Cardiovascular Disease Risk Factor Profile Research Articles

Racial and ethnic disparities in longitudinal trajectories of cardiovascular risk factors in U.S. middle-aged and older adults.

Racial and ethnic disparities in cardiovascular disease (CVD) risk factors are well-documented. However, racial and ethnic differences in the longitudinal changes among multiple CVD risk factors are unknown. We used prospective cohort data of U.S. adults aged ≥50 in the 2006-2016 Health and Retirement Study. Group-based multi-trajectory models characterized age-related trajectories of systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dL), diabetes mellitus (DM), and smoking. Racial and ethnic differences in the multi-trajectory profiles were examined using multinomial logistic regression. Karlson-Holm-Breen methods were used to assess factors contributing to these associations. Among 10,292 participants (median age: 61), approximately 32% had an overall favorable profile of CVD risk factors. Compared with non-Hispanic White adults, non-Hispanic Black adults were more likely to exhibit elevated systolic BP with high risks of DM (relative risk ratio [RRR] = 3.36; 95% CI, 2.69-4.21; P < .001) and with low risks of DM (RRR = 3.23; 95% CI, 2.38-4.38; P < .001). Non-Hispanic Black adults were also more likely to exhibit high rates of smoking with and without other co-occurring risk factors. Hispanic adults were most likely to exhibit high risks of DM with elevated systolic BP (RRR = 1.74; 95% CI, 1.28-2.38; P < .001) and without elevated systolic BP (RRR = 1.90; 95% CI, 1.50-2.40; P < .001). Education, income, and country-of-origin were significantly associated with the excess CVD risks observed among racial and ethnic minority groups. Significant racial and ethnic disparities were observed in trajectories of CVD risk factors in U.S. adults. Social determinants largely contributed to these associations in non-Hispanic Black adults and Hispanic adults.

Cardiovascular disease risk factors and infertility: multivariable analyses and one-sample Mendelian randomization analyses in the Trøndelag Health Study.

Are cardiovascular disease (CVD) risk factors causally associated with higher risk of infertility among women and men? We found evidence to support a causal relationship between smoking initiation and history of infertility in women. Several CVD risk factors are associated with history of infertility. Previous studies using Mendelian randomization (MR) further support a causal relationship between BMI and infertility in women. We used data from the Trøndelag Health Study (HUNT) in Norway, a prospective population-based cohort study, including 26811 women and 15598 men participating in three survey collections in 1995-1997 (HUNT2), 2006-2008 (HUNT3), and 2017-2019 (HUNT4). Our outcome was women's self-reported history of infertility, defined as ever having tried to conceive for 12 months or more or having used ART. We assigned the history of infertility reported by women to their male partners; therefore, the measure of infertility was on the couple level. We used both conventional multivariable analyses and one-sample MR analyses to evaluate the association between female and male CVD risk factors (including BMI, blood pressure, lipid profile measurements, and smoking behaviours) and history of infertility in women and men, separately. A total of 4702 women (18%) and 2508 men (16%) were classified with a history of infertility. We found a higher risk of infertility among female smokers compared to non-smokers in both multivariable and MR analyses (odds ratio (OR) in multivariable analysis, 1.20; 95% CI, 1.12-1.28; OR in MR analysis, 1.13; CI, 1.02-1.26), and potentially for higher BMI (OR in multivariable analysis, 1.13; CI, 1.09-1.18; OR in MR analysis, 1.11, CI, 0.92-1.34). In multivariable analysis in women, we also found evidence of associations between triglyceride levels, high-density lipoprotein cholesterol, lifetime smoking index, and smoking intensity with higher risk of infertility. However, these results were not consistent in MR analyses. We found no robust or consistent associations between male CVD risk factors and infertility. Our main limitation was that the CVD risk factors measured might not adequately capture the relevant time periods for when couples were trying to conceive. Additionally, we did not have information on causes of infertility in either women or men. Women with infertility could have a worse CVD risk factor profile and thus public health interventions aimed at reducing the impact of some CVD risk factors, such as smoking and BMI, could reduce the burden of infertility. However, additional MR studies of the relationship between CVD risk factors and infertility with a larger sample size would be of value. The study was supported by a grant from the European Research Council under the European Union's Horizon 2020 research and innovation program (grant agreements no. 947684). This research was also supported by the Research Council of Norway through its Centres of Excellence funding scheme (project no. 262700) and partly funded by the Research Council of Norway, project: Women's fertility-an essential component of health and well-being (project no. 320656). D.A.L. and A.F. work in a unit that is supported by the University of Bristol and the UK Medical Research Council (MC_UU_00011/6). D.A.L.'s contribution to the article is supported by the European Research Council (101021566), the British Heart Foundation (CH/F/20/90003 and AA/18/7/34219). S.B.'s contribution to the article is supported by the Wellcome Trust (225790/Z/22/Z). B.M.B. is funded by The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. The genotyping in HUNT was financed by the National Institute of Health (NIH); University of Michigan; The Research Council of Norway; The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St. Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. None of the funding organizations influenced the study design, reporting, or interpretation of results. The views expressed in the present article are those of the authors and not necessarily any acknowledged funding organization. D.A.L. reports grants from Medtronic Ltd and Roche Diagnostics outside the submitted work. The other authors have no conflicts of interest. N/A.

