Lower CVD Risk Research Articles

Association of spironolactone treatment and arterial stiffness and cardiovascular disease in hypertensive patients.

IntroductionThe aim of the current study was to evaluate the association of spironolactone and arterial stiffness and composite cardiovascular disease (CVD, including coronary heart disease, congestive heart failure and ischemic stroke) in hypertensive patients.Material and methodsBaseline data were collected and arterial stiffness was presented by carotid-femoral pulse wave velocity (cf-PWV) using applanation tonometry. Serum levels of fasting plasma glucose, total cholesterol, C-reactive protein and creatinine were measured using an automatic biochemistry analyzer. Plasma aldosterone concentration and plasma renin activity were determined by radioimmunoassay. The associations of spironolactone and arterial stiffness and composite CVD were evaluated.ResultsCompared to patients without spironolactone (n = 274), those with spironolactone (n = 170) were older and more likely to have diabetes and chronic heart failure. No differences in antihypertensive medications used were observed except for spironolactone. Mean number of antihypertensive medications used was significantly higher in the spironolactone group (2.6 ±0.8 vs. 2.2 ±0.6). Compared to patients without spironolactone, those with spironolactone had significantly lower cf-PWV (9.4 ±1.8 vs. 10.1 ±2.2 m/s). After adjustment for covariates, spironolactone was still associated with 10% lower risk of arterial stiffness, with a 95% confidence interval (CI) of 0.85–0.97. In patients without arterial stiffness, after adjustment for covariates, no significant association of spironolactone and composite CVD was observed. However, in patients with increased arterial stiffness, after adjustment for covariates, spironolactone was still independently associated with 11% lower risk of composite CVD (95% CI: 0.83–0.97).ConclusionsSpironolactone treatment is independently associated with lower cf-PWV and lower prevalence of composite CVD in patients with increased arterial stiffness.

22-LB: Baseline and Short-Term Change in Plasma Uric Acid on Fenofibrate Predict Cardiovascular Risk: A Post Hoc Analysis of FIELD

Background: Fenofibrate increases renal clearance of uric acid (UA). Relationships between baseline and short-term changes in plasma UA with fenofibrate and subsequent cardiovascular risk in patients with type 2 diabetes (T2D) are unknown. Method: Post hoc analyses of the FIELD trial explored the relationships between CVD events and 1) baseline UA level; and 2) short-term change in UA level over 6-week single-blind active fenofibrate run-in. Results: The FIELD trial showed 11% fewer cardiovascular events in patients with T2D assigned to fenofibrate compared to placebo over 5 years (HR = 0.89, 95% CI: 0.80-0.99, p = 0.035). Baseline UA (n=9622) ranged between 0.11 to 0.79 mmol/L (mean = 0.33, SD = 0.078). Each 0.1 mmol/L higher baseline UA increased CVD events by 21% (HR = 1.21 95% CI: 1.13-1.29, p < 0.001; Fig. 1A), and remained after adjusting for other classic risk factors (HR = 1.12, 95% CI: 1.04-1.21, p = 0.002). Fall in UA level with fenofibrate run-in also predicted lower CVD risk, adjusted for baseline UA and irrespective of trial treatment allocation (HR = 0.86, 95% CI: 0.76-0.97, p = 0.015; Fig. 1B). Discussion: Baseline and short-term fenofibrate-induced lowering of UA predict cardiovascular risk in patients with T2D, irrespective of long-term trial treatment allocation. The reduction in total CVD events with fenofibrate was not shown to be mediated through lowering of UA levels. Disclosure J.Y. Cao: None. B. Waldman: None. R.L. OConnell: None. D. Sullivan: None. V. Gebski: None. A.S. Januszewski: None. I. Marschner: None. R. Scott: None. M. Taskinen: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Akcea Therapeutics, Chiesi USA, Inc. Research Support; Self; Amgen Inc., Novo Nordisk A/S. Speaker’s Bureau; Self; Amgen Inc. R. Simes: None. N. McGill: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A.C. Keech: None.

