Predictor Of Future Cardiovascular Disease Research Articles

Neck circumference as an additional predictor of cardiovascular disease mortality: A multi-center prospective population-based study in northeastern China

Background and aimsThis study aimed to assess the potential of neck circumference (NC) and neck-to-height ratio (NHR) as predictors of future cardiovascular disease (CVD) mortality in a general population from Northeastern China. MethodsA multi-center prospective study was conducted in Northeastern China, involving 18, 796 participants. The associations between NC or NHR and the incidence of overall CVD mortality, stroke mortality, and coronary heart disease (CHD) mortality were examined using multivariate Cox regression models. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated. Reclassification analyses were conducted to determine the incremental predictive value of NC or NHR. ResultsNC was significantly associated with the risk of CVD mortality, independent of other anthropometric measurements for obesity. Individuals in the highest quartile of NC had a 1.83-fold (95% CI 1.29 to 2.61) and a 2.40-fold (95% CI 1.45 to 4.00) higher risk of overall CVD mortality and CHD mortality, respectively. Larger NC was significantly related to a heightened risk of ischemic stroke mortality, although no such association was observed with hemorrhagic stroke mortality. Furthermore, the risk of overall CVD mortality, stroke mortality, and CHD mortality increased by approximately 1.21 to 1.25 times per 1-SD change in NC. Similar findings were observed for NHR. The percentages of correct classification of overall CVD mortality improved by 12.1% and 16.3% after the addition of NC or NHR into established models, respectively. ConclusionsNC and NHR might be promising predictors of CVD mortality, with higher values indicating greater risk.

Varying Definitions of Carotid Intima-Media Thickness and Future Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta-analysis of the associations between different cIMT definitions and CVD. A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA-IMT], internal carotid artery IMT [ICA-IMT], combined segments [combined-IMT], mean CCA-IMT, and maximum CCA-IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta-analysis. After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27-1.38]), MI (HR, 1.27 [95% CI, 1.22-1.33]), and CVD events (HR, 1.28 [95% CI, 1.19-1.37]). A 1-SD increase in ICA-IMT was related to future stroke (HR, 1.25 [95% CI, 1.11-1.42]) and CVD events (HR, 1.25 [95% CI, 1.04-1.50]) but not MI (HR, 1.26 [95% CI, 0.98-1.61]). A 1-SD increase in combined-IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08-1.57]) and CVD events (HR, 1.36 [95% CI, 1.23-1.49]). Maximum CCA-IMT was more strongly related than mean CCA-IMT with risk of MI, and both measures were similarly associated with stroke and CVD events. Combined-IMT is more strongly associated with CVD events compared with single-segment cIMT definitions. Maximum CCA-IMT shows a stronger association with MI than mean CCA-IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.

Abstract 15735: Antibody-Based Plasma Proteomics Profiling Reveals New Markers of Cardiorespiratory Fitness

Background: Plasma proteins can be biomarkers of cardiovascular health status but also physiologic effectors that mediate health benefits. Cardiorespiratory fitness (CRF) is an integrative measure of cardiovascular and metabolic health and independent predictor of future cardiovascular disease (CVD) and mortality risk, however limited knowledge exists regarding its molecular transducers. We sought to expand upon prior proteomic studies of CRF using an antibody-based technology (Olink TM ). Hypothesis: Olink proteomic profiling will identify new markers and potential mediators of CRF. Methods: We measured plasma proteins (N=1,472) using Olink’s platform in a pilot study within the HERITAGE Family Study (N=209 participants, mean age=34 years, 56% female, 36% Black) before and after 20 weeks of endurance exercise training (ET). We performed multivariable linear regression to measure the association between protein levels and CRF measured by CPET (VO 2 max in ml*kg -1 *min -1 ) adjusting for age and sex. Lean body mass was measured by hydrostatic weighing. Protein changes after ET were assessed using paired Student’s t-tests. Results: We identified 70 proteins significantly associated (FDR q <0.05) with VO 2 max. Among these, 14 have not previously been measured in the context of CRF, including perilipin-1, a modulator of lipid homeostasis in adipocytes (beta=-3.8, q=2.4x10 -4 ); latent-transforming growth factor beta-binding protein 3 (beta=-2.6, q=1.3x10 -3 ), a key regulator of TGF-beta activation; and hydroxysteroid 11-beta dehydrogenase 1 (beta=3.2, q=1.2x10 -3 ), which regulates cortisol metabolism. Carbonic anhydrase (CA) XIV (CA14; beta=5.4, q=1.3x10 -8 ), a member of the CA family with extracellular activity, had the strongest positive association with VO 2 max in our primary model as well as after further adjusting VO 2 max for lean body mass. Further, CA14 levels increased significantly after ET (log2 fold change: 0.14, q=0.007). Conclusions: Antibody-based plasma proteomics profiling identified new markers of CRF, including a CA isoform that increases after ET. These findings motivate further study of CA14’s mechanistic role in CA14 and expanded proteomics profiling to investigate molecular transducers of CRF.

