Risk Of Coronary Heart Disease Events Research Articles

Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis.

Effective therapies for reducing cardiovascular disease (CVD) risk in people with elevated lipoprotein(a) are lacking, especially for primary prevention. Because of the potential association of lipoprotein(a) with thrombosis, we evaluated the relationship between aspirin use and CVD events in people with elevated lipoprotein(a). We used data from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of baseline cardiovascular disease. Due to potential confounding by indication, we matched aspirin users to nonusers using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) stratified by baseline lipoprotein(a) level (threshold of 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. After propensity matching, the study cohort included 2183 participants, including 1234 (57%) with baseline aspirin use and 423 (19%) with lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had a higher burden of CVD risk factors, more frequent aspirin use (61.7% versus 55.3%, P=0.02), and higher rate of incident CHD events (13.7% versus 8.9%, P<0.01). Aspirin was associated with a significant reduction in CHD events among those with elevated lipoprotein(a) (hazard ratio, 0.54 [95% CI, 0.32-0.94]; P=0.03). Those with lipoprotein(a) >50 mg/dL and aspirin use had similar CHD risk as those with lipoprotein(a) ≤50 mg/dL regardless of aspirin use. Aspirin use was associated with a significantly lower risk for CHD events in participants with lipoprotein(a) >50 mg/dL without baseline CVD. The results of this observational propensity-matched study require confirmation in studies with randomization of aspirin use.

Sex differences in risk factors for coronary heart disease events: a prospective cohort study in Iran

We investigated sex-specific associations and their differences between major cardiovascular risk factors and the risk of incident coronary heart disease (CHD) and hard CHD (defined as nonfatal myocardial infarction and CHD death). A total of 7518 (3377 men) participants from the Tehran Lipid and Glucose Study were included. Cox models were used to estimate the hazard ratios (HRs) and women-to-men ratios of HRs for CHD events associated with each risk factor. During 20 years of follow-up (1999–2018), 1068 (631 men) and 345 (238 men) new cases of CHD and hard CHD, respectively, were documented. In total population, the incidence rates per 1000 person-years were 9.5 (9.0–10.1) and 2.9 (2.6–3.2) for CHD and hard CHD, respectively. Hypertension, diabetes, pre-diabetes, and a high waist-to-hip ratio (WHR) were associated with a greater HR of hard CHD in women than men; the women-to-men HRs were 2.85 [1.36–5.98], 1.92 [1.11–3.31], 2.04 [1.09–3.80] and 1.42 [1.10–1.82], respectively. Diabetes was associated with a higher HR of CHD in women than men (ratio of HRs 1.49 (1.10–2.01). In conclusion, we found that hypertension, diabetes, pre-diabetes, and high WHR conferred a greater excess risk of CHD events in women than in men, suggesting that Iranian women may require greater attention for the prevention of CHD events.

Obesity, metabolic health and clinical outcomes after incident cardiovascular disease: A nationwide population-based cohort study.

The association between metabolic syndrome and increased cardiovascular disease (CVD) risk is well-established. However, in patients with incident CVD, the relationship between obesity, metabolic health, and subsequent CVD and mortality outcomes are less well-established. This study investigated the association between body mass index (BMI), metabolic health and the risk of subsequent cardiovascular mortality and morbidity outcomes in patients with incident CVD events. This cohort study identified 130685 patients from the nationwide Clinical Practice Research Datalink (CPRD GOLD) and Hospital Episode Statistics (HES) databases in the United Kingdom. Patients were ≥18years with incident CVD [coronary heart disease (CHD), stroke, or peripheral vascular disease (PVD)] between 1 January 1998 and 31 December 2017. BMI (in kg/m2 ) was categorized as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9) and obese (≥30). Within each BMI category, patients were grouped by increasing count of 1, 2 or 3 metabolic risk factors [RF] (dyslipidaemia, diabetes mellitus and hypertension) and were regarded as metabolically unhealthy while absence of these factors was considered metabolically healthy (MH). Multivariable Cox regression was used to assess the risk (hazard ratio with 95% confidence interval) of subsequent outcomes (non-fatal CHD, stroke, PVD, incident heart failure, CVD-mortality and all-cause mortality) in BMI subgroups with incremental count of metabolic RFs. During a median follow-up of 13.0years, a higher BMI was associated with reduced risk for stroke, PVD, CVD-mortality and all-cause mortality within each metabolic risk category, while increasing metabolic RFs within each BMI subgroup accounted for increasing risks. When compared with patients with normal BMI and no RF, CVD-mortality risk in overweight patients with no RF was 0.76 (0.70-0.84), and in obese patients with no RF was 0.85 (0.76-0.96). The respective risk for all-cause mortality in patients with overweight and no RF was 0.69 (0.65-0.72), and in obese patients with no RF was 0.75 (0.70-0.79). Subsequent outcomes of stroke and PVD showed similar trends. In contrast, the risk of subsequent non-fatal CHD events and incident HF increased with higher BMI and with incremental metabolic risk factors within each BMI category. Underweight was constantly associated with increased risk for all outcomes regardless of the presence of metabolic RFs except for non-fatal CHD events. In patients with incident CVD, overweight and obesity were related to a more favourable prognosis for subsequent stroke, PVD and mortality (CVD-related and all-cause) irrespective of the presence of other metabolic risk factors.

Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality.

ACC/AHA guidelines caution against the use of antihypertensive therapy in the setting of low standing systolic BP (SBP) < 110 mm Hg due to unclear benefits. The Atherosclerosis Risk in Communities (ARIC) Study measured supine and standing SBP in adults aged 45-64 years between 1987 and 1989. We used Cox regression to evaluate the associations of low standing SBP (<110 mm Hg) with risk of falls, syncope, coronary heart disease (CHD), and mortality through December 31, 2019. Falls and syncope were ascertained by hospitalization and outpatient claims; CHD events were adjudicated. Associations were examined overall and in strata of hypertension stage, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and sex. Among 12,467 adults followed a median of 24 years (mean age at enrollment 54.1 ± 5.8 years, 55% women, 26% Black adults), 3,000 (24%) had a standing SBP < 110 mm Hg. A standing SBP < 110 mm Hg compared to standing SBP ≥ 110 mm Hg was not significantly associated with falls or syncope, and was associated with a lower risk of CHD events and mortality with HRs of 1.02 (95% CI 0.94, 1.11), 1.02 (0.93, 1.11), 0.88 (0.80, 0.97), and 0.91 (0.86, 0.97), respectively. There were no clinically meaningful differences when stratified by hypertension stage, 10-year ASCVD risk, age, and sex. In this community-based population, low standing SBP was common and not significantly associated with falls or syncope, but was associated with a lower risk of CHD and mortality. These findings do not support screening for low standing BP as a risk factor for adverse events.

1362-P: The Long-Term Cardiovascular Effects of Metformin on Patients with Newly Diagnosed Type 2 Diabetes

Objective: Metformin is the first pharmacological option for preventing and treating type 2 diabetes. However, the use of this drug in preventing cardiovascular disease associated with the development of newly diagnosed type 2 diabetes is unclear. We aimed to examine whether the metformin reduced the incidence of major cardiovascular events over a 20-year follow-up of patients with newly diagnosed type 2 diabetes. Research Design and Methods: We conducted a retrospective observational cohort study of 48,338 patients with type 2 diabetes from Anhui Provincial Hospital between January 1, 2000, and June 30, 2021. Data were collected for patients with newly diagnosed T2D (within 6 months) who did not have prior cardiovascular disease and took metformin at baseline were compared with those who did not using. The primary outcome was the first occurrence of major cardiovascular events including coronary heart disease (CHD), stroke, and hospitalization due to heart failure (HF). The multivariate Cox proportional hazards regression with inverse probability of treatment weighting. Propensity score matching (PSM) was conducted for reducing the biases of baseline characteristics. Results: After matching, newly diagnosed T2D patients who used metformin, compared with those who did not use, had significantly lower risk of HF (HR 0.51, 95% CI 0.28 to 0.93) and CHD (HR 0.37, 95% CI 0.13 to 1.09). No difference in the risk incident stroke (HR 0.89, 95% CI 0.68 to 1.17) was observed. In both the original and PSM groups, use of metformin can reduce the risk of CHD events from newly diagnosed T2D patients (adjusted HR 0.74; 95% CI 0.69-0.87; P = 0.029). Conclusions: In the present retrospective study, metformin use may be beneficial for preventing CHD and HF in newly diagnosed T2D patients. Further randomized controlled trials are needed to confirm these findings. Disclosure T.Yue: None. X.Wang: None. M.Zhao: None. J.Weng: None. S.Luo: None. X.Zheng: None.

