Lifetime Risk Of Cardiovascular Disease Research Articles

Understanding the spectrum of cardiovascular risk in women - A primer for prevention.

Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.

The burden of cardiovascular disease and related risk factors, in Greece; the ATTICA epidemiological study (2002-2022)

AimThe aim of this study was to present the burden of cardiovascular disease (CVD) and its related risk factors based on a 20-year observation period (2002-2022). MethodsIn 2002, 3,042 Greek adults (aged: 45 (12) years) free of CVD, cancer, or any other chronic infections were enrolled. In 2022, the 20-year follow-up was performed on 2,169 participants (1,988 had complete data for CVD). Lifetime risk for CVDs and Disability-Adjusted-Life-Years (DALYs) lost were also calculated. ResultsThe 20-year CVD incidence was 3,600 cases/10,000 individuals (man-to-woman ratio 5:4). At the index age of 40 years, the lifetime risk for developing CVD was 68% for men and 63% for women; as the participants were getting older, the lifetime risk declined by approximately 19% and 13% for men and women, respectively, but remained at high levels, reaching 55% for both sexes. Participants between 45-55 years exhibited the highest CVD burden concerning aggregated DALYs. The burden was greater in men than in women, at ages below 35 years; beyond this age threshold, this trend shifted, and women exhibited a higher CVD burden. ConclusionThe burden of CVD in Greece has shown increasing trends over the past 20 years as a result of the accumulative growth of the prevalence of modifiable CVD risk factors. The disability-adjusted life-years lost are the most observed ever before, urging for efficient public health strategies and measures.

“They are saying it’s high, but I think it’s quite low”: exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients – a qualitative study

BackgroundNHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators.MethodsQualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis.ResultsAnalysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding.ConclusionsEffective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes.Trial registrationISRCTN10443908. Registered 7th February 2017.

Incorporating Cardiovascular Risk Assessment into Adolescent Reproductive Health and Primary Care Visits

Study ObjectiveThis study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits. MethodsWe recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in two adolescent clinics in Atlanta, GA. Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants’ perceived risk, blood pressure, and body mass index were measured at baseline and three months after enrollment. Healthcare providers (HCP, n=5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice. ResultsAdolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (IQR 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants’ median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants’ median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits. ConclusionHerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics.

The potential interaction between chemosensitivity and the development of cardiovascular disease in obstructive sleep apnea

ObjectivesChemosensitivity is an essential part of the pathophysiological mechanisms of obstructive sleep apnea (OSA). Not only does OSA have a certain relationship with the comorbidity of cardiovascular disease (CVD) but also chemosensitivity plays a crucial role in the development of CVD. This study aims to investigate the potential interaction between chemosensitivity and the development of CVD in OSA. MethodsA total of 169 participants with suspected OSA were included. Data were gathered on the parameters of polysomnography and baseline clinical features. Peripheral chemosensitivity was evaluated by employing the rebreathing test. The lifetime CVD risk was computed using the China-PAR (Prediction for atherosclerotic CVD Risk in China) risk equation. ResultsAfter controlling for covariates, participants with chemosensitivity levels in the second and fifth quantiles tended to hold an increased proportion of high lifetime CVD risk (OR 10.90, 95%CI [2.81–42.28]; OR 6.78, 95%CI [1.70–27.05], respectively). The diagnosis of OSA would significantly increase the 10-year and lifetime CVD risks in participants with low chemosensitivity, while no such differences were found in participants with high chemosensitivity. ConclusionHigher lifetime CVD risk was associated with participants who had greater peripheral chemosensitivity. In terms of the CVD outcomes, adult patients with a relatively low level of chemosensitivity may be primarily related to their diagnosis of OSA, whereas adult patients with a relatively high level of chemosensitivity may be more strongly associated with their elevated levels of chemosensitivity rather than OSA.

Monitoring of selected anthropometric and biochemical parameters in men and women in Bardejov District.

