Risk Factors For Primary Prevention Research Articles

Abstract WP276: Large Artery Atherosclerosis and Young Stroke

Introduction: It is known that past the age of 35, the prevalence of large artery atherosclerosis (LAA) related strokes increases with a cardiovascular risk factor (CVRF) profile beginning to resemble that of elderly patients. However, LAA-related strokes still only account for <10% of all young strokes over the age of 35. Further, there is limited data regarding the location, intracranial or extracranial, of LAA in this patient population. Methods: We conducted a retrospective review of stroke patients between the ages of 18 to 50 years presenting to our Young Stroke Center between April 2022 through August 2023. For each case, data including basic demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Patients with LAA as the stoke etiology were compared to all non-LAA stroke etiologies. The two groups were analyzed with respect to baseline demographics and CVRFs. Analysis was performed with logistic regression adjusting for age, sex, and race. Results: Of 179 patients in the registry, 15 patients had LAA compared with 164 patients with non-LAA as their stroke etiology. Only one patient had extracranial carotid stenosis, with the rest of the LAA patients having intracranial atherosclerotic disease. There was a significant difference in age at time of stroke (42.9 ± 5.0 vs. 38.2 ± 8.0 years; OR [95% CI]: 1.11 [1.01-1.21]) between LAA and non-LAA groups, respectively. There was no significant difference in sex (66.7% vs. 62.8% female) and race (46.7% vs. 54.9% Black). A significantly larger proportion of patients with LAA had baseline CVRFs including hypertension (80.0% vs. 44.5%; 5.0 [1.2-20.3]), dyslipidemia (66.7% vs. 31.7%; 4.3 [1.3-14.1]), and obesity (33.3% vs. 12.2%; 5.6 [1.5-20.7]). There was also a trend toward increased rates of smoking (40.0% vs. 20.7%; 2.82 [0.9-9.0]) and diabetes (26.7% vs. 18.9%; 1.3 [0.3-4.7]). Conclusion: In the young stroke population, stroke due to LAA is more likely due to intracranial disease rather than extracranial disease and is associated with traditional CVRFs including hypertension, dyslipidemia, and obesity. These findings reinforce the importance of early intervention of modifiable risk factors for primary prevention of stroke in the young.

Pharmacist intervention in outpatients with hypertension, type 2 diabetes mellitus, ad impact on cardiovascular risk

About 80% of CVDs are linked to behavioral risk factors. The effects of physical inactivity and unhealthy diet may present in an individual as overweight and obesity, high blood pressure, elevated blood glucose levels, and elevated blood lipid levels. Aim: This study aims to assess the impact of pharmacist interventions focusing on the medical risk factors for primary prevention in outpatients with Hypertension, Diabetes and their impact on Cardiovascular risk. Material and Methods: The selected patients were grouped randomly into interventional and usual care groups. The different intervention steps and the protocol of the study were explained to the patients included in the interventional group whereas the normal care group will be directed to follow their normal treatment protocol. Results & Conclusion: In both interventional group (61.3%) and usual care group (57.7%) majority were females. The age group of the patients varied from 41 to 70. There were significantly results in the Interventional group in clinical outcomes, biomedical outcomes and adherence of medication compared with the Usual care group.

Abstract 6447: Carotenoid and tocopherol intake in relation to pancreatic cancer risk in a population-based case-control study

