Cardiovascular Disease Risk Reduction Research Articles

Incident cardiovascular disease by clustering of favourable risk factors in type 1 diabetes: the EURODIAB Prospective Complications Study

AimsThe aim of this prospective study was to examine CVD risk reduction in type 1 diabetes (1) for people with favourable cardiovascular health metrics and (2) by clustering of these metrics.MethodsData from 2313 participants from the EURODIAB Prospective Complications Study were analysed. All had type 1 diabetes (51% men, mean ± SD age 32 ± 9 years). Seven cardiovascular health metrics were studied—smoking, BMI, physical activity, a diet score, total cholesterol/HDL-cholesterol ratio, combined systolic and diastolic BP and HbA1c—divided into favourable/less favourable categories. Cox proportional hazards models were used to calculate HRs (95% CIs) of incident CVD for each metric. Clusters were made by scoring each individual by the number of favourable metrics.ResultsA total of 163 people developed incident CVD during a mean ± SD follow-up of 7.2 ± 1.3 years. Participants with more favourable HbA1c levels of <57 mmol/mol (<7.4%) had a 37% significantly lower CVD risk than those with a less favourable HbA1c (HR [95% CI] 0.63 [0.44, 0.91]), and participants with a more favourable BP (systolic BP <112 mmHg and diastolic BP <70 mmHg) had a 44% significantly lower CVD risk than participants in the less favourable BP group (HR [95% CI] 0.56 [0.34, 0.92]). There was a dose–response relation with a lower HR observed with greater clustering of more favourable metrics: people with four or more favourable metrics had an HR of 0.37 (95% CI 0.18, 0.76), adjusted for sex and age at diabetes diagnosis, compared with those with no favourable metrics.Conclusions/interpretationLow HbA1c and low BP were protective cardiovascular health metrics in our study of people with type 1 diabetes. Targeting all cardiovascular health metrics could be more effective in preventing CVD than targeting single metrics.Graphical abstract

Novel Pharmaceutical and Nutraceutical-Based Approaches for Cardiovascular Diseases Prevention Targeting Atherogenic Small Dense LDL.

Compelling evidence supports the causative link between increased levels of low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (CVD) development. For that reason, the principal aim of primary and secondary cardiovascular prevention is to reach and sustain recommended LDL-C goals. Although there is a considerable body of evidence that shows that lowering LDL-C levels is directly associated with CVD risk reduction, recent data shows that the majority of patients across Europe cannot achieve their LDL-C targets. In attempting to address this matter, a new overarching concept of a lipid-lowering approach, comprising of even more intensive, much earlier and longer intervention to reduce LDL-C level, was recently proposed for high-risk patients. Another important concern is the residual risk for recurrent cardiovascular events despite optimal LDL-C reduction, suggesting that novel lipid biomarkers should also be considered as potential therapeutic targets. Among them, small dense LDL particles (sdLDL) seem to have the most significant potential for therapeutic modulation. This paper discusses the potential of traditional and emerging lipid-lowering approaches for cardiovascular prevention by targeting sdLDL particles.

Dual endothelin receptor antagonism increases resting energy expenditure in people with increased adiposity.

Increased adiposity is associated with dysregulation of the endothelin system, both of which increase the risk of cardiovascular disease (CVD). Preclinical data indicate that endothelin dysregulation also reduces resting energy expenditure (REE). The objective was to test the hypothesis that endothelin receptor antagonism will increase REE in people with obesity compared with healthy weight individuals. Using a double blind, placebo-controlled, crossover design, 32 participants [healthy weight (HW): n = 16, BMI: 21.3 ± 2.8 kg/m2, age: 26 ± 7 yr and overweight/obese (OB): n = 16, BMI: 33.5 ± 9.5 kg/m2, age: 31 ± 6 yr] were randomized to receive either 125 mg of bosentan (ETA/B antagonism) or placebo twice per day for 3 days. Breath-by-breath gas exchange data were collected and REE was assessed by indirect calorimetry. Venous blood samples were analyzed for concentrations of endothelin-1 (ET-1). Treatment with bosentan increased plasma ET-1 in both OB and HW groups. Within the OB group, the changes in absolute REE (PLA: -77.6 ± 127.6 vs. BOS: 72.2 ± 146.6 kcal/day; P = 0.046). The change in REE was not different following either treatment in the HW group. Overall, absolute plasma concentrations of ET-1 following treatment with bosentan were significantly associated with kcal/day of fat (r = 0.488, P = 0.005), percentage of fat utilization (r = 0.415, P = 0.020), and inversely associated with the percentage of carbohydrates (r = -0.419, P = 0.019), and respiratory exchange ratio (r = -0.407, P = 0.023). Taken together, these results suggest that modulation of the endothelin system may represent a novel therapeutic approach to increase both resting metabolism and caloric expenditure, and reduce CVD risk in people with increased adiposity.NEW & NOTEWORTHY Findings from our current translational investigation demonstrate that dual endothelin A/B receptor antagonism increases total REE in overweight/obese individuals. These results suggest that modulation of the endothelin system may represent a novel therapeutic target to increase both resting metabolism and caloric expenditure, enhance weight loss, and reduce CVD risk in seemingly healthy individuals with elevated adiposity.