Metabolic and cardiovascular diseases represent a significant and ever-increasing problem, accounting for nearly one-third of all deaths and leading to significant morbidity. Lifestyle changes, which introduce new risk factors for cardiovascular disease, are leading to an increase in the risk of cardiovascular disease worldwide. The burden of cardiovascular disease can be reduced by careful risk reduction, and as such, primary prevention is an important priority for all. There is strong consensus among international guidelines regarding the necessity of smoking cessation, weight optimization, and the importance of exercise, while guidelines differ slightly in their approach to hypertension and vary greatly in their approach to the optimal lipid profile, which remains a controversial issue. The work is focused on the analysis of biochemical (glucose, cholesterol and triacylglycerols) and anthropometric (body mass index) parameters in selected probands (n = 140), including men (n = 70) and women (n = 70) in the Bardejov district. Probands were divided into groups depending on age (18-38, 39-50, 51-60, and over 61 years). For statistical evaluation, the program Statistica ver. 12 and ANOVA were used. The results of the study showed statistically significantly higher values of BMI, total cholesterol (TC), triacylglycerides (TG), and glucose (GLU) (p < 0.001) between men and women in the age groups (18-38 years, 39-50 years). In probands from the age group 51-60 years and over 61 years, we found a high level of cholesterol above the reference limit, but a significant difference between men and women was not confirmed. Correlation analysis confirmed the positive correlation between glucose and BMI. Differences in risk-factor (e.g., biochemical and anthropometrics) burden translate into marked differences in the lifetime risk of cardiovascular disease. These differences are consistent across age groups.

Sex specific lifetime risk of incident cardiovascular events. Results from a large British population-based cohort study

Abstract Background There are marked sex differences in cardiovascular (CV) disease, most characteristically with men having a higher risk of coronary heart disease and myocardial infarction (MI). The sex differences in the absolute lifetime risk of CV disease as well as the different profiles of first incident CV events remain poorly described. Purpose Using data from a large British population-based cohort study with long follow-up, we aimed to compare the sex differences in the lifetime risk of incident CV events (MI, stroke, atrial fibrillation (AF), heart failure (HF), peripheral artery disease (PAD) and CV mortality). Methods Eligible participants at the study baseline (1993-1998) were included and followed up until March 2018. Cause-specific hazard ratios were ascertained using Weibull regressions. The sex-specific lifetime risks of each outcome were ascertained using Weibull regressions accounting for the competing risk of death. All models were adjusted for time-updated covariates: ethnicity, Townsend index of deprivation, systolic blood pressure, hypercholesterolaemia, diabetes, smoking, alcohol intake, physical activity, body mass index, fruit/vegetable intake, non-cardiovascular conditions and medication. Results 8975 men and 11,330 women aged ≥40 and free of CV disease at baseline were included. The median follow-up was 22.3 years. Compared to women, men were more likely to be older, have higher systolic blood pressure, higher BMI and be less physically active. Men were less likely to have prevalent non-cardiovascular comorbidities. The adjusted cumulative incidence of a CV event ranged between 13.8%-28.2% for men and 7.5%-21.2% for women (Figure 1). The lifetime risk of CV mortality was 28.7% for men and 22.9% for women. Compared to women, the relative risk of incident CV events for men was two-fold higher for MI (cause specific hazard ratio (95% confidence interval) – 2.05 (1.83-2.30)) and PAD (2.02 (1.83-2.23)), 50% higher for HF (1.52 (1.39-1.66)) and AF (1.51 (1.40-1.62)), 42% for cardiovascular mortality (1.42 (1.32-1.53)) and 12% for stroke (1.12 (1.03-1.22)). There were also sex differences in the lifetime incidence of different types of first CV event (Figure 2). Amongst men, MI had the highest incidence as a first CV event throughout lifetime. The earliest incidence rise in MI occurred by 50 years and was followed by AF, PAD, stroke and heart failure over the following decades. In women, the incidence of MI as a first CV event was highest between 50-60 years but was overtaken by AF by 65 years and stroke by 70 years. Conclusions Men had a higher risk of incident cardiovascular disease throughout their lifetime than women, but these sex differences were most pronounced for MI and PAD, followed by AF, HF and CV mortality. These were also reflected in the different sex profiles characterising the type of first incident CV event. These differences highlight the importance of tailoring sex-specific primary preventative strategies.Figure 1Figure 2

