Moderate Cardiovascular Disease Risk Research Articles

Evaluation of Antihyperlipidaemic and Cardioprotective Action of a Herbal Formulation

As per WHO, Cardiovascular diseases (CVDs) are the leading cause of death globally. CVDs also impart a huge financial burden and remain a hurdle for sustainable development in low and middle income countries. Hence there is an urgent need to identify individuals with high CVD risk and begin appropriate preventive intervention well in advance. In this study, 60 individuals of either sex, within the age group of 30 – 70 years, having hyperlipidaemia along with more than 10% of CVD risk were identified in lipid screening camps with the help of JBS 3 Heart Risk android application tool. A combination of three well known herbs in capsule form containing 500mg extract of Guggulu (Commiphora mukul), Pushkarmool (Inula racemosa) and Arjuna (Terminalia arjuna) in equal proportion was administered in a dose of 1 capsule twice daily after food with warm water for 3 months to treat hyperlipidaemia. Only 55 participants completed the trial. Different parameters of lipid profile, CVD risk score and biological heart age were compared before and after treatment using appropriate statistical method. The intervention resulted in reduction of total cholesterol by 17.49%, LDL by 21.04%, VLDL by 24.55% and Triglycerides by 24.55% whereas HDL increased by 10.48 %. As a secondary outcome, the mean CVD risk score was reduced by 6.91% and the mean biological heart age was also reduced by 6.64 years. The trial drug was well tolerated and free from adverse effects. Hence the trial drug can offer a safe and effective solution to individuals with hyperlipidaemia and moderate CVD risk.

Effects of Pitavastatin on Coronary Artery Disease and Inflammatory Biomarkers in HIV: Mechanistic Substudy of the REPRIEVE Randomized Clinical Trial.

Cardiovascular disease (CVD) is increased in people with HIV (PWH) and is characterized by premature noncalcified coronary plaque. In the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), pitavastatin reduced major adverse cardiovascular events (MACE) by 35% over a median of 5.1 years. To investigate the effects of pitavastatin on noncalcified coronary artery plaque by coronary computed tomography angiography (CTA) and on inflammatory biomarkers as potential mechanisms for MACE prevention. This double-blind, placebo-controlled randomized clinical trial enrolled participants from April 2015 to February 2018 at 31 US clinical research sites. PWH without known CVD who were taking antiretroviral therapy and had low to moderate 10-year CVD risk were included. Data were analyzed from April to November 2023. Oral pitavastatin calcium, 4 mg per day. Coronary CTA and inflammatory biomarkers at baseline and 24 months. The primary outcomes were change in noncalcified coronary plaque volume and progression of noncalcified plaque. Of 804 enrolled persons, 774 had at least 1 evaluable CTA. Plaque changes were assessed in 611 who completed both CT scans. Of 611 analyzed participants, 513 (84.0%) were male, the mean (SD) age was 51 (6) years, and the median (IQR) 10-year CVD risk was 4.5% (2.6-7.0). A total of 302 were included in the pitavastatin arm and 309 in the placebo arm. The mean noncalcified plaque volume decreased with pitavastatin compared with placebo (mean [SD] change, -1.7 [25.2] mm3 vs 2.6 [27.1] mm3; baseline adjusted difference, -4.3 mm3; 95% CI, -8.6 to -0.1; P = .04; 7% [95% CI, 1-12] greater reduction relative to placebo). A larger effect size was seen among the subgroup with plaque at baseline (-8.8 mm3 [95% CI, -17.9 to 0.4]). Progression of noncalcified plaque was 33% less likely with pitavastatin compared with placebo (relative risk, 0.67; 95% CI, 0.52-0.88; P = .003). Compared with placebo, the mean low-density lipoprotein cholesterol decreased with pitavastatin (mean change: pitavastatin, -28.5 mg/dL; 95% CI, -31.9 to -25.1; placebo, -0.8; 95% CI, -3.8 to 2.2). The pitavastatin arm had a reduction in both oxidized low-density lipoprotein (-29% [95% CI, -32 to -26] vs -13% [95% CI, -17 to -9]; P < .001) and lipoprotein-associated phospholipase A2 (-7% [95% CI, -11 to -4] vs 14% [95% CI, 10-18]; P < .001) compared with placebo at 24 months. In PWH at low to moderate CVD risk, 24 months of pitavastatin reduced noncalcified plaque volume and progression as well as markers of lipid oxidation and arterial inflammation. These changes may contribute to the observed MACE reduction in REPRIEVE. ClinicalTrials.gov Identifier: NCT02344290.

