Major Modifiable Cardiovascular Risk Factors Research Articles

Investigating the association between ambient particulate matter (PM10) exposure and blood pressure values: Results from the link between the Portuguese Health Examination Survey and air quality data

Introduction and objectivesHigh blood pressure (BP) remains a major modifiable cardiovascular (CV) risk factor. Several epidemiologic studies have been performed to assess the association between air pollution exposure and this CV risk factor but results remain inconsistent. This study aims to estimate the effect of short-term PM10 exposure (average previous three-day concentration) on diastolic (DBP) and systolic (SBP) blood pressure values of the resident mainland Portuguese population. MethodsOur study was based on available DBP and SBP data from 2272 participants from the first Portuguese Health Examination Survey (INSEF, 2015) living within a 30 km radius of at least one air quality monitoring station, with available measurements of particulate matter with an aerodynamic equivalent diameter ≤10 μm (PM10). We used data from the air quality monitoring network of the Portuguese Environment Agency to obtain the individual allocated PM10 concentrations. Generalized linear models were used to assess the effect of PM10 exposure on DBP and SBP values. ResultsNo statistically significant association was found between PM10 exposure and both DBP and SBP values (0.42% DBP change per 10 μg/m3 of PM10 increment (95% confidence interval (CI): −0.85; 1.70) and 0.47% SBP change per 10 μg/m3 of PM10 increment (95% CI: −0.86; 1.79)). Results remain unchanged after restricting the analysis to hypertensive or obese participants or changing the PM10 assessment methodology. ConclusionsIn view of the PM10 levels observed in 2015, our results suggests that exposure to PM10 concentrations have a small or no effect on the blood pressure values. Other air pollutants and mixtures of pollutants that were not included in our study should considered in future studies.

Abstract 15612: Association Between ECG-Derived Age With Coronary Artery Calcium

Introduction: We have previously shown that ECG-derived age (ECG-Age) predicts all-cause and cardiovascular (CV) mortality, reflecting physiologic age. We hypothesized that ECG-Age minus chronological age (Age-Gap) would be associated with coronary artery calcium (CAC) assessed by computer tomography. Methods: We developed a neural network model to predict ECG-Age using 12 lead ECGs from 399,750 training, 99,977 validation and 275,056 testing patients. We then applied the algorithm to 41,202 consecutive patients that from 1997-2020 underwent clinically indicated CAC and ECG within 1 year. Major modifiable CV risk factors were collected as part of preventive cardiology or general medical evaluations. Exclusion criteria were statin therapy, pacemakers, or history of coronary artery disease. Results: We included 41,202 subjects (68.5% males, 83.6% Caucasian), mean chronological age was 55.2±9.1 yrs and the ECG-Age was 56.01±9.3 yrs. The mean Age-Gap was -0.78±7 yrs, R 2 =0.78, p<0.0001. Mean CAC score was 140.2±532.3, and 21,483 (52%) had CAC >0. After adjustment for age and sex, those older by ECG (defined as having a positive Age-Gap) were more likely to have CAC>0 (OR 1.35, 95% CI 1.34-2.37 for those with >1 but <2 SD of a positive Age-Gap; and OR 1.80, 95% CI 1.34-2.37 for those with ≥2 SD of a positive Age-Gap), while those younger by ECG were less likely to have any CAC (OR 0.70, 95% CI 0.57-0.87 for those with >1 but <2 SD of a negative Age-Gap; and OR 0.75, 95% CI 0.67-0.84 for those with ≥2 SD of a negative Age-Gap), respectively. This association remained significant after multivariate adjustment, Fig. A and increased with CAC burden, Fig. B , all P for trend <0.01. Conclusions: The difference between physiologic AI-ECG age and chronologic age, something likely representing rate of biological aging, is associated with presence of CAC, further supporting the hypothesis that AI-ECG age can identify people more likely to have subclinical coronary atherosclerosis.

Joint statement from the European Atherosclerosis Society and European Society of Vascular Medicine focuses on patients with peripheral arterial disease

Joint statement from the European Atherosclerosis Society and European Society of Vascular Medicine focuses on patients with peripheral arterial disease

Social and economic benefits of secondary prevention of arterial hypertension.

