Non-conventional Risk Factors Research Articles

Influence of non-conventional risk factors on peripheral arterial diseases

Objective: to study the effect of non-conventional risk factors on the progression of peripheral artery diseases.Material and methods. The study involved 250 patients (76.8 % men (192 patients) and 23.2 % women (58 patients)). The non-conventional risk factors among the patients were identified using the «Hospital Anxiety and Depression Scale» (HADS), «Scales for assessing the level of reactive and personal anxiety» (Ch. D. Spilberger, Yu. L. Khanin). The degree of chronic arterial insufficiency was determined in accordance with the classification of Pokrovsky-Fontaine (1985). The statistical analysis of the obtained data was performed by means of the «Statistica» 8.0 program, using the Pearson χ2 criterion. Differences between the groups were considered statistically significant at p < 0.05.Results. A high prevalence rate of personal (95.2% of the patients) and reactive (91.6 % of the patients) anxiety has been revealed among patients with peripheral artery disease. Higher levels of personal and reactive anxiety have been found among patients with critical ischemia threatened by limb loss (group 3) (46.0 (41.0; 50.0); 47.0 (43.0; 51.0), respectively) compared with the values in groups 1 and 2 of the patients.

Association of coronary heart disease and sleep disorders among men in a medium-sized urban city of Western Siberia

The aim of the study was to establish the association of the prevalence of coronary heart disease (CHD) and sleep disorders among men between the ages of 25 and 64 belonging to an open population of a medium-sized urban city of Western Siberia. Materials and methods . A cross-sectional epidemiological study was conducted on a representative sample of the population among males of 25–64 years old in Tyumen. The prevalence of coronary heart disease was determined based on standard epidemiological methods. Self-assessments by participants in the study of quality of sleep was determined by the World Health Organization (WHO) Monitoring Trends and Determinants in Cardiovascular Disease-Psychosocial Program (WHO MONICA-psychosocial). When calculating the odds ratio of developing coronary heart disease), self-reports of satisfactory, good, or very good sleep were regarded as a lack of an indicator; while very bad and bad sleep were considered positive indicators. Results. The prevalence of CHD according to the extended epidemiological criteria for men in an open urban population was 12.4%; the detection rate of “definite” and “possible” CHD was almost equal. The age-standardized prevalence rate of sleep disorders was 50.9%. There is a significant risk of developing CHD with extended criteria (5.05), as well as “definite” (5.28) and “possible” (3.13) forms in the male population at 25–64 years of age. In the 55 to 64 age group, there is a significant risk of developing CHD according to the extended criteria (5.57) and the “definite” form of CHD (10.21). Conclusion. Thus, the findings suggest the importance of further study of sleep disorders in working age men in Siberian populations, its relationships with conventional and non-conventional risk factors of CHD, as well as the feasibility of preventive measures aimed at reducing the influence of psycho-emotional stress factors among the Russian population.

230 Machine Learning Models for Predicting Ischemic Stroke and Major Bleeding Risk in Patients with Atrial Fibrillation

Background Risk scores such as CHA2DS2-VASc and HAS-BLED are used to assess stroke and bleeding risk respectively and choose appropriate antithrombotic therapy in patients with atrial fibrillation (AF). The application of ML models may improve risk prediction and identification of potential risk factors. Objective To investigate the usefulness of ML methods in estimating one-year risk of ischemic stroke and major bleeding in patients after hospitalisation with AF. Methods We identified adults with a history of non-valvular AF or atrial flutter who were admitted to a tertiary or secondary hospital in Perth, Western Australia from 2009 to 2016 using linked clinical and administrative data. Based on all the available risk factors in the data including individual risk factors in the scores, we built ML models and compared their predictive performance [Area under the receiver operating characteristic curve (AUC)] with the standard risk scores. Results There were 9,634 patients in the study cohort with a mean age of 77 years and 46% were female. 2407 patients died (n=1636) or were readmitted for ischemic stroke (n=157) and major bleeding (n=614) within one year after the first admission. All-cause death was treated as a competing risk. Gradient Boosting Machine identified nonconventional risk factors and achieved the best prediction (ischemic stroke: AUC 0.67 vs 0.64 for CHA2DS2-VASc; major bleeding: AUC 0.66 vs 0.53 for HAS-BLED). Conclusion ML models can identify nonconventional risk factors and also outperform commonly used risk scores for predicting ischemic stroke and major bleeding in patients with AF.

