Cardiovascular Disease Risk Factors Research Articles

Plasma atherogenicity index is a powerful indicator for identifying metabolic syndrome in adults with type 2 diabetes mellitus: A cross-sectional study.

Metabolic syndrome (MetS) is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated triglyceride (TG) levels and decreased high-density lipoprotein levels (HDL-C) are predisposing factors for the development of ASCVD. Evidence on the association between atherosclerotic index of plasma [AIP = log (TG/HDL-C)] and MetS is limited. Our study aimed to investigate the association between AIP and MetS. This is a cross-sectional study that determines the presence of MetS by assessing anthropometric and biochemical parameters. Multivariate log-binomial regression models were used to analyze the relationship between AIP and MetS risk. To further test the stability of the results, we performed sensitivity analyses in young, non-obese, and normal lipid population. Smoothing plots explored the potential nonlinear relationship between the AIP index for MetS and the estimated potential risk threshold. Predictive power of AIP for MetS using respondent operating characteristic (ROC) curves. The prevalence of MetS was 67.35%. Multivariate logistic regression analysis showed an independent and positive association between AIP and MetS (Per 1 SD increase, PR = 1.31, 95% CI: 1.15-1.47). Sensitivity analysis demonstrated the stability of the results. Smoothing plot showed a nonlinear relationship between AIP and MetS, with an inflection point of 0.66. ROC curve analysis, AIP was an accurate indicator for assessing MetS in type 2 diabetics (AUC = 0.840, 95% CI: 0.819-0.862). AIP is a stable and independently powerful predictor of MetS in T2DM patients. AIP can be used as a simple assessment tool for the early detection of MetS and disease management for the prevention of cardiovascular disease.

Changes in 10-Year Predicted Cardiovascular Disease Risk for a Multiethnic Semirural Population in South East Asia: Prospective Study.

Cardiovascular disease (CVD) risk factors tend to cluster and interact multiplicatively and have been incorporated into risk equations such as the Framingham risk score, which can reasonably predict CVD over short- and long-term periods. Beyond risk factor levels at a single time point, recent evidence demonstrated that risk trajectories are differentially related to CVD risk. However, factors associated with suboptimal control or unstable CVD risk trajectories are not yet established. This study aims to examine factors associated with CVD risk trajectories in a semirural, multiethnic community-dwelling population. Data on demographic, socioeconomic, lifestyle, mental health, and cardiovascular factors were measured at baseline (2013) and during follow-up (2018) of the South East Asia Community Observatory cohort. The 10-year CVD risk change transition was computed. The trajectory patterns identified were improved; remained unchanged in low, moderate, or high CVD risk clusters; and worsened CVD risk trajectories. Multivariable regression analyses were used to examine the association between risk factors and changes in Framingham risk score and predicted CVD risk trajectory patterns with adjustments for concurrent risk factors. Of the 6599 multiethnic community-dwelling individuals (n=3954, 59.92% female participants and n=2645, 40.08% male participants; mean age 55.3, SD 10.6 years), CVD risk increased over time in 33.37% (n=2202) of the sample population, while 24.38% (n=1609 remained in the high-risk trajectory pattern, which was reflected by the increased prevalence of all major CVD risk factors over the 5-year follow-up. Meanwhile, sex-specific prevalence data indicate that 21.44% (n=567) of male and 41.35% (n=1635) of female participants experienced an increase in CVD risk. However, a stark sex difference was observed in those remaining in the high CVD risk cluster, with 45.1% (n=1193) male participants and 10.52% (n=416) female participants. Regarding specific CVD risk factors, male participants exhibited a higher percentage increase in the prevalence of hypertension, antihypertensive medication use, smoking, and obesity, while female participants showed a higher prevalence of diabetes. Further regression analyses identified that Malay compared to Chinese (P<.001) and Indian (P=.04) ethnicity, nonmarried status (P<.001), full-time employment (P<.001), and depressive symptoms (P=.04) were all significantly associated with increased CVD risk scores. In addition, lower educational levels and frequently having meals from outside were significantly associated to higher odds of both worsening and remaining in high CVD risk trajectories. Sociodemographics and mental health were found to be differently associated with CVD risk trajectories, warranting future research to disentangle the role of psychosocial disparities in CVD. Our findings carry public health implications, suggesting that the rise in major risk factors along with psychosocial disparities could potentially elevate CVD risk among individuals in underserved settings. More prevention efforts that continuously monitor CVD risk and consider changes in risk factors among vulnerable populations should be emphasized.

