Risk Factors Smoking Research Articles

Abstract 4136145: All-cause and Cause-specific Mortality Disparities in the District of Columbia: Temporal Trends from 2000 to 2020

Background: A report evaluating all-cause mortality in 30 major U.S. cities documented that inequality between Black and White populations in Washington, D.C. was the greatest. However, little is known about disparities in cause-specific mortality over time or by racial groups. Aims: Evaluate trends in all-cause and cause-specific mortality in D.C. from 2000 to 2020 by race, and concurrently examine trends in cardiovascular (CV) risk factors. Methods: Using the CDC WONDER database, we calculated age-adjusted mortality rates per 100,000 persons (2000-2020) for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios. Average Annual Percentage Change (AAPC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) using the Behavioral Risk Factor Surveillance System (2000-2020). Results: Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 32%) and cancer (22%) accounted for over half of the deaths. All-cause mortality declined between 2000-2012 (AAPC: -2.9%, 95% CI: -5.6, 1.0) but stagnated between 2012-2018 (AAPC:-1.1%, 95% CI: -4.6, 0.9) and increased after 2018 (AAPC: 7.7%, 95% CI: 0.6, 11.9). CVD mortality declined between 2000-2011 and plateaued thereafter among Black individuals, contrasting with a monotonous decline (AAPC: -4.7%, 95% CI: -5.3, -4.0) among White individuals, resulting in a magnification of the disparities. Cancer mortality decreased over time for both White and Black individuals (AAPC: -3.4%, 95% CI: -3.9, -2.9 vs. AAPC: -1.8%, 95% CI: -2.1, -1.4, respectively), with a greater magnitude in White individuals. Risk factors were more prevalent among Black individuals over the period. Conclusion: In D.C., the mortality rate is higher in Black vs. White populations, and disparities are increasing over time. While CVD and cancer mortality rates declined overall, profound disparities remain. CVD risk factors are more common in Black populations, with persisting disparities. There is an urgent need for CVD prevention and management, tailored to Black populations in D.C.

The Complement Factor H (Y402H) risk polymorphism for age-related macular degeneration affects metabolism and response to oxidative stress in the retinal pigment epithelium

Age-related macular degeneration (AMD), the leading cause of central vision loss in the elderly, involves death of the retinal pigment epithelium (RPE) and light-sensing photoreceptors. This multifactorial disease includes contributions from both genetic and environmental risk factors. The current study examined the effect of the Y402H polymorphism of Complement Factor H (CFH, rs1061170) and cigarette smoke, predominant genetic and environmental risk factors associated with AMD. We used targeted and discovery-based approaches to identify genotype-dependent responses to chronic oxidative stress induced by cigarette smoke extract (CSE) in RPE differentiated from induced pluripotent stem cells (iPSC) derived from human donors harboring either the low risk (LR) or high risk (HR) CFH genotype. Chronic CSE altered the metabolic profile in both LR and HR iPSC-RPE and caused a dose-dependent reduction in mitochondrial function despite an increase in mitochondrial content. Notably, cells with the HR CFH SNP showed a greater reduction in maximal respiration and ATP production. Significant genotype-dependent changes in the proteome were observed for HR RPE at baseline (cytoskeleton, MAPK signaling) and after CSE exposure, where a less robust upregulation of the antioxidants and significant downregulation in proteins involved in nucleic acid metabolism and membrane trafficking were noted compared to LR cells. In LR cells, uniquely upregulated proteins were involved in lipid metabolism and chemical detoxification. These genotype-dependent differences at baseline and in response to chronic CSE exposure suggest a broader role for CFH in modulating the response to oxidative stress in RPE and provides insight into the interaction between environmental and genetic factors in AMD pathogenesis.