IDF21-0228 Stakeholder views on the acceptability and sustainability of a multicomponent diabetes care strategy in South Asia

Background: The Cardiovascular Disease Risk Reduction Strategies in South Asia (CARRS) Translational Trial demonstrated the effectiveness of a clinic-based multi-component (non-physician care coordinators [CCs] and decision-support electronic health record [DS-EHR] software) cardiovascular disease (CVD) risk reduction intervention among 1146 diabetes patients across 10 sites in South Asia. Considering that South Asia has the highest worldwide burden of diabetes, the need to implement and sustain quality improvement care models is critical. Previous work examined how intervention characteristics impacted physician’s acceptability of the DS-EHR, yet little is known about what organizational factors enhance or inhibit sustainability of integrated diabetes care in South Asia or it’s perceived acceptability among healthcare users. Aim: To evaluate how organizational features influence sustainability of the CARRS Trial intervention and assess patient’s acceptability of the diabetes care model. Method: As a part of a longitudinal evaluation of the CARRS Trial, in-depth interviews with clinical stakeholders were conducted pre-implementation (physicians, n=19), during late implementation, after 2.5 years of supported intervention (physicians, n=9), and two years post-implementation (CCs, n=3; patients, n=34). Nineteen physicians representing the ten participating study sites were interviewed about their perceptions of utilizing a CC and the DS-EHR to assess changes in perceptions and examine how integration of care components were sustained throughout implementation. Post-implementation interviews with CCs and patients representing five clinics were also conducted to characterize the maintenance of care components and explore patient acceptability of the care model. Verbatim transcriptions were independently coded by two investigators using a codebook developed from the consolidated framework for implementation research (CFIR). A thematic analysis approach was used to identify how organizational features of the implementing clinics may influence intervention sustainability and to describe patients’ acceptance of the intervention. Results: Prior to implementation, physicians were receptive to the care model and perceived it as an opportunity to streamline clinical care processes for patients with diabetes. Recognizing the need to improve the quality of diabetes care in India, physicians felt it was important to leverage available resources to enhance communication with patients and clinic-level tracking of patients’ glycemic control. By late implementation, physicians reported that the intervention was compatible with clinics’ organizational cultures and priorities, but that sustainability would require evidence of effectiveness in preventing CVD events, administrative buy-in, and a fee system that would cover the cost of hiring CCs and maintaining long-term use of the DS-EHR. Pre-existing networks of communication within and across clinics enabled CCs to access additional training support and get feedback that helped them stay motivated. Patients appreciated that the care model optimized their time in clinic and found the CCs helpful in managing their care. Discussion: Efforts to integrate this intervention into routine care in diabetes clinics should focus on enhancing intervention compatibility with clinics’ needs, namely through tailoring the role of CCs and by generating more evidence around the long-term effectiveness of the care model to prevent diabetes complications. These findings indicate that a clinic’s implementation climate and communication system are critical in sustaining intervention implementation, and demonstrate acceptability of the intervention among patients.

