Nontraditional Risk Factors Research Articles

Hypertension among adolescents in sub-Saharan Africa: a systematic review.

Hypertension (HTN) among adolescents is common in high-income countries, and leads to increased premature cardiovascular diseases (CVD). In sub-Saharan Africa (SSA), the prevalence of HTN among adolescents, associated risk factors and CVD complications are not well-described. Such data is needed for planning public health programs to prevent premature CVD in SSA. We systematically searched 5 databases (MEDLINE, Embase, Google Scholar, Web of Science, and African Index Medicus) from their establishment to December 2021. Key search terms were: adolescent, arterial hypertension, and names of the 48 countries in SSA. We used Covidence® to manage the search results. The review was registered in the Open Science Framework (OSF) https://osf.io/p5sbt/. We identified 4,008 articles out of which we screened 3,088 abstracts, and reviewed 583 full-text articles. We finally included 92 articles that were published between 1968 to December 2021. The majority were cross-sectional studies (80%) and conducted in school settings (78%). The risk of bias was low for 59 studies (64.1%), moderate for 29 studies (31.5%), and high for 4 studies (4.3%). Overall, the prevalence of HTN varied widely from 0.18% to 34.0% with a median (IQR) of 5.5% (3.1%, 11.1%). It was relatively higher in studies using automated blood pressure (BP) devices, and in studies defining HTN using thresholds based on percentile BP distribution for one's height, age, and sex. In addition, the prevalence of HTN was significantly higher in studies from Southern Africa region of SSA and positively correlated with the year of publication. Across studies, traditional risk factors such as age, sex, body mass index, and physical inactivity, were commonly found to be associated with HTN. In contrast, non-traditional risk factors related to poverty and tropical diseases were rarely assessed. Only three studies investigated the CVD complications related to HTN in the study population. The prevalence of HTN among adolescents in SSA is high indicating that this is a major health problem. Data on non-traditional risk factors and complications are scarce. Longitudinal studies are needed to clearly define the rates, causes, and complications of HTN. https://osf.io/p5sbt/, identifier (10.17605/OSF.IO/P5SBT).

Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association.

Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.

Quantitative Association between Computed-Tomography-Based L1 Skeletal Muscle Indices and Major Adverse Clinical Events Following Percutaneous Coronary Intervention

Sarcopenia is as a non-traditional risk factor for atherosclerotic cardiovascular disease. Further investigation is required to elucidate the prognostic significance of computed tomography (CT)-based sarcopenia assessment in coronary artery disease (CAD). We prospectively enrolled 475 patients, who underwent coronary stent implantation and peri-procedural CT scans within one month. Skeletal muscle index (SMI) was assessed cross-sectionally at the first lumbar vertebra (L1) level. The participants were grouped based on sex-specific L1 SMI quartiles. The primary endpoint was all-cause mortality, and the secondary composite endpoint was major adverse cardiovascular events (MACEs) over a 3-year follow-up period. Three-year all-cause mortality and MACE incidence increased significantly in patients in the lower L1 SMI quartiles compared to those of patients in the higher quartiles (p < 0.001). The individual composite endpoints consistently showed a higher incidence in the lower quartiles of L1 SMI (p < 0.001). In multivariable analysis, the lower L1 SMI quartiles independently predicted 3-year all-cause mortality and MACEs (lowest vs. highest quartiles, respectively: OR 4.90 (95% CI 1.54–15.5), p = 0.007; and OR 12.3 (95% CI 4.99–30.4), p < 0.001). In conclusion, CT-based L1 SMI demonstrated a distinct dose-dependent relationship with future MACEs in CAD patients undergoing percutaneous coronary intervention, thereby enhancing cardiovascular risk stratification.

Age and the Residual Risk of Cardiovascular Disease following Low Density Lipoprotein-Cholesterol Exposure.