Abstract Pancreatic cancer is the third leading cause of cancer-related death in the U.S. and has a 5-year relative survival rate of only 11.5%. The etiology of pancreatic cancer is not well understood, with cigarette smoking, type 2 diabetes, and chronic pancreatitis as the only well-established risk factors. Therefore, it is critical to identify modifiable risk factors for primary prevention. Persistent oxidative stress and resultant oxidative damage can lead to accumulated mutations in oncogenes and tumor suppressor genes and subsequent carcinogenesis of the pancreas. Carotenoids are abundant in fruits and vegetables, while tocopherols are rich in oilseeds and nuts. Both carotenoids and tocopherols have antioxidant functions. Thus, it is possible that high intake of these bioactive compounds can reduce risk of pancreatic cancer. The present study sought to investigate this question in a case-control study conducted during 1994-1998 in Minnesota. Cases (n=150), aged 20 years or older, were ascertained from all hospitals in the metropolitan area of the Twin Cities and the Mayo Clinic; from the latter, only cases residing in the Upper Midwest of the US were recruited. Controls (n=459) were randomly selected from the general population and frequency matched to cases by age (within 5 years) and sex. Intake of carotenoids and tocopherols from diet and supplements was estimated from a validated food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using unconditional logistic regression. As lutein and zeaxanthin are isomers that have identical chemical formulas, they are combined into a single variable in the analysis. All dietary variables were adjusted for energy intake with the residual method prior to data analysis. After adjustment for age, sex, race, education, physical activity, cigarette smoking, and alcohol consumption, intake of lutein and zeaxanthin was associated with a significantly reduced risk of pancreatic cancer [OR (95% CI) for quartile 4 (median: 4972 µg/day) vs. quartile 1 (median: 976 µg/day): 0.39 (0.19-0.79); p-trend: 0.06]. This inverse association became slightly weaker but remained statistically significant after additional adjustment for intake of energy, fat, and fiber. No significant associations were observed for intake of α-carotene, β-carotene, lycopene, β-cryptoxanthin, α-tocopherol, β-tocopherol, and δ-tocopherol, although a higher intake of all these nutrients except α-tocopherol and δ-tocopherol tended to confer a lower risk. Our study shows that there is a significant, beneficial effect of lutein and zeaxanthin intake on pancreatic cancer risk, although it may be a chance finding due to multiple comparisons. More epidemiologic studies are warranted to further elucidate the roles of carotenoids and tocopherols in the etiology and prevention of pancreatic cancer. Citation Format: Bronson Dokmanovich, Hao fan, Yunpeng Yu, Kristin Anderson, Jianjun Zhang. Carotenoid and tocopherol intake in relation to pancreatic cancer risk in a population-based case-control study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6447.

Abstract 6456: Association of dietary inflammatory and insulinemic potential with risk of liver cancer and chronic liver disease mortality

Abstract Background: Increasing burdens of liver cancer and chronic liver disease (CLD) urge investigation of modifiable risk factors for primary prevention. Despite strong experimental evidence showing the role of chronic insulin resistance/hyperinsulinemia and inflammation in liver cancer and CLD, whether the insulinemic and inflammatory potential of diet are independently associated with higher risk of these outcomes requires further investigation. Methods: We conducted a prospective cohort study among 78,356 postmenopausal women in the Women’s Health Initiative Observational Study. Two validated dietary indices that predict circulating C-peptide or biomarkers of inflammation, namely, the empirical dietary index for hyperinsulinemia (EDIH) and the empirical dietary inflammation pattern (EDIP), were estimated from a food frequency questionnaire. Incident cases of liver cancer and CLD mortality were ascertained via review of medical records and linkage to national registries. Multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models, adjusted for age, diabetes, body mass index (BMI), and other covariates. Results: During a median 22.1 years of follow-up, we documented 176 primary liver cancer cases and 156 CLD mortality cases. The EDIH was positively associated with incident liver cancer risk (HRQuartile4 vs. Quartile1 = 1.70; 95% CI: 1.03, 2.81; p-trend = 0.03) and CLD mortality risk (HRQ4 vs. Q1 = 2.75; 95% CI: 1.54, 4.93; p-trend = 0.01) in the multivariable adjusted model, including diabetes and BMI as covariates. The EDIP was also positively associated with liver cancer (HRQ4 vs. Q1 = 1.93; 95% CI: 1.21, 3.09; p-trend <0.001) and CLD mortality risk (HRQ4 vs. Q1 = 2.09; 95% CI: 1.24, 3.52; p-trend <0.001) in the multivariable adjusted model. The estimates remained significant and robust in sensitivity analyses, after exclusion of cases in the first 2 years of follow-up or with liver disease history. There was no additive effect between the two dietary indices. Further analyses of individual food groups and liver outcomes indicated positive associations with refined grains, processed meat, butter, and eggs, and inverse associations with coffee, poultry, green leafy vegetables, and dark yellow vegetables. Conclusions: Dietary insulinemic and inflammatory potential were independently associated with higher risk of liver cancer and CLD mortality in US postmenopausal women. Monitoring dietary patterns to reduce chronic hyperinsulinemia and inflammation may contribute to the primary prevention of liver cancer and CLD mortality. Citation Format: Xinyuan Zhang, Longgang Zhao, Cami Christopher, Fred K. Tabung, Wei Bao, David O. Garcia, Marian L. Neuhouser, Aladdin H. Shadyab, Nazmus Saquib, Lesley Tinker, Xuehong Zhang. Association of dietary inflammatory and insulinemic potential with risk of liver cancer and chronic liver disease mortality. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6456.

