Role Of Traditional Risk Factors Research Articles

Diagnosis and Management of Cardiovascular Risk in Individuals With Spinal Cord Injury: A Narrative Review.

More than 16 000 Americans experience spinal cord injury (SCI), resulting in chronic disability and other secondary sequelae, each year. Improvements in acute medical management have increased life expectancy. Cardiovascular disease is a leading cause of death in this population, and seems to occur earlier in individuals with SCI compared with the general population. People with SCI experience a high burden of traditional cardiovascular disease risk factors, including dyslipidemia and diabetes, and demonstrate anatomic, metabolic, and physiologic changes alongside stark reductions in physical activity after injury. They also experience multiple, complex barriers to care relating to disability and, in many cases, compounding effects of intersecting racial and socioeconomic health inequities. Given this combination of risk factors, some investigators have proposed that people with SCI are at increased risk for cardiovascular disease, beyond that associated with traditional risk factors, and SCI could be considered a risk-enhancing factor, analogous to other risk-enhancing factors defined by the 2019 American Heart Association/American College of Cardiology Primary Prevention Guidelines. However, more research is needed in this population to clarify the role of traditional risk factors, novel risk factors, health care access, social determinants of health, and intersectionality of disability, race, and socioeconomic status. There is an urgent need for primary care physicians and cardiologists to have awareness of the importance of timely diagnosis and management of cardiac risk factors for people with SCI.

Venous Thromboembolism in Rheumatoid Arthritis: The Added Effect of Disease Activity to Traditional Risk Factors.

Many epidemiological studies have shown an increased risk of venous thromboembolism (VTE) in patients with rheumatoid arthritis (RA). RA and VTE share some background factors, such as increasing age, smoking, and obesity. At the same time, other VTE factors, such as knee replacement and oral contraceptive pills, occur commonly in RA patients. In addition, the chronic inflammatory state of RA might hypothetically lead to endothelial injury and a hypercoagulable state. Two critical pathophysiological pathways lead to VTE. Recently, concerns increased about the increased risk of VTE in patients using Janus Kinase inhibitors. This review aims at reviewing the risk of VTE in RA and the role of traditional risk factors and disease-related inflammation and develops a conceptual framework that describes the interaction between these factors.

Role of Traditional Cardiovascular Risk Factors after Initiation of Statin Therapy: A PharmLines Inception Cohort Study.

Background Multiple studies and meta-analyses examined the role of traditional risk factors for cardiovascular events in statin treatment-naive patients. Nowadays, millions receive such therapy for the primary prevention of cardiovascular events (CVE). Objective CVEs still occur in patients on primary preventive statin therapy. Therefore, further risk stratification within these patients is urgently needed. Methods Using the unique linkage between biomedical data and prescription data from the PharmLines Initiative, we assessed the role of several risk factors used in cardiovascular risk models, using a time-dependent Cox PH model, in the occurrence of drug treatment of CVEs after initiation of statin therapy. Results Among 602 statin therapy starters, 11% received drug treatment for CVE within an average follow-up period of 832 days. After multivariable modelling, cholesterol levels and blood pressure at baseline were no longer associated, whereas self-reported diabetes and increasing age were highly associated with the outcome when on statin therapy (hazard ratio (HR): 3.01, 95% confidence interval (95% CI): 1.48-6.12 and 1.04; 95% CI: 1.01-1.07, respectively). Males, smokers, and nonadherent patients had increased risks (HR 1.6, 1.12, and 1.18, resp.), though not statistically significant. Conclusion Drug treatment for CVEs after statin initiation is increased in patients with diabetes type 2, in aged patients, males, smokers, and those with poor adherence, while there was no association with baseline cholesterol levels and blood pressure. These factors should be taken into account during the monitoring of statin therapy and may lead to changes in statin treatment or risk-related lifestyle factors.