We believe that there is sufficient evidence from basic science, longitudinal cohort studies and randomised controlled trials which validates the low-density lipoprotein cholesterol (LDL-C) or lipid hypothesis. It is important that we can communicate details of the cardiovascular disease (CVD) risk reduction that the average patient could expect depending on the scale of LDL-C decrease following lipid lowering therapy. It is also essential that residual risk (ResR) of CVD be highlighted. To achieve this aim by using existing trial evidence, we developed mathematical models initially for relative risk reduction (RRR) and absolute risk (AR) reduction and then showed that despite optimising LDL-C levels, a considerable degree of ResR remains that is dependent on AR. Age is significantly associated with AR (odds ratio: 1.02, 95% confidence intervals: 1.01-1.04) as was previously demonstrated by analysing the Whickham study cohort using a logistic regression model (age remaining significant even when all the other significant risk factors such as sex, smoking, systolic blood pressure, diabetes and family history were included in the regression model). A discussion of a paper by Ference et al. provided detailed evidence of the relationship between age and AR, based on lifetime LDL-C exposure. Finally, we discussed non-traditional CVD risk factors that may contribute to ResR based on randomised controlled trials investigating drugs improving inflammation, thrombosis, metabolic and endothelial status.

Pathways Linking Post-Traumatic Stress Disorder to Incident Ischemic Heart Disease in Women: Call to Action

BackgroundPost-traumatic stress disorder (PTSD) is associated with increased rates of incident ischemic heart disease (IHD) in women. ObjectivesThe purpose of this study was to determine mechanisms of the PTSD-IHD association in women. MethodsIn this retrospective longitudinal cohort study, data were obtained from electronic health records of all U.S. women veterans who were enrolled in Veterans Health Administration care from January 1, 2000 to December 31, 2017. Propensity score matching was used to match women with PTSD to women without PTSD on age, number of prior Veterans Health Administration visits, and presence of various traditional and nontraditional cardiovascular risk factors at index visit. Cox regression was used to model time until incident IHD diagnosis (ie, coronary artery disease, angina, or myocardial infarction) as a function of PTSD and potential mediating risk factors. Diagnoses of IHD, PTSD, and risk factors were defined by International Classification of Diseases-9th or -10th Revision, and/or Current Procedural Terminology codes. ResultsPTSD was associated with elevated rates of developing each risk factor. Traditional risk factors (hypertension, hyperlipidemia, smoking, diabetes) accounted for 24.2% of the PTSD-IHD association, psychiatric risk factors (eg, depression, anxiety, substance use disorders) accounted for 33.8% of the association, and all 13 risk factors accounted for 48.5% of the association. ConclusionsTraditional IHD risk factors explained a quarter of the PTSD-IHD association in women veterans, and over half of the risk of IHD associated with PTSD remained unexplained even when adjusting for a wide range of risk factors. To be actionable, factors underlying the remaining PTSD-IHD association warrant timely investigation.

Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA)

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) remains a puzzling clinical entity characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). This pathology is poorly understood, several studies are underway for a better understanding of this disease. The aim of our work was to review the literature and assess the epidemiology, clinical features, prognosis and etiologies of MINOCA. Methods: Descriptive, prospective study, spread over a period of 36 months from January 2018 to December 2020 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen, for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (MI-CAD) if there was revascularization or plaque ≥ 50% and as having MINOCA if there was <50% obstruction or a mechanism without plaque. Patients who received thrombolytics before angiography were excluded. We studied the epidemiological, clinical and prognostic profile of the MINOCA population then compared them to patients with obstructive coronary artery disease and finally we established an etiological analysis of the MINOCA population. Results: The number of MINOCA cases in our sample of 585 AMI patients was 10.25% vs. 525 (89.74%) cases of AMI-CO, it was more common in men (78.3% vs. 21, 7%; odds ratio at 3.61) and in the youngest patients. MINOCA patients were more likely to be without traditional cardiac risk factors (7.9% vs. 2.1%; P <0.001) but more predisposed to non-traditional risk factors than AMI-CO patients (3.7% against 1.8%; P = 0.026). Smoking is the only traditional risk factor frequent in the MINOCA population versus MI-CAD (P at 0.001). Depression, stress, drug addiction, DVT history and autoimmune disease history are more frequent in the MINOCA population versus MI-CAD (P <0.05) STEMI are more found in the MINOCA population versus MI-CAD (P = 0.000) In terms of prognosis, the MINOCA population had a better prognosis: less risk of recurrence than the MI-CAD population 6.7% versus 10.45% (P = 0.03) also less mortality 0% versus 4.6% (P = 0.007). Conclusion: The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (MI- CAD) however they had a better quality of life and a good prognosis.