Association of Trajectory of Cardiovascular Health Score and Incident Cardiovascular Disease

The American Heart Association 2020 Strategic Impact Goals target an improvement in overall cardiovascular health, as assessed by 7 health metrics (smoking, body weight, physical activity, diet, plasma glucose level, plasma cholesterol level, and blood pressure). To examine whether trajectories of overall cardiovascular health over time, as assessed by the cardiovascular health score (CHS) in 2006, 2008, and 2010, are associated with subsequent risk of CVD. The Kailuan study is a prospective, population-based study that began in 2006. The cohort included 74 701 Chinese adults free of myocardial infarction, stroke, and cancer in or before 2010. In the present study, CHS trajectories were developed from 2006 to 2010 to predict CVD risk from 2010 to 2015. Data analysis was performed from January 1, 2006, to December 31, 2015. The CHS trajectories during 2006-2010 were identified using latent mixture models. Incident CVD events (myocardial infarction and stroke) during 2010-2015 were confirmed by review of medical records. The CHS trajectories were determined using 7 cardiovascular health metrics scored as poor (0 points), intermediate (1 point), and ideal (2 points); total score ranges from 0 (worst) to 14 (best). Based on the baseline CHS and patterns over time, 5 trajectories were categorized (low-stable, moderate-increasing, moderate-decreasing, high-stable I, and high-stable II). Of the 74 701 adults included in the study (mean [SD] age at baseline, 49.6 [11.8] years), 58 216 (77.9%) were men and 16 485 (22.1%) were women. Five CHS trajectories were identified from 2006 to 2010: low-stable (n = 4393; range, 4.6-5.2), moderate-increasing (n = 4643; mean increase from 5.4 to 7.8), moderate-decreasing (n = 14 853; mean decrease from 7.4 to 6.3), high-stable I (n = 36 352; range, 8.8-9.0), and high-stable II (n = 14 461; range, 10.9-11.0). During 5 years of follow-up, 1852 incident CVD cases were identified. Relative to the low-stable trajectory, the high-stable II trajectory was associated with a lower subsequent risk of CVD (adjusted hazard ratio, 0.21; 95% CI, 0.16-0.26, after adjusting for age, sex, educational level, income, occupation, alcohol intake, and serum high-sensitivity C-reactive protein concentration at baseline). Cardiovascular health trajectories may be associated with subsequent CVD risk.

Prevalence of hypertension among office workers in a multi-national company in the Niger-Delta with the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines.

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines propose a new classification of blood pressure (BP).The objective was to compare the prevalence of hypertension among staff of a multinational oil/gas company in Niger-Delta, Nigeria using the 2017 ACC/AHA guidelines and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) guidelines.Cross-sectional analysis of 235 individuals who presented for their annual medical review between March 2017 and February 2018 was done. Demographic, medical and family history data were obtained with a questionnaire. Blood pressure was measured using the recommended procedure. Fasting blood samples were analysed for blood glucose and lipids. Ten-year cardiovascular risk was estimated with the 2008 modified Framingham risk score (FRS).The prevalence of hypertension using the JNC7 and the 2017 ACC/AHA guidelines was 25.9% and 53.9% respectively. With the former, family history of hypertension and increased BMI were independently significantly associated with hypertension. With the latter, male gender, family history of hypertension, BMI and physical inactivity were significant predictors of hypertension. 184 (78.3%) were categorised as low CVD risk, 38 (16.2%) intermediate risk and 13 (5.5%) high risk for CVD.The 2017 ACC/AHA guidelines doubled the prevalence of hypertension from 25.9% to 53.9%. Adoption of this guideline will necessitate careful consideration of the consequences of labeling individuals as hypertensive as well as an increment of the health care budget provided by companies for its staff to meet the increased burden of hypertension.

