Cardiovascular Disease In Later Life Research Articles

Cardiometabolic Risks in Gestational Diabetes Mellitus: A Mini-Review

Diabetes is one of the most common medical problems encountered in about 3.8% - 41% of pregnancies across the various parts of India. It contributes to maternal morbidity and mortality, especially in developing countries. Insulin resistance and β – cell dysfunction are the characteristics of GDM. Women with GDM had many immediate adverse fetomaternal and neonatal outcomes. In addition to the immediate adverse outcomes, women with GDM also had long-term complications such as dyslipidemia, metabolic syndrome, hypertension, type 2 diabetes, cardiovascular disease in later life. Current evidence suggests that GDM is highly associated with cardiometabolic risks (CMR) during gestation and in post-gestational period. Though the mechanism behind the pathogenesis of CMR in GDM is multifactorial, placental hormones, inflammation, endothelial dysfunction and oxidative stress play a significant role in the pathophysiology of cardiovascular risks in pregnant women with GDM.

Chronic developmental hypoxia alters mitochondrial oxidative capacity and reactive oxygen species production in the fetal rat heart in a sex-dependent manner.

Insufficient oxygen supply (hypoxia) during fetal development leads to cardiac remodeling and a predisposition to cardiovascular disease in later life. Previous work has shown hypoxia causes oxidative stress in the fetal heart and alters the activity and expression of mitochondrial proteins in a sex‐dependent manner. However, the functional effects of these modifications on mitochondrial respiration remain unknown. Furthermore, while maternal antioxidant treatments are emerging as a promising new strategy to protect the hypoxic fetus, whether these treatments convey similar protection to cardiac mitochondria in the male or female fetus has not been investigated. Therefore, using an established rat model, we measured the sex‐dependent effects of gestational hypoxia and maternal melatonin treatment on fetal cardiac mitochondrial respiration, reactive oxygen species (ROS) production, and lipid peroxidation. Pregnant Wistar rats were subjected to normoxia or hypoxia (13% oxygen) during gestational days (GDs) 6–20 (term ~22 days) with or without melatonin treatment (5 µg/ml in maternal drinking water). On GD 20, mitochondrial aerobic respiration and H2O2 production were measured in fetal heart tissue, together with lipid peroxidation and citrate synthase (CS) activity. Gestational hypoxia reduced maternal body weight gain (p < .01) and increased placental weight (p < .05) but had no effect on fetal weight or litter size. Cardiac mitochondria from male but not female fetuses of hypoxic pregnancy had reduced respiratory capacity at Complex II (CII) (p < .05), and an increase in H2O2 production/O2 consumption (p < .05) without any changes in lipid peroxidation. CS activity was also unchanged in both sexes. Despite maternal melatonin treatment increasing maternal and fetal plasma melatonin concentration (p < .001), melatonin treatment had no effect on any of the mitochondrial parameters investigated. To conclude, we show that gestational hypoxia leads to ROS generation from the mitochondrial electron transport chain and affects fetal cardiac mitochondrial respiration in a sex‐dependent manner. We also show that maternal melatonin treatment had no effect on these relationships, which has implications for the development of future therapies for hypoxic pregnancies.

Early life exposure to the Chinese Famine of 1959-1961 is an independent risk factor of adulthood elevated homocysteine, hyperuricemia, high LDL, and hypertension.

