Cardiovascular Disease Prevention Strategies Research Articles

Mediterranean lifestyle and cardiovascular disease prevention.

Adherence to a Mediterranean dietary pattern is a well-established protective factor against cardiovascular disease (CVD). However, diet quality is only one aspect of the overall healthy lifestyle adopted by Mediterranean populations. The latter has never been evaluated as a multi-factorial composite lifestyle. Thus, the aim of the present study was to provide a broader picture of the Mediterranean lifestyle and its effects on CVD risk, among elderly individuals. During 2005-2015, 2,749 older (aged 65-100 years) from 21 Mediterranean islands (MEDIS) and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled onto the study. Dietary habits, physical activity status, socio-demographic characteristics, lifestyle parameters (sleep, smoking habits, social life and educational status) and clinical profile aspects were derived through standard procedures. The overall prevalence of the traditional CVD risk factors were 62.3% for hypertension, 22.3% for diabetes mellitus (type 2) and 47.7% for hypercholesterolemia. The presence of diabetes mellitus was positively predicted by the geriatric depression scale (GDS) [odds ratio (OR) =1.13, 95% confidence interval (CI): 1.02-1.25] and by an urban residential environment (OR =2.57, 95% CI: 1.10-6.06) after adjusting for several confounders. Presence of hypertension was predicted by increasing age (OR =1.07, 95% CI: 1.02-1.12), increasing body mass index (BMI) (OR =1.12, 95% CI: 1.04-1.21), the habit of midday sleep (OR =2.07, 95% CI: 1.07-4.02) and inversely predicted by the frequency of socializing with friends (OR =0.767, 95% CI: 0.616-0.955). The estimated score in the GDS was the only independent positive predictor for the presence of hypercholesterolemia (OR =1.10, 95% CI: 1.01-1.21). Lifestyle parameters such as social life, midday sleep (siesta) and residential environment are strongly associated with the presence of CVD risk factors in elderly and should be part of broader CVD prevention strategies to reduce the burden of the disease.

Inflammatory Markers and Brain-Derived Neurotrophic Factor as Potential Bridges Linking Bipolar Disorder and Cardiovascular Risk Among Adolescents.

Bipolar disorder (BD) is associated with increased rates of cardiovascular disease (CVD). Brain-derived neurotrophic factor (BDNF) and inflammatory markers are leading biomarkers in BD. We examined whether these biomarkers underlie the link between BD and CVD proxies among adolescents with bipolar spectrum disorders. Subjects were 60 adolescents, 13-19 years old (40 with BD and 20 healthy controls [HCs]). Semistructured interviews determined diagnoses based on DSM-IV. Serum was assayed for BDNF, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and flow-mediated dilation were assessed using ultrasound. Procedures were conducted at a subspecialty clinic (January 2011-May 2014). Adolescents with BD had significantly greater waist circumference (BD: 81.72 cm [11.67 cm], HC: 75.64 cm [8.63 cm]; U = 547.5, P = .021), body mass index (BMI) (BD: 25.50 kg/m²undefined[5.29 kg/m²], HC: 21.76 kg/m² [3.43 kg/m²]; U = 608.5, P < .0001), pulse pressure (BD: 42.31 mm Hg [10.57 mm Hg], HC: 33.84 mm Hg [6.69 mm Hg]; U = 561.5, P < .001), and IL-6 (BD: 8.93 pg/mL [7.71 pg/mL], HC: 4.96 pg/mL [6.38 pg/mL]; U = 516.0, P < .0001) than HC adolescents. Subjects with BD-I (n = 14) and BD-II (n = 16) had greater IL-6 versus HCs (F₃,₅₁ = 5.29, P = .003). Controlling for BMI and age did not alter these findings. IL-6 was higher in symptomatic (n = 19) and asymptomatic BD (n = 21) versus that found in HCs (F₂,₅₂ = 7.96, P = .001). In symptomatic BD, lower BDNF was associated with greater mean cIMT (ρ = -0.507, P = .037). This study found evidence of increased inflammation among adolescents with BD. While present findings suggest a potential interplay between symptomatic status, biomarkers, and atherosclerosis proxies, there were no significant differences in cIMT or flow-mediated dilation in adolescents with BD compared to HCs. This may indicate that there is potential opportunity for CVD prevention strategies in adolescents with BD.