IDF21-0231 Effect of multidisciplinary for improves diabetes outcomes: Diabetes Education, Awareness and Lifestyle modification

Background: There is a global pandemic of type2 diabetes mellitus (T2DM), mainly in Asia. Thailand has a prevalence of T2DM at 9.6%, which is higher than the world average of 8.9%. Multiple studies have shown that multidisciplinary, team-based, coordinated care has been associated with improved measures of quality care and reduced healthcare utilization. Patients with poor glycemic control and nephropathy are at the highest risk of developing cardiovascular complications and renal failure. Aim: In this study, we aimed to explore the impact of intensive multidisciplinary diabetes mellitus care with patient empowerment versus routine clinical care on the rate of progression of micro and macro vascular complications and peripheral atherosclerotic burden, as measured by change in arterial blood Index (ABI) in patients with persistently elevated HbA1c and nephropathy. Method: The study is randomized controlled trial (RCT) of intensive diabetes mellitus care with patient empowerment versus routine clinical care. Patient in the intensive arm will receive care from a multidisciplinary team consisting of an endocrinologist, diabetes nurse educator, dietitian, renal pharmacist and social worker for counseling. In addition, patients will be provided with tools for self-care empowerment such as glucometers, blood pressure monitors and calendar record to facilitate care, monitoring and education. Patients in the routine clinical care will receive standard clinical care. Follow up (FU) will be 2 years. Primary outcomes include cardiovascular events, rate of progression of nephropathy and development of end-stage renal disease. Secondary endpoints include the proportions of patients with documented improved control of cardiovascular risk factors (HbA1c, blood pressure, low density lipoprotein-(LDL-C), reduction in body weight), frequency of hypoglycemia, hospitalization days and change in ABI. We will also examine the prevalence of peripheral atherosclerosis and the predictive value and usability of lower extremity arterial ultrasound to predict cardio-cerebrovascular events, amputation and peripheral intervention. Results: The cumulative incidence of all events (DM-related complications and all-cause mortality) was 21.2% in the Trial-DM group and 40.6% in the usual care group. Trail-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 52.6% (95% CI 50.5, 54.6), micro vascular complications by 10.9% (95% CI 6.8, 14.6), mortality by 65.1% (95% CI 61.3, 62.9), specialist attendance by 31.0% (95% CI 30.6, 32.4), emergency attendance by 39.2% (95% CI 36.8, 40.5), and hospitalizations by 53.5% (95% CI 53.2, 56.7). Patients with low baseline CVD risks benefitted the most from Trail-DM, which decreased CVD and mortality risk by 58.4% (95% CI 50.8, 64.5) and 79.6% (95% CI 72.3, 81.0), respectively. Discussion: Diabetes mellitus carries significant health care cost. Patients with poorly glycemic control and nephropathy are at highest risk of developing cardiovascular complications and renal failure. Intensive diabetes mellitus care with patient empowerment may lead to sustained glycemic control, reduction of clinical complications and progression of nephropathy, and incidence of cardiovascular complications.

The Controversial Role of HCY and Vitamin B Deficiency in Cardiovascular Diseases

Plasma homocysteine (HCY) is an established risk factor for cardiovascular disease CVD and stroke. However, more than two decades of intensive research activities has failed to demonstrate that Hcy lowering through B-vitamin supplementation results in a reduction in CVD risk. Therefore, doubts about a causal involvement of hyperhomocysteinemia (HHcy) and B-vitamin deficiencies in atherosclerosis persist. Existing evidence indicates that HHcy increases oxidative stress, causes endoplasmatic reticulum (ER) stress, alters DNA methylation and, thus, modulates the expression of numerous pathogenic and protective genes. Moreover, Hcy can bind directly to proteins, which can change protein function and impact the intracellular redox state. As most mechanistic evidence is derived from experimental studies with rather artificial settings, the relevance of these results in humans remains a matter of debate. Recently, it has also been proposed that HHcy and B-vitamin deficiencies may promote CVD through accelerated telomere shortening and telomere dysfunction. This review provides a critical overview of the existing literature regarding the role of HHcy and B-vitamin deficiencies in CVD. At present, the CVD risk associated with HHcy and B vitamins is not effectively actionable. Therefore, routine screening for HHcy in CVD patients is of limited value. However, B-vitamin depletion is rather common among the elderly, and in such cases existing deficiencies should be corrected. While Hcy-lowering with high doses of B vitamins has no beneficial effects in secondary CVD prevention, the role of Hcy in primary disease prevention is insufficiently studied. Therefore, more intervention and experimental studies are needed to address existing gaps in knowledge.

Hypertension: Potential Player in Cardiovascular Disease Incidence in Preeclampsia.

