Relative Risk Of Cardiovascular Disease Research Articles

Unsupervised hierarchical clustering identifies a metabolically challenged subgroup of hypertensive individuals.

The current classification of hypertension does not reflect the heterogeneity in characteristics or cardiovascular outcomes of hypertensive individuals. Our objective was to identify distinct phenotypes of hypertensive individuals with potentially different cardiovascular risk profiles using data-driven cluster analysis. We performed clustering, a procedure that identifies groups with similar characteristics, in 3726 individuals (mean age 59.4years, 49% women) with grade 2 hypertension (blood pressure ≥160/100mmHg or antihypertensive medication) selected from FINRISK 1997, 2002, and 2007 cohorts. We computed clusters based on eight factors associated with hypertension: mean arterial pressure, pulse pressure, non-high-density lipoprotein cholesterol, blood glucose, BMI, C-reactive protein, estimated glomerular filtration rate, and alcohol. After that, we used Cox regression models adjusted for age and sex to assess the relative risk of cardiovascular disease (CVD) outcomes between the clusters and a reference group of 11020 individuals. We observed two comparable clusters in both men and women. The Metabolically Challenged (MC) cluster was characterized by high blood glucose (Z-score 4.4±1.1 vs 0.2±0.8, men; 3.5±1.1 vs 0.0±0.6, women) and elevated BMI (30.4±4.1 vs 28.9±4.3, men; 32.7±4.9 vs 29.3±5.5, women). Over a 10-year follow-up (1034 CVD events), MC had 1.6-fold (95% CI 1.1-2.4) CVD risk compared to non-MC and 2.5-fold (95% CI 1.7-3.7) CVD risk compared to the reference group (P≤.009 for both). Using unsupervised hierarchical clustering, we found two phenotypically distinct hypertension subgroups with different risks of CVD complications. This substratification could be used to design studies that explore the differential effects of antihypertensive therapies among subgroups of hypertensive individuals.

Use of proton pump inhibitors is associated with lower rates of first-time ischemic stroke in community-dwelling elderly.

Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first-time ischemic stroke (FTIS) among elderly. The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002-2016) for community-dwelling individuals (≥65-95 years) for demographics and co-morbidities. Follow-up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS. 29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65-95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non-users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69-0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non-users (HR 0.9, 95% C.I. 0.85-0.96 for 7-48 yearly prescriptions and HR 0.51, 95% C.I. 0.46-0.55 for ≥49 yearly prescriptions). PPI use was associated with lower rates of FTIS in community-dwelling elders. Prospective large-scale studies are needed to fully elucidate the effect of PPI in this aging population.

Short-term effect of extreme air temperature on hospital emergency room visits for cardiovascular diseases from 2009 to 2012 in Beijing, China.

Extreme air temperature directly affected human health. However, the short-term effect of extreme air temperature on the incidence of cardiovascular diseases has rarely been reported in China. In this study, we focused on Beijing, China, and assessed the effects of cold/warm days and nights on the number of hospital emergency room (ER) visits for cardiovascular diseases from 2009 to 2012. We used a generalized additive model (GAM) to estimate the association between extreme air temperature and the number of hospital ER visits for cardiovascular diseases. We divided the entire study group into two gender subgroups and three age subgroups. The results showed that the short-term effect of extreme air temperature on hospital ER visits for cardiovascular diseases was more profound in females and the elderly (aged ≥ 75years). Among all the study subgroups, the highest relative risk (RR) of cardiovascular diseases associated with extremely cold days, warm days, cold nights, and warm nights was 3.0% (95% CI, 1.6%-4.4%), 0.8% (95% CI, - 0.9%-2.6%), 2.8% (95% CI, 1.6%-4.2%), and 1.8% (95% CI, 0.6%-4.3%), respectively. Overall, the effect of extremely low air temperature (during both days and nights) on the incidence of cardiovascular diseases was stronger and more acute than that of extremely high air temperature.

Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients.

To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach. We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients. The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.

Psoriasis and Cardiovascular Disease: A Narrative Review.

