Prevalence Of Cardiovascular Disease Risk Factors Research Articles

Cardiovascular wellness in low-resource settings: A mobile app-based risk prediction study among fuel filling station employees in Puducherry district

ABSTRACT Background: India is witnessing a significant increase in the prevalence of non-communicable diseases (NCDs), and addressing this requires a comprehensive and multi-faceted approach. The burden of NCDs puts a strain on the healthcare system, requiring an increased focus on preventive measures, early detection, and management of chronic conditions. Adopting a risk-based approach to cardiovascular diseases (CVDs) in resource-poor settings offers several economic and social advantages. Aims and Objectives: The aim of the study was to assess the prevalence of CVD risk factors among fuel filling station employees in the Puducherry district and the 10-year CVD risk prediction score among the study participants with the World Health Organisation package of essential non-communicable (WHO PEN) app and package for resource-poor settings. Methods: A community-based cross-sectional study was conducted among the fuel filling station employees in Puducherry. A universal sampling method was employed. The data were collected using a pilot-tested, predesigned, structured questionnaire and the WHO PEN app was used to estimate the CVD risk score. The data were collected from February 2021 to January 2022 and analysed using Statistical Package for Social Sciences (SPSS) version 20. Frequency distribution along with the Chi-square test was employed to test statistical significance. Results: Out of 212 subjects, 170 (80.2%) were males, out of which 116 (54.7%) were between 40 and 50 years old. Nearly half the participants (48%) had CVD risk scores ranging from 5 to 20%, with an increased prevalence of CVD risk factors, namely, obesity/overweight (65.5%), physical inactivity (58.5%), hypertension (52%), alcohol consumption (51%) and tobacco consumption in any form (25.5%). Conclusions: This study sheds light on the sedentary nature of the occupation and the increased prevalence of CVD risk factors among the study participants. It is also evident that the participants had higher CVD risk scores for developing CVDs in the future. Recommendations: The use of mobile-based apps can be used as a feasible strategy to save scarce resources in delivering primary health care. We also propose that the nature of occupation be taken into account as one of the parameters for risk prediction. Risk prediction assessment should be made mandatory during the annual examination of employees.

External validation of the Systematic COronary Risk Evaluation 2 (SCORE2) model in cancer patients

Abstract Background Guidelines recommend cardiovascular disease (CVD) risk stratification before cancer treatment to better identify patients for intensified follow-up or cardioprotective treatment. Only a limited number of CVD risk stratification tools exists for cancer patients which at present is not widely used nor extensively validated. The ESC Guidelines on Cardio-oncology 2022 suggest using traditional CVD models like the SCORE2 (Systematic Coronary Risk Estimation 2). However, external validation in cancer populations is lacking. Purpose Our aim was to study the prevalence of CVD risk factors and incidence of cardiovascular events in a cancer cohort and externally validate the Systematic COronary Risk Evaluation 2 (SCORE2) model in this context. Methods We included 1058 patients from a large-scale populational study without diabetes or established CVD aged 40 to 69 years and diagnosed with cancer between 2006 and 2012. Participants were assessed for cardiovascular risk factors at baseline and followed until Sept 2023. The Norwegian Cancer Registry provided patient specific information about cancer characteristics and therapy. The primary outcome was the combination of myocardial infarction (MI), stroke or CVD mortality, which was retrieved from the local hospitals’ registries and the national causes of death registry. Performance was assessed using smooth calibration curves of predicted and observed risk and Harrel’s C-statistic for discrimination, both corrected for competing risks. SCORE2 was recalibrated by adapting the model with a single multiplicative constant based on the expected-to-observed ratio (E/O-ratio). Results The most common cancer types were gastrointestinal cancer (19%), male genital including prostate cancer (19%) and breast cancer (18%). Mean (SD) age was 58.6 (7.6) years, 54% were female. Prevalence of cardiovascular risk factors are shown in Table 1. In total, 121 (11%) individuals had a CVD event (MIs 53 (44%), strokes 46 (38%) and CVD deaths 22 (18%)) during a median (interquartile range) follow-up of 11.1 (3.4 to 13.1) years, and 360 (34%) died due to non-CVD causes. Calibration plots showed adequate agreement between estimated and observed 10-year prognosis after recalibration (C-statistics 0.685, 95% CI 0.643 to 0.728), Figure 1. E/O-ratio for men was 0.65 and for women 0.63, indicating underestimation of the observed CVD incidence. After recalibration, the median estimated 10-year risk was 8.1% (IQR 5 to 11), 36% had >10% 10-year risk and 9% had >15% 10-year risk. Conclusion SCORE2 underestimated CVD risk in a general cancer population but showed adequate agreement after recalibration and C-statistics aligned with the original external validation cohorts. SCORE2 is useful also in cardio-oncology setting (after recalibration) to identify individuals at higher risk of developing CVD.

