Subclinical Cardiovascular Disease Risk Research Articles

Objectively Measured Hot Flashes and Moderate-Vigorous Activity Predict Arterial Stiffness in Healthy Perimenopausal Women

Perimenopause is the period of transition when midlife women experience increases in cardiovascular disease (CVD) risk. Arterial stiffness (AS) is a preclinical CVD risk factor that precedes the manifestation of clinical CVD. Hot flashes (HF) are bothersome symptoms of menopause which are correlated with some subclinical CVD risk factors, but the exact relationship between HF and CVD risk factors remain equivocal. Habitual physical activity (PA) is effective in the prevention and treatment of CVD in many populations. However, the relationship between PA and CVD risk remains unclear for perimenopausal women. Therefore, the objective of our study was to determine the effects of HF and PA on AS in healthy perimenopausal women. We hypothesized that HFs would be associated with AS and PA would influence the association between HFs and AS. There were 61 participants (age 43-54) free from CVD risk factors included in this analysis. Arterial stiffness was measured via augmentation index (AIx), backwards wave (PB, mmHg), and reflection magnitude (RM, %). Hot flashes were measured objectively for 24 hours using ambulatory sternal skin conductance monitoring. Objective HF rate was calculated by normalizing HF count to wear time. Habitual PA activity was quantified objectively as average daily minutes of waking moderate-vigorous PA (MVPA) over 7-day using actigraphy and the R package GGIR. All statistical analyses were performed using R (version 4.2.3) and RStudio (2023.06.2+561). Pearson’s correlation and multiple regression were used to evaluate the associations between dependent and outcome variables. Age and body mass index (BMI) were controlled, and assumption testing was completed for all models. Objective HF rate was significantly positively correlated with PB, r(53) = 0.38, p < 0.01, and RM, r(53) = 0.35, p <0.01. Objective MVPA was significantly negatively associated with AIx, r(61) = -0.45, p <0.001, PB, r(61) = -0.29, p <0.05, and RM, r(61) = -0.34, p < 0.01. Objective HF rate significantly predicted arterial stiffness variables, AIx (β = 14.58, p =0.05; adjR2 = 0.38), PB (β = 6.48, p<0.01; adjR2 = 0.24), and RM (β = 17.79, p <0.01; adjR2 = 0.39). Objective MVPA significantly predicted AIX (β = -0.12, p <0.01; adjR2 = 0.41), and RM (β = -0.06, p = 0.05; adjR2 = 0.29). When HF and MVPA were added in the same model, HF and MVPA were both significant predictors of RM (βHF = 16.25, p <0.01, βMVPA = -0.06, p <0.05; adjR2 = 0.42), MVPA only was significant with AIx (βHF = 11.38, p = 0.10, βMVPA = -0.13, p <0.01; adjR2 = 0.49), and HF only was significant with PB (βHF = 6.11, p <0.01, βMVPA = -0.02, p = 0.212; adjR2 = 0.25). Adding the interaction between HF and MVPA did not help explain variation in any AS variable. In conclusion, our data showed that more objectively-measured HF were associated with negative AS outcomes and that greater MVPA may be worth considering in decreasing arterial stiffness in perimenopausal women. Contrary to our hypothesis, MVPA did not help to explain the effects of HF on AS. Future studies should focus on understanding the mechanisms behind the negative relationship between hot flashes and arterial stiffness in midlife women. NIH NHLBI R15 Grant 1R15HL145650-01A1 (Witkowski); Smith College McKinley Honors Fellowship (Tha Ra Wun). 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.

Does Systemic Anti-Psoriatic Treatment Impact the Risk of Cardiovascular Disease? A Review Over Cardiovascular Imaging Studies.

Psoriasis is an immune-mediated inflammatory disease associated with an increased risk of cardiovascular disease (CVD). The risk of CVD increases with the severity of psoriasis, and exposure to systemic inflammation may partly explain the increased risk of CVD in these patients. This raises the question of whether anti-psoriatic treatment, in addition to treating the skin lesions, also lowers the risk of developing CVD. Different types of studies have examined the impact of systemic anti-psoriatic treatments on the risk of CVD in patients with psoriasis and epidemiological observational studies with, e.g., myocardial infarction and stroke as outcomes, and clinical studies investigating circulating inflammatory biomarkers in the blood indicate that anti-psoriatic therapy has a protective effect; however, no randomized controlled trial (RCT) has examined the impact of systemic anti-psoriatic treatment on future hard cardiovascular endpoints. This narrative review provides an overview of the clinical cardiovascular imaging studies examining the effect of systemic anti-psoriatic treatment on the risk of subclinical CVD in patients with psoriasis. We found a total of 24 clinical imaging studies, where 16 of these were observational cohort studies and eight were RCTs. The observational studies suggest an improvement in the risk of subclinical CVD based on different cardiovascular imaging biomarkers; however, the RCTs showed inconsistent results and mainly included vascular inflammation as theoutcome. Future RCTs including other imaging biomarkers as surrogates for subclinical CVD, with longer follow-up and with hard cardiovascular endpoints are warranted to address whether systemic anti-psoriatic treatments reduce the risk of CVD.

