Major Coronary Heart Disease Risk Factors Research Articles

Abstract 4128698: Mental Health and Sleep Quality as Determinants of Physical Activity Levels in Depressed Rural Patients with Coronary Heart Disease

Background: Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined. Purpose: The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD. Methods: A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress. Results: Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p < .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity. Conclusions: Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.

Prevalence and predictors of coronary heart disease among individuals with and without obesity in North Dakota.

Coronary heart disease (CHD) is the most common cardiovascular disease in the United States and heart disease is the leading cause of death in North Dakota. Although obesity is a major risk factor for CHD, some studies have reported an inverse relationship between body mass index (BMI) and CHD outcomes. Understanding the epidemiology of CHD among individuals with and without obesity is essential to guide health planning. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of CHD among North Dakota adults with and without obesity. Behavioral Risk Factor Surveillance System data from 2017 to 2021 were provided by the North Dakota Department of Health and Human Services. Weighted prevalence estimates and 95% confidence intervals (CIs) were computed for CHD and potential risk factors among respondents with and without obesity (BMI ≥30 kg/m2). Multivariable logistic regression was used to identify significant predictors of CHD in both groups. A total of 17,092 respondents were included in the study. Respondents with obesity had a higher prevalence of CHD (4.7%, 95% CI: 4.2-5.4) than those without obesity (3.0%, 95% CI: 2.7-3.4). Predictors of CHD among both groups included age, sex, self-reported general health, high blood pressure, high cholesterol, chronic obstructive pulmonary disease, and diabetes. Having a personal doctor (Odds Ratio [OR] = 1.91, 95% CI: 1.13-3.23) and arthritis (OR = 1.72, 95% CI: 1.34-2.22) were significant predictors of CHD among respondents without obesity, but not among those without obesity. While the prevalence of CHD was significantly higher among adults with obesity compared to those without obesity, the findings of the stratified analysis indicated that predictors of the condition tended to be similar for the two groups. This study provides useful information to guide health planning and control programs that aim to reduce the burden of CHD in North Dakota.

Correlation of Hba1c, Triglyceride, HDL with the Degree of Stenosis in Coronary Heart Patients with Type 2 Diabetes Mellitus

Background: Coronary Heart Disease (CHD) is a disease caused by the narrowing of the coronary artery wall as a result of the atherosclerosis process. Atherosclerosis plays an important role from the beginning of plaque formation until plaque rupture which causes blood clots. Diabetes mellitus and dyslipidemia are one of the major risk factors for CHD. In patients with type 2 Diabetes Mellitus, there was an altered lipid profile which led to endothelial damage that caused the formation of atherosclerosis. HDL cholesterol labeled as good cholesterol was decreased due to uncontrolled LDL cholesterol labeled as bad cholesterol. LDL cholesterol synthesis process was disrupted then causing plaque formation in the arteries which causes CHD. Aim: The aim of this study was to analysis correlation between HbA1c levels, triglyceride levels, HDL levels and the degree of stenosis in coronary heart disease sufferers with type 2 diabetes mellitus. Method: This study was an observational cross-sectional analytical study with total of 51 patients with CHD who underwent cardiac catheterization at Telogorejo Hospital. Semarang. The correlation test in this study using the Spearman test with p 0.05 is considered significant. Results: Results of this study show that there is no significant correlation between HbA1C levels and triglyceride levels (p= 0.793), and Hba1C with the degree of stenosis was (p= 0.685) but, there was significant correlation between HDL cholesterol level with the degree of stenosis (p=0.015). Conclusion: It was concluded that there was no significant correlation between the correlation of HbA1c levels and triglyceride levels with the degree of stenosis and there was a moderately negative significant correlation between HDL levels and the degree of stenosis.

Abstract 17639: Association of Retinal Microvascular Changes With Incidence and Progression of Coronary Artery Calcium Score in Individuals With vs Without Diabetes Mellitus; Data From the Multi-Ethnic Study of Atherosclerosis

