Prevalence Of Traditional Risk Factors Research Articles

Chronic obstructive pulmonary disease and cardiovascular co-morbidities

BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is the fourth largest cause of death worldwide. However, most patients with COPD die from cardiovascular causes (CVD). COPD is an independent risk factor for CVD and a predictor of long-term mortality. There is a high prevalence of traditional risk factors in this patient group, including smoking, sedentary behaviour and low socio-economic class. COPD is now recognized to having both local lung and systemic effects. The mechanism of such systemic effects is not completely known, but it is supposed to be related to enhanced systemic inflammation and to oxidative stress, both implicated in the pathogenesis of atherosclerotic process. CONCLUSIONS COPD is frequently associated with congestive heart failure (CHF). It is also a confounding factor for the diagnosis of CHF. In fact, some studies demonstrate that about 20% of patients diagnosed with COPD had also or only CHF. Patients with CHF and associated COPD have less frequently β-blockers prescription than CHF patients without COPD. COPD is a heavy negative prognostic factor for CHF hospitalization and mortality. Pulmonary Embolism (PE) in patients with COPD is generally underdiagnosed, and this last disease is a risk factor for a complicated course of PE, with increased mortality.

A critical epidemiological review of cardiovascular disease risk in HIV‐infected adults: the importance of the HIV‐uninfected comparison group, confounding, and competing risks

Dear Editor,The systematic review and meta-analysis of cardiovasculardisease (CVD) in HIV-infected individuals was an importantcontribution to the growing field of research in aging withHIV infection [1]. While the analysis appears of highquality, there were three areas that we believe were notgiven critical attention: the HIV-uninfected comparisongroup, the presence of residual confounding, and the needfor a competing risks analysis.First, although the research question was succinctlystated as whether there was a difference in CVD riskin HIV-infected compared with HIV-uninfected adults,the HIV-uninfected comparison groups were not givenadequate scrutiny. The ideal comparison group would be anHIV-uninfected group that would have a similar prevalenceof risk factors for CVD compared with HIV-infected indi-viduals. Reflecting the paucity of data in this area, onlythree of the 23 studies investigated had an HIV-uninfectedcomparison group. Two of these three studies made acomparison to the general population [2,3]. The generalpopulation is an inappropriate control group because HIV-infected populations have an increased prevalence of tra-ditional risk factors for CVD such as cigarette smoking[4,5], high blood pressure [5], and dyslipidaemia [5,6] com-pared with the general population. The third study usedHIV-uninfected adults seeking care at the same affiliatedcare facilities as the HIV-infected adults [7]. However,HIV-infected participants had a greater proportion of maleand Black individuals as compared with HIV-uninfectedparticipants [7]. It is likely that the differences in theHIV-infected and -uninfected groups do not end withsociodemographic characteristics. The HIV-uninfectedgroup probably had prevalences of risk factors that weresimilar to those of the general population, as comparedwith the HIV-infected population; however, these data werenot shown.Secondly, to best isolate the causal effect of HIV, con-founders must be taken into account in the analyses. Thestudy by Lang and colleagues reported an age- and sex-standardized morbidity ratio, but did not account for otherconfounders. In the study by Obel and colleagues, HIV-uninfected participants were matched on age, sex andmunicipality of residence; they were also able to accountfor diabetes, alcoholism, hypertension, liver disease, andkidney disease. Finally, Triant and colleagues were able toadjust for age, sex, race, hypertension, diabetes, and dys-lipidaemia. Smoking data were not available for all studyparticipants; Triant and colleagues concluded “It is possiblethat increased smoking rates in the HIV group contribute tothe increased rate of AMI in the HIV group” [7], as has beendemonstrated elsewhere [4]. In addition to smoking, noneof these three studies were able to adjust for family historyof CVD and substance abuse, as the authors correctly pointout. This inability to control for these confounders amongHIV-infected compared with HIV-uninfected participantsundermines the internal validity of these studies.Finally, the authors missed the opportunity to discussa critical element missing from all the studies to date:the impact of competing risks. Prior to the advent ofeffective therapy, CVD was not a major contributor to deathamong those with HIV infection – AIDS death was CVD’smain competitor. Without utilizing methods that properlyaccount for competing risks [8], these studies are unable toproperly answer the question: Is there truly an increase inthe risk of CVD attributable to HIV, or is the CVD burdenamong people with HIV being unmasked by the increasedlife expectancy resulting from effective treatment?Although the methods of the systematic review andmeta-analysis were impeccable, the study would have beenstrengthened by a critical epidemiological examination ofthe included studies.