Abstract 14586: Early Life Trauma Exposure and Subclinical Cardiovascular Disease Risk in Black Men and Women

Introduction: Childhood trauma is associated with a greater risk of developing hypertension in adulthood. Black individuals develop hypertension at younger ages, have more aggressive hypertension, and are more likely to experience childhood trauma compared to White individuals. Yet, the impact of childhood trauma on vascular stiffness in Black individuals remains less clarified; thus, we examined the association between childhood trauma and arterial stiffness in Black individuals. Hypothesis: Childhood trauma exposure will be associated with vascular dysfunction and this association may differ by sex. Methods: Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known CVD [n=404] from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory short form [ETISR-SF] consisting of four-physical, sexual, emotional, and general-domains, with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index [CAIx] and carotid femoral pulse wave velocity [CfPWV] were measured as indices of wave reflections and arterial stiffness using applanation tonometry [Sphygmocor Inc.], and central pulse pressure [CPP] was calculated as the difference between the aortic systolic and diastolic blood pressures. Relationships between ETISR-SF and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. Results: Mean age of the cohort was 53(SD=10.3), 61% women. Cumulative childhood trauma was associated with CAIx β =0.33%, 95%CI: 0.04,0.62 and CPP β =0.24mmHg, 95%CI:0.04,0.45, but not CfPWV β =-0.02m/s, 95%CI:-0.07,0.02 after adjusting for demographic, BMI, BP, lipids, glucose, clinical history, health behaviors, and depression. Significant traumaxSex interactions were identified for CAIx P=0.01 and CPP P=0.02 . Among women, childhood trauma was associated with higher CAIx β =0.32%, 95%CI: 0.04, 0.60 and CPP β =0.19 mmHG, 95%CI: -0.02, 0.41, but not in men. Conclusion: Exposure to childhood trauma is associated with measures of arterial stiffness in Black women, noting the detrimental effects of childhood trauma on future CVD risk in Black women.

Relation of forward and backward traveling pressure waves with subclinical carotid artery wall remodeling and central pulse pressure.

Central pulse pressure (PP) is the sum of forward and backward traveling pressure waves that have been associated with cardiovascular disease (CVD) risk. However, previous studies have reported differential findings regarding the importance of the forward versus the backward wave for CVD risk. Therefore, we sought to determine the degree to which the forward and backward pressure waves are associated with subclinical carotid artery wall remodeling and central PP in healthy adults. Using applanation tonometry, carotid pressure waveforms were acquired in 308 healthy individuals (aged 45 ± 17 years, range 19-80 years, 61% women), from which the time integral of the forward (PfTI) and backward (PbTI) pressure waves were derived via pressure-only wave separation analysis. Common carotid artery intima-media thickness (cIMT), a biomarker of subclinical CVD risk, was derived via B-mode ultrasonography measured ∼2 cm from the carotid bulb. Both PfTI (r = 0.31, P < 0.001) and PbTI (r = 0.40, P < 0.001) were correlated with cIMT. However, further analysis revealed that PbTI mediated the relation between PfTI and cIMT (proportion mediated = 156%, P < 0.001). The association between PbTI and cIMT remained after adjusting for age, sex, body mass index, blood glucose, low-density lipoprotein cholesterol, heart rate, brachial systolic pressure, and aortic stiffness (B = 0.02, 95% confidence interval = 0.01, 2.77, P < 0.001). Both PfTI (r = -0.58, P < 0.001) and PbTI (r = -0.50, P < 0.001) were correlated with central PP, however, PfTI fully mediated the association between PbTI and central PP (proportion mediated = 124%, P < 0.001). Although PfTI is correlated with higher central PP, it is PbTI that is directly associated with carotid artery wall remodeling.NEW & NOTEWORTHY The present study contributes to the growing body of evidence highlighting the physiological and clinical insight provided by the pulsatile hemodynamic components of central artery pulse pressure. The notable findings of this study are: 1) The reflected (backward) pressure wave is associated with carotid intima-media thickness independent of traditional cardiovascular risk factors, including systolic blood pressure and aortic stiffness. 2) The incident (forward) pressure wave, and not the reflected pressure wave, is associated with greater central pulse pressure.