Introduction: Retinopathy (RP) is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. Microvascular disease may play a prominent role in coronary heart disease (CHD) development. We performed this study to evaluate the association of grades of RP with incidence of CAC (Coronary Artery Calcium) among those with zero CAC at baseline. Hypothesis: We performed this study to evaluate the association of grades of RP with incidence of CAC among those with zero CAC at baseline and to Identify the association of grades of MA and RP with progression of CAC among those with positive CAC at baseline. Methods: We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis (MESA), who had retinal photos and CAC score available. We analyzed the association of grades of RP with incidence and progression of CAC among subjects with and without DM with zero CAC and positive CAC at baseline from robust regression models. The grades of RP were defined as: no retinopathy, minimal non-proliferative R (NPR) (level 14 -20), early to moderate NPR (level 31-41) and severe NPR or proliferative RP (level 51-80). Results: Among those with zero CAC, in the diabetic group, early to moderate (95% CI [1.2, 2]) and severe (95% CI [1.3, 3]) NPR had significantly higher incident CAC risk than the non-retinopathy group. Among those with positive CAC at baseline, in the diabetic group, the early to moderate NPR group had higher CAC progression than the non-retinopathy group. (95% CI [-146, 228]). In the non-diabetic group, the minimal NPR group had significantly higher CAC progression than the non-retinopathy group (95% CI [1.8, 52.7]). Conclusions: In conclusion, after adjustment for major CHD risk factors, RP with any severity was associated with incident CAC in DM individuals, however only early to moderate NPDR was associated with CAC progression in them.

Non-HDL Cholesterol and LDL Cholesterol as Main Risk Factors for Coronary Heart Disease: Meta-Analysis

Coronary heart disease is a highly frequent illness in both developed and developing nations. Non-HDL cholesterol (n-HDL-c) and LDL cholesterol (LDL-c) stages are biomarkers that doctors frequently utilize to assess the risk of Coronary Heart Disease (CHD). This study was a systematic review and meta-analysis to assess the association between n-HDL-c and LDL-c as major risk factors for CHD. Cochrane, PubMed, and Science Direct searches were conducted using the keywords "LDL cholesterol," "non-HDL cholesterol," and "coronary heart disease." Any research that describes the analysis of LDL-c and n-HDL-c as key risk factors for CHD and all studies involving patients diagnosed with CHD are included in the literature. A total of seven papers were involved in the qualitative analysis (systematic review), while five studies were included in the quantitative analysis (meta-analysis). The English-language research includes two RCTs, four case-control studies, and one cohort study, with a total of 68,713 individuals. LDL-c parameters were obtained (MD = 8.45; 95 percent CI = 7.03-9.87 p=0.001) and n-HDLc (p=0.001) (MD = 35.57; 95 percent CI = 33.27-37.88). n-HDL-c may be a more significant parameter of CHD risk because it has a higher MD value.

Efficacy of Lipid-Lowering Therapy during Cardiac Rehabilitation in Patients with Diabetes Mellitus and Coronary Heart Disease.

Background: Cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) increases adherence to a healthy lifestyle and to secondary preventive medication. A notable example of such medication is lipid-lowering therapy (LLT). LLT during CR improves quality of life and prognosis, and thus is particularly relevant for patients with diabetes mellitus, which is a major risk factor for CHD. Design: A prospective, multicenter registry study with patients from six rehabilitation centers in Germany. Methods: During CR, 1100 patients with a minimum age of 18 years and CHD documented by coronary angiography were included in a LLT registry. Results: In 369 patients (33.9%), diabetes mellitus was diagnosed. Diabetic patients were older (65.5 ± 9.0 vs. 62.2 ± 10.9 years, p < 0.001) than nondiabetic patients and were more likely to be obese (BMI: 30.2 ± 5.2 kg/m2 vs. 27.8 ± 4.2 kg/m2, p < 0.001). Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95% CI 1.3 to 2.9) until 3 months of follow-up (OR 1.9; 95% CI 1.2 to 2.9). During 12 months of follow-up, overall and LDL cholesterol levels decreased within the first 3 months and remained at the lower level thereafter (p < 0.001), irrespective of prevalent diabetes. At the end of the follow-up period, LDL cholesterol did not differ significantly between patients with or without diabetes mellitus (p = 0.413). Conclusion: Within 3 months after CR, total and LDL cholesterol were significantly reduced, irrespective of prevalent diabetes mellitus. In addition, CHD patients with diabetes responded faster to LTT than nondiabetic patients, suggesting that diabetic patients benefit more from LLT treatment during CR.

