Cardiovascular Disease Risk In Adults Research Articles

Association between cardiovascular disease risk and sarcopenia in community-dwelling Japanese older adults.

Sarcopenia's high prevalence in older adults with cardiovascular disease (CVD) suggests that the risk of comorbidity in sarcopenia might also be increased during the at-risk phase of CVD. However, the relationship between CVD risk and sarcopenia has not been elucidated. Therefore, the purpose of this cross-sectional study was to investigate the association between CVD risk and sarcopenia in community-dwelling Japanese older adults. The participants in this cross-sectional study included 14 923 community-dwelling Japanese older adults (mean age 73.2 ± 5.6 years). The present study estimated the CVD risk using the revised World Health Organization risk chart, and classified CVD risk into "low" (<10%) and "mid-high" (≥10%). Assessments of sarcopenia, muscle mass, muscle strength and gait speed were measured based on the clinical definitions. Among the participants, 654 people (4.4%) had sarcopenia, and 4857 (32.6%) had CVD mid-high risk. A multiple logistic model showed that the CVD mid-high risk was associated with sarcopenia (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.28-1.89). In addition, CVD mid-high risk was associated with low muscle mass (OR 1.74, 95% CI 1.50-2.01), low muscle strength (OR 1.25, 95% CI 1.14-1.37) and slow gait speed (OR 1.17, 95% CI 1.07-1.27) in the adjusted model. Among community-dwelling older adults, high or moderate CVD risk was associated with an increased risk of sarcopenia. Our findings could help identify older adults with a future high risk for sarcopenia. Geriatr Gerontol Int 2024; ••: ••-••.

Abstract 4114461: Low-density lipoprotein cholesterol, prevalence of cardiovascular disease risk factors, and predicted cardiovascular disease risk among young adults: National Health and Nutrition Examination Survey 2015-2020

Introduction: It is unclear if young adults with hyperlipidemia are also more likely to have non-lipid cardiovascular disease (CVD) risk-factors or higher long-term CVD risk. As such, we assessed associations between low-density lipoprotein cholesterol (LDL-C) levels and non-lipid CVD risk factors as well as 10- and 30-year risk of CVD in young adults. Methods: We included a nationally representative sample of adults 20-&lt;40 years from the National Health and Nutrition Examination Survey (January 2015-March 2020). We described sociodemographic characteristics and CVD risk factors by LDL-C level. We used simple logistic regression to determine associations between LDL-C level and each CVD risk factor. We then calculated the median 10- and 30-year CVD risk by LDL-C category for each participant using the PREVENT risk estimating equations. Results: Among 2,133 (weighted estimation: 90.3 million) young adults, 51.0%, 32.6%, 12.5%, and 3.9% had an LDL-C &lt;100 mg/dL, 100-&lt;130 mg/dL, 130-&lt;160 mg/dL, and 160-&lt;190 mg/dL, respectively. Compared to participants with an LDL-C &lt;100mg/dL, those with an LDL-C 100-&lt;130 mg/dL, 130-&lt;160 mg/dL, and 160-189 mg/dL were more likely to have metabolic syndrome, an enlarged waist, hypertension, elevated glucose, diabetes mellitus, high triglycerides, and high hs-CRP (Table). The median 10-year risk of CVD was approximately 1% across all baseline LDL-C levels. Over a 30-year time horizon, the median risk of incident CVD exceeded 5% only in the 130-&lt;160mg/dL and 160-189mg/dL LDL-C categories (6.0% and 7.6%, respectively). LDL-C and the interaction between LDL-C and CVD risk enhancing factors were independently associated with 30-year predicted risk of CVD (p=0.006 and p=0.005, respectively). Discussion: Many young adults with an elevated LDL-C have concomitant high-risk CVD characteristics. The risk/benefit calculous for addressing this modifiable risk factor in these patients should be further explored.

Protein Consumption and Risk of CVD Among U.S. Adults: The Multi-Ethnic Study of Atherosclerosis (MESA).

