Prevalent CHD Research Articles

Abstract P439: Atherosclerotic Cardiovascular Risk Factor Burden Among Marijuana Users in the US Population

Background: The prevalence of marijuana use in the US is increasing. Marijuana use has been associated with increased atherosclerotic cardiovascular disease (ASCVD) events. The ASCVD risk factor burden among marijuana users compared with non-users and tobacco users has not been defined. We sought to define ASCVD risk factor burden among marijuana users in a nationally representative sample of the US population. Methods: We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from the 2017-2018 cycle including 4991 participants aged 18-59 representing 223 million US adults. Participants were placed in 4 groups: marijuana and cigarette user (MS), exclusive marijuana user (M), exclusive cigarette user (S), and non-users (NS). ASCVD risk factors were assessed and compared using chi-squared and ANOVA with Tukey’s adjustment for multiple hypothesis testing. Results: The N=4991 participants representing 223 million US adults were a mean 51 years old, 54.82% female and BMI of 32.53. The N=1691 M-users were compared to the N=2552 NS, N=2439 S-users, and N=1020 MS users (Table 1). The M-users were younger, mean age (38.8 years) with a higher BMI (32.9 kg/m 2 ) compared to exclusive smokers, dual-users and non-users. Prevalent coronary heart disease differed by use-group (p < 0.05). Conclusion: Exclusive M-users and dual users had higher prevalent CHD. ASCVD risk factor burden differed slightly between the groups.

Aortic dilation in adults with repaired tetralogy of Fallot: a single-centre study.

Tetralogy of Fallot is the most prevalent cyanotic CHD. With the advent of advanced surgical methods, the majority of tetralogy of Fallot patients reach adulthood. However, many need re-intervention for the residual anomalies including residual right ventricular outflow obstruction, pulmonary regurgitation, residual ventricular septal defects, and progressive aortic dilatation. Aortic dilation could lead to aortic regurgitation or dissection requiring surgical correction. In the current study, we aimed to determine the prevalence and outcomes of aortic root dilatation in adults with repaired tetralogy of Fallot in our tertiary care centre. In this retrospective study, 730 consecutive patients with history of repaired tetralogy of Fallot were included. Aortic diameter at the level of annulus, the sinus of Valsalva, sinotubular junction, and the ascending aorta as measured by echocardiography were evaluated. Prevalence of outcomes necessitating re-intervention including aortic regurgitation and dissection were recorded. The mean size of annulus, sinus of Valsalva, sinotubular-junction, and ascending aorta in the latest available echocardiography of patients were 2.4+/-0.4 cm, 3.3+/-0.5 cm, 2.9+/-0.5cm, and 3.2+/-0.5cm, respectively. Prevalence of dilatation of sinus of Valsalva, dilation of Ascending aorta, sinotubular-junction, and aortic annulus was 28.7%, 21%, 8.3%, and 1 %, respectively. Five patients had severe aortic regurgitation (0.6%) and underwent surgical repair. One of these patients presented with acute aortic dissection. Aortic dilation is common in tetralogy of Fallot but prevalence of redo surgery for aortic dilation, regurgitation, and adverse events including acute dissection is low.

Traditional and novel risk factors for incident aortic stenosis in community-dwelling older adults

ObjectivesCalcific aortic stenosis (AS) is the most common valvular disease in older adults, yet its risk factors remain insufficiently studied in this population. Such studies are necessary to enhance understanding...

Clinical Pattern and Malnutrition among Children with Congenital Heart Disease at Tertiary Care Hospital