Abstract P532: Risk Factor Differences for Coronary Artery Calcium in Self versus Provider-Referred Groups

Introduction: To detect coronary artery disease (CAD) in asymptomatic patients, noninvasive coronary artery calcium (CAC) computed tomography (CT) can be used in the decision to start statin or further lipid lowering management. The test is appropriate for adult patients 40-75 years old at 10-year atherosclerotic cardiovascular disease intermediate risk (7.5-20%) without diabetes mellitus and with low-density lipoprotein cholesterol 70-189 mg/dL. The study was to identify risk factor differences between self and provider-referred groups. We hypothesized that the provider-referred group would have greater risk factors. Methods: Patients who received CAC CT at seven southwest Ohio hospitals for the first 6 months of 2019 were self or provider-referred for CAC CT during a community campaign for persons who identified as having cardiovascular risk factors. Their background information and labs were obtained and compared to ascertain differences. Results: The analyses involved 2124 patients who received CAC CT. 163 were self and 1961 were provider-referred. With 30 demographic and clinical risk factors compared, peripheral vascular disease, higher triglyceride levels, higher LDL and beta blocker prescription were associated with higher odds for elevated CAC score in the self-referred group. There was no difference between white or black races. Conclusion: CAC CT testing can be used to clarify cardiovascular risk and to optimize medical therapy for both self and provider-referred groups. Self-referred patients seem to identify with similar or advanced awareness of risk factors for primary prevention concerns when a community initiative was issued. Therefore, community initiatives may have a public health benefit for primary prevention and early detection of cardiac risk. This is a study that may be repeated in other communities.

The association between circulating docosahexaenoic acid and lung cancer: A Mendelian randomization study

Lung cancer is a malignant tumor with a high incidence, it is vital to identify modifiable and avoidable risk factors for primary prevention, which can significantly lower the risk of cancer by preventing exposure to hazards and altering risky behavior. Some observational studies suggest that an increase in docosahexaenoic acid (DHA) consumption can reduce lung cancer risk. However, interpretation of these observational findings is difficult due to residual confounding or reverse causality. To evaluate the link between DHA and lung cancer, we have undertaken this analysis to examine the causal association between DHA and the risk of lung cancer using a two-sample Mendelian randomization (MR) framework. We performed a two-sample MR analysis to evaluate the causal effect of plasma DHA levels on lung cancer risk. For the exposure data, we extracted genetic variants as instrumental variables (IVs) that are strongly associated with DHA from a large-scale genome-wide association study (GWAS). We obtained the corresponding effect estimates for IVs on the risk of lung cancer with 11,348 cases and 15,861 controls. Finally, we applied Mendelian randomization analysis to obtain preliminary MR results and performed sensitivity analyses to verify the robustness of our results. According to the primary MR estimates and further sensitivity analyses, a higher serum DHA level was associated with a higher risk of lung cancer [OR=1.159, 95% CI (1.04-1.30), P=0.01]. For lung adenocarcinoma, the results also showed a close correlation between the DHA level and lung adenocarcinoma [OR=1.277, 95% CI (1.09-1.50), P=0.003], but it was not statistically significant for squamous cell carcinoma [OR=1.071, 95% CI (0.89-1.29), P=0.467]. Our study revealed that plasma DHA is positively associated with the risk of lung cancer overall, especially for lung adenocarcinoma. This study provides new information to develop dietary guidelines for primary lung cancer prevention.

Vascular risk factors and staging of atherosclerosis in patients and controls: The Norwegian Stroke in the Young Study.