Abstract P657: Association Between Perceived Discrimination and Arterial Stiffness: A Scoping Review

Introduction: The association of perceived discrimination (PD) and subclinical cardiovascular disease (CVD) risk has not been established, limiting our understanding of the importance of PD to CVD pathology. Purpose: With respect to PD and pulse wave velocity (PWV), a measure of arterial stiffness and subclinical CVD risk, this scoping review aimed to: (i) identify and synthesize the available research, and (ii) identify research gaps and make recommendations for future research. Hypothesis: We hypothesized that greater PD would be associated with greater (worse) PWV. Methods: All original research was eligible if it included adults (≥18 years) and co-measurement of PD and PWV. Electronic databases (PubMed, Embase, SPORTDiscuss, and CINALH+) were searched up to June 28 th , 2022. Results: We identified 419 articles, of which 58 were duplicates, and 355 were irrelevant. We reviewed the full text of six articles. Three articles evaluated the same cohort, so two were excluded to minimize confounding, and another for lacking a measure of PD. As summarized in Table 1, a total of three observational (one longitudinal) studies were identified from Brazil, the UK, and the US. In the UK and Brazil studies, PD was associated with greater (worse) PWV. The Brazil study also reported that Black and Brown adults had greater odds of high PWV (&gt;10 m/s) compared to the reference group and to those in the same racial/ethnic group without PD. For the US study, PD was significantly associated with PWV in non-Hispanic Black (NHB) females only. Conclusion: There was a trend of a positive association between PD and greater (worse) PWV. In the US, the positive association was evident only for NHB females, suggesting sex may impact the effect of PD on PWV. Future studies should focus on characterizing the effect of PD by sex and consider additional factors like intersectionality or coping mechanisms that may influence the association and predispose certain populations to added CVD risk.

Sex-specific associations of reservoir-excess pressure parameters with age and subclinical vascular remodeling.

Central artery reservoir pressure and excess pressure (XSP) are associated with cardiovascular disease (CVD) events and mortality. However, sex differences in the trajectory of central reservoir pressure and XSP with advancing age and their relations with vascular markers of subclinical CVD risk are incompletely understood. Therefore, we tested the hypothesis that central reservoir pressure and XSP would be positively associated with advancing age and vascular markers of subclinical CVD risk in men and women. Healthy adults ( n = 398; aged 18-80 years, 60% female individuals) had central (carotid) artery pressure waveforms acquired by applanation tonometry. Reservoir pressure and XSP peaks and integrals were derived retrospectively from carotid pressure waveforms using custom written software. Carotid artery intimal-medial thickness (IMT) was measured by ultrasonography, and aortic stiffness was determined from carotid-femoral pulse wave velocity (cfPWV). Reservoir pressure peak, reservoir pressure integral and XSP integral were higher with age in both men and women ( P < 0.05), whereas XSP peak was lower with age in men ( P < 0.05). In women, both reservoir pressure peak ( β = 0.231, P < 0.01) and reservoir pressure integral ( β = 0.254, P < 0.01) were associated with carotid artery IMT, and reservoir pressure peak was associated with cfPWV ( β = 0.120, P = 0.02) after adjusting for CVD risk factors. Central artery reservoir pressure and XSP were higher with advancing age in men and women, and reservoir pressure peak was associated with both carotid artery wall thickness and aortic stiffness in women but not men. Central reservoir pressure peak may provide some insight into sex differences in vascular remodeling and subclinical CVD risk with advancing age in healthy adults.

Abstract 12239: Objectively Measured Physical Activity Decreases the Risk of Subclinical Cardiovascular Disease: A Systematic Review

Introduction: Physical activity (PA) decreases the risk of cardiovascular events, but to what degree this is related to effects on surrogate markers of subclinical cardiovascular disease (CVD) is unclear. Clarifying the relationship between objectively measured PA and subclinical CVD would provide justification for using measures of subclinical CVD in clinical trials of PA interventions. Hypothesis: We hypothesized that higher levels of objectively measured PA are associated with less subclinical CVD. Methods: We performed a systematic review using Medline, Embase, CINAHL and Cochrane (January 1, 2000 - January 12, 2022). Studies of adult populations that examined the relationship between objectively measured PA (accelerometry) and subclinical CVD were included. Markers for subclinical CVD included: ankle brachial index ( n =4 studies); arterial stiffness ( n =31); carotid artery plaque/stenosis and intima media thickness ( n =9); coronary artery atherosclerosis ( n =4); endothelial function ( n =8); measures of cardiac structure and function ( n =4); and eight studies included multiple of the aforementioned outcomes. For those studies, we considered results on each outcome separately. Risk of bias was also assessed. Results: PA was inversely associated with subclinical CVD in 60 of 78 included analyses (76.9%). Of these, five studies (6.4%) found only an association with higher levels of PA. In six studies (7.7%), PA was no longer associated with subclinical CVD after adjustment for confounders. Seven analyses (9.0%) demonstrated mixed results but demonstrated an inverse relationship between PA and subclinical CVD in specific circumstances. Only 18 studies (23.1%) suggested that PA was not associated with decreased subclinical CVD. Conclusions: Increased PA is associated with less subclinical CVD across diverse populations. Interventions to increase PA have the potential to reduce the burden of subclinical CVD and, therefore, clinical CVD events.