Defining the role of exposure to ACEs in ADHD: Examination in a national sample of US children

BackgroundClinical presentations of ADHD vary according to biological and environmental developmental influences. An emerging field of research has demonstrated relationships between exposure to adverse childhood experiences (ACEs) and ADHD prevalence, particularly in high-risk samples. However, research examining the combined role of traditional risk factors of ADHD and ACEs is limited, and reliance on high-risk samples introduces sampling bias. ObjectiveTo examine the influence of ACEs on ADHD diagnosis using a large, nationally representative sample of US children. Participants and settingNationally representative samples (2017 and 2018) of 40,075 parents from the National Survey of Children’s Health (NSCH). MethodsWe conducted logistic regression models to examine the association of ACEs and ADHD diagnosis, controlling for child and parent demographic variables and other risk factors. ResultsExposure to ACEs was significantly associated with parent-reported ADHD diagnosis, controlling for known parental and child-risk factors of ADHD. The association followed a gradient pattern of increased ADHD prevalence with additional exposures. Compared to children with no ACEs, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration. ConclusionsResults further strengthen the evidence that ACEs exposure is associated with increased ADHD prevalence. Clinicians should assess ACEs in the diagnosis of ADHD. Furthermore, results of the study lend support to the efforts of agencies (both institutional and state-level) promoting routine screening of ACEs in children.

Rediscussing the Role of Traditional Risk Factors in Young Adults With Oral Squamous Cell Carcinoma.

The current literature conjectures that oral squamous cell carcinoma (OSCC) in younger patients is an entirely separate entity with a different risk profile. We aimed to uncover the potential risk factors of OSCC and evaluated the long-term outcome in such patients. This hospital-based case-control study included 40 patients with OSCC and 40 controls under the age of 46 years. Survival was analyzed via Kaplan-Meier estimates, including a follow-up of up to 24.3 years. The patients with OSCC were prone to smoking and drinking heavily and even suffered secondary organ damage to the lungs and the liver at this young age. Early diagnosed as well as surgically treated patients had superior 5-year recurrence-free and overall survival. Young patients with OSCC were found to have a traditional risk profile. Secondary organ damage to the liver and the lungs might be considered as a risk indicator. The meticulous screening of every age group with this risk profile is key to early diagnosis and acceptable treatment results.

The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III)

Objective─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ​≥ ​3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.

Abstract P552: The Role of Traditional Risk Factors in Mediating the Influence of Cumulative Social Risk Exposure on Cardiovascular Death

Introduction: Cumulative social risk exposure, defined as experiencing more than one social risk factor and captured through an index of cumulative social risk, is associated with a significant increase in cardiovascular disease (CVD) mortality. However, the role of CVD risk factors in explaining this association is unclear. Methods: This analysis included 15,906 participants (45.6±19.5 years, 53.4% women, 57.7% minority race) from the Third National Health and Nutrition Examination Survey (NHANES-III) who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio&lt;1, education&lt;12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). The mediation by each CVD risk factor was assessed by estimating the magnitude of attenuation in the hazard ratio for the association between social risk score and CVD death adjusted by demographics and risk factors. Results: During a median follow up of 14 years, 1,309 CVD deaths occurred. Participants with more than one social risk factor were at increased risk of CVD death (Table) . The risk of CVD death in demographic adjusted models was attenuated by 31%, 21% and 36% in people with social risk score 1, 2, and ≥3 versus 0, respectively, after further adjustment for traditional CVD risk factors. Among all CVD risk factors included in the analysis, current smoking was the most powerful mediating effect, accounting for approximately one half of the combined risk factor effect, followed by obesity and diabetes ( Table ). Conclusions: Traditional CVD risk factors explain about one third of the association between cumulative social risk exposure and CVD death. While these findings underscore the importance of management of traditional CVD risk factors, particularly smoking, in socially disadvantaged population, they call for further studies to identify other pathways that explain the link between social risk exposure and CVD.

The Role of Traditional Risk Factors and Inflammation Activity in Atherosclerosis Development in Psoriatic Arthritis Patients

It is known that patients with autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus) have early atherosclerosis development which might lead to the life threatening complications and death. Epidemiology studies demonstrated the risk of myocardial infarction, cardiovascular death is increased in patients with psoriatic arthritis (PsA), which also can be explained by premature atherosclerosis development but its risk factors (RF) remain unclear.The objective: defining relationship of traditional RF for cardiovascular diseases (CVD) with the activity of the inflammatory process and atherosclerosis in patients with PsA.Materials and methods. The study included 42 patients with PsA and 20 patients with skin psoriasis (PS) who did not have atherosclerotic CVD, diabetes, chronic kidney disease and other serious diseases and did not take statins. The control group consisted of 20 healthy persons who had no signs of rheumatic, infectious and other inflammatory diseases. All enrolled patients underwent complete physical examinations, evaluation of disease activity (DAS28, PASI indexes); laboratory investigations included full blood count and ESR, CRP, plasma lipids and uric acid level. Ultrasound of carotid arteries was performed to evaluate the surrogate atherosclerosis markers – intima-media complex thickness (IMT) and atherosclerotic plaques (AP).Results. It was determined that in patients with PsA, the severity of the atherosclerotic process is more prominent compared to patients with PS (the traditional RF profiles were the same).Сonclusion. The highest level of C-reactive protein, fibrinogen, uric acid, thicker intima-media complex was found in PsA group, which may indicate a pathogenetic association of additional RF with the development of a more aggressive atherosclerotic process.

