0.05) at 6 months post-operation. Moreover, there were significant reductions in the ICVD total score in the male subgroup [3 (3, 5) vs. 2.5 (2, 4), p < 0.001] and female subgroup [3 (2, 4) vs. 2 (1, 3), p < 0.001] 6 months post-operation compared with baseline. At last there were also significant reductions in the ICVD total score in the diabetic subgroup [5 (4, 6) vs. 4 (3, 5), p < 0.001] and non-diabetic subgroup [2 (2,3) vs. 2 (1, 2), p < 0.001] 6 months post-operation compared with baseline.ConclusionsBariatric surgery could provide early cardiovascular benefits for patients with obesity in China by reducing the 10-year risk of ICVD. Both men and women with obesity achieved cardiovascular benefits according to bariatric surgery, so did diabetic and non-diabetic patients.

Coronary calcification and bone microarchitecture by high-resolution peripheral quantitative computed tomography from the S\xe3o Paulo Ageing and Health (SPAH) Study

Epidemiological studies reveal a link between osteoporosis and the risk of ischemic cardiovascular disease. We illustrate an association between coronary calcification and bone microarchitecture in older adults based on the SPAH study. This cross-sectional research comprised 256 individuals subjected to cardiac coronary computed tomography angiography (CCTA) for coronary artery calcification (CAC), high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and radius with standardized z score parameters, and dual-energy X-ray absorptiometry (DXA) to evaluate bone status. We used Student’s t test and the Mann–Whitney and Chi-squared tests for comparison of basal measurements. Association analysis was performed using the Poisson regression model with adjustment for CAC and sex. Multivariate analysis revealed different bone variables for predicting CAC in DXA and HR-pQCT scenarios. Although most of the bone parameters are related to vascular calcification, only cortical porosity (Ct.Po) remained uniform by HR-pQCT. Results for were as follows: the tibia—women (exp β = 1.12 (95% CI 1.10–1.13, p < 0.001) and men (exp β = 1.44, 95% CI 1.42–1.46, p < 0.001); the radius—women (exp β = 1.07 (95% CI 1.07–1.08, p < 0.001) and men (exp β = 1.33 (95% CI 1.30–1.37, p < 0.001). These findings suggest an inverse relationship between CAC and cortical bone content, as assessed by HR-pQCT, with higher coronary calcification in individuals older than 65 years.

Low testosterone concentrations and risk of ischaemic cardiovascular disease in ageing: not just a problem for older men

Coronary heart disease, myocardial infarction, and ischaemic stroke increase sharply in prevalence with age in both men and women.1 The understanding that such diseases are more likely to occur in women after the menopause has motivated research into the cardiovascular effects of low blood oestrogen concentrations. By contrast, it is less well appreciated that blood testosterone concentrations also decrease gradually with age in women, although these concentrations can rise again at the start of the seventh decade.

Effects of aerobic training and resistance training in reducing cardiovascular disease risk for patients with prediabetes: A multi-center randomized controlled trial

AimsAerobic training (AT) and resistance training (RT) can reduce blood glucose and type 2 diabetes risk, and increase muscle mass for prediabetes patients. However, the impact of long-term AT and RT on cardiovascular disease (CVD) risk remains unclear. The purpose of this study was to investigate the impact of AT and RT on CVD risk reduction in prediabetes patients. Materials and methods248 prediabetes patients were enrolled in this multi-center randomized controlled trial (RCT). Patients were randomly divided into 3 groups: RT (n = 82), aerobic training (AT (n = 83)), and control group (n = 83). Participants in RT and AT groups had moderate RT or AT 3 times a week (150 min/week) under supervision in 3 research centers for 24 months. Primary outcome was CVD risk measured by Framingham Risk Score (FRS) and The Chinese 10-year ischemic cardiovascular disease (ICVD) risk assessment tool. Secondary outcomes included in HOMA2-IR, HbA1c, blood pressure and serum lipid profile. ResultsBoth RT and AT groups experienced a significant reduction in HOMA2-IR, HbA1c, LDL-C, TC, SBP, and DBP at the end of 12 and 24 months. Compared to the control group, Both RT and AT groups had significant reduction of the Chinese 10-year ICVD risk (P < 0.05), but FRS CVD risk declined significantly only in the AT group (all P < 0.05). Although FRS CVD risk decreased more in the RT group than in the control group, the difference was not statistically significant. After adjusting for age, gender, statin use, BMI, and WHR, in COX’s proportional hazard model, RT (HR = 0.419, P = 0.037) and AT (HR = 0.310, P = 0.026) were protective factors for CVD risk in prediabetes patients. 24-month RT and AT decreased respectively 58.1% and 69.0% of CVD risk (10-year ICVD risk assessment) in prediabetes patients. ConclusionsThis study demonstrated that 24-month moderate AT reduces the Chinese 10-year ICVD risk and FRS CVD risk in prediabetes patients. RT groups had significant reduction of CVD risk (10-year ICVD risk assessment) in prediabetes patients. Trial registrationClinical trial registration number: NCT 02561377. Date of registration24/09/2015.

