Risk Factor For Cardiovascular Mortality Research Articles

Is dynapenic abdominal obesity a risk factor for cardiovascular mortality? A competing risk analysis.

Dynapenic abdominal obesity has been shown as a risk factor for all-cause mortality in older adults. However, there is no evidence on the association between this condition and cardiovascular mortality. We aimed to investigate whether dynapenic abdominal obesity is associated with cardiovascular mortality in individuals aged 50 and older. A longitudinal study with an 8-year follow-up was conducted involving 7,030 participants of the English Longitudinal Study of Ageing study. Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102cm for men and > 88cm for women) and grip strength (< 26kg for men and < 16kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). The outcome was cardiovascular mortality. The Fine-Grey regression model was used to estimate the risk of cardiovascular mortality as a function of abdominal obesity and dynapenia status in the presence of competing events controlled by socio-demographic, behavioural and clinical variables. The risk of cardiovascular mortality was significantly higher in individuals with D/AO compared with ND/NAO (SHR 1.85; 95% CI: 1.15-2.97). D/NAO was also associated with cardiovascular mortality (SHR: 1.62; 95% CI: 1.08-2.44). Dynapenic abdominal obesity is associated with cardiovascular mortality, with a larger effect size compared to dynapenia alone in individuals older than 50years. Thus, prevention strategies and clinical interventions that enable mitigating the harmful effects of these conditions should be adopted to diminish such risk.

Cardiovascular mortality in women in their forties after hypertensive disorders of pregnancy in the Netherlands: a national cohort study

Hypertensive disorders of pregnancy are associated with cardiovascular disease later in life. Given that hypertensive disorders of pregnancy often occur at a relatively young age, there might be an opportunity to use preventive measures to reduce the risk of early cardiovascular disease and mortality. The aim of this study was to assess the risk of cardiovascular mortality in women after a hypertensive disorder of pregnancy. In this population-based cohort study, the Netherlands Perinatal Registry (PRN) and the national death registry at the Dutch Central Bureau for Statistics were linked. We analysed women in the Netherlands with a first birth during 1995-2015 to determine the association between cardiovascular mortality and hypertensive disorders of pregnancy (based on recorded diastolic blood pressure or proteinuria, or both). We analysed the association between the highest diastolic blood pressure measured in pregnancy and cardiovascular mortality and constructed survival curves to assess cardiovascular mortality after hypertensive disorders of pregnancy, specifically pre-eclampsia and gestational hypertension. To differentiate between the severity of hypertensive disorders of pregnancy, cardiovascular mortality was assessed in women with a combination of hypertensive disorders of pregnancy with preterm birth (gestational age <37 weeks) and growth restriction (birthweight in the 10th percentile or less). All hazard ratios (HRs)were adjusted for maternal age. Between Jan 1, 1995, and Dec 31, 2015, the PRN contained 2 462 931 deliveries and 1 625 246 women. In 1 243 890 women data on their first pregnancy were available and were included in this analysis after linkage, with a median follow-up time of 11·2 years (IQR 6·1-16·3). 259 177 (20·8%) women had hypertensive disorders of pregnancy, and of these 45 482 (3·7%) women had pre-eclampsia and 213 695 (17·2%) women had gestational hypertension; 984 713 (79·2%) women did not develop hypertension in their first pregnancy. Compared with women without hypertensive disorders of pregnancy, the risk of death from any cause was higher in women who had hypertensive disorders (HR 1·30 [95% CI 1·23-1·37], p<0·001), pre-eclampsia (1·65 [1·48-1·83]; p<0·0001), and gestational hypertension (1·23 [1·16-1·30]; p<0·0001). Those women with pre-eclampsia had a higher risk of cardiovascular mortality compared with those without any hypertensive disorders of pregnancy (adjusted HR 3·39 [95% CI 2·67-4·29]), as did those with gestational hypertension (2·22 [1·91-2·57]). For women with a history of hypertensive disorders of pregnancy combined with preterm birth (gestational age <37 weeks) and birthweight in the 10th percentile or less, the adjusted HR for cardiovascular mortality was 6·43 (95% CI 4·36-9·47), compared with women without a hypertensive disorder of pregnancy. The highest diastolic blood pressure measured during pregnancy was the strongest risk factor for cardiovascular mortality (for 80-89 mm Hg: adjusted HR 1·47 [95% CI 1·00-2·17]; for 130 mm Hg and higher: 14·70 [7·31-29·52]). Women with a history of hypertensive disorders of pregnancy have a risk of cardiovascular mortality that is 2-3 times higher than that of women with normal blood pressure during pregnancy. The highest measured diastolic blood pressure during pregnancy is an important predictor for cardiovascular mortality later in life; therefore, women who have hypertensive disorders of pregnancy should be given personalised cardiovascular follow-up plans to reduce their risk of cardiovascular mortality. None.