Although some randomized trials have reported beneficial effects of protein intake on cardiometabolic risk factors, evidence from prospective studies have not supported a strong link between protein intake and cardiovascular disease (CVD) risk. It is also unclear whether diversity in protein intake plays a role in CVD risk. We investigated prospective associations of (1) protein intake, overall and by food source and (2) diversity of protein sources with risk of CVD, coronary heart disease (CHD), and stroke. In a multi-ethnic cohort of 5879 U.S. adults (45-84 years), who were free of CVD at baseline, protein intake was assessed at baseline (2000-2002) using a validated 120-item food frequency questionnaire. Two different aspects of protein diversity were assessed including count (number of protein food consumed at least once/week) and dissimilarity (diversity of the attributes of the protein sources consumed). Relationships with incident CVD outcomes through 2019 were assessed using Cox proportional hazards models adjusting for sociodemographic, lifestyle, and comorbidity factors. During 83,430 person-years, 1045 CVD cases were identified, including 668 CHD and 332 stroke cases. In multivariable models, we found no significant associations between protein intake, overall and by food source, with incident CVD, CHD, or stroke. Protein count, but not protein dissimilarity, was weakly associated with CVD risk. We found no significant associations between diversity of consumption of animal or plant food source and CVD outcomes. Our findings suggest protein consumption may not significantly impact CVD risk in middle-aged adults.

Impact of mental disorders on the all-cause mortality and cardiovascular disease outcomes in adults with new-onset type 1 diabetes: A nationwide cohort study

AimsThis population-based study aimed to investigate the impact of mental disorders on the risk of mortality and cardiovascular disease (CVD) outcomes in adults with new-onset type 1 diabetes. Materials and methodsWe included 17,429 patients with new-onset type 1 diabetes without CVD from the Korean National Health Insurance Service database. Mental disorders include depression, bipolar, persistent affective and other affective disorders, anxiety, eating disorders, personality and behavioral disorders, and substance abuse. Individuals with or without mental disorders were matched 1:1 by age, sex, and year of the index date. The primary outcomes were all-cause mortality and composite CVD events. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression models. ResultsDuring a median follow-up of 7.99 years, all-cause mortality (composite CVD outcomes) occurred in 1,562 patients (1,993 patients with CVD outcomes) with mental disorders and 1,211 patients (1,611 patients with CVD outcomes) without mental disorders. The adjusted HR for all-cause mortality and composite CVD outcomes in patients with mental disorders was 1.35 and 1.32, respectively, compared to those without mental disorders. The aHR for the all-cause mortality and composite CVD events was 1.27 and 1.28 in the subgroup with one mental disorder and 1.57 and 1.43 in the subgroup with multiple mental disorders, compared to those without mental disorders. ConclusionsMental disorders are associated with an elevated risk of all-cause mortality and CVD in adults with newly diagnosed type 1 diabetes. Early detection and greater attention to premature death and CVD development are required in patients with new-onset type 1 diabetes and mental disorders.

Consumption of plant sterols-enriched soy milk with a healthy dietary pattern diet lowers blood pressure in adults with metabolic syndrome: A randomized controlled trial

Background & aimsPlant sterols (PS) have been shown to lower blood lipid-lipoproteins concentrations and may serve as a potential functional ingredient for cardiovascular disease (CVD) risk management. However, there are limited studies examining this effect in individuals with metabolic syndrome (MetS). The aim of this study was to evaluate the effects of PS-enriched food consumption as part of a healthy dietary pattern (HDP) on blood pressure and endothelial function in Singaporean adults with MetS. Methods and resultsThis was a 12-week, crossover, randomized controlled trial with a 4-week washout period. Thirteen subjects were instructed to consume an HDP diet either with normal soy milk (control group) or with PS (2 g/day)-enriched soy milk (PS group) for 4 weeks. Blood lipid-lipoproteins and glucose concentrations, blood pressure, and endothelial function-related indicators (flow-mediated dilation, total plasma nitrate/nitrite and endothelin-1 concentrations, circulating endothelial progenitor cells) were assessed before and after the intervention. Systolic blood pressure [mean change, PS group: -4.0 ± 3.7 mmHg; control group: 5.9 ± 2.5 mmHg (PInteraction =0.01)] and long-term CVD risk [mean change, PS group: -0.2 ± 1.0 %; control group: 2.7 ± 1.3 % (PInteraction =0.03)] decreased following PS consumption. No changes were observed in the other endothelial function-related outcomes. ConclusionsConsumption of PS-enriched food with an HDP diet may lower blood pressure and long-term CVD risk in adults with MetS. Clinical trial registrationNCT03723330, https://clinicaltrials.gov/.

