Risk Factor For Ischemic Heart Disease Research Articles

Lp(a) Levels in Relatives of Patients with Acute Coronary Syndrome and Elevated Lp(a): HER(a) Study.

Background: Lipoprotein(a) [Lp(a)] is a proatherogenic particle associated with increased cardiovascular risk. It is mainly genetically determined; so, the aim of our study is to evaluate the levels of Lp(a) in the relatives of a prospective cohort of patients who have suffered from an acute coronary syndrome (ACS) with Lp(a) ≥ 50 mg/dL. Methods: We conducted a multicenter prospective study, in which consecutive patients who had suffered from an ACS and presented Lp(a) ≥ 50 mg/dL and their first-degree relatives were included. Results: We included 413 subjects, of which 56.4% were relatives of the patients. Family history of early ischemic heart disease was present in 57.5%, and only 20.6% were receiving statin treatment. The family cohort was younger (37.5 vs. 59.1 years; p < 0.001), and 4% had ischemic heart disease and fewer cardiovascular risk factors. Mean Lp(a) levels were 64.9 mg/dL, 59.4% had levels ≥ 50 mg/dL, and 16.1% had levels ≥ 100 mg/dL. When comparing the patients with respect to their relatives, the mean level of Lp(a) was lower but without significant differences regarding the levels of LDLc, ApoB, and non-HDL. However, relatives with Lp(a) ≥ 50 mg/dL, had values similar to the group of patients with ACS (96.8 vs. 103.8 mg/dL; p = 0.18). No differences were found in Lp(a) levels in relatives based on the other lipid parameters. Conclusions: Overall, 59.4% of the first-degree relatives of patients who suffered from an ACS with Lp(a) ≥ 50 mg/dL also had elevated levels. Relatives with elevated Lp(a) had similar levels as patients.

Burden of ischaemic heart disease and attributable risk factors among Nanjing adults in China from 2011 to 2017

Burden of ischaemic heart disease and attributable risk factors among Nanjing adults in China from 2011 to 2017

Risk Factors of Ischaemic Heart Disease in 419 385 Outpatients: a Long-term Comparative Study.

To determine the incidence rate of risk factors in patients who visited polyclinics at their place of residence. The study included 419,385 patients who visited polyclinics in 2018-2023, in whom the most easily measurable risk factors for ischemic heart disease (IHD) were identified: arterial hypertension, total cholesterol (TC) and blood plasma glucose. During 4 years of follow-up, the proportion of patients with blood pressure (BP) higher than 140/90 mm Hg decreased (35.9%). The proportion of patients with blood glucose higher than 6.1 mmol/l (4.2%) also significantly decreased. The proportion of patients with a TC level higher than 5.2 mmol/l as well as of patients with a body mass index higher than 30 kg/m2 did not significantly change (67.4% and 23.9%, respectively). An analysis of 274 deaths during the follow-up period showed that the main causes for death in patients with arterial hypertension were IHD (69.6%) and cerebrovascular diseases (30.3%). People who visited polyclinics at their place of residence retained a high incidence of easily measurable risk factors for IHD, including arterial hypertension, high TC and blood glucose. The proportion of patients with blood pressure higher than 140 and 90 mm Hg was 49.7%, the proportion of patients with TC higher than 5.2 mmol/l was 63.1%, and the proportion of patients with blood glucose higher than 6.1 mmol/l exceeded 10%.

NT-pro BNP level at dialysis initiation is a useful biomarker for predicting hospitalization for ischemic heart disease.

Patients with end-stage kidney disease (ESKD) are at high risk of cardiovascular disease including stroke, heart failure, and ischemic heart disease (IHD). To prevent the occurrence and progression of CVD, a reliable prognostic cardiac biomarker is essential. We investigated the prognostic value of NT-proBNP for each incident type of CVD. Male patients from the Ibaraki Dialysis Initiation Cohort (iDIC) study with preserved serum samples from dialysis initiation day (n = 212) were analyzed. Patients were classified into four groups according to quartiles of baseline NT-pro BNP levels. The relationship between NT-proBNP levels at the initiation of dialysis and the subsequent incidence of hospitalization events due to IHD, heart failure, and stroke was analyzed. The incidence rate for hospitalization due to IHD was significantly higher in the highest NT-proBNP category (Log rank p = 0.008); those of stroke and heart failure showed no significant differences among quartiles. Cox proportional hazards regression analysis revealed that serum NT-proBNT was the only prognostic factor for hospitalization for IHD after adjustment by major known IHD risk factors. (HR, 1.008; 95% confidence interval, 1.002-1.014; p = 0.01) The ROC curve analysis for the incidence of hospitalization due to IHD showed that NT-proBNP had an area under the curve (AUC) of 0.759 (95% CI 0.622-0.897; p = 0.004) at a cut-off value of 956.6pg/mL. NT-proBNP measurement at the initiation of dialysis therapy is useful to predict later hospitalization for IHD. UMIN000010806.