Preeclampsia (PE) is one of the complications, that threatens pregnant mothers during pregnancy. According to studies, it accounts for 3-7% of all pregnancies, and also is effective in preterm delivery. PE is the third leading cause of death in pregnant women. High blood pressure in PE can increase the risk of developing cardiovascular disease (CVD) in cited individuals, and is one of the leading causes of death in PE individuals. Atrial natriuretic peptide (ANP), Renin-Angiotensin system and nitric oxide (NO) are some of involved factors in regulating blood pressure. Therefore, by identifying the signaling pathways, that are used by these molecules to regulate and modulate blood pressure, appropriate treatment strategies can be provided to reduce blood pressure through target therapy in PE individuals; consequently, it can reduce CVD risk and mortality.

Changes in the Second Ventilatory Threshold Following Individualised versus Standardised Exercise Prescription among Physically Inactive Adults: A Randomised Trial.

The second ventilatory threshold (VT2) is established as an important indicator of exercise intensity tolerance. A higher VT2 allows for greater duration of higher intensity exercise participation and subsequently greater reductions in cardiovascular disease (CVD) risk. This study aimed to compare the efficacy of standardised and individualised exercise prescription on VT2 among physically inactive adults. Forty-nine physically inactive male and female participants (48.6 ± 11.5 years) were recruited and randomised into a 12-week standardised (n = 25) or individualised (n = 24) exercise prescription intervention. The exercise intensity for the standardised and individualised groups was prescribed as a percentage of heart rate reserve (HRR) or relative to the first ventilatory threshold (VT1) and VT2, respectively. Participants were required to complete a maximal graded exercise test at pre-and post-intervention to determine VT1 and VT2. Participants were categorised as responders to the intervention if an absolute VT2 change of at least 1.9% was attained. Thirty-eight participants were included in the analysis. A significant difference in VT2 change was found between individualised (pre vs. post: 70.6% vs. 78.7% maximum oxygen uptake (VO2max)) and standardised (pre vs. post: 72.5% vs. 72.3% VO2max) exercise groups. Individualised exercise prescription was significantly more efficacious (p = 0.04) in eliciting a positive response in VT2 (15/19, 79%) when compared to the standardised exercise group (9/19, 47%). Individualised exercise prescription appears to be more efficacious than standardised exercise prescription in eliciting a positive VT2 change among physically inactive adults. Increasing VT2 allows for greater tolerance to higher exercise intensities and therefore greater cardiovascular health outcomes.

Interpersonal Trauma and Risk of Incident Cardiovascular Disease Events Among Women.

BackgroundTraumatic experiences have been linked to risk for cardiovascular disease (CVD). Interpersonal violence is a trauma that is prevalent in women. Among midlife women followed up for 2 decades, we examined whether interpersonal violence (childhood abuse, adulthood abuse, or intimate partner violence [IPV]) was related to increased risk of subsequent clinical CVD events.Methods and ResultsA total of 2201 women, aged 42 to 52 years at baseline, underwent up to 16 in‐person visits over 22 years. Measures included questionnaires (including of childhood physical/sexual abuse, adult physical/sexual abuse, and IPV), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). Death certificates were collected. Relationships between childhood abuse, adult abuse, and IPV with incident fatal/nonfatal CVD were tested in Cox proportional hazards models. Women with a childhood abuse history had increased risk for incident CVD (versus no abuse; hazard ratio [HR] [95% CI], 1.65 [1.12–2.44]; P=0.01; adjusted for demographics and CVD risk factors); associations were strongest for childhood sexual abuse. Adult abuse was not significantly associated with CVD. Women with IPV had a doubling of risk for incident CVD in demographic‐adjusted models (versus no IPV; IPV: HR [95% CI], 2.06 [1.01–4.23]; P=0.04; no partner: HR [95% CI], 1.79 [0.91–3.53]; P=0.09); systolic blood pressure partially mediated relationships between IPV and CVD.ConclusionsChildhood abuse, particularly sexual abuse, was associated with increased risk of CVD in women. IPV was associated with risk for CVD, with the higher systolic blood pressure among IPV‐exposed women important in these associations. Interpersonal violence prevention may contribute to CVD risk reduction in women.

A Heart Healthy Intervention Improved Tobacco Screening Rates and Cessation Support in Primary Care Practices.

We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support-extracted from practices' electronic health records-and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices' tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.