Relationship of Endothelial Microparticles to Obesity and Cardiovascular Disease Risk in Children and Adolescents.

Background Microparticles and endothelial microparticles (EMPs) are implicated in accelerating cardiovascular disease (CVD); however, data in pediatrics are limited. We examined the relationship of microparticles and EMPs with adiposity and subclinical CVD risk measures in a pediatric population to determine their potential as biomarkers of CVD risk. Methods and Results A cross-sectional study of youth (n=280; ages 8-20 years) with a range of body mass index categories was used. Microparticles, EMPs, and activated EMPs were measured by flow cytometry. %Body fat and %visceral adipose tissue were measured by dual X-ray absorptiometry. Measures of arterial stiffness and vascular wall structure were obtained. Linear regression (with log-transformed outcomes) and logistic regression were used to evaluate associations and all results were exponentiated. Youth with overweight/obesity and severe obesity had 2.50 (95% CI, 1.56-4.01) and 3.42 (95% CI, 2.15-5.43) times the geometric means of the total number of microparticles, respectively, compared with those with normal weight. Youth with overweight/obesity and severe obesity had 1.97 (95% CI, 1.09-3.55) and 2.34 (95% CI, 1.31-4.19) times the geometric means of the total number of EMPs, respectively, compared with those with normal weight. There were positive associations between the levels of both microparticles and EMPs with higher adiposity measures and poor CVD risk measures. Youth with higher adiposity showed 1.84 times the odds of having high levels of activated EMPs (%) (odds ratio, 1.84; 95% CI, 1.08-3.14) compared with those with normal weight. Conclusions Levels of microparticles, EMPs, and activated EMPs were positively associated with adiposity and poor subclinical CVD risk in a pediatric population.

The Africans in America study demonstrates that subclinical cardiovascular risk differs by etiology of abnormal glucose tolerance

Abnormal-glucose tolerance (Abnl-GT) is due to an imbalance between β-cell function and insulin resistance (IR) and is a major risk factor in cardiovascular disease (CVD). In sub-Saharan Africa, β-cell failure is emerging as an important cause of Abnl-GT (Abnl-GT-β-cell-failure). Visceral adipose tissue (VAT) volume and hyperlipidemia are major contributors to CVD risk when Abnl-GT is due to IR (Abnl-GT-IR). Yet, the CVD profile associated with Abnl-GT-β-cell failure is unknown. Therefore, our goals in 450 African-born Blacks (Male: 65%; Age: 39 ± 10 years; BMI 28 ± 5 kg/m2), living in America were to: (1) determine Abnl-GT prevalence and etiology; (2) assess by Abnl-GT etiology, associations between four understudied subclinical CVD risk factors in Africans: (a) subclinical myocardial damage (high-sensitivity troponin T (hs-cTnT)); (b) neurohormonal regulation (N-terminal pro-Brain-natriuretic peptide (NT-proBNP)); (c) coagulability (fibrinogen); (d) inflammation (high-sensitivity C-reactive protein (hsCRP)), as well as HbA1c, Cholesterol/HDL ratio and VAT. Glucose tolerance status was determined by the OGTT. IR was defined by the threshold at the lowest quartile for the Matsuda Index (≤ 2.97). Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell-failure was defined as Abnl-GT without IR. VAT was assessed by CT-scan. For both the Abnl-GT-β-cell-failure and Abnl-GT-IR groups, four multiple regression models were performed for hs-cTnT; NT-proBNP; fibrinogen and hsCRP, as dependent variables, with the remaining three biomarkers and HbA1c, Cholesterol/HDL and VAT as independent variables. Abnl-GT occurred in 38% (170/450). In the Abnl-GT group, β-cell failure occurred in 58% (98/170) and IR in 42% (72/170). VAT and Cholesterol/HDL were significantly lower in Abnl-GT-β-cell-failure group vs the Abnl-GT-IR group (both P < 0.001). In the Abnl-GT-β-cell-failure group: significant associations existed between hscTnT, fibrinogen, hs-CRP, and HbA1c (all P < 0.05), and none with Cholesterol/HDL or VAT. In Abnl-GT-IR: hs-cTnT, fibrinogen and hsCRP significantly associated with Cholesterol/HDL (all P < 0.05) and NT-proBNP inversely related to fibrinogen, hsCRP, HbA1c, Cholesterol/HDL, and VAT (all P < 0.05). The subclinical CVD risk profile differed between Abnl-GT-β-cell failure and Abnl-GT-IR. In Abnl-GT-β-cell failure subclinical CVD risk involved subclinical-myocardial damage, hypercoagulability and increased inflammation, but not hyperlipidemia or visceral adiposity. For Abnl-GT-IR, subclinical CVD risk related to subclinical myocardial damage, neurohormonal dysregulation, inflammation associated with hyperlipidemia and visceral adiposity.ClinicalTrials.gov Identifier: NCT00001853.