Objectives:We studied the prevalence of vascular risk factors (RFs) among 385 ischaemic stroke patients ⩽60 years and 260 controls, and their association with atherosclerosis in seven vascular areas.Methods:History of cardiovascular events (CVE), hypertension, diabetes mellitus (DM), dyslipidaemia, pack-years of smoking (PYS), alcohol, and physical inactivity were noted. Blood pressure, body mass index (BMI), waist-hip ratio (WHR), lipid profile, epicardial adipose tissue (EAT), visceral abdominal adipose tissue (VAT), and subcutaneous abdominal adipose tissue were measured. Numeric staging of atherosclerosis was done by standardized examination of seven vascular areas by right and left carotid and femoral intima-media thickness, electrocardiogram, abdominal aorta plaques, and the ankle-arm index. All results were age and sex-adjusted. Poisson regression analysis was applied.Results:At age ⩽49 years at least one RF was present in 95.6% patients versus 90.0% controls. Compared to controls, male patients and middle-aged female patients showed no significant differences. Young female patients compared to young female controls had a higher burden of RFs (94.3% vs 88.6%, p = 0.049). Poisson regression analysis combined for patients and controls, adjusted for age and sex, showed numeric staging of atherosclerosis associated with age, prior CVE, hypertension, DM, dyslipidaemia, PYS, alcohol, BMI, WHR, EAT, VAT, and an increased number of risk factors. Adjusted for all risk factors, numeric staging of atherosclerosis was associated with increasing age, hypertension, DM, PYS, and BMI.Conclusion:Vascular risk factors are highly prevalent in young- and middle-aged patients and controls, and are predictors of established atherosclerosis at study inclusion. Focus on main modifiable vascular RFs in primary prevention, and early and aggressive secondary treatment of patients are necessary to reduce further progression of atherosclerosis.

Abstract 2586: Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO)

Abstract Pancreatic cancer is one of the deadliest malignancies in the US. Most cases are diagnosed in the late, non-resectable stages largely due to lack of effective screening tests. There is an urgent need to identify modifiable risk factors for primary prevention of this malignancy. To date, only a few risk factors (family history, smoking, and type-2 diabetes) have been identified for pancreatic cancer. Although several lines of evidence suggest that nutrition plays a role in pancreatic cancer, few nutrients have been consistently associated with its risk in epidemiologic studies. Therefore, the present study sought to investigate the association between the 2015 Healthy Eating Index (HEI-2015) score and pancreatic cancer risk among participants in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The HEI-2015 is a measure of overall diet quality used to assess how well a diet conforms to key recommendations of the 2015-2020 Dietary Guidelines for Americans. The HEI score is made up of 13 food components, with higher scores (ranged 0-100 points) indicating better dietary quality. In the present study, the HEI-2015 scores were calculated from participant responses to two food frequency questionnaires, dietary questionnaire (DQX) and dietary history questionnaire (DHQ) administered at baseline and the three-year anniversary of enrollment, respectively. During a median follow-up of 12.2 years, 279 cases of pancreatic cancer were identified among 58,477 participants who completed the DQX, while 101,721 participants who responded to the DHQ gave rise to 380 cases of pancreatic cancer over a median follow-up of 8.9 years. Hazard ratios (HR) and 95% confidence internals (CI) were estimated using Cox proportional hazards regression for total HEI score and individual score components, classified into adequacy components (total fruit, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins, and fatty acids) and moderation components (refined grains, sodium, added sugars, and saturated fats). After adjustment for confounders, no significant association between total HEI score and pancreatic cancer was identified [HR (95% CI) for quartile (Q) 4 vs. Q1: 0.86 (0.60, 1.09) for DQX and 1.03 (0.77, 1.39) for DHQ]. The individual component scores for total vegetables and added sugar in the DHQ analysis and whole grain score in the DQX analysis were inversely associated with pancreatic cancer risk [HR (95% CI) for one-point score increase: 0.89 (0.81, 0.98), 0.95 (0.91, 0.99), and 0.94 (0.89, 0.99), respectively]. In summary, our study did not find a significant association between overall diet quality and pancreatic cancer risk but revealed significant associations with total vegetables, added sugar, and whole grains in the PLCO trial. Citation Format: Margaret L. Hoyt, Jianjun Zhang. Association between healthy eating index score and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial (PLCO) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2586.