Educational Attainment and Lifetime Risk of Cardiovascular Disease

Education is a social determinant of health. Quantifying its association with lifetime cardiovascular disease (CVD) risk has public health importance. To calculate lifetime risk estimates of incident CVD and CVD subtypes and estimate years lived with and without CVD by education. Included community-based cohort studies with adjudicated cardiovascular events used pooled individual-level data from 1985 to 2015 of 6 prospective cohort studies. The study team assessed the association between education and lifetime CVD risk with modified Kaplan-Meier and Cox models accounting for competing risk of noncardiovascular death. The study team estimated years lived with and without CVD by education with the Irwin restricted mean and the utility of adding educational attainment to CVD risk assessment. Participants (baseline 40 to 59 years old and 60 to 79 years old) were without CVD at baseline and had complete education, cardiovascular risk factors, and prospective CVD outcomes data. Data were analyzed from January 2022 to September 2022. Educational attainment (less than high school, high school completion, some college, or college graduate). Cardiovascular events (fatal and nonfatal coronary heart disease, heart failure, and stroke; CVD-related deaths; and total CVD encompassing any of these events). There were 40 998 participants (23 305 female [56.2%]) with a mean (SD) age of 58.1 (9.7) years for males and 58.3 (9.9) years for females. Compared with college graduates, those with less than high school or high school completion had higher lifetime CVD risks. Among middle-aged men, the competing hazard ratios (HRs) for a CVD event were 1.58 (95% CI, 1.38-1.80), 1.30 (95% CI, 1.10-1.46), and 1.16 (95% CI, 1.00-1.34) in those with less than high school, high school, and some college, respectively, compared with those with college completion. Among women, these competing HRs were 1.70 (95% CI, 1.49-1.95), 1.19 (95% CI, 1.05-1.35), and 0.98 (95% CI, 0.83-1.15). Individuals with higher education had longer duration of life prior to incident CVD. Education provided limited contribution toward enhancing CVD risk prediction. Lower education was associated with lifetime CVD risk across adulthood; higher education translated to healthy longevity. Educational policy initiatives may associate with long-term health benefits.

Impact of a high dietary fiber cereal meal intervention on body weight, adipose distribution, and cardiovascular risk among individuals with type 2 diabetes.

This study sought to examine the impacts of a high dietary fiber cereal meal in comparison to conventional dietary management for diabetes on body weight, distribution of adipose tissue, and cardiovascular risk among individuals diagnosed with type 2 diabetes (T2DM). A cohort of 120 patients diagnosed with T2DM was enlisted as the study population and divided into two groups using a ratio of 2:1-namely, the W group (n=80) and the U group (n=40). The U group (control) received usual diet, while the W group (intervention) incorporated a high dietary fiber cereal meal in place of their regular staple food in addition to adhering to conventional diabetes dietary recommendations. The high dietary fiber cereal meal was based on whole grains, traditional Chinese medicinal foods, and prebiotics. A subsequent follow-up period of 3 months ensued, during which diverse parameters such as body mass index (BMI),waist-hip ratio (WHR), glycated hemoglobin (HbA1c),fasting blood glucose(FBG),C-peptide levels, blood pressure, blood lipids, high-sensitivity C-reactive protein (hsCRP),10-year cardiovascular disease (CVD) risk, and Lifetime CVD risk were assessed before and after the intervention. Among the participants, a total of 107 successfully completed the intervention and follow-up, including 72 individuals from the W group and 35 from the U group. Following the intervention, both cohorts exhibited decrease in BMI, WHR, HbA1c, FBG, blood pressure, and blood lipid levels in contrast to their initial measurements. Remarkably, the improvements in BMI, WHR, HbA1c, FBG, total cholesterol (TC), triglycerides(TG), low-density lipoprotein cholesterol (LDL-C), the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C), and the ratio of 2-hour C-peptide (2hCP) to fasting C-peptide (FCP) were more marked within the W group, exhibiting statistically significant disparities (P<0.05) in comparison to the U group. Furthermore, the levels of hsCRP declined among individuals in the W group, while the U group experienced an elevation.10-year CVD risk reduction were similar in the two groups. While, Lifetime CVD risk only decreased significantly in the W group. The intervention centred on a cereal-based dietary approach showcased favourable outcomes with regard to body weight, adipose distribution, and cardiovascular risk in overweight individuals grappling with T2DM.