Background and Aim: Congenital heart disease is defined as the heart or intra-thoracic great vessel structural abnormalities present since birth with significantly functional irrespective of their detection age. It is the most prominent congenital anomaly and cause of morbidity and mortality among the pediatric age group population. The present study aimed to investigate the clinical pattern and malnutrition among children with congenital heart disease. Methodology: This descriptive cross-sectional study was carried out on 132 congenital heart disease patients in the Department of Pediatric, Imran Idrees Teaching Hospital Sialkot from January 2021 to December 2021. Children with clinical basis of cyanosis, feeding refusal, decreased activity, cough, hurried breathing, fever, and excessive sweating were enrolled. Acquired heart diseases and post-operative cardiac cases were excluded. Eligible children were assessed for sociodemographic details, physical examination, nutritional status, history, and types of congenital heart diseases. SPSS version 25 was used for data analysis. Results: Of the total 132 CHD children, there were 92 (69.7%) male and 40 (30.3%) females. The prevalence of acyanotic heart diseases, cyanotic heart diseases, complex CHD, and valvular diseases were 98 (74.2%), 22 (16.7%), 10 (7.6%), and 2 (1.5%) respectively. Age-wise distribution of all the children were as follows: 38 (28.8%) < 1 month, 62 (47%) 1 month-1 year, 20 (15.2%) 1-5 years, and 12 (9.1%) 5-10 years. Based on presented symptoms, the incidence of breathlessness, fever, cough, and other symptoms were 68 (51.5%), 58 (43.9%), 54 (40.9%), and 49 (37.1%) respectively. The incidence of protein-energy malnutrition and normal cases were 72 (54.5%) and 60 (45.5%) respectively. Anemia was the most prevalent risk factor CHD in 52 (39.4%) cases followed by pneumonia 41 (31.1%). Conclusion: The present study concluded that acyanotic heart diseases were the most commonly found in children followed by cyanotic, complex, and valvular diseases. Infancy and childhood age are more susceptible to congenital heart diseases. Breathlessness and fever were the most common symptoms. Nutritional anemia followed by pneumonia and failure to thrive were the major risk factors for congenital heart diseases among children. Keywords: Congenital heart diseases, Clinical pattern, Malnutrition

Cerebral Small-Vessel Disease in Individuals with a Family History of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study

Introduction: The degree to which a family history of coronary heart disease (FHCHD) is associated with silent cerebral small-vessel disease (cSVD) among healthy adults, independent of prevalent CHD and traditional risk factors, is unknown. Methods: The Atherosclerosis Risk in Communities (ARIC) study is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (ages 68–88). The association between markers of cSVD (lacunar infarcts and cerebral microbleeds), or log-transformed white matter hyperintensity (WMH) volume, and FHCHD, or the number of affected relatives was examined using separate adjusted logistic or linear regression models, respectively. Race interaction terms were evaluated. Results: Of 1,639 participants without prevalent CHD (76 ± 5 years, 62% female, 29% black), 686 (42%) had FHCHD. There were higher odds of lacunar infarct (OR 1.40, 95% CI 1.07–1.84) among those with parental FHCHD and higher odds of microhemorrhages (lobar OR 1.86, 95% CI 1.13–3.06; subcortical OR 1.47, 95% CI 1.01–2.15) among those with sibling FHCHD. A greater number of any relative affected was associated with higher odds of lacunar infarct (OR 1.24, 95% CI 1.04–1.47) and lobar microhemorrhages (OR 1.31, 95% CI 1.05–1.64) but not subcortical microhemorrhages (OR 1.09, 95% CI 0.92–1.28). Odds of having a lacunar infarct were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35–3.58) than whites with paternal FHCHD (OR 1.17, CI 0.87–1.56). There was no association with WMH. Discussion/Conclusion: Markers of cSVD, specifically lacunar infarcts and microhemorrhages, appear to be associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.

Abstract MP26: Silent Small-vessel Cerebrovascular Disease In Individuals With A Family History Of Coronary Heart Disease: The Atherosclerosis Risk In Communities (ARIC) Study

Background: It is established that a family history of coronary heart disease (FHCHD) is associated with coronary atherosclerosis in healthy first-degree relatives, but the extent to which FHCHD is associated with silent cerebrovascular disease (cSVD) is unknown. We hypothesized a higher prevalence of cSVD in healthy persons with FHCHD, independent of traditional risk factors, compared to those without FHCHD. Methods: ARIC is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (visit 5; 2011-13). The association between binary markers of cSVD (lacunar infarcts and/or cerebral microbleeds), or log-transformed white matter hyperintensity volume (WMH), and FHCHD (parent and/or sibling), or number of relatives was examined using separate adjusted multivariable logistic or linear regression models respectively. Sensitivity analysis (N=183) excluded prevalent CHD. Race interaction terms were included. Results: Of 1828 participants (76±5yo, 60% female, 28% black), 787 had FHCHD (699 parental, 209 sibling FHCHD). There were increased adjusted odds of lacunar infarct among those with parental FHCHD (Table). An increased odds of cerebral microbleeds were seen among those with sibling history but not parental. Effect estimates were similar when excluding those with prevalent CHD (Table). Greater number of siblings affected was associated with higher odds of lacunar infarct (OR 1.35, CI 1.04-1.74), lobar (OR 1.53, CI 1.12-2.09) and subcortical microbleeds (OR 1.30, CI 1.01-1.66). Odds of a lacunar infarct being present were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) compared to whites (OR 1.17, CI 0.87-1.56). Neither FHCHD nor number of affected relatives was associated with WMH. Conclusions: Our results suggest that some cSVD manifestations are associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.

