Related Cardiovascular Risk Research Articles

Near-infrared spectroscopy for cardiovascular risk assessment? Not ready for prime time

This editorial refers to ‘Determinants of high cardiovascular risk in relation to plaque composition of a non-culprit coronary segment visualized by near-infrared spectroscopy in patients undergoing percutaneous coronary intervention’[†][1], by S.P.M. de Boer et al. , on page 282 The rupture of an unstable atherosclerotic plaque precedes the majority of acute coronary syndromes, and considerable effort has been devoted to identifying patients at increased risk of future coronary ischaemic events. Atherosclerosis imaging is a potentially attractive strategy to detect vulnerable coronary plaques, with each modality having its own advantages and limitations. Different characteristics of the atherosclerotic plaque can be targeted with imaging, such as the number and severity of luminal narrowings with angiography, atheroma burden and remodelling with intravascular ultrasonography (IVUS), elastic properties with elastography, radiofrequency-determined plaque types with virtual histology, fibrous cap thickness and necrotic core with optical coherence tomography, extent of calcifications with computed tomography, and inflammation with positron emission tomography.1 Near-infrared spectroscopy (NIRS) provides chemical assessment of tissues, and catheter-based NIRS can generate spectra that may distinguish cholesterol from collagen and may identify chemical fingerprints in coronary plaques in the cardiac catheterization laboratory ( Figure 1 ).2 Although intravascular NIRS has been compared with pathological findings, its research and clinical implications remain to be established. de Boer et al. now report their use of NIRS in a non-culprit coronary artery and the associations with clinical characteristics and biomarkers in 208 patients undergoing percutaneous coronary intervention.3 History of hypercholesterolaemia, male sex, use of beta-blockers, and a history of peripheral artery disease and/or cerebrovascular disease were modestly associated with NIRS-derived lipid core burden index (LCBI), while biomarkers such as blood lipids and high-sensitivity C-reactive protein were not. Approximately 23% of the variance in LCBI was explained by all available baseline characteristics including plasma … [1]: #fn-2

Determinants of high cardiovascular risk in relation to plaque-composition of a non-culprit coronary segment visualized by near-infrared spectroscopy in patients undergoing percutaneous coronary intervention

The aim of this study was to determine the relationship between clinical and blood characteristics of a vascular inflammatory milieu and coronary plaque composition visualized by near-infrared spectroscopy (NIRS) in percutaneous coronary intervention (PCI) patients. Between April 2009 and January 2011, we performed NIRS in 208 patients who underwent PCI or invasive diagnostic coronary exploration for various indications. Imaging was performed of one non-intervened coronary segment after the initial procedure. Univariate and multivariate linear regression analyses were applied to evaluate the relationship between the acquired NIRS-derived lipid core burden index (LCBI) and clinical and blood (lipids and hs-C-reactive protein) characteristics. Patients with a history of hypercholesterolaemia [median 48 (inter-quartile range 21-101) vs. 38 (13-70), P = 0.043] and multi-vessel disease [55 (24-104) vs. 32 (12-71), P = 0.012] had higher LCBI levels. Men had higher LCBI than women [48 (21-95) vs. 27 (9-59), P = 0.003]. Hypercholesterolaemia and gender remained significant in multivariate regression analysis, whereas also a history of non-cardiac vascular disease and beta-blockers were positively associated with LCBI. Altogether 23.2% of the variability in LCBI could be explained by clinical and blood characteristics. Clinical characteristics reflecting patients with a high cardiovascular risk profile explained 23.2% of the variability in LCBI, whereas blood biomarkers added little. Further research is warranted to evaluate whether NIRS has the potential to provide additional prognostic information about patients' cardiovascular risk.