Menopausal Hormone Therapy in Women with Type 2 Diabetes Mellitus: An Updated Review.

Menopause is accompanied by several metabolic adaptations, which are related to insulin resistance, increased total body fat mass, and central abdominal fat accumulation, predisposing women to type 2 diabetes mellitus (T2DM) development. Metabolic syndrome has a high prevalence in postmenopausal women, indicating the loss of estrogen protection on metabolic and cardiovascular health. Moreover, earlier age at menopause has been related to increased risk of T2DM. Menopausal hormone therapy (MHT) has favorable results in glucose metabolism. Indeed, it reduces the risk of T2DM in women without this condition and improves glycemic control in women with T2DM. Before MHT initiation in women with clinical indications, it is imperative to assess their cardiovascular disease (CVD) risk, using official electronic algorithms for score calculation. The latter will determine regimen, dose, and administration route of MHT. Oral estrogens are preferable in women with low CVD risk, while transdermal administration is indicated in those with moderate and high CVD risk, as the risk of stroke and venous thromboembolism (VTE) is increased with oral administration. Oral 17β-estradiol is usually preferred in women with T2DM, as this route has more beneficial effects on glucose metabolism. Oral estrogens are also suggested in perimenopausal or recently postmenopausal women with low CVD risk. Although oral estrogens have favorable effects when indicated, the risk of VTE or stroke should always be considered. Micronized progesterone, dydrogesterone, and transdermal norethisterone are the progestogens used in postmenopausal women with T2DM and intact uterus. MHT should not be initiated in women > 60years or > 10years in menopause, as there is an increased thromboembolic risk in women with established atherosclerosis and no additional cardiovascular benefit in women without atherosclerosis. In conclusion, MHT administration in postmenopausal women with T2DM can be safe and effective as long as the therapeutic regimen has been properly selected according to their cardiovascular, metabolic, and fracture risk.

Association between cardiovascular disease risk and incident type 2 diabetes mellitus in individuals with prediabetes: A retrospective cohort study

AimsIn this study, we aimed to evaluate the impact of overall cardiovascular disease (CVD) risk on the development of incident T2DM in patients with prediabetes. MethodsWe retrospectively enrolled 5,908 subjects with prediabetes who underwent health check-ups at the Asan Medical Center. CVD risk was estimated using the Framingham Risk Score (FRS). We compared moderate- to high-risk groups with low-risk controls based on the FRS. Cox proportional hazards regressions were conducted to estimate the time-to-develop incident T2DM. ResultsAmong the 5908 subjects with prediabetes, 3031 (51.8 %) were identified to have either moderate or high CVD risk scores. During a median follow-up of 5.2 years, 278 (9.2 %) patients from the moderate- to high-risk group and 171 (5.9 %) from the low-risk group were diagnosed with T2DM. The covariate-adjusted hazard ratio for the incident T2DM was 1.30 (95 % CI, 1.06–1.60, p = 0.011) in the moderate- to high-risk group compared to the low-risk controls. ConclusionAmong patients with prediabetes, those with high CVD risk were more likely to develop incident T2DM, as determined by the FRS. CVD risk factors should be properly evaluated and managed in individuals with prediabetes to reduce the risk of both incident T2DM and associated cardiovascular complications.

Association Between the Composite Cardiovascular Risk and mHealth Use Among Adults in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study.

