Major Coronary Heart Disease Risk Factors Research Articles

Prevalence of Coronary Heart Diseases Risk Factors in Adults Population Living in Nigeria’s Largest Urban City

Coronary Heart Disease (CHD) remains a major cause of morbidity and a leading contributor to mortality worldwide. This study was conducted to determine the prevalence of risk factors of CHD in apparently healthy adult’s population living in Nigeria’s largest urban city. Five hundred subjects were selected using systematic sampling technique. Data were collected using a pre-tested, semi-structured questionnaire to obtain information on sociodemographic characteristics, lifestyle, physical activities and other risk factors. Anthropometric measurements were made using standard procedures, while food intake data was collected using 24-hr dietary recall. Blood samples of the selected healthy subjects were analyzed for haematological indices. Data were analyzed using Pearson Product Moment Correlation to establish relationships among variables. Logit model was used in predicting major risk factors for CHD. The results showed that prevalence of overweight among urban and rural subjects was 37.6% and 26.8%, respectively while 28.4% of urban and 17.2% of rural subjects had waist-hip ratio indicating high risk of heart disease. Sixty-eight percent of urban subjects and 52% of rural had energy intake above 75% Recommended Dietary Allowance (RDA), while 80% urban and 68% rural subjects met above 75% RDA for protein. Total Cholesterol (TC) was above 240 mg/dl in 28% and 20% of urban and rural subjects, respectively. Triglycerides (TG) was >200 mg/dl in 36% of urban and 28% rural healthy subjects. Low density lipoprotein (LDL) (>l60 m g/dl) was similar in 20% of rural and urban subjects. High density lipoprotein (HDL) was <40 mg/dl in 16% and 20% of urban and rural subjects respectively. There was positive relationship between blood pressure and nature of job (r = 0.033, p<0.0l), blood pressure and age (r =0.122; p<0.0l), blood pressure and alcohol consumption (r = 0.021, p<0.05). Logit model used in predicting the probability of developing CHD showed that it is possible to predict to about 49% accuracy the probability of individuals developing CHD. This study has established high blood pressure, tobacco smoking, high lipid profile, physical Inactivity, obesity and diabetes as prevalent risk factors of CHD in healthy adults in Nigeria.

Genetic variants in loci 1p13 and 9p21 and fatal coronary heart disease in a Norwegian case-cohort study.

Single nucleotide polymorphisms (SNPs) in loci 1p13 and 9p21 have previously been found to be associated with incident coronary heart disease (CHD). This study aimed to investigate whether these SNPs show associations with fatal CHD in a population-based cohort study after adjustment for socioeconomic- and lifestyle-related CHD risk factors not commonly included in genetic association studies. Using the population-based Cohort of Norway (CONOR), a nested case-cohort study was set up and DNA from 2,953 subjects (829 cases and 2,124 non-cases) were genotyped. The association with fatal CHD was estimated for four SNPs, three from locus 1p13 and one from locus 9p21. Multivariable Cox regression was used to estimate unstratified and gender-stratified hazard ratios while adjusting for major CHD risk factors. The associations between three SNPs from locus 1p13 and non-HDL cholesterol levels were also estimated. Men homozygous for the risk alleles on rs1333049 (9p21) and rs14000 (1p13) were found to have significantly increased hazard ratios in crude and adjusted models, and the hazard ratios remained statistically significant when both genders were analyzed together. Adjustment for additional socioeconomic- and lifestyle-related CHD risk factors influenced the association estimates only slightly. No significant associations were observed between the other two SNPs in loci 1p13 (rs599839 and rs646776) and CHD mortality in either gender. Both rs599839 and rs646776 showed significant, gradual increases in non-HDL cholesterol levels with increasing number of risk alleles. This study confirms the association between 9p21 (rs1333049) and fatal CHD in a Norwegian population-based cohort. The effect was not influenced by several socioeconomic- and lifestyle-related risk factors. Our results show that 1p13 (rs14000) may also be associated with fatal CHD. SNPs at 1p13 (rs599839 and rs646776) were associated with non-HDL cholesterol levels.