Similarities and Differences Between Carotid Artery and Coronary Artery Function.

Background: Cardiovascular Disease (CVD) remains one of the leading causes of mor-bidity and mortality. Strategies to predict development of CVD are therefore key in preventing and managing CVD. One stratergy in predicting CVD is by examining the role of traditional risk factors for CVD (e.g. age, sex, weight, blood pressure, blood lipids, blood glucose, smoking and physical activity). Although these measures are non-invasive and simple to perform, they provide limited in-formation of CVD prediction. Directly examining functional characteristics of arteries that are in-volved in the pathophysiological changes that contribute to the development of CVD improve predic-tion of future CVD. Nevertheless, examining the function of arteries susceptible to atherosclortic changes, such as the coronary arteries, is invasive, expensive, and associated with high risk for com-plications. More accessible arteries can be used as a surrogate measure of coronary artery function. For example, the carotid artery may be a superior surrogate measure of coronary artery function given that, the carotid artery represents a central vessel that shows similarities in vasomotor function and anatomical structure with coronary arteries.Conclusion: This review summarises the similarities between the carotid and coronary arteries, de-scribes how both arteries respond to specific vasoactive stimuli, and discusses if the easily assessible carotid artery can provide information about vascular function (e.g. vasomotor reactivity to sympa-thetic stimulation) which is prognostic for future cardiovascular events. Finally, the impact of older age and lifestyle interventions (e.g. exercise training) on carotid artery function will be discussed

Impact of body fat changes in mediating the effects of antiretroviral therapy on blood pressure in HIV-infected persons in a sub-Saharan African setting.

BackgroundPrevious studies of HIV-infected patients have shown significant associations between highly active antiretroviral therapy (HAART) and increased blood pressure; however, the mechanisms involved are less clear. Therefore, we sought to investigate the potential impact of body fat changes in mediating the effects of HAART on blood pressure changes among people living with HIV.MethodsFour hundred six consenting patients (≥18 years of age) attending a tertiary HIV clinic in semi-urban Nigeria were recruited between August and November 2014 as part of a cross-sectional study. We performed bias-corrected bootstrap tests of mediation using 95 % confidence intervals (CI) to determine the mediating effects of body mass index and waist circumference (mediators) on the total effects of HAART exposure (primary predictor) on blood pressure (outcome), while controlling for age, sex and other potential confounders.ResultsWaist circumference remained a significant partial mediator of the total effects of HAART exposure on increasing systolic blood pressure (coefficient: 1.01, 95 % CI: 0.33 to 2.52, 11 % mediated) and diastolic blood pressure (coefficient: 0.68, 95 % CI: 0.26 to 1.89, 9 % mediated) after adjusting for age, sex, smoking status, CD4 count and duration of HIV infection. No significant mediating effect was observed with body mass index alone or in combination with waist circumference after adjusting for all potential confounders.ConclusionWaist circumference significantly mediates the effects of HAART on blood pressure in persons living with HIV, independent of the role of traditional risk factors. The use of waist circumference as a complementary body fat measure to body mass index may improve the clinical prediction of hypertension in HIV-infected patients on antiretroviral therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0152-7) contains supplementary material, which is available to authorized users.

Epidemiology of Diabetes-Status of a Pandemic and Issues Around Metabolic Surgery.

The number of people with diabetes worldwide has more than doubled during the past 20 years. One of the most worrying features of this rapid increase is the emergence of type 2 diabetes in children, adolescents, and young adults. Although the role of traditional risk factors for type 2 diabetes, such as genetic, lifestyle, and behavioral risk factors, has been given attention, recent research has focused on identifying the contributions of epigenetic mechanisms and the effect of the intrauterine environment. Epidemiological data predict an inexorable and unsustainable increase in global health expenditure attributable to diabetes, so disease prevention should be given high priority. An integrated approach is needed to prevent type 2 diabetes and must recognize its heterogeneity. Future research needs to be directed at improved understanding of the potential role of determinants, such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programs. Equally important is a better understanding of the role of metabolic surgery in helping to address the management both of persons with type 2 diabetes and of those persons in the community who are at higher risk for type 2 diabetes, particularly in emerging nations where the diabetes epidemic is in full flight.