Association of serum uromodulin with mortality and cardiovascular disease in the elderly-the Cardiovascular Health Study.

Uromodulin (UMOD) is released by renal tubular cells into the serum (sUMOD) and urine. Lower urine UMOD has been linked to mortality and cardiovascular disease but much less is known about sUMOD. We evaluated the association of sUMOD with these outcomes in community-dwelling older adults. We measured sUMOD in a random subcohort of 933 participants enrolled in the Cardiovascular Health Study. The associations of sUMOD with all-cause mortality, incident heart failure (HF) and incident cardiovascular disease (CVD; myocardial infarction, stroke and mortality due to coronary disease or stroke) were evaluated using multivariable Cox regression, adjusting for study participants' demographics, estimated glomerular filtration rate (eGFR), albuminuria and CVD risk factors. Generalized additive models with splines were used to address the functional form of sUMOD with outcomes. Due to nonlinear associations of sUMOD with all outcomes, 2.5% of the values on either end of the sUMOD distribution were excluded from the analyses, limiting the range of sUMOD to 34.3-267.1 ng/mL. The mean age was 78 ± 5 years, 40% were male, sUMOD level was 127 ± 64 ng/mL, eGFR was 63 mL/min/1.73m2 and 42% had CKD defined as eGFR <60 mL/min/1.73m2. Patients in the lower sUMOD quartiles had lower eGFR and higher albuminuria (P < 0.01, respectively). During a median follow-up of 9.9 years, 805 patients died, 283 developed HF and 274 developed CVD. In multivariable analysis, higher sUMOD was significantly associated with a lower hazard for mortality {hazard ratio [HR] 0.89 [95% confidence interval (CI) 0.80-0.99] per 1 standard deviation (SD) higher sUMOD}, CVD [HR 0.80 (95% CI 0.67-0.96)] and the composite endpoint [HR 0.88 (95% CI 0.78-0.99)]; the association with HF was not statistically significant [HR 0.84 (95% CI 0.70-1.01)]. Higher sUMOD is independently associated with a lower risk for mortality and CVD in older adults.

Whole grain, bran and cereal fibre consumption and CVD: a systematic review.

Whole grain intake is associated with lower CVD risk in epidemiological studies. It is unclear to what extent cereal fibre, located primarily within the bran, is responsible. This review aimed to evaluate association between intake of whole grain, cereal fibre and bran and CVD risk. Academic databases were searched for human studies published before March 2018. Observational studies reporting whole grain and cereal fibre or bran intake in association with any CVD-related outcome were included. Studies were separated into those defining whole grain using a recognised definition (containing the bran, germ and endosperm in their natural proportions) (three studies, seven publications) and those using an alternative definition, such as including added bran as a whole grain source (eight additional studies, thirteen publications). Intake of whole grain, cereal fibre and bran were similarly associated with lower risk of CVD-related outcomes. Within the initial analysis, where studies used the recognised whole grain definition, results were less likely to show attenuation after adjustment for cereal fibre content. The fibre component of grain foods appears to play an important role in protective effects of whole grains. Adjusting for fibre content, associations remained, suggesting that additional components within the whole grain, and the bran component, may contribute to cardio-protective association. The limited studies and considerable discrepancy in defining and calculating whole grain intake limit conclusions. Future research should utilise a consistent definition and methodical approach of calculating whole grain intake to contribute to a greater body of consistent evidence surrounding whole grains.

A cross-sectional study on serum high-sensitivity C-reactive protein level and shift work among reproductive age women.

