Single Cardiovascular Risk Factors Research Articles

Updated Perspectives on Lifestyle Interventions as Secondary Stroke Prevention Measures: A Narrative Review.

Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.

Effects of Physical Activity, Vascular Burden and Clinical Diagnosis on White Matter Integrity

AbstractBackgroundAlzheimer’s disease (AD) is the most common type of dementia. Both degenerative and vascular pathology tend to contribute to dementia as AD coexists with single or multiple cardiovascular risk factors (vascular burden). Modifiable lifestyle factor such as physical activity has been associated with lower vascular burden (VB) and a lower risk of dementia. To test whether physical activity characterised as being inactive or active helped preserve white matter microstructure in a sample consisting of healthy controls and patients from the clinical AD continuum (mild cognitive impairment to dementia) with either low or high VB.Method213 participants were recruited from three memory clinics and were classified as being either physically active (n = 113) or inactive (n = 100) based on the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) questionnaire. Voxel‐wise tract‐based spatial statistics (TBSS) was carried out using a set of 5000 permutations and threshold‐free cluster enhancement (TFCE) to find significant clusters for fractional anisotropy (FA), axial diffusivity (AxD), mean diffusivity (MD) and radial diffusivity (RD).ResultParticipants who were physically active had higher FA and lower AxD, MD and RD values relative to the inactive participants. Changes in indices of WM integrity were widespread across the brain covering mainly association and projection tracts but a few commissural tracts. A three‐way interaction effect between Group × Physical Activity × VB was found for FA that was present in mainly projection tracts with a rightward asymmetry along with some association and commissural tracts. Post hocs revealed greater FA in physically active patients with high VB compared with inactive patients with high VB in projection and association/limbic tracts with a rightward asymmetry. Furthermore, the patients with high VB showed higher FA in bilateral projection fibers and cerebellar regions compared with inactive controls with high VB.ConclusionTBSS analysis revealed that high risk patients such as those with high VB achieved the maximum benefit by being physically active as it led to a much greater preservation of white microstructure relative to controls with high VB. This preservation of white matter microstructure was only observed in patients but not in controls.

Association between cardiovascular risk factors and atrial fibrillation.

The most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF. Studies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882. A total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30-1.49) for obesity, 1.27 (95% CI, 1.22-1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10-1.28) for former smokers, 1.23 (95% CI, 1.09-1.38) for current smokers, 1.31 (95% CI, 1.23-1.39) for diabetes mellitus, 1.68 (95% CI, 1.51-1.87) for hypertension, and 1.12 (95% CI, 0.95-1.32) for dyslipidemia. Adverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors. https://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882).

SERUM OMENTIN-1 LEVEL IS ASSOCIATED WITH THE AGGREGATION OF CARDIOVASCULAR RISK FACTORS IN ADOLESCENTS.

The existing studies involving omentin-1 have mainly focused on relationships with single cardiovascular risk factor. Whether omentin-1 is associated with the aggregation of cardiovascular risk factors has not been reported. We investigate the relationship between the serum omentin-1 level and aggregation of cardiovascular risk factors in adolescents. A total of 741 young students, 11-16 years of age, were enrolled using a stratified cluster sampling method. The participants were given a questionnaire survey and underwent a physical examination. The aggregation of cardiovascular risk factors was defined as two or more cardiovascular risk factors occurring simultaneously in the same individual. Partial correlation analysis suggested that serum omentin-1 level was significantly correlated with waist circumference (R=-0.086, P=0.019) and Body Mass Index (R=-0.096, P=0.009). Logistic regression analysis showed that as the serum omentin-1 level increased, the risk of aggregation of cardiovascular risk factors decreased. Cardiovascular risk factors which were most closely associated with a decrease in the serum omentin-1 level were obesity calculated by Body Mass Index (OR=0.988, P=0.043) and central obesity calculated by waist circumference (OR=0.993, P=0.012). The serum omentin-1 level in adolescents is inversely associated with the aggregation of cardiovascular risk factors. Waist circumference and Body Mass Index are factors most closely associated with a decrease in the serum omentin-1 level.