Abstract P079: Body Fat Changes Mediate the Effects of Antiretroviral Therapy on Blood Pressure and Blood Glucose Levels in People Living with HIV in a Sub-Saharan African Setting: A Mediation Analysis

Background: Previous studies of HIV-infected patients show significant associations of highly active antiretroviral therapy (HAART) with worsening blood pressure and blood glucose levels; however, the mechanisms involved are less clear. Therefore, we sought to investigate the potential mediating effects of body fat changes on HAART-associated increases in blood pressure and blood glucose levels among people living with HIV. Methods: Four Hundred and Six consenting patients (≥ 18 years) attending a tertiary HIV clinic in semi-urban Nigeria were recruited between August and November 2014 as part of a cross-sectional study. We performed bias-corrected bootstrap tests of mediation using 95% confidence intervals (CI) to determine the mediating effects of body mass index and waist circumference (mediators) on the total effects of HAART exposure (primary predictor) on blood pressure and blood glucose levels (outcomes), while adjusting for potential confounders including age, sex, smoking status, CD4 cell count and duration of HIV infection. Results: Waist circumference remained a significant partial mediator of the total effects of HAART exposure on increasing systolic blood pressure (coefficient: 1.01, 95% CI 0.33 to 2.52, 11% mediated), diastolic blood pressure (coefficient: 0.68, 95% CI 0.26 to 1.89, 9% mediated) and blood glucose levels (coefficient: 0.67, 95% CI 0.14 to 1.67, 25% mediated) after adjusting for all potential confounders; whereas, no significant mediating effect was observed with body mass index or combined body mass index/waist circumference. Conclusion: Our findings suggest that body fat, especially central fat accumulation, may mediate HAART-associated increases in blood pressure and blood glucose levels among HIV-infected patients, independent of the role of traditional risk factors. The use of waist circumference as a complementary measure of body fat to body mass index may improve the clinical prediction of hypertension and diabetes among HIV-infected patients on antiretroviral therapy.

Aortic Intima-Media Thickness as an Early Marker of Atherosclerosis in Children With Inflammatory Bowel Disease.

The aims of this study were to determine the presence of endothelial dysfunction by measuring aortic intima-media thickness (aIMT) and carotid intima-media thickness (cIMT) and to evaluate the role of traditional risk factors for premature atherosclerosis in children with inflammatory bowel disease (IBD). Thirty-four children with IBD (25 Crohn disease [CD] and 9 ulcerative colitis [UC]; mean age 11.1 years) and 27 healthy subjects matched for sex and age were enrolled. In all of the patients, demographic characteristics and risk factors for atherosclerosis (age, sex, body mass index, blood pressure, dyslipidemia, active and passive smoking, and family history for cardiovascular diseases), CD and UC clinical activity scores, and inflammatory markers were evaluated. aIMT and cIMT were measured by high-resolution B-mode ultrasound. aIMT was significantly higher in patients than in controls (P < 0.0005). No significant differences were found for cIMT, although the carotid thickness was higher in patients with IBD than in healthy subjects. At a univariate analysis, inflammatory markers levels and tobacco smoking exposure were significantly related to higher aIMT values, whereas in a multivariate regression model, the inflammatory status was the only independent variable correlated with high aIMT. aIMT is an earlier marker of preclinical atherosclerosis than cIMT in young children with active IBD. The inflammatory status and the smoking exposure are significantly correlated with the premature endothelial dysfunction. These data emphasize the importance of controlling the chronic intestinal inflammation and endorsing smoke-free environments for children and adolescents with IBD.

Reassessing lipid metabolism and its potentialities in the prediction of cardiovascular risk.