Plasma viscosity, immunoglobulins and risk of cardiovascular disease and mortality: new data and meta-analyses

AimsAssociations of plasma viscosity and plasma Ig levels (a determinant of viscosity) with incident coronary heart disease (CHD) events; and with CHD, cardiovascular disease (CVD: CHD and stroke) and all-cause...

General practice management of depression among patients with coronary heart disease in Australia

BackgroundIncident depression is associated with coronary heart disease (CHD) and increased morbidity and mortality. Treatment of depression with antidepressants and psychotherapy can be beneficial for these patients to reduce the risk of further CHD events. Ongoing management of CHD and depression mainly occurs in the community, but little is known about the identification and care of patients with comorbid CHD and depression in general practice. This study explores the prescription of antidepressants for these patients by sociodemographic variables.MethodsThis is an open cohort study with de-identified data based on electronic medical records of 880,900 regular patients aged 40 + years from a national general practice database in Australia (MedicineInsight). Data from 2011–2018 was used to classify patients as newly recorded CHD (CHD recorded in 2018 but not in previous years), previously recorded CHD (CHD recorded between 2011–2017) or no recorded history of CHD. Antidepressant prescribing in 2018 considered active ingredients and commercial brand names. The association between sociodemographic variables and antidepressant prescribing was tabulated according to the CHD status.ResultsThe proportion of current depression among patients with newly recorded CHD was 11.4% (95%CI 10.3–12.6), 10.5% among those with previously recorded CHD (95%CI 10.0–11.1) and 9.6% among those with no recorded history of CHD (95%CI 9.2–10.1). Antidepressant prescribing was slightly higher among those with newly recorded CHD (76.4%; 95%CI 72.1–80.6) than among those with previously recorded CHD (71.6%; 95%CI 69.9–73.2) or no history of CHD (69.5%; 95%CI 68.6–70.4). Among males with newly recorded CHD and depression, antidepressant prescribing was more frequent in major cities or inner regional areas (~ 81%) than in outer/remote Australia (66.6%; 95% CI 52.8–80.4%).ConclusionsAlthough antidepressant prescribing was slightly greater in those with newly recorded CHD compared to those with depression alone, its clinical significance is uncertain. Much larger differences in prescribing were seen by geographic location and could be addressed by innovations in clinical practice.

Relationship of low-density lipoprotein-cholesterol and lipoprotein(a) to cardiovascular risk: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background and aimsPlasma low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) are both associated with coronary heart disease (CHD). This study investigated whether elevated plasma Lp(a) concentration was associated with increased CHD risk when LDL-C was low (≤100 mg/dL) in individuals not on statin therapy. MethodsParticipants from the Multi-Ethnic Study of Atherosclerosis (MESA) (n = 4,585) were categorized into four groups: Group 1: LDL-C ≤ 100 mg/dL, Lp(a) < 50 mg/dL; Group 2: LDL-C > 100 mg/dL, Lp(a) < 50 mg/dL; Group 3: LDL-C ≤ 100 mg/dL, Lp(a) ≥ 50 mg/dL; and Group 4: LDL-C > 100 mg/dL, Lp(a) ≥ 50 mg/dL. The relationship of Lp(a) and LDL-C with time to CHD events was assessed with Kaplan Meier curves and multivariable Cox proportional hazard models. ResultsParticipants were followed for a mean of 13.4 years and a total of 315 CHD events occurred. Compared to participants with LDL-C ≤ 100 mg/dL and Lp(a) < 50 mg/dL, those with LDL-C > 100 mg/dL and Lp(a) < 50 mg/dL (Group 2) demonstrated no increased risk for CHD events (HR: 0.92; 95% CI: 0.69, 1.21). However, participants with LDL-C ≤ 100 mg/dL and Lp(a) ≥ 50 mg/dL (Group 3) and those with LDL-C > 100 mg/dL and Lp(a) ≥ 50 mg/dL (Group 4) exhibited significantly increased risk of CHD events compared to Group 1 (HR: 1.83; 95% CI: 1.02, 3.27) and Group 2 (HR: 1.61; 95% CI: 1.15, 2.26), respectively. ConclusionsWhen Lp(a) was elevated, risk of CHD events increased, regardless of baseline LDL-C.