A Cross-Sectional Study on the Role of a Lab Test Screening Program in Defining Cardiovascular Disease Risk Prevalence.

Recent epidemiologic studies carried out in Romania confirmed an ascending trend for cardiovascular disease (CVD) risk factor prevalence such as diabetes mellitus (DM), obesity and dyslipidemia. The aim of this study is to describe the CVD risk factor profile and preventative behavior in a representative sample of the general adult population of an Eastern Romanian urban area. More than 70% of the studied population had a body mass index (BMI) above the normal range for their age, with 36.7% of the subjects residing in obesity and severe obesity clusters. For overweight and obese subjects, the number of comorbidities (CVD, arterial hypertension and DM type 2) was higher than in the population with normal weight (44% vs. 31%, 22% vs. 14% and 18% vs. 10%, respectively). The prevalence of high blood pressure was almost double that reported in previous Romanian studies (69.3% vs. 36.6%) and higher than expected, based on self-reported known CVD diagnoses (37.5%). There was a visible difference between the results obtained for quantifiable CVD risk factors and self-reported lifestyle ones. Routine blood test monitoring may be an easy and inexpensive tool to guide educational and medical interventions to address modifiable CV risk factors in the adult population in order to prevent the fatal consequences of cardiovascular disease.

Evaluation of Exercise Mobile Applications for Adults with Cardiovascular Disease Risk Factors.

To conduct a systematic review to determine if there are exercise mobile applications (apps) that can produce evidence-based, individualized exercise plans. We searched the Apple Store and Google Play for exercise apps with terms related to exercise and health. Exercise apps were eligible if they: (1) had a ≥4 out of 5 overall rating with ≥1000 reviews; (2) were free to download; and (3) were not gender specific. Exercise apps were evaluated via the evidence-based exercise prescription (ExRx) standards of the American College of Sports Medicine (ACSM) and American Heart Association. For the exercise app evaluation criteria, an app was included if it (1) was evidence-based; (2) contained a preparticipation health screening protocol; (3) built a cardiovascular disease (CVD) risk factor profile; (4) prioritized one chronic disease or health condition to focus on; (5) framed the exercise plan by the frequency, intensity, time, and type principle (FITT) of ExRx; and (6) specified special considerations. Of the 531 potentially qualifying apps, 219 qualified. The qualifying apps were rarely evidenced-based (0.5%) or had a preparticipation screening protocol (3.7%). Only 27.7% built CVD risk factor profiles. Most apps (64.8%) focused on body image and/or athletic performance. Only 4.3% focused on chronic diseases or health conditions, while the remainder (34.5%) did not disclose a focus. No app framed the exercise plans by the FITT of ExRx. Only 1.4% of the apps specified special considerations. There are no commercially available exercise apps that generate an evidence-based, individualized exercise plan for adults with CVD risk factors.

The Association between Cardiovascular Risk Factors and Carotid Intima-Media Thickness in 42,726 Adults in UK Biobank: A Cross-Sectional Study.