Psoriasis is a chronic, autoimmune, and inflammatory disease that affects 2% of the world’s population. In recent years, it has been demonstrated that psoriasis confers a 25% increase in relative risk of cardiovascular disease, independent of factors such as hyperlipidemia, smoking, and obesity. The objective of this review was to analyze and describe the association between psoriasis and cardiovascular disease. In this review, we describe the epidemiological association of psoriasis and cardiovascular disease, pathophysiology, mechanisms, and its association with the well-known cardiovascular risk calculators. In addition, we describe diagnostic tools, such as imaging techniques and novel biomarkers, that are useful in the evaluation of atherosclerotic cardiovascular disease. Finally, we present different systemic therapies that are used in patients with psoriasis and their effect on atherosclerotic cardiovascular disease. This article provides an overview of the current literature on psoriasis and cardiovascular risk, which can be useful for primary care physicians in their daily clinical practice.

Gamma-glutamyl transferase and cardiovascular risk in nonalcoholic fatty liver disease: The Gut and Obesity Asia initiative.

BACKGROUNDGamma-glutamyl transferase (GGT) is associated with the risk of cardiovascular disease (CVD) in the general population.AIMTo identify the association of baseline GGT level and QRISK2 score among patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).METHODSThis was a retrospective study involving 1535 biopsy-proven NAFLD patients from 10 Asian centers in 8 countries using data collected by the Gut and Obesity in Asia (referred to as “GO ASIA”) workgroup. All patients with available baseline GGT levels and all 16 variables for the QRISK2 calculation (QRISK2-2017; developed by researchers at the United Kingdom National Health Service; https://qrisk.org/2017/; 10-year cardiovascular risk estimation) were included and compared to healthy controls with the same age, sex, and ethnicity. Relative risk was reported. QRISK2 score > 10% was defined as the high-CVD-risk group. Fibrosis stages 3 and 4 (F3 and F4) were considered advanced fibrosis.RESULTSA total of 1122 patients (73%) had complete data and were included in the final analysis; 314 (28%) had advanced fibrosis. The median age (interquartile range [IQR]) of the study population was 53 (44-60) years, 532 (47.4%) were females, and 492 (43.9%) were of Chinese ethnicity. The median 10-year CVD risk (IQR) was 5.9% (2.6-10.9), and the median relative risk of CVD over 10 years (IQR) was 1.65 (1.13-2.2) compared to healthy individuals with the same age, sex, and ethnicity. The high-CVD-risk group was significantly older than the low-risk group (median [IQR]: 63 [59-67] vs 49 [41-55] years; P < 0.001). Higher fibrosis stages in biopsy-proven NAFLD patients brought a significantly higher CVD risk (P < 0.001). Median GGT level was not different between the two groups (GGT [U/L]: Median [IQR], high risk 60 [37-113] vs low risk 66 [38-103], P = 0.56). There was no correlation between baseline GGT level and 10-year CVD risk based on the QRISK2 score (r = 0.02).CONCLUSIONThe CVD risk of NAFLD patients is higher than that of healthy individuals. Baseline GGT level cannot predict CVD risk in NAFLD patients. However, advanced fibrosis is a predictor of a high CVD risk.

Maternal cardiovascular risk after hypertensive disorder of pregnancy

Background and objectiveHypertensive disorders of pregnancy (HDPs) affect 5%–10% of pregnancies and have been associated with excess maternal cardiovascular disease (CVD) risk. The primary aim of this study was to...

Prediction of cardiovascular events in rheumatoid arthritis using risk age calculations: evaluation of concordance across risk age models

BackgroundIn younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics.MethodsRA patients aged 30–70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up.ResultsA total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15–32% of patients. C-statistics ranged 0.68–0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results.ConclusionsThe cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.

High-normal blood pressure conferred higher risk of cardiovascular disease in a random population sample of 50-year-old men: A 21-year follow-up.