Evaluating trends and insights in cardiovascular risk among the polish population

Abstract Introduction Cardiovascular diseases (CVD) are the leading cause of death in Poland and worldwide. Lifestyle changes and early diagnosis can reverse this unfavorable trend. In the face of escalating global health challenges, the identification of CVD risk factors becomes paramount, especially within national contexts where demographic shifts and lifestyle changes can significantly impact the health profile of the population. Aim of the study. Determining the prevalence of CVD risk factors in the Polish population and analyzing their changes over time. Material and Methods Data of 705,420 Poles aged 35-55 years who were enrolled in CVD disease prevention programme between 2012 and 2021 were analysed. The prevalence of the following CVD risk factors was determined: nicotinism, hypertension, elevated total cholesterol, elevated LDL, reduced HDL, elevated triglycerides, elevated glucose (indicating pre-diabetes), low physical activity, overweight, obesity, SCORE ≥5%. In addition, we assessed how the mean SCORE, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, LDL cholesterol, triglycerides, glucose levels and waist circumference changed over time. Results Nicotinism affected 17.98%-24% of women (W) and 27.29%-36% of men (M). Hypertension was in 7.04%-8.58% of W and 17.45%-19.62% of M. Elevated total cholesterol were in 55.69%-63.64% of W and 65.91%-72.68% of M. Elevated LDL were in 44.77%-54.2% of W and 58.26%-65.48% of M. Reduced HDL were in 9.84%-11.52% of W and 14.48%-16.57% of M. Elevated triglyceride were in 13.44%-15.37% of W and in 33.81%-36.29% of M. Elevated glucose indicating a pre-diabetic status were in 10.70%-13.16% of W and in 18.91%-22.76% of M. Low physical activity was in 75.96%-82.2% of W and 73.32%-81.67% of M. Overweight conditions were in 30.37%-31.67% of W and 48.61%-49.45% of M. Obesity affected 14.04%-17.12% of W and 20.67%-24.69% of M. SCORE ≥ 5% was in 0.23%-0.38% of W and in 13.08%-18.72% of M. There was a decrease in the mean SCORE value (-0.08; 95%CI: -0.09 - -0.06) from 2012. An increase over time was noted in mean BMI (-0.01; 95%CI: -0.05 - 0.04). There was a slight decrease followed by a notable increase over time in mean systolic (-0.35; 95%CI: -0.47 - -0.24) and diastolic blood pressure (-0.25; 95%CI: -0.32 - -0.18). There was a decrease in mean total cholesterol (-3.29; 95%CI: -4.27 - -2.31) and mean LDL cholesterol (-3.11 95%CI: -4.22 - -2.01). A notable increase was observed in mean glucose values (0.01; 95%CI: 0-0.01). Over time, there was an increase in mean waist circumference value (-0.19; 95%CI: -0.54-0.16). Conclusions The escalation of CVD risk among the Polish population is illustrated, with a marked increase in obesity, sedentary lifestyles and indicators of metabolic syndrome. These trends highlight the urgent need for targeted public health initiatives and for the implementation of comprehensive strategies to mitigate these risks

Prevalence of cardiovascular disease risk factors and their association with outcomes in working-age patients with arterial hypertension

Most epidemiological studies are devoted to studying the prevalence of risk factors (RFs) for cardiovascular diseases (CVD) in the general population, but this problem has not been sufficiently studied in people of working age. Purpose. To study the prevalence of CVD risk factors and their relationship with outcomes in working-age patients with arterial hypertension (AH). Material and methods. Data from 13,994 working-age patients with hypertension who were observed on an outpatient basis were analyzed. The analysis was carried out according to the following CVD risk factors: gender, age, body mass index (BMI), smoking history, diabetes mellitus (DM), levels of systolic and diastolic blood pressure (BP), cholesterol, glucose, glomerular filtration rate, risk on the SCORE scale. The effect of risk factors on unfavorable outcome of the disease was also studied. Results. Patients with AH of working age, who were observed and treated on an outpatient basis, had fairly good control of AH (average values – 135/80 mm Hg). Women had lower systolic BP, total cholesterol levels and BMI were higher than men. Men were more likely to have a history of smoking and T2DM. Among all patients, T2DM was detected in 4.7% of cases, while patients with DM were older in age, had a higher BMI, and were more likely to smoke compared to patients without DM. In patients with T2DM, BP control was better (average value – 130/80 mm Hg), the level of total cholesterol did not differ significantly from patients without DM. During the observation period, 234 (1.7%) patients died (from coronary heart disease – 69.7%, from CVD – 30.3%). The following risk factors for unfavorable outcome were identified: age, male gender, increased systolic BP, smoking, presence of diabetes, increased risk score on the SCORE scale.