ABO Blood Type and the Risk of Cardovascular Events: An Analysis of Framingham Data and Meta-Analysis

Objective An association between ABO blood group and cardiovascular risk has been postulated and explored in the literature but results have been inconsistent. A possible mechanism for variability in ischemic risk by blood group was elucidated in the late 1980s and early 1990s when evidence emerged that levels of von Willebrand factor varied depending upon blood type. The lowest levels were observed in people with two O genes, the highest level in people who were genotypically AA, BB, or AB, and intermediate levels with AO and BO. Additionally a study which quantified plasma levels of factor VIII-VWF showed they are 25% higher in non-O individuals than in those with type O. Based upon this preliminary supportive data we sought to to examine this relationship using Framingham data with the full cohort and more than 30 years of follow up.Methods and Results A large prospective cohort study consisting of 4018 subjects without prior cardiovascular events was conducted with 38 years of follow up. All data collected in the Framingham Heart Study cohort were reviewed for use as potential confounders. We used the log-rank test for equality of survivor functions to assess the unadjusted association between ABO blood group and MI, stroke, and the combined endpoint of non-fatal MI or death associated with CHD (coronary heart disease). We compared blood group O to non-O (combining the A,B, and AB groups) and to (A or B) and AB individually with the goal of comparing those patients that should be least likely to clot in a VWF-dependent manner to those with intermediate and high risk. We designated A and B as intermediate risk because genotyping was unavailable and therefore phenotypic blood groups A and B included a mixture of AO, AA, BO, and BB which should place them between O and AB individuals in terms of VWF levels and risk of cardiovascular events. The reported hazard ratios describe the risk of events in the non-O blood groups compared to O. We used a Cox regression model to adjust for potential confounders. In analyses adjusted for cardiovascular risk factors and comparing participants with blood group O to those with A, B, or AB, there was no statistically significant relationship found between blood group and any cardiovascular outcome. Comparing the most disparate groups, non-O vs O found the correlation to be MI (HR =1.10 with confidence interval 0.96 to 1.25), stroke(1.03, confidence interval 0.89 to 1.19) , or the combined end point of non-fatal MI and death (HR of 1.04 with confidence interval of 0.93 -1.16).A meta-analysis of 5 prior studies plus this cohort demonstrated that non-O blood types are associated with an increased risk of cardiovascular events [OR 1.12 (1.06 to 1.18).Conclusion Our analysis yielded a non-significant effect but when included in a meta-analysis demonstrated 12% increased risk in cardiovascular events for people with non-0 compared with O blood types. ABO blood group could be considered when evaluating risk factors for primary prevention for cardiovascular disease. DisclosuresNo relevant conflicts of interest to declare.

Association of Arrhythmias in Cardiac Amyloidosis and Cardiac Sarcoidosis.

Cardiac involvement in amyloidosis and sarcoidosis is poorly understood, and is associated with high morbidity and mortality. Atrial and ventricular arrhythmias, along with conduction defects, are frequent in cardiac amyloidosis and sarcoidosis. Atrial dysfunction in cardiac amyloidosis may result in atrial fibrillation and increases the risk of stroke, making anticoagulation significant and challenging. Ventricular arrhythmia and conduction defects are more common in AL amyloidosis and cardiac sarcoidosis. Premature ventricular contractions (PVCs) from Purkinje fibers trigger ventricular arrhythmias in cardiac amyloidosis, while the inflammation and scarring leading to the reentrant process is the cause in cardiac sarcoidosis. The typical treatment modalities include Class II and III antiarrhythmic drugs and ablation techniques, while corticosteroids and immunosuppressants are indicated in cardiac sarcoidosis to reduce the burden of the disease and arrhythmias. Sudden cardiac death can be a manifestation of both disorders that can be prevented by the Implantable cardioverter-defibrillator (ICD), although the predictive risk factors for primary prevention remain uncertain. In this review, we addressed the current understanding of the pathways involved in inducing arrhythmias in cardiac amyloidosis and sarcoidosis-also, the complications including sudden death and stroke associated with arrhythmia in both diseases. We have discussed other preventive steps needed to minimize arrhythmias to provide symptomatic relief and palliation to patients.

