Measurement Of Traditional Risk Factors Research Articles

Aerobic fitness thresholds to define poor cardiometabolic health in children and youth.

Aerobic fitness is an apparent candidate for screening children and youth for poor cardiometabolic health and future risk of cardiovascular disease (CVD). Yet, age- and sex-specific cut points for children and youth determined using a maximal protocol and directly measured peak oxygen consumption (VO2peak ) does not exist. We used a nationally representative sample of 1462 Norwegian children and youth (788 boys and 674 girls aged 8.7-10.4years and 14.7-16.7years) who in 2005-2006 performed a maximal cycle ergometer test with direct measurement of VO2peak , along with measurement of several other risk factors for CVD (systolic blood pressure, waist circumference:height ratio, total:high-density lipoprotein cholesterol ratio, triglycerides, Homeostasis Model Assessment for Insulin Resistance). Based on the proportion of children having clustering (least favorable quartile) of 6 (1.6%), ≥5 (5.2%), and ≥4 (10.6%) CVD risk factors, we established the 2nd, 5th, and 10th percentile cut points for VO2peak (mL/kg/min) for children and youth aged 8-18years. Classification accuracy was determined using the Kappa coefficient (k), sensitivity, and specificity. For boys, the 2nd, 5th, and 10th percentile VO2peak cut points were 33.6-36.4, 36.3-39.8, and 38.7-43.0mL/kg/min, respectively. For girls, the corresponding cut points were 29.7-29.1, 32.4-31.4, and 34.8-33.5mL/kg/min Together with BMI, but without more invasive measures of traditional risk factors for CVD, these cut points can be used to screen schoolchildren for poor cardiometabolic health with moderate discriminating ability (k≤0.53).

Accelerated coronary atherosclerosis not explained by traditional risk factors in 13% of young individuals

Most individuals who die of sudden cardiac death (SCD) display very advanced lesions of atherosclerosis in their coronary arteries. Thus, we sought to identify and characterize a putative subpopulation of young individuals exhibiting accelerated coronary artery atherosclerosis. Our analysis of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study-which examined 2651 individuals, obtaining quantitative measurements of traditional risk factors for coronary heart disease (CHD)-aimed to identify individuals with advanced coronary artery lesions, and to determine whether risk factors could account for such rapid disease progression, or not. Using the cross-sectional PDAY study data, an exploratory de facto analysis stratified the population by age and observed number of coronary raised lesions and examined these groups via Poisson regression modeling. A separate de novo approach utilized Poisson mixture modeling to generate low- and high-growth groups based on measurements of traditional risk factors, and identified factors contributing to disease progression. Participants, n = 2651 individuals aged 15-34, who had died of non-cardiac death, were recruited post mortem. Tissues and other samples were harvested for analysis (details in previously published PDAY studies). Main Outcome(s) and Measure(s). Using quantitative measurements of raised coronary lesions and traditional risk factors of CHD, we sought to identify which risk factors account for disease progression. A group of ~13% of the PDAY population exhibits accelerated coronary atherosclerosis despite their young age. Several traditional risk factors were associated with increased odds of inclusion in this subgroup, reflecting current understanding of these markers of disease. However, only age was a significant contributing factor to the observed coronary lesion burden. While a range of traditional risk factors contribute to an individual's inclusion to the identified subgroup with accelerated atherosclerosis, these factors, with the exceptions of age, are not able to predict an individual's lesion burden. Moreover, unattributed variances in observations indicate the need to study novel risk factors. Hypothesis The extent of coronary atherosclerotic disease is limited and homogeneous within youth, and its progression can be accounted for by traditional risk factors in this population. A subpopulation (~13%) of the Pathobiological Determinants of Atherosclerosis in Youth cohort exhibited accelerated coronary artery atherosclerosis. While several traditional risk factors contribute to an individual's inclusion in this subgroup, these factors, with the exceptions of age, do not predict accurately an individual's lesions burden. Critically, unattributed variances in observations indicate the need for the identification of novel risk factors. Screening of the general population at a young age for high-risk group membership could provide opportunity for disease prevention and avoidance of the worse complications such as myocardial infarction and sudden cardiac death later in life.

Breast Arterial Calcification: Expanding the Reach of Cardiovascular Prevention.