A Cross-Sectional Study of Hypertension among 20-40 Years Old Residing in an Urban Area of Bagalkot City, North Karnataka.

Hypertension is the commonest cardiovascular disorder and one of the major risk factors for cardiovascular mortality which accounts for 20-50% of all deaths. Although most studies describe hypertension in older adults and the elderly, there is a paucity of data on young adults as they are deemed to be at a lower risk of developing the disease. To study the prevalence of hypertension and study the risk factors and strength of association between factors and hypertension among 20-40 years old. A cross-sectional study was conducted among 20-40 years old residing in the urban field practice area to find the prevalence of hypertension and its association with socio-demographic factors. After obtaining informed consent, data were collected with the help of an interview method by systematic random sampling using predesigned and pretested semi-structured questionnaires. Three readings of blood pressure were recorded using a sphygmomanometer, and the average reading was considered. Data analysis was done using Microsoft Excel, Open Epi software, and SPSS software. Out of 420 subjects, the prevalence of hypertension was found to be 17.9% and pre-hypertension was 52%. Factors significantly associated with hypertension were age, marital status, type of family, family history of hypertension, tobacco chewing, stress, and body mass index (BMI). The present study reveals a high prevalence of hypertension (17.9%) in the 20-40 years old age group, which can lead to increased cardiovascular disease burden in the population.

Blood Pressure and Mortality in the 4D Study

Introduction: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is an easily available parameter of vascular stiffness, but its impact on CVM in chronic dialysis patients with diabetes is unclear. Methods: Therefore, we have examined the predictive value of baseline, predialytic PP, SBP, DBP, and MAP in the German Diabetes and Dialysis (4D) study, a prospective, randomized, double-blind trial enrolling 1,255 patients with type 2 diabetes on hemodialysis in 178 German dialysis centers. Results: Mean age was 66.3 years, mean blood pressure 146/76 mm Hg, mean time suffering from diabetes 18.1 years, and mean time on maintenance dialysis 8.3 months. Considered as continuous variables, PP, MAP, SBP, and DBP could not provide a significant mortality prediction for either cardiovascular or all-cause mortality. After dividing the cohort into corresponding tertiles, we also did not detect any significant mortality prediction for PP, SBP, DBP, or MAP, both for all-cause mortality and CVM after adjusting for age and sex. Nevertheless, when comparing the HR plots of the corresponding blood pressure parameters, a pronounced U-curve was seen for PP for both all-cause mortality and CVM, with the trough range being 70–80 mm Hg. Discussion: In patients with end-stage renal disease and long-lasting diabetes mellitus predialytic blood pressure parameters at study entry are not predictive for mortality, presumably because there is a very high rate of competing mortality risk factors, resulting in overall very high rates of all-cause and CVM that may no longer be significantly modulated by blood pressure control.

Diabetes Remission

The rising prevalence of diabetes mellitus (DM) increases the burden of morbidity and mortality worldwide. DM is recognized as an independent risk factor of cardiovascular mortality. Uncontrolled diabetes leads to various long-term microvascular and macrovascular complications. Optimum control of glycemia is desirable to prevent these complications to improve quality of life and decrease mortality. The concept of remission or reversal of diabetes is evolving for many decades and various definitions and approaches to achieve remission also have evolved. Obesity-related surgeries had shown remarkable control of blood glucose levels. Recently, therapy directed toward weight loss either by medical nutrition therapy, physical activity, or anti-diabetic medications seems promising in achieving remission of diabetes.