Relation between Retinopathy and Progression of Coronary Artery Calcium in Individuals with Versus Without Diabetes Mellitus (From the Multi–Ethnic Study of Atherosclerosis)

Retinopathy is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. The microvascular diseases may play a prominent role in coronary heart disease (CHD) development in individuals with DM. We performed the study to evaluate the relation between non-DM retinopathy and CHD and also the association between baseline retinopathy and incidence and progression of CHD in individuals with and without DM. We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis, who had retinal photos and coronary artery calcium score (CACS) available. We studied the association between baseline retinopathy and incidence and progression of coronary artery calcification (CAC) in subjects with and without DM. In DM group, the presence of retinopathy was significantly associated with an increased rate of CAC (RR 1.3 (95% CI [1.02, 1.66]) after adjusting for age, sex, race, follow-up time, and CHD risk factors. In non-DM group, the presence of retinopathy was not significantly associated with increased risk of CAC, however, the interaction between presence of retinopathy and DM status was not statistically significant. Within the DM group with CAC present at baseline, the presence of retinopathy was significantly associated with greater CAC progression (113 Agatson units (AU) greater, (95% CI [51-174]). In the non-DM group with present CAC at baseline; the presence of retinopathy was associated with 24 (95% CI [-0.69, 48.76]) AU higher CAC progression. All findings were adjusted for CHD risk factors. In conclusion, after adjustment for major CHD risk factors, retinopathy was associated with progression of CAC in both DM and non-DM individuals. However, the association was stronger in those with DM.

The Reversion of DNA Methylation at Coronary Heart Disease Risk Loci in Response to Prevention Therapy

Coronary heart disease (CHD) is preventable, but the methods for assessing risk and monitoring response rely on imprecise lipid-based assessments. Recently, we have shown that an integrated genetic–epigenetic test that includes three methylation-sensitive digital PCR assays predicts 3-year risk for incident CHD better than lipid-based methods. However, whether methylation sites change in response to therapies that alter CHD risk is not known. Therefore, we assessed methylation at these three incident CHD-related sites in DNA from 39 subjects before and after three months of biochemically verified smoking cessation, then analyzed the relationship between change in methylation at each of the sites to the change in smoking intensity as assessed by cg05575921 methylation. We found that, in those who quit smoking, methylation change at one CHD risk marker (cg00300879) was significantly associated with change in cg05575921 methylation (p &lt; 0.04). We conclude that changes in incident CHD-related methylation occur within three months of cessation of smoking, a major risk factor for CHD. This suggests that the effectiveness of treatment of other CHD risk factors, such as high cholesterol, may be similarly quantifiable using epigenetic approaches. Further studies to determine the relationship of changes of methylation status in response to treatment of other CHD risk factors are indicated.

Cardiovascular Risk in Perimenopausal Women.

Cardiovascular disease, and particularly coronary heart disease (CHD), has a low incidence in premenopausal women. Loss of ovarian hormones during the perimenopause and menopause leads to a sharp increase in incidence. Although most CHD risk factors are common to both men and women, the menopause is a unique additional risk factor for women. Sex steroids have profound effects on many CHD risk factors. Their loss leads to adverse changes in lipids and lipoproteins, with increases being seen in low density lipoprotein (LDL) cholesterol and triglycerides, and decreases in high density lipoprotein (HDL) cholesterol. There is a reduction in insulin secretion and elimination, but increases in insulin resistance eventually result in increasing circulating insulin levels. There are changes in body fat distribution with accumulation in central and visceral fat which links to the other adverse metabolic changes. There is an increase in the incidence of hypertension and of type 2 diabetes mellitus, both major risk factors for CHD. Oestrogens have potent effects on blood vessels and their loss leads to dysfunction of the vascular endothelium. All of these changes result from loss of ovarian function contributing to the increased development of CHD. Risk factor assessment in perimenopausal women is recommended, thereby permitting the timely introduction of lifestyle, hormonal and therapeutic interventions to modify or reverse these adverse changes.

P2637Hypertension as a risk factor for all-cause and cardiovascular mortality in women compared with men: a systematic review and meta-analysis of prospective cohort studies