Famine exposure in early life was associated with cardiovascular diseases in later life. Whether biochemical surrogates of cardiovascular diseases, such as homocysteine and uric acid, are also associated with famine exposure is unknown so far. Data were derived from a population-based cross-sectional study in the Hunan Province of China, which was heavily affected by the Famine in 1959-1961. A total of 1,150 adults born between 1952and1964 were selected, and 5 cohorts were defined: no exposure, fetal, early childhood, mid-childhood, and late childhood exposure. Compared with the no-famine exposure group, participants exposed to famine in their fetal period had a higher risk of high homocysteine in adulthood with OR of 2.21 (95% CI: 1.01-4.83), whereas famine exposures in early, mid, or late childhood were not significantly associated with high homocysteine in adulthood. Similarly, participants in the fetal famine exposure group had a 1.59-fold higher risk of hyperuricemia (OR = 2.59, 95% CI: 1.07-5.30) and a 2.03-fold higher risk of high low-density lipoprotein cholesterol (LDL) (OR = 0.03, 95% CI: 1.35-6.78) in adulthood compared to those without famine exposure, respectively. We furthermore conducted a meta-analysis including 16 studies regarding the association between fetal famine exposure and adulthood hypertension, including our study. The meta-analysis, including 34,804, subjects showed that fetal famine exposure is associated with a higher risk of adulthood hypertension (OR=1.22, 95% CI: 1.07-1.40). Taken together, fetal famine exposure is related to higher odds of cardio-metabolic risk factors, such as high homocysteine, hyperuricemia, and LDL as well as hypertension, suggesting that undernutrition during fetal life may affect metabolism of homocysteine, uric acid, and LDL in adulthood.

FAMINE EXPOSURE IN EARLY-LIFE AND HIGH CARDIOVASCULAR RISK IN ADULTHOOD: FINDINGS FROM THE CHINA PATIENT-CENTERED EVALUATIVE ASSESSMENT OF CARDIAC EVENTS MILLION PERSONS PROJECT

Objective: Previous studies reported that early-life exposure to undernutrition play key roles in the development of metabolic diseases, but the association with high cardiovascular disease (CVD) risk in later life remains unclear. We aimed to investigate whether exposure to famine in early life is associated with high cardiovascular disease (CVD) risk in adulthood. Design and method: This study included 85,473 participants from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project in southern China who were born around the time of the Chinese Great Famine. They were divided into four famine exposure groups according to the birth year, including nonexposed (1963–1974), fetal exposed (1959–1962), childhood exposed (1949–1958), and adolescent exposed (1941–1948). High CVD risk was defined as having previous heart disease or a predicted 10-year risk of CVD greater than 20% based on the WHO/ISH criteria. Logistic regression models were used to examine the association between famine exposure and high CVD risk. Results: Among the participants included, 4.6% (3893) participants had high risk for CVD, including 2543 (3.0%) participants had a predicted 10-year risk of CVD greater than 20%. Compared with the nonexposed group, childhood-exposed and adolescent exposed but not fetal-exposed participants had increased risk of having high CVD risk in adulthood, with odd ratios (ORs) (95% CIs) of 1.40 (1.15–1.70), 1.43 (1.07–1.90) and 1.14 (0.97–1.33), respectively, after adjusting for age and other covariates. For individuals without previous heart disease, fetal, childhood, and adolescent famine exposure were associated with higher likelihood of predicted 10-year risk of CVD greater than 20%, with multivariable-adjusted ORs (95%CI) of 1.34 (1.08–1.66), 2.17 (1.69–2.78), and 2.84 (1.98–4.07). Sensitivity analysis showed similar results by combining the relatively older and younger age group as the reference, which neutralized the age gap between the nonexposed group and the exposed groups in the main analysis. Conclusions: Early-life exposure to famine is significantly associated with higher risk of developing CVD in later life. These findings have important epidemiological and clinical implications on the understanding and prevention of CVD.