Prediction of lifetime risk for cardiovascular disease, by risk factors level: the ATTICA epidemiological cohort study (2002–2022)

PurposeWe aimed to predict lifetime risk for cardiovascular disease (CVD). MethodsThe sample consisted of 1988 participants with complete CVD data during the 20-year follow-up (50% men, 45 ± 14 years) of the ATTICA study. Lifetime risk for CVD was predicted at specific index ages (40, 50, and 60 years), based on the life-table method, with death free-of-CVD treated as a competing event. Results718 participants experienced a fatal or nonfatal CVD event, corresponding to a crude CVD incidence of 36.1% (men: 40.2%, women: 32.1%, P-value < .001). Overall, women and men had similar lifetime CVD risk (P-value = .245); at index age of 40, the lifetime risk for CVD was 68% for men and 63% for women, with a progressive decline to 56% and 50% at the index age of 50, and to 55% for both men and women, at the index age of 60 years, respectively. ConclusionsThese results on lifetime risk for CVD can guide the allocation of resources to improve public health and preventive services, especially in ages below 50 years, in both men and women.

The Effects of Subjective Wellbeing and Self-Rated Health on Lifetime Risk of Cardiovascular Conditions in Women.

Subjective wellbeing may predict future health conditions, and lower self-rated physical health (SRH) is associated with the presence of chronic conditions, such as cardiovascular disease (CVD). This study examines whether subjective wellbeing and SRH predict long-term CVD conditions for women using the Midlife in the United States study. The study cohort includes 1716 women participants who completed waves 1 (1995-1996), 2 (2004-2006), and 3 (2013-2014). Data on demographics, chronic conditions of diabetes and CVD, subjective wellbeing (life satisfaction, positive affect, and negative affect), and SRH were collected repeatedly at each wave. Multiple logistic regressions were conducted to test whether subjective wellbeing was associated with a lifetime CVD risk. Greater life satisfaction was significantly associated with a lower risk of CVD at 10 years (odds ratio (OR): 0.83; 95% confidence interval (CI): 0.74-0.95) and 19 years (OR: 0.83; 95% CI: 0.74-0.93), while positive and negative affects were not significantly associated. Additionally, better physical SRH significantly lowered odds of having cardiovascular conditions at both 10 years (OR: 0.79; 95% CI 0.68-0.92) and 19 years (OR 0.74; 95% CI: 0.64-0.86). Measures of life satisfaction and SRH can be used as additional CVD screening tools.

Staying up late increases cardiovascular disease risk in women with polycystic ovary syndrome.