Relationship between vitamin D and coronary artery disease in Egyptian patients

BackgroundPrevious studies have reported conflicting results about the association of vitamin D (VD) level with coronary artery disease (CAD). We aimed to study the association of VD with atherosclerotic CAD in Egyptian individuals.ResultsWe prospectively enrolled 188 consecutive CAD patients with a median age of 55(50–62) years; 151(80.3%) were male. All patients were diagnosed by cardiac catheterization and were compared with 131 healthy controls. VD levels were measured in serum samples of all participants. Compared to controls, CAD patients had a significantly lower median VD level, 14.65 (9.25–21.45) versus 42.0 (32.0–53.0) ng/mL, p < 0.001. VD was correlated with the number of diseased coronary arteries and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, p < 0.001 for each). By multivariate analyses, VD was an independent predictor of CAD [OR 1.22 (95% CI 1.07–1.4), p = 0.003, optimal cut-off value 30 ng/mL (AUC 0.92, sensitivity 81% and specificity 81.4%), p < 0.001], and the number of diseased coronary arteries, p < 0.001, especially three-vessel disease [OR 0.83 (95% CI 0.72–0.95), p = 0.008].ConclusionsWe have shown that low VD should be considered a non-traditional risk factor for CAD in Egyptian individuals. Low VD was correlated with coronary atherosclerosis, especially in patients with multivessel effects.

Abstract 13595: Sex-Specific Burden of Peripheral Arterial Disease Across the United States: Analysis of the Global Burden of Disease 1990-2019

Background: Peripheral arterial disease is a ubiquitous disease that varies in terms of morbidity and mortality due to biologic sex, including the impact of traditional and non-traditional risk factors and sex-specific conditions that adds complexity and contributes to the existing disparities. Thus, understanding the sex-specific trends of PAD in the United States population is critical for developing targeted interventions. We sought to analyze the burden of PAD in male and female patients across the US from 1990 to 2019. Methods: Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of PAD from 1990-2019, across US states. The GBD defined PAD based on studies that used symptom-based criteria and expressed the burden of PAD as the age-standardized prevalence and disability adjusted life years (DALYs) rates. We additionally estimated the regional relative change in DALYs. Results: In 2019, there were 5.4 million males and 7.1 million females with PAD in the US. Absolute PAD prevalence and DALYs increased in both sexes between 1990 and 2019, figure. The 2019 age-standardized prevalence of PAD (per 100,000) in the US in 2019 was 2,124 (95% Uncertainty Interval (UI): 1905-2354), and 2,302 (95% UI: 2,079-2,522) for females. Between 1990 and 2019, females had higher increase in age-standardized PAD DALYs compared with males (13.8% vs 5.5%). Significant state-level geographic variance was noted in age-standardized prevalence of PAD in both sexes (2-fold difference between lowest and highest state), figure. Conclusion: The burden of PAD is increasing in the US owing to the aging population. The absolute prevalence of PAD is higher in women compared with men in the US. Over the past 3 decades, there has been a more significant increase age-standardized PAD DALYs in women as compared with men. Future studies are needed to investigate and target these disparities.

Abstract 18033: Nationwide Trends in Major Adverse Cardiac and Cerebrovascular Events Hospitalizations and Cardiac Arrests in Young Women (18-44 Years), 2016-2019