Investigating the Interplay between Cardiovascular and Neurodegenerative Disease.

Neurological diseases, including neurodegenerative diseases (NDDs), are the primary cause of disability worldwide and the second leading cause of death. The chronic nature of these conditions and the lack of disease-modifying therapies highlight the urgent need for developing effective therapies. To accomplish this, effective models of NDDs are required to increase our understanding of underlying pathophysiology and for evaluating treatment efficacy. Traditionally, models of NDDs have focused on the central nervous system (CNS). However, evidence points to a relationship between systemic factors and the development of NDDs. Cardiovascular disease and related risk factors have been shown to modify the cerebral vasculature and the risk of developing Alzheimer's disease. These findings, combined with reports of changes to vascular density and blood-brain barrier integrity in other NDDs, such as Huntington's disease and Parkinson's disease, suggest that cardiovascular health may be predictive of brain function. To evaluate this, we explore evidence for disruptions to the circulatory system in murine models of NDDs, evidence of disruptions to the CNS in cardiovascular disease models and summarize models combining cardiovascular disruption with models of NDDs. In this study, we aim to increase our understanding of cardiovascular disease and neurodegeneration interactions across multiple disease states and evaluate the utility of combining model systems.

Women Veterans' Stroke Risk Factors: Identified Prevention Methods and Knowledge Gaps.

Stroke is a significant health burden for veterans and the fifth leading cause of death for women. Compared to civilian women, women veterans have significant multimorbid physical and mental health conditions contributing to their stroke risk. This scoping review aimed to synthesize evidence on the stroke risk factors specific to U.S. women veterans and identify any association between risk factors and a delay in prevention and treatment for women veterans. This study was approved by the organizational Institutional Review Board. The search strategy was run across 6 databases: MEDLINE and EMBASE via Ovid, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. A total of 1218 records were uploaded to Covidence for screening. Criteria for included studies were peer-reviewed primary research articles written in English about women veterans and cardiovascular disease and stroke risk factors. No restrictions were placed on publication date. Fourteen articles met the inclusion criteria. Cohorts were 30 years and older. Data originated from national and individual Veterans Affairs studies. Women veterans starting at age 30 have a steadily increasing positive curvilinear association with stroke risk, indicating a need to screen earlier than the recommended age of 45 years. Stroke incidence was higher in veterans with post-traumatic stress disorder, insomnia, restless leg syndrome, traumatic brain injury, constipation with laxative use, egg consumption (2-4 eggs/wk), frailty, and systemic sclerosis. When comparing White veterans and civilian counterparts, Black veterans had a higher incidence of stroke. Ten studies addressed prevention methods. The clinicians should screen and treat women veterans for post-traumatic stress disorder and constipation and consider alternative treatment methods for constipation. Empirical literature on this matter is lacking. Examining and understanding the differences in sex, gender, and veteran status, and their association with stroke risk, is warranted. Screening women veterans for post-traumatic stress disorder and for stroke early, at 30 years of age, is recommended.

Associations between neutrophil-percentage-to-albumin ratio level and all-cause mortality and cardiovascular disease-cause mortality in general population: evidence from NHANES 1999-2010.