ASSOCIATIONS OF LONG-TERM VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY WITH SUBCLINICAL RENAL DAMAGE AND ALBUMINURIA IN ADULTHOOD: A 30-YEAR PROSPECTIVE COHORT STUDY

Objective: To determine the potential associations of long-term BPV from childhood to middle age with subclinical renal damage (SRD) and albuminuria in adulthood, independently of mean BP and cumulative exposure to BP. Design and method: Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and young adults aged 6 to 18 years at baseline, we assessed BP variability by standard deviation (SD) and average real variability (ARV) for 30 years (6 visits). Results: During a follow-up of 30 years, of the 1115 participants, 146 SRD events occurred. After adjustment for demographic, clinical characteristics and mean BP during 30 years, higher SDSBP, ARVSBP, SDDBP, ARVDBP, SDMAP and ARVMAP were significantly associated with higher risk of SRD [ORs (95% CIs) were 1.06(1.03–1.10), 1.12(1.06–1.19), 1.17(1.11–1.23), 1.22(1.13–1.32), 1.13(1.08,1.19) and 1.21(1.12–1.31), respectively]. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria [ORs (95% CIs) were 1.06(1.12–1.10) for SDSBP, 1.12(1.06–1.19) for ARVSBP, 1.14(1.08–1.21) for SDDBP, 1.19(1.10–1.30) for ARVDBP, 1.13(1.07–1.19) for SDMAP, and 1.20(1.11–1.32) for ARVMAP] adjusting for demographic, clinical characteristics, mean BP or cumulative exposure to BP during 30 years. Conclusions: Long-term BP variability for 30 years from childhood to middle age was associated with higher risk of subclinical renal damage and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up. Identifying long-term BP variability from early age may assist in predicting renal disease and cardiovascular disease in later life.

Advanced Maternal Age and Its Association With Cardiovascular Disease in Later Life.

Fertility among women at advanced maternal age (AMA) is increasing at a rapid rate in the United States. Although much is known about the impact of older maternal age on the risk for proximate adverse pregnancy outcomes, it is unclear whether older maternal age affects subsequent health. The objective of this study was to evaluate whether AMA is associated with cardiovascular disease (CVD) later in life, adjusting for important social and health factors related to maternal age. Data were obtained from the Nurses' Health Study II, a longitudinal prospective cohort study. We investigated whether women with an AMA first or subsequent birth were at higher risk for developing CVD (myocardial infarction or stroke) after age 42 than women without births at AMA. Cox proportional hazard models were estimated to evaluate this association, adjusting for demographic, fertility, and health characteristics. A total of 5,471 women (7.7%) in the sample had a first birth at an AMA and 1,282 (1.8%) developed CVD at age 42 or older. Women with first births at AMA had a 26% lower unadjusted hazard of CVD than women not at an AMA during their first birth (hazard ratio, 0.74; 95% confidence interval, 0.57-0.95). This association was attenuated (hazard ratio, 0.80; 95% confidence interval, 0.62-1.05) and no longer significant after adjustment for covariates; the modest association remained significant for women with any AMA birth. We found no evidence that AMA births were associated with increased risk for developing CVD later in life in this sample.

Protein Restriction in the Peri-Pubertal Period Induces Autonomic Dysfunction and Cardiac and Vascular Structural Changes in Adult Rats.

Perturbations to nutrition during critical periods are associated with changes in embryonic, fetal or postnatal developmental patterns that may render the offspring more likely to develop cardiovascular disease in later life. The aim of this study was to evaluate whether autonomic nervous system imbalance underpins in the long-term hypertension induced by dietary protein restriction during peri-pubertal period. Male Wistar rats were assigned to groups fed with a low protein (4% protein, LP) or control diet (20.5% protein; NP) during peri-puberty, from post-natal day (PN) 30 until PN60, and then all were returned to a normal protein diet until evaluation of cardiovascular and autonomic function at PN120. LP rats showed long-term increased mean arterial pressure (p = 0.002) and sympathetic arousal; increased power of the low frequency (LF) band of the arterial pressure spectral (p = 0.080) compared with NP animals. The depressor response to the ganglion blocker hexamethonium was increased in LP compared with control animals (p = 0.006). Pulse interval variability showed an increase in the LF band and LF/HF ratio (p = 0.062 and p = 0.048) in LP animals. The cardiac response to atenolol and/or methylatropine and the baroreflex sensitivity were similar between groups. LP animals showed ventricular hypertrophy (p = 0.044) and increased interstitial fibrosis (p = 0.028) compared with controls. Reduced protein carbonyls (PC) (p = 0.030) and catalase activity (p = 0.001) were observed in hearts from LP animals compared with control. In the brainstem, the levels of PC (p = 0.002) and the activity of superoxide dismutase and catalase (p = 0.044 and p = 0.012) were reduced in LP animals, while the levels of GSH and total glutathione were higher (p = 0.039 and p = 0.038) compared with NP animals. Protein restriction during peri-pubertal period leads to hypertension later in life accompanied by sustained sympathetic arousal, which may be associated with a disorganization of brain and cardiac redox state and structural cardiac alteration.

