Modifiable Risk Factor For Cardiovascular Disease Research Articles

The burden of cardiovascular disease and related risk factors in Greece: the ATTICA epidemiological study (2002–2022)

ObjectiveThe aim of this study was to present the burden of cardiovascular disease (CVD) and its related risk factors based on a 20-year observation period (2002–2022). MethodsIn 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD, cancer, or any other chronic infections were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants (1988 had complete data for CVD). Lifetime risk for CVDs and disability-adjusted-life-years (DALYs) lost were also calculated. ResultsThe 20-year CVD incidence was 3600 cases/10,000 individuals (man-to-woman ratio 5:4). At the index age of 40 years, the lifetime risk for developing CVD was 68% for men and 63% for women; as the participants were getting older, the lifetime risk declined by approximately 19% and 13% for men and women, respectively, but remained at high levels, reaching 55% for both sexes. Participants between 45 and 55 years exhibited the highest CVD burden concerning aggregated DALYs. The burden was greater in men than in women, at ages below 35 years; beyond this age threshold, this trend shifted, and women exhibited a higher CVD burden. ConclusionThe burden of CVD in Greece has shown increasing trends over the past 20 years as a result of the accumulative growth of the prevalence of modifiable CVD risk factors. The disability-adjusted life-years lost are the most observed ever before, urging for efficient public health strategies and measures.

Food and Cardiovascular Disease: What to Eat and What Not to Eat

In 2019, the Global Burden of Disease study revealed alarming statistics regarding cardiovascular disease (CVD) in Pakistan. The estimated age-standardized incidence and death rates were 918.18 and 357.88 per 100,000 respectively, surpassing global averages.1 Notably, Pakistan faces unique challenges with a high prevalence of Rheumatic heart disease and early onset coronary artery disease.1
 The World Health Organization's 2021 factsheet underscores four pivotal modifiable behavioral risk factors for CVD and stroke: unhealthy diet, physical inactivity, tobacco use, and harmful alcohol consumption. These behaviors manifest in individuals as elevated blood pressure, glucose, lipids, and adverse body mass index, exacerbating cardiovascular risk.2 In Pakistan, the consumption of unhealthy foods and excessive calories significantly contributes to adverse cardiometabolic profiles, including obesity and dyslipidemia.2
 Recent research, such as that by Daruish Mozaffain et al. in "Food is Medicine," advocates for food-based interventions tailored to individual health conditions, ranging from medically tailored meals to nutritional and culinary education.3 However, Pakistani patients with CVD face challenges due to the lack of localized guidelines, educational resources, and accessible nutritionists. Shah et al.'s review underscores the importance of providing clear and culturally relevant dietary guidance for the local population.4
 Addressing these challenges requires the development of high-quality, culturally sensitive educational materials. These resources should be readily understandable, pictorial, and integrated into both inpatient and outpatient care. Local experts, including dietitians and researchers, can play a crucial role in creating tailored educational content. Figures 1 exemplify the efforts of these experts to provide practical guidance to the Pakistani population.4
 In conclusion, there is an urgent need for comprehensive, easy-to-understand patient education resources catering to the unique nutritional needs of Pakistani individuals with cardiovascular disease. By addressing these gaps, we can empower patients to make informed dietary choices and improve cardiovascular outcomes.
 References
 
 Samad Z, Hanif B. Cardiovascular Diseases in Pakistan: Imagining a Postpandemic, Postconflict Future. Circulation. 2023;147(17):1261-3.
 Liaquat A, Javed Q. Current trends of cardiovascular risk determinants in Pakistan. Cureus. 2018;10(10):e3409.
 Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, et al. “Food Is Medicine” Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(8):843-64.
 Shah SU, Waseem T, Afridi T, Shah MI. Nutritional Needs for Cardiovascular Health in Pakistani Population. Pak Heart J. 2022;55(2):101-13.
 American Heart Association. Lifestyle Changes for Heart Failure. Accessed on March 30, 2024. Available at: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure
 American Diabetes Association. What superstar foods are good for diabetes? Accessed on March 30, 2024. Available at: https://diabetes.org/food-nutrition/food-and-blood-sugar/diabetes-superstar-foods
 American Heart Association. The American Heart Association Diet and Lifestyle Recommendations. Accessed on March 30, 2024. Available at: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle-recommendations
 American Heart Association. Managing Blood Pressure with a Heart-Healthy Diet. Accessed on March 30, 2024. Available at: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-healthy-diet