Abstract P320: Discordance of Framingham Risk Score and Reynolds Risk Score to Global Vascular Risk Score: Results from the Hispanic Community Health Study/Study of Latinos

Introduction: The Framingham Risk Score (FRS) is a coronary heart disease (CHD) risk model established using an ethnically homogeneous population that predicts 10-year hard CHD events, myocardial infarction (MI) and coronary death. The Reynolds Risk Score (RRS) and Global Vascular Risk Score (GVRS) are validated CHD risk models that, in addition to hard CHD events, predict stroke and other CHD outcomes. In addition to major CHD risk factors, RRS adds systemic inflammation and family history of MI as GVRS adds behavioral and anthropometric measures. This study aims to compare agreement of RRS and GVRS with FRS among Hispanic/Latino adults and to describe discordance in RRS and GVRS with FRS categories, by socio-demographic characteristics. Methods: HCHS/SOL is a population-based cohort study of Hispanics/Latinos in four US communities. The analytic sample includes 6,058 non-diabetic participants 45-74 years of age with no past history of CHD and stroke who underwent comprehensive baseline examination. 10-year hard CHD risk score was calculated; participants were categorized as low (&lt;10%), moderate (10-&lt;20%), and high (≥20%) risk. Kappa scores were calculated to compare agreement of RRS and GVRS with FRS. Socio-demographic characteristics of concordance and discordance were characterized overall; multinomial logistic regression models was used to examine age-sex-adjusted likelihood of in discordance by these factors. Results: Mean age of the participants was 55 (SE=0.15) years, 54.3% were women, 41% had family history of CHD, and 90% were foreign born. Overall, 4,805 (74%) had low FRS, 1,143 (24%) had moderate FRS, and 110 (2%) had high FRS. There was poor agreement between RRS and FRS (Kappa=0.16, P&lt;0.01) and fair agreement between GVRS and FRS (Kappa=0.36, P&lt;0.01). In age-sex-adjusted analyses, RRS and GVRS were both more likely to classify persons of moderate and high risk who are between the ages of 60-74; GVRS classified more moderate and high risk women than the FRS. RRS and GVRS discordance with FRS was not associated with nativity and length of time in US. Conclusion: Significant discordance was observed between RRS and GVRS compared to FRS. Among Hispanic/Latino adults, use of RRS or GVRS may be more inclusive in classifying older age adults and women at high 10-year CHD risk.

Attribution of Risk for Coronary Heart Disease in a Vulnerable Immigrant Population

Coronary heart disease (CHD) is a common and costly condition and is increasing at a higher rate among Asian Indians than among other ethnic groups. An understanding of how Asian Indians perceive their risk is important for health providers to develop culturally appropriate programs to raise awareness of the risk of CHD. The aim of this survey was to investigate the attribution of risk factors for CHD among the Asian Indian community in Australia. Asian Indian community leaders were recruited to provide their views of how their community perceived the risk of CHD. An online survey collected demographic data and information from the Illness Perception Questionnaire-Revised, which measures 6 domains of illness perception: timeline acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. An 84% response rate (n = 49) was achieved from Asian Indian community leaders. Heart disease and cancer were considered to be the illnesses of major concern. Participants indicated that people in their community perceived hereditary factors (90%), hypertension, stress or worry (84%), and aging (86%) as the major cause of their illnesses. Smoking, high blood pressure, and cholesterol were identified as being major risk factors for CHD. These data suggest that as well as strategies to address risk factors such as diet and exercise, stress management is an important issue to consider in developing community-based programs.

Preventing coronary heart disease risk of slum dwelling residents in India.

Coronary heart disease (CHD) is the top cause of mortality and morbidity in India. People in slums are generally at a higher risk for CHD than Indians living in more affluent areas mostly because of the higher prevalence of major CHD risk factors such as uncontrolled hypertension and tobacco use amongst them. Knowing their CHD risk perceptions and bringing them into line with the actual CHD risk is a prerequisite for effective CHD risk management. Consequently, there is need to develop tailored interventions focusing medication management and tobacco cessation to reduce growing CHD epidemic among slum dwellers and long-term CHD burden in India.