Adolescent Afghan Refugees Display a High Prevalence of Hyperhomocysteinemia and Associated Micronutrients Deficiencies Indicating an Enhanced Risk of Cardiovascular Disease in Later Life.

A growing body of research evidence suggests that elevated homocysteine level (hyperhomocysteinemia) is an independent risk factor for cardiovascular diseases. The current study aimed to investigate the prevalence and associated risk factors for hyperhomocysteinemia among adolescent Afghan refugees aged 10–19 years. In total, 206 healthy adolescent boys and girls were randomly recruited from a refugee village in Peshawar, Pakistan, in 2020. Socio-demographic data, anthropometric assessment, and blood sample collection were performed following standard methods. Serum homocysteine was assessed using a chemiluminescent microparticle immunoassay, with hyperhomocysteinemia defined as levels ≥ 15 µmol/L. The overall prevalence of hyperhomocysteinemia was 25%, with mean homocysteine levels significantly (p = 0.004) higher among boys (14.1 µmol/L) than girls (11.8 µmol/L). Multivariate logistic regression analysis revealed a significant association between hyperhomocysteineimia and serum levels of vitamin B12 (OR 0.29; 95% CI of 0.14 to 0.62; p < 0.01) and folate (OR 0.1; 95% CI of 0.03 to 0.27; p < 0.001). Overall, our study findings indicate high prevalence of hyperhomocysteinemia among adolescent Afghan refugees who are potentially at high risk of developing cardiovascular diseases in future. There is a dire need to develop and implement nutritional and public health strategies to control hyperhomocysteinemia, protect against related diseases and complications in future, and ensure healthy lives and well-being among these vulnerable populations.

Associations Between Fitness, Physical Activity, and Fatness in Preschool Children With Typical and Atypical Motor Coordination.

PurposeIncreased adiposity in children confers a higher risk of cardiovascular disease in later life, with low cardiorespiratory fitness strongly linked to poorer metabolic health. Children with motor coordination problems are likely to be less physically fit and at a higher risk of obesity. In this study, we examined the associations between aerobic and anaerobic fitness, device-measured physical activity, and body adiposity in children (aged 4–5 years) with typical and atypical motor coordination.MethodsBaseline data from the Coordination and Activity Tracking in CHildren (CATCH) cohort study were utilised. The assessments included aerobic and anaerobic fitness via time-to-exhaustion on Bruce treadmill test and normalised mean power on Wingate cycling test, respectively; light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and sedentary time via accelerometry; and body adiposity (%) via bioelectrical impedance analysis (BIA). The Movement Assessment Battery for Children-Second Edition (MABC-2) was used to assess motor coordination and classify children as typically developing (TD, >16th percentile) or at risk of developmental coordination disorder (DCD, ≤16th percentile). General linear regression models were fitted to examine associations.ResultsThe analyses included 495 participants (5.0 ± 0.6 years, 56% male, and body adiposity 22.7 ± 4.2%). Aerobic fitness (β = −0.006, p < 0.001) and MVPA (β = −0.018, p = 0.045) were negatively associated with body adiposity when adjusted for age, sex, and MABC-2 score. There was no relationship between sedentary time and body adiposity. There were no interactions of sex or MABC-2 score with any variable.ConclusionLower aerobic fitness and MVPA were associated with higher body adiposity in preschoolers, regardless of motor coordination. Interventions targetting improved aerobic fitness and MVPA are therefore warranted in both TD and atypically developing preschoolers. Whether maintaining high aerobic fitness in children with possible DCD confers protection against obesity requires longitudinal investigation.