Lipoprotein(a) and Cardiovascular Disease.

High lipoprotein(a) concentrations present in 10%-20% of the population have long been linked to increased risk of ischemic cardiovascular disease. It is unclear whether high concentrations represent an unmet medical need. Lipoprotein(a) is currently not a target for treatment to prevent cardiovascular disease. The present review summarizes evidence of causality for high lipoprotein(a) concentrations gained from large genetic epidemiologic studies and discusses measurements of lipoprotein(a) and future treatment options for high values found in an estimated >1 billion individuals worldwide. Evidence from mechanistic, observational, and genetic studies support a causal role of lipoprotein(a) in the development of cardiovascular disease, including coronary heart disease and peripheral arterial disease, as well as aortic valve stenosis, and likely also ischemic stroke. Effect sizes are most pronounced for myocardial infarction, peripheral arterial disease, and aortic valve stenosis where high lipoprotein(a) concentrations predict 2- to 3-fold increases in risk. Lipoprotein(a) measurements should be performed using well-validated assays with traceability to a recognized calibrator to ensure common cut-offs for high concentrations and risk assessment. Randomized cardiovascular outcome trials are needed to provide final evidence of causality and to assess the potential clinical benefit of novel, potent lipoprotein(a) lowering therapies.

Does androgen-deprivation therapy increase the risk of ischemic cardiovascular and cerebrovascular diseases in patients with prostate cancer? A nationwide population-based cohort study.

We investigated whether ADT use was associated with the risk of ischemic cardiovascular diseases (CVD) and cerebrovascular diseases (CrVD) in a nationwide population-based cohort. Claims data of the Health Insurance and Review Assessment system in South Korea were used. In total, 195,308 men with newly diagnosed prostate cancer between January 1, 2008 and December 31, 2017 were identified. After applying the exclusion criteria, 131,189 men were enrolled. The study cohort was divided into ADT and non-ADT groups. Study outcomes were newly developed CVD, cardiovascular intervention (CVI), and CrVD. To control for potential confounders, various cardiovascular risk factors were balanced between groups. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events. Univariable analysis revealed that ADT was significantly associated with an increased risk of CVD and CrVD. Multivariable analysis did not reveal this association. In the propensity score matched cohort (n = 61,722), multivariable analysis demonstrated that ADT independently reduced the risk of CVD (HR 0.890; 95% CI 0.846-0.936; p < 0.0001), CVI (HR 0.873; 95% CI 0.770-0.991; p = 0.0352), and CrVD (HR 0.869; 95% CI 0.824-0.917; p < 0.0001). CVD risk was significantly decreased in patients using ADT for over 2years. CVI and CrVD risks were significantly lower in men using ADT for over 3years. This study demonstrated that ADT may reduce the risk of CVD, CVI, and CrVD, and ADT duration is associated with this risk reduction.

Platform to study intracellular polystyrene nanoplastic pollution and clinical outcomes.