Cardiovascular disease screening in general practice: General practitioner recording of common risk factors.

The assessment and screening of individual risk factors for cardiovascular disease (CVD) is a critical component of CVD prevention strategies in general practice (GP). This study sought to examine current CVD risk factor recording as recommended by Australian guidelines for the management of absolute cardiovascular disease risk. A retrospective analysis of routine GP data from 149,306 GP patients aged 45years and above in eastern Melbourne was conducted. Data were collected from GP clinics located throughout inner east Melbourne from July 2011 to September 2014 through the Melbourne East Monash General Practice Database. Recording of primary risk factors necessary for CVD screening as recommended by the national guidelines was assessed, and logistic regression with generalised estimating equations was used to estimate associations between patient characteristics and risk factor recording. 137,976 (92.4%) patients were found to have had at least one risk factor recorded, 62,214 (41.7%) had the Framingham risk factors recorded (lipids, blood pressure, smoking status), while only 1957 (1.3%) had all risk factors recorded. Females (Odds Ratio [OR]: 0.72, 95% Confidence Interval [CI]: 0.65, 0.81), and those identified with diabetes (OR: 12.26, 95% CI: 9.58, 15.68) were less and more likely to have documented risk factors, respectively. Given the role of GPs in the prevention and management of CVD, it is important to improve the identification of high risk patients through screening and recording of CVD risk factors. Strategies are therefore needed to encourage ongoing CVD risk factor recording to support preventive care by GPs.

Abstract P308: Physical Activity is Associated With Lower Atherosclerotic Risk and Arterial Stiffness in Youth

Introduction: The prevalence of cardiovascular (CV) risk factors in young people has increased related to the pediatric obesity epidemic. An association between physical activity (PA) and target organ damage has been firmly established in adults, and such damage confers increased CV event risk. There is an urgent need to implement prevention strategies for CV disease in youth. Promoting PA holds promise in this regard. However, in order to be a useful marker, PA needs to be quantified accurately and feasibly in the clinical setting, and its relationship to preclinical CV disease in youth needs to be understood. Objective: We aimed to 1) examine the relationship between a subjective measure of PA and an objective measure in a young cohort, 2) determine the association of PA and other CV risk factors, and 3) test the hypothesis that PA is an independent determinant of target organ damage. Methods: Adolescents and young adults were recruited from an ongoing study of the effects of risk factors on CV aging. At baseline adolescents with type 2 diabetes mellitus were matched by age, sex, and race to lean and obese control subjects without diabetes. These analyses were performed at 5 years follow-up on 249 subjects (mean age 22 ± 3.9 years). PA was measured with the International Physical Activity Questionnaire (IPAQ) and the Actical accelerometer. Target organ damage was assessed with echocardiography and vascular structure and function testing. Subjects were stratified into tertiles of average PA with the lean group as the standard. Differences in endpoints by PA tertile were tested by analysis of variance and χ2 tests. General linear models were constructed and used to test for independent associations. Results: Responses to the IPAQ differed greatly from objective accelerometry. There was a weak trend toward increased CV risk factors and target organ damage in those with the lowest IPAQ scores. When subjects were stratified into tertiles of by accelerometry the less active subjects had significantly worse CV risk profiles as indicated by higher Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores, and more signs of target organ damage including stiffer arteries as indicated by greater carotid-femoral pulse wave velocities. These differences did not reach statistical significance when adjusted for metabolic variables. Conclusion: PA is associated with CV risk factor clustering and target organ damage in young people. Measuring PA in this population is feasible, but has limitations. This study confirms the utility of PA in predicting the presence of target organ damage. Our study is the first to demonstrate a negative, cross-sectional relationship between PA and PDAY score. Future opportunities for research include examining the contribution of different levels of PA on CV aging as well as the effect of increasing PA over time.