Background:Among the inflammatory factors, high-sensitivity C-reactive protein (hs-CRP) is one of the strongest predictors of cardiovascular disease. This study aimed to evaluate the relationship of serum hs-CRP level with shift work among reproductive age women.Methods:This cross-sectional study was conducted from September 2017 to May 2018 in three cities in Mazandaran Province, North of Iran. Through purposive sampling, 350 women (172 shift workers and 178 day workers) were recruited. The guideline recommended by the American Heart Association and the Centers for Disease Control and Prevention was used to interpret the result of hs-CRP measurement as the following: less than 1 µg/ml: low CVD risk; 1–3 µg/ml: moderate CVD risk; and more than 3 µg/ml: high CVD risk. The data were analyzed using the independent-sample t and the chi-square tests as well as the logistic regression analysis.Results:11.1% of participants had a serum hs-CRP level of more than 3 µg/ml. This rate among shift workers was significantly greater than day workers (15.6% vs. 7.0%; p=0.012). After adjusting the effects of potential confounders shift work significantly increased the odds of serum hs-CRP level of more than 3 µg/ml by 2.45 times (OR=2.45, 95% CI: 1.01–5.93, p=0.047).Conclusion:Shift work is a significant predictor of high serum hs-CRP level probably due to its association with sleep problems and occupational stress. Improving the knowledge of female shift workers about the importance of quality sleep can reduce their CVD risk and improve their health.

Higher circulating androgens and higher physical activity levels are associated with less central adiposity and lower risk of cardiovascular death in older men.

Low endogenous sex hormones and low physical activity (PA) levels have been associated with CVD risk. Whether these interact to influence CVD outcomes remains unclear. We assessed whether sex hormone concentrations and PA were additively associated with lower central adiposity and CVD risk. 3351 community-dwelling men, mean age 77years. Baseline testosterone (T), dihydrotestosterone (DHT) and oestradiol (E2) were assayed. Levels of PA were ascertained by questionnaire. Men were stratified using median splits into high hormone+high PA (H/H), high hormone+low PA (H/L); low hormone+high PA (L/H) and low hormone+low PA (L/L) groups. A total of 865 CVD events and 499 CVD deaths occurred during 10-year mean follow-up. Men with higher T, DHT or SHBG and higher PA had the lowest BMI, waist circumference and risk of metabolic syndrome. Men with higher T had the lowest risk of incident CVD events, irrespective of PA level. Men with higher T or DHT and higher PA had the lowest risk of dying from CVD (eg, hazard ratios for T/PA H/H 0.76 P=0.031; H/L 0.85 P=0.222; L/H 0.80 P=0.075; L/L 1.00). Higher circulating androgens and higher PA were associated with less central adiposity at baseline and fewer CVD deaths during follow-up. These findings are consistent with a potential additive effect of androgens and PA on cardiometabolic outcomes in older men.

High LDL-C, Non-HDL-C Levels Associated with Higher CVD Death Risk, Even in Those at Low CVD Risk.

According to this study.

Association of ideal cardiovascular health metrics with serum uric acid, inflammation and atherogenic index of plasma: A population-based survey

Background and aimsWe aimed to evaluate the link between inflammatory score [consisting of C-reactive protein (CRP) and white blood cells], serum uric acid (SUA) and atherogenic index of plasma (AIP) and the cardiovascular health (CVH) score. MethodsWe used the cross-sectional National Health and Nutrition Examination Survey database. Statistical analyses accounted for the survey design and sample weights. ResultsOverall, there were 23,004 participants (mean age = 47.2 years, 46.5% males). Participants with an ideal CVH level had the highest ratio of poverty to income (3.62%, p < 0.001), as well as lower levels of CRP, SUA and AIP (p < 0.001 for all comparisons). In adjusted linear regression, a significant negative association was observed between inflammatory score (β = −0.052, p < 0.001), SUA (β = −0.041, p < 0.001) and AIP (β = −0.039, p < 0.001) and CVH score, i.e. participants with a better (greater) CVH score had a lower inflammatory score. Results from adjusted logistic regression showed reduction in the likelihood of “high-risk atherosclerosis” (defined as AIP ≥0.21) [intermediate: odds ratio (OR) = 0.90, 95% confidence interval (CI):0.85–0.95, ideal: OR = 0.81, 95%CI: 0.74–0.88] and “high CVD risk” (defined as CRP ≥3 mg/l) [intermediate: OR = 0.86, 95%CI:0.73–0.98, ideal: OR = 0.82, 95%CI:0.69–0.95] across the categories of CVH. ConclusionsOur findings highlight that CVH metrics were associated with inflammatory score, SUA and AIP. Furthermore, participants with a better CVH score had a lower CVD risk. These results reinforce the importance of implementing healthy behaviours as proposed by the American Heart Association. If confirmed in clinical trials, this knowledge may have implications for CVD prevention and management.