Evaluation of Iron Profiles and Coagulation Profiles in Ischemic Heart Diseases Patients in Elmek Nimir Hospital, Sudan

Background: Ischemic heart disease (IHD) is a constellation of diseases that includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It belongs to the group of cardiovascular diseases and is the most common type among them. Iron is an essential trace element. It plays an important role in maintaining various cellular functions and enzymatic reactions. On the other hand, excessive intake of iron is known to be a risk factor for the progression of atherosclerosis. Abnormal iron deposition in the heart causes hemochromatosis and dilated cardiomyopathy, which leads to ischemic heart disease. Objective: This study aims to investigate the role of serum iron, serum ferritin, total iron-binding capacity (TIBC), PT, and PTT in ischemic heart disease (IHD) and their relationship with other risk factors for IHD. Methods: This is a prospective, case-control, cross-sectional analytical study conducted at Elmek Nimir University Hospital, Shendi City, to assess the iron profile and coagulation profile of patients with ischemic heart disease. The study included (30) patients diagnosed with ischemic heart disease and the study group was compared with the mean of the control group (20). Serum iron, ferritin, and TIBC were estimated using a spectrophotometer, and PT and PTT were estimated using manual methods. Data were collected using a structured personal questionnaire and the program (SPSS) version (11.5) was used for data analysis. Results: In this study, patients with ischemic heart disease were (40%) male and (60%) female. In this study, iron averaged (41.0) ug/dl (P. value 0.010), ferritin averaged (233.0) ug/dl (P. value 0.000), and TIBC averaged (44.0) µg/dl. Was shown. (P. value 0.000) compared to mean controls (27.0), (162.0), (56.0). A significant difference was found between the iron profile and his IHD. This study showed the mean PT, PTT for cases (13.4), (40.4) (P-value 0.024), (P. value 0.009) compared with the mean for controls (12.0), (35.1). A significant difference was found between the coagulation profile and IHD. Conclusions: This study concluded that serum levels of iron, ferritin, TIBC, PT, and PTT may be associated with Ischemic heart disease.

Coronary artery disease

Ischemic heart disease (IHD) is the commonest cause of death worldwide. The primary pathological process that leads to IHD is atherosclerosis, an inflammatory disease of the arteries associated with lipid deposition and metabolic alterations due to multiple risk factors. More than 70% of at-risk individuals have multiple risk factors for IHD, and only 2-7% of the general population has no risk factors. Coronary risk factors include diabetes, hypertension, socioeconomic factors, lifestyle factors and family history. Emotional stress or acute physical exertion may also trigger coronary events. Acute coronary syndrome is often the first clinical manifestation of IHD. Mortality due to IHD increases with advancing age, and death rates are higher among males compared to females. There is a significant regional variation in IHD related mortality both within and between countries.

Association between visit-to-visit lipid variability and risk of ischemic heart disease: a cohort study in China.

To explore the associations between visit-to-visit lipid variability and risk of ischemic heart disease (IHD) in a population-based cohort in China. We evaluated lipid variability in 30,217 individuals from the Yinzhou Health Information System who had ≥3 recorded lipid measurements during 2010-2014. We used various indicators including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV) to quantify the variability in triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Overall, a total of 1305 participants with IHD were identified during the follow-up of 194,421 person-years. Subjects in Q4 had a 21% elevated risk of IHD (HR = 1.21, 95% CI: 1.03-1.41) for LDL-C variability (CV) compared with the reference (Q1). The HRs for Q4 vs Q1 were 1.21 (95% CI: 1.04-1.42) for HDL-C variability, and 1.28 (95% CI: 1.10-1.50) for TC variability. However, no association was observed between triglycerides variability and risk of IHD. Higher variability in LDL-C, HDL-C, and TC levels was associated with an elevated risk of IHD, suggesting that lipid variability could be considered as an independent risk factor of IHD.