Traditional modifiable cardiovascular risk factors, such as high blood pressure, have long been positively correlated with high carotid intima-media thickness (cIMT). However, traditional cardiovascular risk factors made a minor contribution to cIMT variance, meaning that other markers may be regarded as independent markers for increasing cIMT. To investigate the simple demographic patterns of carotid intima-media thickness (cIMT) in the UK Biobank and to identify which upstream cardiovascular disease (CVD) risk factors are independently associated with cIMT. A cross-sectional-based study of healthy middle-aged people recruited in the UK between 2006 and 2010 (n = 42,726). This study showed that the cardiovascular risk profile generally worsened across the cIMT quantiles from lowest to highest. The lowest cIMT quartile was defined as having a mean cIMT < 588 µm, while the highest cIMT quartile was defined as having a mean cIMT > 748 µm. Specifically, the highest cIMT quantile group had a worse CVD risk factors profile compared to the lowest cIMT quantile group. It was found that, for every one SD increase in age and systolic blood pressure, the mean cIMT increased by 0.357 SD and 0.115 SD, respectively. Systolic blood pressure and age were the strongest independent risk factors for a high cIMT value compared to other risk factors.

Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.

The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time. We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models. A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63). Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.

Fatness Predicts Cardiovascular Disease Risk Factor Profile Better than Fitness in Healthy Men A Discriminant Analysis Approach

Fitness is healthy and can help to reduce, but not eliminate, the negative effects of obesity. As a result,identifying variables for categorizing individuals into high-risk or low-risk groups is critical.The study’s goalwasto determine the relationship between fitness, fatness, and cardiovascular disease risk factors as well as to construct a discriminant model for categorizing individuals as high-risk or low-risk. A total of 120 in-service healthy armed forces personnel aged 25 to 49 years were randomly selected as subjects for this study and were measured for the selected fitness and fatness variables, namely cardio respiratory endurance, muscular endurance, muscular leg and back strength, flexibility, weight, waist circumference, hip circumference, waist-hip ratio, body mass index, waist to height ratio, and fat percentage. The findings revealed that fitness variables contribute little to CVD risk factors than specific fatness characteristics, which appear to play a larger role.Based on selected fitness and fatness indicators, a discriminant model was developed to classify subjects into high and low cardiovascular disease risk groups. The group centroid was found to be 0.829. The model validity was determined to be 80.6 per cent based on the classification matrix. Finally, the findings of the study suggest that age and waist circumference play an important role in distinguishing individuals with high and low CVD risk

Abstract P141: Six-Month Follow-Up of Menopausia, Salud, Corazón (Menopause, Health, Heart): A Multi-Component Intervention to Reduce Cardiovascular Disease Risk in Midlife Latinas

Background: Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Latina White women, potentially due to multiple sociocultural and environmental factors. The purpose of this study is to evaluate the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. Here we report data at a 6-month follow-up. Methods: This is a randomized two-group, repeated measures experimental study. Forty-nine perimenopausal Latinas (age 40-60 years) were randomized to a 6-month multi-component intervention or wait-list control. The intervention consists of 12-weekly culturally tailored Spanish language-based sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. Between May 2021 and June 2022, thirty-five participants (18 intervention and 17 control) completed a 6-month follow-up. Primary outcomes at this study visit included weight, body mass index, waist circumference, and blood pressure. Secondary outcomes included health behaviors and psychological factors (nutrition, physical activity, sleep, self-efficacy, perceived stress). We assessed the initial efficacy of the intervention at 6 months using general linear models for continuous outcomes and logistic regression for categorical outcomes. Models adjusted for outcome measures at baseline and baseline group differences (health insurance, vasomotor symptoms). Models were two-sided at a level of significance of p≤0.1. Results: At baseline, the mean age was 47.8 ± 4.4 years, 37% had less than high school education, 97% were born outside of the United States, and 51% reported it was somewhat/very difficult to pay for basics. Women in the intervention group were more likely to have health insurance (61% vs 24%, p=0.06) and less likely to report any vasomotor symptoms (44% vs 77%, p=0.09). At 6 months (post-intervention), compared to the waitlist control group, the intervention group had lower perceived stress (ß[SE]= -2.15 [1.05], p=0.05) and systolic blood pressure (ß[SE]= -2.72 [1.61], p=0.1) even after adjusting for baseline measures and group differences. There were no other significant differences post-intervention. Conclusions: This pilot study found that a culturally tailored Spanish language intervention consisting of nutrition education, physical activity, and stress management may be effective in reducing stress and blood pressure in perimenopausal Latinas —key risk factors for CVD.