Birth by Caesarean Section and Prevalence of Risk Factors for Non-Communicable Diseases in Young Adults: A Birth Cohort Study

BackgroundConflicting findings on the risk of obesity among subjects born by caesarean section have been published. Caesarean section should also increase the risk of obesity related cardiovascular risk factors if type of delivery is associated with obesity later in life. This study was aimed at assessing the effect of type of delivery on metabolic cardiovascular risk factors in early adulthood.Methodology and Principal FindingsIn 1982, maternity hospitals in Pelotas, southern Brazil, were visited and those livebirths whose family lived in the urban area of the city have been followed. In 2000, when male subjects undertook the Army entrance examination (n=2200), fat mass and fat free mass were estimated through bioimpedance. In 2004–2005, we attempted to follow the whole cohort (n=4297), and the following outcomes were studied: blood pressure; HDL cholesterol; triglycerides; random blood glucose, C-reactive protein, waist circumference and body mass index. The estimates were adjusted for the following confounders: family income at birth; maternal schooling; household assets index in childhood; maternal skin color; birth order; maternal age; maternal prepregnancy weight; maternal height; maternal smoking during pregnancy; birthweight and family income at early adulthood.ResultsIn the crude analyses, blood pressure (systolic, diastolic and mean arterial pressure) and body mass index were higher among subjects who were delivered through caesarean section. After controlling for confounders, systolic blood pressure was 1.15 mmHg (95% confidence interval: 0.05; 2.25) higher among subjects delivered by caesarean section, and BMI 0.40 kg/m2 (95% confidence interval: 0.08; 0.71). After controlling for BMI the effect on systolic blood pressure dropped to 0.60 mmHg (95% confidence interval: -0.47; 1.67). Fat mass at 18 years of age was also higher among subjects born by caesarean section.ConclusionCaesarean section was associated with a small increased in systolic blood pressure, body mass index and fat mass.

Relationship of Epicardial Adipose Tissue Thickness with Early Indicators of Atherosclerosis and Cardiac Functional Changes in Obese Adolescents with Metabolic Syndrome

Objective: Epicardial adipose tissue thickness (EATT) is suggested as a new cardiometabolic risk factor. Carotid intima-media thickness (IMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MS). We investigated the association of EATT with carotid IMT and cardiac functional changes in obese adolescents with MS.Methods: One hundred thirty-eight obese adolescents and 63 lean subjects were enrolled in the study. The obese subjects were divided into two subgroups based on the presence or absence of MS (MS group and non-MS group). All subjects underwent transthoracic echocardiographic examination for determination of left ventricular (LV) function, LV mass index (LVMI), and myocardial performance index (MPI). EATT and carotid IMT were also measured during echocardiography.Results: The average LVMI measurements were higher in both MS and non-MS obese patients in comparison with the lean children. The MS group had significantly higher LVMI measurements than the non-MS and lean groups (88.5±23.0, 67.5±24.8 g/m2, and 62.4±18.2 g/m2, respectively; p<0.01). Carotid IMT was higher in both the MS and non-MS obese patients in comparison with the lean group. The MS group had significantly higher carotid IMT measurements than the non-MS and lean groups (0.91±0.23, 0.78±0.18, and 0.52±0.08 mm, respectively; p<0.01). The EATT was also increased significantly in patients with MS compared to lean adolescents (7.42±1.55 vs. 4.28±0.79mm; p=0.001). EATT was positively correlated with body mass index-SDS, waist circumference, fasting glucose, insulin, homeostasis model assessment-insulin resistance, triglyceride levels, LV thickness, LVMI, and MPI in the MS obese group. EATT was the only independent predictor of carotid IMT in the multivariate analysis (β= 0.69, p<0.001).Conclusion: The findings of the present study demonstrate a close relationship of EATT with carotid IMT and early cardiac dysfunction in obese adolescents with MS. Assessment of EATT and carotid IMT in routine echocardiographic examinations is suggested as a feasible and reliable method for the evaluation of obesity with MS and its related cardiovascular risks in children and adolescents. Conflict of interest:None declared.

Arterial hypertension and diabetes mellitus

The pathogenesis of arterial hypertension in patients with diabetes is a complicated process and involves a complex of biological and ecological factors, as well as genetic predisposition; as a result, the elevated blood pressure (BP) in patients with diabetes mellitus (DM) creates a higher risk of adverse events. Morbidity and mortality increase in diabetic patients who do not effectively control their BP to the targeted values of less than 140/90 (130/80) mm Hg. Large randomized trials and meta-analyses of large randomized controlled studies showed that the pharmacological reduction of BP is the most effective single way for reduction of mortality and of target organs damage in patients with DM, especially the related cardiovascular risk. Frequently, a combination of two or more medications (diuretics, angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers, angiotensin receptor blockers, spironolactone, etc.) is needed for effective pharmacotherapy, mostly in patients with difficult BP control. However, the costs of the health care to intensively lower BP are significantly lower than the expenditures to treat the hypertension complications, and the latter may be even prevented with BP reduction.