Novel approach to depression in ischemic heart disease: attenuation of autonomic dysfunction lowers depression scores

Abstract Introduction Depression in ischemic heart disease (IHD) is associated with increased mortality, and autonomic nervous system dysfunction (ANSD) may link the two conditions. Regulatory functions of the autonomic nervous system with respect to IHD risk factors include heart rate, blood pressure, serum cholesterol, and glycated hemoglobin. While painful sensitivity to pressure (Pressure-Pain Sensitivity, PPS) at the sternum rises with increased depression in IHD, reduction of elevated PPS reflects lower depression scores, lower ANSD, and lower mortality rates in IHD. Beta-adrenoreceptor blockade (BB) inhibits the anti-depressive effect associated with reduced PPS measures as well as the efferent sympathetic autonomic activity. Purpose We tested the hypothesis that lowering of elevated PPS measures is associated with restored autonomic regulation of depression, measured as the association between baseline depression scores and subsequent lowering of the depression score. We determined whether autonomic regulation in depression is associated with non-pharmacological reduction of elevated PPS measures. Methods In a randomized controlled intervention trial of IHD that included 213 individuals with elevated PPS, 20% of participants had elevated Major Depression Inventory scores (MDIS). We compared subjects with previously defined minimum reduction of at least 15 PPS units (PPS reverters) with subjects without this effect (PPS non-reverters), as well as non-users with users of BB. We recorded linear regressions of depression score changes as the dependent variable versus baseline depression scores as the independent variable. We compared active and control treatments by dividing participants into three pre-study defined groups of no depression (MDIS &amp;lt; 15), incipient depression (15 &amp;lt; MDIS &amp;lt; 20), and manifest depression (MDIS &amp;gt; 20). Results For reverters (N=72) compared to non-reverters (N=93), the mean anti-depressive effect increased in favor of reverters by a rate of 0.3 MDI units (95% CI 0.10–0.5, P=0.004) per unit increase in baseline MDIS. Comparing BB non-users (N=97) with BB users (N=67), the rate in favor of BB non-users was 0.4 units (95% CI 0.2-0.6, P=0.0002). In combination, comparing reverting non-users of BB (N=27) to non-reverting BB users (N=52), the rate in favor of the former group was 0.7 MDI (95% CI 0.4-0.9, P&amp;lt;0.00001). For reverting BB non-users, Cohen’s effect size reached 1.5. For the comparison of active and control groups for the three levels of MDIS, the trend was significant at P=0.04. Conclusions In patients with IHD, depression is associated with disruption of specific sympathetic beta-adrenergic regulatory functions of the autonomic nervous system. The findings imply that lowering of elevated PPS measures is associated with enhanced autonomic regulation of depression scores, and with marked clinical effect in individuals with elevated depression scores, but with no effect in BB users.

Abstract 12874: Risk of Ischemic Heart Disease in Young Women With Dysmenorrhea: A Cross-Sectional Study on Electronic Health Records

Introduction: Ischemic heart disease (IHD) incidence is increasing among young individuals, particularly women. Suboptimal primary prevention due to risk underestimation is thought to contribute to this trend. Non-traditional risk factors, such as stress and female-specific factors, are often overlooked but offer an opportunity to improve risk stratification. Dysmenorrhea is the most prevalent menstrual complaint, and associated with increased stress and autonomic dysfunction. To date, contribution of dysmenorrhea to cardiovascular disease risk has not been investigated. Hypothesis: Dysmenorrhea is associated with increased risk of IHD before 50 years of age. Methods: We extracted a cohort of 30,554 women with dysmenorrhea and 25,350 controls from Mount Sinai data warehouse as shown in Fig 1. For statistical analysis we performed full propensity score matching on demographic and clinical covariates, followed by weighted logistic regression with IHD before age 50 as a binary outcome. We then investigated IHD subtypes (angina, acute myocardial infarction (AMI), AMI complications, chronic IHD) in separate regression models, and evaluated the inclusion of menstrual abnormalities (MA) and endometriosis as additional covariates in the models (vs other covariates only). Results: Dysmenorrhea was associated with a significant increase in the OR for overall IHD, angina and chronic IHD (Table 1), independently from MA or endometriosis. Conclusions: Dysmenorrhea might be an important risk factor for early IHD. The risk appears to be largest for angina and chronic IHD. Further research can investigate dysmenorrhea as a predictor of future IHD risk.