EPIDEMIOLOGICAL ASPECTS OF THE PREVALENCE OF CORONARY HEART DISEASE IN AN OPEN URBAN POPULATION: GENDER DIFFERENCES

The aim. To determine gender differences in the prevalence of coronary heart disease in an open urban population.Material and Methods. For a one-stage epidemiological study in an open urban population, a representative sample of 25–64-year-old residents was formed from the electoral lists of the Central Administrative District of Tyumen (n=2000) using a “random” mathematical method. The response rates of the study were 85.0% among men and 70.3% among women. The conclusion about the presence of coronary artery disease was carried out according to strictly standardized epidemiological methods. Definite CHD (strict criteria) and possible CHD (lax criteria) were distinguished based on the extended criteria.Results. The prevalence rates of CHD in the open 25–64-year-old population were 12.4% in men and 10.0% in women. According to strict epidemiological criteria, the prevalence of painless ischemic heart disease prevailed in men; the prevalence of angina pectoris prevailed in women (predominantly at a young age). According to non-strict criteria, possible myocardial ischemia prevailed in men and women.Conclusion. The results can serve as a scientific basis for primary prevention of coronary artery disease and also necessitate identification of the gender differences in the study of the profile of conventional and non-conventional risk factors and their relationships with the prevalence of CHD in an open population of the urbanized Siberian city.

Study to Test and Operationalize Preventive Approaches for CKD of Undetermined Etiology in Andhra Pradesh, India

IntroductionHigh prevalence of chronic kidney disease (CKD) not associated with known risk factors has been reported from coastal districts of Andhra Pradesh. The Study to Test and Operationalize Preventive Approaches for Chronic Kidney Disease of Undetermined Etiology in Andhra Pradesh (STOP CKDu AP) aims to ascertain the burden (prevalence and incidence) of CKD, the risk factor profile, and the community perceptions about the disease in the Uddanam area of Andhra Pradesh.MethodsStudy participants will be sampled from the Uddanam area using multistage cluster random sampling. Information will be collected on the demographic profile, occupational history, and presence of conventional as well as nonconventional risk factors. Glomerular filtration rate (GFR) will be estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and proteinuria will be measured. All abnormal values will be confirmed by repeat testing after 3 months. Cases of CKD not associated with identified etiologies will be identified. Biospecimens will be stored to explore future hypotheses. The entire cohort will be followed up every 6 months to determine the incidence of CKD and to identify risk factors for decline in kidney function. Qualitative studies will be performed to understand the community perceptions and expectations with respect to the interventions.ImplicationsCKD is an important public health challenge in low- and middle-income countries. This study will establish the prevalence and determine the incidence of CKD not associated with known risk factors in a reported high-burden region, and will provide insights to help design targeted health systems responses. The findings will contribute to the policy development to tackle CKD in the region and will permit international comparisons with other regions with similar high prevalence.

Using of questionnaire of European Society of Cardiology to identify non-conventional risk factors in patients with coronary artery disease in the Kyrgyz Republic

Aim.To analyze the results of using of the European Society of Cardiology (ESC) questionnaire regarding the assessment of non-conventional risk factors in patients with coronary artery disease (CAD).Material and methods. Three hundred and ten patients with CAD (mean age 59,6±8,8 years, men 62,2) underwent a general clinical examination with the identification of conventional risk factors and assessing standard treatment goals. The cardiologist performed a two-stage assessment of non-conventional risk factors using the ESC questionnaire and validated questionnaires (DS-14, Hamilton Rating Scale for Depression and Anxiety) for clinical identification of anxiety, depression, type D personality.Results.In hospitalized patients, predominantly we noted severe clinical manifestations of the disease: acute coronary syndrome (51,6%), a decrease in the ejection fraction of less than 50% (40%), a history of acute myocardial infarction (29%), and a high frequency of conventional risk factors: arterial hypertension (75,8%), dyslipidemia (75,1%), obesity (40,9%). The majority of respondents did not reach the standard treatment goals: 13,8% of patients smoked, 30,9% did not follow the lipid-lowering diet, 81,3% did not follow recommendations regarding fish eating, 51,6% did not have recommended physical activity, 40,6% did not reached the target level of blood pressure, 59,3% — the target level of low-density lipoproteins, 59,8% — the target level of body mass index. We determined prevalence of following non-conventional risk factors: hostility (30,9%), type D personality (25,4%), low socio-economic status (12,2%) and anxiety (10%). Depression (5,1%), stress at work and in family life (4,5%), social exclusion (1,6%) were less common.Conclusion.The results are consistent with data obtained by foreign researchers. The use of the ESC questionnaire allows practitioners to focus on identifying nonconventional risk factors, receive data on the individual risk profile and expand the range of treatment and prevention strategies.