Chronic inflammation is a recognized independent risk factor for cardiovascular disease (CVD), highlighting the need for reliable inflammatory indicator to predict CVDs. As an inflammatory indicator which has been proved to have predictive value for prognosis of CVDs, neutrophil percentage-to-albumin ratio (NPAR) has obtained increasing attention, but further research is needed to confirm the relationship with mortality in the general population. This prospective cohort study included 21,317 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010, where baseline characteristics and NPAR level were extracted. Data for CVD and all-cause mortality were acquired by linking the cohort database with the National Death Index through December 31, 2019. We employed restricted cubic spline analyses to examine the nonlinear association. Weighted Kaplan-Meier curves with log-rank tests were conducted to access cumulative survival differences across different NPAR results. Multivariable Cox proportional hazards regression models were used to compute hazard ratios and 95% CIs. Receiver Operating Characteristic (ROC) curves were used to compare predictive value of NPAR with systemic immune inflammation index (SII) and neutrophils percent. In this cohort study, during 270,014 person-years of follow-up, 4,074 all-cause deaths and 1,116 CVD-cause deaths were documented. NPAR levels exhibited significant nonlinear associations with both CVD-cause (P = 0.018 for nonlinearity) and all-cause mortality (P < 0.001 for nonlinearity). Participants in the highest NPAR tertile had a significantly increased risk of all-cause mortality (HR: 1.46, 95% CI: 1.33-1.61) and CVD-cause mortality (HR: 1.54, 95% CI: 1.32-1.80) compared to those in the lowest tertile in the fully adjusted model, while no association was detected for individuals in the middle tertile. Further ROC analysis confirmed that NPAR had higher predictive value than neutrophil percent segment and SII. Elevated NPAR level was significantly associated with an increased risk of all-cause and CVD-cause mortality in general population. The high predictive value of NPAR, combined with the easy-to-calculate property, suggests that its potential as a novel inflammatory indicator is worthy of further investigation.

Evaluation of the Antihyperlipidemic Effect of Encapsulated Octacosanol for Lipid-Lowering Effect Against High-Fat Diet-Induced Hyperlipidaemia in Experimental Rats.

Background: Elevated blood lipid levels, or hyperlipidemia, are the main risk factors for cardiovascular illnesses and are frequently brought on by high-fat diets. Objectives: In this work, high-fat diet-induced hyperlipidemia in experimental rats is used to examine the antihyperlipidemic efficacy of a test formulation containing 1-octacosanol. Method: A healthy female Wistar rat was utilized for investigation, separated into four groups: normal, disease, standard control, and test group, receiving the 1-octacosanol formulation. Results: Hyperlipidemia was induced in the rats through a high-fat diet over 28 days, followed by a 28-day treatment period. Various parameters, including lipid profile (LDL, TC, TG, VLDL, HDL), body weight and antioxidant properties (MDA, SOD, GSH), were evaluated. The results showed that the 1-octacosanol formulation significantly reduced body weight and improved lipid profiles by decreasing levels of TC, TG, LDL and VLDL while increasing HDL levels. Additionally, the formulation exhibited notable antioxidant properties, contributing to its lipid-lowering effects. Statistical analysis using ANOVA and multiple comparison tests confirmed the significance of these findings, underscoring the therapeutic potential of 1-octacosanol in managing hyperlipidemia and mitigating associated cardiovascular risks. Conclusion: The test formulation of 1-octacosanol demonstrated a significant antihyperlipidemic effect in rats with high-fat diet-induced hyperlipidemia. The treatment effectively reduced serum levels of total cholesterol, triglycerides, LDL and VLDL while increasing HDL cholesterol levels. These marks suggest that 1-octacosanol has the potential as a therapeutic agent for managing hyperlipidemia, a key risk factor for cardiovascular diseases.

Effects of Idiopathic Restless Leg Syndrome on Intima-Media Thickness of Carotid Artery: A Case Control Study

Purpose: Restless legs syndrome is claimed to be associated with a higher risk of cardiovascular diseases. Intima-media thickness has been reported to be the most valuable surrogate marker and predictor of atherosclerosis progression and upcoming cardiovascular diseases. In this study, we aimed to evaluate the relationship between restless legs syndrome and intima-media thickness of the carotid artery. Materials and Methods: In this case-control study, a total of 23 patients with restless legs syndrome without other known risk factors of cardiovascular diseases were evaluated with regard to the intima-media thickness of the carotid artery by employing a high-resolution B-mode ultrasound study. The findings of the ultrasound study between the case and the control group were compared and statistically analyzed. Results: Intima-media thickness was revealed to be of a lower value in subjects with restless legs syndrome (0.79 ± 0.10) compared to the control group (0.88 ± 0.13). Also, our study showed that older age and the presence of hypertension directly correlates with intima-media thickness. Conclusion: It can be concluded that restless legs syndrome is associated with a lower intima-media thickness.