Abstract P183: Incident Chronic Kidney Disease and Myocardial Infarction Without Chest Pain: Results From the Atherosclerosis Risk in Communities Study

Background: Chronic kidney disease (CKD) and cardiovascular disease share similar risk factors, such as diabetes, hypertension, and dyslipidemia promoting atherosclerosis. Acute myocardial infarction (MI) presenting without chest pain is associated with higher case fatality compared to MI with chest pain. Patients with non-ST-elevation MI (NSTEMI) are more likely to present without chest pain than patients with ST-elevation MI (STEMI). Few if any studies have examined the risk of incident CKD following MI with and without chest pain. Hypothesis: We hypothesized that MI presenting without chest pain is associated with greater risk of incident CKD after adjustment for demographic factors, in-hospital complications, and comorbidities among adults in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: The ARIC Study is a community-based cohort study that began recruitment in 1987. MI without chest pain includes persons presenting with shortness of breath, nausea, or dyspnea that is determined to be of cardiac origin. Follow-up time for this analysis was calculated from date of MI hospitalization (index date) to incident CKD, death, or administrative censoring in 2017. Incident CKD was defined as eGFR <60 mL/min/1.73 m 2 and ≥25% eGFR decline from previous measurements, CKD-related hospitalization or death, or end-stage renal disease. In-hospital complications included acute heart failure, ventricular fibrillation, and cardiogenic shock. Prevalent CHD and chronic heart failure were measured at visit 1 (1987-1989) and history of diabetes and hypertension were captured from the MI hospitalization record. Results: There was a total of 1,332 MI hospitalizations with data on MI type and symptom presentation. Among 1,038 NSTEMI events, 19% presented without chest pain, compared to 7% of the 294 STEMI events presenting without chest pain. Age greater than 65 years, female gender, and hypertension at the time of the MI as well as in-hospital complications of heart failure and ventricular fibrillation were more common among NSTEMI without chest pain compared to NSTEMI with chest pain. Median follow-up time was 4.9 years (Q1, Q3: 0.9, 11.4 years). Persons with NSTEMI events presenting without chest pain had 1.82 times the risk of incident CKD (95% CI: 1.39, 2.38) compared to NSTEMI events presenting with chest pain. This association was attenuated after adjustment for age at MI, female gender, and black race (HR: 1.36, 95% CI: 1.04, 1.80) and further attenuated after additional adjustment for reperfusion within 24 hours (HR: 1.30, 95% CI: 0.99, 1.72). Conclusion: NSTEMI presenting without chest pain was associated with increased risk of incident CKD, though this association was attenuated after adjustment.

Abstract P348: Long-term Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of Coronary Artery Bypass Grafting Surgery or Percutaneous Coronary Intervention

Objective: We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline. Methods: The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI. Results: For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up. Figure Panel A shows model-predicted mean 3MS trajectories without CHD (blue) and after incident CHD (red) diagnosed at ages 70, 75, 80, or 85. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI ( Figure Panel B ). Conclusions: Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.