Abstract P332: High Shared Decision-Making Scores Associated with Blood Pressure Control: The Office Guidelines Applied to Practice (Office-GAP) IMPACT Program

Introduction: Cardiovascular disease (CVD) mortality is higher in people with diabetes mellitus due to the increased prevalence of CVD risk factors. The Office-Gap IMPACT Program (Office-Guidelines Applied to Practice Improving Diabetic Patients’ Adherence to Treatment and Prevention of Cardiovascular Disease) is a patient activation cluster-randomized trial (intervention: Office-GAP + text vs. control: text alone) seeking to improve communication and patient-provider partnerships through patient and provider training in shared decision-making (SDM), use of a guideline-based checklist, and text messaging to improve medication adherence in Federally Qualified Health Care Centers. Hypothesis: We assessed the hypothesis that individual level demographic and clinical characteristics of patients enrolled in Office-GAP IMPACT would be associated with patient-reported SDM using the CollaboRATE 3-item instrument, which measures three core SDM domains: (1) explanation of health issues, (2) elicitation of patient preferences and (3) integration of patient preferences into decisions with a 10-point response scale for each domain ranging from 0 “No effort was made” to 9 “Every effort was made.” Methods: The CollaboRATE was completed three months after baseline. A top-scoring method (a rating of 9 for all three items) was used to dichotomize CollaboRATE responses into two categories - participants who reported the highest levels of SDM on each of the three items versus those who did not. Accounting for the cluster-randomized design, generalized estimating equations (GEEs) were used to compare demographics and baseline factors that may be associated with the outcome. Results: A total of 288 patients were enrolled (intervention, N=158 and control, N=130). Among those with non-missing CollaboRATE scores, 152 (73% ± 3%) had high SDM. The inverse probability of non-missing weighting method was used to account for the missing data in CollaboRATE. Results from the weighted univariable models suggested older patients, history of smoking, and those with BP under control (< 140/90 mmHg) at baseline were more likely to be satisfied with the SDM process. In multivariable logistic regressions, only BP control was statistically significant after adjusting for other factors. Conclusions: In conclusion, participants with BP control had higher SDM scores, which could lead to better health outcomes. Providers should include the practice of SDM principles in every clinical encounter.

Exploring the cardiovascular health behaviors of college students and the areas that need increased public health efforts.

Cardiovascular disease (CVD) is a leading cause of death worldwide among adults. Traditionally, the disease has been considered as a condition affecting older adults. However, its risk factors (e.g., poor diet, sedentary behavior, inadequate sleep, and obesity) are increasingly being identified in younger populations. There is a need to increase the evidence of CVD risk factors in this population to further support preventive programs in this demographic. This study investigates the prevalence of CVD risk factors in young adult, college students. Data was used from the American College Health Association's National College Health Assessment (ACHA-NCHA) II-C. The sample included data from 426,259 students, ages 18-25. Data was reviewed on race, nutrition, physical activity, tobacco use, sleep, weight, and history of chronic disease. Descriptive statistics were utilized to examine the prevalence of CVD risk factors. There was a notable prevalence of CVD risk factors, such as insufficient nutrition, obesity, insufficient physical activity, and inadequate sleep, among college students. CVD-related risk factors are on the rise within this demographic. There is a pressing need for the expansion of public health initiatives aimed at enhancing CVD awareness and prevention among college students.

Evaluation of Cardiovascular Risk Profile and Risk Scores of Antiretroviral Therapy-naïve HIV Patients in Eastern India.