HEALTHY ORGAN AGEING IS ASSOCIATED WITH LOW CVD RISK IN CHINESE ELDERLY

HEALTHY ORGAN AGEING IS ASSOCIATED WITH LOW CVD RISK IN CHINESE ELDERLY

URIC ACID AS A RISK FACTOR FOR CARDIOVASCULAR DISEASE. A PROSPECTIVE OBSERVATIONAL STUDY

Objective: Hyperuricaemia is associated with many traditional cardiovascular risk factors such as arterial hypertension, diabetes and dyslipidaemia. Our purpose was to investigate the relationship of Serum Uric Acid (SUA) levels with the ten – year risk of fatal cardiovascular disease. Design and method: We prospectively enrolled 568 hypertensive patients (mean age 63 ± 10 years) presented for evaluation in the hypertension clinic. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination, office and 24 h ambulatory blood pressure (BP) monitoring were obtained along with data regarding lifestyle habits (smoking, alcohol consumption and exercise). The ten – year risk of fatal cardiovascular disease was evaluated by using the SCORE chart for countries with low CVD risk based on the following risk factors: age, sex, smoking, systolic blood pressure, and total cholesterol. Results: Mean average 24 hours systolic blood pressure (SBP) was 132 ± 15 mmHg, mean 24 hours average diastolic blood pressure (DBP) was 77 ± 10 mmHg while mean total cholesterol was 198 ± 39 mg/dl. Spearman analysis showed that SUA levels were significantly and positively associated with the average 24 hours systolic blood pressure levels (rs = 0.092, p < 0.05 for SBP) but not with diastolic BP levels (rs = 0.06, p > 0.05). Furthermore the kruskal Wallis analysis revealed that SUA levels were significantly associated with 10year risk of fatal cardiovascular disease (p < 0.001). Specifically, patients with 10year risk < 1%, 1–5%, > 5%, had SUA levels 4,8 ± 0.1 mg/dl, 5,4 ± 0.5 mg/dl and 6,0 ± 0.1 mg/dl respectively (Z: −7,7 p < 0.001). Conclusions: Subjects with lower SUA levels presented lower BP levels as well as 10year risk of fatal cardiovascular disease and vice versa. SUA levels were significantly associated with systolic blood pressure levels and 10year risk of fatal cardiovascular disease.