Lifestyle related health risk factors regarding non-communicable diseases among adults in Morang District

Introduction: Non-communicable diseases are the leading causes of disease burden worldwide. According to World Health Organization estimates, NCDs are responsible for 74% of all deaths globally, with around 77% of premature deaths from NCDs occurring in low- and middle-income countries. This study aims to assess the lifestyle related health risk factors of non-communicable diseases among adults in Nepal, in which two- third of annual deaths are attributable to non-communicable diseases. Methods: A cross sectional study was conducted among adults in Morang district, Nepal. Data collection involved the assessment of the risk factors of obesity, smoking, alcohol consumption, inadequate fruits and vegetable consumption, inadequate physical activity, are raising blood pressure. Ethnical approval was obtained. Results: Two hundred forty participants participated in the study, of which the most prevalent risk factor was obesity (58.3%). Out of total participants, 41.6% had consumed tobacco, 31.2% had consumed alcohol, 41.6% had consumed inadequate fruits and vegetables, 30.4% had inadequate physical activity, and 29.1% had raised blood pressure. Similarly, education is statistically associated with lifestyle risk factors. Male participants of age above 40 years were found to be statistically associated with current tobacco and alcohol consumption. Conclusion: Health related risk factors are causes of non-communicable disease. Most of the participants had two or more risk factors for non-communicable disease. Education is significantly associated with all the risk factors among the participants.

Predictors of new-onset in-hospital atrial fibrillation in 122 089 patients admitted with COVID-19: an Australian statewide population study

Abstract Background New-onset atrial fibrillation (AF) when encountered in COVID-19 patients may be associated with increased mortality and thromboembolic events. Few studies have investigated predictors of new-onset AF in the context of COVID-19 and no study has assessed the utility of CHA2DS2VASc score in predicting new-onset AF in COVID-19 patients. Purpose This study aims to identify independent predictors of new-onset in-hospital AF in patients admitted with COVID-19. Methods Patients admitted with COVID-19 (1-Jan-2020 to 30-Sept-2021) were identified from the Admitted-Patient-Data-Collection database in an Australian state, stratified by AF status (no-AF vs new-AF during index COVID-19 admission) and followed-up until 31-Mar-2022. Patients with prior-AF were excluded from analysis. New-AF was defined as new-onset AF during the hospital admission for COVID-19. Independent predictors of new-AF were identified using multivariable logistic regression. Receiver Operating Characteristic (ROC) derived Area Under Curve (AUC) score was performed to determine the predictive power of independent predictors of new-AF. Results The cohort comprised 122089 COVID-19 patients (median age 62.7 yrs; 48.5% males) of whom 5140 developed new-AF (4.2%). Compared to patients with no-AF, patients with new-AF had a higher prevalence of comorbidities and cardiac risk factors (hypertension, diabetes and smoking) as well as a higher CHA2DS2VASc score (p < 0.001) (Table 1). Independent predictors of new-AF included referral from Emergency Department (adjusted odds ratio [aOR] =1.63, 95% confidence interval [CI]=1.49-1.78, intensive-care-unit admission (aOR=3.46, 95%CI=3.22-3.71), current/ex-smoker (aOR=1.20, 95%CI=1.12-1.27), prior coronary revascularization (percutaneous coronary intervention or coronary artery bypass graft surgery) (aOR=1.33, 95%CI=1.01-1.75), valvular heart disease (aOR=3.20, 95%CI=2.73-3.75), malignancy (aOR=1.15, 95%CI=1.02-1.29), chronic pulmonary disease (aOR=1.30, 95%CI=1.19-1.42) and higher CHA2DS2VASc score (per-1-score increase: aOR=1.62, 95%CI=1.59-1.65) (all P<0.05). CHA2DS2VASc score alone had an AUC score of 0.729 (95%CI=0.72-0.74) (Figure 1). Adding the above additional independent variables to CHA2DS2VASc score improved the predictive model to an overall AUC score of 0.773 (95%CI=0.77-0.78), p < 0.001. Conclusions This study identified patients at risk of developing new-AF in the setting of COVID-19 infection. Our multivariable logistic regression analysis that included CHA2DS2VASc score has a relatively good predictive value and if confirmed in other COVID-19 cohorts, may be used to identify patients in whom antiarrhythmic and more aggressive thromboprophylactic strategies can be considered.