Vascular dysfunction and atherosclerosis in chronic kidney disease; A distinct entity

Cardiovascular disease (CVD) is prevalent among patients with chronic kidney disease (CKD) and its occurrence and severity cannot be fully defined by the conventional cardiovascular risk factors namely age, hypertension, dyslipidaemia, diabetes mellitus and obesity. Contemporary studies have examined the role of non-conventional risk factors such as anemia, hyperhomocysteinemia, calcium and phosphate metabolism, vascular stiffness due to endothelial dysfunction ( ED), oxidative injury, and inflammation in the causation of CVD in CKD. Therapeutic interventions used in non-CKD patients are found to be less effective on patients with CKD. The purpose of this review was to gather available evidence on the CVD risk among CKD patients. Numerous mechanisms have been postulated to describe the increased atherogenicity in CKD patients. We discuss these mechanisms especially arterial stiffness, ED and inflammation in detail. In conclusion, CVD in CKD is still an unexplored area which needs further studies to uncover the possible mechanisms. Identifying newer therapies to improve health among this group of patients is of paramount importance.

A case of old Anterior wall MI Presenting with left Ventricular clot and systemic embolization in a young man

Patients having myocardial infarction with severe Left ventricular dysfunction should be followed up regularly as clot formation can be there in akinetic scarred areas. Other non-conventional risk factors should also be assessed. Our patient also had high homocysteine levels making such patients more prone for increased vascular risks, clot formation and embolization. Early anticoagulation, surgical intervention should be warranted in such patients so they can be saved from embolic complications especially in young age group.

Role of lipoprotein (A) as a Nonconventional Risk Factor in Patients of Acute Myocardial Infarction in Tertiary Centre of North India

Role of lipoprotein (A) as a Nonconventional Risk Factor in Patients of Acute Myocardial Infarction in Tertiary Centre of North India

A case of pulmonary embolism with rare unusual presentation of syncope

Presentation in pulmonary embolism may be variable and each patient should be thoroughly investigated including young patients. Other non-conventional presentation and risk factors should also be assessed. Appropriate management should be considered for this life threatening disease in hospital and follow up with anticoagulants is necessary for prevention of recurrences.

Blocking mitochondrial cyclophilin D ameliorates TSH-impaired defensive barrier of artery

AimsEndothelial cells (ECs) constitute the defensive barrier of vasculature, which maintains the vascular homeostasis. Mitochondrial oxidative stress (mitoOS) in ECs significantly affects the initiation and progression of vascular diseases. The higher serum thyroid stimulating hormone (TSH) level is being recognized as a nonconventional risk factor responsible for the increased risk of cardiovascular diseases in subclinical hypothyroidism (SCH). However, effects and underlying mechanisms of elevated TSH on ECs are still ambiguous. We sought to investigate whether cyclophilin D (CypD), emerging as a crucial mediator in mitoOS, regulates effects of TSH on ECs. Methods and resultsSCH patients with TSH > = 10mIU/L showed a positive correlation between serum TSH and endothelin-1 levels. When TSH levels declined to normal in these subjects after levothyroxine therapy, serum endothelin-1 levels were significantly reduced. Supplemented with exogenous thyroxine to keep normal thyroid hormones, thyroid-specific TSH receptor (TSHR)-knockout mice with injection of exogenous TSH exhibited elevated serum TSH levels, significant endothelial oxidative injuries and disturbed endothelium-dependent vasodilation. However, Tshr-/- mice resisted to TSH-impaired vasotonia. We further confirmed that elevated TSH triggered excessive mitochondrial permeability transition pore (mPTP) opening and mitochondrial oxidative damages in mouse aorta, as well as in cultured ECs. Genetic or pharmacological inhibition of CypD (the key regulator for mPTP opening) attenuated TSH-induced mitochondrial oxidative damages and further rescued endothelial functions. Finally, we confirmed that elevated TSH could activate CypD by enhancing CypD acetylation via inhibiting adenosine monophosphate-activated protein kinase/sirtuin-3 signaling pathway in ECs. ConclusionsThese findings reveal that elevated TSH triggers mitochondrial perturbations in ECs and provide insights that blocking mitochondrial CypD enhances the defensive ability of ECs under TSH exposure.