Trends and Outcomes of ST-Segment-Elevation Myocardial Infarction Among Young Women in the United States.

Background Although there has been a decrease in the incidence of ST-segment-elevation myocardial infarction (STEMI) in the United States, this trend might be stagnant or increasing in young women. We assessed the trends, characteristics, and outcomes of STEMI in women aged 18 to 55 years. Methods and Results We identified 177 602 women aged 18 to 55 with the primary diagnosis of STEMI from the National Inpatient Sample during years 2008 to 2019. We performed trend analyses to assess hospitalization rates, cardiovascular disease (CVD) risk factor profile, and in-hospital outcomes stratified by three age subgroups (18-34, 35-44, and 45-55 years). We found STEMI hospitalization rates were decreased in the overall study cohort from 52 per 100 000 hospitalizations in 2008 to 36 per 100 000 in 2019. This was driven by decreased proportion of hospitalizations in women aged 45 to 55 years (74.2% to-71.7%; P<0.001). Proportion of STEMI hospitalizationincreased in women aged 18-34 (4.7%-5.5%; P<0.001) and 35-44 years (21.2%-22.7%; P<0.001). The prevalence of traditional and non-traditional female-specific or female-predominant CVD risk factors increased in all age subgroups. The adjusted odds of in-hospital mortality in the overall study cohort and age subgroups were unchanged throughout the study period. Additionally, we observed an increase in the adjusted odds of cardiogenic shock, acute stroke, and acute kidney injury in the overall cohort over the study period. Conclusions STEMI hospitalizations are increasing among women aged <45 years, and in-hospital mortality has not changed over the past 12 years in women aged <55 years. Future studies on the optimization of risk assessment and management of STEMI in young women are urgently needed.

Association between Cardiovascular Disease Risk Factors and Cardiorespiratory Fitness in Firefighters: A Systematic Review and Meta-Analysis.

Approximately 45% of on-duty related mortalities were due to sudden cardiac death, with many of these fatalities related to cardiovascular disease and overexertion, while performing emergency duties. Therefore, the aim of this systematic review was to determine the association between cardiovascular disease risk factors and cardiorespiratory fitness in firefighters. A literature search of PubMed, SCOPUS, Web of Science, Embase, EBSCOHost, and ScienceDirect was conducted; the Rayyan® intelligent systematic review tool was used to screen and select studies for inclusion. The appraisal tool for cross-sectional studies and the Critical Appraisal Skills Programme toolkit were used for methodological assessment of included studies. Data were analyzed using the Review Manager 5.3 and MedCalc® statistical softwares to determine the effects of obesity (Z = 10.29, p < 0.001) and aging (Z = 4.72, p < 0.001) on cardiorespiratory fitness. Furthermore, there was a significant effect for cardiorespiratory fitness level on systolic blood pressure (Z = 5.94, p < 0.001), diastolic blood pressure (Z = 2.45, p < 0.001), total cholesterol levels (Z = 3.80, p < 0.001), low-density lipoprotein cholesterol (Z = 4.44, p < 0.001), triglycerides (Z = 3.76, p < 0.001) and blood glucose concentration (Z = 4.78, p < 0.001). Cardiovascular disease risk factors and cardiorespiratory fitness were significantly and inversely associated in firefighters. Fire service departments should adopt behavioral intervention strategies to maintain optimum cardiovascular disease risk factor profiles and cardiorespiratory fitness among firefighters to ensure their occupational well-being.

Abstract 10406: Longitudinal Trends in Cardiovascular Complications Among Patients Hospitalized for Covid-19 Infection: A National Multi-Center Analysis

