Prevalence Of Subclinical Cardiovascular Disease Research Articles

Law Enforcement Officers Have an Increased Prevalence of Subclinical Cardiovascular Disease That Is Not Explained by Traditional Risk Factors.

The aim of the study is to determine if law enforcement officers develop subclinical atherosclerotic cardiovascular disease (ASCVD) earlier than nonofficers and, if so, the extent to which conventional risk factors explain this difference. Methods: Estimated pulse wave velocity (ePWV) was the marker of subclinical ASCVD. EPWV, ASCVD risk factors, metabolic syndrome (MetS), and 10-year risk for ASCVD were compared among 408 law enforcement officers and a civilian cohort. Results: EPWV, 10-year ASCVD risk, and MetS prevalence increased significantly with age. All but the officers age 55 and older had higher ePWV cohort than the civilian cohort ( P < 0.001). Ten-year ASCVD risk explained the most variability of ePWV ( R2 = 0.49, P < 0.001). Conclusions: Officers develop subclinical ASCVD earlier than nonofficers. Conventional ASCVD risk factors only explain about half of this increase. Occupational factors may play a role in contributing to this increased ASCVD risk.

Prevalence of Subclinical Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease: Analysis of the Paracelsus 10,000 Cohort Study

Background: In patients with nonalcoholic fatty liver disease (NAFLD), cardiovascular diseases are more often the cause of death than the liver disease itself. However, the prevalence of atherosclerotic manifestations in individuals with NAFLD is still uncertain. This study aimed to explore the association between NAFLD and coronary artery calcification (CAC) in a Central European population. Methods: A total of 1,743 participants from the Paracelsus 10,000 study were included. The participants underwent CAC scoring and were assessed for fatty liver index (FLI), fibrosing nonalcoholic steatohepatitis (NASH) index (FNI), and fibrosis-4 index (FIB-4 score), which are indicators for steatosis and fibrosis. Multivariable logistic regression models were calculated. Results: Results revealed an association between liver steatosis/fibrosis and CAC. An FLI >60 was associated with higher odds of NAFLD (odds ratio [OR] 3.38, 95% CI: 2.61–4.39, p < 0.01) and increased prevalence of CAC score >300 compared to FLI <30 (9% vs. 3%, p < 0.01), even after adjusting for traditional cardiometabolic risk factors. While the crude ORs of the FIB-4 scores ≥ 1.3 and FNI score were significantly associated with increased odds of CAC, they became nonsignificant after adjusting for age, sex, and MetS. Conclusion: This study reveals a significant association between NAFLD and CAC. The findings suggest that assessing liver fat and fibrosis could enhance the assessment of cardiovascular risk, but further research is needed to determine whether hepatic fat plays an independent role in the development of atherosclerosis and whether targeting liver steatosis can mitigate vascular risk.

Dietary intake of isoflavones is associated with a lower prevalence of subclinical cardiovascular disease in postmenopausal women: cross-sectional study.

Menopause has been associated with an increased risk of cardiovascular disease. It has been shown that isoflavones protect vascular endothelial cells against induced oxidative stress injury. Therefore, the present study aimed to investigate the association between the dietary intake of isoflavones and the presence of subclinical cardiovascular disease (CVD) in postmenopausal women. Ninety-six postmenopausal women [mean (SD) age 55.2(4.9)years, body mass index (BMI) 27.2(4.6)kgm-2 ] completed the study protocol. Habitual physical activity was assessed using a digital pedometer, resting metabolic rate was measured by indirect calorimetry and dietary intake was assessed via a validated food frequency questionnaire. Subclinical CVD was defined as carotid artery intima-media thickness (C-IMT) >0.9mm and/or the presence of one or more atherosclerotic plaques in any of the studied segments. Mean (SD) C-IMT was 0.74(0.2)mm, 25% of participants were found to have atherosclerotic plaques and the prevalence of subclinical CVD was 35%. Participants with subclinical CVD were more likely to consume less selenium, magnesium, folate and isoflavones, even after adjusting for total energy intake. A multivariate-adjusted regression model showed that a BMI >27kgm-2 was associated with 90% higher risk of having ≥1 plaque and/or C-IMT >0.9mm (P=0.017). Higher oestradiol levels (P=0.004) and isoflavone intake (P=0.021) were independently associated with a lower risk of having subclinical CVD. In the present study, we observed that a higher isoflavone dietary intake was associated with a lower risk of subclinical CVD in postmenopausal women, independent of BMI and endogenous oestradiol levels.

Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in Psoriasis: A Prospective Cohort Study

ObjectivesThis study hypothesized that there is an association between chronic stress (as indexed by resting amygdalar activity [AmygA]), hematopoietic system activity (HMPA), and subclinical cardiovascular indexes (aortic vascular inflammation [VI] and noncalcified coronary plaque burden [NCB]) in psoriasis (PSO). The study also hypothesized that treatment of PSO would improve these parameters. BackgroundPSO is a stress-related chronic inflammatory condition that is associated with increased prevalence of subclinical cardiovascular disease (CVD). In individuals without PSO, stress has been linked to CVD through a serial biological pathway that involves the amygdala, hematopoietic tissues, and atherosclerotic plaques. MethodsA total of 164 consecutive patients with PSO and 47 healthy volunteers underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography scans for assessment of AmygA, HMPA, and VI, as well as coronary computed tomography angiography scans for quantifying NCB. Furthermore, a consecutive subset of 30 patients with severe PSO (Psoriasis Area Severity Index Score >10) were followed at 1 year to assess the relationship between skin disease improvement and AmygA, HMPA, VI, and NCB. ResultsThe PSO cohort was middle-aged (mean age: 50 years), had low cardiovascular risk (Framingham risk score: median: 3) and had mild to moderate PSO activity (median Psoriasis Area Severity Index Score: 5.6). AmygA was higher in patients with PSO compared to volunteer participants. AmygA was associated with HMPA (bone marrow activity: β = 0.20, p = 0.01) and subclinical CVD (VI: β = 0.31, p < 0.001; NCB: β = 0.27, p < 0.001) The AmygA−CVD association was in part mediated by HMPA (VI: 20.9%, NCB: 36.7%). Following 1 year of PSO treatment in those with severe disease, improvement in skin disease was accompanied by a reduction in AmygA, bone marrow activity, and VI, with no progression of NCB. ConclusionsIn PSO, a chronic inflammatory disease state, AmygA, which is a manifestation of chronic stress, substantially contributes to the risk of subclinical CVD. Additional studies that use psychometric measures of stress are required to explore therapeutic impact.

Is the SCORE chart underestimating the real cardiovascular (CV) risk of patients with psoriatic arthritis? Prevalence of subclinical CV disease detected by carotid ultrasound

ObjectivesTo analyse the cardiovascular risk according to the SCORE chart in a series of patients with psoriatic arthritis, and to study the presence of subclinical cardiovascular disease by carotid ultrasound. MethodsCross-sectional descriptive study of patients with psoriatic arthritis attended in a tertiary hospital. The presence of classical cardiovascular risk factors and the clinical characteristics of the patients were recorded. The cardiovascular risk was calculated with SCORE, calibrated for Spain. Common carotid ultrasound was conducted to assess intima-media thickness and the presence of atheroma plaques. Patients were reclassified upon ultrasound results. Statistical analyses were made for sample description, and multivariate analyses were performed to investigate the associations with the presence of atheroma plaques. ResultsA total of 102 patients were included. According to SCORE charts, 70.6% of the patients had intermediate cardiovascular risk, 25.5% high risk and 3.9% very high risk. After the ultrasound study, 26.5% of the patients were upgraded, and reclassified as very high risk due to the presence of plaques. The presence of subclinical vascular disease was associated with higher uric acid levels (P=0.036) and the presence of 2 or more cardiovascular risk factors (P=0.021). ConclusionsA considerable number of psoriatic arthritis patients have a priori moderate or high risk of a fatal cardiovascular event. Carotid ultrasound detects subclinical vascular disease and increases the real risk in a substantial proportion of patients. Cardiovascular risk prediction clinical tools such as the SCORE underestimate the presence of subclinical cardiovascular disease in patients with psoriatic arthritis.