The relationship between various categories of blood pressure (BP), subtypes of hypertension, and development of cardiovascular disease (CVD) have not been extensively studied. Therefore, our study aimed to explore this relationship in a random population sample of men born in 1943, living in Sweden and followed over a 21-year period.Participants were examined for the first time in 1993 (age 50 years), where data on medical history, concomitant diseases, and general health were collected. The examination was repeated in 2003 and with additional echocardiography also in 2014. Classification of participants according to their BP at the age of 50 years was as follows: optimal-normal BP (systolic blood pressure [SBP] <130 and diastolic BP [DBP] <85 mmHg), high-normal BP (130 ≤ SBP < 140, 85 ≤ DBP < 90 mmHg), isolated systolic-diastolic hypertension (ISH-IDH) (SBP ≥140 and DBP <90 or SBP <140 and DBP ≥90 mmHg), and systolic-diastolic hypertension (SDH) (SBP ≥140 and DBP ≥90 mmHg).During the follow-up, the incidence of heart failure (HF), CVD, and coronary heart disease were all lowest for those with optimal-normal BP. Participants with high-normal BP showed greater wall thickness and left ventricular mass index, larger LV size and larger left atrial size when compared with the optimal-normal BP group. Furthermore, those with high-normal BP, ISH-IDH, and SDH had a higher risk of CVD than those with optimal-normal BP. The adjusted relative risk of CVD was highest for SDH (hazard ratio [HR] 1.95; 95% confidence interval [95% CI] 1.37–2.79), followed by ISH-IDH (HR 1.34; 95% CI 0.93–1.95) and high-normal BP (HR 1.31; 95% CI 0.91–1.89).Over a 21-year follow-up, the participants with high-normal BP or ISH-IDH had a higher relative risk of CVD than those with optimal-normal BP.

Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019

Recent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. The study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: <5%, 5% to 20%, and >20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT5) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH5) estimations. Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants <70 years of age not at high risk of bleeding (n=3540). The overall NNT5 with aspirin to prevent 1 cardiovascular disease event was 476 and the NNH5 was 355. The NNT5 was also greater than or similar to the NNH5 among estimated ASCVD risk strata. Conversely, CAC≥100 and CAC≥400 identified subgroups in which NNT5 was lower than NNH5. This was true both overall (for CAC≥100, NNT5=140 versus NNH5=518) and within ASCVD risk strata. Also, CAC=0 identified subgroups in which the NNT5 was much higher than the NNH5 (overall, NNT5=1190 versus NNH5=567). CAC may be superior to the pooled cohort equations to inform the allocation of aspirin in primary prevention. Implementation of current 2019 American College of Cardiology/American Heart Association guideline recommendations together with the use of CAC for further risk assessment may result in a more personalized, safer allocation of aspirin in primary prevention. Confirmation of these findings in experimental settings is needed.

Association between obstructive sleep apnoea syndrome and the risk of cardiovascular diseases: an updated systematic review and dose–response meta-analysis

ObjectiveThe aim of this study was to summarize the evidence concerning the relationship between obstructive sleep apnoea syndrome (OSAS) and the risk of cardiovascular diseases (CVDs). MethodsA systematic search was carried out using PubMed and Web of Science up to September 10, 2019. Categorical as well as linear and non-linear dose–response meta-analyses were respectively performed to evaluate the association between the severity of OSAS and the risk of CVDs. Apnoea-hypopnea index (AHI) was used as an indicator of OSAS severity. ResultsThis study included 10 cohort studies targeting a total of 36,347 subjects and 3362 patients with CVDs. The pooled RRs of overall CVDs were 1.13 (95% confidence interval [CI] = 1.02–1.24) for mild versus non/normal OSAS, 1.16 (95% CI = 1.02–1.32) for moderate versus non/normal OSAS, 1.26 (95% CI = 1.15–1.39) for moderate-severe versus non/normal OSAS, and 1.41 (95% CI = 1.22–1.63) for severe versus non/normal OSAS. The linear dose–response meta-analysis showed that every 10 events/hour increment in AHI value was associated with a 9% increased risk of suffering from CVDs. The non-linear dose–response meta-analysis showed that the risk of CVDs increased continuously with the increment in AHI. ConclusionThe present systematic review and meta-analysis provide evidence for a positive association between OSAS and the risk of CVDs, despite the severity of OSAS. The relative risk of CVDs increases continuously with the increment in AHI.