Preconception lifestyle intervention in women with obesity and echocardiographic indices of cardiovascular health in their children

Improving maternal lifestyle before conception may prevent the adverse effects of maternal obesity on their children's future cardiovascular disease (CVD) risk. In the current study, we examined whether a preconception lifestyle intervention in women with obesity could alter echocardiographic indices of cardiovascular health in their children. Six years after a randomized controlled trial comparing the effects of a 6-month preconception lifestyle intervention in women with obesity and infertility prior to fertility care to prompt fertility care, 315 of the 341 children conceived within 24 months after randomization were eligible for this study. The intervention was aimed at weight loss (≥5% or until BMI < 29 kg/m2). Children underwent echocardiographic assessment of cardiac structure and function, conducted by a single pediatric cardiologist, blinded to group allocation. Results were adjusted for multiple variables including body surface area, age, and sex in linear regression analyses. Sixty children (32 girls, 53%) were included, mean age 6.5 years (SD 1.09). Twenty-four children (40%) were born to mothers in the intervention group. Children of mothers from the intervention group had a lower end-diastolic interventricular septum thickness (-0.88 Z-score, 95%CI -1.18 to -0.58), a lower left ventricle mass index (-8.56 g/m2, 95%CI -13.09 to -4.03), and higher peak systolic and early diastolic annular velocity of the left ventricle (1.43 cm/s 95%CI 0.65 to 2.20 and 2.39 cm/s 95%CI 0.68 to 4.11, respectively) compared to children of mothers from the control group. Children of women with obesity, who underwent a preconception lifestyle intervention, had improved cardiac structure and function; a thinner interventricular septum, lower left ventricle mass, and improved systolic and diastolic tissue Doppler velocities. Despite its high attrition rates, our study provides the first experimental human evidence suggesting that preconception lifestyle interventions may present a method of reducing CVD risk in the next generation. LIFEstyle study: Netherlands Trial Register: NTR1530 ( https://www.trialregister.nl/trial/1461 ). This follow-up study was approved by the medical ethics committee of the University Medical Centre Groningen (METC code: 2008/284).

Reducing Cardiovascular Risk in the Medicare Million Hearts Risk Reduction Model: Insights From the National Cardiovascular Data Registry PINNACLE Registry.

The Million Hearts Cardiovascular Disease Risk Reduction Model provides financial incentives for practices to lower 10-year atherosclerotic cardiovascular disease (ASCVD) risk for high-risk (ASCVD ≥30%) Medicare patients. To estimate average practice-level ASCVD risk reduction, we applied optimal trial outcomes to a real-world population with high ASCVD risk. This study uses observational registry data from the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence Registry from January 2013 to June 2016. We modeled ASCVD risk reductions using historical clinical trial data (reducing cholesterol by 26.5%, reducing systolic blood pressure by 10.9%, reducing smoking rates by 21.8%) the average reduction in ASCVD risk associated with individual and combined risk factor modifications, and then percentage of practices achieving the various incentive thresholds for the Million Hearts Model. The final study population included 135 166 patients, with 16 248 (12.0%) with 10-year ASCVD risk of ≥30%, but without existing ASCVD. The mean 10-year ASCVD risk was 41.9% (±1 SD of 11.6). Using risk factor reductions from clinical trials, lowering cholesterol, blood pressure, and smoking rates reduced 10-year ASCVD risk by 3.3% (±3.1), 6.3% (±1.1) and 0.5% (±1.3), respectively. Combining all 3 reductions resulted in a 9.7% (±3.6) reduction, with 67 (27.0%) of practices achieving a patient-level average 10-year ASCVD risk reduction of ≥10%, 181 (73.0%) achieving a 2 to 10% reduction, and no practice achieving <2% reduction. In cardiology practices, about 1 out of 8 patients have a 10-year ASCVD risk ≥30% and qualify as high risk in the Million Hearts Model. If practices target the three main modifiable risk factors and achieve reductions similar to clinical trial results, ASCVD risk could be substantially lowered and all practices could receive incentive payments. These findings support the potential benefit of the Million Hearts Model and provide guidance to participating practices.