DIABETES EM MOVIMENTO® - COMMUNITY-BASED EXERCISE PROGRAM FOR PATIENTS WITH TYPE 2 DIABETES

BackgroundExercise is widely recommended as a nonpharmacological therapeutic strategy essential to control of type 2 diabetes and cardiovascular related risk. This study aims to present Diabetes em Movimento® a community-based...

AB0582 Traditional cardiovascular risk factors in psoriatic arthropathy. association with cardiovascular events.

BackgroundInflammatory diseases seem to be associated with increased cardiovascular risk in relation to the disease itself. In patients with psoriatic arthritis (PsA) there is evidence of increased morbidity and mortality...

Home-Based Circuit Resistance Training to Overcome Barriers to Exercise for People With Spinal Cord Injury

People with spinal cord injury (SCI) have limited options for aerobic exercise. Existing options are often difficult to access, or they result in muscle imbalances that can eventually contribute to joint dysfunction. These difficulties can cause individuals to live a more sedentary lifestyle, putting them at greater risk for developing obesity and other cardiovascular disease risk factors. Therefore, a mode of exercise that allows people with SCI an affordable, accessible, and effective way to engage in cardiovascular exercise is needed. The participant was a 44-year-old man with chronic, complete T12 SCI resulting from a motor vehicle accident 28 years ago. He participated in a case study evaluating the effectiveness of a home-based aerobic and strengthening exercise program. Outcome measures were assessed before and after completing a 12-week home-based circuit resistance training (CRT) program. The intervention was a modified version of a previously studied CRT program performed in a traditional gym that was designed to improve strength and aerobic fitness and to elicit healthy cholesterol levels in people with paraplegia. After performing the CRT program, the participant demonstrated improvements in cardiovascular fitness and upper extremity strength. Cholesterol levels were unchanged. He also lost weight and his shoulder pain improved. The findings demonstrate the potential for some individuals with SCI to safely and effectively engage in aerobic and strengthening exercise in their home to improve or prevent cardiovascular-related risk factors.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A44) for more insights from the authors.

Echocardiographic assessment of epicardial adipose tissue in obese children and its relation to clinical parameters of metabolic syndrome

The aim of the study was to evaluate cardiac function and epicardial adipose tissue (EAT) of obese children with echocardiography and to study the relationship of EAT to other echocardiogrpahic findings and to clinical parameters of metabolic syndrome(MS) in children. This study included 74 obese children and adolescents form the patients attending the obesity clinic of National Research Centre. Metabolic syndrome was determined according to International Obesity Task Force (IOTF) 2007 criteria. Forty leanchildren were included in the study as a control group. All children were subjected to: clinical assessment including standing height, body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Echocardiography examination with measurement of EAT thickness and Biochemical parameters (fasting glucose, insulin, HOMA index, total cholesterol, triglyceride, HDL-C and LDL-C). BMI, SDS BMI, WC, HC and HOMA index were significantly higher in obese compared to lean children P = 0.001. Left atrial (LA) diameter, septal, posterior wall thickness, relative wall thickness and left ventricular mass (LVM) were increased in obese compared to non obese group while LV systolic and diastolic functions did not differ in obese versus lean children P > 0.05. The patients had significantly thicker EAT compared to control P = 0.01. There was a significant correlation between EAT thickness in comparison to BMI, WC, HC, LA diameter, LVM, HOMA, Triglyceride and LDL-C No significant difference in EAT thickness between obese patients with or without metabolic syndrome. Assessment of EAT thickness in routine echocardiographic examinations might be a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood. There is no significant association between EAT thickness and metabolic syndrome in obese children.