Multiple behavioural risk factors and mental health complaints among adults in Estonia

Abstract Background Behavioural risk factors are inter-related and often coincide, resulting in potentially worse mental health outcomes. This study explores the association between multiple behavioural risk factors and mental health among adults in Estonia. Methods We used nationally representative survey data from 2020 (n = 6404) to study the co-occurrence of lifestyle risk factors (smoking, alcohol consumption, physical inactivity, unhealthy diet, drug use, and high screen time) in relation to mental health indicators. Latent class analysis (LCA) was used to identify lifestyle risk profiles, while regression analysis was used to examine associations. Results Mental health outcomes were more frequent among females and younger respondents, but 54.4% of respondents reported having at least one mental health problem. Using LCA, three lifestyle classes were identified: multiple risk factors (17.9% of respondents), healthy lifestyle (76.1%), and drug use lifestyle (5.9%). Compared to individuals in healthy lifestyle class, respondents in multiple risk factors had higher odds for experiencing depressiveness (OR 1.46; CI 1.24-1.72), stress (OR 1.26; CI 1.06-1.49), and suicidal thoughts (OR 1.50; CI 1.26-1.80), as well as self-reported diagnoses of depression and insomnia, and using medications, such as antidepressants, hypnotics and sedatives. Respondents in drug use lifestyle had 1.5-2.5 times higher odds for all mental health items compared to healthy lifestyle class with largest difference found for suicidal thoughts (OR 2.46; CI 1.92-3.16) and medication use (OR 2.58; CI 1.91-3.47). Conclusions The current data highlights the importance of preventive measures targeting multiple behavioural risk factors, given that these factors often coincide. Moreover, the study showed a high proportion of individuals with at least one mental health problem, highlighting the necessity to continue efforts in preventive and interventive methods. Key messages • The study highlights the significant association between multiple behavioural risk factors and mental health outcomes. • The study also emphasizes the importance of focused interventions targeting multiple behavioural risk factors to address the increased risk of mental health problems.

Polygenic prediction of coronary artery disease among 130,000 Mexican adults

Abstract Background Coronary artery disease (CAD) is a leading cause of premature mortality globally. Polygenic risk scores (PRSs) have been reported to enhance CAD prediction in populations of European ancestry but evidence from other populations is limited. We assessed the transferability and relevance of eight different external PRSs to the odds of premature CAD in a Mexican population with high levels of relatedness and ancestry admixture. Methods 128,388 genotyped participants aged 35-74 years who were recruited between 1998 and 2004 into the Mexico City Prospective Study (MCPS) were included. We selected and recreated eight previously-reported CAD PRSs. The number of single nucleotide polymorphism variants included in the PRSs varied from 44 to 6,472,620. Premature CAD was defined as either self-reported history of heart attack or angina at recruitment or death before age 75 with CAD recorded on the death certificate. Age and sex-adjusted logistic regression was used to estimate the ability of each PRS to predict CAD, both overall and separately by age, sex and estimated proportion of Indigenous American ancestry. Analyses were repeated after further adjustment for conventional risk factors (blood pressure, adiposity, smoking, diabetes and highest education achieved). Risk discrimination was assessed using C-statistic. Results Of the 128,388 participants, 68% were women, mean (SD) age was 50.2±10.9 years and the average proportion of Indigenous American ancestry was 67%. CAD was identified for 3,871 (3.0%) participants; prior CAD was reported by 1,669 (1.3%) participants while 2,360 (1.8%) participants died before age 75 years with CAD mentioned on the death certificate. All eight PRSs were positively and approximately log-linearly associated with the odds of CAD, but the strength of association varied between the PRSs, ranging from a 7% increase per 1SD higher PRS (odds ratio [OR] 1.07, 95% CI 1.04-1.11) to a 33% increase (OR 1.33, 95% CI 1.29-1.37). Collectively, age, sex and (any) PRS resulted in a C-statistic of 0.70-0.71. C-statistics were slightly lower among those with a higher proportion of indigenous American ancestry. For four of the eight PRSs (including three of the four multi-ancestry PRSs) the increase in odds of CAD per 1SD higher PRS was significantly greater for men than women (eg, for the PRS with the strongest overall association with CAD the OR per 1SD higher PRS was 1.43 [95% CI 1.36-1.49] in men and 1.25 [1.20-1.31] in women). Further inclusion of conventional vascular risk factors reduced the strengths of associations of each PRS with CAD only slightly but increased the model C statistic to 0.74 in all cases. Conclusions In this population of admixed Mexican adults, existing PRSs predicted CAD reasonably well and independently of conventional vascular risk factors. Ancestry-specific instruments that more closely represent genetic variation in Mexico may further enhance polygenic prediction of CAD risk.Table 1.Baseline characteristicsFigure 1.Main analysis results