Abstract MP78: Race/Ethnic Disparities in Children’s Cardiovascular Health: The Role of Social Disadvantage in Early Life

Introduction: The loss of cardiovascular health (CVH) begins early in life and disproportionately affects racial/ethnic minorities, particularly children in single parent households, and households with lower education, family income and food insecurity. However, the contribution of these social determinants to CVH disparities in childhood are poorly understood. Hypothesis: We hypothesized that racial/ethnic differences in CVH among US children are explained by social disadvantages. Methods: Data from the 2013-2018 National Health and Nutrition Examination Survey for children aged 2-18 (N=4,792) were used. CVH was measured using the AHA Life’s Essential 8 scores that combine nicotine exposure, diet, physical activity, sleep, body mass index, and blood pressure, lipids, and glucose. Oaxaca-Blinder decomposition methods were used to quantify the contributions of parental education, marital status and household income to poverty ratio, and food security to differences in CVH by race and sex. Results: Mean CVH score was highest among non-Hispanic White (mean [SE] = 73.7 [0.5]) than non-Hispanic Black (71.3 [0.6]) and Hispanic children (71.0 [0.4]). There was no significant difference among Black-White boys (mean differences [MD] = -1.52; 95% CI: -3.25, 0.21). Black girls had significantly lower CVH than White girls (MD= -2.66; 95% CI: -4.40, -0.91). Differences in parental college education accounted for 46% of the differences in CVH scores (MD = -1.21; 95% CI: -1.89, -0.54). Among Hispanic children, both boys (MD = -2.47; 95% CI: -4.22, -0.73) and girls (MD = -3.09; 95% CI: -4.60, -1.58) had significantly lower CVH scores than White boys and girls, respectively. Differences in parental education explained 66% of the difference in CVH among White-Hispanic boys and girls (MD= -0.66; 95%CI-1.11, -0.20; and MD= -0.66; 95%CI-1.20, -0.13). Discussion: Differences in parental college education largely explained lower levels of CVH among US Black and Hispanic children, a predictor of future cardiovascular disease.

PS-C30-2: SHORT STATURE IS ASSOCIATED WITH HIGHER PULSE WAVE VELOCITY IN SUBJECTS WITHOUT OVERT CARDIOVASCULAR DISEASE

Objective: Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD. Design and method: A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders. Results: Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = -0.131, P = .003) and women (r = -0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (< 50 years old) but not in older men, while group height was correlated with baPWV in older women (50 years old or more, P for trend = .014) but not in younger women. Conclusions: Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.

Racial Differences in Nontraditional Risk Factors Associated with Cardiovascular Conditions in Pregnancy Among U.S. Women Veterans.

Background: Pregnancy-related cardiovascular (CV) conditions are important predictors of future cardiovascular disease (CVD). Nontraditional factors, such as depression and chronic stress, have been associated with CVD, but their role in pregnancy-related CVD conditions (pCVD) remains unknown. To determine the association between nontraditional factors and CV conditions in pregnancy, and to explore if this risk varies by race. Methods: Using data from a prospective study of pregnant women within the veterans affairs health system (COMFORT study), we described the prevalence of nontraditional factors (e.g., depression, post-traumatic stress disorder [PTSD], chronic stress) and used logistic regression to determine the association between nontraditional factors and pregnancy-related CV conditions (pre-eclampsia/eclampsia, gestational hypertension, gestation diabetes, or preterm delivery). Analyses were then stratified by race. Results: Among 706 enrollees, 26% had pregnancy-related CV conditions. These women had significantly higher rates of depression (62% vs. 45%, p < 0.01), anxiety (50% vs. 37%, p = 0.01), PTSD (44% vs. 29%, p < 0.01), and high stress levels before pregnancy (22% vs. 16%, p = 0.05) compared with women with normal pregnancies. Overall, these factors were not associated with increased adjusted odds of pCVD. Overall, Black women had disproportionately higher rates of prepregnancy hypertension compared with White women (22% vs. 6%, p < 0.01). Conclusions: Women Veterans with pCVD are a high-risk group for future CVD, with disproportionately high rates of depression, anxiety, PTSD, and chronic stress. Racial disparities exist in pregnancy-related CV risk factors, which may further compound existing racial disparities in CVD among women Veterans.