People living with human immunodeficiency virus (PLHIV) are known to have an increased prevalence of traditional cardiovascular risk factors and are at a higher risk of cardiovascular disease (CVD). This study was done to assess the CVD risk factors in treatment naïve PLHIV in a center of the national program. In this cross-sectional explorative study, traditional CVD risk factors were assessed, and 10-year Framingham and atherosclerotic cardiovascular disease (ASCVD) risk score were calculated in treatment naïve PLHIV attending the antiretroviral therapy (ART) center, IMS, BHU. The study included 337 ART naïve patients. The prevalence of CVD risk factors in treatment naïve PLHIV - were low high-density lipoprotein cholesterol levels (81.4%), high triglyceride levels (32.7%), smoking (32.3%), obesity (13.6%), hypertension (5%), diabetes (2.7%), and high low-density lipoprotein cholesterol levels (2.1%). Moderate-to-high 10-year Framingham Risk Score and American Heart Association/American College of Cardiology 10-year ASCVD risk score were 10.8% and 8.9%, respectively. In Framingham Risk Score, age ≥40 years (odds ratio [OR] - 131) (95% confidence interval [CI] - 6.5-1043) alcohol intake (OR - 5.14 [95% CI - 1.82-14.46] and presence of tuberculosis (OR - 4.78) (95% CI - 1.48-15.40), while in ASCVD risk score history of alcohol intake (OR - 26.20 [95% CI - 3.1-216.8] were at higher risk of CVD in multivariate variate analysis. CVD risk factors were common among ART naïve patient. Thus, screening, education, and treatment of CVD risk factors should be done in these patients at initiation of care.

Prevalence of Cardiovascular Risk Factors in Rural Kenya-2023: Vihiga II.

The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) risk factors among adults in Vihiga County, Western Kenya. A cross-sectional population-based study was completed. Participants (n = 575) were selected at the household level using a systematic random sample, and sociodemographic, anthropometrical, clinical, and biochemical data were collected. The sample consisted of 71.8% women and 28.2% men. The prevalence of high blood pressure (BP) was 56.4%. A greater proportion of women (62.8%) had low levels of high-density lipoprotein (HDL) compared with men (44.7%) (odds ratio [OR], 2.99; 95% CI, 1.59-5.64). High triglyceride levels were more prevalent in men (16.4%) compared with women (15.4%) (OR, 0.37; 95% CI, 0.19-0.71). Based on average waist to hip ratio, abdominal obesity was significantly higher in women (55.4%) compared with men (27.6%) (OR, 2.62; 95% CI, 1.52-4.49). Low levels of physical inactivity were prevalent in women (36.3%) at significantly higher proportions compared with men (22.7%) (OR, 1.73; 95% CI, 1.02-2.92). Women used tobacco at significantly lower proportions (0.5%) compared with men (27.2%) (OR, 0.01; 95% CI, 0.00-0.06). A higher proportion of women (47.9%) rated their general health as poor compared with men (37.1%), a statistically significant difference (OR, 2.0; 95% CI, 1.23-3.28). The prevalence of CVD risk factors, such as hypertension, obesity, dyslipidemia, low physical activity, and tobacco use indicates the urgent need for comprehensive health promotion programs to improve public health in rural areas of Kenya.

Ten-year risk of cardiovascular events among the adult population of West Tripura District of India by the Framingham risk score: A cross-sectional study.

Cardiovascular diseases (CVDs) are the leading causes of mortality worldwide. Predicting the 10-year risk of cardiovascular events (CVEs) may save lives through timely intervention. Framingham risk scoring (FRS) can effectively predict this risk. This study aimed to estimate the 10-year risk of CVE using FRS and to estimate the prevalence of CVD risk factors and their associations with FRS among adults in the West Tripura District of India. This community-based cross-sectional study was conducted from 1 November 2019 to 30 November 2021 in the West Tripura District of India, using FRS 2008 and a pretested interview schedule among 290 individuals aged ≥ 30 years chosen by multistage sampling. The majority, that is 61.7%, of the study subjects had low risk, 18.6% had intermediate risk and 19.7% had high risk of CVE within 10 years. The prevalence of hypertension was 55.6%; diabetes mellitus, 55.9%; smoking, 96.2%; dyslipidaemia, 34.3%; alcohol consumption, 96.2%; physical inactivity, 54%; and obesity, 64.6%. The bivariate analysis detected a significant association of FRS with age, sex, residence, literacy, marital status, obesity, smoking, alcoholism, blood pressure (BP), high-density lipoprotein cholesterol (HDL-C) and glycaemic status of the study subjects. The logistic regression analysis has identified age >50 years, male sex, hypertension, smoking and diabetes mellitus as significant determinants of high FRS. Adults living in the West Tripura District of India have a high prevalence of CVD risk factors. About one-fifth of this population has a high risk of CVE in 10 years. Controlling hypertension, smoking and diabetes mellitus may help reduce this risk.