Introduction: COVID-19 is associated with multiple cardiovascular disease (CVD) complications, while pre-existing CVD and CVD risk factors increase the risk of severe COVID. The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of CVD complications or risk factor profiles of hospitalized patients have changed over the course of the pandemic. Methods: We analyzed the AHA COVID-19 CVD registry, a national multi-center registry of hospitalized adults with active COVID-19 infection. Data from March 2020 were excluded, and subsequent periods from April 2020 to December 2021 were divided into 3-month epochs. Trends in CVD risk factors and CVD outcomes, including a composite primary outcome of CVD death, cardiogenic shock, new heart failure (HF), stroke, and MI, were evaluated across epochs. Results: 39,961 patients were included. Mean age was 62±18 years during the first epoch and remained consistent through March 2021, after which it decreased and remained stable (55±18 years by the last epoch; p trend &lt;0.001). Patients admitted later in the pandemic were more likely to be obese and less likely to have existing CVD (p trend &lt;0.001 for each). The incidence of the primary outcome (Figure) increased from 7.2% to 9.8% from the first to the last epoch (p trend &lt;0.001). This was driven by an increase in the diagnosis of MI and stroke. Diagnosed pulmonary embolism also rose from 1.9% to 4.7% over the study period (p trend &lt;0.001). There was no consistent trend in the rates of new HF, cardiogenic shock, or CVD mortality, all of which were uncommon, occurring in ≤2% of the overall study population. Conclusions: Despite a shifting risk factor profile towards a younger population with lower rates of established CVD, the incidence of diagnosed CVD complications among patients hospitalized for COVID-19 increased over the course of the pandemic.

Urinary metabolomics profiling by cardiovascular risk factors in young adults: the African Prospective study on Early Detection and Identification of Cardiovascular disease and Hypertension study.

Risk factors contributes to a dysregulated metabolism and may ultimately increase the predisposition for cardiovascular disease (CVD) development. To increase our understanding of mechanistic pathways associated with CVD risk, we profiled the urinary metabolome according to individual and clusters of CVD risk factors in comparison with a control group without any risk factors. Healthy black and white women and men ( N = 1202), aged 20-30 years with a detailed CVD risk factor profile were included. CVD risk groups: obese, physical inactive, smoking, excessive alcohol intake, masked hypertensive, hyperglycaemic, dyslipidemic and low socioeconomic status. CVD risk clusters were based on the presence of 1, 2 and 3 or more risk factors. Liquid chromatography-tandem mass spectrometry was used to obtain urinary metabolomics data (amino acids and acylcarnities). Compared with the control group, higher levels of metabolites associated with aromatic and branched chain amino acid metabolism including phenylalanine, tyrosine and leucine/isoleucine were found in the obese, masked hypertensive, hyperglycaemic, low socioeconomic groups (all q ≤ 0.032) and 3+ CVD risk cluster (all P ≤ 0.034). Metabolites associated with the y-glutamyl cycle including glycine, histidine, serine, glutamine, methionine, cystine and pyroglutamic acid were found in the hyperglycaemic, low socioeconomic groups (all q ≤ 0.050), 2 and 3+ CVD risk clusters (all P ≤ 0.041). Metabolites associated with energetics including acetylcarnitine (lower levels), hexanoylcarnitine and decanoylcarnitine were found in the low socioeconomic group, 1 and 3+ CVD risk clusters ( q / P ≤ 0.050) ( β -oxidation). In addition to the above-mentioned amino acids, alanine and threonine were found in the hyperglycaemic, low socioeconomic groups, 2 and 3+ CVD risk clusters (all q / P ≤ 0.047) (glycolysis). Creatine in the obese, hyperglycaemic groups (all q ≤ 0.049) and 3+ CVD risk cluster (all P ≤ 0.041) (creatine pathway). Exposure to CVD risk factors is associated with a dysregulated metabolism in the above-mentioned pathways that may precede the development of CVD.

Cardio-Respiratory Fitness and Cardiovascular Disease Risk Factors Among South African Medical Students.

Cardiovascular disease (CVD) risk factors have been associated with CVD mortality, and physicians use CVD risk factor profiles (smoking, dyslipidemia, hypertension, etc.) to address patient health. Furthermore, cardio-respiratory fitness (CRF) has been shown to be an independent risk factor for CVD and all-cause mortality. Cardio-respiratory fitness is also the risk factor that contributes the highest percentage to all-cause deaths when compared to other traditional risk factors. In addition, studies have reported that adding CRF to established CVD risk factors improves the precision of prediction for CVD morbidity and mortality. Medical students tend to adopt sedentary and unhealthy lifestyles during the course of their education that negatively affect CVD risk factors and CRF. The majority of research on CVD risk, health status and lifestyle factors of medical students has used self-reported data and questionnaires for CVD risk factors and not included CRF in the health status measurements. In addition, studies have found that future medical doctors' own health and lifestyle practices influence their counselling activities. Allowing future medical doctors to assess their personal CVD risk factors and CRF may thus be important in their use of physical activity counselling with patients' lifestyle management for health benefits and improvement. A descriptive, cross-sectional cohort study design was used with the aim to determine CVD risk factors using CRF measures and physical activity levels in a cohort of South African medical students. The most significant finding was that they were not meeting the PA levels recommended to maintain health and lower CVD risk.