Abstract 6294: Subclinical atherosclerosis in newly diagnosed colorectal cancer patients

Abstract Introduction: Recent advances in early detection and treatment have improved survival rates for patients with colorectal cancer (CRC), and emerging data suggests patients may be at elevated risk of cardiovascular disease (CVD). However, there are no standard recommendations for assessing CVD risk in patients with CRC. Coronary artery calcium (CAC) is a measure of the quantity of coronary artery calcification using noninvasive scanning and has been shown to be predictive of CVD risk. This prospective cohort study utilizes CAC to evaluate the occurrence of subclinical atherosclerosis at the time of CRC diagnosis and the risk of major adverse cardiovascular events (MACE). Methods: The ColoCare Study is a prospective cohort study across six U.S. and European sites. Data from one of the ColoCare consortium sites in Los Angeles, California was analyzed. Adults with newly diagnosed stage I- IV colorectal cancer and available non-contrast CT scans were included. Electronic medical records were reviewed for assessment of baseline cardiovascular risk factors and adverse events. Subclinical atherosclerosis was defined as the presence of CAC (CAC>0). CAC was manually measured from routine oncologic diagnostic CT and PET-CT scans at the time of cancer diagnosis using the Agatston method. MACE was defined as hospitalization due to heart failure, cardiomyopathy, ischemic heart disease, or ischemic stroke after the diagnosis of CRC cancer. Multivariable-adjusted Cox regression was used to evaluate the association between CAC at diagnosis and the risk of MACE. Results: Among 109 individuals with CAC measured at the time of CRC diagnosis, 41 (37.6%) had subclinical atherosclerosis (CAC=1-399 [n=29], CAC>400 [n=12]). Individuals with CAC>0 were older (67.0 vs. 51.9 years, p<0.01), more likely to be former or current smokers (48.0 vs. 29.0 years, p=0.04), and to have hypertension (61% vs. 23%, p<0.01) compared to those without CAC (CAC=0). Among individuals with CAC (n=41), 51.2% had scores >100, and 29.2% had scores >400, indicating moderate and severe atherosclerosis respectively. Among patients with moderate or greater CAC burden (>100; statin therapy indicated), 28.6% were not on statin therapy. CAC>0 was associated with an increased incidence of MACE (13% vs. 53%, p<0.01). Discussion: Subclinical atherosclerosis was observed in nearly 40% of patients with CRC at diagnosis and MACE occurred in 38.2% of patients. Most patients were under-optimized for CVD risk, with nearly 30% of statin-eligible patients with at least moderate CAC burden not prescribed statin therapy. These findings highlight an opportunity for improved CVD risk mitigation in patients with CRC, including guidelines-based CVD risk factor modification. Citation Format: Julia A. Levy, Maimoona Nadri, Elham Kazemian, Katelyn M. Atkins, Jordan O. Gasho, Katrina D. Silos, Cody Ramin, Andriana P. Nikolova, Erin M. Siegel, Biljana Gigic, Adetunji T. Toriola, Jennifer Ose, Christopher I. Li, David Shibata, Cornelia M. Ulrich, Jane C. Figueiredo. Subclinical atherosclerosis in newly diagnosed colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6294.

Abstract P362: Differences in Cardiovascular Health, Physical Activity Determinants, and Desired Intervention Components in Individuals With a History of Hypertensive Disorders of Pregnancy by Activity Level

Introduction: Hypertensive Disorders of Pregnancy (HDP) affects ~16% of pregnancies and is associated with a 2- to 4-fold greater risk of cardiovascular disease (CVD). Physical activity (PA) is a known modifiable risk factor for CVD; however, little is known about the CVD risk factors potentially related to postpartum PA after HDP. More research is also needed examining specific behavioral determinants influencing postpartum PA and a postpartum PA intervention would be desired. Purpose: To assess differences in CVD risk factors, behavioral determinants of PA, and desired PA intervention components among postpartum individuals with HDP, stratified by PA level. Hypothesis: Inactive individuals will have more CVD risk factors, different behavioral determinants and desired PA intervention components compared to active individuals after HDP. Methods: Individuals residing in Iowa who were <1 year postpartum and experienced a HDP were recruited to complete online surveys assessing demographics, PA, CVD risk factors, behavioral determinants of PA (e.g., barriers and facilitators of PA), and desired PA intervention components. Individuals were classified as active or inactive using the 2018 PA guidelines for Americans. Results: Participants (N=72) were 30±6 years old, mostly white (84%), and 54% were sufficiently active. Inactive individuals were more likely to be diagnosed with hypertension after delivery, had lower CVD knowledge, and were 2.9 times less likely to identify facilitators of PA compared to active individuals (Table; p<0.05). All indicated interest in a postpartum PA intervention, with inactive individuals expressing greater interest in information on postpartum PA safety, PA while breastfeeding, and social media interventions compared to active individuals (Table; p<0.05). Preferred communication included text, email, and video call. Conclusions: Development of PA interventions after HDP should consider the unique needs of individuals across current postpartum activity levels.