Arterial blood pressure is one of the main vital signs reflecting body functions and, at the same time, the most important functional parameter of the cardiovascular system. High blood pressure is the major modifiable cardiovascular risk factor. The aim of the study was assessment of the frequency of occurrence of cardiovascular risk factors, with particular consideration of arterial blood pressure. The study was conducted among 509 volunteers from Lublin in eastern Poland who participated in the prophylactic programme entitled 'White Sunday'. Standard measurements of blood pressure were performed using a TM-Z dial pressure gauge. The level of arterial blood pressure and socio-demographic parameters were analyzed. Hypertension was more frequently observed in the group of males than females. The age group especially vulnerable to abnormal blood pressure values were those aged 51-60. Isolated hypertension significantly more often occurred in the group of respondents who mentioned hypertension in an interview, compared to those who reported its absence. Among 367 persons who, in preliminary interview, did not declare hypertension, 60 cases of isolated arterial hypertension were noted (16.3%). From among respondents who declared absence of hypertension in an interview, the largest age group diagnosed with isolated arterial hypertension were those aged 61-70 (17.9%). Arterial hypertension is a civilisation disease which may be effectively prevented, simultaneously reducing the risk of premature death due to cardiovascular events, as well as reducing social and economic costs. International health organizations recommend the implementation of social screening programmes in order to diagnose high blood pressure and the promotion of routine measurements of arterial blood pressure.

Relationship between cardiovascular parameters and body mass index in perimenopausal women

Introduction: Cardiovascular disease (CVD) is the most common cause of death in women worldwide. Estrogen deficiency due to menopause is associated with an increased risk of this pathology. Objective: To analyze cardiovascular risk factors in perimenopausal women with at least one major modifiable cardiovascular risk factor (diabetes, hypertension, dyslipemia) between the ages of 45 and 60 of two urban primary care services. Methodology: Cross-sectional descriptive study in two health centers in the city of Ourense (Novoa Santos Health Center and A Ponte Health Center). The variables analyzed were: estrogenic activity, pharmacological treatment, smoking habit, quality of life, body mass index (BMI), total cholesterol, high density lipoprotein (cHDL), low-density lipoprotein (cLDL) and triglycerides, systolic blood pressure (TAS), diastolic blood pressure (TAD), heart rate (FC). The study was approved by the Ethics Committee of Galicia. Data analysis was performed through the free R software. Results: 316 women participated, of whom 64.9% were menopausal. The average age of the sample was 53.35 ± 4.35 years. The average BMI value was 28,125 ± 5.54 Kg/m2. 27.8% said they had a smoking habit. 77.2% of the women in the sample had total cholesterol levels ≥200 mg/dL. In relation to the cLDL, in 72.6% of the population studied it was ≥130 mg/dL. A statistically significant correlation was observed between BMI and triglyceride, cHDL, TAS, TAD and FC levels. Conclusion: Perimenopausal women had a high prevalence of smoking habit, obesity and overweight, despite suffering at least one cardiovascular risk factor. On the other hand they showed a low quality of life in both the physical and mental dimension

Relationship of Annual Health Checkups with the Subject's Subsequent Behavior of Cardiovascular Risk Management in a Real-World Setting in Japan: A Retrospective Cohort Study on Changes in Antihypertensive Drug Prescription and Blood Pressure from 2015 to 2017.

