Ten-year Cardiovascular Disease Risk Research Articles

Association of cardiovascular disease risk with liver steatosis and fibrosis in people with HIV in low- and middle-income countries.

The aim of this study was to understand the relationship between cardiovascular disease (CVD) risk and liver steatosis and fibrosis among people with HIV (PLWH) at least 40 years of age on antiretroviral therapy (ART) in low and middle-income countries (LMIC). We used cross-sectional behavioral and clinical data collected during study enrollment visits in 2020-2022 for the Sentinel Research Network of International epidemiology Databases to Evaluate AIDS (SRN of IeDEA). Ten-year CVD risk was calculated using 2019 WHO nonlaboratory and laboratory models. Transient elastography was used to assess liver disease. Presence of steatosis and significant fibrosis were defined by controlled attenuation parameter (CAP) at least 248 dB/m and liver stiffness measurement (LSM) at least 7.1 kPa, respectively. Participants with viral hepatitis, hazardous alcohol consumption, and unsuppressed HIV viral load were excluded from the analysis. Logistic regression was used to estimate odds ratios, adjusting for study site, CD4 + T cell count, stavudine and didanosine exposure, and in models stratified by sex and geographic region. There were 1750 participants from nine LMIC. Median CVD risk was 3% for both nonlaboratory and laboratory-based models. Adjusted odds ratios (ORs) for steatosis and significant fibrosis associated with laboratory CVD risk (≥10 vs. <5%) were OR = 1.83 [95% confidence interval (95% CI) = 1.21-2.76; P = 0.004] and OR = 1.62 (95% CI = 0.85-3.07; P = 0.14), respectively. Associations of CVD risk with steatosis were stronger in men and among participants at study sites outside Africa. Higher CVD risk was associated with steatosis but not with significant fibrosis in PWH in our LMIC cohort.

Ten-year cardiovascular disease risk and related factors in lifetime marijuana use with comorbid methamphetamine-associated psychotic disorder: a QRISK®3 study

BackgroundMethamphetamine use and related direct and indirect problems are increasing all over the world. The coexistence of lifetime marijuana use (LMU) and methamphetamine use disorder (MUD) may also be accompanied by psychotic symptoms (MAP). Methamphetamine and marijuana use are known to pose risks for cardiovascular diseases (CVDs). However, ten-year CVD risk and inflammation markers of LMU-MUD (non-psychosis group) and LMU-MAP (psychosis group) subjects and the relationship of various sociodemographic and clinical variables with these markers have not yet been examined.MethodsThirty-two male subjects were included in non-psychosis group and 72 male subjects in psychosis group. Sociodemographic and clinical characteristics were recorded. Psychotic symptom severity of psychosis group subjects was measured. The ten-year CVD risk was calculated using QRISK®3 model.ResultsAge, cigarettes/pack-years, alcohol use onset age, drug use onset age, methamphetamine use onset age, duration of methamphetamine use, education and marital status of the groups were similar (p > 0.05). There was a statistical difference between the non-psychosis and psychosis groups in terms of self-mutilation history (p < 0.001), suicidal attempt history (p = 0.007), homicidal attempt history (p = 0.002), psychiatric hospitalization history (p = 0.010). Ten-year QRISK®3 score was 4.90 ± 9.30 in the psychosis group, while it was 1.60 ± 1.43 in the non-psychosis group (p = 0.004). The mean heart age of the psychosis group was 14 years higher than their chronological age, while the mean heart age of the non-psychosis group was 8 years higher. Neutrophil to lymphocyte ratio (NLR) (p = 0.003) was higher in the psychosis group. A significant correlation was detected between ten-year QRISK®3 and positive psychotic symptoms in the psychosis group (r = 0.274, p = 0.020). Regression analysis showed that self-mutilation history, NLR and relative risk obtained from QRISK®3 can be used to distinguish non-psychosis group and psychosis group subjects (sensitivity = 91.7; Nagelkerke R2 0.438; p = 0.001).ConclusionsThis study is important as it demonstrates for the first time that among the subjects using marijuana and methamphetamine, those with psychotic symptoms have a higher NLR and ten-year CVD risk.