Predictors of Pre-Hypertension and Hypertension in Rural Adults: Insights Into the Impact of Yoga, Lifestyle, and Demographic Factors

Background: Hypertension is a leading risk factor for cardiovascular diseases, particularly in rural areas where healthcare access is limited. This study investigates predictors of pre-hypertension and hypertension, with a focus on yoga and lifestyle factors such as physical activity, smoking, and alcohol consumption. Methods: A cross-sectional study was conducted among rural adults to collect data on demographic factors (age, gender, education level), lifestyle habits (smoking, alcohol, physical activity), and yoga participation. Blood pressure was measured and classified into normal, pre-hypertension, and hypertension categories. Logistic regression was used to identify significant predictors of hypertension and pre-hypertension. Results: Key predictors of hypertension include age (OR = 0.998), gender (OR = 0.648 for males), and BMI (OR = 1.012). Alcohol consumption was significantly associated with higher hypertension risk (OR = 1.293). Yoga participation, particularly improvements in flexibility, showed a modest reduction in hypertension odds (OR = 0.945). Non-yoga physical activity also demonstrated a protective effect (OR = 0.958). Conclusion: Lifestyle factors such as alcohol consumption and physical activity play important roles in hypertension risk. While yoga showed some benefits, particularly in flexibility improvements, further research is needed to explore its longterm effects. Public health interventions targeting modifiable risk factors, including yoga, may help reduce the prevalence of hypertension in rural communities.

The role of physical exercise in modifying cardiovascular parameters in hypertensive patients

Hypertension is among the top risk factors for cardiovascular diseases. Diversified rehabilitation programs are needed to limit the progression of the high blood pressure condition. The welfare of aquatic therapy is acknowledged, but hydrotherapeutic procedures are rarely used in cardiovascular diseases. The study aims to assess the impact of an exhaustive hydro-kinetic thermo therapeutic program compared to other methods of treatment, i.e., cardiovascular rehabilitation program, recommendation for a healthy life, and antihypertensive medication. Four groups of patients (46 years ±0,32) diagnosed with hypertension participated in four different rehabilitation programs to analyze the impact on their effort capacity. Their ability to achieve average effort without the appearance of fatigue symptoms was studied for a period of eight weeks by monitoring six parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), Borg Scale, Medical Research Council Dyspnoea Scale (MRC-DS), pulse (P) and oxygen saturation (O2). Group A, which benefited only of recommendations for a healthy life, didn’t register any significant p values between the initial and final evaluation; group B, which had medications and recommendations for a healthy life, registered significant p values for 2 parameters (SBP and P have p&lt;0.0001); group C, which took part in a cardiovascular rehabilitation program, obtained significant p values for 5 parameters (SBP, DBP, Borg, MRC-DS and O2 have p&lt;0.0001); Group D, the recipient of hydrotherapeutic program, registered significant p values for all statistically 6 monitored parameters (SBP, DBP, Borg, MRC-DS, P and O2 have p&lt;0.0001). Physical activity in water performed regularly within a controlled therapeutic program with the thermal and electrotherapy components, leading to improved capacity for the effort by decreasing blood pressure values and dyspnea parameters.

Non-Invasive Serum Markers of Non-Alcoholic Fatty Liver Disease Fibrosis: Potential Tools for Detecting Patients with Cardiovascular Disease.

Non-alcoholic fatty liver disease (NAFLD), one of the most common chronic liver diseases with a prevalence of 23%-25% globally, is an independent risk factor for cardiovascular diseases (CVDs). Growing evidence indicates that the development of NAFLD, ranging from non-alcoholic fatty liver (NAFL), non-alcoholic steatohepatitis (NASH), advanced fibrosis to cirrhosis, and even hepatocellular carcinoma, is at substantial risk for CVDs, which clinically contribute to increased cardiovascular morbidity and mortality. Non-invasive serum markers assessing liver fibrosis, such as fibrosis-4 (FIB-4) score, aspartate transaminase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), are expected to be useful tools for clinical management of patients with CVDs. This review aims to provide an overview of the evidence for the relationship between the progression of NAFLD and CVDs and the clinical application of non-invasive markers of liver fibrosis in managing patients with CVDs.