Numerous studies have suggested that the relationship between cardiovascular disease (CVD) risk and the usage of mobile health (mHealth) technology may vary depending on the total number of CVD risk factors present. However, whether higher CVD risk is associated with a greater likelihood of engaging in specific mHealth use among US adults is currently unknown. We aim to assess the associations between the composite CVD risk and each component of mHealth use among US adults regardless of whether they have a history of CVD or not. This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey. The exposure was CVD risk (diabetes, hypertension, smoking, physical inactivity, and overweight or obesity). We defined low, moderate, and high CVD risk as having 0-1, 2-3, and 4-5 CVD risk factors, respectively. The outcome variables of interest were each component of mHealth use, including using mHealth to make health decisions, track health progress, share health information, and discuss health decisions with health providers. We used multivariable logistic regression models to examine the association between CVD risk and mHealth use adjusted for demographic factors. We included 10,531 adults, with a mean age of 54 (SD 16.2) years. Among the included participants, 50.2% were men, 65.4% were non-Hispanic White, 41.9% used mHealth to make health decisions, 50.8% used mHealth to track health progress toward a health-related goal, 18.3% used mHealth to share health information with health providers, and 37.7% used mHealth to discuss health decisions with health providers (all are weighted percentages). Adults with moderate CVD risk were more likely to use mHealth to share health information with health providers (adjusted odds ratio 1.49, 95% CI 1.24-1.80) and discuss health decisions with health providers (1.22, 95% CI 1.04-1.44) compared to those with low CVD risk. Similarly, having high CVD risk was associated with higher odds of using mHealth to share health information with health providers (2.61, 95% CI 1.93-3.54) and discuss health decisions with health providers (1.56, 95% CI 1.17-2.10) compared to those with low CVD risk. Upon stratifying by age and gender, we observed age and gender disparities in the relationship between CVD risk and the usage of mHealth to discuss health decisions with health providers. Adults with a greater number of CVD risk factors were more likely to use mHealth to share health information with health providers and discuss health decisions with health providers. These findings suggest a promising avenue for enhancing health care communication and advancing both primary and secondary prevention efforts related to managing CVD risk factors through the effective usage of mHealth technology.

Effects of diets rich in monounsaturated fatty acids on the management and prevention of insulin resistance: A systematic review

Insulin resistance (IR), which is linked to obesity, is a mechanism associated with metabolic diseases, mainly type 2 diabetes mellitus. Studies have shown that monounsaturated fatty acids (MUFAs) have anti-inflammatory and anti-oxidative properties which positively affect IR. This systematic review examined the effects of MUFAs from different sources on IR in obese or overweight patients with or without metabolic syndrome. A search was carried out in the PubMed/Medline and Bireme/VHL databases, and data from 16 studies were analysed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The intervention time ranged from 1 day to 5.2 years. All participants were overweight or obese; some had central obesity, a moderate risk of cardiovascular disease, low high-density lipoprotein levels, altered fasting glucose levels, prediabetes or type 2 diabetes mellitus. This systematic review provides evidence that MUFA-rich diets can improve IR.

Menopausal treatment in women with diabetes and hypertension

Menopausal transition is associated with increased risk of hypertension and metabolic changes predisposing for type 2 diabetes. Moreover, hypertension and type 2 diabetes are independent risk factors for cardiovascular disease, which is the leading cause of morbidity and mortality in women. It is well-known that endogenous estrogen protects against cardiovascular disease by vasodilatation through mechanisms including increased nitric oxid synthesis and reduced angiotensin receptor activity leading to reduced blood pressure. What about menopausal hormone treatment (MHT), could MHT be beneficial and prevent from development of diabetes and cardiovascular disease? Furthermore, is MHT safe in women with pre-existing diabetes and hypertension? Well-controlled diabetes and/or hypertension are not contraindications for MHT. Vasomotor symptoms should be indication for treatment also in these women with special consideration of cardiovascular risk. In fact, MHT can improve diabetic control. However, there is no clear evidence to support that MHT can prevent from developing diabetes. The oral route of MHT can affect blood pressure by liver induction of plasma proteins, which may increase blood pressure and aggravate hypertension. Furthermore, oral estrogen increaes coagulation factors and therby increases the risk of thrombosis. In women with hypertension, transdermal estrogen might be the most appropriate MHT. Transdermal estrogen does not increase blood pressure and is preferable for women with moderate risk for cardiovascular disease. Progestogens with neutral effect on metabolic parameters could also be recommended. The risk benefit balance of using MHT for healthy women is favorable if introduced early in relation to menopause, but the timing hypothesis for primary prevention of cardiovascular disease is still under debate. These questions and the management of menopausal symptoms in women with diabetes and hypertension will be illustrated by a patient case.

Assessment of Total Cardiovascular Risk Using WHO/ISH Risk Prediction Chart Among Adults in Oman: A Nationally Representative Survey.

Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality globally and in Oman. Stratifying the population under different risk levels based on the total CVD risk approach using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction chart would be more effective in primary prevention of CVD to prioritize and utilize valuable resources. Hence, this study aimed to assess the total 10-year CVD risk among adults in Oman and to ascertain the proportion of the population in need of pharmacotherapy. We used the data from the 2017 national community-based STEPS survey conducted among men and women in Oman aged 40-80 years. Ten-year total cardiovascular risk was measured using the WHO/ISH risk prediction chart for Eastern Mediterranean Sub-Region B. Independent t-test and Chi-square were used to test significance. There were 2510 participants in the study. Their mean age was 51.5±10.1 years and 51.3% were male. The prevalence of low, moderate, and high CVD risk was 68.0%, 19.1%, and 12.9%, respectively, as benchmarked by the WHO/ISH chart. Immediate pharmacotherapy was needed by 30.3% of participants. Factors significantly associated with elevated CVD risk were the participant's age (p < 0.001), education level (p < 0.001), and employment status (p < 0.001). A substantial fraction of the population in Oman are at moderate or high CVD risk. Prompt pharmacological interventions are warranted for at least one in every five individuals in conjunction with lifestyle changes.

Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda.

Cardiovascular disease (CVD) is a global health issue. Low- and middle-income countries (LMICs) are facing early CVD-related morbidity. Early diagnosis and treatment are an effective strategy to tackle CVD. The aim of this study was to assess the ability of community health workers (CHWs) to screen and identify persons with high risks of CVD in the communities, using a body mass index (BMI)-based CVD risk assessment tool, and to refer them to the health facility for care and follow-up. This was an action research study conducted in rural and urban communities, conveniently sampled in Rwanda. Five villages were randomly selected from each community, and one CHW per each selected village was identified and trained to conduct CVD risk screening using a BMI-based CVD risk screening tool. Each CHW was assigned to screen 100 fellow community members (CMs) for CVD risk and to refer those with CVD risk scores ≥10 (either moderate or high CVD risk) to a health facility for care and further management. Descriptive statistics with Pearson's chi-square test were used to assess any differences between rural and urban study participants vis-à-vis the key studied variables. Spearman's rank coefficient and Cohen's Kappa coefficient were mainly used to compare the CVD risk scoring from the CHWs with the CVD risk scoring from the nurses. Community members aged 35 to 74 years were included in the study. The participation rates were 99.6% and 99.4% in rural and urban communities, respectively, with female predominance (57.8% vs. 55.3% for rural and urban, p-value: 0.426). Of the participants screened, 7.4% had a high CVD risk (≥20%), with predominance in the rural community compared to the urban community (8.0% vs. 6.8%, p-value: 0.111). Furthermore, the prevalence of moderate or high CVD risk (≥10%) was higher in the rural community than in the urban community (26.7% vs. 21.1%, p-value: 0.111). There was a strong positive correlation between CHW-based CVD risk scoring and nurse-based CVD risk scoring in both rural and urban communities, 0.6215 (p-value < 0.001) vs. 0.7308 (p-value = 0.005). In regard to CVD risk characterization, the observed agreement to both the CHW-generated 10-year CVD risk assessment and the nurse-generated 10-year CVD risk assessment was characterized as "fair" in both rural and urban areas at 41.6% with the kappa statistic of 0.3275 (p-value < 001) and 43.2% with kappa statistic of 0.3229 (p-value =0.057), respectively. In Rwanda, CHWs can screen their fellow CMs for CVD risk and link those with high CVD risk to the healthcare facility for care and follow-up. CHWs could contribute to the prevention of CVDs through early diagnosis and early treatment at the bottom of the health system.

Association between obesity and high-sensitivity C-reactive protein in Korean adults without cardiovascular disease

Purpose: This study aimed to investigate the association between obesity and high-sensitivity C-reactive protein (hs-CRP) levels in Korean adults without cardiovascular disease (CVD). Methods: The subjects were 3,634 adults, and data were extracted from the seventh Korea National Health and Nutrition Examination Survey (KNHANES Ⅶ-3). A complex sampling design analysis was applied to reflect the stratified and clustered weights. The data were analyzed using the complex sample Rao-Scott chi-square test and multiple logistic regression analysis (in SPSS for Windows version 26.0). Obesity, according to body mass index (BMI), was defined as obesity (BMI=25-29.9 kg/m²), high obesity (BMI=30-34.9 kg/m²), and super-high obesity (BMI≥35 kg/m²), and abdominal obesity (AO) was defined as a waist circumference (WC) ≥90 cm in males and WC ≥85 cm in females.Results: The odds ratios for moderate CVD risk (hs-CRP; 1-3 mg/dL) were 2.21, 4.16, and 7.13 in the obesity, high obesity, and super-high obesity groups, respectively, compared to the normal BMI group. The odds ratio for moderate CVD risk was 2.18 in males with AO and 1.88 in females with AO. The odds ratios for high CVD risk (hs-CRP&gt;3mg/L) were 4.40 and 17.55 in the high obesity and super-high obesity groups, respectively, compared to the normal BMI group.Conclusion: This study provides evidence that early detection and prevention programs for CVD should include obesity-related interventions aiming to modulate hs-CRP.