Abstract 27: Chronotype, Life’s Essential 8, and Risk of Cardiovascular Disease: A Prospective Cohort Study in UK Biobank

Introduction: Individuals with evening chronotype often experience circadian misalignment, which may disrupt health behaviors and circadian regulation of cardiometabolic functions such as blood pressure and heart rate. However, the association of chronotype with cardiovascular disease (CVD) and the interplay with other CVD risk factors are not fully understood. Hypothesis: We assessed the hypothesis that individuals with an evening chronotype, compared to those with a morning chronotype, have a poorer cardiovascular health as measured by the Life’s Essential 8 (LE8), and consequently an increased CVD risk. We further explored if the associations differed by sex. Methods: We conducted a prospective study in the UK Biobank among 477,878 adults aged 39-74 years and free of CVD at baseline in 2006-2010. Chronotype was self-reported using a single representative question from the Morningness-Eveningness Questionnaire. The LE8 score was calculated based on 8 modifiable CVD risk factors, and ranged from 0 to 100 with higher scores indicating better cardiovascular health. Incident CVD was defined as first myocardial infarction (MI) or stroke leading to hospitalization or death, identified via validated algorithms that mapped national medical records and death certificates to ICD-10 codes until May 2022. We used Cox proportional hazards models to estimate the association between chronotype and CVD risk. Models were adjusted for demographics, shift work, and family history of CVD. We applied causal mediation framework to decompose the total chronotype-CVD effect into estimated natural direct effect (i.e., independent of LE8) and natural indirect effect (i.e., mediated by LE8; NIE). Results: Participants with a “definite evening” chronotype were 75% more likely to have a low LE8 score (<50) compared to “intermediate” type (prevalence ratio 95% CI: 1.67, 1.84). This association was notably stronger among women ( P -interaction: 0.0001). Over 12.7 years of follow-up, there were 27,346 documented incident CVD events (17,180 MI; 11,329 stroke). The hazard ratio (HR) for total CVD was 1.03 (95% CI: 1.00, 1.06) for the “definite morning” and 1.15 (95% CI: 1.10, 1.20) for “definite evening” compared with “intermediate” chronotype ( P -trend: 0.06). This association was stronger in women ( P -interaction: 0.05), and similar for MI and stroke. The NIE of the chronotype-CVD association comparing “definite evening” to “intermediate” was 1.11 (95% CI: 1.09, 1.13), equivalent to 95% of the association being mediated by LE8. Conclusions: Evening chronotype was associated with a modest increase in CVD risk, compared to intermediate chronotype, which appeared to be mainly explained by overall poor cardiovascular health. Our results suggest potential benefits of targeted interventions in evening chronotype for CVD prevention. Ongoing work is exploring potential effect modification by night shift work.

Sleep Attributes Influencing Cardiovascular Morbidity Among Young Adults Pursuing Professional Courses in Dehradun, India: A Cross-Sectional Study.

Cardiovascular diseases (CVDs) are evolving as a cause of mortality and morbidity among young adults. Young adults, particularly those pursuing professional courses in colleges, face unique challenges that may influence their risk of developing CVD. Despite screening guidelines, CVD risk factors often go undetected in the young population, highlighting the need for increased awareness among adolescents. Sleep is an essential indicator of well-being, and its impact on cardiovascular risk factors is increasingly being recognized. An observational cross-sectional study was conducted among young adults aged 18 to 24 years pursuing professional courses in Dehradun, Uttarakhand, India. A total of 156 participants were recruited through multistage, systematic random sampling, and snowball sampling. Data on sleep patterns and cardiovascular morbidity were collected using a pretested questionnaire. Among the study participants, 46.8% reported having less than four hours of sleep on average, and 25% were suffering from sleep problems. The prevalence of diagnosed CVDs was low, with 6.14% reporting arrhythmias and 3.84% reporting hypertension. An association was found between sleep duration, sleep problems, and the presence of CVDs. Participants with shorter sleep durations and more severe sleep problems had a higher prevalence of CVDs. The findings suggest that sleep duration and sleep problems may be modifiable risk factors for CVDs among young adults. Effective health promotion activities focusing on behavior and lifestyle modifications are essential to preventing CVDs from an early age. The study emphasizes the importance of early intervention and health promotion strategies to reduce CVD risk factors in this population. Community-based research and behavior change communication initiatives are recommended to promote healthy sleep habits and prevent cardiovascular diseases among young adults beyond the college setting.