Leisure-time Physical Activity Throughout Adulthood

PURPOSE: Limited evidence documents the benefits of leisure-time physical activity (LTPA) throughout adulthood on mortality risk. This study modelled LTPA patterns from adolescence into middle-age and their associations with all-cause, CVD, and cancer mortality. METHODS: In 1994-96, 315,059 adults (58% males) aged 50-71 yrs enrolled in the NIH-AARP Diet and Health study retrospectively described their participation in LTPA (hours/week) for approximate ages 15, 25, 35 yrs, and 50 yrs. LTPA patterns over these age-periods were modelled using semi-parametric group-based mixture models and 10 LTPA patterns throughout adulthood were identified. Participants were followed for mortality through 2011. Associations between life-course LTPA patterns and mortality were modelled using Cox proportional hazard models [(Hazard Ratios (HR) and 95% CI)] adjusting for age, sex, race, education, smoking, body mass index, and diet. The least active LTPA pattern (0 hrs/wk throughout all age-periods) was used as the referent group. RESULTS: Over 13.6 yrs of follow-up. a total of 71,377 deaths from all-causes, 22,219 deaths from CVD, and 16,388 deaths from cancer occurred. Compared to those who were consistently inactive throughout adulthood, participants who maintained LTPA participation over time were at lower risk for all-cause, CVD, and cancer mortality. For example, maintaining 7+ hrs/wk resulted in risk reduction of 29% for all-cause [HR: 0.71 (0.68, 0.73)], 24% for CVD [HR: 0.66 (0.62, 0.70)], and 10% for cancer mortality [HR: 0.90 (0.83, 0.97)]. Adults who were inactive at ages 15-35 (~1hr/week) but increased LTPA over time also had consistent reductions in risk for all-cause [HR: 0.65 (0.62, 0.68)], CVD [HR: 0.57 (0.53, 0.61)], and cancer mortality [HR: 0.84 (0.77, 0.92)]. In contrast, adults who reduced LTPA in adulthood had the lowest mortality benefits for all- cause and CVD mortality, and no benefits for cancer mortality. CONCLUSIONS: Participants who maintained or increased LTPA by their ~50’s had the lowest risk for mortality, independent of previous LTPA. LTPA during midlife (i.e., ~50yrs) rather than LTPA early in adulthood (i.e., 15’s through 35’s) seems to be most important for both all- and cause-specific mortality.

NHS health checks: a cross- sectional observational study on equity of uptake and outcomes

BackgroundThe National Health Checks programme aims to reduce the incidence of cardiovascular diseases and health inequalities in England. We assessed equity of uptake and outcomes from NHS Health Checks in general practices in Bristol, UK.MethodsA cross-sectional study using patient-level data, from 38 general practices. We descriptively analysed the socioeconomic status (SES) of patients invited and the SES and ethnicity of those attending. Logistic regression was used to test associations between invitation and attendance, with population characteristics.ResultsBetween June 2010 to October 2014, 31,881 patients were invited, and 13,733 NHS Health Checks completed. 47% of patients invited from the three least and 39% from the two most-deprived index of multiple deprivation quintiles, completed a Check. Proportions of invited patients, by ethnicity were 64% non-black and Asian and 31% black and Asian. Men were less likely to attend than women (OR 0.73, 95% confidence interval 0.67 to 0.80), as were patients ≤ 49 compared to ≥ 70 years (OR 0.40, 95% confidence interval 0.65 to 0.83).After controlling for SES and population characteristics, compared to patients with low CVD risk, high risk patients were more likely to be prescribed cardiovascular drugs (OR 6.2, 95% confidence interval 4.51 to 8.40). Compared to men, women (OR 01.18, 95% confidence interval 1.03 to 1.35) were more likely to be prescribed cardiovascular drugs, as were those ≤ 49 years (50–59 years, OR 1.42, 95% confidence intervals 1.13–1.79, 60–69 years, OR 1.60, 95% confidence intervals, 1.22–2.10, ≥ 70 years, OR 1.64, 95% confidence intervals, 1.14 to 2.35).Controlling for population characteristics, the following groups were most likely to be referred to lifestyle services: younger women (OR 2.22, 95% CI 1.69 to 2.94), those in the most deprived IMD quintile (OR 3.22, 95% CI 1.63 to 6.36) and those at highest risk of CVD (OR, 2.77, 95% CI 1.91 to 4.02).ConclusionsWe found no statistically significant evidence of inequity in attendance for an NHS Health Check by SES. Being older or a woman were associated with better attendance. Targeting men, younger patients and ethnic minority groups may improve equity in uptake for NHS Health Checks.