Male Gender Expressivity and Diagnosis and Treatment of Cardiovascular Disease Risks in Men

Male gender expressivity (MGE), which reflects prevalent sociocultural pressures to convey masculinity, has been associated with health. Yet, little is known about associations of MGE with the diagnosis and treatment of modifiable cardiovascular disease (CVD) risks. To investigate associations of MGE with modifiable CVD risk diagnoses and treatment in men. This population-based cohort study included data from waves I (1994-1995), IV (2008-2009), and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were male adolescents (age 12-18 years) followed up longitudinally through younger adulthood (age 24-32 years) and adulthood (age 32-42 years). Data were analyzed from January 5, 2023, to August 28, 2024. Male gender expressivity was quantified in adolescence and younger adulthood using an empirically-derived and validated measurement technique that incorporates participants' responses to existing Add Health survey items to capture how similarly participants behave to same-gendered peers. Outcomes included self-reported diagnoses of CVD risk conditions (hypertension, diabetes, or hyperlipidemia) in adult men with elevated blood pressure, hemoglobin A1c, or non-high-density lipoprotein cholesterol levels, and self-reported treatment with antihypertensive, hypoglycemic, or lipid-lowering medications in adults reporting hypertension, diabetes, or hyperlipidemia. Multivariable regression was used to examine associations of adolescent and younger adult MGE with adult CVD risk diagnoses and treatment, adjusting for sociodemographic covariates. Among 4230 eligible male participants, most were non-Hispanic White (2711 [64%]) and privately insured (3338 [80%]). Their mean (SD) age was 16.14 (1.81) years in adolescence, 29.02 (1.84) years in younger adulthood, and 38.10 (1.95) years in adulthood. Compared with participants whose younger adult MGE was below average, those with higher younger adult MGE were overall less likely to report hypertension (22% vs 26%; P < .001), diabetes (5% vs 8%; P < .001), and hyperlipidemia (19% vs 24%; P < .001) diagnoses and diabetes treatment (3% vs 5%; P = .02) as adults. In multivariable models, every SD increase in adolescent MGE was associated with lower probabilities of adult hypertension treatment (MGE,-0.11; 95% CI, -0.16 to -0.6) and diabetes diagnoses (MGE, -0.15; 95% CI, -0.27 to -0.03). Higher younger adult MGE was associated with lower probabilities of adult hypertension diagnoses (MGE, -0.04; 95% CI, -0.07 to -0.01), hypertension treatment (MGE, -0.07; 95% CI, -0.13 to -0.01), and diabetes treatment (MGE, -0.10; 95% CI, -0.20 to -0.01). Adolescent and younger adult MGE outcomes were not associated with other adult CVD outcomes. In this cohort study of US males, higher adolescent and younger adult MGE was associated with lower adult hypertension and diabetes diagnoses and treatment. These findings suggest that males with high MGE may bear distinctive risks and correspondingly benefit from tailored public health efforts to prevent downstream CVD.

Low-Density Lipoprotein Cholesterol, Cardiovascular Risk Factors, and Predicted Risk in Young Adults.

Young adults with elevated LDL-C may experience increased burden of additional cardiovascular disease (CVD) risk factors. It is unclear how much LDL-C levels, a modifiable factor, correlate with non-LDL-C CVD risk factors among young adults or how strongly these CVD risk factors are associated with long-term predicted CVD risk. We quantified clustering of non-LDL-C CVD risk factors by LDL-C among young adults to assess the association between non-LDL-C and LDL-C risk factors with predicted CVD risk in young adults. The current analysis is a cross-sectional study of adults < 40 years with an LDL-C< 190 mg/dL participating in the National Health and Nutrition Examination Survey (NHANES) between January 2015 and March 2020. We measured the prevalence of non-LDL-C risk factors by LDL-C and association between LDL-C and non-LDL-C risk factors with predicted risk of CVD by the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations. Among 2108 young adults, the prevalence of LDL-C ≥ 130 mg/dL was 15.5%. Compared with young adults with LDL-C < 100 mg/dL, those with LDL-C 100-< 130, 130-< 160, and 160-< 190 mg/dL had greater non-LDL-C risk factors. Both LDL-C and non-LDL-C risk factors were independently associated with a 30-year risk of CVD (OR 1.05, 95% CI 1.03-1.07 and OR 1.17, 95% CI 1.12-1.23, respectively). The association of LDL-C and 30-year risk did not vary by non-LDL-C risk factor burden (pinteraction = 0.43). Non-LDL-C risk factors cluster among increasing levels of LDL-C in young adults. Greater guidance on how to manage cardiovascular risk factors in young adults is needed.