Aspirin for Primary Prevention of Cardiovascular Disease: What We Now Know

Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.

The association between stair climbing and modifiable cardiovascular disease risk factors: the Suita Study.

Stair climbing is a readily available form of physical activity with potential cardiovascular benefits. This study aimed to investigate the association between stair climbing and numerous modifiable cardiovascular disease (CVD) risk factors. In this cross-sectional study, we used data from 7282 Japanese people (30-84 years) residing in Suita City, Osaka. CVD risk factors and stair climbing frequency were assessed during the Suita Study health examination. Logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for CVD risk factors across stair climbing frequencies. After adjustment for age, sex, lifestyle, and medical conditions, stair climbing >60% of the time, compared to <20% of the time, was inversely associated with obesity, smoking, physical inactivity, and stress: ORs (95% CIs) = 0.63 (0.53, 0.75), 0.81 (0.69, 0.96), 0.48 (0.41, 0.55), and 0.67 (0.58, 0.78), respectively (p-trends < 0.05). Stair climbing was inversely associated with obesity, smoking, physical inactivity, and stress; suggesting a potential role for cardiovascular disease prevention.

Modifiable risk factors for cardiovascular disease in Iraqi Kurdistan population: a large epidemiological study

Cardiovascular diseases (CVDs) are considered the leading factor of morbidity and mortality across the world. This study aimed to identify the modifiable risk factors of CVDs in the Kurdistan Region. In this retrospective cross-sectional study, the patients who visited and were diagnosed with any type of CVDs and treated in a main private cardiac center in Duhok governorate in Kurdistan Region were included between the years 2018 and 2023. The study found a similar percentage of male and female patients. The percentage of old patients was significantly increased from 18-19 to ≥70. The most preventable modifiable risk factors among cardiac patients were hypertension (86.17%), physical inactivity (60.59%), diabetes (40.15%), and dyslipidemia (56.31%). The less preventable modifiable risk factors were alcohol (4.01%) and cigarette smoking (14.43%). Males had a higher prevalence of cigarette smoking (24.63% vs. 4.38%; P&lt;0.0001) and female patients had a higher prevalence of hypertension (91.25% vs. 81.02%; P&lt;0.000), diabetes (44.43% vs. 35.80 %; P=0.0007) and dyslipidemia (59.15% vs. 53.43%; P=0.0257). In terms of family history of heart disease, the middle age group had a higher prevalence compared to younger and older age groups. Diabetes and cigarette smoking was more prevalent among older age groups, while dyslipidemia was more prevalent among younger and older age groups. Alcohol, physical inactivity, and hypertension were similar among age groups. Hypertension, diabetes, dyslipidemia, and physical inactivity were the most prevalent risk factors for CVDs in this region. The older patients had significantly higher rates of some of these risk factors.

Monoclonal Gammopathy of Undetermined Significance and Risk of Cardiovascular Disease in US Veterans