284 EFFECTS OF TWO DIFFERENT COMBINATIONS OF POLICOSANOLS IN LIPID LOWERING AND ENDOTHELIAL FUNCTION

Abstract Aims Current guidelines recommend the use of lipid lowering agents based on the patient's cardiovascular risk. In the last years, a great interest was driven towards the cathegory of "very low risk" patients, in which a single cardiovascular risk factor is sufficient to make them been considered at "relatively higher" risk. For the last category of patients nutraceutical acquired importance in the last years. The present study aims to evaluate the efficacy and safety of a combination of monacolin K 2.9 mg, (fermented yest rice), coenzyme Q10 30 mg (Formulation A) versus monacolin K 10 mg, and coenzyme Q10 10 mg (Formulation B) on lipidic profile and on the vascular function evaluated as endothelial function and arterial stiffness. Methods The present is a single-center, open-label randomized controlled parallel group study to compare efficacy and safety of two different type of nutraceutical compounds (Formulation A or Formulation B). Patients enrolled were with low cardiovascular risk, in primary prevention, in order to evaluate the evolution of the lipidic profile of these patients and the impact of a nutraceutical-based treatment strategy. Patients eligible for the study were randomized 1:1 to receive either a pill day of Formulation A or B. Results Both treatments with Formulation A or B were tolerated; no patients reported side effects or withdrew from the study. The two groups were balanced with respect clinical and biochemical variables. After 24 weeks of treatment we demonstrated a statistically significant reduction in total cholesterol (p 0.010) and LDL (p 0.002). We observed also an improvement in endothelial function (p 0.292) and a reduction of arterial stiffness (p 0.209) evaluated through the non-invasive methods of EndoPAT and SphygmoCOR. Data obtained suggest monacolin K 2.9 mg, coenzyme Q10 30 mg and rice policosanols 20 mg (Formulation A), was non inferiority to monacolin K 10 mg, coenzyme Q10 10 mg (Formulation B) in endothelial function improvement and serum lipids lowering. Conclusions The new combination of natural nutraceuticals, have a protective cardiovascular effect, not also through reduction of plasma lipids but also in endothelial function and arterial stiffness, despite the reduction of monacolin K.

Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study.

BACKGROUNDEpidemiologic studies have explored the association between a single cardiovascular risk factor (CVRF) and resting heart rate (RHR), but the research on the relation of multiple risk factors with RHR remains scarce. This study aimed to explore the associations between CVRFs clustering and the risk of elevated RHR.METHODSIn this cross-sectional study, adults aged 35–75 years from 31 provinces were recruited by the China PEACE Million Persons Projects from September 2015 to August 2020. We focused on seven risk factors: hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcohol use, and low physical activity. Multivariate logistic regression was used to calculate odds ratios (OR) for elevated RHR (> 80 beats/min).RESULTSAmong 1,045,405 participants, the mean age was 55.67 ± 9.86 years, and 60.4% of participants were women. The OR (95% CI) for elevated RHR for the groups with 1, 2, 3, 4 and ≥ 5 risk factor were 1.11 (1.08–1.13), 1.36 (1.33–1.39), 1.68 (1.64–1.72), 2.01 (1.96–2.07) and 2.58 (2.50–2.67), respectively (Ptrend < 0.001). The association between the CVRFs clustering number and elevated RHR was much more pronounced in young males than in other age-sex subgroups. Clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR than those comprising more behavioral risk factors. CONCLUSIONSThere was a significant positive association between the CVRFs clustering number and the risk of elevated RHR, particularly in young males. Compared clusters comprising more behavioral risk factors, clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR. RHR may serve as an indicator of the cumulative effect of multiple risk factors.

Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy.

Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.

Isolated acute renal infarction in an obese patient

Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events. Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis.