Ten-Year Cardiovascular Risk Estimation through the Framingham Risk Score among Commercial Motor Vehicle Drivers with High and Low Risk of Obstructive Sleep Apnea

Abstract Objective Obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are both major medical causes of road accidents among commercial motor vehicle (CMV) drivers. The present study aimed to determine the association of the ten-year risk of developing CVD and other cardiac risk factors with the risk of developing OSA among apparently healthy CMV drivers. Materials and Methods The present cross-sectional study was conducted on 315 male CMV drivers. Demographic characteristics were collected, and the Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed Apnea, High Blood Pressure, Body Mass Index (BMI) &gt; 35 kg/m2, Age &gt; 50 Years, Neck Circumference &gt; 40 cm, and Male Gender (STOP-Bang) questionnaire, and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were filled out, and the ten-year CVD risk was calculated through the Framingham Risk Score (FRS) for each individual. Laboratory tests also were performed. The participants were divided into two groups based on the STOP-Bang score and FRS, and other CVD risk factors were compared, accordingly. The Chi-squared test, the Student t-test, analysis of variance (ANOVA), and logistic regression were used for the analysis. Results The mean age of the drivers was of 45.57 (range: 30 to 70) years. In the univariate analysis, the mean age, years of driving experience, FRS, vascular age, blood pressure, diabetes mellitus, metabolic syndrome, ESS score, BMI, and circumference of the waist and hip presented a significant association with STOP-Bang score ≥ 3 (p &lt; 0.05). The metabolic equivalents of task (METs) for total physical activity and walking (min/week), time spent sitting (h/day), lipid profiles, smoking history, vehicle type, and shift type were statistically similar in both groups. In the multivariate analysis, a high risk of OSA was independently associated with higher FRS (odds ratio: 1.92; p &lt; 0.001). Conclusion The STOP-Bang score presented a direct correlation with the estimated ten-year CVD risk in CMV drivers. The high risk of developing OSA among CMV drivers is accompanied by higher CVD risk factors such as old age, diabetes, hypertension, BMI, and waist and hip circumference. The FRS was statistically higher in CMV drivers with high OSA risk.

Low income and education are associated with greater ASCVD risk scores among adults in the US

IntroductionSocial determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults. MethodsUtilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999–2018 and included participants aged 40–79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design. ResultsMean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K–<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K–<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education. ConclusionWe found strong graded associations between lower income and lower educational attainment with greater CVD risk.

Effects of Chinese heart-healthy diet on blood lipids, glucose, and estimated 10-y cardiovascular disease risk among Chinese adults: results on secondary outcomes of a randomized controlled trial

BackgroundHealthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown. MethodsIn this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population. ResultsAmong 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (−0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (−1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (−0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results. ConclusionsThe CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted.This trial was registered at clinicaltrials.gov as NCT03882645.

Percentiles of predicted 10-year cardiovascular disease risk by sex and age in Brazil and their association with estimated risk of long-term atherosclerotic events

ObjectiveExpressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk. MethodsA cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40–74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group. ResultsTen-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46–59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the ≥75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18–8.30] in females and 11.59 [8.42–15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6. ConclusionsWe established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.

Ten-Year Risk for Developing Cardiovascular Disease Among Older Adults and Elderly in India: A Secondary Analysis of Wave-1 of Longitudinal Aging Study in India.

Background Cardiovascular disease (CVD) risk stratification is recommended by the World Health Organization (WHO) for effective CVD management in primary healthcare settings. Using the 2019 updated WHO CVD risk charts, we estimated the 10-year risk for developing fatal and non-fatal CVD among participants of the Longitudinal Aging Study in India (LASI). Methods We conducted secondary data analysis using the Wave-1 dataset of LASI. Analysis was performed in Stata software (version 14.1; StataCorp LLC, College Station, Texas) after applying sample weights. Ten-year CVD risk was estimated using a non-laboratory-based CVD risk chart. Logistic regression analysis was performed to determine the association between socio-demographic characteristics and 10% or more 10-year CVD risk. Results The weighted prevalence of 10% or more 10-year CVD risk was 24.70% (95% CI: 23.94%-25.47%). Participants who were currently working, living alone, and widowed had 3.63, 1.42, and 1.59 times increased odds of having a high 10-year CVD risk, respectively, after adjusting for other variables. Conclusion About a quarter of older adults and the elderly population in India have a 10-year risk for a fatal or non-fatal cardiovascular event of 10% or more, as estimated using a non-laboratory based chart.