APOA5 Gene Polymorphisms and Cardiovascular Diseases: Metaprediction in Global Populations.

Apolipoprotein A5 (APOA5) 1131 is one of the most investigated gene polymorphisms in association with cardiovascular diseases (CVD) for its roles in epigenetics pathways. The major objective of this metaprediction study was to comprehensively examine the association of polymorphism risk subtypes of APOA5 1131 gene and potential contributing factors of CVD risks in global populations. This study is a meta-analysis to determine APOA5 gene polymorphisms as risk factors for CVDs. Following the guidelines of meta-analyses, we applied big data analytics including the recursive partition tree, nonlinear association curve fit, and heat maps for data visualization-in addition to the conventional pooled analyses. A total of 17,692 CVD cases and 23,566 controls from 50 study groups were included. The frequency of APOA5 1131 CC and TC polymorphisms in Asian populations (22.2%-52.6%) were higher than that in other populations, including Caucasians and Eurasians (10.0%-25.0%). The homozygous CC and heterozygous TC genotypes (both p < .0001) were associated with increased risks for CVD and were higher in many Western nations, including Canada, Spain, the Czech Republic, Hungary, Turkey, Egypt, France, and Iran. The CC genotype was associated with greater risks (RR > 2.00, p < .0001) for dyslipidemia and myocardial infarction, whereas RR > 1.00 was associated with metabolic syndrome, coronary artery disease, and stroke. Air pollution was significantly associated with APOA5 1131 CC and TC polymorphisms. The findings of this study provided novel insight to further understand the associations among APOA5 1131 polymorphisms, air pollution, and the development of CVDs. Methylation studies are needed to examine epigenetic factors associated with APOA5 1131 polymorphisms and CVD and to suggest potential prevention strategies for CVD.

Population strategy for cardiovascular disease prevention: The stand of European Societies of Cardiology

Population strategy for cardiovascular disease prevention: The stand of European Societies of Cardiology

Cardiac Disease after Pregnancy: A Growing Problem.

Pregnancy complications, such as hypertensive disorders or preterm delivery, identify families predisposed to cardiovascular problems at other times in life. Whether the pregnancy complication induces cardiac disease or whether the pregnancy stress unmasks an underlying predisposition remains unclear. However, improved survival following severe pregnancy complications for both the mother and, in particular, the offspring - who is often born preterm - has resulted in a growing cohort of individuals who carry this increased cardiovascular risk. Research to understand the underlying pathological mechanisms that link these conditions might ultimately lead to novel therapeutic or prevention strategies for both cardiovascular and pregnancy disease.

Evaluation of the Pooled Cohort Equations for Prediction of Cardiovascular Risk in a Contemporary Prospective Cohort

Most guidelines suggest a baseline risk assessment to guide atherosclerotic cardiovascular disease (ASCVD) prevention strategies. The American Heart Association/American College of Cardiology Pooled Cohort Equations (PCEs) is one tool to assess baseline risk; however, the accuracy of this tool has been called into question. We aimed to examine the calibration and discrimination of the PCEs in the BioImage study, a contemporary multiethnic cohort of asymptomatic adults enrolled from 2008 to 2009 in the Humana Health System in Chicago, Illinois, and Fort Lauderdale, Florida. Our primary end point was hard ASCVD, defined as cardiovascular death, myocardial infarction, and stroke. A total of 3,635 adults who were not on lipid-lowering therapy at baseline were followed for a maximum of 4.6years. The mean age was 68.6 years; 2000 (55%) participants were women and 935 patients reported being of non-white race (26%). Although 74 ASCVD events were observed over a median follow-up of 2.7years, 198 events were predicted by the PCEs. The observed event rate was 7.9 per 1,000 participant-years (95% confidence interval [CI] 6.1 to 9.8), whereas the predicted rate by the PCEs was 21 per 1,000 participant-years (95% CI 20.7 to 21.8). This represents an overestimation of 167% (Hosmer-Lemeshow chi-square= 173; p <0.001). With regard to discrimination, the C-statistic of the PCEs was 0.65 (CI 0.58 to 0.71). In an analysis restricted to 3,080 participants without diabetes mellitus and with low-density lipoprotein cholesterol between 70 and 189mg/dl, the PCEs similarly overestimated risk by 181% (152 predicted events vs 54 observed events; p <0.001). The PCEs substantially overestimate ASCVD risk in this middle-aged adult insured population. Refinement of existing risk prediction functions may be warranted.