Inverse correlation between serum irisin and cardiovascular risk factors among Chinese overweight/obese population

BackgroundIrisin is a novel myokine associated with obesity, which is a traditional cardiovascular risk factor (CVRF). The present study aimed to investigate the association between serum irisin and a single CVRF as well as the clustering of CVRFs among Chinese overweight/obese population.MethodsA total of 98 overweight and 93 obese subjects without clinical treatments were enrolled in this study. Subjects were then divided into two groups, based on the serum irisin level: a low irisin group (1.10–13.44 ng/ml) and a high irisin group (13.49–29.9 ng/ml). The clustering of CVRFs, smoking, diabetes mellitus, dyslipidemia and hypertension, was classified as 0, 1, 2 and ≥ 3 CVRFs. The demographic and baseline clinical characteristics of all participants were collected and serum irisin was measured.ResultsThe high serum irisin group had significantly higher high-density lipoprotein cholesterol but lower fasting plasma glucose than the low serum irisin group. Additionally, the high serum irisin group had a significantly lower prevalence of smoking, diabetes mellitus and dyslipidemia than the low serum irisin group. Increased serum irisin was significantly associated with a reduced risk of smoking and dyslipidemia in both the unadjusted and adjusted models. Furthermore, high serum irisin significantly reduced the risk of the prevalence of 1, 2 and ≥ 3 CVRFs.Conclusionsamong the Chinese overweight/obese populations, high serum irisin is negatively associated with smoking, dyslipidemia and the clustering of CVRFs. Thus, high serum irisin is potentially associated with a low risk of cardiovascular diseases in the Chinese overweight/obese population.

Text messages for primary prevention of cardiovascular disease: The TextMe2 randomized clinical trial

Primary prevention guidelines emphasize the importance of lifestyle modification, but many at high-risk have suboptimal cardiovascular risk factor (CVRF) control. Text message support may improve control, but the evidence is sparse. Our objective was to determine the impact of text messages on multiple CVRFs in a moderate-high risk primary prevention cohort. This study was a single-blind randomized clinical trial comparing semi-personalized text message-based support to standard care. A random sample of adults with 10-year absolute cardiovascular risk score ≥10% and without coronary heart disease, referred from February 2019 to January 2020, were recruited from an outpatient cardiology clinic in a large tertiary hospital in Sydney, Australia. Patients were randomized 1:1 to intervention or control. Intervention participants received 4 texts per week over 6 months, and standard care, with content covering: diet, physical activity, smoking, general cardiovascular health, and medication adherence. Controls received standard care only. Content was semipersonalized (smoking status, vegetarian or not-vegetarian, physical ability, taking medications or not) and delivered randomly using automated software. The primary outcome was the difference in the proportion of patients who have ≥3 uncontrolled CVRFs (out of: low-density lipoprotein cholesterol >2.0 mmol/L, blood pressure >140/90 mm Hg, body mass index ≥25 kg/m2, physical inactivity, current smoker) at 6 months adjusted for baseline. Secondary outcomes included differences in biomedical and behavioral CVRFs. Among 295 eligible participants, 246 (mean age, 58.6 ± 10.7 years; 39.4% female) were randomized to intervention (n=124) or control (n=122). At 6 months, there was no significant difference in the proportion of patients with ≥3 uncontrolled CVRFs (adjusted relative risk [RR] 0.98; 95% confidence interval [CI] 0.75-1.29; P=.88). Intervention participants were less likely to be physically inactive (adjusted RR 0.72; 95% CI 0.57-0.92; P=.01), but there were no significant changes in other single CVRFs. More intervention participants reduced the number of uncontrolled CVRFs at 6-months from baseline than controls (86% vs 75%; RR 1.15; 95% CI 1.00-1.32; P=.04). In moderate-high cardiovascular risk primary prevention, text message-based support did not significantly reduce the proportion of patients with ≥3 uncontrolled CVRFs. However, the program did motivate behavior change and significantly improved cardiovascular risk factor control overall. Larger multicenter studies are needed.