Dietary intake of potassium, vitamin E, and vitamin C emerges as the most significant predictors of cardiovascular disease risk in adults.

Prediction models were developed to assess the risk of cardiovascular disease (CVD) based on micronutrient intake, utilizing data from 90,167 UK Biobank participants. Four machine learning models were employed to predict CVD risk, with performance evaluation metrics including area under the receiver operating characteristic curve (AUC), accuracy, recall, specificity, and F1-score. The eXtreme Gradient Boosting (XGBoost) model was utilized to rank the importance of 11 micronutrients in cardiovascular health. Results indicated that vitamin E, calcium, vitamin C, and potassium intake were associated with a reduced risk of CVD. The XGBoost model demonstrated the highest performance with an AUC of 0.952, highlighting potassium, vitamin E, and vitamin C as key predictors of CVD risk. Subgroup analysis revealed a stronger correlation between calcium intake and CVD risk in older adults and those with higher BMI, while vitamin B6 intake showed a link to CVD risk in women. Overall, the XGBoost model emphasized the significance of potassium, vitamin E, and vitamin C intake as primary predictors of CVD risk in adults, with age, sex, and BMI potentially influencing the importance of micronutrient intake in predicting CVD risk.

Cardiovascular disease risk factors and their associations with inflammation among US adolescents: NHANES, 2015 to March 2020

IntroductionThe prevalence of obesity and glycemic dysfunction in adolescents has increased over the past several decades but less is known on how these conditions are associated with systemic inflammation in...

Sex-specific associations between self-reported sleep characteristics and 10-year cardiovascular disease risk in men and women of African descent living in a low socioeconomic status environment

BackgroundRisk factors for cardiovascular disease (CVD) and sleep health are well-known to be sex- and race-specific. To build on the established relationship between sleep duration and CVD risk, this cross-sectional study aimed to describe sex-specific associations between CVD risk and other sleep characteristics (sleep quality, sleep timing and sleep onset latency) in low-income adults of African descent. MethodsSelf-reported sleep (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]), demographic and lifestyle data were collected in 412 adults (56 % women, 35.0 ± 7.6y, 40 % employed) living in an informal settlement in South Africa. CVD risk was determined using the BMI-modified Framingham 10-year CVD risk formula. ResultsLogistic regression analyses, adjusted for employment, alcohol use and physical activity, indicated that men reporting poor sleep quality (OR: 1.95[95 %CI: 1.07–3.51], p=0.025) and earlier bedtimes (0.54[0.39–0.74], p<0.001) were more likely to belong to a higher 10-year CVD risk score quintile. Women reporting earlier bedtimes (0.72[0.55–0.95], p=0.020) and wake-up times (0.30[0.13–0.73], p=0.007), longer sleep-onset latency (1.47[1.43–1.88], p=0.003), shorter total sleep times (0.84[0.72–0.98], p=0.029), higher PSQI global scores (1.93[1.29–2.90], p=0.001) and more moderate to severe symptoms of insomnia (ISI≥15)(3.24[1.04–10.04], p=0.016) were more likely to belong to higher 10-year CVD risk score quintile. ConclusionIn addition to sleep duration, we found that sleep quality, sleep timing and sleep onset latency are additional risk factors for CVD in adults of African descent. Sex-specific differences in the sleep-CVD-risk relationship observed suggests that future studies and recommendations about sleep health in relation to CVD should take sex into account.

Impact of an 8-Week Well-Formulated Ketogenic Diet on Advanced Lipid Biomarkers Associated With Atherosclerotic Cardiovascular Disease Risk in Healthy Adults

Impact of an 8-Week Well-Formulated Ketogenic Diet on Advanced Lipid Biomarkers Associated With Atherosclerotic Cardiovascular Disease Risk in Healthy Adults

Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension

Hypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment. To determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension. This was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded. Incident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension. The primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression. A total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls. Children diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.

