Premature CVD Research Articles

Effects of a lifestyle intervention on markers of cardiometabolic risk and oxidized lipoproteins among obese adolescents with prediabetes.

Obesity and hyperglycaemia contribute to the atherosclerotic process in part through oxidative modifications to lipoprotein particles. The present study aimed to evaluate the effects of a lifestyle intervention on markers of oxidized lipoproteins in obese Latino adolescents with prediabetes. Pre-post design. Participants were enrolled into a 12-week lifestyle intervention. Measurements pre- and post-intervention included anthropometrics and body composition, lipid panel, oxidized LDL (oxLDL), oxidized HDL (oxHDL), intake of fresh fruits and vegetables, and cardiorespiratory fitness. Thirty-five obese Latino adolescents (seventeen females, eighteen males; mean age 15·5 (sd 1·0) years; mean BMI percentile 98·5 (sd 1·2)) with prediabetes. Intervention participation resulted in significant reductions in weight (-1·2 %, P = 0·042), BMI and BMI percentile (-2·0 and -0·4 %, respectively, P < 0·001), body fat (-7·0 %, P = 0·025), TAG (-11·8 %, P = 0·032), total cholesterol (-5·0 %, P = 0·002), VLDL-cholesterol (-12·5 %, P = 0·029), and non-HDL-cholesterol (-6·7 %, P = 0·007). Additionally, fitness (6·4 %, P < 0·001) and intake of fruits and vegetables (42·4 %, P = 0·025) increased significantly. OxLDL decreased significantly after the intervention (51·0 (sd 14·0) v. 48·7 (sd 12·8) U/l, P = 0·022), while oxHDL trended towards a significant increase (395·2 (sd 94·6) v. 416·1 (sd 98·4) ng/ml, P = 0·056). These data support the utility of lifestyle intervention to improve the atherogenic phenotype of Latino adolescents who are at high risk for developing premature CVD and type 2 diabetes.

Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.

High-Density Lipoprotein Function in Cardiovascular Disease and Diabetes Mellitus.

Cardiovascular disease (CVD) is the most common cause of death worldwide.1 Major CVD risk factors are hypertension, smoking, physical inactivity, abnormal glucose levels/diabetes mellitus, and dyslipidemia. Among these, dyslipidemia characterized by a low level of HDL-C (high-density lipoprotein cholesterol) is strongly and inversely correlated with CVD risk,2–4 and low HDL-C levels is part of the atherogenic dyslipidemia complex associated with diabetes mellitus.5 These observations triggered intense interest in increasing HDL-C levels for therapeutic intervention of CVD.6,7 However, several recent lines of evidence now suggest that the association between HDL-C levels and CVD status may be indirect or more complicated than previously recognized.7 Thus, human genetic studies demonstrate that genetically altered HDL-C levels do not necessarily translate to an altered risk of CVD.8–12 Phase III clinical trials of drugs that elevate HDL-C, such as niacin and CETP (cholesteryl ester transfer protein) inhibitors, also have largely failed to reduce CVD events in statin-treated subjects with established CVD.13–15 For several CETP inhibitors, improvement in CVD prevention was unsuccessful because of off-target effects (torcetrapib) or lack of efficacy (dalcetrapib and evacetrapib).14,16–18 The exception is the recent REVEAL trial (Randomized Evaluation of the Effects of Anacetrapib Through Lipid-Modification), which included more subjects and was performed for longer than previous CETP inhibitor trials. The REVEAL demonstrated that the CETP inhibitor anacetrapib exhibited beneficial effects on cardiovascular outcomes on top of those of statin therapy, although the risk reduction was moderate19,20 and might have been due, at least in part, to a reduction in non-HDL-C rather than elevated HDL-C.21 Considering these cumulative observations, it remains uncertain whether increased HDL-C directly impacts atherosclerosis and the …

Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring

Introduction This article summarises the Cardiac Society of Australia and New Zealand position statement on coronary artery calcium (CAC) scoring. CAC scoring is a non-invasive method for quantifying coronary artery calcification using computed tomography. It is a marker of atherosclerotic plaque burden and the strongest independent predictor of future myocardial infarction and mortality. CAC scoring provides incremental risk information beyond traditional risk calculators such as the Framingham Risk Score. Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as individualised coronary risk scoring for intermediate risk patients, allowing reclassification to low or high risk based on the score. Medical practitioners should carefully counsel patients before CAC testing, which should only be undertaken if an alteration in therapy, including embarking on pharmacotherapy, is being considered based on the test result. Main recommendations CAC scoring should primarily be performed on individuals without coronary disease aged 45-75 years (absolute 5-year cardiovascular risk of 10-15%) who are asymptomatic. CAC scoring is also reasonable in lower risk groups (absolute 5-year cardiovascular risk, < 10%) where risk scores traditionally underestimate risk (eg, family history of premature CVD) and in patients with diabetes aged 40-60 years. We recommend aspirin and a high efficacy statin in high risk patients, defined as those with a CAC score ≥ 400, or a CAC score of 100-399 and above the 75th percentile for age and sex. It is reasonable to treat patients with CAC scores ≥ 100 with aspirin and a statin. It is reasonable not to treat asymptomatic patients with a CAC score of zero. Changes in management as a result of this statement Cardiovascular risk is reclassified according to CAC score. High risk patients are treated with a high efficacy statin and aspirin. Very low risk patients (ie, CAC score of zero) do not benefit from treatment.

Abstract MP021: Identification of “At Risk” and “Resilient” CVD Census Tracts in the Morehouse-Emory Cardiovascular (MECA) Study

The MECA study is unique in that it will study CVD resilience in blacks at both the individual and community (census tract) level in the Atlanta Metropolitan Area. It is well established that blacks suffer from greater cardiovascular morbidity and mortality than whites in the United States. Not all blacks suffer from poor cardiovascular health, some individuals manage to live long healthy lives without ever developing cardiovascular conditions. The causes of this resilience are not known. Both individual and community level factors may be responsible for cardiovascular risk and resilience in blacks. The first stage of the MECA study was to identify “at risk” and resilient communities based on their rates of CVD related ED visits, hospitalizations and mortality. Objectives: To determine if in fact a wide distribution of CVD rates exist among Blacks in census tracts in Metro Atlanta. To determine if there were still large differences in rates when black household income was controlled for. Methods: Count data on CVD related emergency department and hospitalizations for blacks aged 35-64 living in census tracts in the Atlanta--Athens-Clarke--Sandy Springs combined statistical area during 2010-2014 were obtained from the Georgia Hospital Association. CVD mortality data for the same population for the same time period were obtained from the Georgia Department of Public Health. In order to control for the socioeconomic status, age and gender distribution of the neighborhoods, negative binomial regression models controlling for median black household income, percent of 5-year age groupings, and percent male were estimated for each of the outcomes. Residuals in top 25% were considered to be “at risk tracts (high rate) while residuals in the bottom 25% were considered resilient (low rate tracts). Results: 106 tracts were resilient for at least 2 of the 3 outcomes, 188 were “at risk” for 2 out of 3 outcomes. Both types of tracts were located throughout the Atlanta metropolitan area. Mean black household income in the tracts are similar (resilient: $46,335, “at risk”: $44,721). Black CVD hospitalization event rate was 28 vs. 132 per 1000 population(p&lt;.0001) for resilient tracts vs “at risk” tracts. Black CVD ED visit event rate and CVD mortality rate was also lower in resilient (ED: 33 per 1000 pop; Mortality: 8 deaths per 1000 pop) than “at risk” (ED: 147/ 1000 pop; Mortality: 14 deaths per 1000 pop) census tracts. Conclusion: We have identified census tracts in Metro Atlanta that have large differences in premature CVD outcomes for Blacks despite having similar mean income levels. The next phase of the MECA study will examine census tract and survey data to elucidate what contextual (demographic, food environment, reported neighborhood characteristics) and individual level (behavioral, psychological, social) factors may be associated with the different rates of CVD in resilient and “at risk” census tracts.