Apolipoprotein B/A1 ratio as a potential marker of cardiovascular risk in women

Background: There has been a significant steady rise in the prevalence of cardiovascular disease (CVD) among Nigerian women within the last decade. The balance between pro-atherogenic particles and antiatherogenic particles has been markedly reflected in the apolipoprotein B/A1 ratio (Apo B/A1), and this ratio has been shown to be the strongest single lipoprotein-related cardiovascular risk factor. The cutoff value for the apo B/A1 ratio that defines high cardiovascular risk has been proposed to be 0.8 for women. This study is to determine the apo B/A1 ratio in apparently healthy Nigerian women and to evaluate the relationship of this ratio with other lipid indices. Methods: A total of 161 apparently healthy female adults between the ages of 30 and 66 years were selected for this study over a period of 6 months. Plasma total cholesterols (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured using the enzymatic methods, whereas low-density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula. Apolipoprotein A1 and B were determined using immunoturbidimetry methods. Results: The mean of plasma apo B/A-I ratio in the studied participants was 0.68, with values ranging from 0.27 to 1.46. The percentage of participants with the apoB/apoA-I ratio exceeding 0.8 (the cutoff value for CVD risk) was 24.2%. The participants with apoB/apoA-I &gt;0.8 were characterized by higher mean TC (216 mg/dl vs. 171 mg/dl; P &lt; 0.001), TG (80 mg/dl vs. 66 mg/dl; P = 0.007), LDL-C (163 mg/dl vs. 120 mg/dl; P &lt; 0.001), and lower HDL-C (36 mg/dl vs. 43 mg/dl; P &lt; 0.001) compared with women with apoB/apoA-I &lt; 0.8. Conclusion: This study has demonstrated that the women with apo B/A1 &gt;0.8 have worse atherogenic lipid profile (high plasma TC, TG, low-density lipoprotein cholesterol, and low high-density cholesterol). It has also shown that only the apoB/A-I ratio correlates with other lipid markers; it should be considered as a potential useful tool in cardiovascular risk assessment in women. Its potential use in the national guideline for assessment and management of dyslipidemia will be invaluable.

Age-Dependent Disparities in the Prevalence of Single and Clustering Cardiovascular Risk Factors: A Cross-Sectional Cohort Study in Middle-Aged and Older Adults.

BackgroundCardiovascular diseases (CVDs) are the leading cause of mortality worldwide; with age acknowledged as an independent cardiovascular risk factor (CRF) in adults. Appreciating the association between age and classic CRFs is believed to boost all potential benefits of prevention.PurposeAssessment of the prevalence of single and clustered CRFs and their association with age.Patients and MethodsThe survey involved 4735 people (33.6% men) who were PONS project attendees aged 45–64. The study protocol comprised the Health Status Questionnaire, general medical examination, anthropometric measurements, and blood and urine sampling. The prevalence of single and clustered CRFs (hypertension, dyslipidemia, diabetes mellitus, and obesity) in the incrementally split age groups was calculated. The incidence rate of CRFs, against their absence, was determined by Poisson regression models with robust standard errors.ResultsThe prevalence of CRFs was established in 90% of the respondents. Except dyslipidemia and ≥1 CRFs, prevalence of risk factors increased with age, although this trend was the weakest in men. In the total group, and in women, prevalence of dyslipidemia and ≥1 CRFs was unrelated to age, whereas in men, it was on the rise in the younger age groups. The incidence rate of CRFs was strongly related to age, and, with the exception of dyslipidemia, was higher in the older age groups.ConclusionCardiovascular risk factors are common in the adult population, while their prevalence and clustering are more prevalent in seniors. Apart from dyslipidemia, the risk of CRFs is appreciably age-related, and higher in seniors.