Sex-Related Differences in Vascular Function Among Older Adults with Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep disorder associated with hypertension and cardiovascular disease (CVD) risk. Endothelial dysfunction and altered shear stress are implicated in OSA-related CVD pathogenesis, however, their contributions to CVD risk in males vs females remains unclear. We obtained measures of resting blood pressure (BP), brachial artery flow-mediated dilation (FMD), brachial artery diameter, and shear stress in 71 older adults (F=30, M=41; age=66.9±7.7) diagnosed with mild, moderate, or severe OSA based on oxygen desaturation index (ODI) score. All were prospective participants in an ongoing clinical trial (NCT04932447). Group differences (mean ± SD) were assessed with two-way ANOVAs (sex X severity) and associations between ODI score, baseline diameter, relative FMD, shear stress, and BP were assessed with Pearson correlations. We hypothesized that a) regardless of sex, individuals with greater OSA severity exhibit lower relative FMD and mean shear stress, greater baseline diameter and higher BP, and b) for a given OSA severity, females have greater relative FMD and mean shear stress and lower baseline diameter and BP compared to males. In line with our hypotheses, we found greater mean shear stress in females compared to males (F=69.6±26.9 s−1, M=53.5±16.7 s−1, p=0.035) and among females, those with mild OSA had higher mean shear stress than those with severe OSA (mild=77.6±26.1 s−1, severe= 44.4±8.5 s−1, p=0.009). Contrary to expectations, mean shear stress did not differ as a function of OSA severity in male subjects, nor was there any difference in FMD or BP across OSA severity between males and females. In subjects with moderate OSA, FMD was greater in females than males (F=6.07±3.89%, M=3.07±2.39%, p=0.047). On average, baseline diameters were larger in adults with severe OSA compared to moderate OSA (moderate=3.66±0.59 mm, severe=4.33±0.61 mm, p=0.003), and females with mild (F=3.20±0.47 mm, M=4.73±0.50 mm, p&lt;0.001) and moderate (F=3.31±0.42 mm, M=3.91±0.57 mm, p=0.007) OSA had smaller baseline diameters than their male counterparts. There were no differences in baseline diameter between males and females with severe OSA. We report a negative correlation between mean shear stress and BP (systolic BP, r=-0.48, p=0.011; diastolic BP, r=-0.55, p=0.002) and a positive correlation between ODI score and baseline diameter (r=0.54, p=0.003) in females but not males. Conversely, ODI score and relative FMD were positively correlated in male subjects (r=0.45, p=0.009), but not females. Overall, our findings highlight sex-specific vascular differences in older adults with OSA. Relative to males, females with mild OSA exhibit greater mean shear stress and lower baseline diameters, which may confer a cardiovascular advantage. In contrast, males and females with severe OSA exhibit similar vascular characteristics. Our findings provide new insights into the impact of sex and OSA severity on vascular function and CVD risk in older adults. This work is supported by NIH/NIA grant number: 1R01AG065346. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

CARDIOVASCULAR RISK FACTOR TRAJECTORIES AND INCIDENT CARDIOVASCULAR DISEASE IN OLDER ADULTS: THE KAILUAN STUDY

Objective: Long-term condition and longitudinal accumulation of cardiovascular risk factor (CRF) may be associated with adverse outcomes in the elderly, but the previous evidence is scarce. We studied the associations of CRF trajectories, their accumulation, with incident cardiovascular disease (CVD) in older adults. Design and method: From 2006, a population-based cohort of 8505 older adults have been repeatedly followed up for 14 years (until 31 December 2020). Blood pressure, serum lipids, height and weight, and blood glucose were assessed in all follow-ups and their trajectories from 2006 to 2010 were identified using latent class growth mixture modeling. Main outcome was incident CVD, which was a composite of coronary revascularization, myocardial infarction, heart failure, or stroke. The associations of CRF trajectories and incident CVD were studied for individual CRF trajectory and their accumulation, using Cox proportional hazards regression models. Results: We identified 3, 4, 2, 2 trajectories for systolic blood pressure (SBP), body mass index (BMI), total cholesterol (TC), and fasting blood glucose (FBG), respectively. Compared with low-increasing SBP, the multivariable-adjusted hazard ratio (HR) and 95% CI were 1.35 (1.19-1.54) for moderate-increasing SBP and 1.54 (1.28-1.86) for high-increasing SBP. Compared with low-stable BMI, the HRs (95% CIs) were 1.30 (1.11-1.53), 1.41 (1.19-1.66), 1.35 (1.07-1.71) for moderate-stable, elevated-stable, and high-stable BMI, respectively. Compared with low-stable TC, the HR (95% CI) were 1.19 (1.06-1.33) for high-stable TC. Compared with low-stable FBG, the HR (95% CI) were 1.38 (1.17-1.63) for high-stable FBG. A positive association was observed for the CRF trajectory accumulation with incident CVD (P for trend &lt; 0.001), with HRs (95% CIs) of 1.54 (1.16-2.04), 2.15 (1.63-2.83), 2.58 (1.93-3.45) and 2.92 (1.95-4.36) for 1, 2, 3, 4 high CRF trajectories, respectively. Sensitivity analyses showed consistent results after excluding those who ever used antihypertensive, antidiabetic, or lipid-lowering drugs during 2006 to 2010, excluding events within the first year of follow-up, and considering death as competing risk. Conclusions: Longitudinal higher CRF trajectory was independently associated with higher CVD risk in older adults. Besides, the higher the number of adverse CRF trajectories, the higher was the observed CVD risk.