Reduction of mortality following better detection of hypertension and alcohol problems in primary health care in Spain.

Through a simulation study, we estimated the potential effects of better detection of hypertension and improved screening for alcohol problems with subsequent interventions. Results showed that if 50% of Spanish males between 40 and 64 years of age who are currently unaware of their hypertension become aware of their condition and receive the usual treatment, and 50% of these males with hypertension are screened for alcohol and are treated for hazardous drinking or alcohol use disorders, then the percentage of uncontrolled hypertension among men with hypertension decreases from 61.2% to 55.9%, i.e. by 8.6%, with about 1/3 of the effect due to the alcohol intervention. For women, likewise, these interventions would decrease the percentage of women in the same age group with uncontrolled hypertension by 7.4% (about 40% due to the alcohol intervention). The reduction of blood pressure in the population would avoid 412 premature CVD deaths (346 in men, 66 in women) within one year. Therefore, better detection of hypertension and screening for alcohol with subsequent interventions would result in marked reductions of uncontrolled hypertension and CVD mortality.

Factors influencing low-density lipoprotein cholesterol target achievement in primary care — Results from DYSIS China

BackgroundPrimary care facilities are the base for hypercholesterolemia treatment. However, data regarding the effectiveness of lipid management in primary care are lacking. Methods and resultsTo evaluate lipid management in the primary care setting in China, we compared patients' characteristics and lipid management outcomes between 6100 outpatients treated at primary care versus 19,217 patients in non-primary settings using data from the DYSlipidemia International Study-China (DYSIS-CHINA). Compared to patients treated at non-primary hospitals, patients who received treatment at primary settings were younger, thinner, and were more likely to be female and to have a family history of premature CVD. Overall, 26.8% of very high-risk and 40.8% of high-risk patients achieved the LDL-C target with primary care treatment, whereas these target rates were 41.2% (p<0.001) and 58.6% (p<0.001), respectively, among patients treated at non-primary hospitals. High-dose statin therapy was underused in primary care patients compared to non-primary hospital patients (p<0.001). Logistic regression analysis showed that female gender, diabetes, and obesity were negative factors, whereas life-style modification and use of high-dose statin (40mg/d simvastatin equivalent) were favorable factors in predicting LDL-C target attainment in the primary care setting. ConclusionSedentary life style, alcohol drinking, and use of suboptimal statin dosage are key factors that unfavorably affect the LDL-C target rate among patients treated at primary care facilities in China. Sufficient training for primary care physicians regarding proper statin use and support for the combined use of a statin with ezetimibe could promote LDL-C target attainment in primary care.

The Heart of 25 by 25: Achieving the Goal of Reducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and World Heart Federation.

In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors.

The Heart of 25 by 25: Achieving the Goal ofReducing Global and Regional Premature Deaths From Cardiovascular Diseases and Stroke: A Modeling Study From the American Heart Association and WorldHeart Federation.

In 2011, the United Nations set key targets to reach by 2025 to reduce the risk of premature noncommunicable disease death by 25% by 2025. With cardiovascular disease being the largest contributor to global mortality, accounting for nearly half of the 36 million annual noncommunicable disease deaths, achieving the 2025 goal requires that cardiovascular disease and its risk factors be aggressively addressed. The Global Cardiovascular Disease Taskforce, comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, with expanded representation from Asia, Africa, and Latin America, along with global cardiovascular disease experts, disseminates information and approaches to reach the United Nations 2025 targets. The writing committee, which reflects Global Cardiovascular Disease Taskforce membership, engaged the Institute for Health Metrics and Evaluation, University of Washington, to develop region-specific estimates of premature cardiovascular mortality in 2025 based on various scenarios. Results show that >5 million premature CVD deaths among men and 2.8 million among women are projected worldwide by 2025, which can be reduced to 3.5 million and 2.2 million, respectively, if risk factor targets for blood pressure, tobacco use, diabetes mellitus, and obesity are achieved. However, global risk factor targets have various effects, depending on region. For most regions, United Nations targets for reducing systolic blood pressure and tobacco use have more substantial effects on future scenarios compared with maintaining current levels of body mass index and fasting plasma glucose. However, preventing increases in body mass index has the largest effect in some high-income countries. An approach achieving reductions in multiple risk factors has the largest impact for almost all regions. Achieving these goals can be accomplished only if countries set priorities, implement cost-effective population wide strategies, and collaborate in public-private partnerships across multiple sectors.