Cognition impairment and risk of subclinical cardiovascular disease in older adults: The atherosclerosis risk in communities study.

BackgroundClinical cardiovascular disease (CVD) and cognition impairment are common and often coexist in aging populations, and CVD is associated with greater cognition impairment risk; however, the association between cognition impairment and CVD risk is inconsistent. It is unknown if pathways that contribute to CVD are caused by impaired cognition. We hypothesized that cognition impairment would be associated with greater subclinical CVD including subclinical myocardial damage [assessed by high-sensitivity cardiac troponin T (hs-cTnT)] and cardiac strain or dysfunction [assessed by N-terminal pro-B-type natriuretic peptide (NT-proBNP)].MethodsThis analysis included Atherosclerosis Risk in Communities Study (ARIC) participants who underwent global cognition z-score tests between 1991 and 1993. Cardiac biomarkers were measured from stored plasma samples collected between 1996 and 1999. Logistic regression models were used to determine the association of cognitive function with subclinical CVD risk.ResultsThere were 558/9216 (6.1%) and 447/9097 (5.0%) participants with incident elevated hs-CTnT (≥14 ng/L) and NT-proBNP (≥300 pg/mL) levels, respectively. Comparing the lowest and highest quartiles of global cognition z-scores, a higher incidence of elevated hs-CTnT [odds ratio (OR) = 1.511, 95% confidence interval (CI): 1.093–2.088, P = 0.013] and NT-proBNP (OR = 1.929, 95% CI: 1.350–2.755, P < 0.001) were observed, respectively. In structural equation modeling, the indirect effect of global cognition z-score on major adverse cardiac events was 42.1% (P < 0.05).ConclusionImpairments in baseline cognitive function were associated with subclinical myocardial damage or wall strain. Although future studies are warranted to investigate the pathophysiological mechanisms behind these associations, our study suggests common pathways between cognitive and cardiac dysfunction.

Sex differences in the association of vital exhaustion with regional fat deposition and subclinical cardiovascular disease risk

ObjectiveVital exhaustion (VE) is more strongly associated with cardiovascular disease (CVD) risk for women than men. This study examined whether sex differences in associations of VE with CVD risk markers are accounted for by unique associations of VE with regional adiposity. MethodsThe study enrolled 143 persons (18–55 years) without diagnosed conditions. VE was assessed by the Maastricht questionnaire. CVD indices were measured using the euglycemic-hyperinsulinemia clamp, resting blood pressure, and blood draws. Regional adiposity was measured using computed tomography and 2-D echocardiography. This cross-sectional study employed a path analysis approach, including relevant covariates. ResultsOf the cohort, aged 38.7 ± 8.4 years, 65% were men, and 41% were obese. The final model had excellent fit (χ2(36) = 36.5, p = .45; RMSEA = 0.009, CFI = 0.999). For women, but not men, the model indicated paths from VE to: 1) lower insulin sensitivity (B = −0.10, p = .04), and higher total cholesterol to HDL ratio (B = 0.12, p = .09), triglycerides (B = 0.10, p = .08), and C-reactive protein (B = 0.08, p = .09) through visceral adiposity; 2) higher mean arterial pressure (B = 0.14, p = .04), lower insulin sensitivity (B = −0.09, p = .08), and higher C-reactive protein (B = 0.12, p = .07) through subcutaneous adiposity; 3) lower insulin sensitivity (B = −0.07, p = .08) and higher total cholesterol to HDL ratio (B = 0.16, p = .03) through liver adiposity; and 4) higher C-reactive protein (B = 0.08, p = .09) through epicardial adiposity. ConclusionResults extend prior evidence by showing that the association of VE with CVD risk in women is linked with specific regional adiposity elevation. Further study of adiposity-related mechanisms in women who experience early decline in vitality may inform clinical targets for CVD prevention.

Stress and social isolation, and its relationship to cardiovascular risk in young adults with intellectual disability

Purpose Stress produces many physiological changes, some of which may contribute to the development of cardiovascular disease (CVD). Individuals with intellectual disability (ID) are exposed to multiple and stressful challenges everyday which may put them at increased cardiovascular risk. This current study aimed to establish whether adults with ID experience higher levels of subjective stress and encounter different stressors (including social isolation) than the general population, and whether there is a relationship between stress and cardiometabolic profile in this population. Methods Adults with ID (n = 35) aged 18–45 years completed the Subjective Stress Survey, and underwent a physiological assessment to measure blood pressure, metabolic profile and subclinical CVD risk factors, and were compared to a control group (n = 29). Multiple regression was used to investigate whether cardiometabolic parameters were predicative of SSS scores. Results Findings showed adults with ID have higher perceived stress levels (total score ID: 21.3 ± 11.4 vs control: 13.9 ± 9.0, p = 0.006), which is elicited by unique stressors, when compared to people without ID. Stress was strongly associated with increased social isolation (r = −0.38, p = 0.002) and with obesity in females with mild ID (r = 0.72). Regression showed that arterial stiffness was predictive of total SSS score (p = 0.038). Conclusions Adults with ID aged 18–45 years report higher levels of perceived stress when compared to people without ID. Implications for Rehabilitation Reducing stress in this young population may prevent development of arterial stiffness, and consequently lower the risk of cardiometabolic morbidity and mortality. There are unique targets for stress management in young adults with intellectual disability, including supporting decision-making and improving self-efficacy. Improving community integration and reducing social isolation may decrease perceived stress in young adults with intellectual disability.