There are numerous particles, enzymes, and mechanisms in the lipid metabolism that are involved in the genesis of cardiovascular disease (CVD). Given its prevalence in populations and its impact on mortality, it is relevant to review the lipid metabolism as it may potentially provide subsidies to better prediction. This article reviews the importance of traditional cardiovascular risk factors and comments on the potential of novel lipid biomarkers involved in the physiopathology of CVD. The Framingham cohorts proved the role of traditional risk factors (physical inactivity, smoking, blood pressure, total cholesterol, LDL-C, HDL-C, plasma glucose) in the prediction of cardiovascular events. However, a significant number of individuals that suffer from a cardiovascular event has few or none of these factors. Such finding indicates the need for new biomarkers able to identify plaques that are more susceptible to rupture. Some of bloodstream biomarkers related to lipid metabolism are modified LDL particles, apolipoprotein AI (apo AI), apolipoprotein B, lipoprotein (a) [Lp (a)], cholesteryl ester transfer protein (CETP), subtypes of LDL and HDL particles, and lipoprotein-associated phospholipase A2 (Lp-PLA2). These factors participate in the atherosclerotic process, and are abnormal in individuals at high risk, or in those who suffered from a cardiovascular event. Lp (a) determination is already employed in clinical practice and should be included as a reference parameter for CVD monitoring. Furthermore, there are expectations for wider use of apo B, non-HDL cholesterol and total cholesterol / HDL-C determination to improve cardiovascular risk assessment.

Health-related quality of life and risk of hypertension in the community: prospective results from the Western New York Health Study.

Measures of health-related quality of life (HRQL) are strong predictors of health outcomes including cardiovascular disease (CVD). However, prospective evidence on the potential impact of these measures on hypertension risk is scant. We therefore examined the independent role of HRQL on the risk of hypertension in a 6-year longitudinal investigation among 979 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD and diabetes at the baseline examination. Baseline variables included socio-demographics, anthropometrics, blood pressure, behavioural risk factors and measures of HRQL, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure at least 140/90 mmHg or on antihypertensive medication at the follow-up visit. The cumulative 6-year incidence of hypertension was 21.9% (214/979). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, abdominal height, BMI and baseline blood pressure levels in both sexes, whereas impaired fasting glucose, family history of hypertension and the SF-36 physical score were all significantly associated with hypertension among women only. After multivariate adjustment, the SF-36 physical scores [odds ratio (OR) 0.97, 0.94-0.99 for unit change] were still significant predictors of hypertension in women only, independent of age, anthropometrics, baseline SBP levels, behavioural risk factors and other covariates. Measures of HRQL may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, anthropometrics and genetic predisposition.

Assessment of cardiovascular magnetic resonance aortic stiffness in patients with increased cardiovascular risk: role of traditional risk factors and lung hyperinflation

Background Cardiovascular disease (CVD) accounts for up to 50% of all deaths in patients with Chronic Obstructive Pulmonary Disease (COPD). Increased arterial stiffness has been shown to predict cardiovascular events beyond the current traditional risk factors. We sought to assess the relationship of aortic stiffness in patients with elevated global cardiovascular risk against those with COPD and lung hyperinflation. Methods

Personality traits, cardiac risk factors, and their association with presence and severity of coronary artery plaque in people with no history of cardiovascular disease

Coronary artery disease (CAD) is a multifactorial complex disease. The aim of the present study is to verify whether the personality traits in CAD are associated with coronary artery plaque (CAP) presence and severity in people with no history of cardiovascular disease. A cross-sectional monocenter study. Seventy five individuals with no history of CAD underwent 64-slice computed tomography coronary angiography (CTCA) and were screened for traditional cardiac risk factors and for hostility, anger, and type D personality traits. In total, 48 patients (64%) had evidence of CAP, with mild (31%), moderate (33%), and severe (35%) coronary stenosis. Male sex, hypertension, being overweight, and number of cardiovascular risk factors increased the likelihood of CAP presence. Findings showed a significant difference between CAP presence vs. CAP absence for anger (26 vs. 30%, χ2 = 6.82) and type D personality (23 vs. 35%; χ2 = 8.23, P = 0.03), but not hostility (P > 0.05). Anger personality, and the type D subscale social inhibition, but not negative affectivity, were associated with an increased prevalence and severity of CAP. Univariate analysis confirms anger (odds ratio, OR = 1.38, 95% confidence interval, CI = 1.12-2.31), social inhibition (OR = 2.01, 95% CI = 1.81-2.93), 'negative affectivity by social inhibition' (OR = 1.24, 95% CI = 1.12-2.14), and type D personality (OR = 1.9, 95% CI = 1.11-2.03) as predictors of CAP presence. Moreover, multivariate analysis suggests social inhibition as also a unique CAP predictor (OR = 2.14, 95% CI = 1.89-2.96) after adjustment for having cardiac risk factors as a covariate. The present data confirm the core role of traditional risk factors and suggest the primacy of social inhibition and anger personality traits in association with CAP presence and severity.