Abstract Background What is more, some recent meta-analysis have demonstrated the sex difference between smoking, diabetes, and atrial fibrillation, and the risk of CVD mortality. Whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men remain unclear. Objective A systematic review with meta-analysis was performed to explore whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men. Methods PubMed and EMBASE was systematically searched for prospective cohort studies published from inception to 7 October 2017. Eligible studies reported sex-specific relative risk (RR) estimates for mortality of all-cause, CVD, coronary heart disease (CHD) and stroke associated with hypertension. The data were pooled using random effects models with inverse variance weighting, and estimates of the women-to-men ratio of RRs (RRR) for each outcomes were derived. Results Twenty-four studies with 2,939,659 participants were included in this meta-analysis. The RR for CHD mortality associated with hypertension compared with no hypertension was 2.24 (95% CI 2.03–2.46) in women and 1. 72 (1.61–1.84) in men. The multiple-adjusted RRR for CHD mortality was 22% greater in women with hypertension than in men with hypertension (RRR 1.22, 95% CI 1.03–1.44) with no significant heterogencity between studies (I2=45%, P=0.11, Figure 1). No evidence was observed sex difference in the relationship between hypertension and the mortality from all-cause, CVD and stroke. Furthermore, the subgroup analyses showed that the pooled RRR for all-cause mortality, CVD and stroke mortality were not significantly associated with cohort region, the duration of follow-up, mean age of participants and the publication year of studies. Conclusions Hypertension is a major risk factor for all-cause, CVD, CHD and stroke among women and men. Moreover, women with hypertension have more than a 22% higher risk of CHD mortality compared with men with hypertension. Further studies need to identify the biological and/or lifestyle mechanisms involved in sex differences driving these associations.

70-year legacy of the Framingham Heart Study.

The Framingham Heart Study (FHS) was established in 1948 to improve understanding of the epidemiology of coronary heart disease (CHD) in the USA. In 1961, seminal work identified major risk factors for CHD (high blood pressure, high cholesterol levels and evidence on the electrocardiogram of left ventricular hypertrophy), which later formed the basis for multivariable 10-year and 30-year risk-prediction algorithms. The FHS cohorts now comprise three generations of participants (n ≈ 15,000) and two minority cohorts. The FHS cohorts are densely phenotyped, with recurring follow-up examinations and surveillance for cardiovascular and non-cardiovascular end points. Assessment of subclinical disease and physiological profiling of these cohorts (with the use of echocardiography, ambulatory electrocardiographic monitoring, exercise stress testing, cardiac CT, heart and brain MRI, serial vascular tonometry and accelerometry) have been performed repeatedly. Over the past decade, the FHS cohorts have undergone deep 'omics' profiling (including whole-genome sequencing, DNA methylation analysis, transcriptomics, high-throughput proteomics and metabolomics, and microbiome studies). The FHS is a rich, longitudinal, transgenerational and deeply phenotyped cohort study with a sustained focus on state-of-the-art epidemiological methods and technological advances to facilitate scientific discoveries.

Study of risk factors causing coronary heart disease among army personnel of the rank non-commissioned officers and below in the age group of 20-50 years and its association with prehypertension

Background: Coronary heart disease (CHD) is an acute public health problem both in developed and in developing countries, like India. Assessing the prevalence of CHD in the community is equivalent to assessing the tip of the iceberg. Hypertension is a major risk factor for CHD and hypertension disease prevalence tip of the iceberg in the community is much more obscure. Objective: The objective of the study was to carry out a cross-sectional study among serving Army personnel, comprising healthy non-commissioned officers and other rank personnel to successfully assess the risk factors for CHD and their association with prehypertension. Materials and Methods: Screening of risk factors for CHD among 200 randomly selected participants was carried out. Blood pressure, height, weight, serum total cholesterol, serum triglycerides, serum high-density lipoprotein (HDL), random blood sugar levels, and smoking status were the major risk factors screened. Results: Nearly 63% of Army personnel were found to be having blood pressure commensurate to the range of prehypertension. About 15% were detected to be overweight, 22% had hypercholesterolemia, 5.4% had impaired glucose tolerance (IGT), and 19.2% were current smokers. Higher age, body mass index, high serum triglycerides, low serum HDL, and IGT were found to be independently associated with increased prevalence of prehypertension in multiple logistic regression analysis. Conclusion: Our findings recommend the constant monitoring of CHD risk factors and the formulation of effective preventive strategies for adequate control of alarming incidence.

Can we still learn from the Seven Countries Study?