Impact of antihypertensive medication regimens on blood pressure control in individuals with established coronary heart disease

Abstract Background and purpose Hypertension is a major risk factor for coronary heart disease (CHD) development and progression, with pharmacological control of blood pressure reducing the risk of CHD events and death [1]. Treatment and control of blood pressure in CHD is suboptimal, with many patients failing to achieve guideline-directed targets [1,2]. This study aims to assess the relationship between antihypertensive medication regimens and blood pressure control in patients with hypertension and established coronary heart disease. Methods The iASPIRE study recently evaluated secondary prevention in an Irish cohort with coronary heart disease [2]. Based on a method used in a similar study [3], we calculated the average percentage daily dose of each prescribed antihypertensive agent. We then assessed the relationship between dose and number of antihypertensive agents with blood pressure control. Results 540 (75.5%) of iASPIRE participants had an underlying diagnosis of hypertension, and at the study examination, 56% of these had a blood pressure ≥140/90 mmHg, while 83% had a blood pressure ≥130/80 mmHg. The median number of antihypertensive agents prescribed was 2 (IQR 1–2), with 88% of those with hypertension on at least one blood pressure medication. In participants with hypertension on treatment, the median percentage daily medication dose was 29% (IQR 14–50). After adjustment for age and sex, the addition of further antihypertensive medications increased the odds of achieving a blood pressure target of &amp;lt;130/80 mmHg (OR 1.3, 95% CI 1.07–1.69, p=0.012). The average percentage daily dose of each antihypertensive agent was lower in both participants with a medication-controlled blood pressure of &amp;lt;130/80 mmHg and &amp;lt;140/90 mmHg compared to those without blood pressure control (30% versus 37% p=0.006 and 33% versus 38% p=0.028 respectively). Conclusion Many patients with hypertension and coronary heart disease currently fail to achieve blood pressure control. This analysis found that an increasing number of antihypertensive medications but not increasing dose was associated with better blood pressure control. Combination therapy is superior to sequential monotherapy in the treatment of hypertension [1], and an approach that emphasises the initiation of several antihypertensive agents would likely lead to better blood pressure control in individuals with coronary heart disease. Funding Acknowledgement Type of funding sources: None.

Association of TGFB1 rs1800469 and BCMO1 rs6564851 with coronary heart disease and IL1B rs16944 with all-cause mortality in men from the Northern Ireland PRIME study.

BackgroundHistorically, high levels of morbidity and mortality have been associated with cardiovascular disease in the Northern Ireland population. Previously reported associations between single nucleotide polymorphisms (SNPs) and cardiovascular disease within other populations have not always been consistent.ObjectiveTo investigate associations between 33 SNPs with fatal or non-fatal incident coronary heart disease (CHD) events and all-cause mortality in the Northern Irish participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME).MethodPhase 2 of the PRIME study prospectively evaluated 2,010 men aged 58–74 years in Northern Ireland for more than 10 years for incident CHD events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass, and cardiac death) and more than 15 years for all-cause mortality. SNPs previously reported in association with cardiovascular outcomes were evaluated against incident CHD events and all-cause mortality using Cox’s proportional hazards models adjusted for established cardiovascular disease risk factors.ResultsDuring the follow-up period, 177 incident CHD events were recorded, and 821 men died. Both BCMO1 rs6564851 (Hazard ratio [HR] = 0.76; 95% confidence intervals [CI]: 0.60–0.96; P = 0.02) and TGFB1 rs1800469 (HR = 1.30; CI: 1.02–1.65; P = 0.04) were significantly associated with incident CHD events in adjusted models. Only IL1B rs16944 was significantly associated with all-cause mortality (HR = 1.18; CI: 1.05–1.33; P = 0.005). No associations remained significant following Bonferonni correction for multiple testing.ConclusionWe report a novel association between BCMO1 rs6564851 and risk of incident CHD events. In addition, TGFB1 rs1800469 and IL1B rs16944 were associated with the risk of incident CHD events and all-cause mortality outcomes respectively, supporting previously reported associations.