Increased pollution by plastics has become a serious global environmental problem, but the concerns for human health have been raised after reported presence of microplastics (MPs) and nanoplastics (NPs) in food and beverages. Unfortunately, few studies have investigate the potentially harmful effects of MPs/NPs on early human development and human health. Therefore, we used a new platform to study possible effects of polystyrene NPs (PSNPs) on the transcription profile of preimplantation human embryos and human induced pluripotent stem cells (hiPSCs). Two pluripotency genes, LEFTY1 and LEFTY2, which encode secreted ligands of the transforming growth factor-beta, were downregulated, while CA4 and OCLM, which are related to eye development, were upregulated in both samples. The gene set enrichment analysis showed that the development of atrioventricular heart valves and the dysfunction of cellular components, including extracellular matrix, were significantly affected after exposure of hiPSCs to PSNPs. Finally, using the HiPathia method, which uncovers disease mechanisms and predicts clinical outcomes, we determined the APOC3 circuit, which is responsible for increased risk for ischemic cardiovascular disease. These results clearly demonstrate that better understanding of NPs bioactivities and its implications for human health is of extreme importance. Thus, the presented platform opens further aspects to study interactions between different environmental and intracellular pollutions with the aim to decipher the mechanism and origin of human diseases.

Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes

BackgroundCardiovascular disease has become a serious public health problem in recent years in China. The aim of the study was to examine sex differences in cardiovascular risk factors and 10-year ischemic cardiovascular disease (ICVD) risk in Chinese patients with prediabetes (PreDM) and type 2 diabetes mellitus (T2DM).MethodsThis was a multi-site retrospective case-control study conducted from April–November 2016 using an electronic medical record database, involving 217 PreDM and 900 T2DM patients admitted to endocrinology units in four hospitals in China. CVD risk was estimated using the Chinese 10-year ICVD risk model. The differences in 10-year absolute ICVD risk according to PreDM, T2DM < 1 year, T2DM 1–5 years or T2DM ≥5 years and sex were analyzed using ANOVA.ResultsWhen compared to PreDM females, males with PreDM had significantly higher 10-year ICVD risk In contrast, the opposite pattern of 10-year ICVD risk was observed in T2DM; males had significantly lower 10-year ICVD risk. Moreover, compared to T2DM females, males with T2DM had a lower proportion s with moderate or greater ICVD risk (p < 0.001). When compared to PreDM males, males with T2DM < 1 year, and with T2DM 1–5 years had no difference in 10-year ICVD risk, but had higher ICVD risk with T2DM ≥5 years (p < 0.05). Compared to PreDM females, females with T2DM in all subgroups had higher ICVD risk (p < 0.05). Among those with T2DM, hypertension rates of awareness, treatment and control were 78.60%, 65.38% and 31.10%, respectively; hyperlipidemia rates of awareness, treatment and control were lower (29.15%, 8.30% and 3.47%, respectively). Females with T2DM had higher prevalence, awareness and treatment of hypertension and hyperlipidemia than males with T2DM (p < 0.001).ConclusionsThere is a greater need for cardiovascular risk reduction programs for females with T2DM at diagnosis. Given the low numbers for awareness, treatment and control of hypertension and hyperlipidemia in both males and females, significant resources focused on them must be expended, specifically improving regular assessment of blood pressure and blood lipids. Strengthening the management of chronic diseases through adherence to evidence-based guidelines to enhance clinical treatment may reduce 10-year ICVD in patients with T2DM in China.

Associations between dietary patterns and 10-year cardiovascular disease risk score levels among Chinese coal miners\u2014\u2014a cross-sectional study

BackgroundDiet-related cardiovascular diseases have produced a large health burden in China. Coal miners are a high-risk population for cardiovascular disease, but there is little evidence concerning associations between coal miners’ dietary patterns and their 10-year cardiovascular disease risk score levels.MethodsThe study included 2632 participants and focused on dietary patterns associated with higher 10-year cardiovascular disease risk score levels. A valid semi-quantitative food frequency questionnaire was used to collect data regarding dietary intake, and dietary patterns were identified using factor analysis combined with cluster analysis. Logistic regression was used to assess associations between dietary patterns and 10-year cardiovascular disease risk score levels.ResultsFor ground workers, compared with the ‘Healthy’ pattern, the ‘High-salt’ and ‘Refined grains’ patterns were significantly associated with higher 10-year atherosclerotic cardiovascular disease risk score level (OR: 1.50, 95% CI: 1.02–2.21; OR: 1.92, 95% CI: 1.26–2.93) and 10-year ischemic cardiovascular disease risk score level (OR: 2.18, 95% CI: 1.25–3.80; OR: 2.64, 95% CI: 1.48–4.72) adjusted for gender, and behavioural and socioeconomic factors. The ‘High-fat and salt’ pattern was significantly associated with higher 10-year ischemic cardiovascular disease risk score level (OR: 1.97, 95% CI: 1.13–3.42). For underground workers, the ‘High-salt’ pattern was significantly associated with higher 10-year atherosclerotic cardiovascular disease risk score level (OR: 1.65, 95% CI: 1.16–2.36) and 10-year ischemic cardiovascular disease risk score level (OR: 1.76, 95% CI: 1.09–2.84).ConclusionsThis study provides evidence for dietary patterns associated with higher 10-year cardiovascular disease risk score levels in Chinese miners, and facilitates relevant departments in designing effective dietary guidelines to ameliorate dietary structures.