Introduction: Incidence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) and cardiac arrests are increasing in younger women aged 18 - 44 years in the context of increasing metabolic syndrome and nontraditional risk factors such as stress, anxiety, and depression. We aim to assess recent trends in hospitalizations associated with MACCE and cardiac arrest in them. Methods: National Inpatient Sample database from 2016 - 2019 was used to examine temporal trends, risk factors, disparities, and outcomes related to hospitalization for MACCE and cardiac arrest in young women (18-44 years). We used the Chi-square test to evaluate the differences and multivariate logistic regression analysis for outcome analysis. Results: A total of 24,882,601 young women admissions were identified, in which 0.8% had MACCE and 0.1% had cardiac arrest. Between 2016 - 2019, there is a statistically significant increase in MACCE (0.7 % to 0.9 %) and cardiac arrests (0.1% to 0.2 %), p&lt;0.001. African Americans experienced higher adjusted odds of MACCE compared to whites (OR 1.06, 95% CI: 1.02-1.09, p&lt;0.001). Asian, white, and Hispanics experienced the lowest (0.1%) increase, while Native Americans experienced the highest (0.6%) increase in MACCE. There is a decrease in adjusted odds in Hispanics and Asians compared to whites in both MACCE and Cardiac arrest with statistical significance. Hypertension was African Americans’ most prevalent risk factor (62%). Length of stay was the same in all races (4 days) except in whites (3 days), with p value &lt; 0.001. The total cost of hospitalization was highest in Hispanics (95067USD) and least in blacks (75074USD). Conclusion: The rise in MACCE and cardiac arrest cases among young women highlights the need to expand the literature on the causes of these trends, female specific risk factors and racial disparities. The declining cardiovascular health of this population demands targeted prevention, early treatment and management strategies.

Abstract 12874: Risk of Ischemic Heart Disease in Young Women With Dysmenorrhea: A Cross-Sectional Study on Electronic Health Records

Introduction: Ischemic heart disease (IHD) incidence is increasing among young individuals, particularly women. Suboptimal primary prevention due to risk underestimation is thought to contribute to this trend. Non-traditional risk factors, such as stress and female-specific factors, are often overlooked but offer an opportunity to improve risk stratification. Dysmenorrhea is the most prevalent menstrual complaint, and associated with increased stress and autonomic dysfunction. To date, contribution of dysmenorrhea to cardiovascular disease risk has not been investigated. Hypothesis: Dysmenorrhea is associated with increased risk of IHD before 50 years of age. Methods: We extracted a cohort of 30,554 women with dysmenorrhea and 25,350 controls from Mount Sinai data warehouse as shown in Fig 1. For statistical analysis we performed full propensity score matching on demographic and clinical covariates, followed by weighted logistic regression with IHD before age 50 as a binary outcome. We then investigated IHD subtypes (angina, acute myocardial infarction (AMI), AMI complications, chronic IHD) in separate regression models, and evaluated the inclusion of menstrual abnormalities (MA) and endometriosis as additional covariates in the models (vs other covariates only). Results: Dysmenorrhea was associated with a significant increase in the OR for overall IHD, angina and chronic IHD (Table 1), independently from MA or endometriosis. Conclusions: Dysmenorrhea might be an important risk factor for early IHD. The risk appears to be largest for angina and chronic IHD. Further research can investigate dysmenorrhea as a predictor of future IHD risk.

Abstract 13466: Trends in Prevalence of Psychiatric Cardiovascular Risk Factors for Women Veterans

Introduction: Psychiatric disorders such as anxiety, depression, and posttraumatic stress disorder (PTSD) have been increasingly recognized as cardiovascular disease (CVD) risk factors in the past two decades. US women Veterans (WV) are a growing and high-risk population for CVD. The goal of this study was to investigate the prevalence of these psychiatric CVD risk factors among US WV over a two-decade period. Methods: The national Veterans Affairs electronic health records were utilized to assess prevalence of the above disorders among US WV who visited a VA facility from 1/1/2000 to 12/31/2019. All diagnoses were based on International Classification of Disease (ICD) 9 th and 10 th version diagnostic codes. Results: Over the study period, the population of WV grew from 80,707 to 739,309, and the average age of the WV remained stable, 48 (2000) and 49 (2019) years old. Table 1 reveals the prevalence of these psychiatric CVD risk factors over the study period. Prevalence of each psychiatric disorder increased over the study period, with accelerated growth over the last decade of the study period. Conclusion: The prevalence and growth of these psychiatric l CVD risk factors among US WV is alarming. Focused research is warranted on potential interventions to reduce, and treat these nontraditional CVD risk factors to improve both psychiatric and cardiovascular health for WV.