Lipoprotein(a) and the Risk for Coronary Heart Disease and Ischemic Stroke Events Among Black and White Adults With Cardiovascular Disease.

BackgroundIt is unclear whether lipoprotein(a) is associated with coronary heart disease (CHD) and ischemic stroke events in White and Black adults with atherosclerotic cardiovascular disease (ASCVD).Methods and ResultsWe conducted a case‐cohort analysis, including Black and White REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants ≥45 years of age with prevalent ASCVD (ie, CHD or stroke) at baseline between 2003 and 2007. Baseline lipoprotein(a) molar concentration was measured in participants with ASCVD who experienced a CHD event by December 2017 (n=1166) or an ischemic stroke by September 2019 (n=492) and in a random subcohort of participants with prevalent ASCVD (n=1948). The hazard ratio (HR) for CHD events per 1 SD (1.5 units) higher log‐transformed lipoprotein(a) was 1.26 (95% CI, 1.02–1.56) among Black participants and 1.16 (95% CI, 1.02–1.31) among White participants (P value comparing HRs, 0.485). The HR for CHD events per 1 SD higher log‐lipoprotein(a) within subgroups with hs‐CRP (high‐sensitivity C‐reactive protein) ≥2 and <2 mg/L was 1.31 (95% CI, 0.99–1.73) and 1.23 (95% CI, 0.85–1.80), respectively (P value comparing HRs, 0.836), among Black participants, and 1.07 (95% CI, 0.91–1.27) and 1.36 (95% CI, 1.10–1.70), respectively (P value comparing HRs, 0.088), among White participants. There was no evidence that the association between lipoprotein(a) and CHD events differed by statin use. There was no evidence of an association between lipoprotein(a) and ischemic stroke events among Black or White participants.ConclusionsHigher lipoprotein(a) levels were associated with an increased risk for CHD events in Black and White adults with ASCVD.

The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD. Methods In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland. Results An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p&amp;lt;0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control. Conclusion Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.

Abstract P179: The Association Of A Genetic Risk Score With Prevalent Coronary Heart Disease In The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL)

Background: Coronary heart disease (CHD) is one of the leading causes of death for the Hispanic/Latino population living in the United States (US). One way to reduce the burden of CHD is to target therapy and primary prevention in high-risk groups. Towards this end, a genetic risk score (GRS) constructed from 71 single-nucleotide polymorphisms (SNPs) has been used in populations of European ancestry to identify those at higher risk for CHD events and who would benefit most from statin therapy. Objectives: The purpose of this study is to evaluate a 71-SNP GRS with prevalent CHD in the HCHS/SOL cohort. Methods: The HCHS/SOL is a prospective, multi-center, population-based study that enrolled 16,415 Hispanic/Latino adults aged 18-74 years from four US communities in 2008-2011. Prevalent CHD was defined as self-reported physician-diagnosed angina, myocardial infarction, bypass, angioplasty, stent placement or evidence of electrocardiographic abnormalities indicative of CHD. We leveraged genome-wide genotype data to assess the association between a 71-SNP GRS and prevalent CHD among 9030 HCHS/SOL participants with accessible genetic data. Multivariable logistic regression was used to derive odds ratios and 95% confidence intervals for the association between GRS and prevalent CHD, adjusted for sex, age, and the first 5 principal components and weighted to adjust for sampling probability and non-response. Stratified analysis was conducted to explore heterogeneity by Hispanic/Latino background group. Results: The 71-SNP GRS had a range of 43-87 risk alleles among participants. In multivariable logistic regression analyses, participants in the top quintile of the GRS had 1.42 (95% CI: 1.11, 1.82) higher odds of prevalent CHD than participants in the lower four quintiles combined. Stratified analyses showed stronger associations between the GRS and prevalent CHD by Hispanic/Latino background group, with the strongest associations observed among participants of Cuban (OR=1.86; 95%: 1.18-2.92) and Central American (OR=2.81; 95% CI: 1.28-6.17) backgrounds. Conclusion: Our findings show that a previously developed 71-SNP GRS is associated with prevalent CHD among Hispanic/Latino participants. These findings may have important implications for lessening future CHD health disparities among Hispanics/Latinos living in the US.