Associations of Long-Term Visit-to-Visit Blood Pressure Variability With Subclinical Kidney Damage and Albuminuria in Adulthood: a 30-Year Prospective Cohort Study.

Background:Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be associated with risk of cardiovascular disease. We, therefore, aimed to determine the potential associations of long-term BPV from childhood to middle age with subclinical kidney damage (SKD) and albuminuria in adulthood.Methods:Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, which recruited children and adolescents aged 6 to 18 years at baseline, we assessed BPV by SD and average real variability (ARV) for 30 years (6 visits). Presence of SKD was defined as estimated glomerular filtration rate between 30 and 60 mL/min per 1.73 m2 or elevated urinary albumin-to creatinine ratio at least 30 mg/g. Albuminuria was defined as urinary albumin-to creatinine ratio ≥30 mg/g.Results:During 30 years of follow-up, of the 1771 participants, 204 SKD events occurred. After adjustment for demographic, clinical characteristics, and mean BP during 30 years, higher SDSBP , ARVSBP , SDDBP , ARVDBP , SDMAP , ARVMAP , and ARVPP were significantly associated with higher risk of SKD. When we used cumulative exposure to BP from childhood to adulthood instead of mean BP as adjustment factors, results were similar. In addition, greater long-term BPV was also associated with the risk of albuminuria. Long-term BPV from childhood to middle age was associated with higher risk of SKD and albuminuria in adulthood, independent of mean BP or cumulative exposure to BP during follow-up.Conclusions:Identifying long-term BPV from early age may assist in predicting kidney disease and cardiovascular disease in later life.

Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women.

Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman's reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.

Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

IntroductionNew-onset hypertension affects approximately 10% of pregnancies and is associated with a significant increase in risk of cardiovascular disease in later life, with blood pressure measured 6 weeks postpartum predictive...

Gestational hyperglycemia and the risk of cardiovascular diseases among elderly Chinese women: Findings from the REACTION study.

Gestational hyperglycemia increases the risk of diabetes in later life. However, the risk of future cardiovascular diseases (CVD) related to gestational hyperglycemia remains inconclusive. The purpose of this study was to investigate the impact of gestational hyperglycemia on the subsequent risk of CVD and its modifying factors among elderly Chinese women. We conducted a case-control study of elderly women from the baseline survey of Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Women with gestational hyperglycemia (n=82), and controls matched by age and study site (n=410) were included. Information on CVD, including reported coronary heart disease, stroke, or myocardial infarction, was collected through an interviewer-assisted questionnaire. Women with gestational hyperglycemia were more likely to develop diabetes (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.18) and CVD (OR, 1.98; 95% CI, 1.05-3.74). Even without progressing to type 2 diabetes, gestational hyperglycemia was associated with an increased risk of CVD (OR, 2.88; 95% CI, 1.18-7.00). However, subgroup analysis indicated that compared with those without gestational hyperglycemia or hypertension, women with both gestational hyperglycemia and hypertension had higher risk of CVD (OR, 3.98; 95% CI, 1.65-9.58), whereas the risk estimate did not significantly change in women with gestational hyperglycemia alone (OR, 2.15; 95% CI, 0.71-6.57). Stratified analysis indicated that among those with overweight/obesity, inactive physical activity, or unhealthy dietary habits, gestational hyperglycemia increased the risk of CVD. In elderly Chinese women, gestational hyperglycemia was associated with an increased risk of CVD in later life. This association was independent of the progression to diabetes and might be modified by lifestyle factors and hypertension.

Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment.