The acute effects on duodenal gene expression in healthy men following consumption of a low-fat meal enriched with theobromine or fat

Increasing apoA-I synthesis may improve HDL functionality and lower CVD risk. As theobromine and fat increase fasting apoA-I concentrations, and the intestine is involved in apoA-I production, the acute effects of both were studied on duodenal gene transcription to better understand underlying mechanisms. In this crossover study, 8 healthy men received once a low fat (LF) meal, a LF meal plus theobromine (850 mg), or a high fat (HF) meal. Five hours after meal intake duodenal biopsies were taken for microarray analysis. Theobromine and HF consumption did not change duodenal apoA-I expression. Theobromine did not change gene expression related to lipid and cholesterol metabolism, whereas those related to glycogen/glucose breakdown were downregulated. HF consumption increased gene expression related to lipid and cholesterol uptake and transport, and to glucose storage, while it decreased those related to glucose uptake. Furthermore, genes related to inflammation were upregulated, but inflammation markers in plasma were not changed. In healthy men, acute theobromine and fat consumption did not change duodenal apoA-I mRNA, but inhibited expression of genes related to glucose metabolism. Furthermore, HF intake activated in the duodenum expression of genes related to lipid and cholesterol metabolism and to inflammation.

Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49).

BackgroundDiabetes and obesity seem to be partly overlapping risk factors for the development of obesity-related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population.MethodsThis study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group.ResultsWomen with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95%CI: 1.63–1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95%CI 1.11–1.64 and SIR: 2.21; 95%CI 1.94–2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95%CI 1.94–2.30).ConclusionsWomen with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.

Associations of the serum long-chain n-3 PUFA and hair mercury with resting heart rate, peak heart rate during exercise and heart rate recovery after exercise in middle-aged men.

Long-chain n-3 PUFA from fish have been associated with lower risk of CVD. Fish may also contain methylmercury, which may attenuate the inverse associations of the long-chain n-3 PUFA. However, the mechanisms underlying these associations are not fully known. We evaluated the associations of the serum long-chain n-3 PUFA (EPA, DPA and DHA) and hair Hg with resting heart rate (HR), peak HR during cycle ergometer exercise and HR recovery after exercise. A total of 1008 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 years and free of CVD, were studied. After multivariate-adjustments in ANCOVA, higher serum total long-chain n-3 PUFA concentration was associated with lower resting HR (extreme-quartile difference 2·2 beats/min; 95 % CI 0·2, 4·1, P trend across quartiles=0·02), but not with peak HR or HR recovery. Associations were generally similar when EPA, DPA and DHA were evaluated individually, except for DPA, which was also associated with better HR recovery after exercise (extreme-quartile difference 2·1 beats/min; 95 % CI 0·1, 4·2, P trend=0·06). Higher hair Hg content had a trend towards lower peak HR after adjusting for the long-chain n-3 PUFA (P trend=0·05), but it only slightly attenuated the associations of the serum long-chain n-3 PUFA with HR. These findings suggest that higher serum long-chain n-3 PUFA concentrations are associated with lower resting HR in middle-aged men from Eastern Finland, which may partially explain the potential cardioprotective effect of fish intake.

Ethnicity influences cardiovascular outcomes and complications in patients with type 2 diabetes

AimTo determine whether cardiovascular outcomes in type 2 diabetes (T2D) differ according to ethnicity, and whether ethnicity influences the effect of gender on these outcomes in Caucasians, East-Southeast-Asians, Middle-Easterners, South-Asians and Pacific-Islanders. MethodsWe compared demographics, HbA1c, lipid profile, renal function markers, and prevalence of macrovascular and microvascular complications between ethnic groups. Cross-sectional data was prospectively collected from 204 consecutive patients at Westmead Hospital's T2D clinic from April–October 2015. Univariate analysis was performed using chi-squared test for categorical data, and Mann-Whitney-U or Kruskal-Wallis test for continuous data. ResultsCompared to Caucasians, South-Asians were diagnosed younger, were currently younger, had lower body-mass-index (BMI) and better renal function but higher rates of non-ST-elevation myocardial infarction (STEMI, 21.7% versus 3.5%, p<0.05). East-Southeast-Asians had lower BMI but more nephropathy than Caucasians (59% versus 39%, p<0.05). East-Southeast-Asian males had fewer CVD than Caucasians, but this protection was absent in East-Southeast-Asian females. Middle-Easterners had more non-STEMI than Caucasians (5.3% vs 3.5%, p<0.05). Middle-Eastern females were not at lower CVD risk than males. Caucasians had most PVD (20% versus 6%, p<0.05). ConclusionsEthnicity influences rates of diabetes-related complications. Female CVD protection is altered in some groups. Ethnicity should be considered in assessing CVD and complications risk.