Abstract 9962: Associations of Prepregnancy Cardiovascular Health and Adverse Pregnancy Outcomes with Incident Coronary Artery Calcium During Midlife: A Mediation Analysis in the Coronary Artery Risk Development in Young Adults Study

Introduction: Adverse pregnancy outcomes (APOs) are emerging as critical risk markers for the development of cardiovascular disease (CVD). Risk of APOs are higher among women with worse prepregnancy cardiovascular health (CVH), but it remains unclear if APOs mediate the relationship between prepregnancy CVH and incident coronary artery calcium (CAC). Methods: We included individuals in the Coronary Artery Risk Development in Young Adults study with at least one singleton birth prior to 2001 and data on prepregnancy CVH (1985-1996) and CAC (2000-2011). Data on APOs were self-reported at each visit (gestational diabetes, hypertensive disorders of pregnancy, preterm birth and small for gestational age). We quantified prepregnancy CVH by summing across the American Heart Association’s Life’s Simple 7 (score 0-14). We used Cox proportional hazards models to obtain hazard ratios (HRs) for a one-point higher (better) prepregnancy CVH score for incident CAC (CAC &gt; 0) adjusted for age, self-reported race, education (years) and parity. We used causal mediation analyses to estimate the proportion of the association between prepregnancy CVH and incident CAC mediated through any APO and each APO subtype. Results: Of the 906 included participants, 46.1% were Black, mean age ± SD was 28.1 ± 4.5 years at baseline and 43.0 ± 4.8 years at follow-up. Among individuals with low (0-7), intermediate (8-11) and high (12-14) prepregnancy CVH, APOs developed in 41.8%, 29.5% and 19.5% respectively, and CAC developed in 38.8%, 14.8% and 11.6% of women, respectively. Adjusted HR (95% CI) for one-point higher (better) prepregnancy CVH on incident CAC was 0.79 (0.72, 0.87). APOs did not significantly mediate the relationship between prepregnancy CVH and CAC ( TABLE ). Conclusions: Higher or more favorable prepregnancy CVH is associated with lower risk of subclinical CVD in midlife, regardless of APO status, and highlights the importance optimizing CVH early in the life course prior to pregnancy.

Central Blood Pressure and Subclinical Atherosclerotic Risk in Young Hispanic American Women.

The incidence of younger women being hospitalized from cardiovascular disease (CVD) events is on the rise. Hispanic women are generally thought to have higher CVD risk factor burden than non-Hispanic White (NHW) women yet Hispanic Americans have lower mortality from CVD. Traditional measures of CVD may not accurately capture CVD risk in Hispanic Americans. Hence, the purpose of this study was to assess the impact of ethnicity on vascular reactivity and central hemodynamic load to gain insight into subclinical CVD risk in young women. Brachial flow-mediated dilation (FMD), low-flow mediated constriction (L-FMC), carotid-femoral pulse wave velocity (cfPWV), and pulse wave analysis (from synthesized aortic pressure waveforms) were measured in 25 Hispanic women and 31 NHW women aged between 18-35 years. FMD and L-FMC were combined to provide an index of total vessel reactivity. NHW and Hispanic women did not differ in age or traditional CVD risk factors (P>.05 for all). Compared with NHW women, Hispanic women had greater vascular reactivity (8.7±4.1 vs 11.7±4.1 %, P=.011), lower central pulse pressure (28±5 vs 24±3 mm Hg, P=.001) and lower pressure from wave reflections (12±2 vs 10±1 mm Hg, P=.001). There were no differences in cfPWV between NHW women and Hispanic women (5.4±0.7 vs 5.3±0.7 m/s, P=.73). Young Hispanic women have greater vascular reactivity and lower central pulsatile hemodynamic load compared with NHW women, suggesting lower subclinical CVD risk.

Cardiac calcium score in systemic sclerosis.