Dietary Oxidized Linoleic Acid Ameliorate Plasma ApoA5 levels in C57BL mice

s 705 Objective/Purpose: Characterize differences in perceived HRQoL between youth at risk for premature CVD and parents. Methods: This is a retrospective study of anonymous responses to the PedsQL of subjects and parents. The study population consisted of 5-17 yr olds (54% males) who were referred to the Pediatric CV Health and Risk Prevention clinic with .1 of the following risk factors: TG $500, LDL-C $160, HDL-C#20, Non-HDL-C $160, FBS $100, 2-hour glucose $140 and HbA1c $6%. Many, but not all were overweight or obese. The questionnaires were scored by trained clinical therapists. Results: 664 self-reported (mean age 12.1, SD 2.8) and parent-proxy questionnaires were completed. Compared to healthy children and their parents, scores in our study population were lower. Mean scores for self-report (74.6, SD 16.7) and parent proxy report (69.5, SD 18.6) were significantly different (p , 0.0001). Conclusions: Our results show significant differences in perceived HRQoL between youth at risk for premature CVD and their parents, as well healthy youth. Future studies will compare subscale scores to help define these differences to help eliminate barriers, improve adherence, and address psychosocial concerns in this unique population. Lipoprotein Metabolism

ACE gene in pregnancy complications: Insights into future vascular risk

ABSTRACTObjective: A history of placenta-mediated pregnancy complications (PMPCs) increases the risk of cardiovascular disease later in life, possibly related to the persistence of endothelial dysfunction. We performed this study in order to search for a common genetic background shared by women with a history of PMPC and vascular disorders, due to their common pathophysiologic pathway of endothelial dysfunction.Methods: We analyzed the prevalence of seven polymorphisms in ACE, AGTR1, AGT, and eNOS genes, endothelial-function related, in 290 women with a history of premature cardiovascular events (CVDs), and in 367 women with a history of PMPC (preeclampsia (PE), stillbirth (SB), and small for gestational age (SGA)), compared with 300 healthy women (HW) who delivered after uneventful pregnancy (HW).Results: ACE D allele frequency was similar between women with history of CVD and PMPC, and significantly higher than that observed in HW [OR (95% CI) 1.91, p = 0.002, and OR (95% CI) 2.18, p < 0.0001, respectively]. In women carrying ACE-240T or eNOS-786C allele, a two-fold increase in SB susceptibility was evidenced (p = 0.004 and p = 0.005, respectively). Women with a history of SB and premature CVD exhibited a significantly higher unfavorable allelic burden ≥ 3 in comparison to that observed in HW (p < 0.0001 and p = 0.002, respectively).Conclusions: Our findings demonstrate a common genetic background shared by women with a history of vascular disorders and PMPCs; pregnancy may be considered a window to future cardiovascular risk; therefore, “non-classic” genetic biomarkers of endothelial dysfunction might allow one to identify women who could have a greater benefit for an early cardiovascular screening and prevention.