The Effect of Race and Shear Stress on CRP-Induced Responses in Endothelial Cells.

Background C-reactive protein (CRP) is an independent biomarker of systemic inflammation and a predictor of future cardiovascular disease (CVD). More than just a pure bystander, CRP directly interacts with endothelial cells to decrease endothelial nitric oxide synthase (eNOS) expression and bioactivity, decrease nitric oxide (NO) production, and increase the release of vasoconstrictors and adhesion molecules. Race is significantly associated with CRP levels and CVD risks. With aerobic exercise, the vessel wall is exposed to chronic high laminar shear stress (HiLSS) that shifts the endothelium phenotype towards an anti-inflammatory, antioxidant, antiapoptotic, and antiproliferative environment. Thus, the purpose of this study was to assess the racial differences concerning the CRP-induced effects in endothelial cells and the potential role of HiLSS in mitigating these differences. Methods Human umbilical vein endothelial cells (HUVECs) from four African American (AA) and four Caucasian (CA) donors were cultured and incubated under the following conditions: (1) static control, (2) CRP (10 μg/mL, 24 hours), (3) CRP receptor (FcγRIIB) inhibitor followed by CRP stimulation, (4) HiLSS (20 dyne/cm2, 24 hours), and (5) HiLSS followed by CRP stimulation. Results AA HUVECs had significantly higher FcγRIIB receptor expression under both basal and CRP incubation conditions. Blocking FcγRIIB receptor significantly attenuated the CRP-induced decrements in eNOS expression only in AA HUVECs. Finally, HiLSS significantly counteracted CRP-induced effects. Conclusion Understanding potential racial differences in endothelial function is important to improve CVD prevention. Our results shed light on FcγRIIB receptor as a potential contributor to racial differences in endothelial function in AA.

Endothelial function in type 1 diabetes: Gender differences

Background and Aims: Premenopausal healthy women have lower incidence of cardiovascular disease (CVD) compared to age-matched men. Type 1 Diabetes (T1D) seems to abolish the female sex protection seen in nondiabetic population, even inverting this trend. Endothelial dysfunction (ED) has been identified as an early biomarker of CVD and predictor of future CVD. We designed our study to evaluate sex differences in ED in a cohort of T1D subjects.

Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations.

Central systolic blood pressure (cSBP) is an independent predictor of future cardiovascular disease. Unattended brachial SBP (bSBP) can eliminate the white-coat effect. However, unattended cSBP and unattended standing cSBP have never been reported. We aimed to compare bSBP and cSBP in attended, unattended, and unattended standing situations. We also aimed to compare the white-coat effect and unattended orthostatic BP change between bSBP and cSBP. Altogether, 104 hypertensive outpatients were included (mean age: 66.0 ± 9.8 years, 41.3% male, mean body mass index: 25.0 ± 4.5). Attended bSBP/cSBP values were 127.3 ± 15.7/119.2 ± 15.0, unattended bSBP/cSBP values were 122.7 ± 15.3/114.4 ± 15.1, and unattended standing bSBP/cSBP values were 123.6 ± 15.7/114.1 ± 14.8 mmHg (correlation coefficients/coefficients of determination between bSBP and cSBP: 0.971/0.943, 0.970/0.941, and 0.964/0.929, respectively; all p < 0.001). No significant difference was observed in the white-coat effect between bSBP and cSBP (4.6 ± 5.8 vs. 4.8 ± 5.7 mmHg). Although there was no significant difference between unattended sitting SBP and unattended standing SBP in terms of both bSBP and cSBP, a numerically small but significant difference was observed in the unattended orthostatic BP change between bSBP and cSBP (0.9 ± 8.0 vs. -0.3 ± 9.0 mmHg, p = 0.002). In conclusion, significant and strong correlations were observed between bSBP and cSBP in attended, unattended, and unattended standing BP measurements. The white-coat effect on bSBP was equivalent to that on cSBP. There was a numerically small but significant difference in the unattended orthostatic BP change between bSBP and cSBP.