Cardiovascular risk factors in scholars (RIVACANGAS)

Background and aimThe current guidelines for treatment of high blood pressure do not include any section dedicated to hypertension in children and adolescents or to cardiovascular disease (CVD) prevention strategies in that age group. Our study was aimed at identifying cardiovascular risk factors (CVRFs) in an adolescent sample. Subjects and methodsA cross-sectional study of a sample of adolescents aged 12–17years (n=630), conducted from October 2014 to February 2015 in four schools in Cangas do Morrazo (Pontevedra). Sociodemographic variables: age, sex, personal and family history of hypertension and diabetes (DM). Anthropometric variables: body mass index (BMI, kg/m2), waist circumference (WC, cm), waist/height index (WHI), blood pressure (mmHg). ResultsThe study sample consisted of 295 female and 335 male adolescents (mean age: 13.8±1.4). CVR-related conditions: hypercholesterolemia (7.1%), CVD (1.7%), hypertension (0.8%) and diabetes (0.3%). BMI (22.0±3,8) was higher in males (22.4±3.8 vs 21.0±3.2; p<.01). Overweight was greater in females (27.6% vs 19.7%; p<.05). Seven percent of subjects were obese, 63.8% had systolic BP>P90 and 23.7% had diastolic BP>P90.Waist circumference positively correlated with age (r=0.1669; p<.0001) and was greater in males (75.4±10.9 vs 72.9±8.9; p<0.01); 27.1% of adolescents had a waist circumference>P75, and 7.5%>P90. Eighty-four (13.3%) adolescents had two CVRFs (overweight+another). ConclusionsDespite their young age, more than 10% of school children had two CVRFs. Abnormal SBP levels were seen in more than 50%, 20% were overweight, and only 75% had normal waist circumference values.

Effectiveness and cost-effectiveness of interventions that cause weight loss and reduce the risk of cardiovascular disease.

Overweight/obesity is associated with significant morbidity, mortality and costs. Weight loss has been shown to reverse some of these effects, reducing the risk of chronic diseases such as cardiovascular disease (CVD). To determine the potential monies available, from an English National Health Service perspective, for weight loss interventions to be cost-effective in the prevention of CVD. A Markov model was developed, populated with overweight/obese individuals from the Health Survey for England, aged 30-74 years, free of pre-existing CVD and with available risk factor information to calculate CVD risk. All individuals were free of CVD at baseline and, with each annual cycle, could transition to other health states of primary CVD, secondary CVD or death according to transition probabilities for a maximum period of 10 years, or until death. Utilities, costs and the effects of weight loss on CVD risk factors were applied. The potential monies available for CVD prevention strategies, provided the incremental cost-effectiveness ratio met UK arbitrary limits of between £20 000 and £30 000, was determined. Applying the effects of weight loss on CVD risk factors prevented 4 CVD events and saved 17 quality-adjusted life-years over 10 years per 1000 individuals. £34 to £51 was available per person per year for up to 10 years when meeting the UK arbitrary limits. Individual annual financial allowances for weight loss interventions to be considered cost-effective is relatively low; however, as a large proportion of the population is affected, wide cheap societal interventions are important.