Abstract P297: Sex Differences in Cardiovascular Risk Factors Before and After Ascertainment of Diabetes and Risk for Incident Cardiovascular Disease; The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Prevalent diabetes mellitus (DM) in mid-life is a stronger risk factor (RF) for cardiovascular disease (CVD) mortality in women than men. However, it is unclear whether (1) changes in CVDRFs before and after incident DM differ by sex, and (2) if such differences are associated with the relationship of incident DM with subsequent CVD events. Hypothesis: Rates of change in CVDRFs after incident DM will be worse in women and incident DM will have a stronger association with CVD events in women than men. Methods: We included 4893 black and white CARDIA participants, ages 18-30 years at enrollment (1985-86). We ascertained incident DM (n=827) and assessed sex differences in annual change in body mass index (BMI); systolic and diastolic blood pressure (SBP/DBP); total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol before and after the ascertainment of DM using piecewise regression, stratified by race. We estimated hazard ratios (HR) for incident CVD over a median of 30.9 years of follow-up (range: 2, 32) and assessed effect modification between sex and DM. All analyses included adjustment for time-varying behavioral and clinical CVDRFs. Results: Age at DM ascertainment was lower for women than men (42.0 vs 45.8 years, sex-difference: 3.8, 95% confidence limits: 2.5, 5.0). Rates of change in CVDRFs before the ascertainment of DM did not differ by sex (Table). However, compared to men, women had greater annual changes in SBP, DBP, total cholesterol, and LDL, but not BMI and HDL, after DM. Median age at CVD did not differ by sex (48.8 years). Incident DM was associated with higher HR for incident overall CVD (HR: 1.45, 95%: 1.07, 1.96) and this association did not differ by sex (p interaction=0.8). Women had lower HR for incident CVD than men (HR: 0.57; 95%: 0.44, 0.74). Conclusion: While CVDRFs worsened more rapidly after DM for women, women had lower absolute and relative risks for incident CVD in mid-life than men. The association of incident DM by mid-life with subsequent CVD events did not differ by sex.

Asymmetric dimethylarginine compartmental behavior during high-flux hemodialysis

Aim The accumulation of uremic toxins, such as asymmetric dimethylarginine (ADMA), has emerged as one of the major cardiovascular disease-related risk factors in patients with end-stage renal disease (ESRD). Based on the low molecular weight of ADMA, hemodialysis (HD) should theoretically effectively remove ADMA. In this study, we investigated the clearance behavior of ADMA during high-flux HD. Methods Eight HD patients without residual renal function were included. Blood samples were collected at 0, 30, 60, 120 and 240 min after dialysis started, as well as 1 h and 48 h after dialysis. ADMA level was detected by HPLC-MS/MS. Herein, the ADMA level in blood cells and the ADMA protein binding rate were measured. Accordingly, the dialyzer extraction ratio was also determined. Results The reduction ratio (RR) of ADMA (corrected for hemoconcentration) was significantly lower, at only 37.21 ± 6.44%, than that of urea and creatinine (p < .05). Interestingly, its clearance from plasma was precipitous early in dialysis and became slowly from 60 to 240 min. Additionally, a greater inlet erythrocyte than plasma concentration was found for ADMA. The dialyzer extraction ratio was comparable between ADMA and creatinine or urea (83 ± 5% for ADMA vs. 84 ± 3% and 88 ± 2% for creatinine and urea, respectively; both p>.05). Urea and creatinine had a slight rebound ratio of less than 10% at 1 h after the completion of HD. In contrast, considerable rebound of approximately 30% was detected in ADMA. Conclusion This study suggests that ADMA may present a multicompartmental distribution that cannot be representatively reflected by the urea kinetics model.

Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose-Response Meta-analysis of Prospective Cohort Studies.

The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose-response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD). PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity. Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1-28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51-0.80] and 0.90 [95% CI: 0.84-0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57-0.85) and 0.86 (95% CI: 0.77-0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88-0.97) and CHD (RR: 0.90, 95% CI: 0.84-0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83-0.96) and CHD (RR: 0.92, 95% CI: 0.82-0.98). Serum/dietary Mg level comparisons presented a 7%-10% decrease in CVD/CHD risk. The dose-response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440). Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.

A study on prevalence of cardiovascular disease related risk factors among tribal population in a block of West Bengal