BackgroundIn Japan, workers receive a health checkup annually, and based on the results, a follow-up health guidance or intervention is provided when deemed necessary. However, it remains unclear whether the current real-world health checkup and guidance programs in Japan successfully lead to behavioral changes or improvement of clinical outcomes in individuals who require cardiovascular (CV) risk management.ObjectiveThis study aimed to explore the association between health checkup and the subsequent behavior change in CV risk management in subjects with uncontrolled blood pressure (BP) without antihypertensive drug prescription, who can have increased risk of CV events.Patients and MethodsThis was a retrospective cohort study that used health-checkup and claims data from a Japanese healthcare database managed by MinaCare Co., Ltd. Of those aged 20–74 years with available data on systolic and diastolic BP from 2015 to 2017, data from individuals with uncontrolled BP who were not prescribed antihypertensive drugs within 6 months before their baseline health checkup in 2015 were extracted and analyzed. The primary outcome measures were changes in antihypertensive drug prescription and BP control status based on health-checkup results from the baseline year (2015) to 2017. CV risk-management behavior was also assessed using body mass index (BMI) and smoking status, as these are the major modifiable CV risk factors.ResultsAmong 39,242 subjects with uncontrolled BP without antihypertensive drug prescription at baseline, 88.9% remained without prescription in 2016. Of the subjects without prescription, 62.9% continued to have uncontrolled BP. Both statuses of the major modifiable CV risk factors remained unchanged in 2016: 92.1% of obese subjects (BMI ≥ 25 kg/m2) at baseline remained obese, and 93.8% of smokers at baseline aged ≥ 40 years continued to smoke. Logistic regression analysis revealed that age 60–69 years (vs. 40–49 years), hypertension (HT) stage II (vs. stage I), HT stage III (vs. stage I), and BMI ≥ 25.0 kg/m2 (vs. < 25.0 kg/m2) were factors associated with uncontrolled BP in 2016 (subsequent year), regardless of antihypertensive drug prescription.ConclusionsUntreated HT for years increases the risk of CV events. These results suggest that current health-checkup and guidance programs are inadequately effective for behavioral change. Further practices for committing to lifestyle modifications and seeking medical advice based on their health-checkup results need to be undertaken to improve health behavior.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-020-00224-5.

Correlation between echocardiographic left ventricular mass and atherogenic index of plasma in adult hypertensive subjects in Olabisi Onabanjo university teaching hospital, Sagamu

Background: Hypertension and dyslipidaemia are two major modifiable cardiovascular risk factors with their co-existence having more than an additive effect on endothelial function causing atherosclerosis. The purpose of this study was to determine the prevalence of dyslipidaemia in hypertensive subjects and to determine its relationship left ventricular hypertrophy.Methods: The study was a cross-sectional comparative one involving 120 hypertensive participants with LVH (subjects) and 60 age and sex-matched hypertensive participants without LVH (controls). Detailed history, physical examination, fasting lipid profile test, and echocardiogram were carried out on all participants.Results: The overall prevalence rate of dyslipidaemia in the study was 61.1%. The prevalence of dyslipidaemia in subjects (60.8%) was slightly lower than in controls (61.7%), though the difference was not statistically significant (p=0.914). The most common isolated lipid abnormality in the study was elevated serum LDL-C (55% in subjects, 46.7% in controls), though the difference did not achieve statistical significance (p= 0.370). The mean atherogenic index of plasma (AIP) was significantly higher in the subjects (0.34+0.23) than in the controls (0.22+0.28) (p=0.001). There was a positive correlation between echocardiographic left ventricular mass and AIP (r=0.298, p=0.001).Conclusion: There is a high prevalence of dyslipidaemia among hypertensive adults. There is also a positive correlation between echocardiographic left ventricular mass and AIP among adult hypertensive subjects.

Proprotein convertase subtilisin/kexin type 9: an update on the cardiovascular outcome studies.

Inhibitors of the 3-hydroxy-3-methylglutaryl coenzyme A reductase enzyme, statins, are powerful cholesterol-lowering medications and have provided outstanding contributions to the primary and secondary prevention of coronary heart disease. Low-density lipoprotein cholesterol (LDL-C) is one of the major modifiable cardiovascular risk factors, indeed, every 1.0 mmol/L (38.7 mg/dL) reduction in LDL cholesterolaemia corresponds to a 21% lowering in the risk of major vascular events. In this context, the pharmacological approach with PCSK9 monoclonal antibodies is considered a promising non-statin therapeutic option for the management of lipid disorders in patients with persistent cardiovascular risk, including patients with diabetes mellitus. Data from two large clinical trials have indisputably demonstrated the efficacy of alirocumab and evolocumab in preventive major adverse cardiovascular events in high risk, secondary-prevention patients with clinical manifestation of atherosclerotic cardiovascular diseases. Finally, PCSK9 monoclonal antibodies did not increase the risk of serious adverse events, neurocognitive events, new-onset of diabetes, muscle-related events, or myalgia.