Therapy-naïve malignancy causes cardiovascular disease: a state-of-the-art cardio-oncology perspective.

Cardiovascular disease (CVD) and cancer are the leading causes of mortality worldwide. Although generally thought of as distinct diseases, the intersectional overlap between CVD and cancer is increasingly evident in both causal and mechanistic relationships. The field of cardio-oncology is largely focused on the cardiotoxic effects of cancer therapies (e.g., chemotherapy, radiation). Furthermore, the cumulative effects of cardiotoxic therapy exposure and the prevalence of CVD risk factors in patients with cancer lead to long-term morbidity and poor quality of life in this patient population, even when patients are cancer-free. Evidence from patients with cancer and animal models demonstrates that the presence of malignancy itself, independent of cardiotoxic therapy exposure or CVD risk factors, negatively impacts cardiac structure and function. As such, the primary focus of this review is the cardiac pathophysiological and molecular features of therapy-naïve cancer. We also summarize the strengths and limitations of preclinical cancer models for cardio-oncology research and discuss therapeutic strategies that have been tested experimentally for the treatment of cancer-induced cardiac atrophy and dysfunction. Finally, we explore an adjacent area of interest, called "reverse cardio-oncology," where the sequelae of heart failure augment cancer progression. Here, we emphasize the cross-disease communication between malignancy and the injured heart and discuss the importance of chronic low-grade inflammation and endocrine factors in the progression of both diseases.

Cardiovascular risk profile in two cohorts of young apparently healthy South Asian descendants in the Netherlands: still a long way to go!

Cardiovascular disease (CVD) imposes a major healthcare burden on young descendants of South Asian migrants living in the western world. In comparison to the native population, the prevalence is significantly higher and the prevalence of CVD risk factors is increasing rapidly. The cardiovascular risk profile and 10-year risk scores of South Asian descendants were evaluated in two cohorts with a 10-year time difference. Two cross-sectional studies, conducted in 2004 and 2014, focused on asymptomatic South Asian descendants aged 18-59 years were performed. A short questionnaire, BMI, waist circumference, blood pressure, and nonfasting blood tests were obtained. The cohort of 2014 was matched with the cohort of 2004, based on age, gender, and family history of CVD. In 2014, 674 South Asians (44% men, age 38.2 ± 12.0 years) were matched with 674 South Asians (44% men, age 38.3 ± 12.1 years) included in 2004. Notably, hypertension prevalence decreased significantly in 2014 (10.6% vs 23.1% in 2004, P < 0.001), while mean BMI increased (26.1 vs 24.9, P < 0.001). The mean Framingham risk score was lower in 2014 (5.31 ± 6.19%) than in 2004 (6.45 ± 8.02%, P < 0.05). This study demonstrates that South Asian descendants in 2014 have a lower but still high absolute risk for coronary events compared to 2004. Important differences in cardiovascular risk profile exist. Despite improvements, South Asian descendants in 2014 still face a high absolute risk for coronary events compared to 2004, indicating the necessity for continued primary prevention and lifestyle interventions.

Cardiovascular risk factors among nurses: A global systematic review and meta-analysis.

Nurses as the largest group of health workers have a very stressful job which can cause number of diseases specially increase cardiovascular risk factors. This study aims to investigate the overall epidemiology of cardiovascular disease (CVD) risk factors among nurses. We searched all four main databases such as Scopus, PubMed, Embase and Web of Sciences from the beginning of 2000 to March 2022 with appropriate Mesh Terms. We also searched Google scholar. Then we applied inclusion and exclusion criteria and after selection the studies the Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Comprehensive Meta-analysis and R software was used for analysis. Finally, 22 articles with a total number of 117922 nurses were included. Among all risk factors, sedentary lifestyle and lack of regular physical activity with a prevalence of 46.3% (CI 95%, 26.6-67.2) was regarded as the main prevalent risk factor among nurses. The mean systolic blood pressure (SBP) measured in the study population was 121.31 (CI 95%, 114.73-127.90) and the mean diastolic blood pressure (DBP) was 78.08 (CI 95%, 74.90-81.25). Also family history of cardiovascular disease (41.9%; 95% IC: 29.8-55.1%), being overweight (33.3%; 95% IC: 24.7-43.2%), and alcohol consumption (24.6%; 95% IC: 16.4-35.2%) was found among the participants. Study results revealed that sedentary lifestyle was the main prevalent CVD risk factor among nurses followed by family history of cardiovascular disease, being overweight and alcohol consumption. Furthermore, among nurses with shift works almost all risk factors got higher score representing the worse condition in comparison with day workers' nurses. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. In general, many studies have emphasized the impact of the nursing profession on the incidence of some cardiovascular patients. Also, different shifts of nurses can have a double effect. In this study, the mean for sedentary lifestyle was reported to be 46.3% which represented the most prevalent risk factor for cardiovascular risk factors among study population. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. This information can comprise essential tools for health human resource management contributing to advance nursing.