Circulating levels of amyloid-beta (1-40) peptide associate with cardiometabolic traits and risk for metabolic dysfunction-associated steatotic liver disease

Abstract Background and Aims The ageing-associated amyloid-beta 1-40 peptide (Αbeta40) has recently emerged as a blood-based biomarker of cardiovascular disease (CVD). Its levels predict future cardiovascular death and MACE in patients with established CVD. The clinical value of Abeta40 in patients with metabolic syndrome who do not concomitantly have clinically overt CVD or other end-organ damage remains poorly understood. At the present study we investigated the clinical value of plasma Αbeta40 in patients with pre- or established metabolic syndrome who are at risk for metabolic dysfunction-associated steatotic liver disease (MASLD). Methods Αbeta40 was measured in plasma by enzyme-linked immunosorbent assay and cardiometabolic traits were determined in a mixed population (n=888) of patients with established (n=243) and pre- or without metabolic syndrome (n=645) who did not have clinical signs of established cardiometabolic disease (heart failure, coronary artery disease, MASLD, chronic kidney disease). The endpoint of the study was the association of Abeta40 with cardiometabolic indices and risk (BARD score) for MASLD. Odds ratio (OR) was calculated by ordinal regression analysis for the increasing incidence of metabolic syndrome components per increasing Abeta40 (1-SD) after adjustment for age, sex, smoking status and hyperlipidemia. Results Abeta40 levels are associated with the presence of metabolic syndrome and with higher odds for increasing incidence of metabolic syndrome components after adjustment for sex, age, smoking status, hypertension and dyslipidemia. Increased Abeta40 plasma levels were associated with decreased HDL-C levels (OR: 1.004, 95% CI:1.000-1.009, P=0.049) and increased triglyceride levels (OR: 1.007, 95%CI: 1.001-1.012, P=0.033) after adjustment for traditional cardiovascular risk factors (age, sex, smoking status, hypertension and hyperlipidemia). Among the total population (n=888), we identified n=473 subjects with increased MASLD risk if any of the following was present: hepatic steatosis index≥36 or fatty liver index≥60 or Fib-4 index≥2.67 or NAFLD score≥0.675. Among patients with high-risk for MASLD, patients with increased BARD score had significantly higher Abeta40 levels (median Abeta40 concentration in patients with BARD score≥2 vs. patients with BARD score<2: 54.9 pg/ml (IQR=38.25) vs. 41.9 pg/m (IQR=30.35), P=0.012). Increased Abeta40 levels were associated with increased odds for AST/ALT≥0.8 ratio and increased odds for BARD score≥2 after adjustment for age, sex, smoking status, hypertension and hyperlipidemia. Conclusion Our findings suggest that Abeta40 peptide is associated with cardiometabolic traits and risk for MASLD. Whether Abeta40 may emerge as an early cardiometabolic prognostic biomarker, future longitudinal studies are warranted to determine the prognostic value of Abeta40 for the development of cardiometabolic diseases in patients with metabolic syndrome.