Estimates of 10-year risk of cardiovascular death and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) increases the risk of cardiovascular disease (CVD) in both morbidity and mortality. We used the risk chart of Systemic Coronary Risk Evaluation (SCORE) from European Society of Cardiology (ESC) to determine the 10-year risk of cardiovascular death, and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea. Research design and methodsIn a prospective cohort study, 303 patients with mild, moderate and severe OSA were investigated for cardiovascular risk factors before initiating CPAP therapy. Primary outcome was estimates of 10-year risk of cardiovascular death assessed from the ESC risk chart SCORE based on sex, age, smoking status, systolic blood pressure and s-total cholesterol. Furthermore we analyzed treatment indication with statins in patients with mild (apnea-hypopnea index, AHI <15), moderate (AHI 15–29.9) and severe OSA (AHI ≥30). ResultsPatients with mild OSA predominately had low or moderate 10-year risk of CVD (low risk 55.4%, moderate risk 30.8%) while patients with moderate and severe OSA were more likely to have high or very high risk of 10-year CVD (p = 0.001). The large majority of included OSA patients had dyslipidemia, 235 (77.6%) and of those, only 27.4% were treated with cholesterol lowering drugs while additional 27.7% were eligible for oral statin supplement as risk-estimated by the ESC SCORE. In multiple regression analysis among statin naive patients, AHI was positively associated with statin eligibility when adjusted for age and sex. ConclusionPatients with moderate and severe OSA had an elevated 10-year risk of fatal CVD and were undertreated with CVD risk lowering agents such as statins.

Screening for cardiovascular risk in the general population: The SPICES implementation survey.

In 2019, cardiovascular diseases (CVD) caused 32% of deaths worldwide. The SPICES survey involved five countries in an international primary CVD prevention implementation study in the general population. The French SPICES survey was implemented in the Centre Ouest Bretagne area (COB), which is a rural, economically deprived, medically underserved territory with high cardiovascular mortality. A CVD screening in the general population was needed to select the implementation population without overburdening family practitioner (FP) workforces. The efficacy and the replicability of such a screening were unknown. The aims of this study were to identify the characteristics of the individuals undergoing CVD risk assessment with the Non-Laboratory Interheart risk score (NL-IHRS), and to identify barriers and explore facilitators when screening the general population. An implementation study combining a cross-sectional descriptive study with qualitative interviews was undertaken. The NL-IHRS was completed by trained screeners selected from health students, pharmacists, nurses, and physiotherapists in the area with a dedicated e-tool in sport and cultural events and public places. After the screening, all screener groups were interviewed until theoretical saturation for each group. Thematic analysis was performed using double-blind coding. In 5 months, 3,384 assessments were undertaken in 60 different places, mostly by health students. A total of 1,587, 1,309, and 488 individuals were at low, moderate, and high CVD risk. Stressed or depressed individuals were remarkably numerous (40.1 and 24.5% of the population, respectively). Forty-seven interviews were conducted. The main facilitators were willingness of the population, trust between screeners and the research team, and media publicity. The main barriers were lack of motivation of some screeners, some individuals at risk, some stakeholders and difficulties in handling the e-tool. The efficacy of CVD risk screening while using mostly health students was excellent and preserved the FP workforce. Replicability was highly feasible if research teams took great care to establish and maintain trust between screeners and researchers. The e-tools should be more user-friendly.