Abstract P517: Age-Stratified Prevalence of Cardiovascular Risk Factors Among Asian American Subgroups

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the US. The prevalence of CVD risk factors and CVD mortality are heterogeneous among disaggregated Asian American subgroups; but little is known about when in the life course these differences arise. Hypothesis: We hypothesize that there are age-specific differences in the prevalence of CVD risk factors across Asian American subgroups that may predispose some subgroups to developing CVD at younger ages. Methods: We analyzed data from 78,559 Asian American adults enrolled in the National Health Interview Survey (2000-2018). CVD risk factors (hypertension, diabetes, high BMI, nicotine exposure, alcohol consumption, insufficient physical activity, and suboptimal sleep) and age were self-reported. We estimated the age-stratified prevalence of each CVD risk factor among Asian American subgroups (Filipino, Indian, Chinese, and “Other Asian”). Analyses accounted for the complex survey design. Results: The study population included 20.3% Chinese, 23.6% Filipino, 18.4% Indian, and 37.7% Other Asian groups. Filipinos had the highest prevalence of hypertension (6.4%, 95% CI: 5.1, 8.1), obesity (24.8%, 95% CI: 22.1, 27.7), alcohol consumption (67%, 95% CI: 63.7, 70.1), and suboptimal sleep (37.3%, 95% CI: 34.3, 40.4) at younger ages (18 - 34). The highest prevalence of diabetes was found in the Indian subgroup starting at ages 35 - 44 years. The Other Asian subgroup had highest prevalence of nicotine exposure (16.1%, 95% CI: 14.6, 17.7) at younger ages (18 - 34). The Chinese subgroup consistently had the lowest prevalence of CVD risk factors across age strata. Conclusions: Our findings show that Indian, Filipino, and Other Asian subgroups have a higher prevalence of most CVD risk factors at earlier ages compared to Chinese subgroup. This may explain why CVD prevalence among Chinese Americans is lower than other Asian subgroups. Our study demonstrates the importance of targeting CVD risk factors among susceptible Asian subgroups earlier in the life course.

Cytokines, C-Reactive Protein, and Risk of Incident Hypertension in the REGARDS Study.

Hypertension is a highly prevalent cardiovascular disease risk factor that may be related to inflammation. Whether adverse levels of specific inflammatory cytokines relate to hypertension is unknown. The present study sought to determine whether higher levels of IL (interleukin)-1β, IL-6, TNF (tumor necrosis factor)-α, IFN (interferon)-γ, IL-17A, and CRP (C-reactive protein) are associated with a greater risk of incident hypertension. The REGARDS study (Reasons for Geographic and Racial Difference in Stroke) is a prospective cohort study that recruited 30 239 community-dwelling Black and White adults from the contiguous United States in 2003 to 2007 (visit 1), with follow-up 9 years later in 2013 to 2016 (visit 2). We included participants without prevalent hypertension who attended follow-up 9 years later and had available laboratory measures and covariates of interest. Poisson regression estimated the risk ratio of incident hypertension by level of inflammatory biomarkers. Among 1866 included participants (mean [SD] aged of 62 [8] years, 25% Black participants, 55% women), 36% developed hypertension. In fully adjusted models comparing the third to first tertile of each biomarker, there was a greater risk of incident hypertension for higher IL-1β among White (1.24 [95% CI, 1.01-1.53]) but not Black participants (1.01 [95% CI, 0.83-1.23]) and higher TNF-α (1.20 [95% CI, 1.02-1.41]) and IFN-γ (1.22 [95% CI, 1.04-1.42]) among all participants. There was no increased risk with IL-6, IL-17A, or CRP. Higher levels of IL-1β, TNF-α, and IFN-γ, representing distinct inflammatory pathways, are elevated in advance of hypertension development. Whether modifying these cytokines will reduce incident hypertension is unknown.