Abstract 13720: Global Burden, Trends, and Attributable Risk Factors for Ischemic Heart Disease, 1990~2019: A Systemic Analysis of the Global Burden of Disease Study 2019

Background: As the primary culprit for nearly half of global cardiovascular deaths, ischemic heart disease (IHD) exerts a significant medical and economic toll, particularly on low- and middle-income countries. The rise in IHD incidence and mortality from 1990 to 2019 necessitates revising analyses and developing effective IHD strategies. Research Questions: To categorize IHD incidence, mortality, and Disability-Adjusted Life Years by country, sex, age, and Sociodemographic Index (SDI) from 1990-2019. To identify key risk factors and establish a model predicting IHD incidence till 2044.Aims: To assess global IHD incidence, dissect disease burden distribution, identify central risk factors, and forecast incidence trends. Methods: Leveraging the Global Burden of Disease (GBD) database for global population and IHD data from 1990 to 2019, we explored regional, gender, age attributes, and IHD temporal progression. We utilized a joinpoint model and an age-period-cohort model to decipher IHD incidence trends, scrutinized primary IHD risk factors, and predicted global IHD incidence till 2044. Results: Global age-standardized IHD incidence decreased from 316 (95% UI 282-352) in 1990 to 262 (95% UI 233-293) in 2019, primarily due to high SDI and high-middle SDI regions. Men had higher IHD incidence across all ages, notably between 35-74. Diet remained the leading risk factor from 1990 to 2019. Projections suggest a steady global IHD incidence similar to 2019 levels by 2044. Conclusions: Future trends indicate the IHD burden will concentrate in middle or lower SDI regions, with stable global IHD incidence over the next two decades. Joint initiatives to mitigate IHD's burden are vital, demanding specific policies and interventions. The GBD database is instrumental for health priority strategies. Collective efforts can lead us towards sustainable development and improved global health.

Dietary fat quality and serum androgen concentrations in middle-aged men

Background/ObjectivesAverage testosterone concentrations in men have declined over the last few decades. The reasons for this are not fully known, but changes in dietary fat quality have been suggested to have a role. This study aimed to investigate the associations of different dietary fatty acids with serum androgen concentrations.Subjects/MethodsA total of 2546 men with a mean age of 53 from the Kuopio Ischaemic Heart Disease Risk Factor Study were included in this cross-sectional study. Associations between dietary saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and trans (TFA) fatty acids and concentrations of serum total and free testosterone and steroid hormone binding globulin (SHBG) were analyzed with analysis of covariance and linear regression analysis. Associations of isocaloric replacement of nutrients and androgen concentrations were analyzed with multivariate nutrient-density models.ResultsAfter adjustment for age, examination year and energy intake, higher SFA intake was associated with higher serum total and free testosterone and SHBG concentrations, and higher PUFA intake with lower concentrations. However, the associations were attenuated and not statistically significant after further adjustments for potential confounders. MUFA and TFA intakes were not associated with androgen concentrations. In isocaloric substitution models, replacing dietary protein with SFA was associated with higher serum total testosterone and SHBG concentrations. After excluding men with history of CVD or diabetes (n = 1021), no statistically significant associations were found.ConclusionsDietary fat quality was not independently associated with serum androgen concentrations in middle-aged men. However, replacing protein with SFA may be associated with higher serum androgen concentrations.

Investigation into the effect of hyperbaric hyperoxia on serum cardiac Troponin T levels as a biomarker of cardiac injury.

There is clinical equipoise as to whether hyperoxia is injurious to the myocardium, both in the setting of acute ischaemic insults and on the stable myocardium. This study examined the effect of extreme hyperoxia - in the form of hyperbaric oxygen treatment - on the myocardium through measurement of high-sensitivity cardiac troponin. Forty-eight individuals were enrolled to undergo a series of 30 exposures to hyperbaric oxygen for treatment of non-cardiac pathologies. High-sensitivity troponin T was measured before and after each session. There was no clinically significant difference in troponin measurements following acute or recurrent sequential exposures to extreme hyperoxia, despite the studied patient population having a high rate of previous ischaemic heart disease or cardiovascular risk factors. This study demonstrates that profound hyperoxaemia does not induce any measurable cardiac injury at a biochemical level. Neither is there a reduction in cardiac troponin to suggest a cardioprotective effect of hyperbaric hyperoxia. This provides some reassurance as to the cardiac safety of the routine use of hyperbaric oxygen treatment in management of non-cardiac pathology.