Influences of cardiovascular risk factors on left ventricular wall motion function in patients treated with epirubicin: a clinical study by layer-specific speckle tracking imaging

Objective To investigate the influences of cardiovascular risk factors on left ventricular wall motion function in patients treated with epirubicin chemotherapy by layer-specific two-dimensional speckle tracking imaging (2D-STI). Methods Sixty-four female patients with breast cancer treated with epirubicin and 36 controls from June 2018 to March 2019 in Renmin Hospital of Wuhan University were included. According to the numbers of cardiovascular risk factors, the patients were divided into group A (without cardiovascular risk factors, 31 cases), group B (single cardiovascular risk factor, 20 cases), and group C (multiple cardiovascular risk factors, 13 cases). All patients underwent echocardiography before and after epirubicin respectively. Global longitudinal strain, circumferential strain, radial strain (GLS, GCS, GRS), endocardial and epicardial layers of GLS and GCS (endoGLS, epiGLS, endoGCS, epiGCS) were obtained by EchoPAC software analysis. The differences of GLS, EndoGLS, EpiGLS, GCS, EndoGCS, EpiGCS and GRS before and after chemotheraphy were calculated as ΔGLS, ΔEndoGLS, ΔEpiGLS, ΔGCS, ΔEndoGCS, ΔEpiGCS and ΔGRS. Results Compared with before chemotherapy, GLS, EndoGLS, EpiGLS, GCS, EndoGCS, EpiGCS and GRS were significantly reduced in group A, B and C after chemotherapy (all P<0.05). ΔEndoGLS and ΔEndoGCS showed an increasing trend in groups A, B and C, with statistical significance (all P<0.05). Correlation analysis showed that after chemotherapy with epirubicin, the numbers of cardiovascular risk factors were significantly correlated with strain parameters, and the correlation coefficient of EndoGLS was relatively higher (r=-0.582, P<0.001). Conclusions Layer-specific imaging can reliably detect the influences of cardiovascular risk factors on the left ventricular wall motion function in breast cancer patients treated with epirubicin. Parameters reflecting the endocardial longitudinal systolic function are sensitive indicators for the early detectin of myocardial damage and toxicity by epirubicin in patients with multiple cardiovascular risk factors. Key words: Two-dimensional speckle tracking imaging; Layer-specific imaging; Breast neoplasms; Epirubicin; Myocardial motion; Cardiovascular risk factors

Association of physical activity and sedentary behavior at school with cardiovascular risk factors in adolescents

Abstract The association of moderate to vigorous physical activity and sedentary behavior performed in the school context with cardiovascular risk factors is unclear. Thus, the purpose of this study was to evaluate whether MVPA and SB during school time are associated with single and clustered cardiovascular risk factors in 10- to 16-year-old school students. This study used the baseline data from a non-randomized controlled clinical trial (“MEXA-SE”) conducted on 6th to 9th-grade students from schools in Florianopolis, Brazil. Skinfolds, resting blood pressure, 20-m shuttle-run test, fasting glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and white blood cell counts were obtained. MVPA and SB were objectively measured with accelerometers. A minimum of 180 minutes was considered valid school-time for analysis. Multiple linear regression adjusted for age, sex and habitual physical activity was used. School-time MVPA was positively associated with the peak VO2 (β = 0.17 ml.kg.min-1), and inversely associated with sum of four skinfolds (β = -0.96 mm), diastolic blood pressure (β = -0.36 mmHg), systolic blood pressure (β = -0.301 mmHg); triglycerides (β = -1.49 mg.dL-1), and clustered cardiovascular risk factors (β = -0.123). School-time SB was positively associated with clustered cardiovascular risk factors (β = 0.033). In conclusion, independently of habitual physical activity level, school-time MVPA and a lower time in SB were associated to single and clustered cardiovascular risk factors. Thus, the promotion of strategies aimed increase MVPA and reduce SB at school may prevent the onset and early accumulation of cardiovascular risk factors in adolescence.

Cardiovascular risk in patients with severe mental illness in Italy.

Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Patients aged 35-69years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients' data were compared with those from the general population. The 10-year CV risk was log-transformed, and multivariable linear regression was used to estimate mean ratios, adjusting for age, and education. Three hundred patients and 3,052 controls were included in the analysis. Among men, the 10-year CV risk score was very similar between patients with SMI and the general population (mean ratio [MR]: 1.02; 95%CI 0.77-1.37), whereas a 39% increase in 10-year CV risk was observed in women with SMI compared to the general population (MR: 1.39; 95%CI 1.16-1.66). In our study, women with SMI were consistently more at risk than the general population counterpart, even at younger age.