Higher hemoglobin A1C and atherogenic lipoprotein profiles in children and adolescents with type 2 diabetes mellitus

AimSignificant knowledge gaps exist regarding lipoprotein profiles in children with type 2 diabetes mellitus (T2DM). The primary objective was to analyze the type and nature of lipoprotein abnormalities present in children with T2DM and to identify determinants of adverse lipoprotein profiles. The secondary objective was to assess associations with elevated glycated hemoglobin (HbA1C), i.e., <8% vs. ≥8.0% and pediatric dyslipidemias in the setting of T2DM. MethodsThis retrospective chart review included children with T2DM who had undergone lipoprotein analysis and were not on lipid lowering medications (n = 93). ResultsThe participants (mean age 15.2 ± 2.7y) were 71% female and 78% African American (AA). Adjusted for age, sex, and race, BMI z-score was positively associated with LDL-pattern B (pro-atherogenic profile with small dense LDL particles) (P = 0.01), and negatively associated with total HDL-C (P = 0.0003). HbA1C was robustly positively associated with the LDL-C, apoB and LDL pattern B (all P < 0.001). Patients with an HbA1C >8% had significantly higher total cholesterol (191.4 vs. 158.1 mg/dL, P = 0.0004), LDL-C (117.77 vs. 92.3 mg/dL, P = 0.002), apoB (99.5 vs. 80.9 mg/dL, P = 0.002), non-HDL-C (141.5 vs. 112.5, P = 0.002), and frequency of LDL pattern B (57% vs. 20%, P = 0.0008). ConclusionHbA1C and BMI were associated with adverse lipoprotein profiles, and may represent two major modifiable cardiovascular risk factors in the pediatric T2DM population. Patients with an HbA1C higher than 8.0% had significantly worse atherogenic lipid profile, i.e., higher LDL-C, non-HDL-C, apoB and LDL pattern B, suggesting adequate glycemia may improve adverse lipoprotein profiles.

Hypertensive Urgency and Crisis: Aetiology, Management, and Outcome

Background: Hypertensive crisis (HC) is a common clinical presentation and hypertension is a major modifiable cardiovascular risk factor. Management includes several effective blood pressure (BP)-lowering strategies, prevention of target-organ dysfunction, and further cardiovascular disease risk assessment.

Pattern and clinical correlates of lipid disorders in patients with cardiovascular risk factors in Yaoundé

Dyslipidemia is a major modifiable cardiovascular risk factor for atherosclerosis and cardiovascular diseases and it is closely related to other cardiovascular risk factors. This study was designed to investigate the pattern and clinical correlates of dyslipidemia in patients with cardiovascular risk factors. It was a cross sectional analytic study conducted in outpatient cardiology unit in 3 reference hospitals in Yaoundé, Cameroon. Five hundred and five subjects with either type 2 diabetes, hypertension, current tobacco smoking and/or obesity were recruited. Relevant history, clinical examinations and laboratory tests were recorded. Dyslipidemia was identified based on serum lipids levels following the standards proposed by the National Cholesterol Education Program Adult Treatment Panel III. The prevalence of dyslipidemia (at least one abnormal lipid parameter) was 65.6%. High TC constituted the highest abnormality (47.5%) followed by high LDL-C (41.6%), low HDL-C (20.7%) and high TG (17.9%). After grouping the subjects according to the number of risk factors, the prevalence of dyslipidemia and low HDL-C increased with the number of risk factors present but there was no significant change in prevalence of high TC, high LDL-C and high TG. Low HDL was significantly associated with male sex and had an inverse correlation with waist–hip ratio. The prevalence of dyslipidemia was very high in these patients who already have other cardiovascular risk factors. Emphasis should be laid on prevention, screening and treatment to control lipid disorders.

Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials

Exercise interventions apparently reduce the risks of and prevent coronary artery disease (CAD). Developing an exercise intervention for patients with CAD is a rapidly expanding focus worldwide. The results of previous studies are inconsistent and difficult to interpret across various types of exercise programme. This study aimed to update prior systemic reviews and meta-analyses in order to determine the overall effects of endurance exercise training on patients with CAD. The databases (PubMed, Medline, CINAHL, EMBASE and Cochrane Library) were searched for the interventions published between January 1, 2000, and May 31, 2015. Comprehensive meta-analysis software was used to evaluate the heterogeneity of the selected studies and to calculate mean differences (MDs) while considering effect size. A total of 18 studies with 1286 participants were included. Endurance exercise interventions at a moderate to high training intensity significantly reduced resting systolic blood pressure (MD: -3.8 mmHg, p = 0.01) and low-density lipoprotein cholesterol (MD: -5.5 mg/dL, p = 0.02), and increased high-density lipoprotein cholesterol (MD: 3.8 mg/dL, p < 0.001). There were also significant positive changes in peak oxygen consumption (MD: 3.47 mL/kg/min, p < 0.001) and left ventricular ejection fraction (MD: 2.6%, p = 0.03) after the interventions. Subgroup analysis results revealed that exercise interventions of 60-90 minutes per week with a programme duration of >12 weeks had beneficial effects on functional capacity, cardiac function and a number of cardiovascular risk factors. Endurance exercise training has a positive effect on major modifiable cardiovascular risk factors and functional capacity. Nurses can develop endurance exercise recommendations for incorporation into care plans of clinically stable CAD patients following an acute cardiac event or revascularisation procedure.

Improving cardiovascular prevention in general practice: Results of a comprehensive personalized strategy in subjects at high risk.

Although high cardiovascular risk patients should be the main target of preventive strategies, modifiable risk factors are often inadequately controlled. To assess feasibility and results of a comprehensive personalized method for cardiovascular prevention in high risk patients followed by their general practitioner. Between 2004 and 2007, 12,513 patients (mean age 64.0 ± 9.5 years; 61.5% males) with multiple cardiovascular risk factors or history of atherosclerotic disease were identified and followed for five years. If control of major modifiable cardiovascular risk factors (hypertension, hypercholesterolaemia, diabetes, obesity, smoking, unhealthy diet, physical inactivity) was sub-optimal, at baseline and yearly thereafter general practitioners planned with patients, with the help of a brief checklist, preventive interventions to improve the global risk profile. Main outcome was the control of the seven major modifiable cardiovascular risk factors during follow-up. Secondary outcome was the incidence of cardiovascular deaths and hospitalization for cardiovascular reasons according to the improvement in global cardiovascular risk profile during the first year. Control of all major modifiable risk factors except physical inactivity improved gradually and significantly (p < 0.0001) during follow-up.The improvement in the global cardiovascular risk profile during the first year was independently and significantly associated with a lower rate of major cardiovascular events in the following years (hazard ratio 0.939; 95% confidence interval 0.887-0.994, p = 0.03). Our comprehensive, personalized method for cardiovascular risk prevention in people at high risk appears feasible in general practice. The improvement in the global cardiovascular risk profile was associated with a better prognosis.

Thiazide Diuretics in Chronic Kidney Disease.

Widely prevalent in the general population, chronic kidney disease (CKD) is frequently complicated with hypertension. Control of hypertension in this high-risk population is a major modifiable cardiovascular and renal risk factor but often requires multiple medications. Although thiazides are an attractive agent, guidelines have previously recommended against thiazide use in stage 4 CKD. We review the updated guidelines on thiazide use in advanced CKD, the antihypertensive mechanism of thiazides, and the clinical studies of thiazides in CKD. Older uncontrolled studies have shown that metolazone reduces blood pressure in CKD, but more recently small randomized controlled trials of hydrochlorothiazide in CKD have shown significant improvement in mean arterial pressure of 15mmHg. Two recent uncontrolled studies of chlorthalidone including one that used ambulatory blood pressure monitoring found significant improvements in blood pressure. These findings all suggest that thiazides may be efficacious even in advanced CKD; however, electrolyte abnormalities were common in the studies reviewed so close monitoring is necessary during use. Adequately powered randomized trials are now needed before the routine use of thiazide diuretics in advanced CKD can be recommended.

Abstract 17011: Gender Differences in the Cardiovascular Risk Factors in First acute myocardial infarction in a Middle Eastern Country over a 20-year period