The Seven Countries Study (SCS) of Cardiovascular Diseases started midway last century and was the pioneer investigation of coronary heart disease (CHD) at international level. The 16 cohorts of middle-aged men enrolled in eight nations of seven countries allowed to show large differences of CHD incidence and mortality across different cultures, partly explained by average levels of serum cholesterol and dietary habits, that is, Western type patterns in the high-risk populations, and Mediterranean or Oriental type in Southern Europe and Japan. Later, critics to the validity of the study were largely based on fake news, wrong or distorted information uncritically transmitted in a cascade of media. Recent analyses based on 45-50 years of follow-up showed and confirmed that diet patterns were associated with all-cause mortality and age at death; that multivariate coefficients of major risk factors of CHD were not heterogeneous across different populations and cultures; that analysis of competing risks of CHD versus other conditions identified serum cholesterol as the critical determinant; that true CHD manifestations had different determinants compared with Heart Diseases of Uncertain Etiology frequently confused with CHD. The SCS can still teach investigators and scholars of cardiovascular epidemiology, if old contributions are carefully read and interpreted; it is still recognized as the seminal study in this area at international level although it had limits as any other study but represented the first step into the identification of the relationship of diet with CHD and mortality across populations, and of the Mediterranean diet.

Intake of glucosinolates and risk of coronary heart disease in three large prospective cohorts of US men and women.

ImportanceGlucosinolates, a group of phytochemicals abundant in cruciferous vegetables, may have cardioprotective properties. However, no prospective study has evaluated the association of intake of glucosinolates with the risk of coronary heart disease (CHD).ObjectiveThe objective of the study was to evaluate the association between the intake of glucosinolates and incident CHD in US men and women.DesignProspective longitudinal cohort study.SettingHealth professionals in the USA.ParticipantsWe followed 74,241 women in the Nurses’ Health Study (NHS; 1984–2012), 94,163 women in the NHSII (1991–2013), and 42,170 men in the Health Professionals Follow-Up Study (1986–2012), who were free of cardiovascular disease and cancer at baseline.ExposureGlucosinolate intake was assessed using validated semi-quantitative food frequency questionnaires at baseline and updated every 2–4 years during follow-up.Main outcome measuresIncident cases of CHD were confirmed by medical record review.ResultsDuring 4,824,001 person-years of follow-up, 8,010 cases of CHD were identified in the three cohorts. After adjustment for major lifestyle and dietary risk factors of CHD, weak but significantly positive associations were observed for glucosinolates with CHD risk when comparing the top with bottom quintiles (hazard ratio [HR]:1.09; 95% CI: 1.01, 1.17; Ptrend<0.001). Higher intakes of three major subtypes of glucosinolates were consistently associated with a higher CHD risk, although the association for indolylglucosinolate did not achieve statistical significance. Regarding cruciferous vegetable intake, participants who consumed one or more servings per week of Brussels sprouts (HR: 1.16; 95% CI: 1.06, 1.26; P<0.001) and cabbage (HR: 1.09; 95% CI: 1.02, 1.17; P=0.009) had a significantly higher CHD risk than those who consumed these cruciferous vegetables less than once per month.Conclusion and relevanceIn these three prospective cohort studies, dietary glucosinolate intake was associated with a slightly higher risk of CHD in US adults. These results warrant replications in further studies including biomarker-based studies. Further studies are needed to confirm these findings and elucidate mechanistic pathways that may underlie these associations.

The strength of the multivariable associations of major risk factors predicting coronary heart disease mortality is homogeneous across different areas of the Seven Countries Study during 50-year follow-up

Objectives: To compare the magnitude of multivariable coefficients and hazard ratios of four cardiovascular risk factors across five worldwide regions of the Seven Countries Study in predicting 50-year coronary deaths.Material and methods: A total of 13 cohorts of middle-aged men at entry (40–59 years old) were enrolled in the mid-1900s from five relatively homogeneous groups of cohorts (areas): USA, Finland and Zutphen – the Netherlands, Italy and Greece, Serbia, Japan for a total of 10,368 middle-aged men. The major risk factors measured at baseline were age, number of cigarettes smoked, systolic blood pressure and serum cholesterol. Cox proportional hazards models were solved for 50-year (45 years for Serbia) deaths from coronary heart disease (CHD), and the multivariable coefficients were compared for heterogeneity.Results: The highest levels of risk factors and CHD death rates were found in Finland and Zutphen – the Netherlands and the lowest in Japan. All four risk factors were predictive for long-term CHD mortality in all regions, except serum cholesterol in Japan where the mean levels and CHD events were lowest. Tests of heterogeneity of coefficients for single risk factors in predicting CHD mortality were non-significant across the five areas. The same analyses for the first 25 years of follow-up produced similar findings.Conclusions: The strength of the multivariable associations of four major traditional CHD risk factors with long-term CHD mortality appears to be relatively homogeneous across areas, pending needed further evidence.