PS-P08-6: ESTIMATION OF TOTAL CARDIOVASCULAR RISK AMONG THE RURAL POPULATION OF BANGLADESH USING 2019 WHO CVD RISK PREDICTION NON-LABORATORY-BASED CHARTS

Objective: Cardiovascular disease (CVD) is the leading cause of death globally, require immediate intervention. Package of Essential Noncommunicable diseases (PEN) intervention implemented by World Health Organization in primary care of low resource setting enables healthcare workers to tailor care for patients according to their risk level, thus decrease the health care cost as well as workload of health facility. The objective of this study was to estimate the distribution of 10-year CVD risk among rural Bangladeshi adults aged &gt; 40 years by using the 2019 WHO CVD risk prediction non-laboratory-based charts. Design and Methods: Cross-sectional, population-based study. We estimated total CVD risk using 2019 WHO CVD risk prediction non-laboratory-based charts and categorized as very low (&lt; 5%), low (5- &lt; 10%), moderate (10- &lt; 20%), high (20- &lt; 30%) and very high risk (&gt; 30%). Participants were selected from four rural areas of two administrative districts of Bangladesh. Participants age, gender, smoking status, blood pressure, height and weight for calculation of body mass index were recorded. Participants with hypertension and moderate and high CVD risk score were referred to respective primary health care facility for further assessment and management. Results: Total of 1234 participants (male 397, female 837) were included in this study. Mean age of the participants was 54.0 years. Among the respondents 42.9%, 33.5%, 18.9% and 4.7% were in the age group of 40 to 50, 51 to 60, 61 to 70 and &gt; 70 years respectively. Among the participants 11.9% were current smoker (men 37.1% and women 0.1%). The mean systolic and diastolic blood pressure of the participants was 134.14 and 85.03 mm of Hg respectively. The prevalence hypertension was 62%. The prevalence of hypertension was much higher among the female participants (men 53.0% and women 66.2%). Three fourth (77.6%) of the participants had CVD risk score of very low and low below (&lt; 10%) and none had CVD score of very high risk (&gt; 30) and one fifth (21.3%) had moderate and high CVD risk score. Among the participants with very low (&lt; 5%), low (5–10%), moderate (10–20%) and high (20–30%) CVD risk score had 20.6%, 38.3%, 57.1% and 95.2% high blood pressure respectively. Conclusion: High prevalence of hypertension may be the main contributor of CVD score in this selected rural adult population of Bangladesh. This population require an early intervention with priority to hypertension management at community level to prevent the epidemic of the cardiovascular events.

Identification of risk factors about cardiovascular disease and diabetes mellitus among employees of selected banks in Indore, Madhya Pradesh

Background: Cardiovascular disease (CVD) remains the highest cause of mortality in India and the majority of the cases are due to risk factor that includes hypertension smoking diabetes mellitus. Sedentary lifestyle and desk job employees are more prone to such diseases. Therefore, present study aimed to assess the risk factors of cardiovascular diseases among bank employees.Methods: Quantitative exploratory research design was used to conduct the study. A sample of 98 bank employees was selected for the study using non probability convenient sampling technique from different branches of SBI Indore.Results: Risk score for cardio vascular disease among bank employees expressed in percentage calculated through the structured interview scheduled and Joint British Societies for the prevention of cardiovascular disease (JBS3) risk calculator. 83% participants were at &lt;10% risk (low), 17% participants were at 10-19.9% (mild) risk, 0 participants were at 20-29.9% (moderate) risk and 0 participants were at ≥30% (high) risk. There was significant association between the risk score and selected socio demographic variable among bank employees.Conclusions: Study concluded that there was a mild to moderate risk of cardiovascular disease among bank employees. Hence, proper awareness regarding various risk factors of cardio vascular diseases can help in reducing such risk among bank employees and personnel with similar working pattern.MethodQuantitative exploratory research design was used to conduct the study. A sample of 98 bank employees was selected for the study using non probability convenient sampling technique from different branches of SBI Indore.ResultsRisk score for cardio vascular disease among bank employees expressed in percentage calculated through the structured interview scheduled and Joint British Societies for the prevention of cardiovascular disease (JBS3) risk calculator. 83% participants were at &lt; 10% risk (low), 15% participants were at 10-19.9% (mild) risk, 0 participants were at 20-29.9% (moderate) risk and 0 participants were at ≥ 30% (High) risk. There is signification association between the risk score and selected socio demographic variable among bank employees.ConclusionStudy concluded that there was a mild to moderate risk of cardiovascular disease among bank employees. Hence, proper awareness regarding various risk factors of cardio vascular diseases can help in reducing such risk among bank employees and personnel with similar working pattern.