What is the association between late bedtime, night sleep duration, and lifetime cardiovascular disease (CVD) risk in women with polycystic ovary syndrome (PCOS)? Both late bedtime (≥1:00) and short sleep duration (<7 h/night) were independently associated with a high-lifetime CVD risk among women with PCOS. Previous studies indicated that sleep disturbances, including altered sleep duration and staying up late (SUL), occurred more frequently among women with PCOS compared to women without PCOS. Studies have shown that both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term. However, there are limited data regarding the possible association between sleep disturbances and CVD risk among reproductive-aged women with PCOS. From the original 393 women identified at our center, a total of 213 women with PCOS aged 18-40 years were enrolled in a cross-sectional study between March 2020 and July 2022. Bedtime and night sleep duration were obtained from a standardized self-administered questionnaire. The prediction for atherosclerotic CVD risk in the China risk model was applied to estimate the lifetime CVD risk in the PCOS population. Restricted cubic spline regression was applied to explore the non-linear association between sleep duration and lifetime CVD risk in a series of models. Multivariable logistic regression analyses were performed to determine the association between bedtime, night sleep duration, and lifetime CVD risk. In our study, we found that the proportion of SUL was 94.25% and the mean (±SD) of night sleep duration was 7.5 ± 1.1 h in women with PCOS. Restricted cubic spline regression analysis showed a U-shaped relation between sleep duration and lifetime CVD risk. After adjusting for occasional drinking, fasting insulin, triglyceride, low-density lipoprotein cholesterol, and testosterone in multivariable logistic analyses, compared with going to bed at 23-24 o'clock, those who went to bed after 1 o'clock were independently associated with high-lifetime CVD risk [odds ratio (OR) = 3.87, 95% CI: 1.56-9.62]; compared with optimal sleep duration (7-8 h/night), short sleep (<7 h/night) was also independently associated with high-lifetime CVD risk (OR = 2.46, 95% CI: 1.01-5.97). Inferring causality is limited owing to the cross-sectional design. All sleep variables data were obtained from a standardized self-administered questionnaire rather than measurements using objective approaches. Even after adjusting for potential confounders, we still cannot completely rule out the possibility of residual confounding from unmeasured factors such as socioeconomic status. Future studies with larger sample sizes are needed to further explore the relation between long sleep duration and lifetime CVD risk. Although these findings are not generalizable to non-SUL PCOS populations, they could be used for guiding multidimensional treatment. Lastly, there is no non-PCOS group in the current cross-sectional study, which limits the interpretation of the findings from the PCOS group. This is the first study to report that both late bedtime (≥1:00) and short sleep duration (<7 h/night) were independently associated with a high-lifetime CVD risk among reproductive-aged women with PCOS, in a sample of Chinese adults. Predicting cardiovascular risk and examining the association between sleep disturbances and predicted CVD risk among women with PCOS help to highlight the need for early interventions on sleep to improve their cardiovascular outcomes. This study was funded by the Natural Science Foundation of Fujian Province (No. 2020J011242), the Fujian provincial health technology project (No. 2022CXB016), the Joint Research Projects of Health and Education Commission of Fujian Province (No. 2019-WJ-39), and the Medical and Health project of Xiamen Science & Technology Bureau (No. 3502Z20214ZD1001). The authors declare that they have no conflict of interest. N/A.

Reduced Sleep Efficiency Mediates the Association of Adverse Childhood Experience Exposure with Impaired Vascular Endothelial Function in Young Adults

Introduction: Adverse childhood experiences (ACEs) are severe psychosocial stressors during the first 18 years of life that promote substantial increases in lifetime risk of cardiovascular disease. ACEs are highly prevalent and associated with impaired vascular endothelial function (VEF) and poor sleep, established cardiovascular risk factors. The purpose of this study was to investigate the role of sleep efficiency (SE%) in the association of ACEs with impaired VEF in young adults. We hypothesized that SE% would mediate the association of ACEs with impaired VEF. μethods: In 22 young adults (75% Female; age = 26 ± 7 y), we assessed ACE exposure and anxiety and depressive symptoms using the Zung Self-Rating Anxiety and Center for Epidemiologic Studies Depression scales, respectively. We assessed SE% as the reported total sleep duration relative to the time-in-bed from the Pittsburgh Sleep Quality Index. We also measured VEF using the flow mediated dilation technique normalized to the shear rate area under the curve. Using zero-order correlations we examined relations among ACE exposure, anxiety and depression symptoms, SE%, VEF, and age. We then utilized multiple-linear regression to examine the effect of ACE exposure and SE% on VEF while accounting for anxiety and depression symptoms. Finally, to better understand the role of SE% in the association of ACE exposure with VEF, we conducted mediation analysis with SE% as the mediator using the bootstrapped bias-corrected percentile confidence interval method. Results: ACEs were highly prevalent (64% with ≥1 ACE; 32% with ≥3 ACEs) and variable (range = 0 – 8 ACEs) in our sample. ACE exposure was associated with anxiety (r=0.48, p=0.018) and depression symptoms (r=0.48, p=0.024), SE% (r=-0.46, p=0.03), and VEF (r=-0.63, p=0.002), but was not associated with age (p=0.96). SE% was associated with VEF (r=0.59, p=0.004), but not correlated with age, anxiety, or depressive symptoms (all p≥0.14). Multiple linear regression analyses indicated that ACE exposure (β=-0.54, p&lt;0.01) and SE% (β=0.45, p=0.02) predicted VEF independently of anxiety and depression symptoms. Further, SE% mediated the association of ACE exposure with VEF (indirect path β-estimate = -0.08 [95% CI = -0.21 – -0.009). Conclusions: ACE exposure is negatively associated with endothelial function, while SE% is positively associated with endothelial function independently of anxiety or depression symptoms among young adults. Notably, SE% appears to be a mediator in the relation between ACE exposure and endothelial function. Larger studies will be needed to more precisely quantify the role of disturbed sleep in the association of ACE exposure with impaired VEF and to determine whether improving sleep causes improvements in vascular health among those with high ACE exposure. This project was supported, in part, by funding from a pilot grant from the Iowa Injury Prevention Research Center through the CDC (R49 CE003095; NDMJ), an Old Gold Summer Fellowship (University of Iowa; NDMJ), the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002537 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm—SCORE2, SCORE-OP— is recommended in these guidelines, which estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40–89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50−69, ≥70 years).Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

