Number Of Cardiovascular Risk Factors Research Articles

Osteocalcin-expressing endothelial progenitor cells and serum osteocalcin forms are independent biomarkers of coronary atherosclerotic disease severity in male and female patients

PurposeOsteocalcin (OC), an osteoblast-derived regulator of metabolic processes, and circulating early endothelial progenitor cells (EPC, CD34 − /CD133 + /KDR +) expressing OC (OC +) are potential candidates linking bone metabolism and the vasculature and might be involved in vascular atherosclerotic calcification. This study aimed at assessing the association of circulating levels of different OC forms and of EPCs count with disease severity in patients with documented coronary atherosclerosis (CAD).MethodsPatients (n = 59) undergoing coronary angiography were divided, according to stenosis severity, into (1) early coronary atherosclerosis (ECA) (n = 22), and (2) late coronary atherosclerosis (LCA) (n = 37). Total OC (TOC), carboxylated OC (cOC), undercarboxylated OC (unOC) were quantified by ELISA. EPC OC + count was assessed by flow cytometry.ResultsEPC OC + counts showed significant differences between ECA and LCA groups. unOC and unOC/TOC ratio were inversely correlated with EPC OC + count. A significant decrease in TOC and unOC plasma levels was associated with higher cardiovascular risk factors (CVRFs) number. EPC OC + count was correlated with LDL-C, total cholesterol, and triglycerides, with a greater significance in the LCA group. No association between the different forms of circulating OC (TOC, ucOC, cOC) and severity of CAD was found.ConclusionThis study showed a significant association between EPCs (CD34 − /CD133 + /KDR + /OC +), CAD severity and CVRFs, suggesting an active role for EPC OC + in the development of CAD. An inverse correlation between TOC, ucOC, and number of CVRFs was observed, suggesting that OC, regardless of its carboxylation status, may be developed as a further cardiovascular risk biomarker.

Impact of cardiovascular burden on coagulation pathway in apparently healthy women planning oocyte donation.

Hormonal fertility treatments are associated with increased coagulation factors inducing procoagulant milieu and possibly thrombotic risk. To assess coagulation by ROTEM and coagulation tests in apparently healthy infertile women before oocyte donation procedure. We enrolled 51 women (Assisted Reproductive Technology Centre, Florence). ROTEM and coagulation parameters were assessed before the start of infertility treatment. We divided women in 3 groups according to the number of cardiovascular risk factors: Group A (n = 10), Group B (n = 16), and Group C (n = 25). By considering ROTEM Extem test, a significantly increased of MCF, TPI, and G were observed in groups B (p = 0.005, p = 0.03, and p = 0.007) and C (p = 0.01, p = 0.05, and p = 0.005) in comparison to group A. As regards ROTEM Intem test, the TPI and G values were significantly higher in groups B and C in comparison to group A (p < 0.01). MCF by Fibtem test significantly increased in groups B and C than in group A (p = 0.004 and p = 0.002, respectively). FVIII, vWF:Ag and D-dimer values significantly increase according to the presence of≥2 risk factors. Data from coagulative assessment permit to sensitively identify women with potentially procoagulable state, which represents a risk factor of thromboembolic event during hormone treatment.

Abstract 13866: Quantity of Cardiovascular Risk Factors and Associated Outcomes in Young Women With ST-Elevation Myocardial Infarction