Childhood-onset depression and arterial stiffness in young adulthood

ObjectivesThe literature on childhood-onset depression and future compromised vascular function is suggestive but limited. The objective of this study was to determine if arterial stiffness, a predictor of future cardiovascular disease (CVD), measured in young adulthood, is associated with childhood-onset depression. MethodsCardiometabolic risk factors and pulse wave velocity (PWV), a measure of arterial stiffness, were cross-sectionally assessed in young adults with a history of childhood-onset depression (clinical diagnosis of major depressive episode or dysthymic disorder; N = 294 probands; initially recruited via child mental health facilities across Hungary; mean age of first depressive episode = 10.4 years), their never-depressed full biological siblings (N = 269), and never-depressed controls (N = 169). The mean ages of probands, siblings, and controls at the PWV visit were 25.6, 25.0, and 21.7 years, respectively, and 8.8% of the probands were in a current depressive episode. ResultsControlling for age, sex, age*sex, education, and family clusters, PWV (m/s) did not statistically differ across the groups (probands = 7.01; siblings = 6.98; controls = 6.81). However, after adjusting for key covariates, there were several across-group differences in CVD risk factors: compared to controls, probands and siblings had higher diastolic blood pressure and lower high-density lipoprotein cholesterol, probands had higher triglycerides, and siblings had higher body mass index (all p < 0.05). ConclusionWe found limited evidence of an association between a history of childhood-onset depression and young adulthood arterial stiffness. However, our findings of elevated cardiovascular risk factors in those with childhood-onset depression suggest that pediatric depression may predispose to increased CVD risk later in life and warrants further investigation.

Dietary fat and alcohol in the prediction of indices of vascular health among young adults

ObjectivesArterial stiffness, particularly of the aorta, is an independent predictor of future cardiovascular disease, all-cause mortality, and hypertension. Arterial stiffening may be caused or exacerbated by the composition of the diet. Current research has indicated that habitual dietary patterns may influence arteriosclerosis, or the thickening and hardening of the artery walls, but has yet to identify a specific food group as the culprit. In young, college-aged adults, dietary fat intake and alcohol consumption tend to be higher compared to other periods throughout the life cycle. Therefore, the purpose of this study was to determine the influence of dietary fat and alcohol consumption on the vascular health of apparently healthy young adults. MethodsThe data collected were assessed to determine if dietary fat and alcohol in young (18–30 y), college-aged adults (n = 50) were independent predictors of an increase in arterial stiffening. Vascular health was determined by the carotid-femoral pulse-wave velocity and the augmentation index corrected for a heart rate of 75 beats/min; dietary patterns were assessed using the Dietary Health Questionnaire II. ResultsThe gold standard marker of aortic stiffness, carotid femoral pulse-wave velocity, was positively correlated with cheese consumption (R2 = 0.092, P = 0.033), alcohol consumption (R2 = 0.102, P = 0.024), and total energy/calories (%) from alcohol (R2 = 0.118, P = 0.015) in univariate analysis. In forward-selection multiple regression analysis, energy from alcohol and cheese consumption accounted for 23.7% of the variance in carotid-femoral pulse-wave velocity (P = 0.009). The augmentation index wave reflection marker was positively correlated with total dietary fat (R2 = 0.110, P = 0.019), trans fatty acids (R2 = 0.092, P = 0.032), saturated fatty acids (R2 = 0.124, P = 0.012), monounsaturated fatty acids (R2 = 0.012, P = 0.015), red-meat consumption (R2 = 0.094, P = 0.030), and discretionary fat from solids in univariate analysis (R2 = 0.137, P = 0.008). Discretionary fat from solids accounted for 13.7% of the variation in augmentation index in forward-selection multiple regression analysis (P = 0.008). ConclusionsThese results indicate the potential roles of dietary fat and alcohol consumption in early vascular aging by stiffening the arteries of young, college-aged adults, which may in turn contribute to future adverse cardiovascular disease outcomes.