Factores de riesgo cardiovascular en adolescentes escolarizados (RIVACANGAS)

Background and aimThe current guidelines for treatment of high blood pressure do not include any section dedicated to hypertension in children and adolescents or to cardiovascular disease (CVD) prevention strategies in that age group. Our study was aimed at identifying cardiovascular risk factors (CVRFs) in an adolescent sample. Subjects and methodsA cross-sectional study of a sample of adolescents aged 12 to 17years (n=630), conducted from October 2014 to February 2015 in four schools in Cangas do Morrazo (Pontevedra). Sociodemographic variables: age, sex, personal and family history of hypertension and diabetes (DM). Anthropometric variables: body mass index (BMI, kg/m2), waist circumference (WC, cm), waist/height index (WHI), blood pressure (mmHg). ResultsThe study sample consisted of 295 female and 335 male adolescents (mean age: 13.8±1.4). CVR-related conditions: hypercholesterolemia (7.1%), CVD (1.7%), hypertension (0.8%) and diabetes (0.3%). BMI (22.0±3,8) was higher in males (22.4±3.8 vs. 21.0±3.2; P<.01). Overweight was greater in females (27.6% vs. 19.7%; P<.05). Seven percent of subjects were obese, 63.8% had systolic BP >P90 and 23.7% had diastolic BP >P90.Waist circumference positively correlated with age (r=0.1669; P<.0001) and was greater in males (75.4±10.9 vs. 72.9±8.9; P<0.01); 27.1% of adolescents had a waist circumference >P75, and 7.5% >P90. Eighty-four (13.3%) adolescents had two CVRFs (overweight+another). ConclusionsDespite their young age, more than 10% of school children had two CVRFs. Abnormal SBP levels were seen in more than 50%, 20% were overweight, and only 75% had normal waist circumference values.

Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study.

Background Chronic stress frequently manifests with anxiety and/or depressive symptomatology and may have detrimental cardiometabolic effects over time. As such, recognising the potential links between stress-related psychological disorders and cardiovascular disease (CVD) is becoming increasingly important in cardiovascular epidemiology research. The primary aim of this study was to explore prospectively potential associations between clinically relevant depressive symptomatology and anxiety levels and the 10-year CVD incidence among apparently healthy Greek adults. Design A population-based, health and nutrition prospective survey. Methods In the context of the ATTICA Study (2002-2012), 853 adult participants without previous CVD history (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent psychological evaluations through validated, self-reporting depression and anxiety questionnaires. Results After adjustment for multiple established CVD risk factors, both reported depression and anxiety levels were positively and independently associated with the 10-year CVD incidence, with depression markedly increasing the CVD risk by approximately fourfold (adjusted odds ratio (95% confidence interval) 3.6 (1.3, 11) for depression status; 1.03 (1.0, 1.1) for anxiety levels). Conclusions Our findings indicate that standardised psychological assessments focusing on depression and anxiety should be considered as an additional and distinct aspect in the context of CVD preventive strategies that are designed and implemented by health authorities at the general population level.

Effects on Nitric Oxide Production of Urolithins, Gut-Derived Ellagitannin Metabolites, in Human Aortic Endothelial Cells.

The consumption of foodstuffs yielding circulating compounds able to maintain endothelial function by improving nitric oxide (NO) bioavailability can be considered as an effective strategy for cardiovascular disease prevention. This work assessed the in vitro effects of urolithin A, urolithin B, and urolithin B-glucuronide, ellagitannin-derived metabolites of colonic origin, on NO release and endothelial NO synthase (eNOS) activation in primary human aortic endothelial cells (HAECs). Urolithins were tested both individually at 15 μM and as a mixture of 5 μM each, at different time points. The biotransformation of these molecules in cell media due to cell metabolism was also evaluated by UHPLC-MSn. The mix of urolithins at 5 μM significantly increased nitrite/nitrate levels following 24 h of incubation, while single urolithins at 15 μM did not modify NO bioavailability. Both the mix of urolithins at 5 μM and urolithin B-glucuronide at 15 μM activated eNOS expression. All urolithins underwent metabolic reactions, but these were limited to conjugation with sulfate moieties. This study represents a step forward in the understanding of cardiovascular health benefits of ellagitannin-rich foodstuffs and backs the idea that peripheral cells may contribute to urolithin metabolism.