Introduction: Despite the remarkable progress in STEMI care, the mortality rates in young women with STEMI remain high. It remains unclear whether this is related to the number of cardiovascular (CV) risk factors. Methods: From 2010 to 2020, we evaluated 10,441 consecutive STEMI patients, including 3,150 (30%) women enrolled in prospective Midwest STEMI Consortium registry, constituted of Minneapolis Heart Institute, Minneapolis, MN, The Christ Hospital, Cincinnati, OH, Prairie Heart Institute, Springfield, IL, and Iowa Heart Center, Des Moines, IA. We categorized baseline CV risk factors (hypertension, dyslipidemia, diabetes, smoking, and family history of CAD) in the 477 (15%) women &lt;55 years and without previous history of CAD. Results: Smoking was the most common, and diabetes the least common CV risk factor. Of the 477 women, 161 (33.8%) had 0 or 1 CV risk factor, 132 (27.7%) had 2, and 184 (38.6%) had at least 3 CV risk factors. As the number of CV risk factors decreased, non-atherosclerotic STEMI etiologies -SCAD or Takotsubo syndrome- increased, as did the incidences of cardiogenic shock or cardiac arrest. There were no differences in reperfusion strategies or time among patients with 0 or more CV risk factors; however, as the number of CV risk factors decreased, patients were less likely to receive antiplatelet or statin at discharge. There was a trend toward higher death in the hospital with decreasing number of CV risk factors, but it did not reach statistical significance (p=0.075) (Table). Conclusions: Young women with fewer traditional CV risk factors more often presented with non-atherosclerotic causes of STEMI and higher incidences of cardiogenic shock or cardiac arrest and had a trend toward a higher risk of in-hospital death. Thus, future epidemiological studies are needed to determine if sex-specific risk enhancers, in addition to traditional CV risk factors, have a role in risk stratification among young women for future CV events.

Accentuated aging associated with HIV in a Mediterranean setting occurs mainly in persons aged>70 years: a comparative cohort study (Over50 cohort)

ABSTRACT In an ongoing Mediterranean cohort, we compared age-related conditions between 208 HIV-infected persons and 104 matched controls. ≥3 comorbidities were found in 31.0% of HIV-infected patients and 8.7% of controls. Conditions significantly more frequent among the HIV-infected population were: lipid abnormalities, cancer, osteopenia/osteoporosis, liver disease, sexual dysfunction, hearing deficit, sleep disorders, falls, cognitive complaints, being single, living alone, and being elderly at risk. HIV-infected patients aged >70 years had a significantly higher number of cardiovascular risk factors (CVRF) and comorbidities than controls. HIV-infected persons who had never smoked had a higher prevalence of CVRFs, ≥3 comorbidities, liver disease, cancer, and cognitive complaints compared to controls. Factors associated with frailty were being a man who has sex with men, ≥3 CVRFs, nadir CD470 years. The multidisciplinary assessment also revealed concerning findings in social, cognitive, and functional variables among HIV-infected individuals, with a higher prevalence of elderly at risk than among controls.

The atrial fibrillation paradox -connecting hypertension to atrial disease and stroke

A “double paradox” exists in the understanding of racial differences in the association between traditional cardiovascular (CV) risk factors, the incidence and prevalence atrial fibrillation (AF), and the increased incidence of ischemic stroke. Simply stated, Black persons have an increased number of CV risk factors yet less AF. Despite lower incidence of AF, Black individuals have higher rates of stroke and systemic embolism. This important public health challenge is notable, given that, despite a significant decline in overall stroke mortality rates since the 1950s, age-adjusted stroke death rates have remained higher in Black versus White individuals through 2008.[2] The purpose of this review is to examine the risk of ischemic stroke in Black persons and provide a summary of options to improve the recognition of individual risk and reinforce preventive care. Consider the following concepts: • Black individuals have more traditional CV risk factors and higher rates of ischemic stroke, than their non-Hispanic White counterparts, yet a lower incidence and prevalence of AF. • The difference in the incidence of AF does not fully explain the differences in stroke risk • The explanation for these differences is likely complex and leads to the following questions. ○ Should researchers and clinicians reassess the way atrial disease and embolic risk are defined in specific populations? ○ Do traditional risk factors for AF account for increased stroke risk in select patient populations which also needs to be re-evaluated in the context of stroke reduction. As with prior work[1,17,18,19,21] which has addressed the “AF Paradox” this review supports the concept of atrial disease - including atrial fibrillation - as a continuum. There also appears to be a risk of stroke associated with this continuum in the absence of a diagnosis of AF.[1,18,21] These factors alone do not account for the differences in overall stroke rates in Black persons. In addition to a revision on the views of atrial disease, there should be a renewed emphasis early and aggressive blood pressure control – as well as other risk factor management – in Black individuals to affect the differences in stroke rates. The objective of this review is to re-examine the specific role of hypertension in atrial disease and perceptions on stroke risk, AF and possible differences between Black and White individuals.