Comparison on the 10 years risk for ischemic cardiovascular disease among Han, Uygur, Kazak population from Xinjiang Uygur Autonomous Region

Objective: To compare the 10 years risk for ischemic cardiovascular disease among Han, Uygur, Kazak nationality residents of Xinjiang Uygur Autonomous Region. Methods: From October 2007 to October 2010,14 618 adult (aged ≥35 years) Han (n=5 757),Uygur (n=4 767) and Kazak (n=4 094) residents were selected to join this study through the four-stage stratified cluster sampling method from 7 cities and regions of Xinjiang Uygur Autonomous Region. The 10 years risk for ischemic cardiovascular disease was calculated according to the 10 years ischemic cardiovascular disease risk assessment form modified with Chinese characteristics and compared among the residents of 3 nationalities. Results: (1) There were significant differences in age, body mass index, systolic blood pressure, diastolic blood pressure,fasting blood glucose,triglycerides,total cholesterol,low-density lipoprotein,high-density lipoprotein cholesterol, smoking history, and drinking history among Han, Uygur, Kazak nationality population (all P< 0.001). (2) There were significant differences in 10 years risk for ischemic cardiovascular disease between different gender and age group including 35-39, 40-44, 45-49, 50-54, 55-59, and ≥60 years old between Han, Uygur, Kazak nationality population (all P<0.001). (3) There were significant differences in rates of 10%-20% and>20% of 10 years risk for ischemic cardiovascular disease between different gender in Han, Uygur, Kazak nationality population (P values were 0.013 and <0.001, respectively). There were no significant differences in rates of <5% and 5%-9% of 10 years risk for ischemic cardiovascular disease between different gender in Han,Uygur,Kazak nationality population (all P>0.05).(4) There were significant differences in detection rates of diabetes,hypertension,smoking,hypertriglyceridemia,and obesity in male and female Han,Uygur,Kazak nationality population with 10 years risk for ischemic cardiovascular disease ≥10% (P<0.01 or 0.05). Meanwhile,there was significant difference in detection rates of hypercholesteremia in male Han, Uygur, Kazak nationality adults(P<0.001). There were no significant differences in detection rates of elevated low density lipoprotein cholesterol and reduced high density lipoprotein cholesterol in male and female Han,Uygur,Kazak nationality adults (all P>0.05). Conclusion: There are gender and age differences in the 10 years risk for ischemic cardiovascular disease in ≥35 years old Han,Uygur,Kazak nationality adults from Xinjiang Uygur Autonomous Region.

Evaluation of 10-year risk for ischemic cardiovascular disease in type 2 diabetes aged 35 years old and above in two cities of Jiangsu Province