Association of modifiable risk factors with progression to dementia in relation to amyloid and tau pathology

BackgroundDementia preventive interventions targeting multiple modifiable risk factors are a promising approach. However, the impact of modifiable risk factors in the presence of beta-amyloid or phosphorylated-tau (p-tau) pathology is unclear.MethodsThe objective of the study was to examine the role of modifiable risk factors (vascular factors, depression, and smoking) in the progression to mild cognitive impairment (MCI) or dementia among 434 cognitively unimpaired (CU) and 611 individuals with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Vascular risk factors were summarized with the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score, dichotomized into higher versus lower risk. Depression and smoking (yes/no) were categorised according to medical history or current symptoms. Analyses were stratified by beta-amyloid negative (A-) and positive (A +), p-tau negative (T-) and positive (T +), or beta-amyloid and p-tau negative (A-T-) and positive (A + T +) biomarker status. Cox proportional hazard models were adjusted for age, sex, education, baseline MMSE score, baseline hippocampal volume and ApoE4 carrier status.ResultsHigher CAIDE score was associated with increased risk of progression to all-cause dementia in most MCI subgroups: adjusted hazard ratios (aHR) [95% CI] were 3.1 [1.43; 6.53] in the A- subgroup, 1.7 [1.20–2.27] in T + , 2.6 [1.06–6.59] in A-T-, and 1.6 [1.15–2.22] in the A + T + subgroup. Smoking (yes/no) was associated with increased dementia aHR in the A + MCI subgroup: 1.6 [1.07–2.34]. Depression increased dementia aHR in the T + MCI subgroup: 1.5 [1.06–2.02]. No significant associations were found in the CU biomarker subgroups.ConclusionAddressing modifiable risk factors carries an important potential for reducing the risk of dementia even after the onset of Alzheimer's pathology. Knowledge of biomarker status can further optimize prevention strategies.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above - 10 CKB Study Areas, China, 2020-2021.

The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults, but the risk factors for this age group were unclear. The prevalence was estimated at 12.8% and 5.7% for males and females over 50 in 2020-2021, with confirmed risk factors of cigarette smoking, a family history of respiratory diseases, respiratory symptoms, and a history of cough or respiratory diseases during childhood. The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

Paid employment for 20-year-olds as a risk factor for smoking and e-cigarette use

Paid employment for 20-year-olds as a risk factor for smoking and e-cigarette use

Rotator Cuff Tear Size: Could It Be Influenced by the Presence of One or More Diseases Capable of Altering the Peripheral Microcirculation?

Background: To date, it is not well known which systemic pathologies most frequently afflict patients with rotator cuff tear (RCT) and whether the coexistence of two or more pathologies can affect the lesion size. Therefore, we analyzed our database relative to a large group of patients who recently underwent rotator cuff repair. Methods: A total of 527 patients with full-thickness RCT were enrolled. For each patient, we checked the presence of at least one of diabetes, venous system diseases, cardiovascular diseases, hypercholesterolemia, blood hypertension, thyroid diseases, and a smoking habit. Patients were subdivided according to risk factors into five groups, representing those who had zero, one, two, three, and four or more risk factors, respectively. Statistical analysis was performed. Results: In total, 37% of our patients had no risk factors; 28% had one risk factor (arterial hypertension, smoking habit, and hypercholesterolemia were the most frequent); 23% had two risk factors (the hypertension/hypercholesterolemia association was the most frequent); and 8% suffered from three pathologies (the diabetes/arterial hypertension/hypercholesterolemia association was the most frequent). Comparing the cuff tear severity in patients without and with at least one risk factor, we observed that tear size increased in those with at least one risk factor. Conclusions: A total of 63% of patients with rotator cuff tears were either smokers and/or had at least one pathology capable of altering the peripheral microcirculation. Hypertension and hypercholesterolemia were the most frequent. Tear severity significantly increased with the presence of at least one risk factor.

Behavior change, health, and health disparities 2024: Smoking and other tobacco use among women and girls

This Special Issue (SI) of Preventive Medicine is the 11th in an annual series on behavior change, health, and health disparities. The theme of this 2024 issue is Smoking and Other Tobacco Use among Women and Girls. Cigarette smoking remains the single most preventable cause of death in the U.S., causing the premature death of more than 200,000 U.S. women annually, a mortality rate that far exceeds levels from conditions more commonly associated with premature death in women (e.g., breast cancer). Of course, cigarette smoking among women and girls is also a well-known cause of intergenerational adverse health effects. Women and girls are also using e-cigarettes and many other tobacco products that are flooding the U.S. tobacco marketplace. This SI includes eleven peer-reviewed articles that advance knowledge across a wide range of topics on disproportionate adverse effects, prevalence, and risk factors for cigarette smoking and other tobacco use in women and girls.