Agreement of PROCAM and SCORE to assess cardiovascular risk in two different low risk European populations.

The quality of cardiovascular risk assessment and subsequent medical treatment for those at elevated risk is dependent on the precision of resource allocation. Several confounders may lead to unnecessary treatments, while those at elevated risk may remain untreated. Confounders occur both in calibration and discrimination. While calibration defines the threshold for individuals, which labels them as low, intermediate, high or very high subjects, discrimination describes the diagnostic accuracy of a test to detect those with future disease (Romanens et al., 2010). Once a test for cardiovascular risk assessment, such as the Framingham algorithm, has been derived from a population over decades, accuracy in different populations and continents still has to be undertaken (external validation). External validation is however difficult to obtain because contemporary performance can be assessed only after decades of observation of the outcome variable. Substitutions are however possible, e.g. with atherosclerosis imaging of carotid or coronary arteries (Romanens et al., 2017) or by measuring cardiovascular risk at the time of a cardiovascular event (Mortensen and Falk, 2017). Other important issues are the demographic or ethnic background of individuals assessed with such risk tools or the type of occupation. The working group on lipids and atherosclerosis (AGLA) recommends the use of cardiac or cardiovascular risk derived from PROCAM and SCORE respectively in Switzerland (Eckardstein, 2014). Based on predefined risk thresholds, a primary care subject is categorized into low, intermediate or high risk. For PROCAM, the categories are 0–9%, 10–19% and 20% or more; for SCORE, the categories are 0.0–0.9%, 1.0–4.9% and 5% or more (Piepoli et al., 2016). A major limitation to calculate global cardiovascular risk is present when single cardiovascular risk factors are high. Therefore, subjects with LDL above 5.0 mmol/l or systolic blood pressure above 160 mmHg are by definition high risk in Switzerland (for SCORE, the high-risk cutoffs are 8.0 mmol/l for total cholesterol and systolic blood pressure of 180 mmHg or more). The SCORE model based the risk algorithm on observations of fatal cardiovascular events in 12 European cohorts undergoing baseline examination between 1967 and 1991 (Conroy et al., 2003). In contrast, PROCAM was derived from working men, later extended to women using observations for myocardial infarction only (Assmann et al., 2007). Therefore, the accuracy of these risk assessment tools may be different in various populations. For the purpose of this study, we assess the agreement for a statin indication in German and Swiss subjects using the PROCAM/AGLA and the SCORE algorithm at various calibration thresholds.

A partially supervised physical activity program for adult and adolescent survivors of childhood cancer (SURfit): study design of a randomized controlled trial [NCT02730767

BackgroundBeyond survival of nowadays >80%, modern childhood cancer treatment strives to preserve long-term health and quality of life. However, the majority of today’s survivors suffer from short- and long-term adverse effects such as cardiovascular and pulmonary diseases, obesity, osteoporosis, fatigue, depression, and reduced physical fitness and quality of life. Regular exercise can play a major role to mitigate or prevent such late-effects. Despite this, there are no data on the effects of regular exercise in childhood cancer survivors from randomized controlled trials (RCTs). Primary outcome of the current RCT is therefore the effect of a 12-months exercise program on a composite cardiovascular disease risk score in childhood cancer survivors. Secondary outcomes are single cardiovascular disease risk factors, glycaemic control, bone health, body composition, physical fitness, physical activity, quality of life, mental health, fatigue and adverse events (safety).MethodsA total of 150 childhood cancer survivors aged ≥16 years and diagnosed ≥5 years prior to the study are recruited from Swiss paediatric oncology clinics. Following the baseline assessments patients are randomized 1:1 into an intervention and control group. Thereafter, they are seen at month 3, 6 and 12 for follow-up assessments. The intervention group is asked to add ≥2.5 h of intense physical activity/week, including 30 min of strength building and 2 h of aerobic exercises. In addition, they are told to reduce screen time by 25%. Regular consulting by physiotherapists, individual web-based activity diaries, and pedometer devices are used as motivational tools for the intervention group. The control group is asked to keep their physical activity levels constant.DiscussionThe results of this study will show whether a partially supervised exercise intervention can improve cardiovascular disease risk factors, bone health, body composition, physical activity and fitness, fatigue, mental health and quality of life in childhood cancer survivors. If the program will be effective, all relevant information of the SURfit physical activity intervention will be made available to interested clinics that treat and follow-up childhood cancer patients to promote exercise in their patients.Trial registrationProspectively registered in clinicaltrials.gov [NCT02730767], registration date: 10.12.2015.