Abstract 10244: Heartmatters Challenge: Therapeutic Lifestyle Program Reduces Cardiovascular Risk Factors and Weight in First Responders Using Personalized Nutrition, Phone-based Coaching and Online Food Journaling

Objective: Premature CVD death is common among first responders. Effective risk reduction programs are urgently needed to address this public health concern. We tested the one year effectiveness of a lifestyle-based intervention program in police officers and firefighters in the Boston and Phoenix areas. Methods: 173 participants with excess abdominal fat or CVD risk were assigned to a one year intervention or control group using cluster randomization by city. The intervention was comprised of a personalized nutrition plan based on an algorithm combining laboratory results with food preferences, phone coaching to encourage adherence to lifestyle recommendations including healthy eating and exercise and online food journaling. Results: 130 participants remained in the study for one year (68 intervention; 62 control). In the intervention group the mean weight loss from baseline was 4.8% (4.9 kg, p&lt;0.01) at 6 months and 3.1% (3.2 kg, p&lt;0.01) from baseline at 1 year; waist circumference reduction was 3.6% (4.1 cm, p&lt;0.01) at 6 months and 3.2% (3.6 cm, p&lt;0.01) at 1 year. Large HDL particles increased 64.4% (9.0 mg/dL, p&lt;0.01) at 6 months and 29.6% (3.8 mg/dL, p&lt;0.01) at 1 year; HDL-C increased 9.3% (3.3mg/dL, p&lt;0.01) at 6 months and 8.4% (3.5 mg/dL, p&lt;0.01); and LDL-C decreased 2.6% (5 mg/dL, NS) at 6 months and increased 1.7% (+0.2 mg/dL, NS) at 1 year. There was no meaningful change in the control group. Adherence to the lifestyle program was a major contributor to individual success over the year. An adherence score was developed based on coaching frequency. Participants with adherence scores above the mean (N=21) reduced LDL-C levels 8.8 mg/dL whereas participants with adherence scores below the mean (N=47) exhibited an increase of 4.2 mg/dL (p&lt;0.05). Other favorable trends included greater weight loss (5.4kg vs 2.1 kg, (NS)), greater increases in large HDL particles (5.9mg/dL vs 2.8 mg/dL (NS)) and greater waist circumference reduction ( 5.3 cm vs 2.6 cm (NS)). Conclusions: Clinically meaningful reductions in CVD risk are achievable in actual practice using carefully designed lifestyle programs in combination with phone-based coaching and online food journaling tools. These data support the use of such programs on a national level.

Cascade screening of familial hypercholesterolemia must go on

PurposeThis study assesses the success of the recently terminated Dutch nationwide cascade screening by examining whether children with familial hypercholesterolemia (FH) were identified through family screening or due to cardiovascular (CVD) events in the FH parent. MethodsWe collected clinical information of all children (0–18 years) with FH with a pathogenic variant at our outpatient lipid clinic between 1992 and 2014 and their FH parents and FH grandparents. ResultsWe analysed 292 FH children from 205 parents with FH. A history of premature CVD was present in 20% of the parents (29% of the fathers, 9% of the mothers) and 49% of the FH grandparents. ConclusionThe fact that CVD is still a presenting event of FH in especially fathers shows that nationwide screening might have been terminated too early. Therefore we recommend to proceed the cascade screening.