The significance of calcium and magnesium content in drinking water for arterial stiffness among residents of the Slovak Republic

ABSTRACT Arterial stiffness (AS) is a significant risk factor for cardiovascular diseases, which are the leading cause of death in developed countries. Based on the measurement of AS among residents supplied with soft drinking water (100 respondents) and hard water (100 respondents), a significant difference was found in the pulse wave velocity (PWVao), arterial age, and the difference between arterial and actual age (delta – Δ age). Among respondents consuming soft drinking water, PWVao was higher by 1.9 m s−1, arterial age was higher by 23 years, and Δ age was higher by 14.5 years. As an intervention, originally soft drinking water was treated to increase calcium (Ca) and magnesium (Mg) content by approximately 10–15 mg l−1. After 18 months of consuming water with elevated Ca and Mg content, PWVao decreased by 0.93 m s−1, arterial age decreased by 10.42 years, and Δ age decreased by 11.79 years among respondents originally consuming soft drinking water. Thus, their risk of developing CVD was significantly reduced.

Utilisation of Potassium Chloride in the Production of White Brined Cheese: Artificial Neural Network Modeling and Kinetic Models for Predicting Brine and Cheese Properties during Storage

Excessive sodium consumption is a worldwide problem, prompting the industry to develop sodium-reduced products and substitute salts. High sodium consumption is a significant risk factor for high blood pressure, cardiovascular disease and kidney disease. Excessive sodium intake also impairs the immune system in the gastrointestinal tract. Potassium chloride (KCl) is the most commonly used mineral salt due to its similarity to sodium chloride (NaCl), and its consumption has been shown to lower blood pressure when consumed in adequate amounts. The aim of this study was to partially replace NaCl with KCl at levels of 25%, 50% and 75% in the brine used to make white brined cheese. Parameters such as acidity, total dissolved solids, salinity, conductivity, colour, texture and sensory properties were evaluated during a 28-day refrigerated storage period. KCl can replace NaCl by 50%, and no significant differences in physicochemical and sensory parameters were observed during cheese storage compared to the control sample. In addition, the study investigates the use of Artificial Neural Network (ANN) models to predict certain brine and cheese properties. The study successfully developed four different ANN models to accurately predict various properties such as brine pH, cheese colour and hardness over a 28-day storage period.

Integrating health screening for non-communicable diseases into dental services: what do we know?

This narrative review describes the impetus for health screening for non-communicable diseases in dental settings and highlights important considerations for evaluating such interventions. Real world cases are presented that showcase health screening interventions implemented in the UK. Non-communicable diseases including diabetes and cardiovascular disease are a global public health challenge. They are largely preventable by implementing lifestyle changes such as healthy eating and participation in physical activity, regular health screening for disease prevention, and/or early initiation of treatment. Hypertension case finding and control is one of the key five areas of focus for adult health, and oral health and diabetes are two of five key clinical areas for children and young people where efforts should be focused to intervene, improve outcomes and reduce inequalities. Links between oral and chronic diseases have been discussed in recent years. Therefore, screening for diabetes and cardiovascular disease has become of greater relevance to the dental profession. There is emerging evidence indicating that screening for the risk factors of cardiovascular diseases and diabetes in dental settings shows promise for improving health outcomes and may offer a cost-effective preventive approach for the detection of diabetes. Real-world services implementing health screening in dental settings have highlighted possibilities for the future and highlight the potential for the role of the dental team in detecting chronic diseases.

Relationship of SOD-1 Activity in Metabolic Syndrome and/or Frailty in Elderly Individuals.