O.2.3-11 Light standing work and high intensity occupational physical activities predict baseline and 8-year progression of carotid atherosclerosis among women

Abstract Purpose Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker selection effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT), a proxy for atherosclerosis, among women. Methods Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between pre-existing CVD and OPA intensity have previously been reported. Results Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work, being hazardous for cardiovascular health. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those still working at baseline. Conclusions Light standing work and higher levels of OPA intensity predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis. This study suggests that inconsistent findings regarding the effects of OPA on cardiovascular diseaes and mortality outcomes may be due to healthy worker selection and exposure misclassification biases including the failure to distinguish between standing and sitting work postures in many cohort studies. Funding Source This project is funded by the Danish taxpayers, via the Danish Work Environment Research Foundation, grant number 20195100247.

The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes

BackgroundHeart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. MethodsThis study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. ResultsA total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. ConclusionsThe risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.

Retinal Ischemic Perivascular Lesions in Individuals With Atrial Fibrillation.

Background We previously demonstrated that retinal ischemic perivascular lesions (RIPLs), which are indicative of ischemia in the middle retina, may be a biomarker of ischemic cardiovascular disease. In this study, we sought to determine the relationship between RIPLs and atrial fibrillation, a common source of cardiac emboli. Methods and Results In this case-control study, we identified individuals between the ages of 50 and 90 years who had undergone macular spectral domain optical coherence tomography imaging. Individuals with atrial fibrillation were identified, and age- and sex-matched individuals from the same pool, but without a diagnosis of atrial fibrillation, were selected as controls. Spectral domain optical coherence tomography scans were reviewed by 3 independent and masked observers for presence of RIPLs. The relationship between RIPLs and atrial fibrillation was analyzed using multivariable logistic regression models. There were 106 and 91 subjects with and without atrial fibrillation, respectively. The percentage of subjects with RIPLs was higher in the atrial fibrillation group compared with the control group (57.5% versus 37.4%; P=0.005). After adjusting for age, sex, smoking history, hypertension, diabetes, coronary artery disease, carotid stenosis, stroke, and myocardial infarction, the presence of RIPLs was significantly associated with atrial fibrillation, with an odds ratio of 1.91 (95% CI, 1.01-3.59). Conclusions RIPLs are significantly associated with atrial fibrillation, independent of underlying ischemic heart disease or cardiovascular risk factors. This association may inform the diagnostic cardiovascular workup for individuals with RIPLs incidentally detected on optical coherence tomography scan of the macula.

Frailty Predicts Incident Atrial Fibrillation in Women but Not in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study

Introduction: Frailty and atrial fibrillation (AF) are common aging problems and increasing globally. The association(s) between frailty and AF has been inconclusive. The purpose of this prospective population-based cohort was to investigate the associations between frailty and incident AF in older men and women. Methods: In total 839 participants, women (n = 458) and men (n = 381), aged 61–74 years from the Kuopio Ischaemic Heart Disease Risk Factor Study were included (March 1, 1998, to December 31, 2001). At the baseline, frailty prevalence was 49.3% (n = 414), and non-frailty 50.7% (n = 425) of the total population. Frailty was ascertained with the presence of 3–5 and prefrailty 1–2 of the following criteria: weight loss (highest 20% over 7 years), self-reported tiredness, weakness (measured by handgrip strength), slow walking speed (walking pace), and low physical activity (lowest 20%). AF events were obtained by record linkages from the national computerized hospitalization registry in Finland up to December 31, 2019. Multivariate Cox proportional hazard regression estimated the hazard ratio (HR) of incident events, adjusted for potential confounders. Results: During the mean follow-up of 14.2 years, 288 AF cases (169 women; 119 men) occurred. After adjustment for possible confounders, the HRs (95% confidence intervals [CIs]) for AF was 1.46 (1.48–1.85) in the frail population, compared to the non-frail group. The association was observed only among older frail women (multivariable-adjusted HR 1.78, 95% CI [1.28–2.48]) (p for interaction = 0.04). No statistically significant associations were observed between frailty and future AF incident among men (multivariable-adjusted HRs 1.12, 95% CI (0.77–1.63)). Conclusions: In this population-based epidemiological cohort, the risk of developing AF was increased in women affected by frailty at baseline but not in men.