10-Year Cardiovascular Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus

BackgroundContemporary data on cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) is needed to guide appropriate preventive management. ObjectivesThe authors sought to investigate sex- and age-specific 10-year CVD risk in patients with newly diagnosed T2DM compared with the general population. MethodsA cohort study was conducted of all Danish patients with T2DM diagnosed between 2006 and 2013 (n = 142,587) and sex- and age-matched individuals from the general population (n = 388,410), all without prior atherosclerotic CVD. Ten-year CVD risk (myocardial infarction, stroke, and fatal CVD) was estimated. ResultsA total of 52,471 CVD events were recorded. Compared with the general population, the 10-year CVD risks were higher in patients with T2DM in both sexes and across all age groups, especially among younger individuals. For example, patients aged 40 to 49 years had the largest 10-year CVD risk difference (T2DM 6.1% vs general population 3.3%; risk difference: 2.8%, subdistribution HR: 1.91; 95% CI: 1.76-2.07). The age when a given CVD risk was reached differed substantially between the cohorts. Thus, a 10-year CVD risk of 5% was reached at age 43 in men with T2DM compared with 12 years later, at age 55, in men without T2DM. A 10-year CVD risk of 5% was reached at age 51 in women with T2DM and 10 years later, at age 61, in women without T2DM. ConclusionsNewly diagnosed T2DM increased 10-year CVD risk across both sexes and all age groups, especially among younger patients, with CVD occurring ≤12 years earlier than in general population individuals.

Ten-Year Cardiovascular Disease Risk Score and Cognitive Function Among Older Adults: The National Health and Nutrition Examination Survey 2011 to 2014.

Background The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non-Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test-specific and global cognition Z scores. Each incremental 5% in Framingham 10-year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (β=-0.06 [95% CI, -0.09 to -0.03]), delayed memory (β=-0.05 [95% CI, -0.08 to -0.01]), immediate memory (β=-0.07 [95% CI, -0.10 to -0.03]), and global cognition (β=-0.05 [95% CI, -0.09 to -0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.

External validation of the QLifetime cardiovascular risk prediction tool: population cohort study

BackgroundPrediction of lifetime cardiovascular disease (CVD) risk is recommended in many clinical guidelines, but lifetime risk models are rarely externally validated. The aim of this study was to externally validate the QRiskLifetime incident CVD risk prediction tool.MethodsIndependent external validation of QRiskLifetime using Clinical Practice Research Datalink data, examining discrimination and calibration in the whole population and stratified by age, and reclassification compared to QRISK3. Since lifetime CVD risk is unobservable, performance was evaluated at 10-years’ follow-up, and lifetime performance inferred in terms of performance for in the different age-groups from which lifetime predictions are derived.ResultsOne million, two hundreds sixty thousand and three hundreds twenty nine women and 1,223,265 men were included in the analysis. Discrimination was excellent in the whole population (Harrell’s-C = 0.844 in women, 0.808 in men), but moderate to poor stratified by age-group (Harrell’s C in people aged 30–44 0.714 for both men and women, in people aged 75–84 0.578 in women and 0.556 in men). Ten-year CVD risk was under-predicted in the whole population, and in all age-groups except women aged 45–64, with worse under-prediction in older age-groups. Compared to those at highest QRISK3 estimated 10-year risk, those with highest lifetime risk were younger (mean age: women 50.5 vs. 71.3 years; men 46.3 vs. 63.8 years) and had lower systolic blood pressure and prevalence of treated hypertension, but had more family history of premature CVD, and were more commonly minority ethnic. Over 10-years, the estimated number needed to treat (NNT) with a statin to prevent one CVD event in people with QRISK3 ≥ 10% was 34 in women and 37 in men, compared to 99 and 100 for those at highest lifetime risk.ConclusionsQRiskLifetime underpredicts 10-year CVD risk in nearly all age-groups, so is likely to also underpredict lifetime risk. Treatment based on lifetime risk has considerably lower medium-term benefit than treatment based on 10-year risk.

Association of circulating MtDNA with CVD in hemodialysis patients and in vitro effect of exogenous MtDNA on cardiac microvascular inflammation