Estimation of serum uric acid in patients of acute myocardial infarction

BACKGROUND: Acute myocardial infarction (AMI), often known as a heart attack, is a medical emergency that is the top cause of mortality for both men and women worldwide. Recent evidence suggests that it is caused by the sudden blockage of a coronary artery by a blood clot, also known as coronary thrombosis. Due to the regional impending of blood supply, heart muscles become damaged. Uric acid has been shown in large cohort studies to be an important independent risk factor for cardiovascular mortality. As serum uric acid (SUA) is an early predictor hence study will help to devise a better remedy for AMI.AIM: This study aims to study the levels of SUA in patients with AMI as compared to the control.OBJECTIVE: The primary goal of this study is to examine SUA levels in patients with AMI and to correlate uric acid levels with associated mortality in AMI. The secondary goal is to predict AMI early diagnosis, better management and treatment, and prognosis.METHODS: The current study was conducted at the department of biochemistry and the central investigation laboratory at our institute, in partnership with the department of medicine, intense cardiac care units, medical intensive care units, and emergency and private hospitals. A total of 100 patients were investigated. There were 50 instances of AMI and 50 age-matched healthy controls. The Microlab 300 analyzers (semi-autoanalyzer) were used to assess SUA concentrations, and the comparisons between the two groups were examined using an unpaired t-test. A P < 0.05 was deemed statistically significant.RESULTS: There was a substantial rise in the mean level of SUA in cases on the 0, 3rd, and 7th days were 8.503 + 2.976 mg/dl, 5.472 + 2.683 mg/dl, and 4.992 + 1.707 mg/dl day, respectively, which were higher than controls group (3.976 + 0.947 mg/dl). Comparison between control and AMI SUA on 0 and 3rd days was found to be more significant than the 7th day. There was a substantial rise in blood uric acid levels in cases when compared to healthy controls (P < 0.005).CONCLUSION: Thus, the study shows that blood uric acid levels play a significant role in the diagnosis and therapy of AMI.

Prognostic implication of left ventricular hypertrophy regression after antihypertensive therapy in patients with hypertension.

Left ventricular (LV) hypertrophy (LVH) in patients with hypertension is a significant risk factor for cardiovascular mortality and morbidity. However, the prognostic implication of LVH regression after antihypertensive therapy has not been clearly investigated. Patients who underwent echocardiography at the time of the diagnosis of hypertension and repeated echocardiography at an interval of 6-18 months were retrospectively identified. LVH was defined as LV mass index (LVMI) >115 g/m2 (men) and >95 g/m2 (women). LVH regression was defined as LVH at initial echocardiography with normal geometry or concentric LV remodeling at follow-up echocardiography. Cardiovascular mortality, hospitalization for heart failure (HHF), coronary revascularization, stroke, and aortic events were analyzed according to changes in LVMI and geometry. Of 1,872 patients, 44.7% (n = 837) had LVH at the time of diagnosis; among these, 30.7% showed LVH regression. The reduction in LVMI was associated with the reduction in BP, especially in those with LVH at baseline. During follow up (median, 50.4 months; interquartile range, 24.9-103.2 months), 68 patients died of cardiovascular causes, 127 had HHF, and 162 had vascular events (coronary revascularization, stroke, and aortic events). Persistent or newly developed LVH during antihypertensive therapy was a significant predictor of cardiovascular mortality and events, especially HHF. On multivariable analysis, women, diabetes, atrial fibrillation, coronary artery disease, larger LVMI and end-diastolic dimension, and less reduction in systolic BP were associated with persistent or newly developed LVH. LVH regression in patients with hypertension is associated with a reduction in cardiovascular events and can be used as a prognostic marker.