Postpartum plasma metabolomic profile among women with preeclampsia and preterm delivery: implications for long-term health

BackgroundPreeclampsia and preterm delivery (PTD) are believed to affect women’s long-term health including cardiovascular disease (CVD), but the biological underpinnings are largely unknown. We aimed to test whether maternal postpartum metabolomic profiles, especially CVD-related metabolites, varied according to PTD subtypes with and without preeclampsia, in a US urban, low-income multi-ethnic population.MethodsThis study, from the Boston Birth Cohort, included 980 women with term delivery, 79 with medically indicated PTD (mPTD) and preeclampsia, 52 with mPTD only, and 219 with spontaneous PTD (sPTD). Metabolomic profiling in postpartum plasma was conducted by liquid chromatography-mass spectrometry. Linear regression models were used to assess the associations of each metabolite with mPTD with preeclampsia, mPTD only, and sPTD, respectively, adjusting for pertinent covariates. Weighted gene coexpression network analysis was applied to investigate interconnected metabolites associated with the PTD/preeclampsia subgroups. Bonferroni correction was applied to account for multiple testing.ResultsA total of 380 known metabolites were analyzed. Compared to term controls, women with mPTD and preeclampsia showed a significant increase in 36 metabolites, mainly representing acylcarnitines and multiple classes of lipids (diacylglycerols, triacylglycerols, phosphocholines, and lysophosphocholines), as well as a decrease in 11 metabolites including nucleotides, steroids, and cholesteryl esters (CEs) (P < 1.3 × 10−4). Alterations of diacylglycerols, triacylglycerols, and CEs in women with mPTD and preeclampsia remained significant when compared to women with mPTD only. In contrast, the metabolite differences between women with mPTD only and term controls were only seen in phosphatidylethanolamine class. Women with sPTD had significantly different levels of 16 metabolites mainly in amino acid, nucleotide, and steroid classes compared to term controls, of which, anthranilic acid, bilirubin, and steroids also had shared associations in women with mPTD and preeclampsia.ConclusionIn this sample of US high-risk women, PTD/preeclampsia subgroups each showed some unique and shared associations with maternal postpartum plasma metabolites, including those known to be predictors of future CVD. These findings, if validated, may provide new insight into metabolomic alterations underlying clinically observed PTD/preeclampsia subgroups and implications for women’s future cardiometabolic health.

Cardiac sympathetic activation and parasympathetic withdrawal during psychosocial stress exposure in 6-month-old infants.

Infant autonomic reactivity to stress is a potential predictor of later life health complications, but research has not sufficiently examined sympathetic activity, controlled for effects of physical activity and respiration, or studied associations among autonomic adjustments, cardiac activity, and affect in infants. We studied 278 infants during the repeated Still-Face Paradigm, a standardized stressor, while monitoring cardiac activity (ECG) and respiratory pattern (respiratory inductance plethysmography). Video ratings of physical activity and affect were also performed. Respiratory sinus arrhythmia (RSA) and T-wave amplitude (TWA) served as noninvasive indicators of cardiac parasympathetic and sympathetic activity, respectively. Responses were compared between infants who completed two still-face exposures and those who terminated after one exposure due to visible distress. Findings, controlled for physical activity, showed robust reductions in respiration-adjusted RSA and TWA, with more tonic attenuation of TWA. Infants completing only one still-face trial showed more pronounced autonomic changes and less recovery from stress. They also showed elevated minute ventilation, suggesting hyperventilation. Both reductions in adjusted RSA and TWA contributed equally to heart rate changes and were associated with higher negative and lower positive affect. These associations were more robust in the group of distressed infants unable to complete both still-face trials. Thus, cardiac sympathetic activation and parasympathetic withdrawal are part of the infant stress response, beyond associated physical activity and respiration changes. Their association with cardiac chronotropy and affect increases as infants' distress level increases. This excess reactivity to social stress should be examined as a predictor of future cardiovascular disease.

Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults.

Recently, more sophisticated blood pressure (BP) measurements, such as central and ambulatory BP (ABP), have proven to be stronger predictors of future cardiovascular disease than conventional office BP. Their predictive value for atrial fibrillation development is not established. We investigated the prognostic impact for incident atrial fibrillation of office, central and ambulatory BP measurements in a predominantly older population-based cohort. Of 1004 participants in the Cardiovascular Abnormalities and Brain Lesions (CABL) study, 769 in sinus rhythm with no history of atrial fibrillation or stroke (mean age 70.5 years) underwent ABP and arterial wave reflection analysis for central BP determination. Fine and Gray's proportional subdistribution hazards models were used to assess the association of BP parameters with incident atrial fibrillation. During 9.5 years, atrial fibrillation occurred in 83 participants. No office BP variable showed a significant association with incident atrial fibrillation. Central SBP and central pulse pressure were marginally associated with incident atrial fibrillation in multivariate analysis. Among ABP variables, 24-h SBP [adjusted hazard ratio per 10 mmHg, 1.24; 95% confidence interval (CI) 1.07--1.44; P = 0.004], daytime SBP (adjusted hazard ratio per 10 mmHg, 1.21; 95% CI 1.04--1.40; P = 0.011) and night-time SBP (adjusted hazard ratio per 10 mmHg, 1.22; 95% CI 1.07--1.39; P = 0.002) were significantly associated with incident atrial fibillation. In a predominantly older, stroke-free community-based cohort, ABP was a better independent predictor of incident atrial fibrillation than central BP, whereas office BP was inadequate for this purpose.