Introduction: Coronary artery disease (CAD) is a global health problem and a leading cause of death worldwide. Hypothesis: In Middle East, the rate of CAD is expected to rise in parallel with the increase in per capita income and cardiovascular risk factors (CVRFs) burden. The present study evaluates temporal trends in CVRFs stratified by gender over a 20-year period in Qatar. Methods: All patients hospitalized with first acute myocardial infarction (AMI) during the study period were analyzed and compared in 2 groups: group 1 (1991-2000) and group 2 (2001-2010). Results: Among 10,915 patients who were admitted with first AMI, 9610 (88%) were men and 1305 (12%) were women. The overall mean age was 52.7±11.8 years. The overall rate of hospitalization increased from 34% to 66% (p&lt;0.001), representing a relative increase by 48%.The proportion of men to women remained relatively constant.During the study period. most of the measured CVRFs have shown a steady upward trend in both sexes. Compared to men, women were older, had a higher burden of CVRFs and presented mainly with non-ST-elevation MI. However, in comparison to group 1, women in group 2 had significant increases in the prevalence of dyslipidemia and obesity. Multivariate logistic regression analysis showed that female gender was independent predictor of in-hospital mortality (odd ratio 1.92, 95% CI 1.60-2.77). Conclusions: Over the study period, the rate hospitalization increased by nearly half, this potentially could be explained by the unfavorable alteration in the major modifiable CVRFs. Furthermore, women with acute myocardial infarction represent a higher risk group.

Benchmarking Is Associated With Improved Quality of Care in Type 2 Diabetes

OBJECTIVETo assess prospectively the effect of benchmarking on quality of primary care for patients with type 2 diabetes by using three major modifiable cardiovascular risk factors as critical quality indicators.RESEARCH DESIGN AND METHODSPrimary care physicians treating patients with type 2 diabetes in six European countries were randomized to give standard care (control group) or standard care with feedback benchmarked against other centers in each country (benchmarking group). In both groups, laboratory tests were performed every 4 months. The primary end point was the percentage of patients achieving preset targets of the critical quality indicators HbA1c, LDL cholesterol, and systolic blood pressure (SBP) after 12 months of follow-up.RESULTSOf 4,027 patients enrolled, 3,996 patients were evaluable and 3,487 completed 12 months of follow-up. Primary end point of HbA1c target was achieved in the benchmarking group by 58.9 vs. 62.1% in the control group (P = 0.398) after 12 months; 40.0 vs. 30.1% patients met the SBP target (P < 0.001); 54.3 vs. 49.7% met the LDL cholesterol target (P = 0.006). Percentages of patients meeting all three targets increased during the study in both groups, with a statistically significant increase observed in the benchmarking group. The percentage of patients achieving all three targets at month 12 was significantly larger in the benchmarking group than in the control group (12.5 vs. 8.1%; P < 0.001).CONCLUSIONSIn this prospective, randomized, controlled study, benchmarking was shown to be an effective tool for increasing achievement of critical quality indicators and potentially reducing patient cardiovascular residual risk profile.

Guide to the Assessment of Physical Activity: Clinical and Research Applications

The deleterious health consequences of physical inactivity are vast, and they are of paramount clinical and research importance. Risk identification, benchmarks, efficacy, and evaluation of physical activity behavior change initiatives for clinicians and researchers all require a clear understanding of how to assess physical activity. In the present report, we have provided a clear rationale for the importance of assessing physical activity levels, and we have documented key concepts in understanding the different dimensions, domains, and terminology associated with physical activity measurement. The assessment methods presented allow for a greater understanding of the vast number of options available to clinicians and researchers when trying to assess physical activity levels in their patients or participants. The primary outcome desired is the main determining factor in the choice of physical activity assessment method. In combination with issues of feasibility/practicality, the availability of resources, and administration considerations, the desired outcome guides the choice of an appropriate assessment tool. The decision matrix, along with the accompanying tables, provides a mechanism for this selection that takes all of these factors into account. Clearly, the assessment method adopted and implemented will vary depending on circumstances, because there is no single best instrument appropriate for every situation. In summary, physical activity assessment should be considered a vital health measure that is tracked regularly over time. All other major modifiable cardiovascular risk factors (diabetes mellitus, hypertension, hypercholesterolemia, obesity, and smoking) are assessed routinely. Physical activity status should also be assessed regularly. Multiple physical activity assessment methods provide reasonably accurate outcome measures, with choices dependent on setting-specific resources and constraints. The present scientific statement provides a guide to allow professionals to make a goal-specific selection of a meaningful physical activity assessment method.