Patient reported health status and cardiovascular risk factors in a remote area of South America: a cross-sectional study

Abstract Background Several studies have indicated that self-perception of health is related to cardiovascular disease. Despite cardiovascular disease is the leading cause of mortality in South America, the relationship between patient reported health and cardiovascular risk is sparsely explored, specifically in indigenous areas. Purpose We assessed if self-rated health is associated with cardiovascular risk factors in a remote area in South America. Methods We included participants by cluster-randomization of community health care clinics from June to December 2020. Sociodemographic variables and information on cardiovascular risk factors were collected by questionnaires and physical examination. All participants rated their present health status according to the validated EQ5D-VAS instrument, ranging from 0 (worst) to 100 (best). Results A total of 492 participants (mean age 41±15 years; 38% men) were included. The mean value of self-rated health was 80 (range 0 to 100) and the prevalence of cardiovascular risk factors were: Hypertension (19%), hypercholesterolemia (15%), smoking (37%), low intake of vegetables (defined as &amp;lt;3 times per week; 54%), no sport activity (62%), diabetes (6%) and obesity (24%). In logistic regression models adjusted for sex, age and socioeconomic status, higher self-rated health was significantly associated with lower risk of hypertension, hypercholesterolemia, smoking, obesity and greater vegetable intake (P&amp;lt;0.05; Figure 1). No association was found with sport activity or diabetes. The total number of cardiovascular risk factors increased with lower self-rated health (beta = 0.100 [0.04 to 0.15], P&amp;lt;0.001 per 10 decrease in self-reported health). Conclusion Self-rated health was significantly associated with a greater burden of cardiovascular risk factors and may influence ideal cardiovascular health. Future studies should assess if patient reported health status constitutes an independent risk factor for heart disease in this specific population, and studies elucidating gaps on self-perception of cardiovascular health are encouraged. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark

102 Detection of Acute Coronary Syndrome by Magnetocardiography

To evaluate the use of magnetocardiography (MCG) for early identification or rule out of acute coronary syndromes (ACS) in emergency department (ED) patients with chest pain. Magnetocardiography is a noninvasive imaging method that measures the electromagnetic fields generated by the heart’s activity. MCG is rapid, easy to perform, and provides a radiation-free imaging assessment for patients with suspected ACS. This is a prospective, observational, multicenter trial comparing the accuracy and time to disposition of ED standard of care (SOC) vs. MCG. Patients were enrolled at 3 sites from January to May 2021. Inclusion criteria were ED patients with chest pain, age ≥ 18 years, modified heart score > 2, and signs/symptoms of ACS in the ED. Exclusion criteria were STEMI, unable to fit into the device, non-ambulatory, hemodynamically unstable, and unable to lie supine for up to 5 minutes. Additional exclusion criteria were patients with pacemakers, AICD, other active devices, or any ferromagnetic metal above the costal margins. Patients underwent a MCG scan in addition to ED SOC. MCG was performed within 4 hours of ED triage. We hypothesize that the use of MCG will lead to shorter ED length of stay (LOS), with equal or improved diagnosis of suspected ACS patients. Of 58 scans, 32 were available for evaluation. 26 were unevaluable due to either insufficient data or uninterpretable. Patients with any artifacts were considered unevaluable. With technical improvements, the arttifact on current scans may be decreased which will result in fewer unevaluable scans. Mean age was 51.3 (SD± 1 .9) years, 50% female, 59.4% Black, 37.5% White, 3.1% other. Mean HEART score was 4.2 (SD± 1.1). Mean number of cardiovascular risk factors was 3.0 (SD± 1.6). Mean LOS (minutes) for MCG was 187 (SD ± 122) vs. SOC 812 (SD ± 73) (P < 0.0001 by paired t-test) (95% CI difference: -882.0, - 368.1). Thus, when compared with standard of care evaluation alone, the mean length-of-stay could have been reduced by 10.6 hours without any significant change in diagnostic accuracy. MCG and SOC based on troponins were both negative in 28 patients.There were 2 false positives by SOC (6.2%, 2/32). In these two patients presumed to have ACS by SOC, both went to cardiac catheterization, which revealed no ACS. MCG correctly identified the patients to have no ACS. There were two false negatives by MCG. In these two patients, MCG was positive and SOC rule out by troponins was negative. No stress test or cardiac catheterization was done in these two patients. Eleven patients (34%) were placed in the observation unit (OU). The MCG done in the ED and the rule out in the OU were both negative for ACS. Furthermore, early MCG done in the ED as compared with standard of care evaluation alone, would potentially eliminate overnight observation unit stays in 34% of the study population. Magnetocardiography results in a significantly lower LOS for chest pain in the ED which could lead to decreased ED LOS, improved ED turnaround times and better ED efficiency. MCG may avoid an OU stay with resultant cost savings in about one-third of ED chest pain patients. More importantly, MCG detected patients who were false positive by SOC and could have avoided a cardiac catheterization. MCG had two false positives which were negative by troponins but no cardiac catheterization or stress test were done in these two patients.