Delivering Keep Well Health Checks within General Dental Practices

An introduction (comprising context and problem statement): The Keep Well programme aims to reduce health inequalities by recognising that quick access to health advice, treatment and support can have a positive impact on the health and wellbeing of targeted populations from deprived and/or disadvantaged communities. The aim of the Programme is to build primary prevention into normal practice, specifically through offering systematic cardiovascular risk assessments (CVD) and related follow up services and support to those communities and specific populations eg. vulnerable groups, at higher risk of premature CVD because of their life circumstances. The dispersion of deprivation across NHS Ayrshire & Arran means that a single model of delivery would be ineffective. Therefore alternative delivery approaches are required if the geographical, individual and diverse needs of the local population are to be fully addressed. Short description of practice change implemented: The General Dental Practices (GDP’s) provide a service to individuals in some of the most deprived areas of Ayrshire. It seemed logical that, given the number of eligible Keep Well patients in these areas, that wherever possible, contact with healthcare service provision should be maximised as this will enhance patient choice and improve access to the programme. It also allowed the linkage between periodontal health and cardiovascular disease to be explored. Aim and theory of change: To identify the effectiveness of delivering a keep Well Health Check within General Dental Practice’s and the benefits this will bring to the practice and the patients. To establish whether there is a link between oral health and cardiovascular health Targeted population and stakeholders: Patients aged 30-64 from SIMD 1 (0-20% most deprived areas), attending their GDP Delivered within 2 dental Practices. Patient lists are screened by the Keep Well (KW) team for eligibility. They then provide GP’s and the 2 GDP’s with a revised list of patients to be screened, which is updated by KW as patients are seen to ensure information is shared and to avoid duplication. Patients can then be referred to the KW team (health and Wellbeing) or local community agencies for help in addressing lifestyle issues. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117078– http://www.ijic.org/ Timeline: January-February 2014 during the first 2 months of health check deliver, a total of 83 people received a health check. Highlights (innovation, Impact and outcomes): • Literature review suggests link between periodontal health and cardiovascular disease is extremely complex and multi-factorial • Telephone engagement was most effective • Patients reported high level of satisfaction of health check experience, as the time allocated for the appointment enabled them to share any health concerns and also offered them a choice if they did not wish to attend their GP • Staff reported skill development and new insight into health and lifestyles • Positive correlation between ASSIGN scores and periodontal scores was found but not significant due to cohort size • Patient and staff stories reflect increased knowledge of health and lifestyles. Comments on sustainability: The GDP staff have been trained to deliver the Health check and it has been incorporated into routine dental appointments. Comments on transferability: Health Check Training has been provided to staff within a Learning disability setting and also within Carers centres in the 3rd sector. The health check has been incorporated into the admission process for patients with a learning disability and the registration process for carers attending the Carers centres. Conclusions: (comprising key findings) Delivery of the health Check is effective and beneficial to patients and staff within GDP’s, as it provides a seamless transition between health care professionals and patients, that is not only holistic but individually tailored. Delivery of the health check within GDP’s has been shown to be appropriate, as people with Periodontal disease are at greater risk of developing CVD than those without Discussions: People appreciate the opportunity to proactively address their health and found the GDP’s to be a suitable venue as they did not associate it with being unwell. Lessons learned: Personal engagement (either face to face or telephone), rather than a written invitation ensured that patients attended their appointments.

Arterial function and cardiorenal damage.

Common mechanisms contribute to the simultaneousdevelopment and progression of CVD and CKD. Hence,similar therapies could be positive to improve renal andCV prognosis. However, improvement in our under-standing of why a significant proportion of patients withCKD progress to end-stage renal disease (ESRD) and/ordie from CVD, whereas others remain stable, is urgentlyrequired. Identification of individualized determinantsof CKD progression and or premature CVD will lead tonovel, innovative nephroprotective and/or cardiopro-tective pharmacologic treatment in these high-riskpatients.

High – Sensitivity C - Reactive Protein: An Independent Proinflammatory Cardiac Marker in Healthy Overweight and Obese Individuals

In Asian countries, Indians are at high risk of premature CVD and T2DM due to abdominal obesity. Adipose tissue over the abdomen is a major source of inflammatory mediators. Numerous studies have demonstrated role of serum high sensitivity C reactive protein (hsCRP) as independent predictor of metabolic syndrome, T2DM and atherosclerotic diseases among healthy individuals. We postulated that in spite of normal glucose tolerance and normal lipid profile, obese persons are at high cardiac risk due to chronic low grade systemic inflammation. In present cross sectional study we enrolled 50 metabolically healthy overweight and obese individuals and 50 age and sex matched lean controls. We recorded history, anthropometric measures of adiposity BMI, waist and hip circumference, in study group. After overnight fast blood samples were assayed for blood glucose, lipid profile and hsCRP levels. Serum hsCRP levels were raised significantly in cases compared to control (mean 3.8+/-1.8 Vs 1.2+/-0.7 p< 0.001). We found significant positive association of hsCRP with anthropometric indices BMI and waist: hip ratio. In obese group there was evidence of significant family history of obesity, T2DM and CVD in first degree relatives compared to control.