Vascular Health Promotion Project and Vascular Medicine in China-CCVM2004-2023.

Cardiovascular disease(CVD) has become a major disease burden affecting people's health in China. Blood vessels are very important for human health and are the "sentinel" for the development of many cardiovascular and cerebrovascular diseases. The key to effectively preventing fatal, disabling heart, brain and peripheral vascular events lies in controlling traditional and non-traditional risk factors for vascular health from the source, and early assessment and intervention of early vascular lesions. Since 2004, China government promoted the early detection technology of vascular lesions and vascular medicine, and proposed the Beijing Vascular Health Stratification (BVHS) to provide suggestions for the examination, evaluation and management of risk factors, and to provide new ideas for lifelong maintenance of vascular health. This review mainly introduces the establishment and development of the clinical discipline of "vascular medicine" in the past 20 years in China, introduces the indicators for detecting vascular function and structure and the predictive value of vascular events, and carries out intelligent and digital management of vascular health throughout the life cycle of individualized prevention, treatment and rehabilitation for people with different parts or degrees of lesions, effectively reducing the occurrence and development of cardiovascular and cerebrovascular diseases, and the prospect of new technology in maintaining vascular health.

Using Repeated Measurements to Predict Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus

The QRISK cardiovascular disease (CVD) risk assessment model is not currently optimized for patients with type 2 diabetes mellitus (T2DM). We aim to identify if the abundantly available repeatedly measured data for patients with T2D improves the predictive capability of QRISK to support the decision-making process regarding CVD prevention in patients with T2DM. We identified patients with T2DM aged 25 to 85, not on statin treatment and without pre-existing CVD from the IQVIA Medical Research Data United Kingdom primary care database and then followed them up until the first diagnosis of CVD, ischemic heart disease, or stroke/transient ischemic attack. We included traditional, nontraditional risk factors and relevant treatments for our analysis. We then undertook a Cox's hazards model accounting for time-dependent covariates to estimate the hazard rates for each risk factor and calculated a 10-year risk score. Models were developed for males and females separately. We tested the performance of our models using validation data and calculated discrimination and calibration statistics. The study included 198,835 (180,143 male with 11,976 outcomes and 90,466 female with 8,258 outcomes) patients. The 10-year predicted survival probabilities for females was 0.87 (0.87 to 0.87), whereas the observed survival estimates from the Kaplan-Meier curve for all female models was 0.87 (0.86 to 0.87). The predicted and observed survival estimates for males were 0.84 (0.84 to 0.84) and 0.84 (0.83 to 0.84) respectively. The Harrell's C-index of all female models and all male models were 0.71 and 0.69 respectively. We found that including time-varying repeated measures, only mildly improved CVD risk prediction for T2DM patients in comparison to the current practice standard. We advocate for further research using time-varying data to identify if the involvement of further covariates may improve the accuracy of currently accepted prediction models.

Changes in Cardiovascular and Renal Biomarkers Associated with SGLT2 Inhibitors Treatment in Patients with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus is a major health problem worldwide with a steadily increasing prevalence reaching epidemic proportions. The major concern is the increased morbidity and mortality due to diabetic complications. Traditional but also nontraditional risk factors have been proposed to explain the pathogenesis of type 2 diabetes mellitus and its complications. Hyperglycemia has been considered an important risk factor, and the strict glycemic control can have a positive impact on microangiopathy but not macroangiopathy and its related morbidity and mortality. Thus, the therapeutic algorithm has shifted focus from a glucose-centered approach to a strategy that now emphasizes target-organ protection. Sodium-glucose transporter 2 inhibitors is an extremely important class of antidiabetic medications that, in addition to their glucose lowering effect, also exhibit cardio- and renoprotective effects. Various established and novel biomarkers have been described, reflecting kidney and cardiovascular function. In this review, we investigated the changes in established but also novel biomarkers of kidney, heart and vascular function associated with sodium-glucose transporter 2 inhibitors treatment in patients with type 2 diabetes mellitus.