Pulse Pressure Independent of Mean Arterial Pressure Is Associated with Cardiovascular and All-Cause Mortality in Normotensive Elders: Findings from National Health and Nutrition Examination Survey III 1999–2014

Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged over 60 years from the 1999–2014 National Health and Nutrition Examination Survey (NHANES). All included participants were followed up until the date of death or 31 December 2015. Restricted cubic spline analyses were used to explore the associations of PP with cardiovascular mortality and all-cause mortality. The population was categorized into two groups according to the optimal cut-off of PP for all-cause mortality by X-tile software. Propensity matching score analysis was further performed to reduce confounding bias. The Kaplan–Meier curves and Cox proportional hazard models were applied to estimate the associations of widening PP cardiovascular mortality and all-cause mortality. Subgroup analyses were also conducted. Results: A total of 6309 participants were included (52.9% men and median age 69 (63, 75) years). The median follow-up duration was 74 (42, 114) months. The restricted cubic spline analyses revealed that continuous PP was linearly related to cardiovascular mortality (p for linearity &lt; 0.001; p for nonlinearity = 0.284) and nonlinearly related to all-cause mortality (p for nonlinearity = 0.001). After propensity score matching, 1855 subjects with widening PP and 1855 matched counterparts were included (50.2% men and average age 72 (66, 78) years, 50.9% men and average age 72 (66, 78) years, respectively), of which 966 (26.0%) died during a median follow-up duration of 71 (39, 105) months. In the Cox proportional hazards model, widening PP was associated with increased cardiovascular mortality Hazard Ratio (HR) 1.47; 95% Confidence Interval (CI) 1.07–2.00, p &lt; 0.05] and all-cause mortality (HR 1.15; 95% CI 1.01–1.31, p &lt; 0.05). After adjusting for other traditional risk factors, the association of widening PP with cardiovascular mortality (HR 1.44; 95%CI 1.05–1.98, p &lt; 0.05) remained, and the association of widening PP with all-cause mortality was not statistically significant (p &gt; 0.05). Conclusion: In the normotensive elder population, a low-risk population without traditional coronary risk factors, PP is an independent risk factor for cardiovascular mortality.

Sleep Apnea and Cardiovascular Risk in Patients with Prediabetes and Type 2 Diabetes

Obstructive sleep apnea (OSA) is a common but largely undiagnosed clinical condition, which is turning into a serious public health issue. Of note is that its prevalence is gradually increasing in parallel with the obesity and type 2 diabetes mellitus (T2DM) epidemics. The aim of this article is to comprehensively review the literature in order to evaluate the cardiovascular (CV) risk among patients with OSA and prediabetes or T2DM. OSA seems to be an independent risk factor for the development as well as the progression of T2DM, whereas it is associated with T2DM-related macrovascular and microvascular complications. OSA may also act as a potential risk factor for the presentation and development of CV disease, such as hypertension, coronary artery disease, heart failure, pulmonary hypertension, atrial fibrillation and other cardiac arrythmias, as well as stroke. OSA and T2DM also share common pathophysiological mechanisms leading to atherosclerosis. Considering that the coexistence of OSA and T2DM is an independent and cumulative risk factor for CV mortality, more so than the two diseases separately, clinicians and healthcare professionals should be aware of and screen for OSA in patients with T2DM. Notably, targeted therapy for both conditions seems to substantially improve CV prognosis.

Lower serum magnesium is a predictor of left ventricular hypertrophy in patients on dialysis.

Left ventricular hypertrophy (LVH) represents one of the main risk factors for cardiovascular mortality in dialysis patients. Low serum magnesium Mg is related with increased mortality in general and dialysis population. Aim of our study was to evaluate the association of Mg with LVH and cardiac geometry in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) patients from nine nephrology departments were included. Echocardiographic LVH was defined by LV mass index > 95g/m2 in women and > 115g/m2 in men. Four LV geometric patterns were defined: normal, concentric remodeling, eccentric LVH and concentric LVH. Demographic and laboratory data were collected. 133 patients (68 HD, 65 PD) with a median age of 63years (IQR 52-74) were studied. Mg correlated positively with creatinine, HDL and negatively with CRP levels and BMI. There were no significant differences in Mg between the modality groups. 80 patients presented LVH (43 HD and 37 PD patients). Patients with LVH were older (median age 68 vs 55years, p < 0.001), with higher BMI (median 26.9 vs 24.7kg/m2, p = 0.009), had a history of PVD or CAD (55% vs 30.2%, p = 0.003), had higher pulse pressure (median 60 vs 50, p = 0.017), MIS score (median 5 vs 4, p = 0.011), lower albumin (median 3.5 vs 3.8g/dl, p = 0.011) and Mg levels (median 2.1 vs 2.4mg/dl, p < 0.001). In univariate analysis age, CVD comorbidities, pulse pressure, CRP, BMI, albumin, Mg, MIS and use of b-blockers or calcium blockers were LVH predictors. In multivariate analysis, Mg was an independent predictor of LVH, adjusted for age, MIS and b-blockers. Considering LV geometry, lower Mg levels were mainly correlated with concentric LVH. Low serum magnesium levels seem to be an independent factor for LVH in hemodialysis and peritoneal dialysis patients.