Cardiovascular risk factors and confounders in severe atopic dermatitis: a scoping review

Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease that could be associated with cardiovascular diseases (CVDs). Interest in determining whether the chronic inflammation of AD is a risk factor for CVD has been growing in recent years, although there are few studies available on this topic, and the results are quite controversial. The purpose of this scoping review was to understand whether severe atopic dermatitis and its chronic systemic inflammatory process contribute, or not, as a risk factor for the development of CVD. Following the development of a study protocol, a scoping review was carried out based on the structure outlined by Arksey and O'Malley, Levac et al., the Joanna Briggs Institute and the PRISMA-ScR guidelines. PubMed, Cochrane, EMBASE, CINAHL, LILACS, Web of Science, Biblioteca Virtual em Saúde (BVS), Scopus and SciELO were the selected databases. Results: Fifty-two studies were included in this review (18 review studies, 16 cross-sectional studies, 15 cohort studies and three meta-analyses). We found that 36 studies could associate AD with CVD, while 16 studies found no relationship between AD and CVD. Conclusions: It is possible that cardiovascular risk in moderate to severe atopic disease is in confounding factors, and not necessarily because AD and CVDs share the same chronic systemic inflammatory pathway. There is no robust evidence that AD is a risk factor for CVD. To reduce CVD risk in patients with AD, we must pay attention to the risk factors commonly present in these patients and strongly recommend a healthy lifestyle.

Association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes: A prospective cohort study

AimsThis study aimed to assess the association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes. MethodsOur study included 12,770 individuals from the UK Biobank at baseline. Sleep patterns were defined by a combination of five sleep behaviors (chronotype, sleep duration, snoring, insomnia, and excessive daytime sleepiness). The competing risk models were used to estimate the relationship between sleep patterns and CVD (including coronary heart disease [CHD] and stroke) in individuals with diabetes. To examine the association between sleep patterns and all-cause mortality risk, we utilized the flexible parametric Royston-Parmar proportion-hazard models. ResultsWe recorded 2627 CVD events, which includes 1999 CHD and 903 S events, and 1576 all-cause mortality events. Compared to those with poor sleep pattern, individuals having healthy sleep pattern have a 24% lower CVD risk (p < 0.001), a 26% lower CHD risk (p = 0.001), a 25% lower stroke risk (p = 0.036), and a 21% lower all-cause mortality risk (p = 0.020). ConclusionsAdherence to healthy sleep pattern has been significantly related to cardiovascular disease and all-cause mortality risk reduction among people with diabetes.

Effects of statin therapy and treatment duration on cardiovascular disease risk in patients with nephrotic syndrome: A nested case-control study.

BackgroundAlthough statins are the cornerstone of lipid management, hardly any of the existing studies on statin treatment of dyslipidemia in nephrotic syndrome (NS) addressed patient‐centered outcomes of cardiovascular events.ObjectiveTo evaluate whether statin treatment impacts the outcomes of cardiovascular events in patients with NS.DesignA single‐center, retrospective, nested case–control study analyzed data from the First Affiliated Hospital of Army Medical University.PatientsPatients diagnosed with NS from January 1, 1999, to November 30, 2014, were selected and followed up for 5 years.Measurements and Main ResultsA total of 2706 patients with NS were enrolled in this study cohort. Among these, 115 patients diagnosed with cardiovascular disease (CVD) at the end of the observational period and 235 CVD‐free controls enrolled by 1:2 matching with gender, age, and index time were included in the study. Propensity score matching was used to match (1:1) the baseline characteristics of the cases and controls. The chi‐square test was performed based on whether the patient used a statin as an exposure factor, and binary logistic regression analysis of the association between cardiovascular events and statin therapy duration was conducted. Subgroup analyses for relevant variables were also performed. The chi‐square test showed that statin therapy was significantly associated with a reduction in CVD risk in patients with NS (p = 0.002). Furthermore, the risk of cardiovascular events in patients with NS decreased as the length of statin treatment increased (OR = 0.82 [95% CI 0.73–0.89], p < 0.001).ConclusionsFor NS patients with dyslipidemia, statin therapy may be used to decrease CVD risk, and extended treatment was associated with more significant risk reduction.