Short stature is associated with higher pulse wave velocity in subjects without overt cardiovascular disease.

Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = –0.131, P = .003) and women (r = –0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (<50 years old) but not in older men, while group height was correlated with baPWV in older women (≥50 years old, P for trend = .014) but not in younger women.Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.

The Quantification of Total Coronary Atheroma Burden - A Major Step Forward.

The extent of coronary artery disease has been shown to be an important indicator of prognosis. Cardiac computed tomography (CT) has the ability to measure plaque, with both coronary artery calcium scanning and CT angiography (CTA), to give a measure of total atheroma burden. Beyond assessing stenosis and atherosclerosis, CTA can assess high-risk plaque. These plaques are thought to be consistent with plaques that are vulnerable and more likely to rupture and cause acute coronary syndromes. However, the high-risk plaque concept suffers from poor reproducibility and poor positive predictive power. Total coronary atheroma burden has been shown to be a better predictor of coronary events than high-risk plaques or stenosis. This paper reviews the literature in this regard and demonstrates total coronary atheroma burden to be the best predictor of future cardiovascular disease. We searched MEDLINE, EMBASE and the Cochrane library database for studies assessing plaque burden and outcomes by CT. We used text words and related Medical Subject Headings (MeSH) for cardiac, calcification, plaque burden, CT, prognosis, mortality, event, death, survival and myocardial infarction.

P3107Effect of cardiac rehabilitation predicts event-free survival

Abstract Background Participation in cardiac rehabilitation (CR) improves prognosis. Whether more effect of exercise training also affects prognosis is unknown. Purpose To investigate whether change in VO2peak after CR is a predictor of future cardiovascular disease and/or mortality Methods Retrospective analysis on 1237 cardiac patients completing a CR program in Copenhagen in 2011–2017 with a cardiopulmonary exercise test performed at baseline and end of CR. The association between change in VO2peak and future risk of morbidity and mortality through registry linkage was assessed by Cox regression analysis adjusting for age, sex, cardiac diagnosis, comorbidities and baseline VO2peak. Results 1237 patients were included, mean was age 64 (±11) years and 75% were males. 30% of the patients did not improve in VO2peak. There were 166 events and 76 deaths during a median follow-up of 2.3 years. Both baseline VO2peak and change in VO2peak were significantly associated with risk after multivariable adjustment. Change in VO2peak: MACE and mortality Conclusion Improvement in VO2peak during a CR program is a strong predictor of subsequent prognosis in cardiac patients.

Atherogenic index of plasma is related to arterial stiffness but not to blood pressure in normotensive and never-treated hypertensive subjects

Background and aims: Atherogenic index of plasma (AIP), defined as the logarithm of triglycerides to high-density lipoprotein cholesterol (HDL-C) ratio, is a strong predictor of future cardiovascular disease. Our aim was to examine the association of AIP with haemodynamic variables in normotensive and never-treated hypertensive subjects in a cross-sectional study.Methods: Supine haemodynamics in 615 subjects without antihypertensive and lipid-lowering medications were examined using whole-body impedance cardiography and radial pulse wave analysis. Linear regression analysis was applied to investigate the association of AIP with haemodynamic variables and age, sex, body mass index (BMI), smoking status, alcohol consumption, plasma C-reactive protein, electrolytes, uric acid, low density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate, and quantitative insulin sensitivity check index.Results: The demographics and laboratory values of the study population were (mean ± 95% confidence interval): age 44.9 ± 1.0 years, BMI 26.8 ± 0.4 kg/m2, office blood pressure 140.6 ± 1.6/89.4 ± 1.0 mmHg, total cholesterol 5.2 ± 0.08, LDL-C 3.1 ± 0.08, triglycerides 1.2 ± 0.08, HDL-C 1.6 ± 0.04 mmol/l, and AIP −0.15 ± 0.02. Age (standardized coefficient Beta 0.508, p < .001) and aortic systolic blood pressure (Beta 0.239, p < .001) presented with the strongest associations with pulse wave velocity. However, AIP was also associated with pulse wave velocity (Beta 0.145, p < .001). AIP was not related with aortic or radial blood pressure, cardiac output, systemic vascular resistance, or augmentation index.Conclusions: AIP is directly and independently associated with arterial stiffness, a variable strongly related to cardiovascular risk. This supports more widespread use of AIP in standard clinical cardiovascular disease risk evaluation.