Salivary biomarkers as assessment of metabolic function and inflammation in children with obesity

Childhood obesity increases adult metabolic and cardiovascular disease risk. Using blood for long-term biomarker analysis in children is problematic because of the discomfort, pain, and anxiety associated with frequent blood draws. Noninvasive methods are vital for predicting childhood obesity complications. This study examined body mass index-for-age percentile scores (zBMI) as a predictor of salivary biomarkers of metabolism and inflammation, including insulin and C-Reactive Protein (CRP), over time. A school sample of 288 adolescents (Mage = 12.1 at study initiation; 46% female; 48% Black, 37% non-Hispanic White, 15% Hispanic or other minorities) were enrolled from greater Birmingham, Alabama. Participants provided salivary samples across four days once per year from 2019–2021. In year 1 of the study, 19% of adolescents were overweight, 18% had obesity, 6.6% had severe obesity, and 7.3% had very severe obesity based on the 2022 CDC Extended BMI-for-Age Growth Charts. Multivariable models showed that lower parental income was associated with an increased risk of obesity (OR = 0.91; 95% CI = 0.85, 0.97; p = 0.009). Greater concentrated poverty, a measure of spatial distribution of socioeconomic deprivation, was associated with an increased risk of severe or very severe obesity (OR = 1.58; 95% CI = 1.01, 2.46; p = 0.043). However, race/ethnicity was not associated with obesity risk. Longitudinal analyses showed that greater zBMI in year 1 was associated with greater salivary CRP ( β = 0.188, SE = 0.058, p = 0.001) and insulin ( β = 0.263, SE = 0.076, p&lt;0.001) in years 2 and 3 of the study after adjusting for year 1 biomarker levels, sex, race/ethnicity, and concentrated poverty. Multivariable models indicated that an accelerated increase in zBMI/year was associated with an accelerated increase in CRP/year ( β = 0.119, SE = 0.048, p = 0.014), but there was no association between the rates of change in zBMI and insulin. Future analyses will incorporate additional hormones, such as adiponectin, and inflammatory cytokines measured in saliva. In conclusion, these results indicate that salivary biomarkers can capture physiological differences associated with zBMI in school-age children. Saliva may constitute a useful non-invasive tool for evaluating markers of inflammation and/or metabolism related to zBMI in children outside clinical settings. This research was supported by an Institute of Education Sciences, U.S. Department of Education Grant (R305A180074) to SM and RE and a National Heart, Lung, and Blood Institute K99R00 Grant (1K99HL165091-01A1) to KMK. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Non–High-Density Lipoprotein Cholesterol Levels From Childhood to Adulthood and Cardiovascular Disease Events