Fixed Airflow Obstruction in Asthma Can Be Identified Early by Low FEF25-75% and is Associated with Environmental Exposure.

This study aimed to identify environmental risk factors associated with asthmatic fixed airflow obstruction (FAO) and assess the relationship between small airway abnormalities defined by forced expiratory flow at 25-75% (FEF25-75%) and FAO. We analyzed data from 312han Chinese patients with stable asthma on standard treatment. Low FEF25-75% was defined as post-bronchodilator FEF25-75% z-score <-0.8435, and FAO as post-bronchodilator FEV1/FVC z-score <-1.645. Exposure levels were retrospectively analyzed in relation to FAO risk in asthmatics. Asthmatics were grouped by low FEF25-75% and FAO, and lung function, environmental exposure, daily symptoms, and exacerbations in the previous year were compared cross-sectionally across groups. In retrospective analyses, pack-years of smoking in male patients (adjusted odd ratio [95% confidence interval] 1.05 [1.03-1.07], P<0.001), biomass exposure for >20 years (2.65 [1.13-6.43], P=0.027), occupational exposure for >10 years (2.01 [1.06-3.86], P=0.035) and occupational exposure for >20 years (2.67 [1.24-5.91], P=0.013) were associated with asthmatic FAO. In cross-sectional analyses, compared with the normal FEF25-75%/ asthmatics without FAO (NON-FAO) group, the low FEF25-75%/ asthmatics with FAO (FAO) group had lower FEV1 z-scores and FEV1/FVC z-scores, more pack-years and years of biomass and occupational exposure, higher Asthma Control Questionnaire-5 and Chronic Obstructive Pulmonary Disease Assessment Test scores, and more frequent exacerbations. The low FEF25-75%/NON-FAO group showed the same trend, but to a lesser extent. Chronic airway inflammation is not the only driver of asthmatic FAO, and management and treatment targeting environmental risk factors (smoking and biomass and occupational exposures) may slow FAO progression in asthmatics. The FEF25-75% determined by the z-score is a reliable marker of small airway abnormalities, and patients with low FEF25-75% are at greater risk for FAO, requiring more frequent follow-up.

Cardiovascular risk factors and all-cause mortality in older age (15-year cohort study)

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Differences Between Vietnamese Living in Germany and German Periodontitis Patients in Periodontal Conditions and Subgingival Microbiota

Introduction and aimsA number of studies have reported ethnic differences in the prevalence and severity of periodontitis. Such discrepancies could be attributed to disparities in periodontal risk factors, as well as variations in the composition of the subgingival microbiota. Given the substantial Vietnamese population residing in the former German Democratic Republic, the present study aimed to compare the clinical and microbial characteristics of periodontitis patients of Vietnamese Asian origin living in Germany with those of German Caucasian periodontitis patients. MethodsA total of 60 patients with a minimum stage II periodontitis diagnosis were included in the study. Of these, 30 were of Vietnamese origin, with an average age of 55 years and a male prevalence of 33.3%. The remaining 30 patients were of German origin, with an average age of 54.5 years and a male prevalence of 40%. The periodontal diagnosis was made in accordance with the recently revised classification of periodontal disease. The pooled subgingival plaque samples were subjected to next-generation sequencing on the MiSeq platform (Illumina). ResultsThe German patients were significantly more likely to be smokers (56.7% vs 13.3%), had significantly higher body mass index (26 vs 22.6 kg/m²), probing depth (4.1 vs 3.6 mm), and clinical attachment loss (5 vs 4.1 mm). In terms of microbiota, the Vietnamese patients exhibited significantly lower beta diversity compared to the German patients, and smokers demonstrated a significantly higher beta diversity compared to nonsmokers. The microbiota of both groups differed most significantly in the relative abundance of Porphyromonas gingivalis (Vietnamese) and Fusobacteriia (German). ConclusionsGerman patients with periodontitis showed more severe periodontal symptoms and more pronounced periodontal risk factors compared to Vietnamese patients. Both patient groups also showed significant differences in the subgingival microbiota. Clinical relevanceCompared to Vietnamese living in Germany, German patients have a higher need for periodontal treatment and at the same time the risk factors of smoking and obesity should be reduced. More research is needed before the differences in oral microbiota between the two groups can lead to individualised therapeutic approaches.