Association between education and the risk of incident coronary heart disease among middle-aged and older Chinese: the Dongfeng-Tongji Cohort

Educational achievement was related to cardiovascular disease in some western populations, but prospective evidence on the relationship between education and the risk of incident coronary heart disease (CHD) in Asians is scarce. We aimed to explore this association and the potential modifying effect of major CHD risk factors related to education in middle-aged and older Chinese adults. We included 18,551 participants with mean age 62.8 years at baseline between September 2008 and June 2010, and followed the population until October 2013. Cox proportional hazard models and log-binomial regression models were used for multivariate analyses. Compared with participants with low education, the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) for incident CHD in those with high education was 0.89 (95% CI: 0.80, 0.98). In addition, such inverse association between education and the risk of incident CHD was more evident among individuals who were more than 60 years, physically active, overweight, and hypertension. Besides, decreases in the relative index of inequality with high education versus low education were from 0.83 to 0.76 for hypertension, from 0.85 to 0.82 for diabetes. In conclusion, education was inversely associated with the risk of incident CHD among middle-aged and older Chinese adults.

Impact of continuous positive airway pressure and oxygen on health status in patients with coronary heart disease, cardiovascular risk factors, and obstructive sleep apnea: A Heart Biomarker Evaluation in Apnea Treatment (HEARTBEAT) analysis

Obstructive sleep apnea (OSA) is associated with impaired health-related quality of life (HRQL). Treatment with continuous positive airway pressure (CPAP) has variable impacts on HRQL, and this may be influenced by patient's tolerance of therapy. The objective is to determine the impact of nocturnal supplemental oxygen (NSO) and CPAP on HRQL compared with healthy lifestyle education (HLSE) in individuals with OSA. Patients with coronary heart disease (CHD) or at least 3 major CHD risk factors with apnea-hypopnea index of 15 to 50 events/h were randomized to CPAP, NSO, or HLSE. Health-related quality of life was assessed using the Short-Form 36, and depression was assessed with Patient Health Questionnaire-9 at baseline and 12 weeks. The treatment effect on HRQL change scores through 12 weeks was assessed using multivariable models adjusting for study site, presence of CHD at baseline, race, and baseline HRQL. A total of 318 patients were randomized to 1 of 3 treatment arms with 1:1:1 ratio and 94% completed baseline and follow-up HRQL instruments. Mean Short-Form 36 scores were similar at baseline in all 3 groups ranging from 41.8±12 to 51.6±12 in various domains. In multivariable models, the CPAP group noted a significantly greater improvement than NSO in mental health (+2.33, 95% CI 0.34-4.31, P=.02) and mental composite score (+2.40, 95% CI 0.40-4.41, P=.02). Conversely, the CPAP group noted less improvement than NSO in physical function (-2.68, 95% CI -4.66 to -0.70, P=.008) and physical composite score (-2.17, 95% CI -3.82 to -0.51, P=.01). Compared with HLSE, vitality and Patient Health Questionnaire-9 improved with CPAP but not with NSO. Significant interactions were noted between treatment effects with larger differences in black and sleepy patients. These data support the use of CPAP for improving vitality, sleepiness, mental health, social functioning, and depressive symptoms in patients with OSA and established CHD or risk factors. Nocturnal supplemental oxygen may have beneficial effects on perceived physical functioning.

Waist-hip ratio and cardiac responses to exercise in young adults with parental history of coronary heart disease

Background: Coronary heart disease (CHD) has become a major health challenge in India in 21st century. Family history is a major risk factor for CHD which strongly predisposes to atherosclerotic process at a younger age. The purpose of the study was to assess whether the parental history of CHD had any influence on waist-hip ratio (WHR) and cardiac responses to exercise in young adults aged 18-30 years. Aims and Objective: (1) The aim of the study is to measure the WHR and assess cardiac responses to exercise in young adults with parental history of CHD. (2) To compare the WHR and cardiac responses to exercise with the control group without parental history of CHD. Materials and Methods: Comparative study was conducted including 100 individuals with age group of 18-30 years. Study group included 50 individuals with parental history of CHD. Control group included 50 individuals without parental history of CHD. WHR was measured in both groups. Heart rate (HR) and blood pressure (BP) were recorded at rest. As per the Modified Bruce protocol, individuals performed submaximal exercise on treadmill. HR and BP were recorded during exercise and post-exercise recovery. The results were statistically analyzed. Results: Control group had excellent WHR (male < 0.85, female < 0.75, P = 0.05) than study group. There was no significant change in HR and BP at rest in both groups. During post-exercise recovery, systolic BP was higher 1 min (P < 0.001) and 5 min (P = 0.006) after exercise in study group. Moreover, HR recovery was delayed (P < 0.001) in study group as compared to control group. Conclusion: Young adults with parental history of CHD showed increased WHR and delayed recovery of HR and BP after exercise. Awareness has to be created in offspring of CHD patients regarding future risk of CHD. They must be advised to maintain ideal weight and cardiorespiratory fitness by regular physical exercise.