Coexistence of Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Kidney Disease Is a More Potent Risk Factor for Ischemic Heart Disease.

Background Metabolic dysfunction-associated fatty liver disease (MAFLD), defined as fatty liver with overweight/obesity, type 2 diabetes, or metabolic abnormalities, is a newly proposed disease. However, it remains unclear whether the coexistence of MAFLD and chronic kidney disease (CKD) is a more potent risk factor for ischemic heart disease (IHD). Methods and Results We investigated the risk of the combination of MAFLD and CKD for development of IHD during a 10-year follow-up period in 28 990 Japanese subjects who received annual health examinations. After exclusion of subjects without data for abdominal ultrasonography or with the presence of IHD at baseline, a total of 14 141 subjects (men/women: 9195/4946; mean age, 48 years) were recruited. During the 10-year period (mean, 6.9 years), 479 subjects (men/women, 397/82) had new onset of IHD. Kaplan-Meier survival curves showed significant differences in rates of the cumulative incidence of IHD in subjects with and those without MAFLD (n=4581) and CKD (n=990; stages 1/2/3/4-5, 198/398/375/19). Multivariable Cox proportional hazard model analyses showed that coexistence of MAFLD and CKD, but not MAFLD or CKD alone, was an independent predictor for development of IHD after adjustment for age, sex, current smoking habit, family history of IHD, overweight/obesity, diabetes, hypertension, and dyslipidemia (hazard ratio, 1.51 [95% CI, 1.02-2.22]). The addition of the combination of MAFLD and CKD to traditional risk factors for IHD significantly improved the discriminatory capability. Conclusions The coexistence of MAFLD and CKD predicts new onset of IHD better than does MAFLD or CKD alone.

Occupational physical activity predicts baseline and 8-year progression of carotid atherosclerosis among women.

Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker survivor effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT) among women. Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between preexisting CVD and OPA intensity have previously been reported. Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those working at baseline. Higher levels of OPA predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis.

The association between population drinking and ischemic heart disease mortality in educational groups.

A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.

Frailty alone and interactively with obesity predicts heart failure: Kuopio Ischaemic Heart Disease Risk Factor Study.

We aim to evaluate the association of frailty and high body mass index with risk of incident heart failure. From the Kuopio Ischaemic Heart Disease Risk Factor Study, 408 women and 369 men, aged 61-74years were included in this study. Frailty was ascertained with the presence of 3-5 and prefrailty 1-2 of the following criteria: weight loss (highest 20% over 7years), self-reported tiredness, weakness (measured by handgrip strength), slow walking speed (walking pace), and low physical activity (lowest 20%). At the baseline, participants were allocated to frail (n=36), prefrail (n=340), and robust (n=441). HF incidents were obtained by record linkages from the national hospitalization registry in Finland up to 31 December 2019. Multivariate Cox proportional hazards regression estimated the hazard ratio (HR) of incident events, adjusted for potential confounders. Two hundred one HF events were recorded (111 in women and 90 in men) during the 14.2years follow-up. After adjustment for the age and sex, the risk of HF events was higher among prefrail (HR 1.42, 95% CI 1.08 to 1.79, P=0.02) and frail (HR 3.39, 95% CI 1.89 to 4.79, P≤0.001) compared with the robust group. After adjusting for multiple confounders result remained significant for HF indecent in prefrail [1.46 (HR 1.46, 95% CI 1.09 to 1.95, P=0.01] and frail (HR 3.33, 95% CI 1.86 to 5.70, P≤0.001). In the sensitivity analysis, significant interaction between high BMI (≥25kg/m2 ) and frailty was observed (P for interaction=0.02). The association of frailty [multivariate-adjusted HR: 2.88 (1.56 to 5.33), P≤0.001)] and prefrailty [multivariate-adjusted HR: 1.40 (1.08 to 1.91), P=0.03)] with risk of HF indecent was more pronounced in those with high BMI. Frailty is highly common in older age, and our results indicated the high risk of HF incident in frail and prefrail groups. While frailty is clinically recognized by weight loss phenotype, our finding showed that frailly and high BMI can coexist and worsen the risk of HF incidence. Further research is warranted to substantiate these results in large studies and clinical settings.