The Unchartered Frontier: Preventive Cardiology Between the Ages of 15 and 35 Years.

It is well established that atherosclerosis, the pathological basis of cardiovascular disease (CVD), begins in childhood and progresses steadily between the ages of 15 to 35 years. These adolescent and young adult years are also marked by significant physiological, psychological, and sociodemographic changes that impact both CVD risk factor development and CVD prevention and treatment strategies. In this review, we highlight the importance of the primordial prevention of CVD risk factors before they ever occur and the primary prevention of CVD by treating CVD risk factors in this age group. Although the long time to first CVD event for most young people precludes the availability of clinical trials with hard end-points, findings from epidemiology, health psychology, health services research, and clinical trials with surrogate endpoints are discussed to inform an evidence-based approach to CVD prevention in adolescents and young adults.

Prevention of stroke: a strategic global imperative.

The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.

113 Preeclampsia and prevention of cardiovascular disease – What do the national guidelines recommend?

Introduction Many studies report that women suffering from preeclampsia have an increased risk of developing hypertension and cardiovascular disease (CVD) later in life. However, due to incomplete understanding of the preeclampsia CVD association, no single CVD prevention strategy is recommended for previously preeclamptic women. Should all women be informed and thereby be classified as at risk? Or should the recommendations be more selective or await more evidence? How are the existing evidence interpreted internationally and which clinical recommendations do different national guidelines offer previously preeclamptic women today? Objectives This study aims to compare the clinical recommendations of different national guidelines on prevention of later in life hypertension and CVD in previously preeclamptic women. Methods Guidelines developed by the National Associations of Gynecologists and Obstetricians in eight different countries were compared. Results The definition of preeclampsia and especially severe preeclampsia differ between the countries. Two of the guidelines only recommend informing the woman and their general practitioner about the risk of hypertension later in life. On the contrary, the remaining six guidelines recommend informing about the increased CVD risk later in life. At the same time, these six guidelines also recommend encouraging previously preeclamptic women to pursue a healthy lifestyle. The recommendations vary substantially from no follow-up to follow-up at the postpartum period or at the age of 50. Additionally, recommendations regarding the content and frequency of follow-up also show great variations. Conclusion The definition of preeclampsia differs between countries making CVD prevention strategies difficult to compare. Furthermore, clinical recommendations of the eight examined national guidelines show substantial variation and these will be presented at the conference. This variation clearly reflects lack of evidence, but also stress the need of international debate on post-preeclampsia CVD prevention strategy.

Correlation between the duration of moderate-intensity aerobic exercise and the atherogenic index of plasma

To investigate the relationship between the duration of moderate-intensity aerobic exercise and the atherogenic index of plasma(AIP) in middle-aged men, in order to provide evidence to formulate strategies for the prevention of cardiovascular diseases. Methods A cross-sectional study was conducted in 27, 827 middle-aged Chinese men who underwent health examinations at our hospital between January, 2014 and June, 2015. The correlation between the duration of moderate-intensity aerobic exercise and AIP was analyzed. Results The mean AIP levels were(0.1166±0.3448), (0.1167±0.3264), and(0.0765±0.3287) in the <1 min/week group, 1-89 min/week group, and ≥90 min/week group, respectively. AIP levels were higher in the <1 min/W group and 1-89min/W group than in the ≥90 min/W group(both P<0.05). Multiple linear regression analysis showed that physical activity significantly reduced AIP after adjustment for age, body mass index, diastolic blood pressure, fasting blood glucose and uric acid levels. The percentage of the population at high risk for atherosclerosis(AIP ≥ 0.21) was significantly lower in the ≥90 min/W group than in the<1 min/W group and 1-89 min/W group(both P<0.05), while no significant difference was found between the <1min/W group and 1-89min/W group. Conclusions The duration of aerobic exercise has a close relationship with AIP. Moderate-intensity aerobic exercise at a weekly duration of 90 min or longer offers cardiovascular health benefits and reduces the risk for atherosclerosis. Key words: Exercise; Atherosclerosis

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

ObjectiveIt is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is...