Abstract MP41: Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study

Health-related Quality of Life and Risk of Hypertension in the Community: A Prospective Analysis from the Western New York Health Study Background: Measures of quality of life and health status are strong predictors of mortality and morbidity outcomes including cardiovascular disease (CVD). However, prospective epidemiological evidence from population-based studies on the potential impact of these measures on hypertension risk is scant. Objective: We sought to examine the independent role of measures of quality of life and health status on the risk of incident hypertension in a community-based sample from Western New York. Methods: A longitudinal analysis, over 6 years of follow-up, among 946 women and men (mean age 54.3 years) from the community, who were free of hypertension, CVD, and diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Baseline variables included socio-demographics, anthropometrics, blood pressure, biomarker data, major behavioural risk factors, and measures of quality of life and health status, such as the physical and mental health component summaries of the short form-36 questionnaire (SF-36). Incident hypertension was defined as blood pressure &gt; or =140/90 or on antihypertensive medication at the follow-up visit. Results: The cumulative six year incidence of hypertension was 22.6% (214/942). In bivariate analyses, there were several baseline correlates of incident hypertension, including age, BMI, and baseline blood pressure levels in both sexes; whereas cigarette smoking, change in BMI, family history of hypertension, and the SF-36 physical score were all significantly associated with hypertension only among women. After multivariate adjustment, cigarette use at baseline (OR: 2.96, 1.35, 6.51), family history of hypertension (OR: 2.59, 1.52-4.42), BMI change since baseline (OR: 1.18, 1.06-1.31), and the SF-36 physical score (OR: 0.97, 0.94-0.99 for a unit change) were the only significant predictors of hypertension independent of age and baseline blood pressure levels in women. Conclusions: Results from this study suggest that measures of health-related quality of life may represent independent predictors of hypertension risk, at least among women, above and beyond the role of traditional risk factors, such as age, smoking, body weight, and familial predisposition.

The Individualization of Risk and Responsibility in Breast Cancer Prevention Education Campaigns

Breast cancer is the most commonly diagnosed cancer in women worldwide. The incidence rates are such that one in nine Canadian women will be diagnosed in her lifetime. While social science research has demonstrated the influence of social, political, economic and environmental factors on health outcomes, many still emphasize the role of traditional risk factors for breast cancer, such as family history or diet. However, these factors are unable to account for the increased incidence of the disease in industrialized countries. Thus, there is a call for more attention to environmental links to breast cancer, and as a result, it has become necessary to consider the ‘everyday exposures' that we experience in our daily lives, which often include mammary carcinogens and endocrine disrupting chemicals through exposure to industrial chemicals and toxic substances in consumer products. In this article, the author explores and critiques two breast cancer education campaigns which are promoted by the Canadian federal government and by mainstream breast cancer organizations. Both the responsibilization paradigm and the promotion of precautionary consumption practices engage with issues of risk and responsibility at the level of the individual. This focus on modifiable behaviours and lifestyle factors is highly problematic as it does not adequately account for other determinants of health, particularly those outside one's control, such as environmental contaminants. Only a truly precautionary approach can be effective in protecting women's health.

Predisposing factors to premature coronary artery disease in young (age ≤ 45 years) smokers: a single center retrospective case control study from India.

Introduction: The role of the conventional risk factors in premature coronary artery disease (CAD) after eliminating the confounding variability of smoking has not been evaluated. This study was conducted to identify role of traditional risk factors in smokers with premature CAD. Methods: The case records of patients presenting acutely with premature CAD during the period 2007-2010 were analyzed retrospectively. Age, sex and smoking matched controls were selected from same time period. Data records were obtained for family history, alcohol, waist size, blood pressure, hypertension, blood sugar, lipid profile and presence of cutaneous markers for both groups and analyzed using statistical software. Results: 234 smokers with CAD and 122 smokers without CAD were included in groups 1 and 2, respectively. The patients in group 1 had significantly increased prevalence of hypertension, diabetes mellitus, metabolic syndrome, dyslipidemia and central obesity. There was no difference in prevalence of family history of CAD, arcus juvenilis and baldness. We found statistically significant association of hypertension, DM and metabolic syndrome in young smokers with premature acute CAD in Indian population as compared to young smokers without CAD. Conclusion: In young smokers, presence of hypertension, central obesity, diabetes mellitus and metabolic syndrome identifies a subset at increased risk for future acute CAD requiring more rigorous follow up and treatment.