警察官における虚血性心疾患の危険因子とその背景要因に関する検討

Compared to other public employees, police officers have higher absence rates due to heart diseases, and ischemic heart disease (IHD) is one of the most frequent causes of death in their occupational life. The aim of this study was to investigate the prevalence of the risk factors for IHD among police officers and to examine its association with working conditions and lifestyles. First, 58 male police officers who developed IHD from 1996 to 2011 and 116 age- and rank-matched controls who were free from cerebro- and cardiovascular diseases were compared with respect to the prevalence of traditional risk factors five years before the onset of IHD. Then, the prevalence of IHD risk factors, and the frequency of metabolic syndrome (MetS) by age group, working condition and lifestyle were investigated in a cross-sectional survey of data of 1,539 male police officers and 153 male office workers in a prefectural police force. In the case control study, the IHD cases had significantly higher prevalences of hypertension (p<0.001), hyper-LDL-cholesterolemia (p<0.05), glucose intolerance (p<0.05), and hyperuricemia (p<0.05) before the onset of IHD. Multiple logistic regression analysis revealed that hypertension (odds ratio [95% confidence interval] : 3.96 [1.82-8.59]), glucose intolerance (3.28 [1.34-8.03]), hypo-HDL-cholesterolemia (2.26 [1.03-4.97]), and hyper-LDL-cholesterolemia (2.18 [1.03-4.61]) were independently associated with the development of IHD (model chi-square, p<0.001; correct classification rate, 77.0%). In the cross sectional analyses, among the police officers, abdominal obesity (waist circumference of ≥ 85 cm) was significantly more frequent (57.3% vs. 35.3%, p<0.001) and the prevalence of dyslipidemia and glucose intolerance increased with age more remarkably than in the general office workers. In the age-group of 45-59 years, the clustering number of risk factors in individuals (1.8 vs. 1.4, p<0.01) and the frequency of MetS (25.0 vs. 15.5, p<0.1) were greater in the police officers than the office workers. Among the police officers, subjects with MetS had significantly higher rates of shift work (33.6% vs. 25.4%, p<0.01), lack of sound sleep (42.5% vs. 33.7%, p<0.01), and heavy drinking (12.8 vs. 6.3%, p<0.01) than those without MetS. In this study, the development of IHD in police officers was significantly associated with traditional risk factors, especially with hypertension, dyslipidemia and glucose intolerance. The increase with age of the prevalence of IHD risk factors and the frequency of MetS were greater in police officers than office workers. Irregular working conditions, such as shift work, long working time, and unfavorable lifestyles, e.g. alcohol drinking and poor sleeping conditions, may influence the higher prevalence of risk factors for IHD in police officers.

Association of Lipoprotein Subfractions and Coronary Artery Calcium In Patient at Intermediate Cardiovascular Risk

More precise estimation of the atherogenic lipid parameters could improve identification of residual risk beyond what is possible using traditional lipid risk factors. The aim of the present study was to explore the association between advanced analysis of lipoprotein subfractions and the prevalence of coronary artery calcium. Consecutive participants at intermediate cardiovascular risk who were undergoing computed tomographic assessment of coronary calcium (calcium score) were included. Using a validated ultracentrifugation method (the vertical autoprofile II test), cholesterol in eluting lipoprotein subfractions [i.e., low- (LDL), very-low-, intermediate-, and high-density lipoprotein subclasses, lipoprotein (a), and predominant LDL distribution] was directly quantified. A total of 410 patients were included (29% women, mean age 57 years), of whom 297 (72.4%) had coronary artery calcium. LDL pattern B (predominance of small dense particles) emerged as an independent predictor of coronary calcium after adjustment for traditional risk factors (odds ratio 4.46, 95% confidence interval 1.19 to 16.7). However, after additional stratification for dyslipidemia, as defined by conventional lipid profiling, a statistically significant prediction was only retained for high-density lipoprotein subfraction 2 (odds ratio 3.45, 95% confidence interval 2.03 to 50.1) and "real" LDL (odds ratio 6.10, 95% confidence interval 1.26 to 23.41) in the normolipidemia group and for lipoprotein (a) (odds ratio 7.81, 95% confidence interval 1.41 to 43.5) in the dyslipidemic group. In conclusion, advanced assessment of the lipoprotein subfractions [i.e., LDL pattern B, high-density lipoprotein subfraction 2, "real" LDL, and lipoprotein (a)] using the vertical autoprofile II test provided additional information to that of conventional risk factors on the prevalence of coronary artery calcium in patients at intermediate cardiovascular risk.