Impact of prediabetes and type 2 diabetes mellitus on cardiac function in the general population

Abstract Introduction Prediabetes and type 2 diabetes mellitus (T2DM) are risk factors for heart failure (HF). The association of prediabetes and T2DM to different forms of functional left ventricular impairment and their impact on clinical outcome in the general population needs to be further investigated. In this context, little is known about the prevalences of prediabetes and different HF subtypes in the general population, especially in Europe. Purpose To investigate the prevalence and clinical impact of prediabetes and type 2 diabetes mellitus (T2DM) on functional cardiac disorder (FCD). Methods The participants of the Gutenberg Health Study sample (15,010 subjects, 35–74 years) were stratified in individuals with euglycaemia, prediabetes and T2DM based on clinical information and HbA1c level. FCD included asymptomatic systolic and diastolic dysfunction, symptomatic systolic and diastolic heart failure, asymptomatic diastolic dysfunction and preserved left ventricular ejection fraction (EF), asymptomatic diastolic dysfunction and reduced EF, asymptomatic preserved diastole and reduced EF, symptomatic heart failure with preserved EF (HFpEF) and symptomatic heart failure with reduced EF HFrEF). Using structured follow-up clinical outcome was assessed. Results Overall, 14,870 individuals were included in the present analysis. Among them, 9,426 individuals were categorized in the euglycaemia group, 4,128 participants had prediabetes and in 1,316 individuals T2DM was present. Prevalence of FCD increased from euglycaemia (19.6%) over prediabetes (33.3%) to T2DM (46.8%, p&amp;lt;0.0001). Prevalence of symptomatic HF was increased in patients with T2DM (euglycaemia 2.8%, prediabetes 5.9%, T2DM 11.9%). T2DM was associated with reduced EF (β −0.63, 95% CI −0.99 to −0.26, P=0.00088) and elevated E/E' (β 0.08, 95% CI 0.06 to 0.10, P&amp;lt;0.0001), whereas prediabetes was associated to elevated E/E' (β 0.02, 95% CI 0.01 to 0.03, P=0.0029). Prediabetes and T2DM revealed increased prevalences of FCD (13%, 18%), asymptomatic diastolic dysfunction with preserved EF (prediabetes: 14%, T2DM: 11%), symptomatic heart failure (prediabetes: 46%, T2DM: 70%) and HFpEF (prediabetes: 49%, T2DM: 82%). With prediabetes and T2DM all-cause mortality was elevated in presence and absence of FCD, only T2DM was also a risk factor for cardiovascular mortality with and without FCD. Within a 5-years follow-up, T2DM was an independent risk factor for the development of FCD, asymptomatic diastolic dysfunction with reduced ejection fraction, symptomatic heart failure and HFrEF. Prediabetes was not an independent risk factor for FCD. Conclusions In the general population, a high prevalence of asymptomatic FCD is present. Coexisting FCD and prediabetes as well as T2DM result in increased mortality elucidating the need for early detection and prevention of DM development, especially with regard to numerous asymptomatic people concerned. T2DM, but not prediabetes, is a risk factor for incident FCD. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The Gutenberg Health Study is supported by the government of Rheinland-Pfalz (`Stiftung Rheinland-Pfalz für Innovation'), the research programmes `Wissen schafft Zukunft' and the Centre forTranslational Vascular Biology (CTVB) of the Johannes Gutenberg-University of Mainz, Germany, and its contract with Boehringer Ingelheim and Philips Medical Systems including an unrestricted grant forthe Gutenberg Health Study. P.S.W. and J.H.P. are funded by the Federal Ministry of Education and Research (BMBF 01EO1503). P.S.W. and T.M. are principal investigators of the German Center for Cardiovascular Research (DZHK). P.S.W. is principal investigator of the DIASyM research core (BMBF 161L0217A).