Cardiovascular risk factors and mortality in children with chronic kidney disease.

Cardiovascular disease (CVD) begins early in children with chronic kidney disease (CKD), and its progression is determined by the presence of single or multiple cardiovascular risk factors (CVRFs). To determine the prevalence of CVRFs in children with CKD and their association with mortality in children on chronic dialysis. This comparative cross-sectional study recruited children aged 5 - 18 years with all stages of CKD. All patients had a short history taken along with a physical examination, and their blood samples were assessed for serum creatinine, urea, albumin, calcium, phosphorus, parathyroid hormone, alkaline phosphatase, total cholesterol (TC), haemoglobin and C-reactive protein. Urine samples were also assessed for proteinuria. One hundred and six children who met the study criteria were recruited, 34 with CKD I, 36 with CKD II - IV and 36 with CKD V (dialysis). The overall median age was 11 years (range 8 - 14), and the male/female ratio was 2.1:1. The most common CVRF was anaemia (39.6%). The rate of anaemia was higher in the dialysis group than in the CKD II - IV and CKD I groups (77.8%, 33.3% and 5.9%, respectively). Other CVRFs detected were hypertension, proteinuria, hypercholesterolaemia and dysregulated mineral bone metabolism. Seven deaths were recorded in the dialysis group during the study period. Severe hypertension and intracranial bleeding were the most common causes of death. Modifiable risk factors such as increased TC and decreased albumin levels were more common than other CVRFs in the dialysis patients who died. CVRFs may be present in early CKD, even before the decline in GFR. Routine screening for CVRFs, along with timely intervention, may prevent the progression of CVD and mortality later in life.

Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses

BackgroundHypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy. ObjectivesThis comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards. MethodsThree individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP. ResultsA total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (−1.0 mm Hg; 95% CI: −2.0 to −0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (−5.7 mm Hg; 95% CI: −8.0 to −3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: −1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively. ConclusionsCuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.

Nutraceutical Value of Citrus Flavanones and Their Implications in Cardiovascular Disease.

Background- Cardiovascular diseases, including myocardial infarction, dyslipidaemia and coronary artery pathology, are a major cause of illness and death in Western countries. Therefore, identifying effective therapeutic approaches and their cellular signalling pathways is a challenging goal for medicine. In this regard, several epidemiological studies demonstrate a relationship between the intake of flavonoid-rich foods and the reduction of cardiovascular risk factors and mortality. In particular, flavonoids present in citrus fruits, such as oranges, bergamots, lemons and grapefruit (95% from flavanones), are emerging for their considerable nutraceutical value. Methods- In this review an examination of literature was performed while considering both epidemiological, clinical and pre-clinical evidence supporting the beneficial role of the flavanone class. We evaluated studies in which citrus fruit juices or single flavanone administration and cardiovascular risk factors were analysed; to identify these studies, an electronic search was conducted in PUBMED for papers fulfilling these criteria and written in English. Results- In addition to epidemiological evidence and clinical studies demonstrating that fruits in the Citrus genus significantly reduce the incidence of cardiovascular disease risk, pre-clinical investigations highlight cellular and subcellular targets that are responsible for these beneficial effects. There has been special attention on evaluating intracellular pathways involved in direct cardiovascular and cardiometabolic effects mediated by naringenin, hesperetin and eriodictyol or their glycosylated derivatives. Conclusions- Although some mechanisms of action remain unclear and bioavailability problems remain to be solved, the current evidence supports the use of a nutraceutical approach with citrus fruits to prevent and cure several aspects of cardiovascular disease.