Epidemiological characteristics of metabolic syndrome among Kazakh children aged from 6 to 13 in Xinjiang, China

This study was designed to evaluate the epidemiology and clinical characteristics on metabolic syndrome (MetS) among overweight and obese children aged from 6 to 13 years old in Kazakh ethnic populations. Based on the data including body mass index (BMI), waist circumference (WC) and blood pressure measured from the 'Kazakh ethnic child Health examination study in Yili', 5360 Kazakh children aged 6 - 13 were screened for overweight and obesity in Xinjiang, using the Chinese BMI cutoffs for schoolchildren (7 - 18 years) and WHO growth reference for school-aged children and adolescents (6 year). Simultaneously a group of children with normal BMI were selected as the control group. Fasting plasma glucose (FPG), insulin (FINS), serum high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. HOMA-IR index was calculated to estimate the individual insulin resistance. Children under study were older than or equal to 10 years and met the criteria according to the definition of metabolic syndrome, prophylaxis and treatment on Chinese children and adolescents, proposed by the Society of Pediatrics in China or NCEP-ATPIII definition as MetS. Risk factors related to cardiovascular diseases were analyzed according to the criteria by the Society of Pediatrics among those aged from 6 to 10 years old children. Connection between waist-to-height ratio (WHtR) and biochemical indexes was explored. Prevalence rates of MetS according to the criteria from Society of Pediatrics in China were: 0%, 9.57%, 19.64% in the normal weight, overweight and obese children, respectively. The rates diagnosed by NCEP-ATPIII definition were 0.64%, 2.61%, 16.07% respectively. The detective rates of individual MetS component among obese children were: 78.95% for abdominal obesity, 29.82% for elevated BPs, 26.32% for high TG, 22.81% for low HDL-C, 0.88% for FPG. High TG (31.15%), abdominal obesity (23.77%) and low HDL-C (22.95%) appeared as the leading three abnormal indices among the overweight children. With increased BMI, the clustering of MetS components were also remarkably increasing. The detective rates of cardiovascular-related risk factors among overweight or obesity children from 6 to 10 years old were:abdominal obesity or obesity, low HDL-C, high TG, impaired FPG, elevated BPs. Differences were seen between overweight or obesity children and normal weight children on the detective rates of high TG, low HDL-C, abdominal obesity or obesity. WHtR was related with FINS, HOMA-IR index and LDL-C. MetS seemed epidemic among obese Hazakh children. Abdominal obesity, elevated BPs and high TG were the leading three abnormal factors among obese children. Compare to NCEP-ATPIII, abnormal biochemical indices on overweight Kazakh children seemed to be more sensitive, proposed by the Society of Pediatrics in China.

Screening low-income women of reproductive age for cardiovascular disease risk factors.

Abstract Background: Identifying and treating chronic diseases, their precursors, and other cardiovascular disease (CVD) risk factors during family planning visits may improve long-term health and reproductive outcomes among low-income women. A cross-sectional study design was used to describe the prevalence of chronic diseases (hypertension, high cholesterol, and diabetes), their precursors (pre-hypertension, borderline high cholesterol, and pre-diabetes), and related CVD risk factors (such as obesity, smoking, and physical inactivity) among low-income women of reproductive age. Prevalence of chronic diseases, their precursors, and related CVD risk factors were assessed for 462 out of 859 (53.8%) female family planning patients, ages 18-44 years, who attended a Title X clinic in eastern North Carolina during 2011 and 2012 and consented to participate. Data were obtained from clinical measurements, blood test results, and questionnaire. Differences in distribution of demographic and health care characteristics and CVD risk factors by presence of prehypertension and pre-diabetes were assessed by Pearson chi-square tests. The prevalence of hypertension was 12%, high cholesterol 16%, and diabetes 3%. Nearly two-thirds of women with hypertension were newly diagnosed (62%) as were 75% of women with diabetes. The prevalence of pre-hypertension was 35%, pre-diabetes 31%, obesity 41%, smoking 32%, and physical inactivity 42%. The majority of participants (87%) had one or more chronic disease or related cardiovascular disease risk factor. CVD screening during family planning visits can identify significant numbers of women at risk for poor pregnancy outcomes and future chronic disease and can provide prevention opportunities if effective interventions are available and acceptable to this population.