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008

BackgroundCoronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments.MethodsThe validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35–84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35–84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards.ResultsBetween 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall.ConclusionReduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

Lipoprotein(a), Cardiovascular Disease, and Contemporary Management

Elevated lipoprotein(a) (Lp[a]) is a causal genetic risk factor for cardiovascular disease. To determine if current evidence supports both screening and treatment for elevated Lp(a) in high-risk patients, an English-language search of PubMed and MEDLINE was conducted. In population studies, there is a continuous association between Lp(a) concentrations and cardiovascular risk, with synergistic effects when low-density lipoprotein (LDL) is also elevated. Candidates for Lp(a) screening include patients with a personal or family history of premature cardiovascular disease, familial hypercholesterolemia, recurrent cardiovascular events, or inadequate LDL cholesterol (LDL-C) responses to statins. Given the comparative strength of clinical evidence, reducing LDL-C to the lowest attainable value with a high-potency statin should be the primary focus of lipid-modifying therapies. If the Lp(a) level is 30 mg/dL or higher in a patient who has the aforementioned characteristics plus residual LDL-C elevations (≥70-100 mg/dL) despite maximum-potency statins or combination statin therapy, the clinician may consider adding niacin (up to 2 g/d). If, after these interventions, the patient has progressive coronary heart disease (CHD) or LDL-C levels of 160-200 mg/dL or higher, LDL apheresis should be contemplated. Although Lp(a) is a major causal risk factor for CHD, no currently available controlled studies have suggested that lowering it through either pharmacotherapy or LDL apheresis specifically and significantly reduces coronary risk. Further research is needed to (1) optimize management in order to reduce CHD risk associated with elevated Lp(a) and (2) determine what other intermediate- or high-risk groups might benefit from Lp(a) screening.

PS1-46: Variation in Hypertension Prevalence Among Asian American Subgroups: Results from PACS (Pan Asian Cohort Study)

Background/Aims Asian Americans are a rapidly growing minority population in the US. Higher rates of coronary heart disease (CHD) have been found for some Asian American subgroups, especially Asian Indians and Filipinos. Hypertension (HTN) is a major CHD risk factor, but rates of HTN among Asian American subgroups are unknown largely due to either underrepresentation or aggregation of Asian American subgroups in epidemiologic surveys.

Screening, referral and treatment for depression in patients with coronary heart disease

In 2003, the National Heart Foundation of Australia position statement on "stress" and heart disease found that depression was an important risk factor for coronary heart disease (CHD). This 2013 statement updates the evidence on depression (mild, moderate and severe) in patients with CHD, and provides guidance for health professionals on screening and treatment for depression in patients with CHD. The prevalence of depression is high in patients with CHD and it has a significant impact on the patient's quality of life and adherence to therapy, and an independent effect on prognosis. Rates of major depressive disorder of around 15% have been reported in patients after myocardial infarction or coronary artery bypass grafting. To provide the best possible care, it is important to recognise depression in patients with CHD. Routine screening for depression in all patients with CHD is indicated at first presentation, and again at the next follow-up appointment. A follow-up screen should occur 2-3 months after a CHD event. Screening should then be considered on a yearly basis, as for any other major risk factor for CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2) or the short-form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimum interference, and may increase uptake of screening. Patients with positive screening results may need further evaluation. Appropriate treatment should be commenced, and the patient monitored. If screening is followed by comprehensive care, depression outcomes are likely to be improved. Patients with CHD and depression respond to cognitive behaviour therapy, collaborative care, exercise and some drug therapies in a similar way to the general population. However, tricyclic antidepressant drugs may worsen CHD outcomes and should be avoided. Coordination of care between health care providers is essential for optimal outcomes for patients. The benefits of treating depression include improved quality of life, improved adherence to other therapies and, potentially, improved CHD outcomes.

Lipid Triad: An Important Predictor of Dyslipidemia Related Disorders and its Therapeutic Intervention