Cardiovascular Disease and Risk Factors in Law Enforcement Personnel

Law enforcement is a high-stress occupation that is prone to increasing the prevalence and incidence of cardiovascular disease. Epidemiological studies suggest that police officers and related public safety personnel have an increased risk of cardiovascular morbidity and mortality. Currently employed police personnel have a high prevalence of traditional risk factors, including hypertension, hyperlipidemia, metabolic syndrome, cigarette smoking, and a sedentary lifestyle. Obesity may be more common in police officers compared with civilians, whereas diabetes is present less frequently. Law enforcement personnel are also exposed to occupation-specific risk factors that include sudden physical exertion, acute and chronic psychological stress, shift work, and noise. Workplace programs to promote the health and fitness of police officers are commonly lacking, but can be an effective means for reducing cardiovascular risk. Physicians should be familiar with the essential job tasks required for police officers to determine whether the individual is fit for duty. Governmental agencies have established strategic goals to reduce cardiovascular complications and improve the health and wellness of public safety personnel.

Multifocal Osteonecrosis Associated to Human Immunodeficiency Virus Infection

The osteonecrosis has emerged in the last years as a potentially disabling osteoarticular complication in HIV-infected patients. There is a high prevalence of traditional risk factors for osteonecrosis development in these patients, but they also have factors associated to HIV infection in itself and the high activity antiretroviral therapy. The HIV-associated osteonecrosis often affects the hips, with a trend to bilaterally, but concomitant affection of 3 or more locations (multifocal osteonecrosis) has been infrequently reported. We present the case of a 49-year-old male patient, with long duration HIV infection and antiretroviral therapy, who developed osteonecrosis with concomitant affection of hips, knees, heels, and tarsus.

Osteonecrosis multifocal asociada a infección por el virus de la inmunodeficiencia humana

The osteonecrosis has emerged in the last years as a potentially disabling osteoarticular complication in HIV-infected patients. There is a high prevalence of traditional risk factors for osteonecrosis development in these patients, but they also have factors associated to HIV infection in itself and the high activity antiretroviral therapy. The HIV-associated osteonecrosis often affects the hips, with a trend to bilaterally, but concomitant affection of 3 or more locations (multifocal osteonecrosis) has been infrequently reported. We present the case of a 49-years-old male patient, with long duration HIV infection and antiretroviral therapy, who developed osteonecrosis with concomitant affection of hips, knees, heels and tarsus.

Acute coronary syndrome in HIV patients: from pathophysiology to clinical practice.

A majority of human immunodeficiency virus (HIV) infected subjects in developed countries have access to highly active anti-retroviral therapy (HAART), which is associated with significantly improved long term survival. In this setting, clinical attention needs to be focused on the impact of premature atherosclerotic cardiovascular disease (CVD), which already represents a leading cause of morbidity and mortality in these patients. While the higher prevalence of traditional risk factors remains the main culprit of increased CVD risk, HIV infection itself and antiretroviral toxicity are confounding proatherogenic factors. It is therefore critical to treat modifiable risk factors, keeping close attention to drug interactions in these patients with high cardiovascular risk profile.

Should psychosocial factors be taken into account when developing and implementing population-level preventive programmes?

Aim. To assess social status and selected psychological characteristics in organised urban populations from 5 Russian regions; to compare the results with the prevalence of traditional risk factors (RFs) and chronic disease. Material and methods. In 2009-2010, representative samples of organised populations from 5 Russian cities were examined (total n=2227, 1336 women and 891 men). The questionnaires assessed socioeconomic status (SES), as well as somatic and psychological health. The assessed psychological parameters included Lifestyle Index (LI), psychological resilience mechanisms (PRM), social adaptation, sanogenic reflection, Eysenck phychoticism scale, personal moral potential, emotional burnout syndrome, Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). The examination included the measurement of blood pressure, heart rate, waist circumference, and hips circumference. Results. The proportion of higher-educated people ranged from 82% in Nalchik to 29,3% in Omsk. Low self-rated wealth levels were highly prevalent (from 10,4-13% to 40,4%). Arterial hypertension was registered in 1,29% and 1,64% of men and women aged 25-34 years. In people aged 65-74 years, the respective figures were 60% and 75,8%. Obesity (body mass index ≥30 kg/m2) was registered in over 50% of the participants from all social groups. Negative (pathological) levels of LI significantly correlated with the majority of somatic diseases (р&lt;0,001) and psychological disorders (р&lt;0,007). In women, negative PRM were significantly more prevalent than in men (р&lt;0,007). In those aged under 50 years, the prevalence of negative PRM was lower (up to 28%) than in those aged 50-60 years (37,8%), or 60-75 years (57,7%) (р&lt;0,001). Conclusion. The development and implementation of population-level preventive programmes should take into account not only morbidity levels and traditional RFs, but also psychosocial features of the respective population groups.