Relationship between reduced heart rate variability and increased arterial stiffness evaluated by the cardio-ankle vascular index in people with type 2 diabetes.

Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality and also is associated with a high risk of lethal arrhythmias and sudden death in people with type 1 or 2 diabetes. Heart rate variability (HRV) is an index of cardiac autonomic function. To investigate the relationship between HRV and arterial stiffness evaluated by the cardio-ankle vascular index (CAVI), a relatively new marker for arterial stiffness and a predictor of cardiovascular disease, in patients with type 2 diabetes. We studied consecutive 313 patients with type 2 diabetes in a cross-sectional design. HRV was estimated by the coefficient of variation of 100 R-R intervals (CVR-R) at rest and during deep breathing (DB). The difference in CVR-R was defined as CVR-R during DB minus CVR-R at rest. Arterial stiffness was evaluated by CAVI, which is independent of blood pressure (BP). A CAVI greater than or equal to 9.0 was defined as significant arterial stiffening. Linear regression analysis showed that CAVI correlated positively with age, duration of diabetes, urinary albumin creatinine ratio (UACR), CVR-R during DB, and the difference in CVR-R and negatively with body mass index (BMI), estimated glomerular filtration rate, and sensory nerve conduction velocity and action potential of the sural nerve. Multivariate analysis found that age, BMI, systolic blood pressure, UACR, and CVR-R during DB were independently associated with arterial stiffness determined by CAVI. The CVR-R at rest and during deep breathing was significantly lower in the patients with arterial stiffness than in those without it. Low HRV estimated by CVR-R during DB is closely associated with arterial stiffness measured by CAVI in people with type 2 diabetes, suggesting that arterial stiffness associated with CAN may be an independent risk factor for cardiovascular disease in people with type 2 diabetes. The online version contains supplementary material available at 10.1007/s13340-022-00604-y.

A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis

Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo—Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (− 10.7, 2.2) in GLU and 5.2 (− 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population.Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador.

Association between Height and Hypertension: A Retrospective Study

Height loss starting in middle age is reported to be an independent risk factor for cardiovascular mortality. Recent studies have revealed an inverse association between height and hypertension, but the influence of hypertension on height loss is unknown. Since hypertension is an established cardiovascular risk factor, clarifying the association between baseline hypertension and height loss could lead to an efficient tool to estimate the risk of mortality. A retrospective study of 11,154 Japanese aged 40–74 years was conducted. Height loss was defined as being in the highest quintile of annual height decrease (≥2.015 mm/year for men and ≥1.756 mm/year). Baseline height was significantly inversely associated with incident hypertension for men only. The adjusted odds ratio (OR) and 95% confidence interval (CI) for incident hypertension for each 1 standard deviation increment of height (5.9 cm for men and 5.6 cm for women) was 0.90 (0.84, 0.97) for men and 1.07 (0.91, 1.26) for women, respectively. We also found that baseline hypertension is independently positively associated with height loss for men only. The adjusted OR was 1.25 (1.11, 1.42) for men and 0.93 (0.71, 1.21) for women. These results might lead to an efficient tool for estimating the risk of height loss, which has been reported to be associated with a higher risk of mortality in adults.

Depression and anxiety in different hypertension phenotypes: a cross-sectional study

BackgroundHypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT).MethodsIn a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A).ResultsBDI points were higher in WhHT (7 (3–11)) and ResHT (6 (3–11.5)) compared with Cont (3 (1–6), p < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5–15)) and ResHT (10.5 (5.25–18.75)) compared with Cont (4 (1–7), p < 0.05) and also compared with non-ResHT (5 (2–10), p < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204–12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165–18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170–7.126).ConclusionsOur results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.