Cardiovascular disease (CVD) is leading cause of premature death worldwide. 30% of all global deaths in 2005, i.e. 17.5 million people died from this CVD. If proper and quick actions are not taken, an estimated number of 20 million people will die by 2015, including stroke [1]. Lavie et al. [2] stated regarding fiscal burden of CVD and, especially, coronary heart disease (CHD), most medical treatments are directed at the major CHD risk factors. CVD implies to any medical disorders related to heart and blood vessels. There are a number of known causative factors that are directly or indirectly responsible for CVD. The lipid triad refers basically to three lipid abnormalities: increased plasma triglycerides and small dense low density lipoprotein (sd-LDL), and decreased high density lipoprotein cholesterol (HDL-C) concentrations. Since lipid triad is highly atherogenic in nature causing CVD, also called as atherogenic lipoprotein phenotype. The liver secretes lipoproteins called very-low-density lipoproteins (VLDL) rich in triglycerides. As these lipoproteins come into contact with lipoprotein lipase situated on capillary endothelial cell, hydrolyzes the triglycerides leaving VLDL remnant. Many patients with premature CHD having cholesterol levels in the range of 200-240 mg/dl show other risk factors like hypertension, obesity or abnormalities in triglycerides metabolism. But these above anomalies are often seen in reduced concentration of HDL [3]. Low density lipoprotein cholesterol (LDL-C) rich in cholesterol has been extensively studied and known for its bad cholesterol because it is considered as a good marker for cardiovascular disease risk assessment [4] and its level in human body should be below 130 mg/dl. HDL-C ranging between 35-40 mg/dl is considered as good cholesterol as it helps in the removal of cholesterol along with it also shows antioxidant property carrying arylesterase/ paraoxonase antioxidant enzyme. High level about 60 mg/dl of HDL-C is believed to be played a good protective role in human health protection as it protects efficiently heart from dangerous attack on it. The various previous studies clearly indicate that high concentration of LDL-C and substantially increased ratio of LDL and HDL are important risk factors which promote atherosclerosis [5]. The study for UK Progression of Diabetes Study showed that LDL-C is the strongest risk factor for coronary heart disease followed by HDL-C in this population [6]. Thus it suggested that 0.1 mM rise in HDL-C would decrease coronary heart disease by 15%. LDL particles are differentiated into large buoyant LDL (lb-LDL) and small dense LDL (sd-LDL). These subfractions are associated with difference in size, density, physico-chemical composition, metabolic behavior and atherogenicity. Different known techniques such as density gradient, ultracentrifugation, polyacrylamide gel electrophoresis, nuclear magnetic resonance, etc. are employed for fractionation of LDL into sd-LDL and lb-LDL subfractions [7-9]. Lb-LDL particle shows >25.5 nm while sd-LDL particle shows ≤ 25.5 nm.

A comparative study of heart rate variability tests and lipid profile in healthy young adult males and females

Coronary Heart Disease (CHD) is the leading cause of death in many developed countries. The relation between heart rate variability (HRV) and CHD was recently explored after the development of HRV techniques. Lower HRV was proven to be associated with a greater risk for developing hypertension among normotensive men, and hypertension is one of the major risk factors of CHD. Acute myocardial infarction is accompanied by decreased HRV, which is due to reduced vagal or increased sympathetic outflow to the heart. This study was designed to test the hypothesis of influence of gender and lipid profile difference on heart rate variability tests. Thirty healthy adult male and thirty healthy adult female subjects in the age group of 18- 25 years without any addictions and gross systemic disease were selected. Heart rate variability tests during Valsalva maneuver, deep breathing and 30:15 R-R intervals ratio were carried and lipid profile of the subjects were analyzed. We found a decrease in values of HRV tests during the Valsalva maneuver, deep breathing in male individuals as compared with age- and Body Mass Index, BMI-matched females. VHeart Rate Variability tests during 30:15 R-R intervals Ratio in male individuals were significantly decreased as compared with females. Values of total cholesterol, Low Density Lipoprotein, LDL cholesterol were found to be significantly increased and High Density Lipoprotein, HDL cholesterol significantly decreased in males. Healthy adult males may be at a higher risk of developing acute myocardial infarction and CHD due to decreased HRV and atherogenic lipid profile. Lower level of serum estrogen may be the cause of this difference in HRV among males. The difference in HRV tests among males and females disappears after menopause.

Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007

Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades. The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments. The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies. Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively. More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.

Update on guidelines for management of hypercholesterolemia

Coronary heart disease (CHD) is a leading cause of morbidity and mortality globally. Hypercholesterolemia is one of the major risk factors for CHD. With the increase in aging populations and progressively sedentary lifestyles, the global burden of CHD is likely to increase in the future despite better preventive strategies. It is vitally important to manage hypercholesterolemia effectively because it is a modifiable risk factor. At present, there are several guidelines with differences in recommendations. In this paper the authors present an update on the guidelines on hypercholesterolemia management. The authors have systematically reviewed guidelines in hypercholesterolemia management and discussed a pragmatic approach to follow the most recent guidelines including guidance from NICE in the primary care setting.