Risk factors for development of cadiovascular diseases in patients with transplanted kidney

Cardiovascular diseases represent a considerable cause of death among patients with transplanted kidney. The study was aimed at defining risk factors, pathogenic progression mechanisms for cardiovascular diseases and pointing at clinical importance for early detection and timely treatment of cardiovascular diseases in patients with transplanted kidney. Expert papers and clinical studies dealing with etiopathogenesis, diagnosis and treatment of cardiovascular diseases in patients with transplanted kidney were analyzed. Increased incidence of cardiovascular diseases in patients with transplanted kidney is the consequence of high prevalence of traditional risk factors (obesity, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus), risk factors due to status of transplantation and its treatment (immunosuppressive agents, graft rejection, viral infections (cytomegalovirus) and risk factors due to chronic reduction of allograft (anemia, volume strain stress, hyperhomocysteinemia, oxidative stress, secondary hyperparathyroidism, microinflammation). Left ventricular hypertrophy, ischemic heart disease and heart weakness bear the highest prevalence among cardiovascular diseases. Early detection of disease in patients with increased risk for progression of cardiovascular diseases enables optimization and individualization of immunosu-ppressive therapy, reaching aimed values for cardiovascular risk factors, all with the view to reduce cardiovascular morbidity and mortality, increase of allograft survival and better life quality of patients with transplanted kidney.

Migrainous infarction: a Nordic multicenter study

Migrainous infarction (MI), i.e., an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included <10 cases which make conclusions less valid. This study aimed to describe characteristics and outcome of MI in a larger sample. We analyzed demographic data, risk factors, migraine medication, stroke localization, symptoms, and outcome in a sample of 33 patients with MI according to second edition of the ICHD criteria collected from seven Nordic headache clinics. Amongst 33 patients with MI, there were 20 (61%) women and 13 (39%) men with the median age for stroke of 39 (range 19-76) years. Traditional risk factors for stroke were rare compared with Scandinavian young ischemic stroke populations. During the acute phase, 12 (36%) patients used ergotamines or triptans. Stroke was located in the posterior circulation in 27 (82%) patients and cerebellum was involved in 7 (21%). Except in two patients with brainstem infarctions, the outcome was favorable with total recovery or limited residual symptoms. The prevalence of traditional risk factors was low and the infarctions were predominantly located in posterior circulation territory, supporting theories of migraine specific mechanisms. The outcome was in general favorable.

Lack of Ostial Coronary Artery Vasoconstriction in Acute ST-elevation Myocardial Infarction

Background: Cardiovascular prevention demonstrates significant gaps between guidelines and clinical practice. Recent European data suggests increasing rates of obesity, diabetes and smoking in patients with coronary heart disease (CHD). We assessed the prevalence of traditional risk factors and guideline compliance in Australians with CHD and compared these to a large European cohort. PCI outcomes were stratified by compliance with lipid guidelines. Methods: We prospectively collected baseline data on 2158 patients undergoing percutaneous intervention (PCI) at six Australian private hospitals between October 2008 and January 2011. These data were compared to Euroaspire III, a survey of 2392 patients with CHD from 2006 to 2007.