Distribution of cardiovascular disease risk according to SCORE2 and potential need for cholesterol and blood pressure lowering therapy in apparently healthy middle-aged individuals

Abstract Background The 2021 European Society of Cardiology (ESC) prevention guidelines recommend the Systemic Coronary Risk Estimation 2 algorithm (SCORE2) to estimate the 10-year risk of cardiovascular disease (CVD) events to guide pharmacological treatment for primary prevention in apparently healthy individuals aged 40–69 years. Purpose To assess the distribution of CVD risk according to SCORE2 and the proportion of individuals who could be eligible for pharmacological treatment of blood cholesterol and blood pressure in an apparently healthy middle-aged population in Sweden. Methods We used data from the Swedish Cardiopulmonary Bioimage Study (SCAPIS) which used population registers to randomly recruit individuals aged 50–64 years at six Swedish study sites. Information was collected from the study participants through clinical examinations, national registries, and questionnaires. We excluded individuals with previously known atherosclerotic CVD, diabetes mellitus, or chronic kidney disease with eGFR &amp;lt;60 mL/min/1.73 m2. The SCORE2 algorithm designed for countries with moderate baseline CVD risk was used to categorize study participants' 10-year CVD risk as low-moderate (&amp;lt;5% risk); high (5-&amp;lt;10% risk); and very-high (≥10% risk). The proportions of the population who could be eligible, according to the 2021 ESC prevention guidelines, for pharmacological treatment of LDL-cholesterol (LDL-C) were assessed. Treatment thresholds for LDL-C according to SCORE2 risk were ≥1.8 mmol/L (high risk) and ≥1.4 mmol/L (very-high risk). Treatment threshold for hypertension was defined as a blood pressure ≥140/90 mmHg regardless of CVD risk. Results SCAPIS included 30,082 individuals. After exclusion criteria were applied 26,877 individuals remained (median age 57.2 years; 52.8% women). The median 10-year risk of CVD according to SCORE2 was 5.0 (interquartile range 3.0, 7.0) %. In total, 47.5% were classified as low-moderate risk, 45.9% as high risk, and 6.6% as very-high risk, with men having higher risk than women (figure). Almost all of those with high and very-high risk had LDL-C levels above the treatment thresholds. As such, according to the guidelines, lipid-lowering treatment should be considered (high risk) or was generally recommended (very-high risk) in 51.7% of the total population (Figure 1). The proportion of individuals with blood pressure ≥140/90 mmHg was 21.9%. The self-reported use of lipid-lowering therapy among low-moderate, high risk, and very-high risk individuals was 3.1%, 6.9%, and 6.3%, respectively. The use of blood pressure lowering therapy was 13.1% for those with blood pressure &amp;lt;140/80 mmHg and 29.2% for those ≥140/90 mmHg. Conclusions In this population-based study of nearly 27,000 apparently healthy middle-aged individuals in Sweden, around half of the individuals could be eligible for LDL-C-lowering therapy and around one in five could be eligible for antihypertensive therapy according to the 2021 ESC prevention guidelines. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): SCAPIS funding: The Swedish Heart-Lung Foundation and Knut and Alice Wallenberg Foundation.

The Experiences of Participants at Moderate Risk of Cardiovascular Disease (CVD) Who Participated in a Nurse-Led 12-Week Physical Activity (PA) Program: A Qualitative Study

The Experiences of Participants at Moderate Risk of Cardiovascular Disease (CVD) Who Participated in a Nurse-Led 12-Week Physical Activity (PA) Program: A Qualitative Study

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

Elevated Lipoprotein(a) prevalence and association with family history of premature cardiovascular disease in general population with moderate cardiovascular risk and increased LDL cholesterol.

BackgroundElevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk. There are discrepancies regarding its epidemiology due to great variability in different populations. This study aimed to evaluate the prevalence of elevated Lp(a) in people with moderate CVD risk and increased LDL-c and to determine the association between family history of premature CVD and elevated Lp(a).MethodsRandom subjects from the CESCAS population-based study of people with moderate CVD risk (Framingham score 10–20 %) and LDL-c ≥ 130 mg/dL, were selected to evaluate Lp(a) by immunoturbidimetry independent of the Isoforms variability. The association between family history of premature CVD and elevated Lp(a) was evaluated using multivariate logistic regression models. Elevated Lp(a) was defined as Lp(a) ​​≥ 125 nmol/L.ResultsLp(a) was evaluated in 484 samples; men = 39.5 %, median age = 57 years (Q1-Q3: 50–63), mean CVD risk = 14.4 % (SE: 0.2), family history of premature CVD = 11.2 %, Lp(a) median of 21 nmol/L (Q1-Q3: 9–42 nmol/L), high Lp(a) = 6.1 % (95 % CI = 3.8–9.6). Association between family history of premature CVD and elevated Lp(a) in total population: OR 1.31 (95 % CI = 0.4, 4.2) p = 0.642; in subgroup of people with LDL-c ≥ 160 mg%, OR 4.24 (95 % CI = 1.2, 15.1) p = 0.026.ConclusionsIn general population with moderate CVD risk and elevated LDL-c from the Southern Cone of Latin America, less than one over ten people had elevated Lp(a). Family history of premature CVD was significantly associated with the presence of elevated Lp(a) in people with LDL-c ≥ 160 mg/dL.

Considering whether countries participating in clinical trials can afford the intervention.

... Clinical trials often recruit from a diverse array of countries to help researchers understand the generalizability of their intervention. The economic circumstances in participating countries may vary substantially. This raises the issue of whether the intervention, even if proven to be effective and cost-effective in wealthy countries, would be cost-effective among resource-limited participant countries. It is only fair that states who help establish an intervention benefit from that intervention immediately after the trial concludes and over an extended period. However, this may be difficult to achieve, particularly for interventions that are inexpensive and exhibit small absolute health gains (cost-effectiveness ratios are generally easier to improve upon for expensive and/or highly effective interventions). Here, we provide an example. It is well established that HIV infection, even when well treated, increases the risk of atherosclerotic cardiovascular disease (ASCVD; Shah et al., 2018). In 2015, a large clinical trial, the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), was launched to test the effectiveness of statins for primary prevention of ASCVD in people living with HIV (PLHIV) at low to moderate risk of cardiovascular disease based on an assessment of traditional risk factors (ClinicalTrials.gov, 2020). Generic statins cost <$1 per day in most parts of the world and typically reduce ASCVD incidence by between 10% and 30% (Cholesterol Treatment Trialists’ Collaborators, 2012). Estimates of primary ASCVD incidence in the current HIV population range from 3 to 6 per 1000 person-years (Friis-Moller et al., 2016; Boettiger et al., 2020). REPRIEVE has now recruited 7770 participants from 11 countries, 9 of which are classified as low- or middle-income (The World Bank, 2020). The results are expected in 2023.

Circulating Extracellular Vesicles Are Strongly Associated With Cardiovascular Risk Markers.

BackgroundExtracellular vesicles (EVs) are submicron membrane-bound vesicles released from various cells, which are emerging as a potential novel biomarker in cardiovascular diseases (CVDs) due to their procoagulatory and prothrombotic properties. However, there is little information about the relationships between circulating EVs and conventional and thrombogenic risk markers of CVDs.ObjectiveTo investigate the relationships between circulating EVs, conventional cardiovascular risk markers and thrombogenic markers in subjects with moderate risk of CVDs.DesignSubjects (n = 40) aged 40-70 years with moderate risk of CVDs were recruited and assessed for body mass index, blood pressure and plasma lipid profile, as well as platelet aggregation, clot formation, thrombin generation and fibrinolysis. Numbers of circulating EVs were assessed by Nanoparticle Tracking Analysis and flow cytometry. A range of assays were used to assess the procoagulatory activity of plasma and circulating EVs.ResultsCirculating EV numbers were positively associated with body mass index, blood pressure, plasma triacylglycerol concentration and overall CVD risk. Higher circulating EV numbers were also associated with increased thrombin generation and enhanced clot formation, and EVs isolated from subjects with moderate CVD risk promoted thrombin generation ex vivo. Higher numbers of endothelial-derived EVs were associated with a greater tendency for clot lysis. Plasma triacylglycerol concentration and diastolic blood pressure independently predicted circulating EV numbers, and EV numbers independently predicted aspects of thrombin generation and clot formation and 10-year CVD risk.ConclusionCirculating EVs were strongly associated with both conventional and thrombogenic risk markers of CVDs, and also with overall CVD risk, highlighting a potentially important role for EVs in CVDs.