Hypertension Among HIV-infected Patients in Clinical Care, 1996-2013.

Persons infected with human immunodeficiency virus (HIV) are at higher risk for major cardiovascular disease (CVD) events than uninfected persons. Understanding the epidemiology of major traditional CVD risk determinants, particularly hypertension, in this population is needed. The study population included HIV-infected patients participating in the UNC CFAR HIV Clinical Cohort from 1996 to 2013. Annual incidence rates of hypertension were calculated. Multivariable Poisson models were fit to identify factors associated with incident hypertension. 3141 patients contributed 21 956 person-years (PY) of follow-up. Overall, 57% patients were black, 28% were women, and the median age was 35 years. Hypertension age-standardized incidence rates increased from 1.68 cases per 100 PYs in 1996 to 5.35 cases per 100 PYs in 2013 (P < .001). In adjusted analyses, hypertension rates were higher among obese patients (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI], 1.43-2.02), and those with diabetes mellitus (IRR 1.44, 95% CI, 1.14-1.83) and renal insufficiency (IRR 1.36, 95% CI, 1.16-1.61), but lower among patients with a CD4 nadir of ≥500 cells/mm(3) (IRR 0.73, 95% CI, .53-1.01). The incidence of hypertension increased from 1996 to 2013, alongside increases in traditional hypertension risk determinants. Notably, HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk. Aggressive CVD risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression, will be important components of a comprehensive primary CVD prevention strategy in HIV-infected persons.

The RADICAL-PC trial.

178 Background: Cardiovascular disease (CVD) occurs frequently in men with prostate cancer (PC), but the reasons are unclear. Specifically, the role of androgen deprivation therapy (ADT) in promoting CVD remains uncertain. There is a lack of evidence to inform preventive strategies against CVD in this high risk group. It is unknown if the evidence to support CVD preventive strategies in the general population can be validly extrapolated to men with PC. Methods: RADICAL-PC combines two prospective studies, one of which is embedded in the other. The Role of Androgen Deprivation Therapy in Cardiovascular Disease – A Longitudinal Prostate Cancer Study (RADICAL PC1) is a prospective cohort study of men within one year of their first diagnosis of PC, or who are within one month of commencing ADT for the first time. Its goal is to identify factors associated with the development of CVD among men with PC, with a particular focus on ADT. The Randomized Intervention for Cardiovascular and Lifestyle Risk Factors in Prostate Cancer Patients (RADICAL PC2) is a randomized, controlled trial embedded in RADICAL PC1. RADICAL PC2 will test a systematic approach to modifying CV and lifestyle risk factors. The intervention group will receive: 1) Standardized advice on healthy diet and exercise; 2) Low-dose antiplatelet agent; 3) Low- to moderate-dose statin; and 4) ACE-I for baseline systolic blood pressure ≥ 130mmHg. Results: The study has been recently funded by Movember clinical trial program of Prostate Cancer Canada, and is launched across Canada. The primary outcome is the occurrence of the composite of cardiovascular death, myocardial infarction, stroke, heart failure, or arterial revascularization. For RADICAL-PC1, 6000 participants will have 90% power to detect a hazard ratio 0.86 for a given exposure. For RADICAL-PC2, 4116 participants randomized, with 434 primary outcome events will have 85% power to detect a hazard ratio of 0.75 in the intervention group. Conclusions: RADICAL PC will be one of the largest prospective studies of CVD – the main competing risk – in men with PC. It will clarify the determinants of CVD in these men, the role of ADT in CVD, and will simultaneously test an intervention to lower the CVD risk in this high-risk population.