Abstract P097: The Missing Link In Current Prevention Strategies Focused On Reducing CVD Risk Among Youth: Youth's Mental Health

Background: Physical activity (PA), sedentary behavior such as screen time (SB), and sleep are well-known health behaviors associated with cardiovascular disease (CVD) risk factors (i.e., obesity) among youth. CVD risk factors are also prevalent among youth with a mental health diagnoses, in particular, depression. PA, SB, and sleep have also been independently associated with an increased risk of depression among youth. How these behaviors interact together and influence CVD risk among youth remains unclear. Such information is vital to the prevention of CVD among youth and further examination is urgently needed to guide the development of future intervention strategies. Objective: To examine the interplay of health behaviors, mental health indicators, and other sociodemographic predictors of obesity risk using a national representative sample of youth in the U.S. Methods: Adolescents (aged 13-18 years) from the 2018-2019 National Survey of Children’s Health data was utilized. Obesity risk was defined as a BMI% 85. Demographics (age, sex, race, ethnicity), PA, screen time, hours of sleep per night on weeknights, and diagnosis of depression and anxiety from a health care provider were extracted. Meeting Recommendations was defined as: PA (60 minutes/day, 4-7 days/week); screen time ( 2 hours/day); and sleep ( 8 hours/night). Multivariable logistic regression analyses examined the predictors of obesity risk. Results: The analytic cohort included 17,053 youth with a mean age of 15.59 1.11 years. Youth with obesity risk were more often (p&lt;0.001) male (55% vs 51%), non-White (22% vs 19%), and Hispanic (13% vs 10%). In the multivariable model, the most significant predictors of obesity risk included not meeting physical activity recommendations (OR = 1.52, 95% CI 1.42, 1.64) and a diagnosis of depression (OR = 1.45, 95% CI 1.28, 1.64). Conclusions: Both physical activity and depression are independently contributing to obesity risk among youth in a large, national cohort. The interplay of health behaviors, mental health, and CVD risk factors among youth need to be examined further to elucidate possible mechanisms of causation.

Abstract P054: Plant-based Nutrition And Lifestyle Intervention To Improve Dietary Behaviors Among Black Adults In The South

Background: Plant-based diets may reduce risk of cardiovascular disease (CVD) and help with weight management, particularly in communities where the burden of chronic disease is high. However, little research has been done on plant-based diet implementation in rural Black communities that are disproportionately affected with obesity/CVD. Since dietary behaviors are closely linked to cultural identity in this community, intervention strategies are needed to preserve cultural traditions while addressing lifestyle behaviors that reduce CVD risk. Methods: The Veggie &amp; Soul pilot program was a 12-week plant-based nutrition and lifestyle intervention implemented in 2020 to prioritize and educate Black adults in rural Georgia about the benefits of a healthy diet and encourage increased consumption of fruits, vegetables, and whole grains. Weekly nutrition education sessions were implemented, in addition to support groups and cooking classes. Multiple instruments for dietary assessment were collected at baseline and 12 weeks including: (1) food frequency questionnaire; (2) food behavior survey, and (3) two 24-hour dietary recalls (1 weekend and 1 weekday). Paired t-tests explored differences between baseline and 12-week measurements. Results: Twenty-four participants (22 women, 2 men) completed the intervention. Participants doubled their daily servings of fruit from baseline to 12 weeks (1.3 vs. 2.6 servings respectively; p&lt;.001) and reported a 76% increase in daily vegetable servings (1.7 vs. 3.0 servings respectively; p&lt;.001). There was also a 90% increase in daily servings of whole grain (1 vs. 1.9 servings respectively; p=0.014). Further, results showed a significant reduction in intake of nutrients to limit including cholesterol (-83%; p&lt;.001), saturated fat (-42%; p&lt;.001), sodium (-28%; p=.004), and added sugars (-54%; p-.002). At baseline, 46% of participants agreed or strongly agreed that “a diet without meat is satisfactory and nutritious.” At 12 weeks, 95% of participants agreed or strongly agreed with this statement (p&lt;.001). There was a significant increase in participant confidence in preparing healthy meals by the end of the intervention (p=.03). Median weight change was 9.6 lbs, with a decrease in both body mass index and waist circumference (p&lt;.001). Waist-hip ratio reductions were also mildly significant (p=0.058). Conclusion: Implementing a 12-week nutrition and lifestyle intervention among Black adults in the rural South improved reported dietary behaviors that may impact obesity and cardiovascular risk. Long-term interventions are needed that will promote permanent behavior changes to improve health in similar communities.