Association of dental caries in the era of COVID-19 with the number of occluded coronary vessels: A non-traditional risk factor in patients with acute coronary syndrome

Background: Dental caries and acute coronary syndrome (ACS) are prevalent chronic multifactorial disorders with several etiopathological risk factors. This study aims to assess the association between carious teeth and the number of coronary arteries identified by angiography among ACS patients. Material and Methods: 118 patients with ACS were evaluated clinically by cardiologists. Participants’ dental hygiene was assessed using the DMFT index. Before having their coronary angiography evaluated, all individuals had their urea, creatinine, and troponin serum levels checked. Echocardiography was also done. The relationship between the DMFT scoring index and echocardiographic and angiographic data was examined. Results: All subjects studied had poor dental health overall (13.7±9.8), and their mean ages were 57.2±10.2 years. There were 118 participants in this study, and males made up 77.1% of the group. The majority of ACS (60.7%) had a high DMFT score (DMFT &gt; 9), which in most cases indicated a significant number of missing teeth (10.9±8.9). Around half of the patients had poor carious status (DMFT &gt; 10). The DMFT index and LVEF% measurements had non-significant positive relationships. According to the ROC curve, DMFT and its components lacked the diagnostic capacity to distinguish participants with one occluded coronary artery from ACS patients affected by multiple coronary arteries. Conclusion: Although it cannot be used to predict the severity of the ACS, oral hygiene regarding dental status is related to the number of stenosed coronary arteries (but not LVEF%).

Non-Traditional Cardiovascular Risk Factors in Adolescents with Obesity and Metabolic Syndrome May Predict Future Cardiovascular Disease.

Obesity in adolescence is associated with significant morbidity and predisposes adolescents to the development of cardiovascular disease (CVD). Although a number of traditional CVD risk factors have been identified in youth, limited data exist regarding non-traditional CVD risk factors. In 89 adolescents with metabolic syndrome (MetS), with 60 age-, gender-, and BMI-matched controls, we determined the non-traditional CVD risk factors (hs-CRP, TG/HDL ratio, ApoB/ApoA1 ratio, NAFLD) in order to investigate whether they may be used as biomarkers for predicting future CVD, and we evaluated their response to the implementation of a multidisciplinary, personalized, lifestyle intervention program for 1 year. We demonstrated that the TG/HDL ratio, IL-2, IL-6, IL-17A, and INF-γ were significantly increased in subjects with MetS than in controls, and may be used as biomarkers to predict future CVD. Subjects with MetS had an increased mean carotid intima-media thickness (cIMT) and prevalence of NAFLD than the controls, while the prevalence of NAFLD correlated strongly with cIMT and IL-6 concentrations. Most of the non-traditional cardiovascular risk factors improved following the implementation of a lifestyle intervention program. These findings indicate that adolescents with MetS may have a greater risk for developing atherosclerosis early in life, while early lifestyle intervention is crucial for preventing the arteriosclerotic process in youth.

Platelets as Potential Non-Traditional Cardiovascular Risk Factor-Analysis Performed in Healthy Donors.

Abnormal lipid profile, increased glucose level, and elevated body weight are traditional cardiometabolic risk factors; however, the role of platelets in the development of cardiovascular disease (CVD) is increasingly being highlighted. The aim of this study was to select platelet-related parameters (non-genetic molecular and routine laboratory measurements) that may be associated with increased cardiovascular risk among healthy populations. We evaluated the level of platelet indices, platelet-based inflammatory markers, platelet reactivity parameters, and platelet reactive oxygen species (ROS) generation in relation to selected cardiometabolic risk factors. We noted the association between total cholesterol and LDL cholesterol with platelet aggregation and platelet ROS generation. We found the relationship between triglycerides, glucose, and body mass index with the relatively new multi-inflammatory indices (MII-1 and MII-3). Moreover, we noticed that the mean platelet volume-to-lymphocyte ratio in healthy subjects is not a good source of information about platelets and inflammation. We also highlighted that platelet-to-HDL-cholesterol ratio may be a promising prognostic cardiometabolic indicator. The association between platelet-related (especially molecular) and cardiometabolic parameters requires further research. However, the goal of this study was to shed light on the consideration of platelets as a non-traditional cardiovascular risk factor and a crucial element in identifying individuals at high-risk of developing CVD in the future.