Mediterranean-Style Diet for the Primary and Secondary Prevention of Cardiovascular Disease: A Cochrane Review.

Background:Diet plays a major role in cardiovascular disease (CVD) risk.Objectives:To determine the effectiveness of a Mediterranean-style diet for the primary and secondary prevention of CVD.Methods:We searched for randomised controlled trials (RCTs) of Mediterranean-style diets in healthy adults and those at increased risk of CVD (primary prevention) and with established CVD (secondary prevention).Results:Thirty RCTs were included, 22 in primary prevention and eight in secondary prevention. Clinical endpoints were reported in two trials where there was moderate quality evidence for a reduction in strokes for primary prevention, and low quality evidence for a reduction in total and CVD mortality in secondary prevention. We found moderate quality evidence of improvement in CVD risk factors for primary prevention and low quality evidence of little or no effect in secondary prevention.Conclusions:There is still some uncertainty regarding the effects of a Mediterranean-style diet in CVD prevention.

An atlas on risk factors for multiple sclerosis: a Mendelian randomization study

ObjectivesWe conducted a systematic review and wide-angled Mendelian randomization (MR) study to examine the association between possible risk factors and multiple sclerosis (MS).MethodsWe used MR analysis to assess the associations between 65 possible risk factors and MS using data from a genome-wide association study including 14 498 cases and 24 091 controls of European ancestry. For 18 exposures not suitable for MR analysis, we conducted a systematic review to obtain the latest meta-analyses evidence on their associations with MS.ResultsChildhood and adulthood body mass index were positively associated with MS, whereas physical activity and serum 25-hydroxyvitamin D were inversely associated with MS. There was evidence of possible associations of type 2 diabetes, waist circumference, body fat percentage, age of puberty and high-density lipoprotein cholesterol. Data of systematic review showed that exposure to organic solvents, Epstein Barr virus and cytomegalovirus virus infection, and diphtheria and tetanus vaccination were associated with MS risk.ConclusionsThis study identified several modifiable risk factors for primary prevention of MS that should inform public health policy.

EUROASPIRE V and uncontrolled risk factors in primary prevention: Atherosclerotic cardiovascular disease in the making.

EUROASPIRE V and uncontrolled risk factors in primary prevention: Atherosclerotic cardiovascular disease in the making.

Diet and liver cancer risk: a narrative review of epidemiological evidence.

Primary liver cancer is the third leading cause of cancer-related death worldwide. Most patients are diagnosed at late stages with poor prognosis; thus, identification of modifiable risk factors for primary prevention of liver cancer is urgently needed. The well-established risk factors of liver cancer include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), heavy alcohol consumption, metabolic diseases such as obesity and diabetes, and aflatoxin exposure. However, a large proportion of cancer cases worldwide cannot be explained by current known risk factors. Dietary factors have been suspected as important, but dietary aetiology of liver cancer remains poorly understood. In this review, we summarised and evaluated the observational studies of diet including single nutrients, food and food groups, as well as dietary patterns with the risk of developing liver cancer. Although there are large knowledge gaps between diet and liver cancer risk, current epidemiological evidence supports an important role of diet in liver cancer development. For example, exposure to aflatoxin, heavy alcohol drinking and possibly dairy product (not including yogurt) intake increase, while intake of coffee, fish and tea, light-to-moderate alcohol drinking and several healthy dietary patterns (e.g. Alternative Healthy Eating Index) may decrease liver cancer risk. Future studies with large sample size and accurate diet measurement are warranted and need to consider issues such as the possible aetiological heterogeneity between liver cancer subtypes, the influence of chronic HBV or HCV infection, the high-risk populations (e.g. cirrhosis) and a potential interplay with host gut microbiota or genetic variations.

Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease.

Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease.

Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD). No long-term intervention trials on CVD risk factors have been published, and a debate on the efficacy...