Although aging is a natural phenomenon, in recent years it has accelerated. One key factor implicated in the aging process is oxidative stress. Oxidative stress also plays a role in frailty (frail) and metabolic syndrome (MetS). A total of 66 elderly persons (65 years old and older) with no acute or severe chronic disorders were assessed for waist circumference (WC), arterial blood pressure, glycemia, glycated hemoglobin (HbA1c), plasma lipids, and activity of erythrocyte superoxide dismutase (SOD-1). Patients were classified as NonMetS-Nonfrail (n = 19), NonMetS-frail (n = 20), MetS-Nonfrail (n = 17), or MetS-frail (n = 10). There were no significant differences in superoxide dismutase activity among investigated elderly groups. However, the data suggest that MetS individuals, both frail and nonfrail, have higher risk factors for cardiovascular disease compared to NonMetS individuals. The correlations analyses of SOD-1 and other metabolic indices suggest that SOD-1 levels may be influenced by age, total cholesterol, HDL cholesterol, and fasting glucose levels in certain groups of seniors. Aging is associated with decreased antioxidant enzyme SOD-1 activity with glucose alteration in frailty syndrome as well as with lipids disturbances in metabolic syndrome. These factors provide a nuanced view of how frailty and metabolic syndrome interact with various health parameters, informing both clinical practice and future research directions.

Inequities in air pollution on stroke mortality among Older Americans: a U.S. nationwide analysis.

Air pollution is a known risk factor for cardiovascular diseases, including stroke. This study examines the impact of county-level air pollution on ischemic and hemorrhagic stroke mortality among U.S. individuals aged 65 and older, emphasizing racial and socioeconomic disparities. Using data from the Center for Disease Control (CDC) Interactive Atlas of Heart Disease and Stroke, we analyzed county-level ischemic stroke mortality rates for older residents between 2016 and 2020. The data on air pollution at the county level, specifically particulate matter (PM2.5) levels, were obtained from the CDC. We applied multivariable linear and logistic regression models to examine the association between PM2.5 levels and stroke mortality, as well as the probability of meeting the Environmental Protection Agency (EPA) air quality standards. County-level analysis revealed a significant correlation (R = 0.68, R2 = 0.48, p < 0.001) between PM2.5 levels and overall stroke mortality. For every 1 μg/m3 increase in PM2.5, there was an increase of 1.89 ischemic stroke deaths per 100,000 residents. Racial and socioeconomic disparities were evident. Counties with predominantly Black populations exhibited a stark disparity, with each 1 μg/m3 increase in PM2.5 correlating with a significant rise in mortality, amounting to 5.81 additional deaths per 100,000 residents. Persistently poor counties displayed vulnerability, experiencing a 4.05 increase in ischemic stroke deaths per 100,000 residents for every 1 μg/m3 increase in PM2.5 levels. Conversely, in counties with a White majority and counties without a persistent state of poverty, the associated increases in stroke mortality per 100,000 residents for every 1 μg/m3 rise in county-level PM2.5 were 1.85 and 1.60, respectively. Counties with a majority of Black residents were over twice as likely to be non-compliant with EPA air quality standards compared to predominantly White counties (aOR 2.36 95% CI: 1.27-4.38, p = 0.006). This study underscores the significant impact of county-level air pollution, particularly PM2.5, on ischemic stroke mortality among older U.S. residents. Our findings indicate that counties with predominantly Black populations and those experiencing persistent poverty not only suffer from higher mortality rates but also are more likely to be non-compliant with EPA air quality standards. Targeted interventions and policies are urgently needed to reduce air pollution in these vulnerable communities and promote equitable public health outcomes.

Sex-Specific Cardiovascular Risk Factors and Treatment in Females With T2DM and CVD: Developments and Knowledge Gaps