Dose-response relationship between serum uric acid levels and risk of incident coronary heart disease in the Dongfeng-Tongji Cohort

BackgroundIn prospective studies, relationship of serum uric acid (SUA) with risk of coronary heart disease (CHD) incidence is inconsistent. We evaluated the association of SUA with incident CHD and the potential modifying effect of major CHD risk factors related to SUA among a middle aged and elderly Chinese population. MethodsWe included 16, 063 participants who were free of CHD, stroke, cancer and renal diseases at baseline from Sep. 2008 to June 2010, and were followed until Oct. 2013. Cox proportional hazard model was used to estimate the hazard ratios (HR) and 95% confidence interval (95% CI) of CHD incidence in relation to SUA. ResultsThe adjusted HR for incident CHD increased gradually with the increasing SUA levels (P for linear trend=0.005), and the HR across sex-specific SUA quartile was 1.26 (95% CI: 1.09, 1.47), 1.13 (95% CI: 0.97, 1.31), 1.23 (95% CI: 1.06, 1.43) and 1.00 (reference; P for trend=0.014), respectively. In particular, the association was more evident in individuals with normal-weight and those without hypertension or metabolic syndrome (all P for interactions<0. 05). ConclusionsThese findings suggested that higher SUA levels were independently associated with a dose-response increased risk of CHD incidence.

Abstract MP25: Adiposity-related DNA Methylation as a Predictor of Coronary Heart Disease in Adult African Americans: The Atherosclerosis Risk in Communities Study

Background: Epigenetic modifications such DNA methylation variation comprise a potentially useful new class of biomarkers that may improve coronary heart disease (CHD) risk stratification, or better capture early pathophysiological processes. However, replicated associations of DNA methylation and CHD are few, and existing studies are primarily cross-sectional and restricted to European ancestry populations. Given the strong association of excess adiposity with CHD risk, we tested 41 DNA methylation variants (CpG sites) that were previously reported to be associated with BMI in African Americans (AA), and tested their association with incident CHD in AA adults. Methods: Genome-wide DNA methylation variation was assayed at a single time point in stored frozen leukocyte samples using the Illumina HM450K chip in a subset of 1,797 AA participants in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study of cardiovascular disease risk conducted in four U.S. communities. Methylation beta values and other continuous covariates were winsorized prior to analysis to reduce outlier influence. Incident CHD cases were identified through annual telephone interviews and medical records review. Proportional hazards regression (frailty) models examined the relationship between DNA methylation beta values and incident CHD with separate models for each of the 41 CpGs, with a random effect specified for chip. Fully adjusted models included age, BMI, sex, center, education, household income, leisure time activity, alcohol and tobacco use, white blood cell count and imputed cell type differentials. To explore the relationship between DNA methylation and CHD risk accounting for major CHD risk factors, mediator models additionally contained prevalent hypertension status, blood glucose, and total and HDL cholesterol. A Bonferroni-corrected p value of 0.00122 was set as the threshold for statistical significance. Results: There were 224 cases of incident CHD out of 1,797 individuals at risk. One CpG, cg09664445 near CLUH was significantly associated with incident CHD in the full (HR=1.47, 95%CI=1.26, 1.72) and mediator model (HR=1.46, 95% CI=1.24, 1.71) while cg06500161 near ABCG1 was significant in the full model only (HR=1.34, 95% CI=1.15, 1.56). Conclusion: Two obesity-related DNA methylation variants were associated with incident CHD independent of known risk factors and potential confounders. In the literature, CLUH is involved in mitochondrial biogenesis while promoter hypermethylation of ABCG1 was previously found to increase CHD risk and atherosclerosis. Replication in additional cohorts is required to further investigate the predictive value of DNA methylation variants over established risk factors and biomarkers for CHD.