Abstract P164: Walking Pace is Inversely Associated With Heart Failure Risk in the Physicians’ Health Study

Background: Heart Failure (HF) continues to place a large burden on the public health. While previous studies reported a lower risk of HF and coronary heart disease with increased physical activity, limited data is known about the role of intensity and duration of exercise, specifically walking pace in relation to heart failure risk. Objective: The primary objective is to assess whether walking pace is associated with a lower risk of heart failure among male US physicians. Methods: In a prospective cohort study of US male physicians, walking pace was collected through a self-reported questionnaire. Incidence of HF was measured via self-reported annual questionnaires and validated in a subsample. Results: We studied 21,345 men with a mean age of 67.6 ± 8.9 years. After a mean follow-up of 8.2 years, 849 cases of HF occurred. In a multivariable Cox regression adjust for age, exercise, prevalent CHD, history of atrial fibrillation, smoking and alcohol consumption, hazard ratios (95% CI) for HF were 1.08 (0.85-1.36) for walking pace of <2 mph, 0.73 (0.60-0.90) for 2-2.9 mph, and 0.55 (0.43-0.71) for ≥3 mph compared to not walking regularly (p trend <0.0001). Conclusions: Walking Pace was inversely associated with HF in male physicians in a dose-response manner

Hypertension genetic risk score is associated with burden of coronary heart disease among patients referred for coronary angiography.

BackgroundRecent GWAS studies have identified more than 300 SNPs associated with variation in blood pressure. We investigated whether a genetic risk score constructed from these variants is associated with burden of coronary heart disease.MethodsFrom 2010–2014, 4,809 individuals admitted to coronary angiography in Capital Region of Copenhagen were genotyped. We calculated hypertension GRS comprised of GWAS identified SNPs associated with blood pressure. We performed logistic regression analyses to estimate the risk of hypertension and prevalent CHD. We also assessed the severity of CHD associated with the GRS. The analyses were performed using GRS quartiles. We used the Inter99 cohort to validate our results and to investigate for possible pleiotropy for the GRS with other CHD risk factors.ResultsIn COGEN, adjusted odds ratios comparing the 2nd, 3rd and 4th cumulative GRS quartiles with the reference were 1.12(95% CI 0.95–1.33), 1.35(95% CI 1.14–1.59) and 1.29(95% CI 1.09–1.53) respectively, for prevalent CHD. The adjusted multinomial logistic regression showed that 3rd and 4th GRS quartiles were associated with increased odds of developing two(OR 1.33, 95% CI 1.04–1.71 and OR 1.36, 95% CI 1.06–1.75, respectively) and three coronary vessel disease(OR 1.77, 95% CI 1.36–2.30 and OR 1.65, 95% CI 1.26–2.15, respectively). Similar results for incident CHD were observed in the Inter99 cohort. The hypertension GRS did not associate with type 2 diabetes, smoking, BMI or hyperlipidemia.ConclusionHypertension GRS quartiles were associated with an increased risk of hypertension, prevalent CHD, and burden of coronary vessel disease in a dose-response pattern. We showed no evidence for pleiotropy with other risk factors for CHD.

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Aims/hypothesisSleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes (‘non-diabetes CHD’) but would hold true for cases of incident CHD following incident diabetes (‘diabetes-CHD’).MethodsA total of 6966 men and 9378 women aged 45–73 years from the Malmö Diet Cancer Study, a population-based, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD.ResultsMean follow-up times for incident diabetes (n = 1137/1016 [men/women]), incident CHD (n = 1170/578), non-diabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/77) were 14.2–15.2 years for men, and 15.8–16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.29, 95% CI 0.86, 1.93).Conclusions/interpretationThe associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes. Incident diabetes may thus be the explanatory mechanism for the association between short and long sleep duration and incident CHD.

Outcome after prenatal and postnatal diagnosis of complex congenital heart defects and the influence of genetic anomalies.

Determine prenatal detection rate, mortality and association with genetic abnormalities in patients with severe CHD. Single center retrospective study in patients with severe CHD diagnosed prenatally or postnatally (2006 to 2014). A total of 567 patients were included, 176 (31%) after prenatal diagnosis, with large differences in prenatal detection rate among CHD types. Coarctation (24%), tetralogy of Fallot (21%) and univentricular heart (19%) were the most prevalent CHD. Overall mortality rate was 30% with important contributions of prenatal mortality including termination of pregnancy (40%) and postnatal compassionate care (15%). In the group requiring surgery, mortality rate was 12%. Genetic testing was available in 70%. A genetic cause was present in 140/394 patients tested (36%; 25% in the total group). Mortality was higher in the group with abnormal genetic testing compared with those with normal or no genetic testing (57/141 vs 112/423; p=0,002). Only one third of severe CHD are detected; overall mortality remains high (30%) with major contributions of termination of pregnancy and compassionate care. A genetic cause was found in 36% and was associated with a decreased survival. Counseling must include the possibility of associated genetic pathology and its impact on survival. © 2017 John Wiley & Sons, Ltd.