Comparison of the Efficacy of Rosuvastatin Monotherapy 20 mg with Rosuvastatin 5 mg and Ezetimibe 10 mg Combination Therapy on Lipid Parameters in Patients with Type 2 Diabetes Mellitus

BackgroundThe apolipoprotein B/A1 (apoB/A1) ratio is a stronger predictor of future cardiovascular disease than is the level of conventional lipids. Statin and ezetimibe combination therapy have shown additional cardioprotective effects over statin monotherapy.MethodsThis was a single-center, randomized, open-label, active-controlled study in Korea. A total of 36 patients with type 2 diabetes mellitus were randomized to either rosuvastatin monotherapy (20 mg/day, n=20) or rosuvastatin/ezetimibe (5 mg/10 mg/day, n=16) combination therapy for 6 weeks.ResultsAfter the 6-week treatment, low density lipoprotein cholesterol (LDL-C) and apoB reduction were comparable between the two groups (−94.3±15.4 and −62.0±20.9 mg/dL in the rosuvastatin group, −89.9±22.7 and −66.8±21.6 mg/dL in the rosuvastatin/ezetimibe group, P=0.54 and P=0.86, respectively). In addition, change in apoB/A1 ratio (−0.44±0.16 in the rosuvastatin group and −0.47±0.25 in the rosuvastatin/ezetimibe group, P=0.58) did not differ between the two groups. On the other hand, triglyceride and free fatty acid (FFA) reductions were greater in the rosuvastatin/ezetimibe group than in the rosuvastatin group (−10.5 mg/dL [interquartile range (IQR), −37.5 to 29.5] and 0.0 µEq/L [IQR, −136.8 to 146.0] in the rosuvastatin group, −49.5 mg/dL [IQR, −108.5 to −27.5] and −170.5 µEq/L [IQR, −353.0 to 0.8] in the rosuvastatin/ezetimibe group, P=0.010 and P=0.049, respectively). Both treatments were generally well tolerated, and there were no differences in muscle or liver enzyme elevation.ConclusionA 6-week combination therapy of low-dose rosuvastatin and ezetimibe showed LDL-C, apoB, and apoB/A1 ratio reduction comparable to that of high-dose rosuvastatin monotherapy in patients with type 2 diabetes mellitus. Triglyceride and FFA reductions were greater with the combination therapy than with rosuvastatin monotherapy.

Large artery stiffness is associated with marinobufagenin in young adults: the African-PREDICT study.

The cardiotonic steroid, marinobufagenin (MBG), has been shown to play a physiological natriuretic role in response to salt intake. However, recent studies in clinical and animal models demonstrated possible links between elevated levels of endogenous MBG and increased arterial stiffness. Large artery stiffness is a known predictor of future cardiovascular disease. We, therefore, investigated whether large artery stiffness relates to 24-h urinary MBG excretion in young apparently healthy black and white adults. This study included data of 711 participants (black 51%, men 42%, mean age 24.8 ± 3.02 years). We measured the carotid-femoral pulse wave velocity (cfPWV), 24-h urinary MBG and sodium excretion. In single, partial and multivariable adjusted (Adj.) regression analyses, we found a persistent positive association between cfPWV and MBG excretion in women [Adj. R = 0.23; standardized (std.) β = 0.15; P = 0.002], but not men (Adj. R = 0.17; std. β = 0.06; P = 0.31). Multiple regression models were adjusted for ethnicity, age, waist-to-height ratio, mean arterial pressure, high-density lipoprotein cholesterol, C-reactive protein, γ-glutamyl transferase and glucose. In conclusion, already at a young age heightened endogenous MBG levels may contribute to large artery stiffness in women via pressure-independent mechanisms, increasing their risk for future cardiovascular disease.