Increased incidence of ischemic stroke in young: A population-based stroke registry study from 2008 to 2018

BackgroundStudying changing patterns in stroke incidence is essential since strokes represent a burden for public health. The aim of our study was to evaluate the epidemiological trend of strokes from 2008 to 2018 in the population-based Brest Stroke Registry (BSR) focusing on patients under 60. MethodsAll first-ever-stroke, patients aged 15 and older, with imaging, in the Pays-de-Brest from January 1st 2008 to December 31st 2017 were included. Cumulative incidence was calculated, by periods of two years, and temporal trends were evaluated by age group, sex, stroke subtype (ischemic or hemorrhagic) using a Poisson regression. Trends in stroke variables were specifically studied for young people. Ischemic stroke mechanism subtypes were analysed according to TOAST and SSS-TOAST classifications. ResultsOver a 10-year study period, there were 6043 first-ever-strokes: 738 intracerebral hemorrhage (ICH) and 5305 ischemic strokes (IS). Mean age was 73.55±14.25years, 82.2% were older than 60 and 51.8% were women. IS incidence increased in young people from 30.4 [95% CI: 27.4; 33.8] to 37.3 [95% CI: 33.9; 41.0] per 100,000 inhabitants (P=0.0025). IS incidence≥60 decreased except for last studied period. ICH remained stable for older people but decreased in young from 5.6 [4.3; 7.1] to 2.8 [2.0; 4.0] per 100,000 inhabitants (P=0.0250). Under 60, the main risk factors were smoking (68.6%); hypertension (27.8%); high-alcohol intake (24.4%) and dyslipidemia (21%). Most IS were minor. Work-up in the IS young population was for the large majority brain magnetic resonance imaging (MRI) (74.5%); cardiac monitoring (80%): echocardiography (83.5%); and imaging of the neck vessels (89.9%). Among IS, 19.8% were taking antihypertensive drugs and 10.9% statins. According to the TOAST classification, there were 46.7% cryptogenic strokes, which was reduced to 25.5% for other cryptogenic strokes, and 2.3% for cryptogenic embolism according SSS-TOAST classification. In IS, risk profiles, clinical parameters and prior-stroke treatments did not significantly change. Dyslipidemia and use of statins were fluctuant. Diagnostic work-up improved but the frequencies of IS mechanism subtypes remained stable. ConclusionIS incidence increased while ICH incidence declined in young people. Major use of MRI may have contributed to the IS trend. The traditional risk factors studied remained stable and did not explain the increase in IS incidence. Improvement in diagnostic work-up did not lead to any change in subtypes of stroke mechanisms. Using the SSS-TOAST classification reduced the rate of cryptogenic strokes. The role of non-traditional risk factors may be explored in an attempt to explain increased incidence.

Pathophysiological concepts and screening of cardiovascular disease in dialysis patients.

Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.

Cardiovascular aging in patients with chronic kidney disease: pathogenesis and potential therapeutics

Patients with chronic kidney dysfunction have an elevated risk for various cardiovascular diseases. Even in the early stages of chronic kidney disease (CKD) the prevalence of cardiovascular events and mortalities is extremely high if compared with age-matched general population. With worsening of kidney function this risk is growing intensely. There are many traditional and non-traditional risk factors that can lead to cardiovascular disease in CKD. Cardiovascular rather than kidney failure, per se, is the main cause of mortality in CKD. The increase of calcification promoters and the decrease of inhibitors leads to the development of vascular calcification in the early stages of CKD. In this regard, CKD mimics cardiovascular system aging with a premature onset and an accelerated progression.Various non-pharmacological and pharmacological interventions have been studied to retard premature cardiovascular aging in CKD. In this review article, we are summarizing the pathogenesis, risk factors, and possible management strategies of cardiovascular disease in CKD.