Prevalence of subclinical cardiovascular disease in healthy HIV infected patients at the University Teaching Hospital in Lusaka, Zambia

Background : Cardiovascular diseases are among the leading cause of morbidity and mortality worldwide. The association between HIV and CVD has been established in many studies. However, information is still lacking on subclinical disease as well as its associated risk factors in this population. This study aimed at establishing the prevalence of subclinical CVD among clinically healthy HIV people attending their regular out- patient visits. It also looked at risk factors (traditional and non traditional) as well as the association of CVD to the CD4 count. Methods : we enrolled a total of 243 asymptomatic HIVinfected patients from the HIV outpatient clinic at the University Teaching Hospital. Data collected included demographic characteristics, duration of HIV infection, drug history including HAART regimen and cardiovascular risk factors (hypertension, diabetes and smoking). Clinical data included blood pressure, weight and height. Laboratory data included CD4 counts, serum creatinine, total cholesterol and triglycerides. We tested for subclinical CVD using 3 tools: Ankle Brachial Index (ABI) to measure for the presence of peripheral artery disease, 12 lead Electrocardiogram (ECG) for electrical abnormalities and transthoracic Echocardiography (ECHO), to measure abnormalities in cardiac structure and function. At analysis, patients where dichotomised into those with CD4≤350 and those with CD4>350. Results : participants characteristics were as follows: the mean age, 42 years (SD±10); 143 (58.5%) females; CD4≤350cells/ml was found in 140 (57.6%); 112(86.2%) were receiving HAART with 86.2% being on 1st line regimen. Systolic hypertension was present in 84(34.6%), diastolic hypertension in 89(36.6%) and 39.5% had creatinine clearance 140mmHg and diastolic BP >90mmHg. Conclusions : Prevalence of subclinical CVD in healthy HIV infected patients is high and those with CD4≤350 have a higher risk. Hypertension is the most important traditional CVD risk factor in this population. There is need to screen HIV patients attending their routine clinic visits for hypertension and subclinical CVD. ABI and ECG are readily available in most institutions and can be used with minimal expertise.

Prevalence of subclinical Cardiovascular Disease in healthy HIV infected patients at the University Teaching Hospital in Lusaka, Zambia

Background: Cardiovascular diseases are among the leading cause of morbidity and mortality worldwide. The association between HIV and CVD has been established in many studies. However, information is still lacking on subclinical disease as well as its associated risk factors in this population. This study aimed at establishing the prevalence of subclinical CVD among clinically healthy HIV people attending their regular out- patient visits. It also looked at risk factors (traditional and non traditional) as well as the association of CVD to the CD4 count.&#x0D; Methods: we enrolled a total of 243 asymptomatic HIVinfected patients from the HIV outpatient clinic at the University Teaching Hospital. Data collected included demographic characteristics, duration of HIV infection, drug history including HAART regimen and cardiovascular risk factors (hypertension, diabetes and smoking). Clinical data included blood pressure, weight and height. Laboratory data included CD4 counts, serum creatinine, total cholesterol and triglycerides. We tested for subclinical CVD using 3 tools: Ankle Brachial Index (ABI) to measure for the presence of peripheral artery disease, 12 lead Electrocardiogram (ECG) for electrical abnormalities and transthoracic Echocardiography (ECHO), to measure abnormalities in cardiac structure and function. At analysis, patients where dichotomised into those with CD4≤350 and those with CD4&gt;350.&#x0D; Results: participants characteristics were as follows: the mean age, 42 years (SD±10); 143 (58.5%) females; CD4≤350cells/ml was found in 140 (57.6%); 112(86.2%) were receiving HAART with 86.2% being on 1st line regimen. Systolic hypertension was present in 84(34.6%), diastolic hypertension in 89(36.6%) and 39.5% had creatinine clearance&lt;90. Diabetes and current smoking were not very common (3.3% and 2.9% respectively). High total cholesterol was found in 19(7.82%) of the participants while 37(15.23%) had high triglycerides. On ECG, ECHO and ABI, abnormalities were found in 53.9%, 44.4% and 20.2% respectively). The commonest cardiac lesion on both ECG and ECHO was left ventricular hypertrophy (27.4% and 23.3% respectively). Participants with CD4≤350 had higher prevalence of abnormalities on ECG (P=0.022) and ABI (P=0.043). Clinical factors associated with increased risk of subclinical CVD on multivariate logistical regression included CD4≤350, systolic BP&gt;140mmHg and diastolic BP &gt;90mmHg.&#x0D; Conclusions: Prevalence of subclinical CVD in healthy HIV infected patients is high and those with CD4≤350 have a higher risk. Hypertension is the most important traditional CVD risk factor in this population. There is need to screen HIV patients attending their routine clinic visits for hypertension and subclinical CVD. ABI and ECG are readily available in most institutions and can be used with minimal expertise.

Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score

ObjectivesTo evaluate the prevalence of subclinical cardiovascular disease (CVD) and its association with clinical and hormone variables in postmenopausal women from Southern Brazil. Study designCross-sectional study. Main outcome measuresCoronary artery calcification (CAC) assessed by electron-beam computed tomography. Carotid intima–media thickness (IMT) and atheromatous plaques assessed using B-mode ultrasound. IMT was measured at three segments. Subclinical CVD was defined as the presence of plaque and/or IMT >0.9mm. ResultsNinety-seven postmenopausal women (mean age 55±5 years, median duration of menopause 5.8 [3–10] years) were studied. A low/medium Framingham risk score (FRS) was present in 97.9% of participants; 35.1% had subclinical CVD on carotid ultrasound, and 24.7% had the presence of plaque. Seven women had a CAC score ≥100, and two had a score ≥200. CAC score (p<0.001) and FRS (p=0.013) were higher in patients with subclinical atherosclerosis. Positive correlations were found between IMT and age (rs=0.293 p=0.004), duration of menopause (rs=0.237, p=0.020), and CAC score (rs=0.468, p<0.001). Common carotid IMT (IMT-CC) was negatively associated with estradiol levels (β=−0.237, p=0.018) and positively with age (β=0.210, p=0.033), and BMI (β=0.260, p=0.010). However, correlations with estradiol and age did not remain significant when adjusted for systolic blood pressure and LDL-cholesterol levels. ConclusionA high prevalence of subclinical atherosclerosis was detected in this sample of postmenopausal women with low/medium CV risk by the FRS. The association between IMT-CC and age or endogenous estrogen levels was dependent of blood pressure and LDL-cholesterol in these postmenopausal women from Southern Brazil.

Abstract P180: Ten-Year and Lifetime Cardiovascular Risk and Subclinical Cardiovascular Disease in Mexican Women