The Impact of Muscular Strength On Cardiovascular Disease Risk Factors

The purpose of this study was to determine the associations between isokinetic leg muscular strength and cardiovascular disease (CVD) risk factor characterizations in Americans aged 50 and older. Using a publicly available dataset from the National Health and Nutrition Examination Survey (NHANES), a secondary analysis was conducted on participants (males ≥50 yrs; females ≥55 yrs; N=10,858) pooled from 1999 to 2002. CVD risk factors were determined using the American College of Sports Medicine (ACSM) cutoff values, with all nine ACSM risk factors analyzed. CVD risk factor characterization was determined by creating CVD risk factor profiles (i.e., the total number of CVD risk factors an individual possesses), then separating participants into low (0‐2 CVD risk factors), moderate (3‐5 CVD risk factors), and high (6‐8 CVD risk factors) risk groups. Muscular strength was determined by isokinetic maximal peak force (PF) of the leg extensors, both raw and normalized to body mass. Normalized, but not raw, muscular strength was shown to be significantly inversely associated with CVD risk factor characterization for both males and females (P&amp;lt;0.001). Muscular strength was separated into quintiles of strength (Q1 = lowest, Q5 = highest). Using ordinal regression and adjusting for all other CVD risk factors, age (males: OR: 1.13, 95% CI: 1.11‐1.15; females: OR: 1.12; 95% CI:1.10‐1.15) obesity (males: OR: 0.54; 95% CI: 0.40‐0.72; females: OR: 0.58; 95% CI: 0.41‐0.82), and smoking status (males: OR: 1.72; 95% CI: 1.31‐2.26; females: OR: 1.39; 95% CI: 1.04‐1.86) were significantly associated with isokinetic leg extensor muscular strength in both males and females, while blood glucose (OR: 1.41; 95% CI: 1.07‐1.86) was only associated with muscular strength in males. Evidence from the present study supports the notion that muscular strength may have a protective effect against CVD. However, this association must be shown independent of cardiorespiratory fitness (CRF) and in clinical trials before any causative link can be established.

Obesity Duration, Severity, and Distribution Trajectories and Cardiovascular Disease Risk in the Atherosclerosis Risk in Communities Study.

BackgroundResearch examining the role of obesity in cardiovascular disease (CVD) often fails to adequately consider heterogeneity in obesity severity, distribution, and duration.Methods and ResultsWe here use multivariate latent class mixed models in the biracial Atherosclerosis Risk in Communities study (N=14 514; mean age=54 years; 55% female) to associate obesity subclasses (derived from body mass index, waist circumference, self‐reported weight at age 25, tricep skinfold, and calf circumference across up to four triennial visits) with total mortality, incident CVD, and CVD risk factors. We identified four obesity subclasses, summarized by their body mass index and waist circumference slope as decline (4.1%), stable/slow decline (67.8%), moderate increase (24.6%), and rapid increase (3.6%) subclasses. Compared with participants in the stable/slow decline subclass, the decline subclass was associated with elevated mortality (hazard ratio [HR] 1.45, 95% CI 1.31, 1.60, P<0.0001) and with heart failure (HR 1.41, 95% CI 1.22, 1.63, P<0.0001), stroke (HR 1.53, 95% CI 1.22, 1.92, P=0.0002), and coronary heart disease (HR 1.36, 95% CI 1.14, 1.63, P=0.0008), adjusting for baseline body mass index and CVD risk factor profile. The moderate increase latent class was not associated with any significant differences in CVD risk as compared to the stable/slow decline latent class and was associated with a lower overall risk of mortality (HR 0.85, 95% CI 0.80, 0.90, P<0.0001), despite higher body mass index at baseline. The rapid increase latent class was associated with a higher risk of heart failure versus the stable/slow decline latent class (HR 1.34, 95% CI 1.10, 1.62, P=0.004).ConclusionsConsideration of heterogeneity and longitudinal changes in obesity measures is needed in clinical care for a more precision‐oriented view of CVD risk.

Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults

There are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis. The purpose of this study was to determine the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile. We included 22,346 CAC Consortium participants aged 30-50 years who underwent noncontrast computed tomography. Sex-specific equations were derived from multivariable logistic modeling to estimate the expected probability of CAC >0 according to age and the presence of ASCVD risk factors. Participants were on average 43.5 years of age, 25% were women, and 34% had CAC >0, in whom the median CAC score was 20. Compared with individuals without risk factors, those with diabetes developed CAC 6.4 years earlier on average, whereas smoking, hypertension, dyslipidemia, and a family history of coronary heart disease were individually associated with developing CAC 3.3-4.3 years earlier. Using a testing yield of 25% for detecting CAC >0, the optimal age for a potential first scan would be at 36.8 years (95% CI: 35.5-38.4 years) in men and 50.3 years (95% CI: 48.7-52.1 years) in women with diabetes, and 42.3 years (95% CI: 41.0-43.9 years) in men and 57.6 years (95% CI: 56.0-59.5 years) in women without risk factors. Our derived risk equations among health-seeking young adults enriched in ASCVD risk factors inform the expected prevalence of CAC >0 and can be used to determine an appropriate age to initiate clinical CAC testing to identify individuals most susceptible for early/premature atherosclerosis.

Adherence to physical activity recommendations and barriers to physical activity participation among adults with type 1 diabetes

BackgroundPhysical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited.AimsThis study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed.MethodsUsing an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors.ResultsMean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0).ConclusionThe majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels.

A precision medicine approach to sex-based differences in ideal cardiovascular health

Cardiovascular disease risk factor profiles and health behaviors are known to differ between women and men. Sex-based differences in ideal cardiovascular health were examined in the My Research Legacy study, which collected cardiovascular health and lifestyle data via Life’s Simple 7 survey and digital health devices. As the study overenrolled women (n = 1251) compared to men (n = 310), we hypothesized that heterogeneity among women would affect comparisons of ideal cardiovascular health. We identified 2 phenogroups of women in our study cohort by cluster analysis. The phenogroups differed significantly across all 7 cardiovascular health and behavior domains (all p < 0.01) with women in phenogroup 1 having a lower Life’s Simple 7 Health Score than those in phenogroup 2 (5.9 ± 1.3 vs. 7.6 ± 1.3, p < 0.01). Compared to men, women in phenogroup 1 had a higher burden of cardiovascular disease risk factors, exercised less, and had lower ideal cardiovascular health scores (p < 0.01). In contrast, women in phenogroup 2 had fewer cardiovascular risk factors but similar exercise habits and higher ideal cardiovascular health scores than men (p < 0.01). These findings suggest that heterogeneity among study participants should be examined when evaluating sex-based differences in ideal cardiovascular health.

Modeling The Recommended Age To Initiate Coronary Artery Calcium Testing Among At-risk Young Adults: The CAC Consortium

Introduction: There are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis. This study explored the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile.

Cardiovascular Risk Factor Knowledge among Monolingual Hispanics.

Hispanics in the United States have worse cardiovascular disease (CVD) risk factor profiles than non-Hispanic Whites. Cardiovascular health literacy is important for health promotion but is not well characterized among monolingual Spanish-speaking Hispanics outside of health care settings. We recruited Hispanic participants (N=235) from a community-based health fair in Denver, Colorado. A total of 182 participants (77%) completed a subsequent language-congruent telephone survey to assess CVD risk-factor knowledge. Of these, 174 self-identified as monolingual Spanish-speaking, and constituted the analysis cohort. Cardiovascular disease risk knowledge score was defined as the number of established risk factors an individual participant could name (out of 10 pre-specified), and multivariable regression analyses were conducted to determine factors independently associated with knowledge. The mean knowledge score for the cohort was 2.2 ± 1.1 out of 10. This suggests an unmet need for tailored educational interventions beyond simple screening events.