BackgroundChronic kidney disease (CKD) patients sustain a fairly high prevalence of cardiovascular disease (CVD). Microvascular inflammation is an early manifestation of CVD, and the released mitochondrial DNA (MtDNA) has been proposed to be a crucial integrator of inflammatory signals. Herein, the aim of this study was to determine the relationship between CVD, microvessel, and circulating MtDNA in the settings of uremia.MethodsForty-two maintenance hemodialysis (MHD) patients and 36 health controls were enrolled in this study. Plasma cell-free MtDNA was detected by TaqMan-based qPCR assay. CVD risk markers including high-sensitive C-reactive protein (Hs-CRP), monocyte chemoattractant protein-1 (MCP-1), fibrinogen, and erythrocyte sedimentation rate (ESR) were measured by standard assays. Ten-year CVD risk was calculated from the Framingham risk score (FRS) model. In vitro study, human cardiac microvascular endothelial cells (HCMECs) were incubated with normal or uremic serum, with or without exogenous MtDNA. Intracellular toll-like receptor 9 (TLR9), adhesion molecule 1 (ICAM-1), MCP-1 and tumor necrosis factor-α (TNF-α) and cytosolic MtDNA were detected by qPCR.ResultsPlasma MtDNA in MHD patients was significantly higher than healthy controls (4.74 vs. 2.41 × 105 copies/mL; p = 0.000). Subsequently, the MHD patients were classified into two groups based on the MtDNA median (4.34 × 105 copies/mL). In stratified analyses, the levels of Hs-CRP (5.02 vs. 3.73 mg/L; p = 0.042) and MCP-l (99.97 vs. 64.72 pg/mL; p = 0.008) and FRS (21.80 vs. 16.52; p = 0.016) in the high plasma MtDNA group were higher than those in the low plasma MtDNA group. In vitro study, we found that exogenous MtDNA aggravated uremic serum-induced microvascular inflammation (ICAM-1 and TNF-α) in HCMECs (all p < 0.05). Besides, the addition of MtDNA to the medium resulted in a further increase in cytosolic MtDNA and TLR9 levels in uremic serum-treated cells (all p < 0.05). In patients with MHD, MtDNA levels in plasma were significantly reduced after a single routine hemodialysis (pre 4.47 vs. post 3.45 × 105 copies/mL; p = 0.001) or hemodiafiltration (pre 4.85 vs. post 4.09 × 105 copies/mL; p = 0.001). These two approaches seem similar in terms of MtDNA clearance rate (21.26% vs. 11.94%; p = 0.172).ConclusionsOverall, the present study suggests that MtDNA released into the circulation under the uremic toxin environment may adversely affect the cardiovascular system by exacerbating microvascular inflammation, and that reducing circulating MtDNA might be a future therapeutic strategy for the prevention of MHD-related CVD.

Cardiovascular disease risk and all-cause mortality associated with accelerometer-measured physical activity and sedentary time ‒ a prospective population-based study in older adults

BackgroundLow levels of physical activity (PA) and high sedentary time (ST) are common in older adults and lack of PA is a risk factor for cardiovascular disease (CVD). Knowledge about associations with accelerometer-measured PA, ST and CVD risk in older adults is insufficient. This study examines the associations of accelerometer-measured PA and ST with cardiovascular risk measured using the Framingham risk score (FRS) and all-cause mortality in older adults.MethodsA population-based sample of 660 (277 men, 383 women) older people (mean age 68.9) participated in the Oulu45 cohort study from 2013‒2015. PA and ST were measured with wrist-worn accelerometers at baseline for two weeks. Ten-year CVD risk (%) was estimated with FRS. The data for all-cause mortality were identified from the Digital and Population Data Services Agency, Finland after an average of 6.2 years follow-up. The associations between moderate to vigorous physical activity (MVPA), light physical activity (LPA), ST and FRS were analyzed using the multivariable linear regression analysis. Associations between LPA, ST and mortality were analyzed using the Cox proportional-hazard regression models.ResultsEach 10 min increase in MVPA (β = -0.779, 95% CI -1.186 to -0.371, p < 0.001) and LPA (β = -0.293, 95% CI -0.448 to -0.138, p < 0.001) was negatively associated with FRS while a 10 min increase in ST (β = 0.290, 95% CI 0.158 to 0.421, p < 0.001) was positively associated with FRS. After adjustment for waist circumference, only ST was significantly associated with FRS. Each 10 min increase in LPA was associated with 6.5% lower all-cause mortality risk (HR = 0.935, 95% CI 0.884 to 0.990, p = 0.020) and each 10 min increase in ST with 5.6% increased mortality risk (HR = 1.056, 95% CI 1.007 to 1.108, p = 0.025).ConclusionA higher amount of daily physical activity, at any intensity level, and avoidance of sedentary time are associated with reduced cardiovascular disease risk in older people. Higher time spent in light physical activity and lower sedentary time are associated with lower all-cause mortality.