A large proportion of cardiovascular events occur among women whose 10-year estimated atherosclerotic cardiovascular disease risk is <7.5%, and thus guidelines would not routinely recommend statins for such patients before their events.1 Additional strategies beyond the measurement of traditional risk factors are therefore needed to identify women who might benefit from medical therapy, based on unexpected higher risk. Coronary artery calcium (CAC) seen on a noncontrast chest computed tomogram is the most potent marker of subclinical cardiovascular disease (CVD), and has been shown to enhance risk prediction in women.1 However, CAC testing is usually not covered by insurance companies, limiting its widespread use as a screening tool for subclinical CVD. Given that millions of women undergo mammograms each year, there has been growing interest in whether the presence of breast arterial calcification (BAC), which is easily detected on a standard mammogram, could help inform cardiovascular risk assessment. Unlike CAC, which represents calcification in the intima, BAC is found along the circumference of the media giving it a tram-track appearance when the burden is severe (Figure). Some studies of BAC described it simply as present versus absent, whereas others attempted to use a semiquantitative assessment based on the density and extent of calcium in each artery, and the number of arteries involved.2 BAC prevalence varies widely depending on the population’s age and comorbidities, ranging from 10% to 12% in healthier population-based cohort studies, to 60% to 70% among women >70 years of age or with chronic kidney disease.2 BAC is thought to develop primarily through pathways related to mineral metabolism and bone formation, but there may be a role for inflammation as well. Although traditional cardiovascular risk factors such as age, hypertension, and diabetes mellitus are associated with BAC presence, BAC has an inverse association with …

A novel association of adenosine deaminase with paroxysmal atrial fibrillation: a propensity score analysis from a case-control study.

Prior work has identified age, body mass index, underlying heart disease, and other comorbidities as risk factors for atrial fibrillation. To date, studies have examined single baseline measures of traditional risk factors, and data on biomarker associations are lacking. We sought to explore novel biochemical measures possibly associated with incident PAF after balancing the traditional risk factors. Men or women aged ≥18 years that were hospitalized between 1(st) Jan. 2010 and 31(st) Dec. 2013 for paroxysmal atrial fibrillation (PAF) and for health checkup (non-PAF) were included. We used propensity score methods to mitigate the influence of the nonrandom selection of PAF and non-PAF patients. Logistic regression was applied for analysis of risk factors for PAF. A total of 1,802 eligible patients were identified, in whom, 895 patients had at least one exclusion criterion. After excluding these patients, the total analytic cohort numbered 907 patients. Of these, 779 patients were for control group and 128 patients were for PAF group. Propensity score matching was used to obtain a balanced cohort of 124 patients per group. The PAF and non-PAF groups were well matched on demographic and clinical characteristics after propensity matching. Risk factors for PAF on multivariate stepwise logistic regression model included adenosine deaminase (ADA) [odds ratio (OR) =0.9160, P=0.015, 95% confidence interval (CI): 0.8536-0.9829], mitral valvular regurgitation (OR =3.4611, P=0.001, 95% CI: 1.7000-7.0467) and left atrial diameter (OR =1.0913, P=0.001, 95% CI: 1.0387-1.1465). Only the ADA was a protective factor for the occurrence of PAF. The ADA seems to be associated with PAF. The current study provides new insights into the prevention and treatment of PAF.

Prognostic Value of Frontal QRS-T Angle in Patients Without Clinical Evidence of Cardiovascular Disease (from the Multi-Ethnic Study of Atherosclerosis)

Abnormal frontal QRS-T angle on a 12-lead electrocardiogram is associated with incident coronary heart disease and total mortality in a biracial cohort, but there have been no studies to date examining QRS-T angle's prognostic value across multiple ethnicities. We studied 6,814 participants (52.7% women, mean age 62 years) from Multi-Ethnic Study of Atherosclerosis, a multiethnic cohort aged 45 to 84 years free of clinical cardiovascular disease (CVD) at enrollment. Baseline examination included measurement of traditional risk factors and 12-lead electrocardiograms. Frontal QRS-T axis was defined as normal (less than seventy-fifth percentile), borderline (seventy-fifth to ninety-fifth percentile), or abnormal (ninety-fifth percentile or more), and participants were followed for the composite end point of incident CVD events: cardiovascular death, myocardial infarction, angina pectoris, or heart failure. After 7.6years of follow-up, there were 444 total events. Borderline (HR [hazard ratio] 1.37, 95% confidence interval [CI] 1.10 to 1.70) and abnormal QRS-T angles (HR 2.2, 95% CI 1.63 to 2.97) were associated with incident CVD events in multivariate-adjusted models. However, after adjusting for T-wave abnormalities, there was no statistically significant association of either borderline (HR 1.12, 95% CI 0.90 to 1.41) or abnormal (HR 1.31, 95% CI 0.93 to 1.84) QRS-T angle with incident CVD events. Abnormal frontal QRS-T angle predicts incident CVD events in a multiethnic population, and this increased risk is primarily mediated through T-wave abnormalities. QRS-T angle provides an easily interpretable continuous marker of abnormal ventricular repolarization that can aid the everyday clinician in risk prediction.