Abstract P097: Shortness of Breath, Edema, and Fatigue and the Risk of Hospitalized Heart Failure (HF). The Atherosclerosis Risk in Communities (ARIC) Study

Background: Shortness of breath, edema, and fatigue are often present in HF and are common among ambulatory care patients. These signs and symptoms (S/S) are predictive of hospital admission for HF but their lack of specificity presents a challenge in risk stratification for HF. Consideration of the cardiac biomarker NT-proBNP may improve the predictive performance of S/S in risk stratification to prevent incident HF hospitalization. Methods: Shortness of breath, edema, and fatigue and NT-proBNP levels were assessed among ARIC cohort participants during 2nd clinical examination (1990-1992). Degree of lower extremity edema was assessed by examination, and NT-proBNP assayed from serum. Shortness of breath and fatigue were assessed by self-report. Incidence of HF was ascertained from ongoing monitoring of participants’ hospitalization records (ICD-9 code 428.xx in any position) through December 31, 2012. Linear regression was used to examine cross-sectional association of signs and symptoms of HF with NT-proBNP levels. Poisson regression was used to assess age-adjusted mortality rates. Cox proportional hazard models, adjusted for age, gender, race, systolic blood pressure (BP), BP-lowering medication use, prevalent CHD, BMI, smoking status and diabetes were used to examine the effect of NT-proBNP on the association of HF S/S with 10-year risk of incident HF hospitalization. Results: Of the 13,312 ARIC participant, free of prevalent HF (mean (SD) age 56.9 (5.7) years, 55% female, 24% black), 5,873 (44.1%) reported shortness of breath, fatigue or had bilateral edema. Median NT-proBNP level (pg/ml) was 47.4 (interquartile range (IQR): 25.4, 86.3) in those without HF S/S, 67.3 (IQR: 34.7, 127.5) among those with shortness of breath; 62.4 (IQR: 31.9, 113.8) among those with edema, and 56.2 (IQR: 29.9, 103) among those with fatigue. Incidence of HF hospitalization (age-adjusted rate/1,000 person-years) was associated with presence of HF S/S: 7.6 (95% confidence interval (CI): 7.3, 8.1) among those without any S/S; 22.2 (95% CI: 19.8, 24.6) among those with shortness of breath, 18.3 (95% CI: 15.8, 20.8) among those with edema, and 12.5 (95% CI: 11.5, 13.4) among those with fatigue. The 10-year risk of HF hospitalization was 64% (95% CI: 47%, 83%) higher among those with any of the HF S/S, as compared to those free of HF S/S. Addition of NT-proBNP to HF risk estimation led to net reclassification of 9.2 % (95% CI: 6.9%, 11.8%) of the study participants with respect to their risk of HF hospitalization. Conclusion: Signs and symptoms frequently related to HF are prevalent in ambulatory care and are associated with increased long term risk of HF hospitalization. Inclusion of these S/S in combination with NT-proBNP in clinical prediction tools may improve the management of patients presenting with signs/symptoms suggestive of HF.

Thyroid Function, Prevalent Coronary Heart Disease, and Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography.

This study investigated if free T4 and TSH concentrations or thyroid function categories were associated with prevalent CHD and the severity of coronary atherosclerosis in a population undergoing coronary angiography. This was a cross-sectional study including 1799 patients who were consecutively admitted and underwent coronary angiography. We evaluated the severity of coronary atherosclerosis using Gensini score. In the entire study population, free T4 level was inversely associated with prevalent CHD (OR = 0.95, 95% CI 0.91–0.99, P = 0.01) and the natural log-transformed Gensini score (ln(Gensini score)) (β = −0.03, 95% CI −0.05–−0.01, P = 0.005). The odds of CHD increased gradually across hyperthyroidism, subclinical hypothyroidism, and overt hypothyroidism groups using the euthyroid group as the reference, and the trend is borderline significant (P for trend = 0.051). When comparing to the euthyroid group, ln(Gensini score) of the overt hypothyroidism group was significantly higher (P = 0.009), but the trend was not significant (P for trend = 0.08). A significant association of thyroid function with CHD or ln(Gensini score) in euthyroid patients was not observed. The present study demonstrated an association of thyroid function with prevalent CHD and the severity of coronary atherosclerosis in a population undergoing coronary angiography. However, this association was not observed in euthyroid individuals.

Abstract P118: Association of Comorbid Depression and Diabetes with Mortality: A Pooled Cohort Analysis

Background: Reports from prior studies testing whether adults with comorbid depression and diabetes have higher mortality than adults with diabetes alone are inconsistent. Explanations may include sample sizes, inadequate follow-up, or populations selected based on disease status (e.g., post- CHD). In a large sample of adults free from prevalent CHD, we tested whether the presence of depressive symptoms in persons with diabetes led to higher mortality than what would be expected by either condition alone. Methods: Participants from the Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study and Multi-Ethnic Study of Atherosclerosis longitudinal cohort studies who had measures available to determine diabetes, depression and mortality were included in the analysis (n=17,160). Diabetes was determined based on medication use or fasting glucose &gt; 126 mg/dL. Centers for Epidemiologic Studies Depression (CES-D) scores &gt; 16 (&gt; 8 short version) indicated high depressive symptoms. We tested whether comorbid depressive symptoms and diabetes exceeded what would be expected by the sum of the two conditions independently on the additive scale by calculating the Relative Excess Risk due to Interaction (RERI; &gt; 0 indicates interaction). Results: Crude mortality was highest in participants who had high depressive symptoms and diabetes, followed by participants who had diabetes and low depressive symptoms. Despite a significantly elevated adjusted hazard ratios (HR) comparing participants with diabetes who had high vs. low depressive symptoms, the RERI was 0.058 (95% confidence interval [CI]: -0.298, 0.413) indicating an absence of additive interaction. Findings were similar across strata by sex, age (&lt; 65, &gt;65), race (non-white vs. white) and education (&lt; high school vs. &gt; high school). Conclusions: While comorbid diabetes and depressive symptoms do not act synergistically to increase mortality, death rates are highest in this subgroup of participants.

Low Serum Adiponectin Predicts 10-Year Risk of Type 2 Diabetes and HbA1c Independently of Obesity, Lipids, and Inflammation: Whitehall II Study

Our aim of the present work was to study the effect of serum adiponectin on incident diabetes and HbA1c values. We measured baseline serum adiponectin levels in a nested case-control selection (n=140) of the Whitehall II Cohort. Participants (mean [SD] age 50.9 [6.3] years) had no prevalent diabetes or CHD at baseline. Cases (n=55) had incident diabetes according to an oral glucose tolerance test during follow-up (mean: 11.5+/-3.0 years). Adiponectin levels were lower among cases (9.3 microg/ml, 3.2 [median; IQR] vs. 10.5; 3.6, p=0.01). The risk of incident diabetes decreased by 11% (p=0.03) for 1 microg/ml higher adiponectin levels. Higher adiponectin levels were associated with lower HbA1c at follow-up (p<0.05). Both associations were stable to adjustment for age, sex, body mass index, systolic blood pressure, and serum lipids, and for the case of HbA1c, also for C-reactive protein (all p<0.05). The observed robust, prospective associations support that adiponectin is an independent predictor of diabetes and the degree of glycaemic impairment.

HbA 1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.

Heart failure (HF) incidence in diabetes in both the presence and absence of CHD is rising. Prospective population-based studies can help describe the relationship between HbA(1c), a measure of glycaemia control, and HF risk. We studied the incidence of HF hospitalisation or death among 1,827 participants in the Atherosclerosis Risk in Communities (ARIC) study with diabetes and no evidence of HF at baseline. Cox proportional hazard models included age, sex, race, education, health insurance status, alcohol consumption, BMI and WHR, and major CHD risk factors (BP level and medications, LDL- and HDL-cholesterol levels, and smoking). In this population of persons with diabetes, crude HF incidence rates per 1,000 person-years were lower in the absence of CHD (incidence rate 15.5 for CHD-negative vs 56.4 for CHD-positive, p<0.001). The adjusted HR of HF for each 1% higher HbA(1c) was 1.17 (95% CI 1.11-1.25) for the non-CHD group and 1.20 (95% CI 1.04-1.40) for the CHD group. When the analysis was limited to HF cases which occurred in the absence of prevalent or incident CHD (during follow-up) the adjusted HR remained 1.20 (95% CI 1.11-1.29). These data suggest HbA(1c) is an independent risk factor for incident HF in persons with diabetes with and without CHD. Long-term clinical trials of tight glycaemic control should quantify the impact of different treatment regimens on HF risk reduction.