Abstract Purpose There are large disparities in the impact of diabetes on cardiovascular disease (CVD) risk and outcomes by sex and gender. Achieving health equity requires understanding risks and medication efficacy in female patients, especially now, as novel pharmacologic treatments are transforming the diabetes and CVD treatment landscape. This review examines 2 bodies of research that can inform sex differences in CVD in patients with diabetes: female-specific risk factors for CVD and sex-related limitations of clinical trial research in evaluating novel diabetes and CVD treatments. Methods Two literature searches were performed using Ovid Medline(R) All. The first retrieved manuscripts covering sex and gender differences related to CVD risk and therapies and diabetes. The second focused on randomized controlled trial data on sex/gender differences and GLP-1/SGLT-2/DPP-4 drugs. Results Female-specific risk factors for CVD include early menarche, premature or early menopause, irregular cycles and polycystic ovary syndrome; pregnancy; adverse pregnancy outcomes; history of breast cancer; and autoimmune diseases. Clinical trials of novel pharmacological treatments for diabetes and CVD have undersampled female populations, and clinical characteristics of male and female participants have differed significantly. Thus, evidence to evaluate potential sex differences in treatment efficacy and side effects has been lacking. Conclusion To improve health of female patients with diabetes, sex-specific cardiovascular risk factors should be taken into account in screening and treatment decisions. Further, studies of cardiovascular and diabetes medications must ensure adequate representation by sex and report participant characteristics and outcomes by sex.

Cardiovascular disease and stroke following cancer and cancer treatment in older adults

AbstractBackgroundCancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort.MethodsThe authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.ResultsOf 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk‐set compared to the cancer‐free risk‐set (20.8 vs. 10.3 events per 1000 person‐years; incidence rate ratio, 2.03; 95% confidence interval, 1.51–2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups.ConclusionsIncidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.

Hypothalamic Gliosis is Associated With Multiple Cardiovascular Disease Risk Factors.

Hypothalamic gliosis is mechanistically linked to obesity and insulin resistance in rodent models. We tested cross-sectional associations between radiologic measures of hypothalamic gliosis in humans and clinically relevant cardiovascular disease risk factors, as well as prevalent coronary heart disease. Using brain MRI images from Framingham Heart Study participants (N=867; mean age, 55 years; 55% females), T2 signal intensities were extracted bilaterally from the region of interest in the mediobasal hypothalamus (MBH) and reference regions in the amygdala (AMY) and putamen (PUT). T2 signal ratios were created in which greater relative T2 signal intensity suggests gliosis. The primary measure compared MBH to AMY (MBH/AMY); a positive control ratio (MBH/PUT) also assessed MBH whereas a negative control (PUT/AMY) did not. Outcomes were BMI, HDL-C, LDL-C, fasting triglycerides, and the presence of hypertension (n=449), diabetes mellitus (n=66), metabolic syndrome (n=254), or coronary heart disease (n=25). Dietary risk factors for gliosis were assessed in a prospective analysis. Statistical testing was performed using linear or logistic regression. Greater MBH/AMY T2 signal ratios were associated with higher BMI (β = 21.5 [95% CI, 15.4-27.6]; P<0.001), higher fasting triglycerides (β = 1.1 [95% CI, 0.6-1.7]; P<0.001), lower HDL-C (β = -20.8 [95% CI, -40.0 to -1.6]; P=0.034), and presence of hypertension (odds ratio, 1.2 [95% CI, 1.1-1.4]; P=0.0088), and the latter two were independent of BMI. Findings for diabetes mellitus were mixed and attenuated by adjusting for BMI. Metabolic syndrome was associated with MBH/AMY T2 signal ratios (odds ratio, 1.3 [95% CI, 1.1-1.6]; P<0.001). Model results were almost uniformly confirmed by the positive control ratios, whereas negative control ratios that did not test the MBH were unrelated to any outcomes (all P≥0.05). T2 signal ratios were not associated with prevalent coronary heart disease (all P>0.05), but confidence intervals were wide. Self-reported percentages of macronutrient intake were not consistently related to future T2 signal ratios. Using a well-established study of cardiovascular disease development, we found evidence linking hypothalamic gliosis to multiple cardiovascular disease risk factors, even independent of adiposity. Our results highlight the need to consider neurologic mechanisms to understand and improve cardiometabolic health.

The changes in cardiovascular disease risk factors after the implementation of the package of essential non-communicable disease control.