Cardiac coronary Ca score (CCS), and extra coronary Ca score (ECCS) estimation in asymptomatic systemic sclerosis (SSc) patients and their relation to different disease and patients' variables. The CCS and ECCS were estimated in asymptomatic 20 SSc patients compared to 20 age and sex-matched healthy control using non-contrast cardiac computed tomography. All were applied for cardiac history taking, examination, echocardiography, body mass index (BMI), complete blood picture, erythrocyte sedimentation rate, and lipid profile estimation. The SSc patients were 11 females and 9 males with a mean age of (42.55 ± 9.145) and mean disease duration (12.9 ± 6.774). CCS was reported in 9 (45%) SSc cases and 2 (10%) of the control; (p = 0.013) and was significantly greater in SSc patients (58.4 ± 175.443) than in the control group (0.7 ± 2.25); (p = 0.01). The ECCS was significantly higher in SSc cases (194.45 ± 586.511) than control group (2.8 ± 7.8); (p = 0.001) and reported in 16 (80%) SSc cases and 3 (15%) of controls; (p = 0.000). Limited scleroderma cases had higher scores than diffuse type. Patients with total ca score (> 100) were older (p = 0.016), had longer disease duration (p = 0.001) and greater BMI (p = 0.002). Significant correlation was found between the log-transformed CCS and disease duration, age, BMI, left ventricular mass, and mass index. Systemic sclerosis patients are at increased risk of subclinical cardiovascular disease determined by cardiac Ca scoring as a noninvasive and reliable method. Extra coronary calcification may be an earlier indicator for this. Disease duration is a determinant risk factor for cardiac calcification in SSc. Key Points • Although the association between interleukin-6 (IL-6) promoter polymorphism and rheumatic arthritis (RA) has been discussed in the previous meta-analysis, their conclusions are inconsistent. • Systemic sclerosis patients are at high risk of accelerated atherosclerosis and cardiovascular diseases. Coronary atherosclerosis was previously estimated in SSc patients through coronary angiography. A novel method of assessing coronary artery disease is the coronary calcium score, as determined by multidetector computed tomography, it measures coronary artery calcification that occurs in atherosclerotic plaque. In this study, the cardiac coronary and extra coronary Ca score were evaluated in relation to disease characteristics in asymptomatic SSC patients for early detection of coronary artery disease.

Association of dietary isoflavone consumption with subclinical cardiovascular disease in middle-aged and elderly Chinese people

Background and aimsThe association between isoflavone (ISF) consumption and cardiovascular disease (CVD) remains controversial because of limited evidence. Carotid atherosclerosis is an established indicator of subclinical CVD. The study aimed to investigate the relationship between dietary ISF intake and subclinical CVD in middle-aged and elderly adults. Methods and resultsA total of 873 subjects aged 40–70 years without CVD were enrolled in this cross-sectional study. A restricted cubic spline was used to investigate the association between ISF intake and subclinical CVD risk. The odds ratio (OR) and 95% confidence interval of the risk of subclinical CVD for ISF were estimated by two-segmented logistic regression analysis. In Model 2, there was a non-linear association between ISF intake and the risk of subclinical CVD among women (Pnon-linear = 0.002), with an inverse association below the change point. The nadir for the risk of subclinical CVD among women was 7.26 mg/day (energy-adjusted). Below the change point, an increase of 1 mg ISF/day reduced the risk of subclinical CVD by 15%. There was no significant association between ISF intake and subclinical CVD risk above the change point (OR = 1.01 [0.99, 1.04]). ISF intake was not associated with subclinical CVD risk in men (Model 2: Pnon-linear = 0.224). ConclusionsBelow the change point (7.26 mg/day), women with a higher intake of ISF had a significantly lower risk of subclinical CVD. Encouraging the consumption of ISF-rich foods may help to lower CVD risk in middle-aged and elderly women. Trial registrationThis study is registered at http://www.chictr.org.cn (ChiCTR 1900022445).

Association of recurrent common infections and subclinical cardiovascular disease in Mexican women.

BackgroundAcute and agent-specific chronic infections have been associated with increased cardiovascular risk, however data on the burden of common recurrent infections on cardiovascular disease is limited. We hypothesized women with greater exposure to uncomplicated common infectious events had an increased risk of subclinical cardiovascular disease (sCVD).MethodsIn a cross-sectional study, we assessed the relation of recurrent infections and carotid artery intima-media thickness (IMT) in 1946 disease-free women from the Mexican Teachers’ Cohort. Through 2012–2016, participants answered structured questions on respiratory, urinary and vaginal infections during the previous year and their IMT was measured using ultrasound by standardized neurologists. We defined sCVD as mean right and left IMT ≥0.8 mm or the presence of atheromatous plaque. Multivariable linear and logistic regression analyses were used to evaluate the association of infectious events with IMT and sCVD adjusting for age, sociodemographic, and cardiovascular risk factors.ResultsAmong participants (50±5 years) 13% reported no infections, 20% one infection and 67% three or more episodes. Overall prevalence of sCVD was 12%(n = 240). Adjusted models for logistic regression showed that women with 2 or more infections had 91% higher odds of sCVD (OR 1.91; 95%CI 1.16, 3.13) compared to women without infections (p-trend:0.015). Sub-analyses by type of infection resulted not significant. Linear regression analysis did not show a significant association between mean IMT and recurrent infections.ConclusionsRecurrent infectious events in young adult women are associated with greater sCVD, which supports the hypothesis of low-grade chronic inflammation in the pathophysiology of cardiovascular disease.