Abstract 3616: Left Atrial Size Association with Incident Ischemic Stroke and All-Cause Mortality in African Americans: the Atherosclerosis Risks in Communities (ARIC) Study

Background: The association between left atrial (LA) size, ischemic stroke and mortality has been investigated in non-Hispanic whites but not in African Americans despite their disproportionately higher rates of stroke and cardiovascular mortality. Purpose: We examined the association of LA size assessed by echocardiogram with the incidence of ischemic stroke and all-cause mortality in a large population-based cohort of African Americans. Methods: Participants in the Jackson cohort of the ARIC study have been extensively evaluated including echocardiograms during the third examination (1993–1995) and have been followed for incident cardiovascular events including stroke. Results: The study population consisted of 1,887 participants of which 660 (35%) were men with a mean age of 58.9 ± 5.7 years. LA diameter by tertile was significantly related to hypertension, diabetes and body mass index (BMI) (p&lt;0.0001 for each). Over a median follow-up period of 8.8 years, there were 103 incident strokes (6.47 per 1,000 person-years) and 206 deaths (13.3 per 1,000 person-years). Adjusting for age, sex, hypertension, smoking, diabetes, total cholesterol:HDL ratio, and BMI, LA size was associated with stroke (HR per 10 mm increment of LA diameter 1.44; 95% CI: 0.99, 2.08, p = 0.05) and significantly associated with mortality (HR 1.38; 95% CI: 1.06,1.79 p &lt; 0.02). After further adjustment for prevalent CHD and congestive heart failure, only the association with mortality remained statistically significant (p &lt; 0.03). Conclusions: In this middle-aged population based cohort of African Americans, LA size was significantly associated with all-cause mortality independent of traditional cardiovascular risk factors.

Frequency of Attendance at Religious Services, Cardiovascular Disease, Metabolic Risk Factors and Dietary Intake in Americans: An Age-Stratified Exploratory Analysis

Few data have been published on the association of attendance at religious services with cardiovascular morbidity and dietary and metabolic risk factors in representative samples of populations despite a known inverse association with mortality and smoking. To test the null hypothesis that frequency of attendance at religious services is unrelated to prevalence or levels of cardiovascular disease, dietary and metabolic risk factors. Cross-sectional survey of a large national sample. American men and women aged 20 years and over with complete data in the Third National Health and Nutrition Examination Survey (N = 14,192). Self-reported frequency of attendance at religious services, history of doctor-diagnosed diseases, food intake frequency, 24-hour dietary intake, health status, socio-demographic variables and measured serum lipids and body mass index. Weekly attenders were significantly less likely to report stroke, even after adjusting for multiple variables only in African American women OR = 0.35, 95% CI 0.19-0.66, p < 0.01. No association was seen for heart attack or diabetes. Fish intake at least weekly was more common in weekly attenders, significantly so only in African American women (odds ratio 1.24, 95% CI 1.01-1.58, p < 0.05) and in older Mexican American men (odds ratio 2.57, 95% CI 1.45-2.57, p < 0.01). In linear regression analyses, no significant independent associations were seen between attendance frequency and serum lipid levels or dietary intake of energy, or fat in g and % of kcal. Hypotheses generated by these analyses are that in African American women stroke is less prevalent and weekly fish intake more prevalent among weekly attenders than others and that there are no significant independent associations of serum lipids, dietary intake, prevalent CHD, or diabetes with frequency of attendance of religious services. Independent testing of these hypotheses in other samples is needed.

W13-P-015 High serum antibody levels toperiodontal pathogens are associated with subclinical, prevalent, and future CHD

W13-P-015 High serum antibody levels toperiodontal pathogens are associated with subclinical, prevalent, and future CHD