Cardiovascular Risk Factors Associated with Mitral Annular Calcification in a Non-Rheumatic Population

Mitral Annular Calcification (MAC), cardiovascular disease marker was common in non-rheumatic populations but was frequently disregarded in clinical evaluations. Objective: To MAC and to assess effect of these factors on cardiac function in non-rheumatic adult population. Methods: From September 2022 to August 2023, we conducted this cross-sectional study at Cardiac Center, Pakistan institute of medical sciences Islamabad that included 182 adults aged 50 years and older. We evaluated the patient's clinical history, demographic data and echocardiographic and laboratory results. The association between the presence of MAC and cardiovascular risk factors (age, hypertension, diabetes, dyslipidemia, smoking, obesity and chronic renal disease) was analyzed using logistic regression. Echocardiographic data were used to provide insight into cardiac function. Results: The prevalence of MAC was substantially correlated with hypertension (OR = 2.30), diabetes (OR = 2.00), dyslipidemia (OR = 1.75) and obesity (OR = 1.07). Also, smoking demonstrated a significant correlation with MAC. In comparison to those without MAC, individuals with MAC exhibited substantially lower ejection fractions, increased left atrial diameters and impaired diastolic function, as indicated by cardiac function assessments. Conclusion: In non-rheumatic population, MAC was significantly associated with conventional cardiovascular risk factors, particularly hypertension and diabetes.

Does cognitive function affect functional capacity and perceived fatigue severity after exercise in patients with coronary artery disease?

Successful execution of exercise-based cardiac rehabilitation programs, an important branch of physiotherapy in individuals with coronary artery disease (CAD), depends on adequate cognitive abilities. It has been identified that coronary microvascular dysfunction, marked by reduced coronary flow reserve, is associated with impaired cerebral blood flow, affecting haemodynamic and cognitive performance. This study aimed to investigate how cognitive function influences functional capacity and differences in fatigue perception in CAD patients. Fifty CAD patients, with an average age of 59.40±6.58years, were evaluated for comorbidities (Charlson comorbidity index), number of CAD risk factors (hypertension, diabetes mellitus, dyslipidaemia, smoking, and physical inactivity), cognitive performance (Montreal cognitive assessment scale [MoCA]), functional capacity (incremental shuttle walk test [ISWT]), exercise-induced fatigue (Modified Bourg Scale), and physical activity (PA) levels (international physical activity questionnaire-short form). Analyses focused on the links between MoCA scores and CRF, ISWT outcomes, and differences in fatigue perception. Findings revealed a strong positive link between MoCA scores and ISWT performance (r=0.83, p<0.001), and a strong inverse relationship between CRF and MoCA scores (r=-0.95, p<0.001). In addition, MoCA score was positively correlated with differences in fatigue perception (r=0.88, p<0.001). These results highlight the critical role of cognitive function in determining functional capacity and managing fatigue in CAD patients. They also suggest that cognitive interventions may be a potential adjunctive approach in physiotherapy programmes.

Effects of Occupational and Leisure-Time Physical Activity on the Risk of Dementia: Results From the Copenhagen City Heart Study.