Background: Non communicable diseases (NCDs) refer to chronic diseases of long duration and generally with slow progression. NCDs are affecting Indian population, both in urban and rural areas. Cardiovascular disease (CVD), one of the major NCDs is the leading cause of death worldwide. The rising prevalence of behavioral and anthropometric risk factors for these lifestyle diseases is postulated to be the cause for the alarming increase of NCDs including CVD. Prevalence of cardiovascular diseases is also increasing in tribal population. Objective of this study was to assess the prevalence of risk factors associated with cardiovascular diseases among the tribal population aged 18 years and above.Methods: A community based, observational, descriptive study was conducted at Kharagpur-II block of Paschim Medinipur district, West Bengal from August 2013 to July 2014 among 540 tribal population aged 18 years and above selected by cluster random sampling method.Results: About 64% individuals were addicted to tobacco product. Prevalence of current smoking and tobacco chewing was 9.1% and 60.2% respectively. Prevalence of current alcohol consumption was 48.9%. About 91% individuals took extra salt with meal. Prevalence of overweight and obesity was 7.8% and 3.5% only according to WHO recommended classification for Asian population. However, higher level of physical activity was found among the study population.Conclusions: The study revealed high prevalence of extra salt intake, tobacco and alcohol consumption among the study population which may endanger their life by increasing the risk of cardiovascular disease.

The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies

BackgroundThere is a controversy about the association between vitamin D and cardiovascular diseases (CVDs). The effect of serum 25-OH-vitD on the risk of CVDs was evaluated.MethodsMajor electronic databases including Scopus, Science Direct, and PubMed were searched. All prospective cohort studies on the relationship between vitamin D status and CVDs conducted between April 2000 and September 2017 were included, regardless language. The study participants were evaluated regardless of their age, sex, and ethnicity. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Two investigators independently selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effects model was used to combine the results.ResultsA meta-analysis of 25 studies with 10,099 cases of CVDs was performed. In general, a decrease in the level of vitamin D was associated with a higher relative risk of CVDs (incidence-mortality combined) (RR = 1.44, 95% CI: 1.24–1.69). This accounts for 54% of CVDs mortality rate (RR = 1.54, 95% CI: 1.29–1.84(. However, no significant relationship was observed between the vitamin D status and incidence of CVDs (RR = 1.18, 95% CI: 1–1.39). In general, low serum vitamin D level increased the risk of CVD by 44% (RR = 1.44, 95% CI: 1.24–1.69). It also increased the risk of CVD mortality (RR = 1.54, 95% CI: 1.29–1.84) and incidence rates (RR = 1.18, 95% CI: 1–1.39).ConclusionsThe findings showed that vitamin D deficiency increases the CVDs mortality rate. Due to the limited number of studies on patients of the both genders, further research is suggested to separately evaluate the effect of vitamin D status on CVD in men and women.

P1548Long-term past, current and usual systolic blood pressure and incident cardiovascular disease: risk prediction using large-scale, routinely recorded clinical data

Abstract Background The impact of long-term exposure to elevated systolic blood pressure (SBP) on future cardiovascular disease (CVD) in “real-world” settings, and its relevance to risk prediction, are less investigated. Purpose To examine the risk of incident CVD in relation to long-term past, current, and usual SBP, and compare their predictive performance, using evidence from large-scale electronic health records (EHR). Methods Using data extracted from UK primary care linked EHR, we applied a landmark cohort study design, by including patients aged 40 (N≈64,000), 50 (N≈80,000) and 60 (N≈67,000) years (y) at study entry who had recorded SBP and with no prior CVD or previous antihypertensive or lipid-lowering prescriptions at baseline. We estimated past SBP (mean, time-weighted mean, and variability recorded up to 10 years prior to baseline) and usual SBP (correcting current values for past time-dependent SBP variability). We used Cox regression to estimate hazard ratio (HR), and applied Bayesian analysis within a machine learning framework in developing and validating models. To evaluate predictive performance of the models, we used discrimination (area under the curve [AUC]) and calibration metrics. The outcome was incident CVD (first hospitalisation for or death from coronary heart disease or stroke/transient ischaemic attack). Analyses were conducted separately for each age cohort. Results After a mean follow-up of 8 years, the numbers of patients who developed incident CVD were over 1000 (40y), 3000 (50y) and 5000 (60y). Higher past, current and usual SBP values were separately and independently associated with increased incident CVD risk. Per 20-mmHg rise in SBP, the HR (95% credible interval [CI]) for current SBP for ages 40, 50 and 60 years were 1.18 (1.08 to 1.26), 1.22 (1.18 to 1.30) and 1.22 (1.19 to 1.24); the corresponding HR were stronger in magnitude for past SBP (mean and time-weighted mean) and usual SBP (HR ranged from: 40y=1.31 to 1.41, 50y=1.39 to 1.45 and 60y=1.32 to 1.48). For each age cohort, the AUC (95% CI) for the model that included current SBP, sex, smoking, deprivation, diabetes and lipid profile in the validation sample were: 40y=0.739 (0.730 to 0.746), 50y=0.750 (0.716 to 0.810), and 60y=0.647 (0.642 to 0.658). Adding past SBP mean, time-weighted mean or variability to this model were associated with modest increases in the AUC and all models showed good calibration. Small improvements in the AUC were similarly observed when evaluating models separately for men and women within each age cohort. Conclusion Using multiple SBP recordings from patients' EHR showed stronger associations with incident CVD than a single SBP measurement, but their addition to multivariate risk prediction models had negligible effects on model performance. Acknowledgement/Funding Oxford Martin School and National Institute for Health Research Oxford Biomedical Research Centre