Introduction: Estimates of Lifetime Cardiovascular Risk may identify individuals with different levels of cardiovascular disease (CVD) risk within the low short-term risk (10-year risk) for coronary heart disease (CHD) category defined by the Framingham Risk Score. Evidence of the applicability of this risk stratification in relatively young people is limited, especially among Hispanics. Hypothesis: We assessed the hypothesis that the risk categories from the combination of these two risk stratification scales are positively associated with subclinical CVD in Mexican women. Methods: We calculated 10-year CHD risk using the Framingham Risk Score and lifetime CVD risk based on risk factor burden in 759 women in Southern Mexico from the Mexican Teachers’ Cohort and evaluated the presence of subclinical CVD. We evaluated common carotid intima-media thickness (IMT), ankle-brachial index (ABI), and inter-arm blood pressure difference (IAD) using standard protocols and performed laboratory analyses from a fasting blood draw. We defined three risk strata: Low 10-year (&lt;10%)/Low lifetime risk, Low 10-year (&lt;10%)/High lifetime risk, and High 10-year risk (≥10%). We evaluated outcome measures continuously and estimated the prevalence of subclinical CVD for each risk strata. We defined subclinical CVD as IMT ≥0.8 mm or atheromatous plaque, ABI &lt;0.90, systolic IAD ≥20 mmHg or diastolic IAD ≥10 mmHg. We calculated the sensibility and specificity of the predicted risk categories to detect subclinical CVD. Results: Women evaluated had a mean age of 48.4 years, 22.5% (n=171) were classified as High 10-year CHD Risk, 58.8% (n=446) as Low 10-year/High lifetime risk and 18.7% (n=142) as Low 10-year/Low lifetime risk. We observed significant increase in IMT measurement according to increasing risk categories: 0.656 mm (±0.062), 0.704mm (±0.085), and 0.739mm (±0.089) (p= &lt;0.001). We found similar significant trends in ABI (p= 0.001), systolic IAD (p= &lt;0.001), and diastolic IAD (p= &lt;0.001). We observed a significant higher prevalence of at least one subclinical CVD as the risk category increased: 10.6%, 26.9%, and 45.6% (p= &lt;0.001). The sensitivity and specificity of the combination of these scores to detect subclinical CVD was of 93% and 23%, whereas only considering the high vs. low 10-year risk categories these parameters were 37% and 83% respectively. Conclusion: The combination of these short-term and lifetime risk scores accurately identify differences in objective measurements of subclinical cardiovascular disease in Mexican women. Further calibration of these risk scores is needed to incorporate them in the risk assessment tools to identify individuals at risk for the implementation of preventive strategies in the Mexican population.

Polycystic Ovary Syndrome-Epigenetic Mechanisms and Aberrant MicroRNA.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age affecting various functions including reproduction and metabolism. This syndrome is associated with increased prevalence of subclinical cardiovascular disease as well as endometrial and ovarian cancer. This syndrome is highly heterogeneous and it is not yet clear which factors are responsible for the development of a particular phenotype. Current research has shown that the interaction of susceptible and protective genomic variants under the influence of environmental factors can modify the clinical presentation via epigenetic modifications. MicroRNA (miRNA) are regulators of gene expression. Altered miRNA expression has been associated with various diseases such as diabetes, insulin resistance, inflammation, and cancer. Several miRNA have been identified in PCOS. This review examines the role of epigenetics and miRNA in the pathophysiology of this complex disease process.

FRI0070 High Prevalence of Subclinical Cardiovascular Disease and Abnormal Left Ventricular Geometry Detected by CMR in Asymptomatic Rheumatoid Arthritis Patients

BackgroundCardiac MRI (CMR) has merit in the assessment of cardiovascular disease (CVD) with increased left ventricular mass/end-diastolic volume (LVmass/EDV) associated (ass.) with greater CV risk.[1] CMR-RA studies are few; unclear...

AB0688 Carotid Intima-Media Thickness in Spondyloarthritis: Prevalence of Subclinical Atherosclerosis in Patients without Clinically Evident Cardiovascular Disease

BackgroundAS and PsA patients without clinically evident cardiovascular disease have a high prevalence of subclinical cardiovascular disease in form of increased carotid intima-media thickness (IMT) and carotid plaques compared to...

Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot

Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. We enrolled 102 consecutive patients with type 2 diabetes mellitus with diabetic foot and 123 patients with type 2 diabetes mellitus without limb lesions to compare the prevalence of main cardiovascular risk factors, subclinical cardiovascular disease, previous cardiovascular morbidity, and incidence of new vascular events on a 5-year follow-up. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A 1c, and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.