External validation of the QLifetime cardiovascular risk prediction tool: population cohort study

BackgroundPrediction of lifetime cardiovascular disease (CVD) risk is recommended in many clinical guidelines, but lifetime risk models are rarely externally validated. The aim of this study was to externally validate the QRiskLifetime incident CVD risk prediction tool.MethodsIndependent external validation of QRiskLifetime using Clinical Practice Research Datalink data, examining discrimination and calibration in the whole population and stratified by age, and reclassification compared to QRISK3. Since lifetime CVD risk is unobservable, performance was evaluated at 10-years’ follow-up, and lifetime performance inferred in terms of performance for in the different age-groups from which lifetime predictions are derived.ResultsOne million, two hundreds sixty thousand and three hundreds twenty nine women and 1,223,265 men were included in the analysis. Discrimination was excellent in the whole population (Harrell’s-C = 0.844 in women, 0.808 in men), but moderate to poor stratified by age-group (Harrell’s C in people aged 30–44 0.714 for both men and women, in people aged 75–84 0.578 in women and 0.556 in men). Ten-year CVD risk was under-predicted in the whole population, and in all age-groups except women aged 45–64, with worse under-prediction in older age-groups. Compared to those at highest QRISK3 estimated 10-year risk, those with highest lifetime risk were younger (mean age: women 50.5 vs. 71.3 years; men 46.3 vs. 63.8 years) and had lower systolic blood pressure and prevalence of treated hypertension, but had more family history of premature CVD, and were more commonly minority ethnic. Over 10-years, the estimated number needed to treat (NNT) with a statin to prevent one CVD event in people with QRISK3 ≥ 10% was 34 in women and 37 in men, compared to 99 and 100 for those at highest lifetime risk.ConclusionsQRiskLifetime underpredicts 10-year CVD risk in nearly all age-groups, so is likely to also underpredict lifetime risk. Treatment based on lifetime risk has considerably lower medium-term benefit than treatment based on 10-year risk.

Stage 1 Hypertension and the 10-Year and Lifetime Risk of Cardiovascular Disease: A Prospective Real-World Study.