Short-term exposure to extreme temperature and risk of hospital admission due to cardiovascular diseases

ABSTRACT Objective: Numerous epidemiological studies have reported relevance of morbidity and mortality from cardiovascular diseases with short-term exposure to environmental temperature. In this study, we examined the hypothesis between temperature indices and hospital admission because of cardiovascular diseases. Methods: The daily number of CVDs was obtained from all hospitals of the Sabzevar city. A semi-parametric generalized additive model (GAM) following a quasi-Poisson distribution with distributed lag non-linear model (dlnm) was selected as a modeling framework for time-series analysis. Results: The overall CVD risk comparing the 1st percentile and the 99th percentile relative to the mean temperature (at lag 0) was 1.33 (95% CI, 1.11: 1.61), and 1.34 (95% CI, 1.10: 1.64), respectively. For all indicators, the extremely cold effects persisted for the initial 7 days. Conclusions: Our results suggest that extremely cold and extremely hot temperatures increase the relative risk of cardiovascular diseases.

Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis.

BackgroundThere is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors.Methods and findingsWe took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992–2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971–2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β −0.036, 95%CI: −0.06, −0.02, p < 0.01; NHANES β −0.032, 95%CI: −0.05, −0.02, p < 0.01), depression (HRS β −0.049, 95%CI: −0.07, −0.03, p < 0.01), triglycerides (NHANES β −0.039, 95%CI: −0.06, −0.01, p < 0.01), and heart disease (HRS β −0.025, 95%CI: −0.04, −0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts.ConclusionsThis study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.

Primary Absolute Cardiovascular Disease Risk and Prevention in Relation to Psychological Distress in the Australian Population: A Nationally Representative Cross-Sectional Study.

People who experience psychological distress have an elevated risk of incident cardiovascular disease (CVD). However, the extent to which traditional CVD prevention strategies could be used to reduce the CVD burden in this group is unclear because population-level data on CVD risk profiles and appropriate management of risk in relation to distress are currently not available. The aim of this study was to use nationally representative data to quantify variation in CVD risk and appropriate management of risk according to level of psychological distress in the Australian population. Data were from 2,618 participants aged 45–74 years without prior CVD who participated in the 2011-12 Australian Health Survey, a cross-sectional and nationally representative study of Australian adults. Age-and sex-adjusted prevalence of 5-year absolute risk of primary CVD (low <10%, moderate 10–15%, or high >15%), CVD risk factors, blood-pressure, and cholesterol assessments, and appropriate treatment (combined blood pressure- and lipid-lowering medication) if at high primary risk, were estimated. Prevalence ratios (PR) quantified variation in these outcomes in relation to low (Kessler-10 score: 10-<12), mild (12-<16), moderate (16-<22) and high (22–50) psychological distress, after adjusting for sociodemographic characteristics. The prevalence of high absolute risk of primary CVD for low, mild, moderate and high distress was 10.9, 12.3, 11.4, and 18.6%, respectively, and was significantly higher among participants with high compared to low distress (adjusted PR:1.62, 95%CI:1.04–2.52). The prevalence of CVD risk factors was generally higher in those with higher psychological distress. Blood pressure and cholesterol assessments were reported by the majority of participants (>85%) but treatment of high absolute risk was low (<30%), and neither were related to psychological distress. Our findings confirm the importance of recognizing people who experience psychological distress as a high risk group and suggest that at least part of the excess burden of primary CVD events among people with high psychological distress could be reduced with an absolute risk approach to assessment and improved management of high primary CVD risk.