Primary Prevention of Cardiovascular Disease in Women.

Cardiovascular disease (CVD) remains a leading cause of mortality in women, necessitating innovative primary prevention strategies. Contemporary guidelines on primary prevention of CVD highlight the increasing prevalence of CVD risk factors and emphasize the significance of female-specific risk enhancers that substantially augment the future risk of CVD. These risk factors occur throughout a woman's life cycle, such as hormonal contraception, hypertensive disorders of pregnancy, and menopause, all of which confer an added layer of risk in women beyond the conventional risk factors. Despite this, current methods may not fully capture the nuanced vulnerabilities in women that increase their risk of CVD. In this review, we highlight gender-specific risk enhancers and subsequent prevention as well as strategies to improve primary prevention of CVD in women.

The prevalence of cardiovascular disease risk factors among adults living in extreme poverty.

Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank's international line for extreme poverty (those with income <$1.90 per day) globally is sparse. Here we pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in extreme poverty globally, and sorted individuals by country-specific measures of household income or wealth to identify those in extreme poverty. CVD risk factors (hypertension, diabetes, smoking, obesity and dyslipidaemia) were present among 17.5% (95% confidence interval (CI) 16.7-18.3%), 4.0% (95% CI 3.6-4.5%), 10.6% (95% CI 9.0-12.3%), 3.1% (95% CI 2.8-3.3%) and 1.4% (95% CI 0.9-1.9%) of adults in extreme poverty, respectively. Most were not treated for CVD-related conditions (for example, among those with hypertension earning <$1.90 per day, 15.2% (95% CI 13.3-17.1%) reported taking blood pressure-lowering medication). The main limitation of the study is likely measurement error of poverty level and CVD risk factors that could have led to an overestimation of CVD risk factor prevalence among adults in extreme poverty. Nonetheless, our results could inform equity discussions for resource allocation and design of effective interventions.

Heterogeneity in the Prevalence of Cardiovascular Risk Factors by Ethnicity and Birthplace Among Asian Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey.

Asian people in the United States have different sociodemographic and health-related characteristics that might affect cardiovascular disease (CVD) risk by ethnicity and birthplace. However, they are often studied as a monolithic group in health care research. This study aimed to examine heterogeneity in CVD risk factors on the basis of birthplace among the 3 largest Asian subgroups (Chinese, Asian Indian, and Filipino) compared with US-born non-Hispanic White (NHW) adults. A cross-sectional analysis was conducted using the 2010 to 2018 National Health Interview Survey data from 125 008 US-born and foreign-born Chinese, Asian Indian, Filipino, and US-born NHW adults. Generalized linear models with Poisson distribution were used to examine the prevalence and prevalence ratios of self-reported hypertension, diabetes, high cholesterol, physical inactivity, smoking, and overweight/obesity among Asian subgroups compared with US-born NHW adults. The study included 118 979 US-born NHW and 6029 Asian adults who self-identified as Chinese (29%), Asian Indian (33%), and Filipino (38%). Participants' mean (±SD) age was 49±0.1 years, and 53% were females. In an adjusted analysis, foreign-born Asian Indians had significantly higher prevalence of diabetes, physical inactivity, and overweight/obesity; foreign-born Chinese had higher prevalence of physical inactivity, and foreign-born Filipinos had higher prevalence of all 5 CVD risk factors except smoking compared with NHW adults. This study revealed significant heterogeneity in the prevalence of CVD risk factors among Asian subgroups by ethnicity and birthplace, stressing the necessity of disaggregating Asian subgroup data. Providers should consider this heterogeneity in CVD risk factors and establish tailored CVD prevention plans for Asian subgroups.

Sex Differences in Cardiovascular Disease Risk Factor Prevalence, Morbidity, and Mortality in Colombia: Findings from the Prospective Urban Rural Epidemiology (PURE) Study.