Omega-3 fatty acids, polymorphisms and lipid related cardiovascular disease risk factors in the Inuit population

BackgroundTissue concentrations of fatty acids (FAs) and genetic variations are well-known factors which affect the cardiovascular disease (CVD) risk. The objective was to examine whether the genetic variability of 20 candidate genes and red blood cells (RBCs) percentage of total n-3 polyunsaturated fatty acids (PUFA), a biomarker of dietary n-3 PUFA intake, modulate lipid related CVD risk factors in the Inuit population.MethodsData from the Qanuippitaa Nunavik Health Survey (n = 553) were analysed via multivariate regression models with 40 known polymorphisms, RBCs percentage of n-3 PUFA, and the interaction term to take into account the effect on plasma lipid and apolipoporotein levels.ResultsIndividuals being heterozygotes for CETP C-4502T (rs183130) or G-971A (rs4783961) together with higher n-3 PUFA had lower triacylglycerol (TG) concentrations compared to homozygotes for the minor allele. Further, effects of a stronger beneficial association between n-3 PUFA in RBCs and plasma lipid parameters- including lower total cholesterol (TC), lower low-density lipoprotein cholesterol (LDL-C) or higher high-density lipoprotein cholesterol (HDL-C) concentrations- were associated with AGT M235T (rs699) TT genotype, CETP G-971A (rs4783961) AG genotype, T allele carriers of CETP C-4502T (rs183130), and T allele carriers of CETP Ile405Val (rs5882). In contrast, higher n-3 PUFA in RBCs were associated with adverse lipid profiles- including increased LDL-C, increased apolipoprotein B100 or decreased HDL-C concentrations- in G allele carriers of the APOA5 -3 A/G (rs651821), C allele carriers of APOA5 T-1131C (rs662799), G carriers of APOC3 SstI (rs5128) and G carriers of APOA4 Asn147Ser (rs5104).ConclusionOverall, these results suggest that percentage of total n-3 PUFA of RBCs are associated with lipids related CVD risk factors conferred by genetic variations in the Inuit population.

Dietary Patterns and Cardiovascular Disease-Related Risks in Chinese Older Adults

Studies of Western populations demonstrate a relationship between dietary patterns and cardiovascular-related risk factors. Similar research regarding Chinese populations is limited. This study explored the dietary patterns of Chinese older adults and their association with cardiovascular-related risk factors, including hypertension, obesity, and metabolic syndrome. Data were collected using a 34-item Chinese food frequency questionnaire from 750 randomly selected older adults aged 50–88 who participated in the study in 2012. Factor analysis revealed four dietary patterns: a “traditional food pattern,” consisting of vegetable, fruit, rice, pork, and fish; a “fast and processed food pattern” consisting of fast or processed food products, sugar, and confectionery; a “soybean, grain, and flour food pattern”; and a “dairy, animal liver, and other animal food pattern.” These patterns explained 17.48, 9.52, 5.51, and 4.80% of the variances in food intake, respectively. This study suggests that specific dietary patterns are evident in Chinese older adults. Moderate intake of “traditional Chinese food” is associated with decreased blood pressure and cholesterol level. A dietary pattern rich in soybeans, grains, potatoes, and flour is associated with reduced metabolic factors including reduced triglycerides, fasting glucose, waist circumference, and waist–hip ratio, and a high level of dairy, animal liver, and other animal intake food pattern is associated with increased level of Body Mass Index. In conclusion, this study revealed identifiable dietary patterns among Chinese older adults that are significantly related to blood pressure and metabolic biomarkers. Further study using prospective cohort or intervention study should be used to confirm the association between dietary patterns and blood pressure and metabolic factors.

Diabetes and associated cardiovascular risk factors in the State of Kuwait: the first national survey