Association of isolated minor non-specific ST-segment and T-wave abnormalities with subclinical atherosclerosis in a middle-aged, biracial population: Coronary Artery Risk Development in Young Adults (CARDIA) study

Isolated minor non-specific ST-segment and T-wave abnormalities (NSSTTAs) are common and known to be independent electrocardiographic risk markers for future cardiovascular disease (CVD) events. The association of NSSTTA with subclinical atherosclerosis is not well defined, but has been postulated as a potential mechanism of association with future clinical events. We studied participants from the Year 20 examination of the middle-aged, biracial CARDIA cohort. This examination included measurement of traditional risk factors, 12-lead electrocardiograms (ECGs), coronary artery calcium (CAC) measurement and common carotid intima-media thickness (CC-IMT). ECGs were coded using both Minnesota Code (MC) and Novacode (NC) criteria. Isolated minor STTA was defined by MC as presence of MC 4-3, 4-4, 5-3, or 5-4, and by NC as presence of NC 5.8. ECGs with secondary causes of STTA (i.e., LVH) were excluded. Multivariable logistic regression was used to determine the cross-sectional association of isolated minor NSSTTAs with CAC and CC-IMT. The study sample consisted of 2175 participants with an average age of 45 years (57% female and 43% Black). Isolated NSSTTAs were present in 5.1% of males and 6.3% of females. No association was observed between NSSTTA and CAC. After multivariable-adjustment for traditional CVD risk factors, the presence of isolated minor NSSTTAs remained significantly associated with the extent of CC-IMT (odds ratio 1.25 (1.06-1.48), p < 0.01). This association remained significant after further adjustment for CAC. Isolated minor NSSTTAs were associated with the extent of CC-IMT, but not with CAC, in this middle-aged biracial cohort. Further study is needed to elucidate potential mechanisms for these findings.

Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study – effect of ethnicity on risk

Background/Aim:People of south Asian origin have an excessive risk of morbidity and mortality from cardiovascular disease. We examined the effect of ethnicity on known risk factors and analysed the risk of cardiovascular events and mortality in UK south Asian and white Europeans patients with type 2 diabetes over a 2 year period.Methods:A total of 1486 south Asian (SA) and 492 white European (WE) subjects with type 2 diabetes were recruited from 25 general practices in Coventry and Birmingham, UK. Baseline data included clinical history, anthropometry and measurements of traditional risk factors – blood pressure, total cholesterol, HbA1c. Multiple linear regression models were used to examine ethnicity differences in individual risk factors. Ten-year cardiovascular risk was estimated using the Framingham and UKPDS equations. All subjects were followed up for 2 years. Cardiovascular events (CVD) and mortality between the two groups were compared.Trial registration number:ISRCTN 38297969.Findings:Significant differences were noted in risk profiles between both groups. After adjustment for clustering and confounding a significant ethnicity effect remained only for higher HbA1c (0.50 [0.22 to 0.77]; P = 0.0004) and lower HDL (−0.09 [−0.17 to −0.01]; P = 0.0266). Baseline CVD history was predictive of CVD events during follow-up for SA (P < 0.0001) but not WE (P = 0.189). Mean age at death was 66.8 (11.8) for SA vs. 74.2 (12.1) for WE, a difference of 7.4 years (95% CI 1.0 to 13.7 years), P = 0.023. The adjusted odds ratio of CVD event or death from CVD was greater but not significantly so in SA than in WE (OR 1.4 [0.9 to 2.2]).Limitations:Fewer events in both groups and short period of follow-up are key limitations. Longer follow-up is required to see if the observed differences between the ethnic groups persist.Conclusion:South Asian patients with type 2 diabetes in the UK have a higher cardiovascular risk and present with cardiovascular events at a significantly younger age than white Europeans. Enhanced and ethnicity specific targets and effective treatments are needed if these inequalities are to be reduced.

Prevalence of electrocardiographic abnormalities in a middle-aged, biracial population: Coronary Artery Risk Development in Young Adults study

BackgroundFew studies to date have described the prevalence of electrocardiographic (ECG) abnormalities in a biracial middle-aged cohort. Methods and ResultsParticipants underwent measurement of traditional risk factors and 12-lead ECGs coded using both Minnesota Code and Novacode criteria. Among 2585 participants, of whom 57% were women and 44% were black (mean age 45 years), the prevalence of major and minor abnormalities was significantly higher (all P < .001) among black men and women compared to whites. These differences were primarily due to higher QRS voltage and ST/T-wave abnormalities among blacks. There was also a higher prevalence of Q waves (Minnesota Code 1-1, 1-2, 1-3) than described by previous studies. These racial differences remained after multivariate adjustment for traditional cardiovascular (CV) risk factors. ConclusionsBlack men and women have a significantly higher prevalence of ECG abnormalities, independent of traditional cardiovascular risk factors, than whites in a contemporary cohort of middle-aged participants.