Preterm birth coincides with a key developmental window of cardiac growth and maturation, and thus has the potential to influence long-term cardiac function. Individuals born preterm have structural cardiac remodelling and altered cardiac growth and function by early adulthood. The evidence linking preterm birth and cardiovascular disease in later life is mounting. Advances in the perinatal care of preterm infants, such as glucocorticoid therapy, have improved survival rates, but at what cost? This review highlights the short-term and long-term impact of preterm birth on the structure and function of the heart and focuses on the impact of antenatal and postnatal glucocorticoid treatment on the immature preterm heart.

Association Between the Reproductive Health of Young Women and Cardiovascular Disease in Later Life: Umbrella Review

(BMJ. 2020;371:1–21) One third of annual global deaths (17.9 million) can be attributed to cardiovascular disease (CVD). Risk factors for women include some outcomes related to pregnancy and fertility, however, these are often underrecognized. Hypertensive disorders of pregnancy, gestational diabetes mellitus, placental abruption, and low birth weight, and preterm births occur in up to one third of parous women in developed countries. Risk of CVD is also associated with early age at menarche/early menopause and use of hormonal contraceptive agents. This study aimed to conduct an umbrella review of systematic reviews to evaluate associations between female-specific risk factors (eg, adverse pregnancy outcomes and issues related to fertility) and CVD outcomes.

Cardiovascular Diseases of Developmental Origins: Preventive Aspects of Gut Microbiota-Targeted Therapy

Cardiovascular diseases (CVDs) can originate from early life. Accumulating evidence suggests that gut microbiota in early life is linked to CVDs in later life. Gut microbiota-targeted therapy has gained significant importance in recent decades for its health-promoting role in the prevention (rather than just treatment) of CVDs. Thus far, available gut microbiota-based treatment modalities used as reprogramming interventions include probiotics, prebiotics, and postbiotics. The purpose of this review is, first, to highlight current studies that link dysbiotic gut microbiota to the developmental origins of CVD. This is followed by a summary of the connections between the gut microbiota and CVD behind cardiovascular programming, such as short chain fatty acids (SCFAs) and their receptors, trimethylamine-N-oxide (TMAO), uremic toxins, and aryl hydrocarbon receptor (AhR), and the renin-angiotensin system (RAS). This review also presents an overview of how gut microbiota-targeted reprogramming interventions can prevent the developmental origins of CVD from animal studies. Overall, this review reveals that recent advances in gut microbiota-targeted therapy might provide the answers to reduce the global burden of CVDs. Still, additional studies will be needed to put research findings into practice.

Abstract MP70: Short-term Fine Particulate Air Pollution Is Associated With Shorter Sleep Duration And Higher Sleep Variability In Adolescents

Introduction: Sleep deprivation and large sleep variability are potential risk factors for obesity and cardiovascular diseases. While it is plausible that particulate air pollution may contribute to these unfavorable sleep patterns, very few studies have been conducted to assess the association between fine particulate (PM 2.5 ) air pollution and objectively measured sleep duration and its variability in an adolescent U.S. population. Hypothesis: We tested the hypothesis that higher individual-level short-term PM 2.5 exposure is associated with shorter sleep duration and higher sleep variability among adolescents. Methods: We analyzed the available data collected from 421 adolescents who participated in the follow-up examination of the population-based Penn State Child Cohort (PSCC) study. To estimate individual-level short-term PM 2.5 exposure, a personal nephelometer (Thermo pDR-1200) was used to measure real-time PM 2.5 concentration for 24 hours from the study participants. The 24-hour mean PM 2.5 concentration was used to quantify the short-term PM 2.5 exposure. To obtain objectively-measured habitual sleep duration (HSD) and habitual sleep variability (HSV), an actigraphy (GT3X+) was used to collect sleep data for 7 consecutive nights, including 1 night in parallel with the PM 2.5 monitoring and 6 nights thereafter. HSD and HSV were calculated as the intra-individual mean and standard deviation (SD) of the 7-night sleep duration, respectively. Participants with &lt; 5 nights (70% of 7 nights) of data were excluded from the analyses. The associations between the individual-level PM 2.5 exposure and HSD/HSV were evaluated by using multi-variable adjusted linear regression models, controlling for age, race, sex, BMI percentile, environmental temperature, and relative humidity. Results: The mean (SD) age of the study population was 16.9 (2.2) years. The study sample consisted of 54% males and 78% whites. The 24-hour mean (SD) of PM 2.5 concentration was 16.9 (26.8) μg/m 3 , while the average HSD and HSV were 7.0 (0.9) hours and 1.2 (0.6) hours, respectively. We observed that a 10 μg/m 3 increase in the 24-hour mean PM 2.5 was associated with significantly lower HSD [β (SE): -0.06 (0.03) hours, p=0.02] and larger HSV [β (SE): 0.04 (0.02) hours, p=0.04]. The effect sizes were approximately 7% of their respective SDs. Conclusion: Individual-level short-term PM 2.5 exposure is associated with objective-measured shorter sleep duration and higher night-to-night sleep variability among U.S. adolescents. These observed associations suggest that particulate air pollution exposure in early life may impact habitual sleep pattern, which may in turn be associated with the risks of obesity and cardiovascular diseases in later life.