Background The 10-year and lifetime cardiovascular disease risk in the population with stage 1 hypertension and the effects of recovery from and progression of stage 1 hypertension remain undetermined. Methods and Results This prospective cohort study included 96 268 individuals with blood pressure measurements obtained in 2006 and again in 2010. The 10-year cardiovascular disease risk was estimated using the multivariable Cox proportional hazards model, and the lifetime risk was calculated using a modified survival analysis that accounted for the competing risk of death. Stage 1 hypertension was detected in 30.83% of the cohort. The 10-year cardiovascular disease risk was 2.80%, and the lifetime risk was 16.61%. Compared with the normal blood pressure group, the stage 1 hypertension group had a 35% higher 10-year risk (hazard ratio [HR], 1.35 [95% CI, 1.19-1.52]) and a 36% higher lifetime risk (HR, 1.36 [95% CI, 1.25-1.49]). By 2010, 12.57% of the participants with stage 1 hypertension had progressed to stage 2, with a significant 156% increase in 10-year risk (HR, 2.56 [95% CI, 2.11-3.11]) and an increased lifetime risk of 129% (HR, 2.29 [95% CI, 1.89-2.77]). There was no appreciable change in risk in those with stage 1 hypertension whose blood pressure returned to the normal-elevated range. Conclusions Stage 1 hypertension was associated with a significant increase in 10-year and lifetime cardiovascular disease risk. Progression to stage 2 hypertension was associated with a marked increase in lifetime risk. The current guidelines require revision to promote early detection and appropriate management of blood pressure.

Lifetime risk of cardiovascular disease stratified by traditional risk factors: Findings from the cohort of Tehran lipid and glucose study

BackgroundWe aimed to estimate the lifetime risk (LTR) of cardiovascular disease (CVD) in the Iranian population, stratified by sex and traditional risk factors including high body mass index (BMI), hypertension, diabetes, smoking, and hypercholesterolemia. MethodsWe included 10222 (4430 men) participants aged ≥20 years without CVD at baseline. LTRs at index ages 20 and 40 years and number of years lived without CVD was estimated. We further assessed the effect of traditional risk factors on the LTR of CVD and the number of years lived without CVD, stratified by sex and index ages. ResultsDuring a median follow-up of 18 years, 1326 participants (774 men) developed CVD and 430 (238 men) died from non-cardiovascular causes. At age 20, the remaining LTR for CVD was 66.7% (95% CI 62.9–70.4) in men and 52.0% (47.6–56.8) in women, with similar LTRs at age 40 for both men and women. The LTRs at both index ages for those with ≥3 risk factors were about 30% and 55% higher in men and women, respectively, than those without any of the five risk factors. At the age of 20, men with ≥3 risk factors lived 24.1 fewer years without CVD compared with men with no risk factors; the corresponding value was 8 years in their female counterparts. ConclusionsOur findings suggest that both sexes may benefit from effective prevention strategies early in the life course, despite the observed differences between men and women in LTR for CVD and number of years lived without CVD.

Abstract P136: Young Women Accept a Developmentally Appropriate Cardiovascular Risk Assessment Tool That Changes Their Perceived Risk of Heart Disease

Introduction: Cardiovascular disease (CVD) remains the leading cause of death for women in the US, yet many young women are unaware of their lifetime risk of CVD. We employed user-centered design principles to adapt a validated CVD risk prediction tool for young women. Hypothesis: We hypothesized that young women would rate the tool (HerHeart) as user-friendly, be likely to recommend it to their friends, experience a change in their perceived risk of CVD, and report intent to change their health habits after engaging with it. Methods: We recruited 13 young women ages 13-21 from two clinical practices in Atlanta, GA to engage with the HerHeart CVD risk prediction tool. Participants rated the tool’s usability via the Website Analysis and Measurement Inventory (WAMMI), which is scored from 0 to 100. Participants rated their perceived 10-year and lifetime risk of CVD on a visual analog scale from 0 (Never going to happen) to 10 (Definitely will happen) before and after completing the tool. Participants reported their likelihood of recommending the tool to their friends and changing their health habits from 0 (Not likely at all) to 10 (Extremely likely). Results: Participants rated the tool’s usability highly on the WAMMI (M = 78.62 +/- 9.70). Participants’ perceived 10-year risk of a heart attack increased from a mean of 0.85 +/- 0.99 to 1.83 +/- 1.90, and perceived lifetime risk increased from a mean of 2.38 +/- 2.72 to 2.75 +/- 2.63, on the 10-point scale after engaging with the tool. Participants were more than likely to recommend HerHeart to their friends (M = 8.00 +/- 2.22) and to report intent to change their health habits (M = 8.82 +/- 1.47) after completing the tool. Participant data captured in the HerHeart tool are shown in the Table. Conclusions: The HerHeart tool is acceptable to young women and demonstrates potential for changing their risk perception and improving their health habits to reduce their risk of CVD. Recruitment is ongoing and will include input from clinicians on the feasibility of incorporating the tool in clinical practice.