Background: Monoclonal gammopathy of undetermined significance (MGUS) has been associated with worse overall survival. The cause of this association is unclear but may result from increased risk of cardiovascular disease (CVD) events. Population-based studies have demonstrated associations between MGUS and CVD, but these were in largely Non-Hispanic White (NHW) populations. As such, we aim to examine the association between MGUS and CVD risk in the US Veterans Health Administration (VHA) which has the largest population of non-Hispanic Black patients (NHB). Additionally, this database can capture patient outcomes with an extensive electronic medical record system. The identification of a novel risk factor for CVD will improve our ability to prevent CVD events further. Methods: This was a population-based retrospective cohort study of US Veterans using linked data from the national Veterans Health Administration and Medicare. Veterans free from CVD events were included in the analytic cohort and were followed from age 50 until they either develop CVD, they expire, or the date 12/31/2022 is reached. Veterans who died or were lost to follow up within 3 years after age 50 were excluded. The exposure is presumed MGUS diagnosis before CVD event or ever. The MGUS diagnosis was captured by a natural language processing (NLP) algorithm (previously developed by our group) based on the presence of a monoclonal protein less than 3 gm/dL and bone marrow plasma cells less than 10%. The outcome of interest was CVD event after age 50 which was identified with International Classification of Diseases (ICD)-9 and -10 codes atherosclerotic cardiovascular diseases and congestive heart failure. A multivariable logistic regression adjusting for sex, race/ethnicity, region of residence, income level, marital status, type 2 diabetes before CVD diagnosis or ever, and BMI at age 50 was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: The analytic cohort contained 523,604 Veterans: 503,098 without MGUS, among whom 25.8% developed CVD and 20,506 with MGUS, among whom, 40% developed CVD (p&amp;lt;0.0001). The CVD events included heart failure with 18.6% (n=3,804) in the MGUS group and 8.7% (n=43,955) in the group without MGUS (p&amp;lt;0.0001). The mean age of MGUS (n=20,506) was 69.2 years and 66.8 in patients who had a CVD event (n=137,918). Compared to individuals without MGUS, individuals with MGUS had a higher proportion of being male (95.5 versus 86.5%, p&amp;lt;0.0001), non-Hispanic Black (29.7 versus 22.0%, p&amp;lt;0.0001), non-Hispanic White (55.2 versus 50.0%, p&amp;lt;0.0001), divorced/separated/widowed (36.2 versus 19.6%, p&amp;lt;0.0001), single/never married (10.6 versus 6.0%, p&amp;lt;0.0001), diabetes mellitus (38.4 versus 22.0%, p&amp;lt;0.001). The odds ratio of having a CVD in the setting of MGUS was 1.23 (95% CI: 1.19-1.26). Conclusions: MGUS was associated with an increased risk of diagnosis of cardiovascular disease for individuals aged 50 years or older. Clinicians should consider evaluation of patients with MGUS for CVD risk factors. Further studies are required to evaluate whether addressing modifiable CVD risk factors is associated with decreased risk of developing CVD in MGUS patients.

Abstract 15052: The Association Between Sleep Duration With Cardiovascular Disease and All-Cause Mortality: Results From the National Health and Nutrition Examination Survey (NHANES)

Background: In 2022, the American Heart Association (AHA) updated the list of modifiable lifestyle factors most important for cardiovascular health to include sleep. Sleep disturbances, such as insomnia and sleep apnea, have been associated with an increased risk of incident cardiovascular disease (CVD). However, the relationship between sleep duration and mortality remains to be fully elucidated. Methods: We used National Health and Nutrition Examination Survey (NHANES) data linked to National Death Index records to examine the association between sleep duration and CVD and all-cause mortality. A representative sample of 37,975 adults aged ≥20 years participated in the survey, which included assessments of social, behavioral, and metabolic factors, including usual weekday sleep duration. Sleep duration was categorized as (1) ideal (6-&lt;9 hours); (2) insufficient (&lt;6 hours); and (3) excessive (≥9 hours). Cox proportional hazards regression models were used to determine the relationship between sleep duration and CVD and all-cause mortality. Models were adjusted for age, sex, and race. Results: Over an average of 7.5 years of follow-up, 2,406 CVD deaths were confirmed. In adjusted models, compared to ideal sleep duration (6-&lt;9 hours), excessive sleep (≥9 hours) was associated with a 65% increase in CVD mortality (HR = 1.65; 95% CI: 1.39, 1.96), a 53% increase in cerebrovascular disease mortality (HR = 1.53; 95% CI: 1.22, 1.92), and a 52% increase in all-cause mortality (HR = 1.52; 95% CI: 1.40, 1.66). Insufficient sleep (&lt;6 hours) was associated with a 38% increase in CVD mortality (HR = 1.38; 95% CI: 1.08, 1.75) and a 54% increase in all-cause mortality (HR = 1.54; 95% CI: 1.38, 1.71). Conclusion: We found that both insufficient and excessive sleep were associated with increased risk of CVD and all-cause mortality, and the risk was more pronounced for excessive sleep. These findings emphasize the importance of recognizing sleep as a modifiable risk factor for CVD. Further research is needed to explore the relationship between sleep and CVD, including incorporating sleep quality into risk assessments and defining clinically meaningful categorizations of sleep metrics.