Leisure-time physical activity (LTPA) decreases the risk of dementia, whereas occupational physical activity (OPA) possibly increases the risk. Yet, previous findings are mixed. We therefore aimed to investigate the effect of LTPA and OPA, respectively, on dementia among men and women. In this observational, longitudinal study, we used data from the second wave of a population-based cohort from the municipality of Copenhagen as baseline. Data were collected in 1981-1983, and 10 343 participants were followed until the end of 2016. LTPA and OPA were self-reported, and information on dementia diagnoses and redemption of dementia medication was obtained at an individual level from national health registers. We used Poisson regression to analyze the association between LTPA/OPA and dementia and adjusted for self-reported age, socioeconomic factors, stress, and cardiovascular risk factors (smoking, alcohol, body mass index, and blood pressure). A higher level of LTPA was associated with a lower dementia risk among men, but we found no clear association among women. OPA and dementia were not associated among men, but occupationally active women who reported OPA in terms of walking, lifting, and heavy work had a higher risk of dementia than women with sedentary jobs. This study supported earlier findings of a protective effect of LTPA on dementia among men. Women in physically demanding jobs possibly have a higher risk of dementia, yet this finding warrants further investigation in future studies.

A protein risk score for all-cause and respiratory-specific mortality in non-Hispanic white and African American individuals who smoke

Protein biomarkers are associated with mortality in cardiovascular disease, but their effect on predicting respiratory and all-cause mortality is not clear. We tested whether a protein risk score (protRS) can improve prediction of all-cause mortality over clinical risk factors in smokers. We utilized smoking-enriched (COPDGene, LSC, SPIROMICS) and general population-based (MESA) cohorts with SomaScan proteomic and mortality data. We split COPDGene into training and testing sets (50:50) and developed a protRS based on respiratory mortality effect size and parsimony. We tested multivariable associations of the protRS with all-cause, respiratory, and cardiovascular mortality, and performed meta-analysis, area-under-the-curve (AUC), and network analyses. We included 2232 participants. In COPDGene, a penalized regression-based protRS was most highly associated with respiratory mortality (OR 9.2) and parsimonious (15 proteins). This protRS was associated with all-cause mortality (random effects HR 1.79 [95% CI 1.31–2.43]). Adding the protRS to clinical covariates improved all-cause mortality prediction in COPDGene (AUC 0.87 vs 0.82) and SPIROMICS (0.74 vs 0.6), but not in LSC and MESA. Protein–protein interaction network analyses implicate cytokine signaling, innate immune responses, and extracellular matrix turnover. A blood-based protein risk score predicts all-cause and respiratory mortality, identifies potential drivers of mortality, and demonstrates heterogeneity in effects amongst cohorts.

A feasibility study of the CRISP intervention; a cardiovascular risk reduction intervention in patients with an abdominal aortic aneurysm.

Abdominal aortic aneurysm (AAA) screening/surveillance is implemented widely. Those in AAA-surveillance are at high-risk of cardiovascular-events. We developed an intervention, called CRISP, using intervention-mapping, to reduce cardiovascular-risk in AAA-surveillance. This study tested the CRISP intervention in routine clinical-care. The CRISP intervention, consisting of a nurse-led cardiovascular risk assessment and subsequent lifestyle change support using a self-care workbook and low-intensity nurse input was delivered in two screening/surveillance programmes. Those consenting to take part were followed-up with cardiovascular-assessments. Fidelity of intervention-delivery was assessed quantitatively/qualitatively. 40 men (mean age 75 ± 7 years) took part over four months and followed-up for a minimum six months. A sub-group of 25 patients and nine Health Care Professionals (HCPs) were interviewed. The median number of risk-factors that patients chose to focus on was two (range 0 to 4), with physical activity (n=17) being the most popular. Participants who had a 'red light' risk factor for stress, low mood, smoking or alcohol intake were offered a referral to appropriate services. Two were offered referral to mental-health services and took it up, three declined referrals to smoking or alcohol support services. The fidelity of intervention-delivery (a score intervention components delivered to each patient based on a score from 0 to 5, with 5 being highest delivery fidelity) was generally low. The highest mean score (on a 0-5 scale) for the nurse assessment was 1.5 for engaging the participant, lowest 0.5 for exploring the importance for selected lifestyle behaviours. In qualitative interviews, the intervention was liked by patients/HCPs. Based on qualitative interviews and observations, the low fidelity of intervention-delivery was due to intervention-training not being detailed. CRISP can be delivered in AAA-surveillance, but fidelity of delivery is low. The intervention and its training need to be refined/tested before wider implementation. ISRCTN9399399518/11/20).