Abstract MP74: Trends in Cardiovascular Health Counseling Among Postpartum Individuals in the United States From 2016-2020: The Pregnancy Risk Assessment Monitoring System

Introduction: Poor pre-pregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are risk factors (RF) for lifetime risk of cardiovascular disease. Contemporary rates and trends of CVH counseling can inform strategies to optimize postpartum CVH. Methods: We used data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a national, population-based survey of postpartum individuals. The primary outcome was self-report of counseling received on “healthy eating, exercise, and losing weight gained during pregnancy,” at the 4-6 week postpartum visit. We calculated the age-standardized weighted percent of individuals reporting CVH counseling for each year, overall, and by RF strata: (1) any pre-pregnancy CVH factor (obesity, diabetes, or hypertension) and (2) any APO (gestational diabetes, hypertensive disorders of pregnancy, or preterm birth). We quantified annual average percent change (APC) from 2016-2020. Lastly, we pooled data from 2016-2020 and determined odds ratios (OR) of counseling comparing individuals with and without RFs, adjusted for age, education, postpartum insurance, and year of delivery. Results: Among 206,080 individuals (weighted N = 10,630,861), 89.8% (95% confidence interval 89.6-90.1%) attended a postpartum visit. In 2016, 57.6% (56.7%-58.5%) reported CVH counseling. From 2016-2020, counseling was similar or experienced small declines overall (APC -1.1%/year [-1.3, -0.8]), for any pre-pregnancy CVH factor (-0.2%/year [-1.1, 0.7]) and any APO (-1.5%/year [-2.2, -0.8]). Counseling was modestly higher among those with any pre-pregnancy CVH factor (OR 1.2 [1.2, 1.3]) or any APO (OR 1.1 [1.1, 1.2]) compared with individuals without RF (TABLE). Conclusions: Of the 9 of 10 individuals who attended a postpartum visit, only about half reported CVH counseling, even among those with poor pre-pregnancy CVH or APOs without improvement in the past 5 years. Multilevel efforts should prioritize the postpartum period as an opportunity for CVH promotion.

Use of family history of cardiovascular disease or chronic hypertension to better identify who needs postpartum cardiovascular risk screening

Individuals with pregnancies complicated by hypertensive disorders of pregnancy are at increased risk of cardiovascular disease. However, not all who have hypertensive disorders of pregnancy are at risk, and not all who have uncomplicated pregnancies are without risk. This study aimed to determine if use of first-degree family history of cardiovascular disease or chronic hypertension better identifies individuals who need postpartum cardiovascular risk screening. Participants were included if they had pregnancies complicated by hypertensive disorders of pregnancy or uncomplicated, term pregnancies. Individuals with a first-degree relative with chronic hypertension, myocardial infarction, or stroke were deemed to have a positive family history and were thus included. Four groups were considered: 302 individuals with hypertensive disorders of pregnancy who had a positive family history, 218 individuals with hypertensive disorders of pregnancy with no family history, 39 control individuals with a positive family history, and 63 control individuals with no family history. Among individuals with hypertensive disorders of pregnancy, those with a positive family history were more likely to be diagnosed with chronic hypertension, and to have elevated 30-year lipid, 30-year body mass index, and lifetime cardiovascular disease risk score (all P<.05). Among individuals with uncomplicated pregnancies, those with a positive family history were more likely to be diagnosed with chronic hypertension (P<.05) and meet criteria for metabolic syndrome (P<.05). First-degree family history of cardiovascular disease and/or chronic hypertension can be used to reliably identify individuals without pregnancy complications who should have postpartum cardiovascular risk screening, and may better determine which individuals who have a pregnancy complicated by hypertensive disorders of pregnancy would most benefit from postpartum cardiovascular risk screening.