Abstract 9121: Lipoprotein(a) and the Risk for Coronary Heart Disease and Ischemic Stroke Events Among Black and White Adults with Cardiovascular Disease

Introduction: Lp(a) is a risk marker for incident coronary heart disease (CHD) and ischemic stroke. It is unclear if Lp(a) is associated with CHD and stroke events among adults with prevalent cardiovascular disease (CVD), particularly in non-White populations. Hypothesis: Higher Lp(a) levels are associated with an increased risk for both CHD and ischemic stroke events in Black and White adults with prevalent CVD. Methods: We conducted a case-cohort analysis including Black and White adults ≥45 years of age enrolled in the nationwide REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007 who had prevalent CVD at baseline. REGARDS study participants were followed for CHD and ischemic stroke events, which were expert adjudicated. Lp(a) molar concentration was measured using a particle-enhanced turbidimetric immunoassay from blood samples collected at baseline in a random subcohort of participants with prevalent CVD (n=1,948), and in all those with prevalent CVD who experienced a CHD event by December 31, 2017 (n=1,166), or an ischemic stroke by September 30, 2019 (n=492). Results: The median [25 th , 75 th percentile] Lp(a) concentration was 100 nmol/L [48, 186] among Black participants and 23 nmol/L [8, 113] among White participants (p-value &lt;0.001). Higher Lp(a) was associated with an increased risk for CHD events among both Black and White participants, but it was not associated with the risk for ischemic stroke (Table). At baseline, 49% of Black participants and 59% of White participants with prevalent CVD were taking a statin. Among Black and White participants taking a statin, the hazard ratio [95% CI] associated with 1 SD higher log-Lp(a) was 1.69 [0.98, 2.93] and 1.38 [1.03, 1.85], respectively, for CHD, and 1.29 [0.70, 2.40] and 1.18 [0.81, 1.72], respectively, for stroke. Conclusion: Higher Lp(a) is a risk marker for CHD but not for ischemic stroke events in Black and White adults with prevalent CVD, including those taking a statin.

Abstract 12860: Effects of Marine Omega-3 and Vitamin D Supplementation on Circulating Biomarkers of Glucose-Insulin Homeostasis and Incident Cardiovascular Disease in the Vitamin D and Omega-3 Trial (VITAL)

Introduction: Dysglycemia and insulin resistance increase cardiovascular disease (CVD) risk. Associations between specific glucose-insulin biomarkers and CVD have been inconsistent. Hypothesis: We hypothesized that higher insulin, C-peptide, insulin resistance score (IRS), and HbA1c are associated with incident CVD and coronary heart disease (CHD) events and that both vitamin D and omega-3 fatty acids (n-3 FA) would improve these biomarkers and attenuate their risks with CVD. Methods: VITAL (NCT01169259) was a 2x2 factorial design RCT testing vitamin D (cholecalciferol, 2000 IU/d) and n-3 FA (EPA+DHA, 1 g/d) for the primary prevention of CVD. Incident CVD cases [non-fatal myocardial infarction (MI), non-fatal stroke, or CV death] were matched 1:1 on age and sex to healthy controls (n=715 CVD pairs including 423 CHD [MI, revascularization, CHD death] pairs). Conditional logistic regression adjusting for demographics, CV risk factors, and randomized treatment was used to assess the adjusted odds ratio (aOR) and 95% CI between baseline levels of insulin, C-peptide, IRS (Insulinх0.0265+C-peptideх0.00511+Creatinineх-3.2641), and HbA1c with risk of CVD and CHD events. In control participants, we examined the randomized effects of vitamin D or n-3 FA on changes in these biomarkers at 1- or 2-years follow-up. Results: Mean age of participants was 71 years, approximately 42% were female, and 12% were African American. Baseline insulin, C-peptide, and IRS were not associated with CVD ( Figure 1 ). HbA1c was associated with CVD risk, aOR (95% CI) per SD increment, 1.17 (1.01, 1.38). Of the 4 biomarkers, only IRS was associated with CHD risk, aOR (95% CI): 1.22 (1.01, 1.46). Randomization to vitamin D or n-3 FA did not modify levels of these biomarkers or their associations. Conclusions: HbA1c was significantly associated with CVD risk, whereas IRS was associated with CHD risk. Neither vitamin D nor n-3 FA appreciably modified these biomarker levels or their risk associations.

Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older adults

BackgroundMigraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine.MethodsThis retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD.ResultsAmong patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07–1.35) for ischemic stroke and 1.02 (95%CI, 0.93–1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20–1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67–0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17–1.39) and 0.99 (0.93–1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07–1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72–0.95]), each versus those without migraine.ConclusionsOlder adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.

Occupational physical activity, mortality and CHD events in the Italian Longitudinal Study

PurposeSeveral recent studies have suggested a ‘physical activity paradox’ whereby leisure-time physical activity benefits health, but occupational physical activity is harmful. However, other studies imply that occupational physical activity is beneficial. Using data from a nationally representative Italian sample, we investigate if the context, or domain, of physical activity matters for mortality and coronary heart disease (CHD) events.MethodsAmong 40,220 men and women aged 40–55 at baseline, we used Cox models to compare associations of occupational, domestic and leisure-time physical activity with risk of mortality and CHD events over a follow-up period of up to 14 years. We accounted for sociodemographic factors, smoking, body mass index (BMI), physical and mental health, and educational qualifications.ResultsOccupational physical activity was not significantly associated with risk of mortality or CHD events for women, or with CHD events for men. In crude models, risk of mortality was higher for men in the highest occupational activity group, compared to the lowest (HR 1.26, 95% CI 1.01, 1.57). This attenuated with adjustment for health-related behaviours, health, and education (HR 1.03, 95% CI 0.77, 1.38). In crude models, leisure-time physical activity was significantly associated with decreased mortality and CHD risk only for men. Domestic physical activity was not associated with either outcome for either gender.ConclusionIn a large sample of middle-aged Italian workers, we found limited evidence of harmful or beneficial effects of occupational physical activity on mortality or CHD events. However, confidence intervals were wide, and results consistent with a range of effects in both directions.

Prevalence and Prognostic Value of Psychological Stress Events in Patients with First Myocardial Infarction-Long-Term Follow-Up Study.

While there is good evidence that symptoms of depression determine prognosis of patients with coronary heart disease (CHD), the role of psychological stress is less clear. We evaluated the prognostic value of stressful events in patients with initial myocardial infarction (MI) with respect to subsequent cardiovascular events. The KAROLA-study included patients with CHD who participated in an in-patient rehabilitation program. A total of 577 patients with initial MI were included and self-reported psychological stressful events before their MI was assessed by a structured questionnaire. Hazard ratios were used to evaluate the long-term association of stressful events with secondary cardiovascular events. Additionally, associations of stressful events with depression, anxiety and other cardiovascular risk factors were investigated. Unusual stress at work (26.5%) and sleep disorder (23.4%) were the most frequently reported stressful events that occurred in the last 4 weeks before MI. However, only death of a family member showed a statistically significant increase in risk for subsequent cardiovascular events (HR: 1.59; 95%-CI: 1.01–2.50) and this result was not corrected for multiple testing. Notably, we found higher symptom scores of anxiety and depression associated with all single stressful event items. In conclusion, we found no clear patterns that psychological stressful events before MI would increase the long-term risk of subsequent adverse CHD events directly. However, we saw increased symptom scores of anxiety and depression in persons with stressful events.