Evaluating the impact of a prison smoking ban on the cardiovascular health of men in a UK prison

PurposeSmoking rates are known to be higher amongst those committed to prison than the general population. Those in prison suffer from high rates of comorbidities that are likely to increase their risk of cardiovascular disease (CVD), making it more difficult to manage. In 2016, a tobacco ban began to be implemented across prisons in England and Wales, UK. This study aims to measure the effect of the tobacco ban on predicted cardiovascular risk for those quitting smoking on admission to prison.Design/methodology/approachUsing data from a prevalence study of CVD in prisons, the authors have assessed the effect of the tobacco ban on cardiovascular risk, using predicted age to CVD event, ten-year CVD risk and heart age, for those who previously smoked and gave up on admission to prison.FindingsThe results demonstrate measurable health gains across all age groups with the greatest gains found in those aged 50 years and older and who had been heavy smokers. Quitting smoking on admission to prison led to a reduced heart age of between two and seven years for all participants.Originality/valueThe data supports tobacco bans in prisons as a public health measure to reduce risk of CVD. Interventions are needed to encourage maintenance of smoking cessation on release from prison for the full health benefits to be realised.

Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults

ObjectiveThis study aims to investigate the association of metabolic phenotypes that are jointly determined by body mass index (BMI) or fat mass percentage and metabolic health status with the ten-year risk of cardiovascular disease (CVD) among Chinese adults. MethodsData were obtained from a cross-sectional study. BMI and body fat mass percentage (FMP) combined with the metabolic status were used to define metabolic phenotypes. Multiple linear regression and logistic regression were used to examine the effects of metabolic phenotypes on CVD risk. ResultsA total of 13,239 adults aged 34–75 years were included in this study. Compared with the metabolically healthy non-obese (MHNO) phenotype, the metabolically unhealthy non-obese (MUNO) and metabolically unhealthy obese (MUO) phenotypes defined by BMI showed a higher CVD risk [odds ratio, OR (95% confidence interval, CI): 2.34 (1.89–2.89), 3.45 (2.50–4.75), respectively], after adjusting for the covariates. The MUNO and MUO phenotypes defined by FMP showed a higher CVD risk [OR (95% CI): 2.31 (1.85–2.88), 2.63 (1.98–3.48), respectively] than the MHNO phenotype. The metabolically healthy obese phenotype, regardless of being defined by BMI or FMP, showed no CVD risk compared with the MHNO phenotype. ConclusionGeneral obesity without central obesity does not increase CVD risk in metabolically healthy individuals. FMP might be a more meaningful factor for the evaluation of the association of obesity with CVD risk. Obesity and metabolic status have a synergistic effect on CVD risk.

The Association between Serum Uric Acid Levels and 10-Year Cardiovascular Disease Risk in Non-Alcoholic Fatty Liver Disease Patients.

Non-alcoholic fatty liver disease (NAFLD) and serum uric acid (SUA) levels are risk factors for developing cardiovascular disease (CVD). Additionally, previous studies have suggested that high SUA levels increase the risk of having NAFLD. However, no study has investigated the relationship between SUA and CVD risk in NAFLD. This study analyzed the relationship between SUA and CVD in NAFLD. Data for this study used the 2016–2018 Korean National Health and Nutrition Examination Survey, which represents the Korean population. A total of 11,160 NAFLD patients were included. Participants with hepatic steatosis index ≥ 30 were considered to have NAFLD. Ten-year CVD risk was estimated using an integer-based Framingham risk score. Estimated 10-year CVD risk ≥ 20% was considered high risk. Multiple logistic regression was conducted to calculate the odds ratios (ORs) associated with SUA level and CVD risk. High CVD risk OR increases by 1.31 (95% CI 1.26–1.37) times per 1 mg/dL of SUA. After adjustment, SUA still had an increased risk (OR 1.44; 95% CI 1.38–1.51) of CVD. Compared with the lowest SUA quartile group, the highest quartile group showed a significantly higher risk of having CVD before (OR 2.76; 95% CI 2.34–3.25) and after (OR 4.01; 95% CI 3.37–4.78) adjustment. SUA is independently associated with CVS risk in NAFLD.

Ten-Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study.

BackgroundWomen with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown.Methods and ResultsWe used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population‐based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10‐year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high‐density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10‐year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest.ConclusionsFindings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.