Sex differences in the association between PTSD symptoms with cardiac autonomic function and subclinical atherosclerotic risk.

Post-traumatic stress disorder (PTSD) is a public health concern that may elevate the risk for cardiovascular disease (CVD). There are established sex differences in both PTSD risk and CVD risk. To examine sex-specific associations between subclinical PTSD symptom severity and subclinical CVD risk in young men and women. A total of 61 young adults (women: n=29, mean age: 26±7years) completed the post-traumatic stress disorder civilian checklist (PCL) and the Center for Epidemiologic Studies Depression Scale (CES-D). Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV). Peripheral vasomotor function was measured as flow-mediated slowing (FMS) of carotid-radial PWV following 5-min forearm occlusion. Heart rate variability was used to assess sympathovagal balance as LF/HF ratio. PCL score was positively correlated with CES-D score (r=0.79, p<.001), cfPWV (r=0.33, p=.03) and LF/HF ratio (r=0.42, p=.009) in men. PCL score was positively correlated to CES-D score (r=0.80, p<.001) in women, but was inversely correlated to cfPWV (r=-0.38, p=.02) and LF/HF ratio (r=-0.34, p=.04). PCL score was also inversely associated with FMS in women (r=-0.49, p=.01). There are sex differences in the association of PTSD symptoms and subclinical atherosclerosis. In men, increased PTSD symptoms may increase CVD risk by increasing sympathovagal balance and aortic stiffness. In women, increased PTSD symptoms may increase CVD risk via reducing vasomotor function.

Association between personality profile and subclinical atherosclerosis: The role of genes and environment

BackgroundThe mechanism underlying the association between personality profile and subclinical atherosclerosis is poorly understood. This study explores the association between personality, carotid atherosclerosis and arterial stiffness, and the contribution of genes and environment to this association. MethodsEarly atherosclerotic traits, including carotid intima-media thickness (CCA-IMT), aortic pulse wave velocity (PWVao) and heart rate, were assessed in 318 adult twins, who also completed a Big Five personality questionnaire. Using the co-twin control approach, the association between intra-pair differences in clinical and personality scores was assessed in dizygotic (DZ) and monozygotic (MZ) twins separately. ResultsAn association between CCA-IMT and extroverted personality, as well as between PWVao and openness to experience was detected. The inverse association between CCA-IMT and extraversion was persistent in DZ and disappeared in MZ twins, suggesting genetic confounding. In contrast, the association between PWVao and openness to experience was of the same magnitude in DZ and MZ twins, thus surviving the adjustment for genetic and shared environmental factors. ConclusionsThis study highlights that the association between some psychological factors and cardiovascular traits may be partly explained by genetic factors. This result may provide support for the feasibility of prevention programs based on assessing familiarity for personality disorders to detect genetic risk for subclinical cardiovascular disease.

Dietary intake of isoflavones is associated with a lower prevalence of subclinical cardiovascular disease in postmenopausal women: cross-sectional study.

Menopause has been associated with an increased risk of cardiovascular disease. It has been shown that isoflavones protect vascular endothelial cells against induced oxidative stress injury. Therefore, the present study aimed to investigate the association between the dietary intake of isoflavones and the presence of subclinical cardiovascular disease (CVD) in postmenopausal women. Ninety-six postmenopausal women [mean (SD) age 55.2(4.9)years, body mass index (BMI) 27.2(4.6)kgm-2 ] completed the study protocol. Habitual physical activity was assessed using a digital pedometer, resting metabolic rate was measured by indirect calorimetry and dietary intake was assessed via a validated food frequency questionnaire. Subclinical CVD was defined as carotid artery intima-media thickness (C-IMT) >0.9mm and/or the presence of one or more atherosclerotic plaques in any of the studied segments. Mean (SD) C-IMT was 0.74(0.2)mm, 25% of participants were found to have atherosclerotic plaques and the prevalence of subclinical CVD was 35%. Participants with subclinical CVD were more likely to consume less selenium, magnesium, folate and isoflavones, even after adjusting for total energy intake. A multivariate-adjusted regression model showed that a BMI >27kgm-2 was associated with 90% higher risk of having ≥1 plaque and/or C-IMT >0.9mm (P=0.017). Higher oestradiol levels (P=0.004) and isoflavone intake (P=0.021) were independently associated with a lower risk of having subclinical CVD. In the present study, we observed that a higher isoflavone dietary intake was associated with a lower risk of subclinical CVD in postmenopausal women, independent of BMI and endogenous oestradiol levels.