Association of Electrocardiographic Abnormalities With Coronary Artery Calcium and Carotid Artery Intima–Media Thickness in Individuals Without Clinical Coronary Heart Disease (from the Multi-Ethnic Study of Atherosclerosis [MESA

Isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTAs), minor and major electrocardiographic (ECG) abnormalities are established, independent risk markers for incident cardiovascular events. Their association with subclinical atherosclerosis has been postulated but is not clearly defined. The aim of this study was to define the association between ECG abnormalities and measurements of subclinical atherosclerosis. We studied participants from MESA, a multiethnic sample of men and women 45 to 84 years of age and free of clinical cardiovascular disease at enrollment. Baseline examination included measurement of traditional risk factors, 12-lead electrocardiograms at rest, coronary artery calcium (CAC) measurement, and common carotid intima-media thickness (CC-IMT). Electrocardiograms were coded using Novacode criteria and were defined as having minor abnormalities (e.g., minor NSSTTAs, first-degree atrioventricular block, and QRS-axis deviations) or major abnormalities (e.g., pathologic Q waves, major STTAs, significant dysrhythmias, and conduction system delays). Multivariable logistic and linear regressions were used to determine cross-sectional associations of ECG abnormalities with CAC and CC-IMT. Of 6,710 participants, 52.7% were women, with a mean age of 62 years. After multivariable adjustment, isolated minor STTAs and minor and major ECG abnormalities were not associated with presence of CAC (>0) in men (odds ratio 1.04, 95% confidence interval 0.81 to 1.33; 1.10, 0.91 to 1.32; and 1.03, 0.81 to 1.31, respectively) or women (1.01, 0.82 to 1.24; 1.04, 0.87 to 1.23; and 0.94, 0.73 to 1.22, respectively). Lack of association remained consistent when using log CAC and CC-IMT as continuous variables. In conclusion, ECG abnormalities are not associated with markers of subclinical atherosclerosis in a large multiethnic cohort.

Is hsCRP Back on Board? Implications from the JUPITER Trial

In primary prevention, measurement of traditional risk factors is considered a useful first step in determining those at risk for cardiovascular disease (CVD).1 In the era of “global risk assessment,” the use of scores such as the Framingham Risk Score or the European Society of Cardiology SCORE (Systematic Coronary Risk Evaluation), derived from multivariable statistical models, is recommended (1). However, it has been noted that a considerable number of those at risk cannot be identified on the basis of traditional risk factors alone(2), and it has also been shown that these scores are not generally applicable because they lead to overestimation of actual risk in various populations and thus must be adapted to the true background risk of the population. As a consequence of these issues and others, acceptance of the use of these scores in general practice is rather low. Although this situation does not invalidate the concept of traditional risk factors, it highlights some of the inherent problems of the global risk assessment approach. Global risk assessment brings about yet another problem. Application of these algorithms yields an estimation of absolute 10-year risk, which for Framingham Risk Score is considered to be high when higher than 20% and low when it is lower than 6%–10%. For either high- or low-risk individuals, recommendations in the guidelines are clear: reevaluate those at very low risk after 3–5 years, advise lifestyle changes, and eventually prescribe a statin to those at high risk. This leaves an intermediate-risk group, comprising approximately 25%–40% (3) of the total population, for whom there is no guidance regarding what to do. The gap in our preventive strategy has prompted the search for novel biomarkers of cardiovascular risk to help improve risk prediction. Potentially useful biomarkers include various blood biomarkers relevant to the pathophysiology of atherothrombosis, …

Childhood Blood Pressure as a Predictor of Arterial Stiffness in Young Adults

Increased arterial stiffness is an independent predictor of cardiovascular disease and mortality in middle-aged and older adults. However, limited data are available regarding the relationship of arterial stiffness in young adults with risk factors measured in childhood, adulthood, or as a cumulative burden from childhood to adulthood. This aspect was examined in a sample of 835 black and white young adults (72% whites, 44% men) aged 24 to 44 years who had at least 4 measurements of traditional risk factors over an average follow-up period of 26.5 years since childhood. Brachial-ankle pulse wave velocity (baPWV) measured by a simple automatic oscillometric technique was used as an index of arterial stiffness. The cumulative burden of risk factors since childhood was measured as area under the curve divided by follow-up years. In young adults, the baPWV was higher in males versus females (P<0.001) and blacks versus whites (P<0.001). In multiple regression analyses, independent predictors of baPWV in young adults were systolic blood pressure in childhood; systolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and smoking in adulthood; and cumulative burden of systolic blood pressure and triglycerides and duration of smoking years from childhood. Thus, systolic blood pressure beginning in childhood is a consistent predictor of arterial stiffness in free-living, asymptomatic young adults. These findings underscore the importance of childhood blood pressure in the evolution of arterial stiffness and the need for beginning preventive cardiology early in life.