The Maternal Health Clinic: A New Window of Opportunity for Early Heart Disease Risk Screening and Intervention for Women with Pregnancy Complications

W cardiovascular health is a key national priority that should be addressed through improving cardiovascular awareness and prevention and reducing care inequities for women in general and younger women in particular.1–5 Given the costs of treating cardiovascular disease and screening for it, novel and innovative ways to identify women who should undergo cardiovascular risk screening, including biochemical testing, is critical to achieving this goal.

Diagnosis and Management of Familial Dyslipoproteinemias

The three major pathways of lipoprotein metabolism provide a superb paradigm to delineate systematically the familial dyslipoproteinemias. Such understanding leads to improved diagnosis and treatment of patients. In the exogenous (intestinal) pathway, defects in LPL, apoC-II, APOA-V, and GPIHBP1 disrupt the catabolism of chylomicrons and hepatic uptake of their remnants, producing very high TG. In the endogenous (hepatic) pathway, six disorders affect the activity of the LDLR and markedly increase LDL. These include FH, FDB, ARH, PCSK9 gain-of-function mutations, sitosterolemia and loss of 7 alpha hydroxylase. Hepatic overproduction of VLDL occurs in FCHL, hyperapoB, LDL subclass pattern B, FDH and syndrome X, often due to insulin resistance and resulting in high TG, elevated small LDL particles and low HDL-C. Defects in APOB-100 and loss-of-function mutations in PCSK9 are associated with low LDL-C, decreased CVD and longevity. An absence of MTP leads to marked reduction in chylomicrons and VLDL, causing abetalipoproteinemia. In the reverse cholesterol pathway, deletions or nonsense mutations in apoA-I or ABCA1 transporter disrupt the formation of the nascent HDL particle. Mutations in LCAT disrupt esterification of cholesterol in nascent HDL by LCAT and apoA-1, and formation of spherical HDL. Mutations in either CETP or SR-B1 and familial high HDL lead to increased large HDL particles, the effect of which on CVD is not resolved. The major goal is to prevent or ameliorate the major complications of many familial dyslipoproteinemias, namely, premature CVD or pancreatitis. Dietary and drug treatment specific for each inherited disorder is reviewed.

Associations between a parental history of premature cardiovascular disease and coronary artery calcium and carotid intima-media thickness: the Coronary Artery Risk Development In Young Adults (CARDIA) study.

It is unclear if associations between a parental history of premature CVD (pCVD) and subclinical atherosclerosis are attenuated by adjustment for long-term risk factor levels through middle adulthood. Prospective community-based cohort study. CARDIA participants who attended the year-20 exam (n = 2283, mean age 45 years) were grouped by pCVD status: maternal only, paternal only, any parental, and no parental history (referent). We used separate logistic regression models, adjusted for average risk factor levels over a 20-year follow up to assess associations of parental pCVD and subclinical atherosclerosis in offspring. White participants with any parental history of pCVD had a higher odds of coronary artery calcium (CAC) >0 than participants with no parental history (OR 1.55, 95% CI 1.01-2.37). This was largely driven by the association of a paternal history of pCVD with CAC >0 (OR 2.15, 95% CI 1.42-3.23), which was minimally attenuated by multivariable adjustment (OR 2.09, 95% CI 1.31-3.32). Similarly, adjusted associations between parental pCVD and intima-media thickness (IMT) >90% were observed in white participants with a paternal history of pCVD (OR 1.93, 95% CI 1.10-3.39) and any parental history pCVD (OR 1.67, 95% CI 1.02-2.74). No significant associations between a parental history of pCVD and the odds of subclinical atherosclerosis were observed in black participants. Parental pCVD is independently associated with early development of subclinical atherosclerosis; these associations may be race-specific for participants in their fifth decade of life.

A simple clinical model predicted diabetes progression among prediabetic individuals

We followed 1372 prediabetic individuals aged ≥20years and documented 278 incident diabetes cases. Family history of diabetes, blood pressure, waist, high-density lipoprotein cholesterol, and FPG independently associated with diabetes progression among women. Among men, family history of premature CVD, waist, and FPG remained independently associated with diabetes progression.