An observational study of T2-weighted white matter hyperintensities on magnetic resonance imaging of the internal auditory meatus and brain: ignore or not?

Magnetic resonance imaging of the internal auditory meatus frequently detects incidental white matter hyperintensities. This study investigated the association between these and the risk of stroke and transient ischaemic attack, or myocardial infarction. The records of patients with incidental white matter hyperintensities were reviewed, and data were collected on: age, sex, cardiovascular risk factors, and incidence of stroke and transient ischaemic attack, or myocardial infarction, five years later. The risk factors associated with vascular events were explored. Of 6978 patients, 309 (4.4 per cent) had incidental white matter hyperintensities. Of these, 20 (6.5 per cent) had a stroke or transient ischaemic attack within five years, and 5 (1.7 per cent) had a myocardial infarction. The number of cardiovascular risk factors was significantly associated with the incidence of stroke and transient ischaemic attack (p = 0.004), and myocardial infarction (p = 0.023). The number of cardiovascular risk factors predicts the likelihood of vascular events; appropriate risk factor management is recommended for patients with incidental white matter hyperintensities of presumed vascular origin.

Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography

ObjectivesThe objective of the study was to assess the relationship between the coexistence of cardiovascular risk factors (CVRFs) and the incidence and severity of obstructive sleep apnoea (OSA). MethodsThe study involved 88 people, aged 53.76 ± 12.59 years. A questionnaire, basic anthropometric measurements, blood pressure, standard laboratory tests (total cholesterol, triglycerides and glucose) and polysomnography were performed. Each patient was assessed for the presence of CVRFs: i.e. obesity, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, type 2 diabetes and smoking. OSA was diagnosed based on the apnoea and hypopnea index (AHI) in polysomnography. ResultsIt was documented that the mean AHI values were significantly higher in obese patients than in non-obese patients, in patients with arterial hypertension than in patients without hypertension, in patients with hypercholesterolaemia than in patients without hypercholesterolaemia and in patients declaring smoking than in non-smoking patients. The correlation analysis revealed a significant positive linear relationship between the number of CVRFs and the AHI value in polysomnography (r = 0.40, p < 0.05). Based on the regression analysis, it was documented that obesity, arterial hypertension and smoking are independent predictors of higher AHI values. ConclusionsIn the study group of patients with multiple cardiovascular risk factors, there is a directly proportional relationship between the number of cardiovascular risk factors and the AHI index in polysomnography.

Aging, Cardiovascular Risk, and SHBG Levels in Men and Women From the General Population.