Controversies exist on whether the presence of cardiovascular risk factors and their association with major cardiovascular events (MACE) is different between men and women. Most of the evidence comes from high-income countries, hindering extrapolation of sociocultural and demographic factors of other regions. To evaluate sex differences in the prevalence of cardiovascular risk factors and the incidence of MACE and diabetes in Colombian adults. We performed a survival analysis from women and men aged 35-70 belonging to the Prospective Urban Rural Epidemiology-Colombia prospective study. Incidence rates for MACE composite (myocardial infarction, stroke, heart failure, death) and each outcome and diabetes were calculated. Kaplan-Meier curves and log-rank tests were performed. The association between demographic, behavioral, and metabolic variables with MACE and diabetes were evaluated with Cox proportional hazards models. 7,552 participants (50±9.7 years) were included; 64% were women. Women had higher hypertension prevalence, body mass index, levels of total cholesterol, LDL-c, and HDL-c but lower triglycerides levels. Women were more sedentary but fewer smokers or active alcohol consumers and had higher educational levels. After 12-year mean follow-up (SD 2.3), the incidence rate of MACE composite was higher in men [4.2 (3.6-4.9) vs. 3.2 (2.8-3.7) cases per 1000 person-years]. Diabetes had the greatest association with MACE (HR = 2.63 95%CI:1.85;3.76), followed by hypertension (HR = 1.75 95%CI:1.30;2.35), low relative grip strength (HR = 1.53 95%CI:1.15;2.02), smoking (HR = 1.47 95%CI: 1.11;1.93), low physical activity (HR = 1.42 95%CI: 1.03;1.96). When evaluating risk factors by sex, only an increased waist-to-hip ratio was more strongly associated with MACE in men (p-interaction <0.05). The composite MACE outcome was higher in men despite having a lower overall burden of risk factors. The risk factors contribution was similar, leading us to reconsider the need to carrying out differentiated cardiovascular risk prevention and management campaigns, at least in our region.

No Evidence for an Association of HIV and Antiviral Treatment With Changes in Framingham Cardiovascular Risk Score in the Ndlovu Cohort Study.

HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high-income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle-income country. This longitudinal analysis of the NCS (Ndlovu Cohort Study), South Africa used baseline to 36-month follow-up data. Demographics, HIV, ART status, and cardiometabolic measures were obtained. FRS was used as a CVD risk measure. Through linear mixed models, FRS trends over time and the association with HIV were studied. Analysis included 1136 participants, with 609 (54%) having HIV, and 495 (81%) taking ART. At baseline, 9.8% of participants had a high FRS. People living with HIV (PLHIV) had a 3.2% lower FRS than HIV-negative participants (P<0.001). FRS increased similarly for both groups over time. Other factors associated with FRS were secondary and higher education (ß value: -0.075, P<0.001; ß value: -0.084, P<0.001) and alcohol consumption (ß value: 0.011, P<0.001). CVD risk increased for all participants over 36 months, suggesting classic risk factors rather than HIV status or ART to be drivers of CVD risk. People living with HIV had a significantly lower FRS than their HIV-negative counterparts, possibly related to HIV itself or a more frequent interaction with healthcare services. No association of HIV and ART with changes in FRS over 36 months was observed, suggesting the need for research using clinical endpoints to elucidate the effects of HIV and ART on CVD risk. Population-based prevention of CVD risk factors in sub-Saharan Africa is warranted, regardless of HIV status.

Cardiovascular disease risk factor prevalence among police officials: findings from a cross-sectional study in Kerala, India.

Police officials' stressful and physically demanding activities reportedly increase the risk of cardiovascular disease (CVD). This study explored the prevalence of CVD risk factors such as hypertension, diabetes, tobacco use, alcohol consumption, and overweight among police officials in Kerala, India. A cross-sectional study was conducted among 255 police officials in selected police stations in the Thiruvananthapuram district, Kerala. The World Health Organization STEPs questionnaire for noncommunicable disease risk factor surveillance was used to collect information. We collected STEP 1 (demographics, tobacco use, alcohol consumption, physical activity, and diet) and STEP 2 (weight, height, and blood pressure) data. Multivariable analysis was done to identify factors associated with hypertension. The mean age of participants was 42years (range: 30-55years) and the majority were men (83.5%). Current use of tobacco or alcohol was reported by 22.7% of the participants. The prevalence of overweight was 64.7% and physical inactivity was 35.1%. Self-reported prevalence of diabetes was 7.5% and of hyperlipidemia was 11.4%. Hypertension prevalence was 40.4%. Among hypertensives, 35.9% were aware, 20.4% were treated, and 5.8% had controlled blood pressure. The control rate was 28.6% among treated hypertensives. When controlling for age, diabetes (odds ratio [OR]: 3.57; 95% CI: 1.16-10.90), and overweight (OR: 1.88; 95% CI: 1.06-3.35) participants were more likely to have hypertension compared with their counterparts. Police officers have a high prevalence of significant CVD risk factors such as hypertension, physical inactivity, and being overweight. These findings reinforce the need for interventions addressing the above risk factors to prevent CVD in this population.