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

BackgroundDespite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them.MethodsThe IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses.ResultsBetween 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD.ConclusionMost of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Predictors of anterior and posterior wall carotid intima media thickness progression in men and women at moderate risk of coronary heart disease

The rate of carotid intima media thickness (CIMT) progression has been widely used in clinical trials as a surrogate marker for subclinical atherosclerosis. The aim of this study was to investigate relationships between coronary heart disease (CHD) risk markers and progression of CIMT in patients at moderate CHD risk. Participants included men (45-75 years) and women (55-74 years) in the control arm of a clinical trial. All had at least one major CHD risk factor and baseline posterior wall CIMT 0.7-2.0 mm, without significant stenosis. Posterior (n = 134) and anterior wall (in a subset, n = 72) CIMT were assessed with B-mode ultrasound at baseline and 12 and ∼18 months. Fasting lipoprotein lipid, apolipoprotein (Apo), inflammatory, and oxidative stress markers were evaluated. Baseline CIMT was inversely associated (P < .001) with CIMT progression. After adjustment for baseline CIMT, significant predictors of anterior wall CIMT progression in linear regression analyses included glucose (P = .044), high-density lipoprotein cholesterol (HDL-C, inverse, P = .006), triglycerides (TG, P = .006), and ratios of total cholesterol (TC)/HDL-C (P = .013), TG/HDL-C (P = .005), and Apo B/HDL-C (P = .021). Posterior wall CIMT progressed on average, whereas anterior wall CIMT regressed (0.0078 vs -0.0164 mm/year, P = .014). Significant baseline CIMT-adjusted predictors of posterior wall CIMT progression included TC (P = .028), low-density lipoprotein-C (P= .035), non-HDL-C (P = .004), TG (P = .016), Apo B (P = .005), and ratios of TC/HDL-C (P < .001), TG/HDL-C (P = .015), Apo B/Apo AI (P = .012) and Apo B/HDL-C (P = .004). The strongest predictors for CIMT progression in anterior and posterior walls were lower baseline CIMT, increased TG, and elevated ratios, including TC/HDL-C, TG/HDL-C and Apo B/HDL-C.

Insulin Resistance and the Relationship of a Dyslipidemia to Coronary Heart Disease

The goal of this study was to examine the effect of insulin resistance (IR) in subjects without diabetes on the relationship of a dyslipidemia with high triglycerides and low high-density lipoprotein cholesterol (HDL-C) to the development of coronary heart disease (CHD). Lower and higher fasting plasma HDL-C and triglyceride concentrations (defined at the study population median) and presence or absence of IR (defined by upper quartile Homeostatic Model Assessment values) were related to the development of myocardial infarction or CHD death in Framingham Heart Study participants without diabetes or a history of CHD (n=2910) attending the 1991 to 1995 examination. During follow-up (mean, 14 years), 128 participants experienced an incident CHD event. With Kaplan-Meier plots, the incidence of CHD was significantly greater with than without IR at either the lowest HDL-C or the highest triglycerides (P<0.001). In multivariable Cox models adjusted for major CHD risk factors, including waist circumference, only subgroups with IR had a significantly higher incidence of CHD. Compared with a reference group without IR and with higher-than-median HDL-C or lower-than-median triglycerides, the hazard ratio (HR) for incident events was significant with only IR and a lower HDL-C (HR 2.83, P<0.001) or higher triglycerides (HR 2.50, P<0.001). These findings were similar in men and women. In this community-based sample exclusive of diabetes, incident CHD risk associated with plasma HDL-C or triglycerides was significantly increased only in the presence of IR.

Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease

More than half a million Americans die each year from coronary heart disease (CHD), 26 million suffer from chronic kidney disease (CKD), and a large proportion have periodontal disease, a chronic infection of the tissues surrounding teeth. Chronic inflammation contributes to CHD and CKD occurrence and progression, and periodontal disease contributes to the cumulated chronic systemic inflammatory burden. This review examines recent evidence regarding the role of periodontal disease in CHD and CKD. Periodontal pathogens cause both local infection and bacteremia, eliciting local and systemic inflammatory responses. Periodontal disease is associated with the systemic inflammatory reactant C-reactive protein (CRP), a major risk factor for both CHD and CKD. Nonsurgical periodontal disease treatment is shown to improve periodontal health, endothelial function, levels of CRP, and other inflammatory markers. Evidence for the association of periodontal disease with CKD consists of a small body of literature represented mainly by cross-sectional studies. No definitive randomized controlled trials exist with either CHD or CKD as primary endpoints. Recent evidence links periodontal disease with CHD and CKD. Adding oral health self-care and referral for professional periodontal assessment and therapy to the repertoire of medical care recommendations is prudent to improve patients' oral health and possibly reduce CHD and CKD risk.