Risk Factor Control for Coronary Artery Disease Secondary Prevention in Large Randomized Trials

This study evaluated data from 3 federally funded trials that focused on optimal medical therapy to determine if formalized attempts at risk factor control within clinical trials are effective in achieving guideline-driven treatment goals for diabetic patients with coronary artery disease (CAD). Despite clear evidence of benefit for CAD secondary prevention, the level of risk factor control in clinical practice has been disappointing. We obtained data from the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) diabetes subgroup, (n = 766 of 2,287), the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (n = 2,368), and the FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900) to evaluate the proportion of patients achieving guideline-based, protocol-driven treatment targets for systolic blood pressure, low-density lipoprotein cholesterol, smoking cessation, and hemoglobin A1c. The primary outcome measure was the proportion of diabetic CAD patients meeting all 4 pre-specified targets at 1 year after enrollment. The pooled data include 5,034 diabetic patients. The percentages of patients achieving the 1-year low-density lipoprotein cholesterol targets compared with baseline increased from 55% to 77% in COURAGE, from 59% to 75% in BARI 2D, and from 34% to 42% in FREEDOM. Although similar improved trends were seen for systolic blood pressure, glycemic control, and smoking cessation, only 18% of the COURAGE diabetes subgroup, 23% of BARI 2D patients, and 8% of FREEDOM patients met all 4 pre-specified treatment targets at 1 year of follow-up. A significant proportion of diabetic CAD patients fail to achieve pre-specified targets for 4 major modifiable cardiovascular risk factors in clinical trials. We conclude that fundamentally new thinking is needed to explore approaches to achieve optimal secondary prevention treatment goals. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657) (Bypass Angioplasty Revascularization Investigation 2 Diabetes [BARI 2D]; NCT00006305) (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450).

Atorvastatin calcium plus amlodipine for the treatment of hypertension

Introduction: Hypertension (HTN) and dyslipemia (DYL) are two of the major modifiable cardiovascular (CV) risk factors, determinants in the development of cerebrovascular and coronary heart disease (CHD). Many patients have both risk factors which increase their total CV risk compared with patients with only one risk factor. Treatment guideline recommendations are poorly implemented in real practice, in part due to numerous and complicated drug regimes which hamper patient´s adherence.Areas covered: In this article the authors describe the first combined fixed-dose pill of an antihypertensive and a lipid-lowering agent, the single-pill combination of amlodipine besylate and atorvastatin calcium (SPAA). They summarize the pharmacokinetic and pharmacodynamic properties of both compounds and the main randomized clinical studies, as well as real-world observational studies, made with the new combined formulation.Expert opinion: The use of the single-pill amlodipine and atorvastatin is an adequate option for the clinician to treat hypertensive patients with DYL or high CV risk burden, with proven efficacy, tolerability, cost-effectiveness, and the advantage of improving patient treatment compliance.

Childhood Physical, Environmental, and Genetic Predictors of Adult Hypertension

Background— Hypertension is a major modifiable cardiovascular risk factor. The present longitudinal study aimed to examine the best combination of childhood physical and environmental factors to predict adult hypertension and furthermore whether newly identified genetic variants for blood pressure increase the prediction of adult hypertension. Methods and Results— The study cohort included 2625 individuals from the Cardiovascular Risk in Young Finns Study who were followed up for 21 to 27 years since baseline (1980; age, 3–18 years). In addition to dietary factors and biomarkers related to blood pressure, we examined whether a genetic risk score based on 29 newly identified single-nucleotide polymorphisms enhances the prediction of adult hypertension. Hypertension in adulthood was defined as systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥85 mm Hg or medication for the condition. Independent childhood risk factors for adult hypertension included the individual's own blood pressure ( P &lt;0.0001), parental hypertension ( P &lt;0.0001), childhood overweight/obesity ( P =0.005), low parental occupational status ( P =0.003), and high genetic risk score ( P &lt;0.0001). Risk assessment based on childhood overweight/obesity status, parental hypertension, and parental occupational status was superior in predicting hypertension compared with the approach using only data on childhood blood pressure levels (C statistics, 0.718 versus 0.733; P =0.0007). Inclusion of both parental hypertension history and data on novel genetic variants for hypertension further improved the C statistics (0.742; P =0.015). Conclusions— Prediction of adult hypertension was enhanced by taking into account known physical and environmental childhood risk factors, family history of hypertension, and novel genetic variants. A multifactorial approach may be useful in identifying children at high risk for adult hypertension.