Ultrasound Assessment of Subclinical Cardiovascular Disease in a Community-Based Multiethnic Population and Comparison to the Framingham Score

The presence of subclinical cardiovascular disease has been documented to indicate high coronary risk. This study investigated the impact of subclinical cardiovascular disease derived from echocardiography and carotid ultrasonography on traditional coronary risk stratification using the Framingham risk score (FRS) in a community-based, multiethnic population. Echocardiography and carotid ultrasonography were performed in 1,445 subjects (aged >39 years; 40% men; 53% Hispanic, 20% white, 24% black) from the Northern Manhattan Study. Subclinical cardiovascular disease was defined as the presence of left ventricular hypertrophy and/or carotid plaque greater than the gender-specific 75th percentile of the left ventricular mass index and maximal carotid plaque thickness distribution. The prevalence of subclinical cardiovascular disease was examined in each FRS category (low, intermediate, and high risk). In subjects with low or intermediate FRSs, 35% had subclinical cardiovascular disease (low FRS 29%, intermediate FRS 42%). In the intermediate FRS category, subclinical cardiovascular disease was significantly more prevalent in women than in men (53% vs 32%, p <0.0001) and in black and white subjects than in Hispanics (59% and 46% vs 33%, p <0.0001 and p = 0.040, respectively). In conclusion, the ultrasound assessment of subclinical cardiovascular disease may help reclassify 1/3 of subjects with low or intermediate FRSs into higher risk groups. In the intermediate FRS category, FRS appears to underestimate the coronary risk more in women than in men and more in whites and especially in blacks than in Hispanics.

The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study

There has been recent interest in determining whether neighborhood characteristics are related to the cardiovascular health of residents. However, there are no data regarding the relationship between neighborhood socioeconomic status (SES) and prevalence of subclinical cardiovascular disease (CVD) in the elderly. We related personal SES (education, income, and occupation type) and neighborhood socioeconomic characteristics (a block-group score summing six variables reflecting neighborhood income and wealth, education, and occupation) to the prevalence of subclinical CVD (asymptomatic peripheral vascular disease or carotid atherosclerosis, electrocardiogram or echocardiogram abnormalities, and/or positive responses to Rose Questionnaire claudication or angina pectoris) among 3545 persons aged 65 and over, without prevalent CVD, in the Cardiovascular Health Study. Sixty percent of participants had at least one indicator of subclinical disease. Compared to those without, those with subclinical disease had significantly lower education, income, and neighborhood scores and were more likely to have blue-collar jobs. After adjustment for age, gender, and race, those in the lowest SES groups had increased prevalence of subclinical disease compared with those in the highest SES groups (OR=1.50; 95% CI 1.21, 1.86 for income; OR=1.41; 95% CI 1.18, 1.69 for education; OR=1.39; 95% CI 1.16, 1.67 for block-group score). Those reporting a blue-collar lifetime occupation had greater prevalence of subclinical disease relative to those reporting a white-collar occupation (OR=1.29; 95% CI 1.02–1.59). After adjustment for behavioral and biomedical risk factors, all of these associations were reduced. Neighborhood score tended to remain inversely associated with subclinical disease after adjustment for personal socioeconomic indicators but associations were not statistically significant. Personal income and blue-collar occupation remained significantly associated with subclinical disease after simultaneous adjustment for neighborhood score and education. Personal and neighborhood socioeconomic indicators were associated with subclinical disease prevalence in this elderly cohort. These relationships were reduced after controlling for traditional CVD risk factors.

Subclinical cardiovascular disease in older adults: insights from the Cardiovascular Health Study.

Knowledge about the epidemiology of subclinical cardiovascular disease (SCVD) in older adults may hold the key for improved opportunities for primary prevention of cardiovascular disease (CVD), a top clinical and public health priority. This review reports findings on the prevalence of SCVD and the ability of SCVD measures to predict incident and adverse outcomes from one of the largest (N=5888) and most comprehensive prospective observational studies on SCVD in older adults, the Cardiovascular Health Study. According to a composite index that combined SCVD measures from different vascular beds, the overall prevalence of SCVD was 37%, making it as common as clinically overt CVD in older adults. SCVD measures strongly predicted incident CVD, stroke, mortality, frailty, and physical and cognitive decline, even after adjustment for traditional CVD risk factors. Ongoing research will address the potential use of SCVD for clinical decision making in older adults.