PP.21.07] SERUM URIC ACID LEVELS AND 10-YEAR RISK OF FATAL CARDIOVASCULAR DISEASE. A PROSPECTIVE STUDY

Objective: Serum uric acid (SUA) is associated with many traditional cardiovascular risk factors such as arterial hypertension. Our aim was to investigate the relationship of SUA levels with the 10-year risk of fatal cardiovascular disease. Design and method: We prospectively enrolled 113 subjects (mean age 53 ± 12 years) presented for evaluation in the antihypertensive clinic. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination, office and 24 h ambulatory blood pressure (BP) monitoring were obtained. In all patients data regarding lifestyle habits (smoking, alcohol consumption and exercise) were recorded. The 10-year risk of fatal cardiovascular disease was evaluated by using the SCORE chart for countries with low CVD risk based on the following risk factors: age, sex, smoking, systolic blood pressure, and total cholesterol. Results: Mean average 24 hours systolic blood pressure (SBP) was 124 ± 13 mmHg, mean 24 hours average diastolic blood pressure (DBP) was 75 ± 10 mmHg while mean total cholesterol was 210 ± 36 mg/dl. From 113 subjects included in the study only 26 (23%) were hypertensives. Pearson and spearman analysis showed that SUA levels were significantly and positively associated with the average 24 hours systolic and diastolic blood pressure levels (r = 0.35, p < 0.0001 for SBP) and (r = 0.33, p < 0.0001 for DBP) respectively. Furthermore the kruskal Wallis analysis revealed that SUA levels were significantly associated with 10-year risk of fatal cardiovascular disease (p < 0.0001). Specifically patients with 10-year risk <5%, 5–10%, >10%, presented SUA levels 4.4 ± 0.9 mg/dl, 5.2 ± 1 mg/dl and 6.4 ± 0.1 mg/dl respectively (p < 0.0001). Conclusions: Subjects with lower SUA levels presented lower BP levels as well as 10-year risk of fatal cardiovascular disease and vice versa. SUA levels were significantly associated with blood pressure levels and 10-year risk of fatal cardiovascular disease. The fact that this study included mainly normotensives, shows that SUA levels are also associated with subjects presenting normal or high normal blood pressure levels.

Health Benefits Associated With Three Helping Behaviors: Evidence for Incident Cardiovascular Disease.

The purpose of this study was to investigate the association between three helping behaviors and incident cardiovascular disease (CVD; heart attack, stroke; fatal and nonfatal), with an exploration of gender differences. The study is framed within the caregiving system model. Helping others is argued to be an evolved characteristic of humans that yields beneficial health effects. Data were taken from the 2004-2014 waves of the Health and Retirement Study. The three forms of helping others considered were formal volunteering, informal helping, and caregiving for a parent or spouse. Cox proportional hazards models were estimated for gender-stratified samples. Women who volunteered showed a lower risk of incident CVD compared to women who did not volunteer. Men who informally helped others in the community exhibited a lower risk of incident CVD compared to men who did not provide this form of help. Caregiving status was generally not associated with incident CVD for women or men. The results demonstrated that specific types of prosocial behavior may be beneficial for women and men. However, tests for effect differences showed that gender did not moderate the relationships between these helping behaviors and CVD risk.