AimsPrior studies have reported inconsistent results for the association between sex hormone-binding globulin (SHBG) and cardiovascular disease among men and women. Although it is suggested that SHBG levels change with aging, the exact trend of SHBG across age and cardiovascular risk and the underlying mechanisms of these changes remain to be elucidated.MethodsUsing data of 3264 men and women from a large population-based cohort study, we first visualized the distribution of serum SHBG levels across age. Second, we computed a cardiovascular risk factor sum score and investigated the mean SHBG levels across categories of the risk factor sum score and stratified per age-category. Next, linear regression models were used to investigate the associations between serum SHBG levels and age and potential regulators of SHBG, including body mass index (BMI), fasting insulin, sex steroids, thyroxine, and triglycerides.ResultsAmong men, a linear increase in SHBG levels with age and among women a U-shaped pattern was observed. Participants with larger number of cardiovascular risk factors had lower SHBG levels. When stratified by age, older participants had higher SHBG levels. A multivariate model including total testosterone and triglyceride levels in men and total testosterone, triglycerides, BMI, and fasting insulin in women explained, respectively, 46.2% and 31.8% of the variance in SHBG levels.ConclusionWe observed a clear sex-specific pattern for SHBG levels with age. Our findings highlight the importance of taking into account the age-related changes in SHBG levels to avoid controversial results in the assessment of the cardiovascular risk associated with SHBG.

The Role of Prediabetes as a Predictive Factor for the Outcomes in Patients with STEMI. Which Is the Right Range of Glycated Hemoglobin to Adopt in This Setting?

Background: Prediabetes (preT2D) is considered a subtle adverse cardiovascular (CV) risk factor after acute myocardial infarction. Glycated hemoglobin (HbA1c) ranges to identify preT2D are different between ADA and WHO guidelines (5.7–6.4 vs. 6.0–6.4%, respectively). Aim: To evaluate the prognostic value of HbA1c different preT2D-ranges and their correlation with demographic, instrumental, and laboratory parameters in STEMI. Methods: A total of 1681 patients (mean age 67 ± 13 years; 1217 males) were enrolled. Admission HbA1c was used to identify patients with no-T2D (&lt;5.7%), HbA1c 5.70–5.99%, and WHO-preT2D with HbA1c 6–6.49%, and T2D (HbA1c ≥ 6.5). Results: HbA1c 5.7–5.99, WHO-preT2D, and T2D progressively correlated with an increasing number of CV risk factors. However, only T2D, but not preT2D, was significantly associated with adverse prognosis (in-hospital and one-year death). Conclusions: PreT2D is correlated with CV risk factors, but not with adverse prognosis as compared to no-T2D. Nonetheless, routine HbA1c testing in the STEMI population and HbA1c-5.7–5.99 patient inclusion in the preT2D category may help to identify those who may benefit from intervention and lifestyle strategies to early prevent preT2D progression.

Myocardial Flow Reserve Measurement During CZT-SPECT Perfusion Imaging for Coronary Artery Disease Screening: Correlation With Clinical Findings and Invasive Coronary Angiography-The CFR-OR Study.

Purpose: The aim of this study was to assess the results of cadmium zinc telluride (CZT)- single-photon emission computed tomography (SPECT) myocardial flow reserve (MFR) in coronary artery disease (CAD) screening regarding clinical risk and its correlation to invasive coronary angiography (ICA).Methods: A total of 137 patients (61 male and 76 female) referred for CAD screening myocardial perfusion imaging (MPI) between November 2018 and April 2020 were included in the CFR-OR prospective trial. The 10-year risk of cardiovascular death according to the European Society of Cardiology (SCORE) was calculated. SPECT 1-day 99mTc-tetrofosmin protocol was acquired on CZT cardiac-dedicated pinhole cameras. Low-dose thoracic CT was used for coronary calcium score (CCS) evaluation. ICA, when performed within 3 months, was also analyzed.Results: Mean SCORE and mean global MFR were, respectively, 4 ± 3.1% and 2.50 ± 0.74; 34 patients had impaired CFR (using a threshold of 2). There was a significant inverse correlation between MFR and SCORE (p = 0.006), gender (p = 0.019), and number of cardiovascular risk factors (p = 0.01). MFR was significantly reduced in patients with CCS above 1 (p = 0.01). No significant correlation was found between MFR and individual cardiovascular risk factors (dyslipidemia, hypertension, diabetes, or family history of CAD). A total of 23 patients underwent ICA. Global MFR SPECT sensitivity and specificity were 83.3 and 100 %, respectively, with an area under the curve of 0.94.Conclusion: Adding MFR to SPECT MPI for CAD screening on CZT camera may contribute to high-risk patient identification and enhance diagnostic performances. MFR could help physician decision to perform ICA.