Novel risk factors for primary prevention of oesophageal carcinoma: a case-control study from Sri Lanka

BackgroundOesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka. Its increasing incidence despite the implementation of various preventive activities addressing the conventional risk factors indicates the possibility of the existence of novel, country-specific risk factors. Thus, the identification of novel risk factors of OC specific to Sri Lanka is crucial for implementation of primary prevention activities.MethodsA case-control study was conducted among 49 incident cases of OC recruited from the National Cancer Institute, Maharagama using a non-probability sampling method, and unmatched hospital controls (n = 196) excluded of having OC recruited from the endoscopy unit of the National Hospital of Sri Lanka. Data were collected using an interviewer administered questionnaire. Risk factors for OC were assessed by odds ratio (OR) with 95% confidence interval (CI). The risk factors were adjusted for possible confounding by logistic regression analysis.ResultsOf the study population, OC was common among males (69%) and the majority presented with squamous cell carcinoma (65%) at late stages (Stage IV: 45%; Stage III: 37%). Following adjusting for confounders, the risk factor profile for OC included; age > 65 years (OR = 4.0; 95% CI: 1.2–14.2); family history of cancer (OR = 5.04; 95% CI: 1.3–19.0); sub-optimal consumption of dietary fibre (OR = 3.58; 95% CI: 1.1–12.3); sub-optimal consumption of anti-oxidants (OR = 7.0; 95% CI: 2.2–22.5); over-consumption of deep fried food (OR = 6.68; 95% CI:2.0–22.6); ‘high risk’ alcohol drinking (OR = 11.7; 95% CI: 2.8–49.4); betel quid chewing (OR = 6.1; 95% CI: 2.0, 20.0); ‘low’ lifetime total sports and exercise activities (MET hours/week/year) (OR = 5.83; 95% CI: 1.5–23.0); agrochemicals exposure (OR = 6.57; 95% CI: 1.4–30.3); pipe-borne drinking water (OR = 5.62; 95% CI:1.7–18.9) and radiation exposure (OR = 4.64; 95% CI: 1.4–15.5). Significant effect modifications were seen between betel quid chewing and male sex (p = 0.01) and between ever exposure to radiation and age over 65 years (p = 0.04).ConclusionsRisk profile for OC includes novel yet modifiable risk factors in relation to diet, occupation, environment and health. Primary prevention should target these to combat OC in Sri Lanka.

Abstract 5262: Associations between intake of calcium, magnesium, and phosphorus and risk of pancreatic cancer in a population-based case-control study in Minnesota

Abstract Pancreatic cancer is the fourth leading cause of cancer death among both men and women in the U.S. and has a dismal prognosis among all cancers due to its aggressive nature and lack of effective screening tests. Pancreatic cancer etiology remains elusive, with few well-established risk factors aside from cigarette smoking; therefore, it is critical to identify other modifiable risk factors for primary prevention. Calcium, magnesium, and phosphorus are essential minerals for bone health and other important metabolic processes. Emerging evidence indicates that these minerals are involved in the carcinogenesis of the colon and other organs through their influence on cellular proliferation, systematic inflammation, immune functions, and/or genomic stability. In the present study, we aimed to investigate the associations between intake of calcium, magnesium, and phosphorus and risk of pancreatic cancer in a case-control study conducted during 1994-1998 in Minnesota. Cases (n=150), aged 20 years or older, were ascertained from all hospitals in the metropolitan area of the Twin Cities and the Mayo Clinic; from the latter, only cases residing in the Upper Midwest of the U.S. were recruited. Controls (n=459) were randomly selected from the general population and frequency matched to cases by age (within 5 years) and sex. Dietary and supplemental intake of three minerals of interest and other nutrients was estimated from a validated food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression. After adjustment for age, sex, race, education, physical activity, cigarette smoking, alcohol use, and intake of energy, total fat, fiber, fruits, and vegetables, risk of pancreatic cancer decreased with an increasing dietary intake of calcium [OR (95% CI) for quartiles 2, 3, and 4 vs. quartile 1: 0.96 (0.54-1.67), 0.65 (0.35-1.17), and 0.58 (0.23-1.40), p-trend = 0.09. A similar inverse but not significant association was observed for total calcium intake. A significantly reduced risk of pancreatic cancer was found among subjects in the third quartile of total magnesium intake compared with those in the first (lowest) quartile [OR (95% CI): 0.35 (0.17-0.69)], although it may be a chance finding due to multiple comparisons. No apparent associations existed between dietary and total intake of phosphorus and risk of pancreatic cancer. Our study shows that there are suggestive, but inconsistent beneficial effects of dietary and/or supplemental intake of calcium and magnesium on the occurrence of pancreatic cancer. This observation warrants confirmation in other epidemiologic studies. Citation Format: Hao Fan, Andrew Marley, Margaret Hoyt, Haocheng Nan, Kristin Anderson, Jianjun Zhang. Associations between intake of calcium, magnesium, and phosphorus and risk of pancreatic cancer in a population-based case-control study in Minnesota [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5262.