Abstract 11600: Association Between Obesity and Risk of Total and Obesity-Related Cancer in Persons With Incident Cardiovascular Disease

Introduction: Cardiovascular disease (CVD) and cancer often occur in the same people, in part due to shared risk factors. In a Global Burden of Disease analysis of cohorts from &gt;180 countries, obesity was a top 3 modifiable risk factor for CVD and cancer. Beyond shared risk factors, CVD pathophysiologies may synergize with obesity to influence carcinogenesis. If so, an excess cancer risk in obese persons with CVD has implications for clinical management. Hypothesis: Obesity is positively associated with obesity-related cancer (ObCa) risk in persons with incident CVD independent of shared risk factors. Methods: We used data from the Atherosclerosis Risk in Communities (ARIC) study, a cohort with 28 years of cancer follow-up. The analytic cohort was 5127 participants with incident CVD among whom 1511 were diagnosed with a first primary cancer. Follow up began at incident CVD diagnosis date after visit 1. Obesity was classified by BMI, waist circumference (WC), and waist-to-hip ratio (WHR) measured by trained technicians. We calculated incidence rate differences (RD) between obesity groups adjusted for age, sex, and center. The obesity-cancer association was estimated using Fine-Gray regression adjusted for shared risk factors, including smoking. Results: In people with CVD, cancer incidence was higher in the obese (BMI: RD=226.6/100,000 person-years) than normal weight group. In people with CVD, obesity was suggestively positively associated with ObCa (Table 1). In females with CVD, obesity was associated with increased ObCa risk. Associations were null in males, including after excluding prostate cancer. Conclusion: In this prospective study, obesity is positively associated with ObCa risk in women with incident CVD independent of shared risk factors. More work is needed to investigate why the association appeared in women only, and to identify possible mechanisms by which CVD pathophysiologies may interact with obesity to produce cancer risk.

The Association of Prescribed Opioids and Incident Cardiovascular Disease

Opioid prescribing remains common despite known overdose-related harms. Less is known about links to nonoverdose morbidity. We determined the association between prescribed opioid receipt with incident cardiovascular disease (CVD) using data from the Veterans Aging Cohort Study, a national prospective cohort of Veterans with/without Human Immunodeficiency Virus (HIV) receiving Veterans Health Administration care. Selected participants had no/minimal prior exposure to prescription opioids, no opioid use disorder, and no severe illness 1 year after the study start date (baseline period). We ascertained prescription opioid exposure over 3 years after the baseline period using outpatient pharmacy fill/refill data. Incident CVD ascertainment began at the end of the prescribed opioid exposure ascertainment period until the first incident CVD event, death, or September 30, 2015. We used adjusted Cox proportional hazards regression models with matching weights using propensity scores for opioid receipt to estimate CVD risk. Among 49,077 patients, 30% received opioids; the median age was 49 years, 97% were male, 49% were Black, and 47% were currently smoking. Prevalence of hypertension, diabetes, current smoking, alcohol and cocaine use disorder, and depression was higher in patients receiving opioids versus those not but were well-balanced by matching weights. Unadjusted CVD incidence rates per 1,000-person-years were higher among those receiving opioids versus those not: 17.4 (95% confidence interval [CI], 16.5–18.3) versus 14.7 (95% CI, 14.2–15.3). In adjusted analyses, those receiving opioids versus those not had an increased hazard of incident CVD (adjusted hazard ratio 1.16 [95% CI, 1.08–1.24]). Prescribed opioids were associated with increased CVD incidence, making opioids a potential modifiable CVD risk factor. PerspectiveIn a propensity score weighted analysis of Veterans Administration data, prescribed opioids compared to no opioids were associated with an increased hazard of incident CVD. Higher opioid doses compared with lower doses were associated with increased hazard of incident CVD. Opioids are a potentially modifiable CVD risk factor.