Impact of Cardiovascular Risk Factors on the Occurrence of Cardiovascular Events in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitides.

Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age >50 years in men and >60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p < 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.

Development and Validation of a Large Synthetic Cohort for the Study of Cardiovascular Health Across the Life Span.

We developed and validated a synthetic cohort approach to examine numbers of cardiovascular risk factors (CRFs) and adverse clinical events, including incident cardiovascular disease and all-cause mortality, across the life span from ages 20 years to 90 years. The current analysis included 40,875 participants from 7 large, population-based longitudinal epidemiologic studies (1948-2016). On the basis of a joint multilevel imputation model, we multiply imputed each participant's life-span numbers of CRFs and events using available records. To validate the imputed values, we partially removed the observed data and then compared the imputed and observed values. The complete life-span synthetic data set reflected the original observed data trends well. In our validation sample, the distributions of imputed CRFs and events were close to the observed distributions but with less variability. Bland-Altman plots indicated that there was a slightly negative trend in general, and the agreement bias was relatively small for the continuous CRFs. The hypothetical linear regression model suggested that the relationships between the CRFs and events were preserved in the imputed data set. This approach generated valid estimates of CRFs and events across the life span for African-American and White participants. The synthetic cohort may be sufficiently accurate to be useful in assessing the origins and timing of accumulating cardiovascular risk that can inform efforts to avoid cardiovascular disease development.

Cardiovascular Risk Factor Trajectories Since Childhood and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study.

Cardiovascular risk factors, such as high blood pressure, adverse serum lipids, and elevated body mass index in midlife, may harm cognitive performance. It is important to note that longitudinal accumulation of cardiovascular risk factors since childhood may be associated with cognitive performance already since childhood, but the previous evidence is scarce. We studied the associations of cardiovascular risk factors from childhood to midlife, their accumulation, and midlife cognitive performance. From 1980, a population-based cohort of 3596 children (3-18 years of age) have been repeatedly followed up for 31 years. Blood pressure, serum lipids, and body mass index were assessed in all follow-ups. Cardiovascular risk factor trajectories from childhood to midlife were identified using latent class growth mixture modeling. Cognitive testing was performed in 2026 participants 34 to 49 years of age using a computerized test. The associations of the cardiovascular risk factor trajectories and cognitive performance were studied for individual cardiovascular risk factors and cardiovascular risk factor accumulation. Consistently high systolic blood pressure (β=-0.262 SD [95% CI, -0.520 to -0.005]) and serum total cholesterol (β=-0.214 SD [95% CI, -0.365 to -0.064]) were associated with worse midlife episodic memory and associative learning compared with consistently low values. Obesity since childhood was associated with worse visual processing and sustained attention (β=-0.407 SD [95% CI, -0.708 to -0.105]) compared with normal weight. An inverse association was observed for the cardiovascular risk factor accumulation with episodic memory and associative learning (P for trend=0.008; 3 cardiovascular risk factors: β=-0.390 SD [95% CI, -0.691 to -0.088]), with visual processing and sustained attention (P for trend<0.0001; 3 cardiovascular risk factors: β=-0.443 SD [95% CI, -0.730 to -0.157]), and with reaction and movement time (P for trend=0.048; 2 cardiovascular risk factors: β=-0.164 SD [95% CI, -0.318 to -0.010]). Longitudinal elevated systolic blood pressure, high serum total cholesterol, and obesity from childhood to midlife were inversely associated with midlife cognitive performance. It is important to note that the higher the number of cardiovascular risk factors, the worse was the observed cognitive performance. Therefore, launching preventive strategies against cardiovascular risk factors beginning from childhood might benefit primordial promotion of cognitive health in adulthood.

The effect of extra virgin olive oil on anthropometric indices, lipid profile, and markers of oxidative stress and inflammation in patients with depression, a double-blind randomised controlled trial.

Epidemiological evidence suggests a mutual association between depression and obesity and also an anti-obesity effect for olive oil. We examined the effect of extra virgin olive oil (EVOO) on weight, waist circumference, and a number of cardiovascular risk factors in patients with depression. The randomised double-blind controlled trial was conducted on 62 patients with depression. Patients were randomly allocated to EVOO and sunflower oil groups (n=31 for each) that consumed 25mL/day of the corresponding oils for 52days. An isocaloric diet was prescribed to each patient according to his/her previous energy intake with considering the energy provided by the administered oils. Weight, body mass index (BMI), waist circumference, blood lipids, malondialdehyde, and hs-C reactive protein (CRP) analysis were performed using the intention-to-treat approach. BMI was significantly decreased in sunflower oil group (-0.20±0.53kg/m2 , P=.047) and waist circumference was significantly decreased in EVOO group (-2.15±2.09cm, P<.001); however, only reduction of waist circumference was significantly different between groups (P<.001). High-density lipoprotein (HDL) cholesterol was significantly increased in EVOO group (3.02±6.79mg/dL, P=.03), without showing a significant between-group difference. Other lipids, malondialdehyde, and hs-CRP did not change. Overall, the results suggest that both EVOO and sunflower oil may benefit overweight patients with depression, as they respectively decreased waist circumference and BMI without need for administration of a low-calorie diet.

Myocardial flow reserve measurement in cardiac SPECT: A strong predictor of lesions at invasive coronary angiography

Myocardial flow reserve (MFR) measurement is predictive of major adverse cardiovascular (CV) events (MACE) and has been shown to improve diagnostic performances of coronary artery disease (CAD) in cardiac positron emission tomography. MFR can now be assessed during dynamic myocardial perfusion imaging (MPI) in SPECT, but its correlation with the patient's risk of coronary artery disease (CAD) remains to be investigated. We evaluated the results of SPECT MFR measurement in patients referred for CAD screening. In total, 137 patients (61 male, 76 female) referred for CAD screening MPI between November 2018 and March 2020 were included in a prospective trial (CFR-OR). 10 years risk of cardiovascular death according to the European Society of Cardiology (SCORE) was calculated. SPECT data were acquired on a CZT-cardiac camera using a stress/rest one-day Tc-99m-tetrofosmin protocol. Low dose thoracic CT was used for coronary calcium score (CCS) evaluation. Invasive Coronary Angiography (ICA) was performed upon decision of the referring cardiologist. Mean SCORE was 4 ± 3.1%. Mean global MFR was 2.50 ± 0.74. There was a significant inverse correlation between MFR and SCORE ( P = 0.006), gender ( P = 0.019), and the number of cardiovascular risk factors ( P = 0.01). MFR was significantly reduced in patients with CCS above 1 ( P = 0.01). Twenty-three patients underwent ICA. Eighteen showed coronary plaques qualifying for high-risk patients; among them, 16 patients had impaired MFR (the 2 other patients had moderate stenosis, < 50%, with negative FFR), whereas only 4 had abnormal visual MPI. Based on global MFR, and with a threshold of 2, sensitivity and specificity were respectively 83.3% and 100%, and Area Under Curve (AUC) was 0.94. Global MFR measured during MPI SPECT for CAD screening may contribute to high-risk patient identification. It significantly enhances SPECT diagnostic performances and could help physician decision to perform ICA.

The inflammatory role of silent urate crystal deposition in intercritical gout.

To study subclinical inflammation in intercritical gout patients and its relation to the estimated size of monosodium urate crystal deposition and cardiovascular risk factors. We performed a secretome analysis and the quantification of cytokine and adipokine plasma levels [IL-1β, IL-18, IL-6, soluble IL-6 receptor (sIL-6R), TNF-α, C-X-C motif chemokine 5, RANTES (Regulated upon Activation, Normal T Cell Expressed and Presumably Secreted), leptin, resistin and adiponectin] to analyse subclinical inflammation in intercritical gout patients. Since it is currently not feasible to determinate the whole body deposit of monosodium urate crystals, we created an indirect clinical classification to estimate it. Then we compared cytokine levels in controls and gout patients and in patients with different crystal deposition sizes. We also studied the association between cytokine-levels and the number of cardiovascular risk factors. Ninety consecutive patients attending a crystal arthritis unit were studied. IL-18, sIL-6R, RANTES, leptin and adiponectin were higher in intercritical gout patients than in controls. An association was observed between IL-18, sIL6-R and RANTES levels and the size of crystal deposition. IL-18, sIL6-R, RANTES and leptin were higher in patients with no cardiovascular risk factors compared with controls with no risk factors. Our results showed that the levels of some pro-inflammatory cytokines and metabolic proteins are elevated in intercritical gout patients. The levels of certain cytokines were related to the estimated size of the monosodium urate crystal deposition and to the number of cardiovascular risk factors. These cytokine changes may help to explain the increase in cardiovascular events in gout patients.

An assessment of the hemorheological profile in patients with subclinical carotid atherosclerosis divided in relation to the number of cardiovascular risk factors and different degrees of insulin resistance.

We present a cohort of 100 subjects [43 men and 57 women; median age 66.00(25)] who were tested using carotid ultrasound to identify subclinical carotid atherosclerosis (SCA). We have evaluated the behaviour of whole blood viscosity (WBV) at high (450 s-1) and low (0.51 s-1) shear rates, plasma viscosity (450-1), hematocrit and mean erythrocyte aggregation. When compared to normal control subjects, using the Mann-Whitney test, we observed in SCA patients a significant increase in WBV only. The results were substantial after having divided the SCA subjects according to the cardiovascular risk factors (CRFs) and the degree of insulin resistance; the research was performed using two surrogate indexes such as TG/HDL-C and TyG. With the division carried out according to CRFs, employing the Kruskal-Wallis test, results show a significant increase in WBV (at high and low shear rates), in plasma viscosity, in erythrocyte aggregation and plasma fibrinogen level. Whereas by dividing them into the median of TG/HDL-C and TyG, we noticed a significant increase in WBV (at high and low shear rates) and in erythrocyte aggregation in the two groups with high TG/HDL-C ratio and with high TyG; having found an increased level of plasma fibrinogen in the latter. The data underlines the role of the main hemorheologic aspects in subclinical carotid atherosclerosis being closely correlated to the CRFs and different degrees of insulin resistance.

The function of matrix metalloproteinase-9 (MMP-9) and its tissue inhibitor (TIMP-1) in several clinical conditions: Results and analysis of our survey.

The goal of this research was to evaluate the plasma concentration of MMP-9 and its tissue inhibitor (TIMP-1) in different clinical conditions. It included several groups of subjects: 31 overweight subjects; 91 obese adults divided into two subgroups according to the BMI value (BMI 30-35 Kg/m2 and BMI > 35 Kg/m2); 90 subjects with metabolic syndrome (MS) divided into two subgroups (with and without diabetes mellitus); 100 subjects with preclinical carotid atherosclerosis (PCA) divided according to the number of cardiovascular risk factors and to the insulin resistance degree; 48 subjects with obstructive sleep apnoea syndrome (OSAS) divided according to the apnoea/hypopnea index (AHI); 27 subjects with chronic kidney disease (CKD) on conservative management; 31 subjects with CKD on regular haemodialysis treatment. We have found a significant increase of MMP-9 and TIMP-1 in overweight subjects, in obese adult and in MS subjects. In obese adults, the behaviour of these two parameters was not influenced by the degree of obesity, while in the group of MS subjects both these parameters were clearly influenced by the presence of diabetes mellitus. In subjects with PCA, we observed an increase of MMP-9 associated with a significant decrease of TIMP-1; the same trend was found by subdividing the entire group in accordance with the number of cardiovascular risk factors and with the insulin resistance degree. In subjects with OSAS, we noted an increase in MMP-9 and TIMP-1; this increase was more evident in subjects with OSAS having AHI > 30. In individuals with CKD on conservative and haemodialysis treatment we have found, at baseline, a marked increase in MMP-9 and a significant decrease of TIMP-1. In dialyzed subjects, after a standard dialysis session was noted, a significant increase in MMP-9 was associated with a further decrease in TIMP-1.