A prospective case-controlled cohort study of endothelial function in patients with moderate to severe psoriasis

There is well-documented evidence that patients with moderate and severe psoriasis have a significantly increased risk of cardiovascular disease (CVD). While this risk can, at least in part, be attributed to the high prevalence of traditional risk factors in the population with psoriasis, some epidemiological evidence suggests it may be independent of these. This prospective, case-controlled study investigates whether psoriasis is a risk factor for CVD using two, validated, sensitive markers of CVD, endothelial dysfunction and high-sensitivity C-reactive protein (hsCRP). Patients were recruited from a tertiary referral psoriasis clinic and exclusion criteria included established CVD and/or conventional risks for CVD. Preclinical CVD was assessed using flow-mediated brachial artery dilatation, which measures endothelial dysfunction, and hsCRP, a serological marker of atherosclerosis. Sixty-four patients (22%) out of a total of 285 consecutive patients attending the severe psoriasis clinic were entered into the study. One hundred and sixty-one (56%) were excluded following identification of cardiovascular risk; 39 of the 161 (24%) had at least two cardiovascular risk factors. A further 16 (6%) patients were excluded because of established CVD. No statistically significant difference in endothelial dysfunction was observed between patients with psoriasis (n = 60) and healthy controls (n = 117) (P = 0·508). The hsCRP level was, however, significantly elevated in the psoriasis group (2·828 mg L(-1), SEM 0·219; controls 0·728 mg L(-1), SEM 0·142; P < 0·05). This large, investigative study is the first to assess endothelial function in patients with psoriasis after exclusion of traditional risk factors for CVD. These data suggest that psoriasis per se is not a risk factor for CVD and that elevated hsCRP is possibly independent of atheroma risk. There was a high prevalence of traditional risk factors in our population with severe psoriasis.

Call to Action: Cardiovascular Disease in Asian Americans

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need. Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research. Because health surveys and questionnaires almost universally combine persons of Asian ancestry into a single group, the heterogeneity within this classification is masked. Socioeconomic and cultural factors have been found to be associated with CVD and its risk factors, which is why it is important to understand these differences among Asian subgroups. The Table shows the number of persons in each group based on the most recent US Census data available (American Community Survey, 2008), with the recognition that …

RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND DIASTOLIC FUNCTION IN POST-MENOPAUSAL WOMEN: PP.31.228

Objective: Cardiovascular risk in post-menopausal women is related not only to the prevalence of traditional risk factors but also to the incidence of alterations in cardiovascular function and structure. Arterial stiffness can represent a mechanism involved in development of cardiac alterations. The aim of this study is to evaluate the relationship between arterial stiffness and left ventricular diastolic function in a group of post-menopausal women entering the prevention program “Woman and Heart”. Design and Methods: In 149 women with no previous cardiovascular events (age 56 ± 6 years, blood pressure-BP 129 ± 17/76 ± 9 mmHg, 38% hypertensives, 30% smokers, 27% hypercholesterolemic, 20% obese, 8% with impaired glucose tolerance or diabetes), carotid-femoral pulse wave velocity (PWV) was measured by applanation tonometry (Sphygmocor, Atcor Medical). Moreover, a trans-toracic echocardiographic study was carried out to measure mitral inflow pattern, left ventricular mass index (LVMI) and relative wall thickness (RWT). Results: In the total population, carotid-femoral PWV was 7.2 ± 1.3m/s. Left ventricular hypertrophy (LVMI >51 g/m2,7) was found in 30% of the population, RWT was>0.42 in 12%, while impaired left ventricular relaxation (E/A ratio < 0.8, deceleration time>200ms) was found in 24%. An increased PWV was associated with the presence of impaired left ventricular relaxation (PWV 7.72 vs 7.15 m/s, p<0.01), but not with left ventricular hypertrophy or concentric remodeling. The only risk factors associated with increased PWV were age, hypertension and altered glucose tolerance. Logistic regression analysis, adjusted for these 3 risk factors, showed that a PWV greater than the median value of 7.1 m/sec was associated with a 2.9-fold greater risk (confidence limits 5–95% 1.11–7.79) of having impaired left ventricular relaxation. Conclusions: In a post-menopausal female population, evaluated in a primary prevention setting, carotid to femoral PWV is associated to mild diastolic dysfunction even after correction for the most important confounders. These data suggest that an increased aortic stiffness could contribute to left ventricular diastolic dysfunction and possibly to diastolic heart failure in post-menopausal women.

End-Stage Renal Disease and Sudden Cardiac Death.

Patients with end-stage renal disease (ESRD) are at a high risk for sudden cardiac death (SCD). SCD is the most common cause of death in this population and, as in the general population, ventricular arrhythmias seem to be the most common cause of SCD. The increased risk of SCD in ESRD is likely due to factors that are unique to the metabolic derangements associated with this state, as well as the increased prevalence of traditional risk factors. Despite this, the evidence base for the assessment and management of SCD in these patients is limited. This article reviews the current data on underlying risk factors for SCD in patients with ESRD, the role of common medical and device-based therapies for the prevention and treatment of SCD, and the applicability of common methods of risk stratification to patients with ESRD.