Social vulnerability and hypoglycemia among patients with diabetes

Lower-income populations are hit harder by the diabetes epidemic as regards both prevalence and the risk of complications. Food Insecurity is one of the mechanisms through which poverty may predispose people with low socio-economic status to poorer control and higher complication rates. The United Nations Food and Agriculture Organization defined food security as “the right to have access to sufficient nutritional and culturally acceptable food choices.” Adults suffering from diabetes with limited income have a 40% greater chance of having food insecurity and an inadequate blood glucose control. Such patients have a two-fold greater risk of developing severe hypoglycemia. In addition, several studies have shown that social vulnerability resulting from food insecurity, low socioeconomic status, low educational levels, and poor health education is an independent risk factor for hypoglycemia, even after conventional predictors are controlled. This review analyzes the literature available on social vulnerability as a non-conventional risk factor for development of hypoglycemia in diabetic subjects.

Social vulnerability and hypoglycemia among patients with diabetes

Lower-income populations are hit harder by the diabetes epidemic as regards both prevalence and the risk of complications. Food Insecurity is one of the mechanisms through which poverty may predispose people with low socio-economic status to poorer control and higher complication rates. The United Nations Food and Agriculture Organization defined food security as “the right to have access to sufficient nutritional and culturally acceptable food choices.” Adults suffering from diabetes with limited income have a 40% greater chance of having food insecurity and an inadequate blood glucose control. Such patients have a two-fold greater risk of developing severe hypoglycemia. In addition, several studies have shown that social vulnerability resulting from food insecurity, low socioeconomic status, low educational levels, and poor health education is an independent risk factor for hypoglycemia, even after conventional predictors are controlled. This review analyzes the literature available on social vulnerability as a non-conventional risk factor for development of hypoglycemia in diabetic subjects.

Contribution of classical and emerging risk factors to coronary artery disease in Asian Indians

BackgroundThe merits and demerits of classical risk factors in coronary artery disease (CAD) are widely debated. We analyzed the role of conventional (age, gender, diabetes, hypertension, smoking) and non-conventional risk factors (anthropometrics, fasting blood sugar, atherogenic index of plasma — AIP, family history) in Asian Indians with CAD. MethodsOut of 11,164 subjects (4855 affected, 6309 unaffected) enrolled in the Indian Atherosclerosis Research Study (IARS), 269 unaffected individuals with abnormal electrocardiogram and seven underage were excluded. Around 10,888 subjects along with two subsets, including 9888 individuals having family history information and 1616 individuals with intermediate Framingham risk score (FRS), were statistically analyzed using SPSS version 17.0 and R software. ResultsA combination of classical risk factors showed good discrimination between affected and unaffected individuals (C>0.85). Hypertension (OR 3.79) or male gender (OR 5.31) showed significant association with CAD when lipids were included or excluded from the predictive model, followed by age, diabetes and smoking. Hypertension and diabetes frequencies were higher in older patients (>55years) while smoking was more prevalent in younger patients (<55years). Family history and AIP provided a modest increase in C index over the classical factors (0.864 to 0.873), with 7.1% net reclassification in the intermediate FRS group. In CAD patients, 4% were classified as high risk by FRS, 52% were classified as having metabolic syndrome with revised criteria and over 90% had a high AIP score. ConclusionAddition of AIP and family history to conventional risk factors improved risk discrimination in Asian Indians with CAD.

Cardiovascular disease after liver transplantation: When, What, and Who Is at Risk.

The evolution of metabolic and cardiovascular disease (CVD) complications after liver transplantation (LT) is poorly characterized. We aim to illustrate the prevalence of obesity and metabolic syndrome (MS), define the cumulative incidence of CVD, and characterize risk factors associated with these comorbidities after LT. A retrospective review of 455 consecutive LT recipients from 1999 to 2004 with an 8- to 12-year follow-up was performed. Obesity increased from 23.8% (4 months) to 40.8% (3 years) after LT. Increase in body mass index predicted MS at 1 year after LT (odds ratio, 1.1; P < 0.001, per point). CVD developed in 10.6%, 20.7%, and 30.3% of recipients within 1, 5, and 8 years, respectively. Age, diabetes, hypertension, glomerular filtration rate < 60 mL/minute, prior CVD, ejection fraction < 60%, left ventricular hypertrophy, and serum troponin (TN) > 0.07 ng/mL were associated with CVD on univariate analysis. Age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.06; P = 0.019), diabetes (HR, 1.78; 95% CI, 1.09-2.92; P = 0.022), prior history of CVD (HR, 2.46; 95% CI, 1.45-4.16; P < 0.001), and serum TN > 0.07 ng/mL (HR, 1.98; 95% CI, 1.23-3.18; P = 0.005) were independently associated with CVD in the long term. Smoking history (ever), sex, hyperlipidemia, and serum ferritin levels were not predictive of CVD. Tacrolimus use versus noncalcineurin-based immunosuppression (HR, 0.26; 95% CI, 0.14-0.49; P < 0.001) was associated with reduced risk of CVD but not versus cyclosporine (HR, 0.67; 95% CI, 0.30-1.49; P = 0.322). CVD is common after LT. Independent of MS, more data are needed to identify nonconventional risk factors and biomarkers like serum TN. Curbing weight gain in the early months after transplant may impact MS and subsequent CVD in the long term.

Unique Aspects of Coronary Artery Disease in Indian Women.

Epidemiologic and clinical research suggests important gender-related differences in the prevalence, presentation, associated conventional and non-conventional risk factors, management and outcomes of coronary heart disease (CHD) patients. Adequate data is not available for Indian population where prevalence of CHD and depression is high. We conducted an observational, single-center, study from January 2010 to December 2011 on 10450 consecutive patients visiting a tertiary care center, Ahmedabad, Gujarat, India who presented with complaints related to CHD. Of these, 6867 patients had coronary artery disease (CAD) as confirmed by angiographic investigation; 5678 were males, and 1189 were females with similar mean age. As compared to males, females had higher prevalence of hypertension, diabetes and obesity while males had higher prevalence of smoking. Invasive treatment options like Coronary Artery Bypass Grafting (p < 0.001) and Percutaneous Coronary Intervention (p = 0.001) were used less often to treat females, and medical therapy (p < 0.001) was the preferred treatment option irrespective of the contributing risk factors/extent of CAD. Depression was observed in 39.8% of acute coronary syndrome patients (n = 1648) as assessed by MARDS scale. It was higher in female patients and in low socioeconomic strata (p < 0.001).At 12 and 36 months, rates of revascularization (p < 0.001) and mortality (p < 0.005) were higher with poor quality of life (QoL) (P < 0.001) in depressed CAD patients. In India, women appear to have a higher prevalence of hypertension, diabetes, obesity, and family history of CHD. Yet women get invasive treatments less often than men. Depression is also more common in women and is associated with poor QoL and early mortality than men.

Evidence Gap on the Prevalence of Non-conventional Risk Factors for Type 2 Diabetes in Iran

ObjectivesRobust scientific evidence exists about the role of non-conventional risk factors in type 2 diabetes worldwide. The current epidemiological pattern of the disease in Iran suggests a precipitating role for these non-conventional risk factors. This review was performed to examine the research evidence suggesting a higher prevalence of non-conventional type 2 diabetes risk factors in Iran. MethodsMeSH keywords were applied to search several databases, including PUBMED, MEDLINE, AMED, EMBASE, Iran DOC, and the Scientific Information Database without a time limit from inception to September 2011. The quality of the non-interventional and population-based studies on Iranians included in these databases was assessed by the authors and any disagreement was resolved with consensus. ResultsThe literature search yielded 1847 publications, of which 62 were included in this study after eliminating non-relevant and overlapping papers. No study was found that verified a higher prevalence of the non-conventional type 2 diabetes risk factors in the Iranian population. ConclusionThe identified evidence gap about the role of prominent non-conventional risk factors of type 2 diabetes in the Iranian population could be a major caveat in the application of an evidence-based approach to endorse or reject existing hypothesis about these risk factors. Studies on the prevalence of non-conventional biomarkers of type 2 diabetes among Iranians could be a promising area of research.

South Asian ethnicity and cardiovascular risk: the known, the unknown, and the paradox.

South Asians (SAs), in their countries or after migration, are at high risk of coronary artery disease (CAD) and mortality compared to other ethnic groups. It has been shown that >90% of CAD global risk could be attributed to 9 modifiable risk factors (RFs) worldwide. However, these conventional RFs may not fully explain this high risk of CAD among SAs. Therefore, attention has been directed toward nonconventional RFs. In this narrative review, we evaluate the conventional and emerging cardiovascular RFs characterizing SAs. These factors may explain the high morbidity and mortality among SAs. Further prospective studies are urgently needed to set algorithms for the optimal management of these RFs in high-risk populations like SAs.

The Impact of Hepatitis C Infection on Ischemic Heart Disease Via Ischemic Electrocardiogram

BackgroundHepatitis C virus (HCV) infection is a serious disease worldwide and it leads to several serious hepatic sequels. Some studies find possible correlation between HCV and ischemic heart disease in retrospective observations. Based on lacked community-based evidence, the study aims to assess correlation between ischemic heart disease and chronic HCV infection via electrocardiogram (ECG) because its abnormalities is strongly associating with cardiovascular disease mortality. MethodsThe population was from one community health examination in December 2010 in a southern village of Taiwan. A total of 9856 participants were evaluated and finally 5015 eligible residents with age older than 40 years were included. The baseline characteristics and laboratory data in nonischemic ECG and ischemic ECG groups were compared, and multivariate-adjusted analysis was used to evaluate the risks to ischemic ECG. ResultsThe higher prevalence of hypertension, metabolic syndrome and even HCV infection (25.3% versus 11.6%; P < 0.001) in ischemic ECG group than those in nonischemic ECG group. In the multivariate adjusted analysis, HCV infection would lead to a 1.759-fold risk to ischemic ECG when compared with non-HCV subjects. ConclusionsHCV was strongly associated with ischemic ECG findings in this community study, and it could be a nonconventional risk factor for coronary artery disease.

Hyperhomocysteinemia and hyperlipoproteinemia (a) in obese south indian men: an indication for increased cardiovascular risk

Obesity is a pathological condition which increases the risk for cardiovascular disease. The present study was designed to evaluate homocysteine, lipoprotein (a) [Lp(a)], apolipoprotein-B (apo-B), apolipoprotein-A-I (apo-A-I) and lipid indices and their association if any in obese South Indian men. Thirty obese men and thirty age-matched males with normal body weight (controls) were recruited in the study. Plasma homocysteine, Lp(a), lipid profile, apo-A-I and apo-B were estimated in all the subjects. Lipid indices such as lipid pentad index (LPI), lipid tetrad index (LTI), atherogenic index of plasma (AIP), non-high density lipoprotein (non-HDL)/high density lipoprotein (HDL) ratio and apo-B/apo-A-I ratio were calculated in all study subjects. Homocysteine, Lp(a), apo-B, apo-B/apo-A-I ratio and lipid indices were significantly increased in obese men, compared to controls. Both homocysteine and Lp(a) were positively correlated with BMI, waist, hip circumference and apo-B and negatively correlated with apo-A-I. Also we found highly significant positive correlation between homocysteine and Lp(a) levels. The data from the present study concludes that non-conventional risk factors like homocysteine, Lp (a), apo-B/apo-A-I ratio, LTI, LPI, non-HDL/HDL ratio and AIP were significantly elevated in obese Indian men, suggesting they are more prone to develop cardiovascular disease, than the age-matched men with normal body weight.