Abstract MP03: The Health And Economic Impact Of Using A Sugar Sweetened Beverage Tax To Subsidize Fruit And Vegetable Purchase In New York City: A Modeling Study

Background: Both high sugar intake and low fruit and vegetable (FV) consumption increase the risk of coronary heart disease (CHD). Sugar-sweetened beverage (SSB) taxes can reduce sugar intake, whereas FV subsidies increase FV consumption. Several cities in the US have proposed an innovative policy that used the SSB tax revenue towards FV subsidies. It is unclear what the long-term health and economic impact this innovative policy could have in large cities such as New York City (NYC). Objective: To project lifetime CHDs averted and costs if a penny-per-ounce SSB tax were used to subsidize FV incentives in NYC using a validated microsimulation model of cardiovascular disease. Methods: We used the SHINE CVD model to compare the cost and CHD outcomes of a combination of SSB tax and FV subsidy policy with only SSB tax, only FV subsidy, and no policy from a healthcare sector perspective, respectively. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. We simulated 10,000 adults starting at age 40. CHD risk factor trajectories and risk of incident CHD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax (penny-per-ounce) and FV subsidy were modeled to directly affect incidence rates of CHD events. Medical costs were included and discounted at 3%. Results: Compared to the non-policy scenario over the simulated lifetime, the SHINE CVD model projected that the policy intervention with SSB taxes only would prevent 62 per 10,000 (95% CI: 57 - 67) CHD events at a penny-per-ounce rate, the intervention with FV subsidies only would prevent 28 per 10,000 (95% CI: 24-34), and the combined policy would prevent 91 CHD events (95% CI: 87 - 96). Total medical cost savings over the simulation period ranged from $22.5 million (95% CI: $21.5 - $23.6 million), $13.1 million (95% CI: $12.3 - $13.8million), and $37.9 million (95% CI: $36.5 - $39.4million), or $0.45 million/year, $0.27 million/year, $0.75 million/year for SSB taxes only, FV subsidies only, and the combined policy, respectively. Conclusion: Using a computer simulation model, we showed how converting SSB tax revenues into FV subsidies could result in substantial benefits within the NYC population in terms of CHD outcomes and overall healthcare cost savings. Results from the SHINE CVD model may inform the ongoing policy-making efforts.

Eicosapentaenoic Acid Increases Plasma ω‐3 Fatty Acids in Hyperlipidemic Children: A Cardioprotective Nutrient?

Background Hyperlipidemic children are at high risk for early coronary heart disease (CHD). Low tissue levels of ω-3 fatty acids are inversely associated with CHD. Previous studies show that high levels of plasma ω-3 fatty acids, eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA) from a seafood diet, are associated with an increased likelihood of healthy aging. The Mediterranean diet rich in EPA and docosahexaenoic (DHA) acids is also associated with decreased risk of CHD. These long chain fatty acids positively influence vascular function and reduce CHD by altering membrane fluidity, receptor activity, gene expression and eicosanoid synthesis. The purpose of this study was to determine the effect of the Mediterranean diet alone or combined with EPA on the plasma fatty acid profile of hyperlipidemic children. Methods A randomized, double-blind, placebo-controlled trial was conducted in 6 children (9-16 yrs) with hyperlipidemia. The Mediterranean diet was consumed for 6 wks, followed by the diet combined with EPA supplements (1.2 gms/day) for 6 wks. A Mediterranean diet score was obtained at baseline and after the diet. Plasma phospholipid fatty acid composition was also determined. Plasma was extracted in chloroform:methanol and thin-layer chromatography was used to separate phospholipid fractions. Fatty acid methyl esters were quantified using gas chromatography and identified with standards and expressed as % of total fatty acids. Results Mean Mediterranean diet scores were significantly increased (Baseline: 5.5 ± 0.5 vs Diet: 8.0 ± 1.3; P <.002) verifying dietary compliance. A significant increase in plasma EPA and DPA and a significant decrease in total ω-6 fatty acids and the Arachidonic Acid/EPA Ratio were observed in hyperlipidemic children following EPA supplementation. Conclusion This is the first study to show that EPA supplementation favorably alters the plasma fatty acid composition in hyperlipidemic children by increasing circulating ω-3 fatty acids, EPA, DPA, but not DHA. Studies suggest that increased plasma EPA and DPA are associated with decreased risk of CHD events and greater likelihood of healthy aging. Therefore, these changes may favorably alter pathophysiological vascular processes in hyperlipidemic children and prevent the development of early CHD.