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Association between sleep duration and high blood pressure in Lithuanian adolescents

Abstract Background Sufficient sleep duration in children plays an essential role in physical, mental, and emotional development. High blood pressure (HBP) is growing public health problem in youth. The aim of this study was to evaluate the association between short sleep duration (SSD) and HBP in Lithuanian adolescents aged 11-18 years. Methods The cross-sectional study was conducted from 2019 to 2020 in Kaunas district, Lithuania. HBP was defined according to the 2017 AAP guidelines. Sleep duration was calculated from the time of going to bed to the time of waking up. SSD was defined as sleeping &amp;lt;8 h/day. Multivariate logistic regression was used to calculate aORs and 95% CI. Results The present analysis included 1368 subjects (723 boys and 645 girls) with a mean age of 13.96±1.76 years. Overall, the prevalence of HBP was 43.6% (51.3% for boys and 34.9% for girls). Overall, 21.7% of the subjects reported sleep duration of 7- &amp;lt; 8 h/day, and 11.3% - &amp;lt;7 h/day. In the total sample, after adjustment for sex, BMI, breakfast consumption, and parental smoking, significant associations were found between SSDs and HBP (7-&amp;lt;8 h/day: aOR=1.47; 95% CI, 1.12-1.95; P = 0.006, and &amp;lt;7 h/day: aOR=1.52; 95% CI, 1.05-2.20; P = 0.025), compared to subjects who were sleeping ≥8 h/day. In boys, after adjustment for potential confounders, SSDs were associated with higher odds of HBP (7-&amp;lt;8 h/day: aOR=1.94; 95% CI, 1.30-2.89; P = 0.001, and &amp;lt;7 h/day: aOR=2.35; 95% CI, 1.35-4.12; P = 0.003). There was no significant association between SSD and HBP among girls. Conclusions Our study showed that SSD was significantly associated with increased odds of HBP in Lithuanian adolescents, especially in boys. Public health strategies should focus more on prevention of modifiable cardiovascular disease risk factors. Key messages • Sufficient sleep duration is important for adolescents’ health and may contribute to reduce the risk of cardiovascular disease. • Future prospective studies are needed to confirm these findings.

2023 Clinical Practice Guidelines for Diabetes: Management of Cardiovascular Risk Factors

To prevent cardiovascular disease (CVD), which is one of the ultimate goals in the management of patients with diabetes, it is important to control not only hyperglycemia, but also modifiable CVD risk factors such as hypertension and dyslipidemia. In addition, antiplatelet agents should be used under appropriate conditions. It is necessary to evaluate whether the patient has CVD, the degree of other complications, the presence of comorbidities or other CVD risk factors, and the duration of diabetes. In this article, I will review the revised and key points of the 8th edition of the Korean Diabetes Association clinical practice guidelines for management of hypertension and dyslipidemia and the use of antiplatelet agents in patients with diabetes.

Relationship between Cardiovascular Risk Factors and Composite Cardiovascular Outcomes in Patients Hospitalized with Takotsubo Syndrome: A Nationwide Analysis.

The association of traditional cardiovascular disease (CVD) risk factors with outcomes of Takotsubo syndrome (TTS) is not well-defined. This study examined how modifiable CVD risk factors affect composite cardiovascular outcomes in TTS hospitalizations. TTS admissions were identified using ICD-10 codes and compared for demographics and comorbidities using the 2019 National Inpatient Sample. A multivariable regression examined the association of traditional CVD risk variables with adverse composite cardiovascular outcomes in TTS, controlling for confounders including sociodemographic or hospital-level characteristics and other relevant comorbidities. A total of 16,055 (38.1%) of the 41,855 adult TTS admissions had composite cardiovascular outcomes (TACCO). The TACCO cohort was 81.5% white, 77.3% female, and 72 years old. This group had higher rates of diabetes and peripheral vascular disease (PVD). The results showed that a higher prevalence of diabetes with chronic complications (OR = 1.18) and complicated hypertension (HTN) (OR = 1.1) predicted TACCO, whereas tobacco use disorder (OR = 0.84), hyperlipidemia (OR = 0.76), and uncomplicated HTN (OR = 0.65) (p < 0.001) showed a paradoxical effect with TACCO. TACCO had fewer routine discharges (35.3% vs. 63.4%), longer stays (6 vs. 3 days), and higher median hospital costs (78,309 USD vs. 44,966 USD). This population-based study found that complicated HTN and DM with chronic complications are strongly associated with adverse cardiovascular outcomes in TTS hospitalizations. But still, some risk factors, such as hyperlipidemia and uncomplicated HTN, have counterintuitive effects that require further evaluation. To prevent cardiac events in TTS patients, traditional CVD risk factors must be addressed.