Elevated non-high-density lipoprotein cholesterol (non-HDL-C; a recommended measure of lipid-related cardiovascular risk) is common in children and increases risk of adult cardiovascular disease (CVD). Whether resolution of elevated childhood non-HDL-C levels by adulthood is associated with reduced risk of clinical CVD events is unknown. To examine the associations of non-HDL-C status between childhood and adulthood with incident CVD events. Individual participant data from 6 prospective cohorts of children (mean age at baseline, 10.7 years) in the US and Finland. Recruitment took place between 1970 and 1996, with a final follow-up in 2019. Child (age 3-19 years) and adult (age 20-40 years) non-HDL-C age- and sex-specific z scores and categories according to clinical guideline-recommended cutoffs for dyslipidemia. Incident fatal and nonfatal CVD events adjudicated by medical records. Over a mean length of follow-up of 8.9 years after age 40 years, 147 CVD events occurred among 5121 participants (60% women; 15% Black). Both childhood and adult non-HDL-C levels were associated with increased risk of CVD events (hazard ratio [HR], 1.42 [95% CI, 1.18-1.70] and HR, 1.50 [95% CI, 1.26-1.78] for a 1-unit increase in z score, respectively), but the association for childhood non-HDL-C was reduced when adjusted for adult levels (HR, 1.12 [95% CI, 0.89-1.41]). A complementary analysis showed that both childhood non-HDL-C levels and the change between childhood and adulthood were independently associated with the outcome, suggesting that from a preventive perspective, both childhood non-HDL-C levels and the change into adulthood are informative. Compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood, participants who had incident non-HDL-C dyslipidemia from childhood to adulthood and those with persistent dyslipidemia had increased risks of CVD events (HR, 2.17 [95% CI, 1.00-4.69] and HR, 5.17 [95% CI, 2.80-9.56], respectively). Individuals who had dyslipidemic non-HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood did not have a significantly increased risk (HR, 1.13 [95% CI, 0.50-2.56]). Individuals with persistent non-HDL-C dyslipidemia from childhood to adulthood had an increased risk of CVD events, but those in whom dyslipidemic non-HDL-C levels resolve by adulthood have similar risk to individuals who were never dyslipidemic. These findings suggest that interventions to prevent and reduce elevated childhood non-HDL-C levels may help prevent premature CVD.

The Significant Impact of High-Fat, Low-Carbohydrate Ketogenic Diet on Serum Lipid Profile and Atherosclerotic Cardiovascular Disease Risk in Overweight and Obese Adults.

Background and objectives Overweight and obesity are becoming more commonplace globally. The ketogenic diet (KD), also known as the high-fat, low-carbohydrate diet, has become increasingly popular in recent years as a means to lose weight quickly. This present study aims to examine the clinical effects of ketogenic diets in individuals who are obese or overweight by evaluating or assessing variations in metabolic parameters associated with lipid control, the risk of atherosclerotic cardiovascular disease, and other kidney risk indicators. Methods and subjects This observational case-control research involved 250 individuals in total and was conducted from May 2023 to January 2024. Of these, 158 were on a ketogenic diet, and 92 adults not following any type of diet were chosen to serve as controls. The biochemistry parameters of the kidney function test and lipid profile were measured for the two comparing groups. Data were analyzed for statistical significance using the Student t-test, Mann-Whitney U test, and one-way analysis of variance (ANOVA), followed by a post hoc test (least significant difference (LSD)). Chi-square tests were employed in the analysis to compare proportions. Results Out of 250 participants, there was a 20-80 age range, with their median age being 40 years old. The two comparing groups' lipid profiles were very different from one another; the cardiovascular risk (triglyceride (TG)/high-density lipoprotein (HDL)), total cholesterol, low-density lipoprotein (LDL), and triglyceride levels were all greater in the KD group when compared to the non-KD group. The mean LDL cholesterol (LDL-C) of the normal-weight participants was 56 mg/dL (p=0.079). Thereafter, it experienced a significant rise to 97.58 mg/dL and 108.2 mg/dL in thoseindividuals who were overweight and obese, respectively (p<0.020). Conclusions As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction. Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants. Additional research is necessary to ascertain if a ketogenic diet can be sustained over the long term and how it affects endpoints that are more clinically significant, such as morbidity and mortality due to obesity.

Long-term ambient ozone exposure and incident cardiovascular diseases: National cohort evidence in China