The challenge of coronary heart disease in South Asians who have migrated to Europe and the United States

Certain populations, such as migrant South Asians from the Indian subcontinent to westernized countries, have excess burden of coronary heart disease compared with Caucasians of European descent despite a lower prevalence of traditional risk factors (except insulin resistance and type 2 diabetes). Recent studies did not show excess visceral fat in South Asians but did show larger adipocytes and abnormal adipokines that were associated with increased insulin resistance compared with Caucasians matched for total and regional fat mass. We propose that genetic predisposition to an adipocyte maturation defect when challenged with an obesogenic environment may precipitate adipose tissue dysfunction at much lower body fat content, as seen in South Asians. The shift in our thinking from excess fat mass—visceral or otherwise—to adipose tissue dysfunction being a cause of metabolic complications of obesity is warranted, especially for populations such as South Asians, to better target screening and prevention strategies.

Review of cardiovascular risk factors in women

Although cardiovascular disease (CVD) is the leading cause of death in women in the United States, a knowledge gap persists regarding the mechanisms and management of CVD in women. Before treatment can be optimized, the role of cardiovascular risk factors must be elucidated. This review provides an updated assessment of cardiovascular risk factors in women, with a focus on cardiometabolic risk. MEDLINE and Cochrane Library databases, and statistics from the National Health and Nutrition Examination Survey and the American Heart Association, were searched from 1990 to September 2008 using the following terms: cardiovascular risk factors, women, gender, cardiometabolic risk, abdominal obesity, and metabolic syndrome. Publications were classified as English-only original data, reviews, and clinical guidelines. Nonpublished data were excluded. Data were extracted by 2 reviewers independently. Investigators performing multivariable predictive models have estimated that traditional risk factors account for approximately 70% of the variance in estimating cardiovascular events. However, substantial sex differences exist in the prevalence of traditional risk factors as well as in cardiovascular outcomes. Hypertension is more prevalent in men until the age of 59 years, but then contributes to greater morbidity in older women. Low levels of high-density lipoprotein and elevated triglyceride levels pose more of a threat to women, yet high levels of low-density lipoprotein pose equal risk for women and men. The CVD mortality rate is -3 times greater in people with diabetes than in those without diabetes. Among diabetic individuals, CVD mortality is slightly higher in women compared with men. Increased knowledge of gender-specific risks for CVD has led to national campaigns to educate women. In addition to traditional risk factors, cardiometabolic risk is an important consideration in women. Controversy exists regarding the exact definitions and usefulness of the term metabolic syndrome, but it is clear that the presence of certain factors contributes to increased morbidity and mortality in affected individuals. Abdominal obesity links insulin resistance, dyslipidemia, and hypertension through complex endocrine pathways. Current research is identifying gene x gender interactions, and continued research is necessary to explore the relationship of sex steroids and cardiovascular risk in both men and women.

Not being “fat” is not always being “fit”: Why are S. Asians more prone to Type 2 diabetes and atherosclerotic cardiovascular disease?

People of South Asian ethnicity, irrespective of their place of residency, have an increased predisposition to Type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD). S. Asians have often shown similar or lower prevalence of traditional risk factors compared to other ethnic groups in spite of a greater risk as compared to the other groups. Recent evidence indicates that obesity and alterations in the levels or actions of adipokines play a key role in leading to insulin resistance and a proinflammatory state which predispose to T2DM and ASCVD. But how does one explain the fact that in spite of people of S. Asian ethnicity being more prone to T2DM and ASCVD, obesity as defined by Body Mass Index (BMI) is significantly lower in Asian Indians compared to Caucasians? So can one not be fat and yet not be fit?

Inflammation and cardiovascular complications in chronic kidney disease

Cardiovascular disease is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), accounting for 50% of deaths of patients on dialysis, even young adults. The etiology of accelerated cardiovascular disease in these patients is likely multifactorial. Although patients with CKD demonstrate a high prevalence of traditional risk factors for cardiovascular disease, these risk factors alone cannot explain the high burden of cardiovascular disease in this patient population. One of several uremia-related risk factors thought to contribute to disease progression is low-grade systemic inflammation. This review summarizes the current literature on the role of inflammation in promoting cardiovascular disease in this patient population as well as potential therapies to address this non-traditional risk factor.