Objective: To evaluate the risk of 10-year risk of ischemic cardiovascular disease (ICVD) in patients with type 2 diabetes aged 35 years old and above in two cities of Jiangsu province. Methods: From December 2013 to January 2014, a total of 15 624 patients with type 2 diabetes aged 35 years old and above, who received national basic public health service in Changshu county of Suzhou city, Huai'an and Qinghe districts of Huai'an city, Jiangsu province, were recruited by cluster sampling method. Face-to-face questionnaire survey, anthropometric and laboratory measurements were conducted to collect exposures to ICVD risk factors. Improved Ten Year Risk Assessment Table of ICVD in Chinese was used to assess the risk score and the absolute risk of developing ICVD. Results: The participants were (62.2±9.7) years old, of which 6 137 were men (39.3%). Among the participants, the highest rate of exposure to ICVD risk factors was high systolic blood pressure (74.8%, n=11 685), followed by high total cholesterol (70.7%, n= 11 051).The score of 10-year risk for ICVD was (10.4±3.3) and the median (P(25)-P(75)) value of absolute risk was 15.6% (6.8%-32.7%). 16.7% (n=2 602) participants were under extremely high risk of 10-year risk for ICVD, 23.8% (n=3 714) under high-risk and 24.0% (n=3 746) under middle-risk. Among the total risk score of ICVD, age (49.1%), hypertension (17.7%) and diabetes (15.5%) accounted for relatively high proportion, however, smoking (11.0%) was the most important risk factor except for age (47.4%) and systolic blood pressure (20.5%) in male participants. Conclusion: Patients with type 2 diabetes aged 35 years old and above in two cities of Jiangsu Province have a high risk of developing ICVD for 10 years, especially in elderly, female, hypertension patients and male smokers.

Association of Time-Dependent Diastolic Blood Pressure Trajectory and Risk for the Ischemic Type of Cardiovascular Disease in Hypertensive Patients

Background: The effect of lowering diastolic blood pressure (DBP) on the risk for ischemic cardiovascular disease (CVD) is usually only assessed with a single timepoint at baseline. This has led to a lack of explanation for the U- or J-shaped association between DBP and the risk for ischemic CVD among hypertensive patients. Methods: We studied a cohort of 7074 hypertensive patients (42.9% men) aged 35-79 years (mean age=56.5 years) at baseline in 1980-1989, with annually repeated blood pressure measurements. Time-dependent DBP trajectories were assessed by group-based trajectory analysis, adjusted by sex, age, and antihypertensive medication use. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of ischemic CVD, composed of ischemic stroke and myocardial infarction, according to DBP trajectories were estimated by competing risk analysis. For references, we examined the same approaches mentioned above were used for systolic blood pressure. Findings: For 24.1 years, there were 799 incident cases of ischemic CVD. Eight DBP trajectories were identified. We found a U-shaped association between DBP trajectories and a risk for ischemic CVD. The HRs (95%CI) of ischemic CVD with reference to a moderately-stable trajectory were 2.0 (1.8-2.2) for a very-low-stable, 1.4 (1.3-1.6) for low-decreasing, 1.6 (1.3-1.5) for low-stable, 1.4 (1.3-1.5) for moderately-decreasing, 1.5 (1.4-1.7) for high-decreasing, 1.2 (1.1-1.4) for high-stable, and 1.4 (1.2-1.62) for very-high-stable. This U-shaped association was more pronounced in antihypertensive medication users than in non-users. No such association was observed for SBP trajectories. Interpretation: We found a U-shaped association between DBP trajectory and ischemic CVD in hypertensive patients in a time-dependent analysis, which cannot be detected by single timepoint analysis. Changes in DBP among hypertensive patients should be carefully documented for preventing ischemic CVD. Funding Statement: Ministry of Health, Labor and Welfare of Japan. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the ethics committees of Osaka University and Osaka Center for Cancer and Cardiovascular Disease Prevention, and was performed in accordance with the Declaration of Helsinki.

A4377 Prevalence of hypertension and risk assessment of cardiovascular disease in 22 community 35∼59 aged hypertensive patients in Shenzhen Futian District