Abstract P094: Awareness Of Cardiovascular Disease Is Low Among Young Women And Varies By Region

Background: Prior research has shown that awareness of cardiovascular disease (CVD) and its risk factors is low among young women. The present study used preliminary data to compare the awareness of CVD in young women seen in primary care clinics in the Northeastern and Southeastern United States. Methods: We recruited 370 females ages 15-24 years from two primary care clinics located in Boston, MA (n=331) and Atlanta, GA (n=39). Recruitment in Atlanta, GA is ongoing. Participants completed a modified version of the AHA Women’s Health Survey. We examined the relationship between location and 1) knowledge about CVD and 2) engagement in preventive behaviors, while controlling for race/ethnicity, age group, and primary caregiver education. Results: Sixty-two percent (n=23) of young women in Atlanta reported feeling informed about CVD, while 53% (n=163) of young women in Boston reported feeling informed about CVD. Only 13% (n=34) of participants in Boston and 6% (n=2) of participants in Atlanta correctly identified CVD as the leading cause of death for women. Participants in Atlanta were less likely to report engagement in CVD preventive behaviors such as exercising (OR: 0.32, 95% CI: 0.12, 0.91), maintaining a healthy cholesterol (OR: 0.13, 95% CI: 0.04, 0.50) or blood pressure level (OR: 0.24, 95% CI: 0.08, 0.74), and reducing sugar in their diet (OR: 0.33, 95% CI: 0.12, 0.91). Moreover, young women in Atlanta were more than twice as likely to report having never discussed CVD-related health topics such as family history of CVD, blood pressure, and cholesterol with their health care provider (OR: 2.46, 95% CI: 0.86, 7.02). Conclusion: CVD awareness is low among young women and varies by region. Despite living in a region where CVD is highly prevalent, young women in Atlanta were less likely to engage in preventive behaviors and less likely to discuss CVD-related topics with their health care provider. In this region where cardiovascular health disparities are common, opportunities remain to promote heart healthy behavior among young women to reduce CVD risk.

Predictors of Informed People's Preferences for Statin Therapy to Reduce Cardiovascular Disease Risk: an Internet Survey Study.

Guidelines suggest clinicians inform patients about their 10-year cardiovascular disease (CVD) risk; however, little is known about how the risk estimate influences patients' preferences for statin therapy for primary prevention. To define predictors of preference for statin therapy after participants were informed about their individualized benefits and harms. Cross-sectional survey in 2020. Online US survey panel. A national sample of 304 respondents aged 40 to 75 who had not previously taken a statin and who knew their cholesterol levels and blood pressure measurements. Participants entered their risk factors into a calculator which estimated their 10-year CVD risk. They were then provided with an estimate of their absolute risk reduction with a statin and the chance of side effects from meta-analyses. We used a hierarchical model to predict participants' preferences for statin therapy according to their 10-year CVD risk, perceptions of the magnitude of statin benefit (large, medium, small, or almost no benefit), worry about side effects (very worried, somewhat worried, a little worried, not worried at all), and other variables. Participants had a mean age of 55 years (SD = 9.9); 50% were female, 44% were non-white, and 16% had a high school degree or less education. After reviewing their benefits and side effects, 45% of the participants reported they probably or definitely wanted to take a statin. In the full hierarchical model, only perceived benefits of taking a statin was a significant independent predictor of wanting a statin (OR 7.3, 95% CI 4.7, 12.2). Participants were from an internet survey panel and making hypothetical decisions. Participants' perceptions of their benefit from statin therapy predicted wanting to take a statin for primary prevention; neither estimated CVD risk nor worries about statin side effects were independent predictors.

The Blood Pressure Lowering Treatment Trialists' Collaboration: methodological clarifications of recent reports.

Epidemiological evidence has consistently shown that people with higher systolic or diastolic blood pressure are at greater risk of cardiovascular diseases. However, there has been limited randomized evidence to determine the role of blood pressure level at treatment initiation in the reduction of cardiovascular diseases risk. The extent to which other characteristics of individuals, such as prior disease history, age or sex, should be taken into account has also been controversial. Furthermore, effects on less commonly reported efficacy and safety outcomes remain underexplored. The Blood Pressure Lowering Treatment Trialists' Collaboration has collected individual-level participant data from 52 randomized clinical trials, with more than 360 000 participants, and is now the largest source of individual-level data from randomized clinical trials of blood pressure-lowering treatment. This resource provides an unprecedented opportunity to address major areas of uncertainty relating to stratified efficacy and safety of antihypertensive therapy. Recent reports have demonstrated the power of pooled analyses of the Blood Pressure Lowering Treatment Trialists' Collaboration dataset in filling long-standing gaps in our knowledge. However, there have been some misconceptions regarding the methods underpinning the recent reports, which we clarify in this article.