SIMILARITIES IN DEPRESSION AND ANXIETY BETWEEN WHITE-COAT AND RESISTANT HYPERTENSION

Objective: Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy subjects (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT). Design and method: In this cross-sectional study, 363 patients were included: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A). Results: BDI points were higher in WhHT (7 (3–11)) and ResHT (6 (3–11.5)) compared with Cont (3 (1–6), p &lt; 0.05). Similarly, HAM-A points were higher in WhHT (8 (5–15)) and ResHT (10.5 (5.25–18.75)) compared with Cont (4 (1–7), p &lt; 0.05) and also compared with non-ResHT (5 (2–10), p &lt; 0.05). ResHT was independently associated with HAM-A scale above 3 points (Beta = 3.804, 95%CI: 1.204–12.015). WhHT was independently associated with HAM-A scale above 2 (Beta = 7.701, 95%CI: 1.165–18.973) and BDI scale above 5 (Beta = 2.888, 95%CI: 1.170–7.126) points. Conclusions: The evaluation of depression and anxiety in hypertensive patients could be useful to identify subjects with risk of white-coat effect and resistant hypertension. Our results suggest the possibility of the progression of white-coat hypertension to resistant hypertension in longer term, however, the proof of this concept requires prospective studies.

MO439: Cardiovascular Mortality Among Persons With Advanced Chronic Kidney Disease: A Matched Cohort Study

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) and diabetes are both well-established risk factors for cardiovascular mortality. However, the risk of cardiovascular mortality and the impact of diabetes for those who have already reached advanced CKD are poorly examined. We examined the risk of cardiovascular mortality among persons with advanced CKD with and without diabetes. METHOD In a nationwide registry-based retrospective matched cohort study, we identified all Danish persons aged ≥ 18 years with advanced CKD between 2002 and 2018. Persons were included in the study at first measured estimated glomerular filtration rate (eGFR) &amp;lt; 30 mL/min/1.73 m2. We excluded persons having a major cardiovascular event or dying &amp;lt; 30 days after inclusion. Non-exposed persons with eGFR ≥ 30 mL/min/1.73m2 (with and without diabetes) were matched on birthyear and sex in a ratio of 4:1. By using the Danish Register of Medicinal Product Statistics, persons with diabetes were identified. Information regarding mortality was obtained from the Danish Registry of Causes of Death. Multiple outcome-specific Cox regression was performed to calculate average treatment effects as standardized absolute risk of cardiovascular mortality adjusted for age, sex and prior cardiovascular disease and subsequently stratified by age group (18–49, 50–59, 60–69, 70–79, 80 years or older). RESULTS We included 135 824 persons with advanced CKD. Overall, 52% were women and the mean age was 76 years. There were 31 991 (23.6%) with diabetes, of whom 2512 (7.9%) had type 1 diabetes. The mean duration of diabetes was 9.7 years. Figure 1 depicts the standardized absolute risk of cardiovascular mortality. Estimations stratified by age groups are shown in Table 1. For persons with diabetes, the standardized absolute risk (95% CI) of cardiovascular mortality was 13.4% (11.5–15.1) in persons aged 18–49 years 5 years after diagnosis, rising to 35.7% (34.7–36.6) in persons aged ≥ 80 years. Compared with age- and sex matched persons, the corresponding relative risk [95% confidence interval (CI)] was 38.0 (29.9–48.1) in persons aged 18–49 years, declining to 1.8 (1.7–1.8) in persons aged ≥ 80 years. Among persons without diabetes, the standardized absolute risk (95% CI) 5 years after diagnosis was 5.2% (4.5–5.8) in persons aged 18–49 years, rising to 33.6% (33.1–34.0) in persons aged ≥ 80 years. The corresponding relative risk was 14.6 (11.7–18.4) and 1.7 (1.6–1.7), respectively, compared with matched persons. Comparing persons with diabetes to persons without diabetes, the relative risk (95% CI) of cardiovascular mortality 5 years after diagnosis was 2.6 (2.2–3.2), 1.8 (1.6–2.9), 1.4 (1.3–1.5), 1.2 (1.1–1.2), 1.1 (1.0–1.1) for age group 18–49, 50–59, 60–69, 70–79, ≥80 years, respectively. CONCLUSION Persons with advanced CKD have, independently of age, a much higher risk of cardiovascular mortality compared with the background population and in the age groups ˂70 years this is even more outspoken in persons with concomitant diabetes. These data highlight the importance of early cardiovascular risk assessment for this population.