Cardiovascular diseases (CVD) are the leading cause of mortality worldwide as well as in Kuwait. People with diabetes have two to five times greater risk of developing CVD as compared with non-diabetic individuals. To date, little information exists on the prevalence and characteristics of cardiovascular risk factors in Kuwait. The objective of this survey was to address the growing burden of diabetes and related cardiovascular risk factors, and to estimate, for the first time, the prevalence of cardiovascular risk factors in the State of Kuwait. The study was carried out using the World Health Organization (WHO) STEPwise approach for surveillance of non-communicable disease risk factors. This study represents a national survey for Kuwaiti nationals aged between 20 and 65 years. All participants were involved in an interview for gathering sociodemographic information, underwent focused physical examination and donated a blood sample for the study-specific laboratory investigations. A total of 1970 subjects, with a mean age of 48.9 ± 10.5, were screened. The prevalence of cardiovascular risk factors was as follows: diabetes 17.9%, dyslipidaemia 70.3%, hypertension 25.3% and obesity 48.2%. Over 62% had a sedentary lifestyle, and 17.8% were smokers. The prevalence of diabetes and dyslipidaemia increased with age and body mass index. Diabetes was also significantly associated with age above 40 years (OR = 10.5), family history of diabetes (OR = 2.79), hypertension (OR = 2.22), obesity (OR = 2.87) and lower literacy (OR = 4.23). This study found that advancing age (≥ 40 years), diabetes mellitus, obesity, positive family history of diabetes, hypertension and dyslipidaemia are significant risk factors for developing CVD in Kuwait as in other parts of the world. Understanding these factors allows for preventive measures to be taken for Kuwaiti population.

The current waist circumference cut point used for the diagnosis of metabolic syndrome in sub-Saharan African women is not appropriate.

The waist circumference cut point for diagnosing the metabolic syndrome in sub-Saharan African subjects is based on that obtained from studies in European populations. The aim of this study was to measure the prevalence of obesity and related metabolic disorders in an urban population of African females, a group at high risk for such diseases, and to determine the appropriate waist cut point for diagnosing the metabolic syndrome. Anthropometry and fasting lipid, glucose and insulin levels were measured in a cohort of 1251 African females participating in the Birth to Twenty cohort study in Soweto, Johannesburg. The waist circumference cut points for diagnosing metabolic syndrome (as defined using the new harmonised guidelines), insulin resistance, dysglycaemia, hypertension and dyslipidaemia were obtained using receiver operator characteristic curve analysis. The prevalence of obesity, type 2 diabetes and metabolic syndrome were 50.1%, 14.3% and 42.1%, respectively. The appropriate waist cut point for diagnosing metabolic syndrome was found to be 91.5 cm and was similar to the cuts points obtained for detecting increased risk of insulin resistance (89.0 cm), dysglycaemia (88.4 cm), hypertension (90.1 cm), hypo-high density lipoproteinaemia (87.6 cm) and hyper-low density lipoproteinaemia (90.5 cm). The present data demonstrates that urban, African females have a high prevalence of obesity and related disorders and the waist cut point currently recommended for the diagnosis of the metabolic syndrome (80.0 cm) in this population should be increased to 91.5 cm. This latter finding demonstrates a clear ethnic difference in the relationship between abdominal adiposity and metabolic disease risk. The similar waist cut points identified for the detection of the individual components of the metabolic syndrome and related cardiovascular risk factors demonstrates that the risk for different metabolic diseases increases at the same level of abdominal adiposity suggesting a common aetiological pathway.

Cardiovascular function in women with recurrent miscarriage, pre-eclampsia and/or intrauterine growth restriction

Objective: To investigate prepregnancy cardiovascular function and risk factors in women with previous pregnancy complications. Methods: Thirty-four women with previous normal pregnancy (controls), 26 with unexplained recurrent miscarriage (RM) and 14 with pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR), planning to conceive were recruited. Brachial and central blood pressures (BP), cardiac output (CO), peripheral vascular resistance (PVR), aortic stiffness, blood biochemistry and platelet aggregation were assessed. Results: Women with previous PE/IUGR had higher brachial diastolic BP (78 ± 9 vs 71 ± 7 mmHg; p = 0.03), central systolic BP (107 ± 10 vs 99 ± 8 mmHg; p = 0.03), mean arterial pressure (92 ± 10 vs 84 ± 8 mmHg; p = 0.01) and PVR (1499 ± 300 vs 1250 ± 220 dynes.s−1 cm−5; p = 0.005), than the controls. No differences were observed in either cardiovascular function or blood biochemistry in women with unexplained RM compared with the controls. Women with previous PE/IUGR though not with RM had a stronger family history of cardiovascular disease (CVD) than controls. Conclusions: Women with previous PE and/or IUGR had higher BP and PVR compared with controls, which may predispose them to CVD later in life. However, in the absence of underlying vascular pathology, women with unexplained RM did not have abnormal cardiovascular function. Prepregnancy period provides an opportunity to identify cardiovascular risks in relation to previous obstetric history.