Abstract 077: Protein Biomarkers Of Hypertension

Background: Hypertension is a major modifiable riskfactor for cardiovascular disease. The discovery of novel protein biomarkers ofhypertension can provide information on disease pathophysiology and highlightpromising therapeutic targets. Methods: We measured plasma levels of 2925proteins in 740 participants (mean age 51.7 ±11.3 years; 46% women) in the Framingham HeartStudy using the Olink Explore proximity extension assay. Linear mixed modelswere used to explore the associations of plasma proteins with systolic anddiastolic blood pressure (BP) and prevalent hypertension. We definedhypertension as having elevated BP (systolic ≥ 140 mmHg or diastolic ≥90 mmHg) or current use of antihypertensive medication. We adjusted all themodels for age, sex, batch effects, eGFR (estimated glomerular filtration rate),pack-years of smoking, and lung function status (normal/obstructive/restrictive). Sensitivity analysis was performed by excluding individuals treated withantihypertensive medication. Using overrepresentation analysis, we annotatedthe proteins associated with hypertension. We adjusted for multiple tests using the Benjamini-Hochberg method and a false discovery rate of &lt; 0.05 wasused to define statistical significance. Results: We observed differential expression of 526proteins (465 upregulated, 61 downregulated) in participants with prevalenthypertension (N=257) vs. normal BP (N= 483). Systolic BP was associated with571 proteins and diastolic BP was associated with 662 proteins. We observed 507protein associations with systolic BP and 626 protein associations withdiastolic BP after exclusion of treated individuals (N=177). Functionalannotation of proteins associated with hypertension showed enrichment of genesassociated with fatty acid transport, regulation of MAPK cascade, response tointerleukin-1 and inflammatory response. Discussion: This study elucidates protein signaturesassociated with BP and hypertension. Hypertension is enriched in pathwaysrelated to fatty acid transport and inflammatory response. These results mayprovide information on the pathogenesis ofhypertension and highlight promising therapeutic targets.

Awareness About Risk Factors, Signs and Symptoms of Cardiovascular Diseases and the Perceived Level of Physical Activity along with Sedentary Behaviour in Young Adults of Pune Region: A Questionnaire Based Study

Background: Cardiovascular diseases (CVDs) are the leading cause of death globally. Young adults are more inclined towards unhealthy lifestyle habits, in turn leading to increased risk of developing CVDs. Identifying the level of awareness about CVDs risk factors and signs and symptoms along with their physical activity and sedentary behaviour will help in creating awareness which in turn might help in reduction of the modifiable CVD risk factors. Objective: To assess awareness and knowledge about risk factors, signs and symptoms of CVDs in young adults of Pune region along with evaluating their perceived level of physical activity and sedentary behaviour. Method: A questionnaire was designed to address all the components. Face validation of the questionnaire was done. Participants were explained in detail about the study purpose and the procedure; post their informed consent questionnaire was administered on an interview basis. Responses analysed using SPSS software and represented as descriptive statistics. Result: Total 115 participants were included in the study, with the mean age 21.94±2.26 years. 68 % of the study participants denied gender predisposition and 12% of participants were not sure about it as a risk factor.69% of the participants had 3-5; whereas 31% had 1-2 modifiable risk factors. Sedentary behaviour was the most prevalent risk factor present in 96.5% of the study participants, followed by physical inactivity in 65.2% of participants. None of the participants met WHO guidelines of healthy diet for adults.55% of the participants perceived to have fair level of awareness. Only 11.30% of the participants perceived to have good level of physical activity. However, 65% of the participants were physically inactive. Sedentary behaviour was found to be 10.8±2.86 hour on a typical day. Conclusion: In our study, participants had good knowledge and awareness about the risk factors and signs and symptoms of cardiovascular diseases except for few factors. Majority of participants perceived that they have fair levels of physical activity but more than half of the study participants failed to meet recommended criteria. Majority of our study participants already possessed three to five modifiable risk factors with unhealthy diet, sedentary behaviour and physical inactivity being at top of the list. They are also engaged in high sedentary behaviour. KEY WORDS: Non communicable diseases, Cardiovascular diseases, Physical activity, Risk factors, Signs and symptoms, Sedentary behaviour, Awareness, Knowledge, Perceived levels.

Trend of risk factors for cardiovascular diseases among young and middle-aged indians: Insights from a nationally representative survey

BackgroundIndia, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states. MethodsThe present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same. ResultsA declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019–21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey. ConclusionThe present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.