PEROKOK PASIF SEBAGAI FAKTOR RISIKO PENYAKIT KARDIOVASKULAR DAN KEMATIAN TERKAIT PENYAKIT KARDIOVASKULAR: SYSTEMATIC REVIEW

Background: The harmfull effects of smoking are not only applied to active smokers but also secondhand smokers. Reseach show that secondhand smokers have an increased risk of cardiovascular disease and cardiovascular mortality. Hence, this systematic review aims to evaluate further the role of passive smoking as the risk factor for cardiovascular disease and cardiovascular mortality. Methods: This systematic review was conducted based on the new PRISMA guidelines. This review included the relevant cohort prospective studies from the last five years in Pubmed, Science Direct, and Cochrane Library. Results: There were five relevant studies included in this review. Four studies found that passive smoking has a higher risk of cardiovascular disease. One study reported that passive smoking is a risk factor for cardiovascular mortality. Conclusion: Passive smoking is a significant risk factor for both cardiovascular disease and cardiovascular mortality.&#x0D; Keywords: secondhand smoker, passive smoking, cardiovascular disease, cardiovascular mortality

An Updated Review On Analytical Methods For Estimation Of Azelnidipine And Telmisartan

High blood pressure, also called hypertension, is a common condition that is characterized by having a higher amount of pressure in blood vessels than normal. Hypertension (HT) is a very common disorder, particularly past middle age. It is not a disease in itself, but is an important risk factor for cardiovascular mortality and morbidity. For improvement activity of hypertension, Azelnidipine and Telmisartan newer combination in market, which is effective in Hypertension. This combination was developed to improve medication for Stage II Hypertension. Azelnidipine is Ca2+ channel blocker and chemically 3-[1-(Benzyldrylazetidin-3-yl] 5-isopropyl- 2- amino 6 methyl-4-(3-nitrophenyl)-1,4- dihydropyridine-3, 5dicarboxylate.Telmisartan is AT1-receptor blocker and Chemically2-{4-[[4-methyl-6-(1-methylbenzimidazol-2yl)-2–propylbenzimidazol-1yl] methyl] biphenyl)-benzoic acid. It provides information about different analytical method development like UV spectrophotometry, HPTLC, HPLC, and LC-MS methods reported for Azelnidipine and Telmisartan for individual and other drug combination. All reported methods found to be simple, accurate, economic, precise and reproducible in nature. This Review focuses on recent development in analytical method development for Azelnidipine and Telmisartan, and there were two methods reported for this combination as per our knowledge.&#x0D;

Dickkopf1 (Dkk1) Alleviates Vascular Calcification by Regulating the Degradation of Phospholipase D1 (PLD1).

Vascular calcification (VC) is a significant risk factor for cardiovascular mortality and morbidity in patients with atherosclerosis (AS), chronic kidney disease, and diabetes. Dickkopf1 (Dkk1) is a multifunctional secreted glycoprotein that has been explored as a novel potential antitumor target. Recently, Dkk1 was shown to be closely associated with AS development. However, the role of Dkk1 in VC remains elusive. In this study, we explored the role and molecular mechanisms of Dkk1 in VC based on a smooth muscle-specific Dkk1-knockout (Dkk1SMKO) mouse model. Our data indicated that Dkk1 expression was decreased under calcifying conditions and that Dkk1 overexpression alleviated high phosphate-induced vascular calcification. In vivo, smooth muscle Dkk1-specific knockout aggravated vascular calcification in mice. However, phospholipase D1 (PLD1) overexpression partially weakened the protective effect of Dkk1 against vascular calcification. Mechanistically, Dkk1 slowed vascular calcification by promoting the degradation of PLD1 via the regulating autophagosome formation and maturation. In conclusion, we found that Dkk1 could alleviate vascular calcification by regulating the degradation of PLD1.