Correlation between Metabolic Control and Periodontal Parameters in Diabetic Patients

Background and aims. Recent reports suggest that some of the risk factors for periodontal disease are similar to those of certain systemic diseases, and that periodontal disease itself may be a risk factor for some systemic diseases. Therefore, the present study investigated the association of markers of metabolic control and systemic inflammation in diabetics with the extent and severity of periodontal disease; in addition, the relative cardiovascular risk was evaluated in such patients. Materials and methods. A total of 50 known diabetic subjects participated in the study. Periodontal examination included a full-mouth assessment for bleeding on probing using sulcus bleeding index (SBI) and probing depths (PD). Blood analyses were carried out for glycosylated hemoglobin, (HbA1c), C-reactive protein (CRP) and lipid profile. Results. Periodontal disease severity, in terms of SBI scores and PD, was found to be associated with inadequate glycemic control as measured by HbA1c. Similarly, increased probing depths were associated with increased CRP levels, total choles-terol, low-density lipoproteins, and triglycerides (Pl0.05). Conclusion. The results suggest that patients with poorer glycemic control are at increased risk for periodontitis with an associated risk for cardiovascular disease.

Should We Be Recommending Vitamin D Supplementation for Hypertension and Cardiovascular Disease Prevention?

Should We Be Recommending Vitamin D Supplementation for Hypertension and Cardiovascular Disease Prevention?

Relação da circunferência do pescoço com a força muscular relativa e os fatores de risco cardiovascular em mulheres sedentárias

To verify the relation of neck circumference and relative muscle strength and cardiovascular risk factors in sedentary women. A cross-sectional study with 60 premenopausal women (33.9±9.1 years; 67.4±13.6kg; 1.57±0.6cm and 27.2±5.3kg/m²). Based on the neck circumference, the sample was divided into two groups: Group Circumference <35cm (n=27) and Group Circumference >35cm (n=33) to compare relative muscle strength and cardiovascular risk factors. The correlation between variables was tested by Pearson and Spearman correlations, with a significance level established at p<0.05. The findings revealed that women with neck circumference >35cm presented higher values of body mass, waist circumference, body adiposity index, body mass index, systolic blood pressure, blood glucose, glycated hemoglobin and volume of visceral fat when compared with the group with neck circumference <35cm. Additionally, the group with larger neck circumference presented lower values of relative strength. Neck circumference seems to be an important predictive factor of cardiovascular risk and of relative strength loss in middle-aged sedentary women.

382 CARDIOVASCULAR OUTCOMES WITH ANTI-HYPERTENSIVE THERAPY IN TYPE 2 DIABETES

Background: Relative cardiovascular (CV) risk reduction (RRR) is largely independent of attained systolic blood pressure (SBP) 1. How this translates to absolute risk reduction (ARR) in diabetes is not clear. Methods: We have compared five year CV outcomes (fatal and non-fatal myocardial infarct or stroke) in ten studies of intensive versus moderate or active versus placebo therapy in subjects with type 2 diabetes and attained SBP < or ≥140 mmHg. Results: Attained SBP ≥140 mmHg occurred in five early studies (HOT n = 1001, UKPDS n = 1148, SHEP n = 583, SYSTEUR n = 422, MICRO-HOPE n = 3377) and attained SBP < 140 mmHg occurred in five recent studies (ABCD-NT n = 480, ADVANCE n = 11,140, INVEST n = 4266, ACCORD n = 4733, ROADMAP n = 4447). In each study, ARR was calculated from group mean data and expressed as % change in CV events over five years per 10 mmHg decrease in attained SBP. In studies with attained SBP ≥140 mmHg, ARR was 13 ± 2.6% per 10 mmHg, and the number needed to treat (NNT) to prevent one event in five years was 8. In studies with attained SBP < 140 mmHg, ARR was 1.6 ± 1.9% per 10 mmHg (p = 0.0007), and NNT was 68.Conclusion: The marked decrease in ARR in studies with attained SBP < 140 mmHg occurred despite maintenance of RRR in 4/5 studies. Whether this is peculiar to diabetes requires further investigation. 1 Law MR, B M J 2009;338:1-9