BackgroundLong-term ozone (O3) exposure has been associated with cardiovascular disease (CVD) mortality in mounting cohort evidence, yet its relationship with incident CVD was poorly understood, especially in low- and middle-income countries (LMICs) experiencing high ambient air pollution. MethodsWe carried out a nationwide perspective cohort study from 2010 through 2018 by dynamically enrolling 36948 participants across Chinese mainland. Warm-season (April–September) O3 concentrations were estimated using satellite-based machine-learning models with national coverage. Cox proportional hazards model with time-varying exposures was employed to evaluate the association of long-term O3 exposure with incident CVD (overall CVD, hypertension, stroke, and coronary heart disease [CHD]). Assuming causality, a counterfactual framework was employed to estimate O3-attributable CVD burden based on the exposure-response (E-R) relationship obtained from this study. Decomposition analysis was utilized to quantify the contributions of four key direct driving factors (O3 exposure, population size, age structure, and incidence rate) to the net change of O3-related CVD cases between 2010 and 2018. ResultsA total of 4428 CVD, 2600 hypertension, 1174 stroke, and 337 CHD events were reported during 9-year follow-up. Each 10-μg/m³ increase in warm-season O3 was associated with an incident risk of 1.078 (95% confidence interval [CI]: 1.050–1.106) for overall CVD, 1.098 (95% CI: 1.062–1.135) for hypertension, 1.073 (95% CI: 1.019–1.131) for stroke, and 1.150 (95% CI: 1.038–1.274) for CHD, respectively. We observed no departure from linear E-R relationships of O3 exposure with overall CVD (Pnonlinear= 0.22), hypertension (Pnonlinear= 0.19), stroke (Pnonlinear= 0.70), and CHD (Pnonlinear= 0.44) at a broad concentration range of 60–160 µg/m3. Compared with rural dwellers, those residing in urban areas were at significantly greater O3-associated incident risks of overall CVD, hypertension, and stroke. We estimated 1.22 million (10.6% of overall CVD in 2018) incident CVD cases could be attributable to ambient O3 pollution in 2018, representing an overall 40.9% growth (0.36 million) compared to 2010 (0.87 million, 9.7% of overall CVD in 2010). This remarkable rise in O3-attributable CVD cases was primary driven by population aging (+24.0%), followed by increase in O3 concentration (+10.5%) and population size (+6.7%). ConclusionsLong-term O3 exposure was associated with an elevated risk and burden of incident CVD in Chinese adults, especially among urban dwellers. Our findings underscored policy priorities of implementing joint control measures for fine particulate matter and O3 in the context of accelerated urbanization and population aging in China.

Food Environments and Cardiovascular Disease: Evidence From the Health and Retirement Study

IntroductionResidential food environments are one of the important determinants of cardiovascular health. However, past literature has been limited by short-term follow-ups, time-invariant environmental measurements at baseline, and/or not investigating both healthy and unhealthy aspects of the food environment. This study examines the effects of time-varying healthy and unhealthy food environments on incident cardiovascular disease (CVD) over ten years, extracting data from the Health and Retirement Study (2006-2016; N=10,413). MethodsCox proportional hazards modeling was performed with inverse probability weighting to assess the association between time-varying food environmental measures (i.e., densities of grocery stores, supercenters/club stores, full-service restaurants, and fast-food restaurants) and incident CVD over 10 years. Education level and race/ethnicity were tested as potential moderators. Analyses were conducted in 2022-2023. ResultsRace/ethnicity had a significant interaction effect with supercenters/club stores and indicated that a 1-standard-deviation increase in the density of supercenters/club stores was associated with a 6-8% lower risk of incident CVD in non-Hispanic Black (HR=0.78, 95% CI=0.70-0.87) and Hispanic older adults (HR=0.69, 95% CI=0.50-0.96), but not non-Hispanic White older adults. Additionally, education had a significant interaction effect with full-service restaurants, indicating that a 1-standard-deviation increase in the density of full-service restaurants was associated with a 10% lower risk of incident CVD in individuals with 13+ years of schooling, but not those with zero to 12 years of schooling. ConclusionsFindings suggest that public policymakers should be aware of the benefits and nuances of varying food environment components as they can contribute to positive or negative cardiovascular health.

Exposure to green spaces, cardiovascular risk biomarkers and incident cardiovascular disease in older adults: The Seniors-Enrica II cohort

IntroductionThe impact of residential green spaces on cardiovascular health in older adults remains uncertain. MethodsCohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF‐15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92). ResultsAfter adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of −5.56 % (95 %CI: −9.77; −1.35), −5.05 % (-9.58; −0.53), −4.24 % (-8.19, −0.19), and −4.16 % (-7.59; −0.74), respectively; and mean differences in hs-TnT among diabetic participants of −8.03 % (95 %CI: −13.30; −2.77), −9.52 % (-16.08; −2.96), −8.05 % (-13.94, −2.16) and −5.56 % (-10.75; −0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes. ConclusionIncreased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas.