Predictor Of Future Cardiovascular Risk Research Articles

Association Between Major Adverse Cardiovascular Events and Left Ventricular Mass Index in Patients Who Have Undergone Coronary Computed Tomography Angiography: From the FU-CCTA Registry.

Left ventricular mass (LVM) is a predictor of future cardiovascular risk. We determined the association between LVM measured by coronary computed tomography angiography (CCTA) and the prognosis in patients who have undergone CCTA for screening of coronary artery disease (CAD). We performed a prospective cohort study. Five hundred twenty consecutive patients who underwent CCTA at Fukuoka University Hospital (FU-CCTA registry) were enrolled. They were clinically suspected of having CAD or had at least one cardiovascular risk factor, and were a follow-up of up to 5 years. Equal to more than 50% of coronary stenosis as assessed by CCTA was diagnosed as CAD. Using CCTA, LVM index (LVMI), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and LV end-systolic volume were measured. The primary endpoint was major adverse cardiovascular events (MACEs: including all causes of death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into non-MACEs and MACEs groups. The non-MACEs and MACEs groups consisted of 478 and 42 patients, respectively. Percent of CAD in the MACEs group was significantly higher than that in the non-MACEs group. The MACEs group showed significantly higher LVMI and tended to have a lower LVEF and LVEDV than the non-MACEs group. Although LVMI was not associated with MACEs in all patients, LVMI was independently associated with MACEs in males (odd ratio: 1.018, 95% confidence interval: 1.002 - 1.035, P = 0.030), but not females. Evaluation of LVMI by CCTA may be useful for predicting MACEs in males.

Serum endocan as a predictive biomarker of cardiovascular risk in obese pediatric patients

BackgroundEndocan is a soluble dermatan sulfate proteoglycan (50 kDa) secreted by endothelial cells and expressed by dermal, coronary, pulmonary and adipose tissue microvasculature. It plays an important role in the pathogenesis of vascular disorders, inflammatory state, endothelium dysfunction and neoangiogenesis. Aims of the study were to compare fasting serum endocan levels between children with obesity and healthy controls and to investigate the relationships between endocan, body mass index (BMI) and other indices of cardiometabolic risk.MethodsThis single-center, observational, retrospective study included 19 pediatric patients with obesity aged 11.94 ± 0.52 years and 19 lean matched controls. Each patient underwent clinical and auxological examination and laboratory investigations including routine organs function tests and lipid profile. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Fasting endocan serum levels were measured using an enzyme-linked immunosorbent assay (ELISA).ResultsCompared to healthy subjects, serum endocan levels were found to be significantly upraised in children with obesity. Endocan resulted significantly correlated with insulin levels (rho 0.47; p = 0.04); in addition, an association with HOMA-IR values with a trend toward the statistical significance (rho 0.43; p = 0.07) was found. No significant correlation with fasting blood glucose values and lipid serum levels was demonstrated. Although not statistically significant, a correlation between endocan and the presence and grading of liver steatosis on ultrasound (rho 0.51; p = 0.08 and rho 0.51; p = 0.08, respectively) was found.ConclusionsThese findings confirm the association between endothelial damage and insulin resistance in children with obesity. Endocan could be used as a biomarker of early endothelial dysfunction in children with obesity and could be a valid predictor of future cardiovascular risk in adulthood.

Comparison of autonomic function tests and high-sensitivity C-reactivity protein in overweight patients of polycystic ovarian syndrome and overweight controls

Objectives: Both polycystic ovarian syndrome (PCOS) and high body mass index (BMI) are associated with autonomic dysfunction. Most of the patients of PCOS have high BMI. Hence, BMI is likely to be a factor contributing to the autonomic dysfunction in PCOS. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and a predictor of future cardiovascular risk. PCOS patients have low-grade chronic inflammatory state. Coexistence of PCOS and obesity causes more increase in CRP, thereby further increasing the risk of cardiovascular morbidity. We have performed autonomic function tests and estimated hs-CRP in overweight patients of PCOS and compared our findings with the control group consisting of overweight normal subjects. Our aim is to find out whether the cardioautonomic and inflammatory changes seen in PCOS are due to the presence of increased weight or do the presence of increased weight add to the severity of these changes seen in PCOS. Materials and Methods: Cases consisted of 44 overweight patients of PCOS and controls included 44 healthy overweight subjects, all in the age group of 18–45 years. Autonomic function test consisted of three sympathetic and three parasympathetic reactivity tests. The following tests were done for parasympathetic reactivity: (a) Deep breathing test – expiration:inspiration ratio (E:I) was calculated. (b) Valsalva maneuver-Valsalva ratio was calculated. (c) Heart rate changes from lying to standing (LST) - 30:15 ratio was calculated. For assessing sympathetic reactivity, the following tests were used: (a) Isometric handgrip test – the difference between resting diastolic blood pressure (DBP) reading and the reading before release of hand grip is noted. (b) Cold pressor test (CPT) – The rise in DBP over the baseline DBP was noted. (c) Systolic BP (SBP) change in LST – the maximum fall in SBP was recorded. Measurement of serum hs-CRP was done using enzyme-linked immunosorbent assay. Results: We found that in the overweight PCOS group, there was a significant decrease in both sympathetic and parasympathetic reactivity than the overweight control group (p=0.000 for Valsalva ratio, 0.027 for 30:15 ratio, and 0.0005 for CPT). The difference between hs-CRP in controls and PCOS was also significant (P = 0.039). Conclusion: In our study, we concluded that the pathological changes due to PCOS could be attributed directly to the extent of inflammation measured by hs-CRP levels. These changes were not directly related to BMI as proven by comparing with controls (overweight non-PCOS subjects).

Prevalence, awareness, treatment and control of young-onset hypertension in Malaysia, 2006\u20132015

The continuous presence of elevated blood pressure (BP) when young is a strong predictor of future cardiovascular risk. This study aimed to elucidate the prevalence, awareness, treatment and control of young-onset hypertension (YOH) in Malaysia during the period 2006–2015. Data on respondents aged 18–39 diagnosed with YOH according to the 7th Joint National Committee Report (USA) were extracted from three National Health and Morbidity Surveys (2006, 2011, and 2015). The prevalence of YOH remained stable: 17.7%, 95% CI [17.0, 18.3] in 2006, 17.0%, 95% CI [16.0, 17.9] in 2011 and 18.4%, 95% CI [17.4, 19.4] in 2015. Awareness, treatment and control rates were suboptimal; 15% were aware of their diagnosis, of which less than 50% were on treatment and less than 40% who were on treatment had their BP controlled. Trend analysis revealed a significant increase in YOH prevalence among urban dwellers; those with no formal and tertiary education and middle-income earners. YOH awareness and treatment rates were lower among respondents <30 years; however, when treated, this group achieved overall better control rates. Females had higher awareness and treatment rates, but lower control. Treatment rates remained stable for all ethnicities with the exception of Chinese, which decreased. This study narrows the knowledge gap on YOH epidemiology in Malaysia by providing crucial information on the pervasiveness of hypertension among young adults. Results can be used to develop non-communicable disease policies and health promotion strategies specially targeted at young adults who are in the prime of life.

Body mass index as the most influential factor of high-sensitivity C-reactive protein in non-diabetic adults

BACKGROUNDHigh-sensitivity C-reactive protein (hsCRP) has been widely accepted as a predictor of future cardiovascular risk that reflects a microinflammatory state. Obesity linked to microinflammation increases the prevalence of metabolic disorders and cardiovascular diseases. This study aimed to determine the association between several obesity indices namely body mass index (BMI), waist circumference (WC), body fat percentage (fat), and visceral fat (VF) with hsCRP in non-diabetic adults. METHODSThis was a cross-sectional study performed on 80 non-diabetic adults with ages ranging from 20-40 years. The obesity indices BMI, WC, body fat percentage, and VF were measured. We then measured the hsCRP levels using an immunoturbidimetric method. Simple and multiple linear regression tests were used to analyze the association between obesity indices and hsCRP levels. RESULTSMean of log BMI, log WC, and log VF was 1.41 ± 0.08 kg/m2, 1.93 ± 0.06 cm, and 0.95 ± 0.27 units, respectively. Simple linear regression tests showed that log BMI (â=3.506; p&lt;0.001), log WC (â=3.672; p&lt;0.001), log VF (â=0.833; p&lt;0.001), and log systolic blood pressure (â=3.739; p=0.024) had a significant positive correlation with log hsCRP levels. Further multiple linear regression test showed that log BMI (â=3.772; Beta=0.674; p&lt;0.001) had the greater effect on log hsCRP levels compared to other indices. CONCLUSIONS BMI had a greater influence on hsCRP levels compared to other obesity indices in non-diabetic adults. Body mass index can be used as a better index in predicting hsCRP levels compared to other indices.

Oral health in childhood as a predictor of future cardiovascular risk.

Oral health in childhood as a predictor of future cardiovascular risk.

Recomendaciones de seguimiento a partir del «cuarto trimestre» de mujeres con complicaciones vasculares y metabólicas durante el embarazo. Documento de consenso de la SEC, SEMERGEN, semFYC y SEGO

Pregnancy is a predictor of future cardiovascular risk in women that could unmask different metabolic or latent vascular disorders. The delay in the reproductive age and its association with other risk factors has increased high risk pregnancies.Currently there is an excellent national protocol for continued care for women who develop these complications during pregnancy. But during the so-called “fourth trimester” that starts after delivery and lasts for the rest of the woman's life, the follow-up is reduced.The objective of this document, endorsed by the Spanish Society of Gynaecology and Obstetrics (SEGO), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Society of Cardiology (SEC), is to establish joint recommendations for this “fourth trimester”, that ensure the follow-up of risk factors and potential cardiovascular complications that may be developed during that period.

REVASCULARIZATION OF A CHRONIC TOTAL OCCLUSION BY PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH A SIGNIFICANT REDUCTION IN MORTALITY: INSIGHTS FROM A 4,327 PATIENT META-ANALYSIS

Around one-third of patients undergoing angiography have a chronic total occlusion (CTO) and its presence is an important predictor of future cardiovascular risk. Percutaneous coronary intervention (PCI) has emerged as a feasible technique for revascularization of CTO, but there remains ongoing

Elevated Blood Pressure Response to Exercise and Recovery in the Offspring of Hypertensive Pregnancies: A Predictor of Future Cardiovascular Risk?

Elevated Blood Pressure Response to Exercise and Recovery in the Offspring of Hypertensive Pregnancies: A Predictor of Future Cardiovascular Risk?

An Observational Study of Correlation Between Risk FactorsObesity, Hypertension, Diabetes, Dyslipidemia with Carotid Intima Media Thickness In Patients Above 40 Years Of Age

The CIMT is a simple and inexpensive tool which can be used to assess the cumulative effect of atherosclerotic risk factors and it is also an independent predictor of future cardiovascular risk. The International Atherosclerosis project suggests that the atherosclerotic process occurs at the same time in the Carotid, Cerebral and Coronary arteries. Measurement of CIMT of CCA by B mode ultrasound is a suitable noninvasive method to visualize the arterial walls and to monitor the early stages of the atherosclerotic process. The CIMT >1 mm is considered to be Abnormal and >1.2mm is High risk. Therse is general agreement that the presence of obvious plaque indicates high risk at any age. When there is only IMT without Obvious Plaque then the normal need to be adjusted for Age, Gender and Perhaps even Ethnicity.

D5. Is maternal arterial function impaired in pregnancies with fetal growth restriction?

Introduction: Studies in pre-eclampsia have demonstrated that central haemodynamic changes give more insight than peripheral measures into maternal cardiac and vascular physiology. This study aims to investigate augmentation index (AIX) and pulse wave velocity (PWV) in pregnancies affected by fetal growth restriction (FGR) and compare them to healthy women in the third trimester of pregnancy. Augmentation index (AIx) is a measure of systemic arterial stiffness derived from the ascending aortic pressure waveform. PWV is widely used as measure of arterial stiffness and predictor of future cardiovascular risk outside pregnancy.Methods: Eight pregnancies with fetal growth restriction (AC < 10th percentile and raised umbilical PI) in the third trimester (27–35 weeks gestation) were compared with 42 healthy pregnancies in similar gestation band. AIX and PWV were measured by the Vicorder device with women in the left lateral position. Unpaired t-test was used to calculate the p values amongst these groups.Results: The mean AIX in pregnancies with FGR was 22.63 compared to 10.10 in healthy pregnancies (p = 0.0005). PWV was 8.15 in the FGR group compared to 7.08 in healthy controls (p = 0.004). See charts.Conclusions: These results show that pregnancies affected by third trimester FGR in the absence of pre-eclampsia show impairment of maternal arterial function with high arterial stiffness. To date, many studies have shown impaired maternal arterial function in preeclampsia but little has been done to characterize maternal arterial function in fetal growth restriction alone. Considering both these conditions are thought to have common underlying etiology, these results suggest that arterial function is impaired in fetal growth restriction independent of hypertension or pre-eclampsia. Characterization of arterial profile could play an important role in the understanding of the etiology of this condition which has hitherto been ascribed purely to placental dysfunction.

Mental stress and cardiovascular reactivity in humans: a time‐dependent response (852.6)

Cardiovascular reactivity (CVR) to acute laboratory mental stress (MS) has been extensively studied as a potential predictor of future cardiovascular risk, but length of MS trial can vary across studies. We hypothesized that CVR would be different between short (1 min) versus longer (3 and 5 min) MS trials, but that within‐subject reactivity would be correlated. We recorded heart rate (HR) and beat‐to‐beat blood pressure reactivity to 1 min, 3 min and 5 min mental arithmetic in 21 subjects (age, 20±3 yrs, 10 men and 11 women). Mean arterial pressure (MAP) reactivity to 1min of MS (∆6±1 mmHg) was blunted compared to 3 min (∆11±1 mmHg; P˂.001) and 5 min (∆11±1 mmHg; P˂.001) of MS. In contrast, HR reactivity to 1 min of MS (∆21±2 beats/min) was augmented compared to 3 min (∆17±2 beats/min; p&lt;.01) and 5 min (∆17±2 beats/min; p&lt;.01) of MS. HR reactivity (range, r=.648 to .790; p&lt;.001), but not MAP reactivity, was consistently correlated across MS trials. When probed for sex differences, CVR across trials tended to be more correlated in women. In conclusion, our findings demonstrate that CVR to acute MS is time‐dependent, thus caution should be taken in interpreting CVR data. However, CVR responders for shorter MS trials appear to remain responders for longer trials, especially in women.

Central blood pressure: current evidence and clinical importance.

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.

A High School-Based Voluntary Cardiovascular Risk Screening Program: Issues of Feasibility and Correlates of Electrocardiographic Outcomes

Risk factors for adult cardiovascular events can be identified from the prenatal period through childhood. We performed a cardiovascular risk-screening program in students from grades 9-12 in 7 high schools in Hillsborough County, FL. We obtained blood pressure (BP) measurements and calculated body mass index (BMI) as risk factors for future cardiovascular events as well as obtained an electrocardiogram (ECG) for the purposes of detecting possible life-threatening arrhythmias. Of ~14,000 students contacted, 600 (4 %) participated in the screening. Of these, 517 (86 %) were diagnosed with normal, 71 (12 %) with borderline, and 12 (1 %) with abnormal ECGs. Although no participant had any cardiac history, two of the abnormal ECGs indicated a cardiac diagnosis associated with the potential for sudden cardiac death. Both systolic and diastolic BP increased as the ECG diagnosis moved from normal (115.6/73.8) through borderline (121.0/75.9) to an abnormal (125.0/80.7) diagnosis (all P ≤ .0016). An increase in BMI was only observed when an ECG diagnosis was abnormal (P = .0180). Boys had a greater prevalence (18.97 %) of borderline or abnormal ECGs compared with girls (6.75 %), whereas no discernible differences were seen in ECG diagnosis between white and nonwhite individuals (15.09 and 12.26 %, respectively). Although participation rates were low, a high school-based cardiovascular risk-screening program including ECG is feasible. Although ECG diagnosis tended to be related to other known cardiovascular risk factors (BP, BMI), the utility of an abnormal ECG in adolescence as a predictor of future cardiovascular risk will require further evaluation in more controlled settings.

Paraoxonase Gene Polymorphisms and Aortic Calcification

Aortic arch calcification is correlated with the extent of atherosclerosis and is a predictor of future cardiovascular risk. The paraoxonase (PON) gene can reduce the risk of atherosclerosis development. The purpose of this study was to determine the relationship between aortic arch calcification and PON gene polymorphisms. We also evaluated the association between aortic arch calcification and the presence of cardiovascular risk factors. This study included 977 subjects (518 men and 459 women). Genotype polymorphisms include PON1M55L, PON1Q192R, PON2A148G, and PON2S311C, as determined by melting point analysis using LightCycler real-time polymerase chain reaction technology. Aortic arch calcifications were assessed by means of posteroanterior chest X-rays. Calcification severity was graded into four groups. There were no significant differences in PON gene polymorphisms or allele frequencies between the groups ( p > 0.05). On simple regression analysis, aortic arch calcification was found to be associated with age, hypertension, diabetes, and apolipoprotein A1 (ApoA1). On multiple regression analysis, aortic arch calcification was found to be associated with age and ApoA1. We did not find an association between PON gene polymorphisms and aortic arch calcification, but we did confirm that aortic arch calcification is correlated with age and ApoA1.

Central blood pressure estimation for the masses moves a step closer

The sphygmomanometer is one of the few medical devices that can be truly said to have stood the test of time. This is in part testament to its simplicity and ease of use, but also that 100 years of careful epidemiological observation and large-scale intervention trials have placed the predictive value of brachial blood pressure beyond question. Despite this, over the last 30 years a few visionaries, or ‘heretics’, depending on one’s viewpoint, have fought for greater recognition of the potential clinical importance of aortic (central) pressure. Their rationale stemmed from the observation, first made at the time of invasive cardiac catheterization, that aortic and brachial systolic pressures vary considerably, and, more recently, that surrogate markers of cardiovascular risk are better related to central systolic pressure than the corresponding brachial artery values. Since then, evidence has accrued that central pressure may actually be an independent predictor of future cardiovascular risk, supporting the visionaries. However, central pressure measurement and its use in risk stratification are yet to enter the clinical arena for two main reasons:

Arteriosclerosis and Atherosclerosis

Over the last decade, there has been a dramatic resurgence of interest in large-artery hemodynamics. This has been driven principally by the accumulating evidence that aortic stiffness is an independent predictor of future cardiovascular risk in a variety of populations.1 The current gold-standard measure of aortic stiffness is aortic pulse wave velocity (aPWV). This reflects the fact that it has the most evidence relating to outcome and that it can be reliably assessed between the carotid and femoral arteries, noninvasively.1 However, there continues to be considerable debate about the nature of the relationship between arterial stiffness and cardiovascular disease: is aPWV truly an independent risk factor or simply a marker? A number of hypothetical relationships exist (Figure), as described below. First, aortic stiffening may promote cardiovascular disease independent of other more established cardiovascular risk factors. Data from some of the published outcome studies would support this view, but it is likely that meta-analysis of these data will be required to demonstrate this convincingly. Figure. Proposed mechanisms linking aortic stiffness with atherosclerotic and nonatherosclerotic cardiovascular disease. Arrows numbered 1 to 3 refer to hypothetical relationships discussed in the text (first, second, and third). Second, an alternative suggestion is that aPWV simply represents the integrated effects over time that established risk factors have on the arterial wall and that stiffening of the wall does not in itself cause disease. Nevertheless, aPWV could still be more closely related to future events than a single “snapshot” measure of individual risk factors in isolation. A simple analogy is weight, which represents the integrated relationship between food intake and energy expenditure over an individual’s lifetime and, thus, is a more reliable measure of overall energy balance than a single day’s assessment of energy intake and usage. Third, if the presence of atheroma alters the …

Arterial stiffness and diastolic blood pressure: what is the connection?

Summary Although brachial systolic blood pressure (SBP) is the overall best predictor of future cardiovascular risk for the entire hypertensive population, there is much that can be learned from assessing diastolic blood pressure (DBP) in relation to simultaneous levels of SBP, because the former is not distorted by pressure amplification. In very young (mean age of 20 years) hypertensives, discordantly low DBP, defined as isolated systolic hypertension (ISH), was associated with increased stroke volumes (SV), increased aortic stiffness or a combination of both. These individuals had a significantly higher mean central SBP than normotensive persons, and therefore, should not be classified as having spurious hypertension. In contrast, young adults with essential hypertension presented with elevated DBP and evidence of increased peripheral vascular resistance. Discordantly high DBP in young adults (mean age of 40 years) with isolated diastolic hypertension (IDH) was associated with a high prevalence of obesity and the metabolic syndrome; DBP was discordantly high because of a limited rise in SBP secondary to decreased pressure amplification. Discordantly very low DBP in the older age population (mean age ⩾ 60 years) with ISH defines a population with LVH, increased ventricular-arterial stiffness, and a propensity for diastolic dysfunction. Therefore, discordantly low DBP may be an early marker of increased SV and/or arterial stiffness in young adults and a late marker of ventricular-arterial stiffness in older adults. In contrast to risk prediction where brachial DBP may be of paramount importance, the therapeutic benefit of antihypertensive therapy is entirely related to decreased SBP.

The importance of diastolic blood pressure in predicting cardiovascular risk

Brachial systolic blood pressure (SBP) is the overall best predictor of future cardiovascular risk for the entire hypertensive population; however, there is much that can be learned from assessing diastolic blood pressure (DBP) in relation to simultaneous levels of SBP, because the former is not distorted by pressure amplification. Low DBP in very young adults (mean age 20 years), presenting as isolated systolic hypertension (ISH), results from elevation in stroke volume and/or arterial stiffness. This subtype of hypertension has a marked male predominance, occurs twice as frequently as essential hypertension, and is potentially not a benign condition. In contrast, isolated diastolic hypertension (IDH) in young adults (mean age of 40 years) with IDH occurs predominantly in men with a high prevalence of metabolic syndrome. Indeed, persons with IDH frequently evolve into systolic-diastolic hypertension and are potentially at increased risk for future diabetes and cardiovascular complications. The older age population with ISH and low DBP (mean age ≥60 years of age) has a high prevalence of left ventricular hypertrophy, increased ventricular-arterial stiffness, and a tendency for diastolic dysfunction and heart failure. Finally, concordant very high DBP, especially in older persons, defines potential hypertensive urgencies, emergencies, secondary forms of hypertension, and other high peripheral resistance states.

Biomarkers of outcome from cardiovascular disease

Recognition of the fact that low-grade local and systemic inflammation accompanies all stages of atherogenesis has led to the identification of a number of novel biomarkers of cardiovascular risk. We highlight recent epidemiological and experimental evidence concerning four emerging biomarkers: C-reactive protein, interleukin-6, D-dimer and white blood cell count. Recent epidemiological and experimental data on C-reactive protein, the most extensively studied marker of systemic inflammation, produced in the liver in response to interleukin-6, has cast some doubt on its clinical utility and causal involvement in atherogenesis. However, a large number of studies still strongly support C-reactive protein as an independent predictor of future cardiovascular risk and a potent proatherogenic agent. Among all markers of inflammation studied to date, C-reactive protein seems the most suitable one for use in clinical practice. Regarding white blood cell count, recent studies focused on the differential leucocyte count in coronary-heart-disease risk assessment; neutrophil count represents the strongest predictor of incident coronary heart disease. Thus, screening for low-grade inflammation using several novel biomarkers might provide an important tool to identify individuals at increased risk who would benefit most from targeted preventive interventions.