Predictors of Anterior and Posterior Wall Carotid Intima Media Thickness Progression in Men and Women at Moderate Risk of Coronary Heart Disease

Synopsis: Early detection of arterial wall thickening, the subclinical phase of atherosclerosis, may be useful for identifying individuals at risk for future cardiovascular events. Carotid intima media thickness (CIMT)-assessed rate of atherosclerosis progression is a risk factor for clinical cardiovascular events, but the relationships between various coronary heart disease (CHD) risk factors and CIMT progression are unclear. Purpose: The aim of this study was to investigate associations between CHD risk markers and CIMT progression in individuals at moderate CHD risk. Methods: Participants included men (45–75 years) and women (55–74 years) in the control arm of a clinical trial. All had at least one major CHD risk factor and baseline posterior CIMT 0.7–2.0 mm, without significant stenosis. Posterior wall (n = 134) and anterior wall with contrast (n = 72) CIMT were assessed by the use of high-resolution B-mode ultrasound at baseline, 12 months and ∼18 months. Fasting lipoprotein lipid, apolipoprotein (apo), inflammatory, and oxidative stress markers were evaluated. Results: Anterior wall CIMT was significantly greater at baseline than posterior wall CIMT (0.86 vs 0.77 mm, P < .001). On average, posterior wall CIMT progressed and anterior wall CIMT regressed (0.0091 vs −0.0164 mm/yr, respectively, P = .014). Baseline CIMT was inversely associated (P < .001) with CIMT progression in both walls. After adjustment for baseline CIMT, significant predictors of anterior wall CIMT progression in linear regression analyses included triglycerides (TG, P = .006), high-density lipoprotein cholesterol (HDL-C, inverse, P = .006), and ratios, including total cholesterol (TC)/HDL-C (p=0.013), TG/HDL-C (P = .005), and Apo B/HDL-C (P = .021). Significant baseline CIMT-adjusted predictors of posterior CIMT progression included TC (P = .028), low-density lipoprotein cholesterol (LDL-C, P =.035), non-HDL-C (P =.004), TG (P =.016), apoB (P =.005), and ratios of TC/HDL-C (P < .001), TG/HDL-C (P =.015), apoB/apoA1 (P =.012), and apoB/HDL-C (P =.004). Oxidative stress and inflammatory markers were generally unrelated to CIMT progression. Conclusions: The strongest predictors for CIMT progression in anterior and posterior walls were lower baseline CIMT, increased TG, and elevated lipid ratios, including TC/HDL-C, TG/HDL-C, and apoB/HDL-C. Non-HDL-C was a stronger predictor than LDL-C. These results support the hypothesis that TG-rich lipoproteins are associated with CIMT progression, either directly, or as an indicator of a greater number of circulating atherogenic particles.

Does interleukin-18 or tumour necrosis factor-α have an independent association with the risk of coronary heart disease? Results from a prospective study in New Zealand

Background: The pro-inflammatory cytokines, interleukin (IL)-18 and tumour necrosis factor-α (TNFα) may play a role in coronary heart disease (CHD). We aimed to extend data on their relationships to the risk of CHD in generally healthy populations. Methods: During 5.5 years follow-up in the Fletcher Challenge general population cohort there were 256 CHD cases, and 615 controls were matched for age and sex. Baseline plasma levels of IL-18 and TNFα were related to CHD risk in available samples (77%). Results: Plasma levels of IL-18 (11% increase in mean, p = 0.01) and TNFα (10% increase in mean p = 0.024) were significantly elevated in CHD cases versus controls. In univariable models IL-18 was associated with CHD risk (odds ratio [OR] upper third to lower third, 1.63; 95% CI 1.08, 2.46), but TNFα was not (OR 1.33; 95% CI 0.87, 2.02).After adjusting for major CHD risk factors and CRP, the association of IL-18 with CHD risk was attenuated (OR 1.69; 95% CI 0.94, 3.03). Conclusions: IL-18, but not TNFα, had a non-negligible association with CHD risk, although the association of IL-18 with risk was weak after full adjustment. These cytokines may play a role in CHD pathology, but may not be robust risk biomarkers.