The Package of Essential Non-Communicable (PEN) Disease Control was implemented in the primary healthcare system to manage cardiovascular disease (CVD) risk factors in Iran. This study aimed to evaluate the status of CVD risk factor control following the implementation of the PEN. This historical cohort study was conducted among 60-65-year-old residents to compare hypertension (HTN) control via mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), diabetes mellitus (DM) control via fasting blood sugar (FBS) and HbA1C tests, hyperlipidemia control via serum cholesterol and triglyceride levels, and overweight and obesity via body mass index (BMI) measurement in 2016 (before the implementation of the PEN project) and 2021 (after 5 years). A total of 1,583 residents with a mean age of 62.32±1.70 years were included in the study. In 2021, compared to 2016, there was a significant decrease in the relative frequency of residents with high SBP from 13.7% to 9.3%, high DBP from 11.3% to 3.4%, FBS≥126 mg/dL from 25.6% to 19.7%, and BMI≥30 from 25.7% to 23.4%. Additionally, the mean DBP and the mean serum levels of FBS among all participants decreased significantly. However, the relative frequency of residents with total cholesterol≥200 mg/dL increased significantly from 11.5% to 14.2%. Following the implementation of the PEN, the control of HTN, DM, and obesity improved among 60-65-year-old residents. However, the control of hypercholesterolemia did not improve.

Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis

AimTo assess the effectiveness of Clinical Decision Support Tools (CDSTs) in enhancing the quality of care outcomes in primary cardiovascular disease (CVD) prevention. MethodsA systematic review was undertaken in accordance with PRISMA guidelines, and included searches in Ovid Medline, Ovid Embase, CINAHL, and Scopus. Eligible studies were randomized controlled trials of CDSTs comprising digital notifications in electronic health systems (EHS/EHR) in various primary healthcare settings, published post-2013, in patients with CVD risks and without established CVD. Two reviewers independently assessed risk of bias using the Cochrane RoB-2 tool. Attainment of clinical targets was analysed using a Restricted Maximum Likelihood random effects meta-analysis. Other relevant outcomes were narratively synthesised due to heterogeneity of studies and outcome metrics. ResultsMeta-analysis revealed CDSTs showed improvement in systolic (Mean Standardised Difference (MSD)=0.39, 95 %CI=-0.31, -1.10) and diastolic blood pressure target achievement (MSD=0.34, 95 %CI=-0.24, -0.92), but had no significant impact on lipid (MSD=0.01; 95 %CI=-0.10, 0.11) or glucose target attainment (MSD=-0.19, 95 %CI=-0.66, 0.28). The CDSTs with active prompts increased statin initiation and improved patients’ adherence to clinical appointments but had minimal effect on other medications and on enhancing adherence to medication. ConclusionCDSTs were found to be effective in improving blood pressure clinical target attainments. However, the presence of multi-layered barriers affecting the uptake, longer-term use and active engagement from both clinicians and patients may hinder the full potential for achieving other quality of care outcomes. Lay SummaryThe study aimed to evaluate how Clinical Decision Support Tools (CDSTs) impact the quality of care for primary cardiovascular disease (CVD) management. CDSTs are tools designed to support healthcare professionals in delivering the best possible care to patients by providing timely and relevant information at the point of care (ie. digital notifications in electronic health systems). Although CDST are designed to improve the quality of healthcare outcomes, the current evidence of their effectiveness is inconsistent. Therefore, we conducted a systematic review with meta-analysis, to quantify the effectiveness of CDSTs. The eligibility criteria targeted patients with CVD risk factors, but without diagnosed CVD. The meta-analysis found that CDSTs showed improvement in systolic and diastolic blood pressure target achievement but did not significantly impact lipid or glucose target attainment. Specifically, CDSTs showed effectiveness in increasing statin prescribing but not antihypertensives or antidiabetics prescribing. Interventions with CDSTs aimed at increasing screening programmes were effective for patients with kidney diseases and high-risk patients, but not for patients with diabetes or teenage patients with hypertension. Alerts were effective in improving patients' adherence to clinical appointments but not in medication adherence. This study suggests CDSTs are effective in enhancing a limited number of quality of care outcomes in primary CVD prevention, but there is need for future research to explore the mechanisms and context of multiple barriers that may hinder the full potential for cardiovascular health outcomes to be achieved.