Age- and Sex-Specific Reference Values for Media/Lumen Ratio in Small Arteries and Relationship With Risk Factors.

Small-artery remodeling is an early feature of target organ damage in hypertension and retains a negative prognostic value. The aim of the study is to establish age- and sex-specific reference values for media/lumen in small arteries obtained in humans by biopsy. Data from 91 healthy individuals and 200 individuals with cardiovascular risk factors in primary prevention from 4 Italian centers were pooled. Sex-specific equations for media/lumen in the healthy subpopulation, with age as dependent variable, were calculated. These equations were used to calculate predicted media/lumen values in individuals with risk factors and Z scores. The association between classical risk factors and Z scores was then explored by multiple regression analysis. A second-degree polynomial equation model was chosen to obtain sex-specific equations for media/lumen, with age as dependent variable. In the population with risk factors (111 men, age 50.5±14.0 years, hypertension 80.5%), media/lumen Z scores were independently associated with body mass index (standardized β=0.293, P=0.0001), total cholesterol (β=0.191, P=0.031), current smoking (β=0.238, P=0.0005), fasting blood glucose (β=0.204, P=0.003), systolic blood pressure (β=0.233, P=0.023), and female sex (β=0.799, P=0.038). A significant interaction between female sex and total cholesterol was found (β=-0.979, P=0.014). Results were substantially similar in the hypertensive subgroup. A method to calculate individual values of remodeling and growth index based on reference values was also presented. Age- and sex-specific percentiles of media/lumen in a healthy population were estimated. In a predominantly hypertensive population, media/lumen Z scores were associated with major cardiovascular risk factors, including body mass index, cholesterol, smoking, glucose, and systolic blood pressure. Significant sex differences were observed.

Risk of Cerebrovascular Events in Pneumoconiosis Patients: A Population-based Study, 1996-2011.

Pneumoconiosis is a parenchymal lung disease that develops through the inhalation of inorganic dust at work. Cerebrovascular and cardiovascular events are leading causes of mortality and adult disability worldwide. This retrospective cohort study investigated the association between pneumoconiosis, and cerebrovascular and cardiovascular events by using a nationwide population-based database in Taiwan.The data analyzed in this study was retrieved from the Taiwan National Health Insurance Research Database. We selected 6940 patients with pneumoconiosis from the database as our study cohort. Another 27,760 patients without pneumoconiosis were selected and matched with those with pneumoconiosis according to age and sex as the comparison cohort. We used univariate and multivariate Cox proportional-hazard regression analyses to determine the association between pneumoconiosis and the risk of cerebrovascular and cardiovascular events after adjusting for medical comorbidities.After adjustment for age, sex, and comorbidities, the patients with pneumoconiosis exhibited a significantly higher incidence of ischemic stroke (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05–1.24) than did those without pneumoconiosis. The incidence of hemorrhagic stroke was higher, but not significant, in the pneumoconiosis patients (HR 1.20, 95% CI 0.99–1.46). No statistically significant differences were observed between the pneumoconiosis and nonpneumoconiosis groups in acute coronary syndrome (HR 1.10, 95% CI 0.95–1.26).The findings of this study reveal an association between pneumoconiosis and a higher risk of cerebrovascular events after adjustment for comorbidities. Healthcare providers should control the related risk factors for primary prevention of stroke in pneumoconiosis patients.