Hostility and Anxiety Differentially Predict Cardiovascular Disease in Men and Women

Consideration of the psychosocial contributions to cardiovascular disease (CVD) remains an ongoing focus of research in the behavioral sciences, with a particular emphasis on the role of hostility. There are, however, a number of inconsistent findings, and the generality of findings across genders remains a continuing concern. This article presents an emotions-theory perspective on the relation between personality and CVD and reports a test of the hypothesis that anxiety predicts CVD in women whereas hostility predicts CVD in men. Six hundred and eighty women and 415 men completed measures of traditional risk factors, emotion, and cardiovascular disease. Structural equation analyses supported our prediction. Data are interpreted in terms of their capacity to inform general psychosocial models of CVD, and implications for gender-specific intervention programs are discussed.

Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study.

Carotid artery intima-media thickness (IMT) is associated with cardiovascular risk factors and is recognized as an important predictive measure of clinical coronary atherosclerosis events in middle-aged and elderly populations. However, information on the association of carotid IMT in young adults with different risk factors measured in childhood, adulthood, or as a cumulative burden of each of the risk factors measured serially from childhood to adulthood is limited. To examine the association between carotid IMT in young adults and traditional cardiovascular risk factors measured since childhood. A cohort study of 486 adults aged 25 to 37 years from a semirural black and white community in Bogalusa, La (71% white, 39% men), who had at least 3 measurements of traditional risk factors since childhood, conducted between September 1973 and December 1996. Association of carotid IMT with risk factors, including systolic blood pressure, lipoprotein levels, and body mass index. Male vs female (0.757 mm vs 0.719 mm) and black vs white (0.760 mm vs 0.723 mm) participants had increased carotid IMT (P<.001 for both). In multivariable analyses, significant predictors for being in top vs lower 3 quartiles of carotid IMT in young adults were childhood measures of low-density lipoprotein cholesterol (LDL-C) level (odds ratio [OR], 1.42, corresponding to 1-SD change specific for age, race, and sex; 95% confidence interval [CI], 1.14-1.78) and body mass index (BMI; OR, 1.25; 95% CI, 1.01-1.54); adulthood measures of LDL-C level (OR, 1.46; 95% CI, 1.16-1.82), high-density lipoprotein cholesterol (HDL-C) level (OR, 0.67; 95% CI, 0.51-0.88), and systolic blood pressure (OR, 1.36; 95% CI, 1.08-1.72); and long-term cumulative burden of LDL-C (OR, 1.58; 95% CI, 1.24-2.01) and HDL-C (OR, 0.75; 95% CI, 0.58-0.97) levels measured serially from childhood to adulthood. An increasing trend in carotid IMT across quartiles of LDL-C level measured in childhood was observed, with a mean value of 0.761 mm (95% CI, 0.743-0.780 mm) for those at the top quartile vs 0.724 mm (95% CI, 0.715-0.734 mm) for those in the lower 3 quartiles (P<.001). Childhood measures of LDL-C level and BMI predict carotid IMT in young adults. The prevention implications of these findings remains to be explored.

Lack of social support and incidence of coronary heart disease in middle-aged Swedish men.

Lack of social support has been found to predict all causes of mortality in population studies. It has often been assumed that the lack of social ties is associated with the general social conditions related to mortality and has little to do with specific disease etiology. So far, the association between lack of support and cardiovascular disease incidence has not been demonstrated. We have measured both emotional support from very close persons ("attachment") and the support provided by the extended network ("social integration"). This measure was applied along with standard measures of traditional risk factors to a random sample of 50-year-old men born in Gothenborg in 1933. All men (n = 736) were followed for 6 years and the incidence of myocardial infarction and death from coronary heart disease (CHD) was determined. Both "attachment" and "social integration" were lower in men who contracted CHD, with a significant effect for social integration (p = 0.04) and an almost significant effect for attachment (p = 0.07). When controlling for other risk factors in multiple logistic regression analyses, both factors remained as significant predictors of new CHD events. Smoking and lack of social support were the two leading risk factors for CHD in these middle-aged men.