Objectives: To understand the risk factors of ischemic cardiovascular disease (CVD) in hypertensive patients in Shenzhen, Futian District, and the evaluate risk of ischemic cardiovascular diseases (ICVD) in the next decade among the community hypertensive patients. Methods: A total of 5195 hypertensive patients aged 35 to 59 were surveyed by multi-stage stratified cluster sampling in Futian District, Shenzhen City. Epidemiological surveyed on prevalence of hypertension and risk factors of cardiovascular diseases. And the use of “National 10-year Risk Assessment for ICVD” to predict the risk of ICVD in the hypertensive patients. Results: (1)5195 subjects aged 35 to 59 were included in the survey from July in 2013 to February in 2014. The blood pressure controled in 2172 cases (41.8%). And 2115 cases had covered more than two risk factors (40.7%). The ICVD risk distribution of the hypertensive patients in 10 years was: extremely low-risk (5%) accounted for 81.2%, low-risk (5%∼9.9%) accounted for 16.7%, the middle risk group (10%∼19.9%) accounted for 1.6%, high-risk (20%∼39.9%) accounted for 0.5%. There were significant differences in the incidence of ICVD in different age groups (P < 0.001), besides the elder the patients are, the higher risk on ICVD (P < 0.001). The higher the grade of hypertension, the higher risk in ICVD (P < 0.001). No matter males or females, the risk level of ICVD was high than the reference indicator of ICVD risk in different age groups (P < 0.001). Conclusion: The hypertension control rate in community in Shenzhen was poor, the levels of cardiovascular disease of risk factors was high and the risk level of ICVD was higher in the group aged 35 to 59.

Association of systolic blood pressure with cardiovascular outcomes in elderly patients with hypertension in Northern China.

The aim of this study was to investigate the association of systolic blood pressure (SBP) with cardiovascular disease and all-cause mortality among elderly hypertensive patients in northern China. In this prospective cohort study, 9655 elderly hypertensive patients from Kailuan study were followed up with the incidence of primary outcomes (composite outcomes including myocardial infarction, stroke, and all-cause death) and the incidence of secondary outcomes (stroke, myocardial infarction, and all-cause death). Patients were categorized into five groups on the basis of SBP levels: Q1 (SBP<130 mmHg), Q2 (130≤SBP<140 mmHg), Q3 (140≤SBP<150 mmHg), Q4 (150≤SBP<160 mmHg), and Q5 (SBP≥160 mmHg). During an average of 7.2±1.6 years of follow-up, patients in the group Q2 had the lowest incidence rates of composite outcomes. Q1 was not associated with a decreased risk of composite outcomes. Interestingly, compared with reference group Q2, the risk of composite outcomes [hazard ratio (HR): 1.36; 95% confidence interval (CI): 1.06-1.75] was significantly increased in the Q3 subgroup with high risk+very high risk for the incidence of ischemic cardiovascular disease (ICVD). Similarly, the risk of composite outcomes (HR: 1.25; 95% CI: 1.01-1.53 and HR: 1.35; 95% CI: 1.04-1.75) was significantly increased in Q4 subgroups, with both intermediate risk and high risk+very high risk for 10-year ICVD. Elderly hypertensive patients with a high risk of 10-year ICVD were still at a higher risk of developing adverse outcomes even with 140≤SBP<150 mmHg. SBP of less than 130 mmHg was not associated significantly with a reduced risk of developing adverse outcomes.

Monocyte gene expression in childhood obesity is associated with obesity and complexity of atherosclerosis in adults

Childhood obesity coincides with increased numbers of circulating classical CD14++CD16- and intermediate CD14++CD16+ monocytes. Monocytes are key players in the development and exacerbation of atherosclerosis, which prompts the question as to whether the monocytosis in childhood obesity contributes to atherogenesis over the years. Here, we dissected the monocyte gene expression profile in childhood obesity using an Illumina microarray platform on sorted monocytes of 35 obese children and 16 lean controls. Obese children displayed a distinctive monocyte gene expression profile compared to lean controls. Upon validation with quantitative PCR, we studied the association of the top 5 differentially regulated monocyte genes in childhood obesity with obesity and complexity of coronary atherosclerosis (SYNTAX score) in a cohort of 351 adults at risk for ischemic cardiovascular disease. The downregulation of monocyte IMPDH2 and TMEM134 in childhood obesity was also observed in obese adults. Moreover, downregulation of monocyte TMEM134 was associated with a higher SYNTAX atherosclerosis score in adults. In conclusion, childhood obesity entails monocyte gene expression alterations associated with obesity and enhanced complexity of coronary atherosclerosis in adults.

Comparing Inhaled Corticosteroids and Long-Acting Beta Agonists Combination To Inhaled Corticosteroids on Risk of Ischemic Cardiovascular Diseases in Patients with Asthma

Comparing Inhaled Corticosteroids and Long-Acting Beta Agonists Combination To Inhaled Corticosteroids on Risk of Ischemic Cardiovascular Diseases in Patients with Asthma