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.

Decreased Flow-Mediated Dilatation in Children With Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Type 1 diabetes (T1DM) is a strong risk factor for the development of cardiovascular disease. Flow-mediated dilatation (FMD) is an early noninvasive marker of endothelial function and it predicts future cardiovascular disease. However, the changes in FMD among T1DM children are still controversial. The present meta-analysis aimed to investigate whether FMD is impaired in children with T1DM. PubMed, EMBASE, Cochrane library, and Web of Science were searched for studies comparing FMD in children with T1DM and healthy controls. The Newcastle-Ottawa quality assessment scale for case-control studies was used to assess study quality. Data were pooled using a random effects models to obtain the weighted mean differences (WMD) in FMD and 95% CIs. Overall, 19 studies with 1245 patients and 872 healthy controls were included in this meta-analysis. Children with T1DM had significantly lower FMDs compared with healthy controls (WMD: -2.58; 95% CI: -3.36 to -1.81; P < .001). Meta-regression analysis revealed that low-density lipoprotein cholesterol levels impacted the observed difference in FMD between T1DM and healthy children. This meta-analysis showed that T1DM children have impaired endothelial function, which indicates they are at higher risk of developing cardiovascular disease in later life.

Cardiac and vascular health in late preterm infants.

Adults who were born preterm are at increased risk of hypertension and cardiovascular disease in later life. Infants born late preterm are the majority of preterm births; however, the effect of late preterm on risk of cardiovascular disease is unclear. The objective of this study was to assess whether vascular health and cardiac autonomic control differ in a group of late preterm newborn infants compared to a group of term-born infants.A total of 35 healthy late preterm newborn infants, with normal growth (34-36 completed weeks' gestation) and 139 term-born infants (37-42 weeks' gestation) were compared in this study. Aortic wall thickening, assessed as aortic intima-media thickness (IMT) by high-resolution ultrasound, and cardiac autonomic control, assessed by heart rate variability, were measured during the first week of life. Postnatal age of full-term and late preterm infants at the time of the study was 5 days (standard deviation [SD] 5) and 4 days (SD 3), respectively.Infants born late preterm show reduced aortic IMT (574μm [SD 51] vs. 612μm [SD 73]) and reduced heart rate variability [log total power 622.3 (606.5)ms2 vs. 1180. 6 (1114.3)ms2], compared to term infants. These associations remained even after adjustment for sex and birth weight.Infants born late preterm show selective differences in markers of cardiovascular risk, with potentially beneficial differences in aortic wall thickness in contrast to potentially detrimental differences in autonomic control, when compared with term-born control infants. These findings provide pathophysiologic evidence to support an increased risk of hypertension and sudden cardiac death in individuals born late preterm.