QRISK*3 Outcome and Its Relationship with Disease Duration and Lipid Parameters in Patients with Obsessive-Compulsive Disorder

Objective: QRISK*3 is an updated web-based calculator that estimates 10-year cardiovascular disease risk based on specific clinical parameters. In this study, individuals with obsessive-compulsive disorder (OCD) who are being monitored in a psychiatric outpatient clinic are analyzed for their ten-year risk of cardiovascular disease. Methods: The study sample consisted of fifty-eight patients diagnosed with OCD. Sociodemographic characteristics and symptom severity of all participants were recorded. The 10-year cardiovascular disease risk of the participants was calculated with the QRISK*3 model. Results: The mean age of the patients was 37.21 (SD=10.48). QRISK*3 score of OCD patients was calculated as 3.59±6.38%. There were positive correlations between duration of illness and QRISK*3 and QAGE scores in patients with OCD (r=.389 and r=.571, respectively). Linear regression analysis showed the predictive effects of duration of illness (t=3.663, p&lt;.001), AIP (t=2.338, p=.023) on QRISK*3 score in patients with OCD. Conclusion: In this study, the risk of cardiovascular illness in OCD patients was independently predicted by the atherogenic index of plasma (AIP) and disease duration. Additionally, the 10-year risk of cardiovascular disease was 3.6% in OCD patients. To explore and comprehend the connection between OCD and cardiovascular illness, more research is required.

The Relationship of Ten-Year Cardiovascular Disease Risk and Clinical Features in Patients with Schizophrenia.

Cardiovascular diseases (CVD) are the one of the most important causes of mortality in patients with schizophrenia. This study aimed to investigate ten-year CVD risk and its relationship with clinical features in patients with schizophrenia. The sample of the study consisted of 208 patients with a diagnosis of schizophrenia. The Positive and Negative Syndrome Scale (PANSS) was administered to each patient to assess symptom severity of schizophrenia. The 10-year CVD risk of the participants was calculated with the QRISK*3 model. 10-year CVD risk of the patients was found to be 7.4%. The mean healthy heart age (QAGE) of the patients was 53.1. Duration of disease, body mass index (BMI), and negative symptoms severity was positively correlated with 10-year CVD risk in patients with schizophrenia (r=0.57, r=0.37, and r=0.49, respectively). Duration of disease, BMI, and severity of negative symptoms predicted a 10-year CVD risk in patients with schizophrenia (t=4.349 and p<0.001; t=2.108 and p=0.037; t=2.836 and p=0.006 respectively). The findings of this study have shown that duration of disease, negative symptoms, and BMI may be important risk factors for increased CVD risk in patients with schizophrenia.

Differences between the Framingham and D:A:D risk models for cardiovascular risk assessment in HIV-positive patients on antiretroviral therapy: an experience in a Colombian Caribbean population

Objective: To assess the five- and ten-year cardiovascular disease risk in HIV-positive patients on antiretroviral therapy,using the Framingham risk score and the Data collection on adverse effects of anti-HIV drugs (D:A:D) study. Materials and methods: An observational prospective cross-sectional study. HIV-positive patients on antiretroviraltreatment from a referral center for HIV patients were included in the study between January 1 and April 30, 2019. Afive- and ten-year cardiovascular risk assessment was performed using the Framingham risk score and the D:A:D study.Additionally, both risk models were compared through statistical models. Results: The study population consisted of 159 patients with a mean age of 48.90 years ± 9.90. The mean cardiovascular riskaccording to the five-year Framingham risk score was 2.70 % ± 2.80, the ten-year Framingham risk score was 6.10 % ± 5.70,the five-year D:A:D study was 3.50 % ± 4.10, the ten-year D:A:D study was 6.90 % ± 7.70, and the ten-year Framingham riskscore recalculated for Colombia (multiplied by 0.75) was 4.50 % ± 4.20. Using a logistic regression model, it was determinedthat the ten-year D:A:D study provided the greatest number of variables significantly related to a high cardiovascular risk. Conclusions: The study showed a significant difference between the risk models. Both the five- and ten-year D:A:D studyprovided a better cardiovascular disease risk estimation than the five- and ten-year Framingham model.

Liver steatosis, metabolically healthy obesity and ten-year cardiovascular disease risk: results from a population based cohort study

Abstract Background/Introduction Inclusion of non-alcoholic fatty liver disease (NAFLD) as a component of metabolic syndrome (MetS) and/or a criterion for defining metabolically healthy vs. unhealthy obese (MHO vs MUO) status remains to be decided. Purpose The present work evaluated the role of NAFLD at baseline in the transition of MHO to MUO status, and its role in predicting cardiovascular disease (CVD) incidence ten years later. Methods A prospective longitudinal study was performed between 2001 and 2012 studying 1,514 (49·8%) men and 1,528 (50.2%) women (&amp;gt;18 years old) free of CVD at baseline and residing in the greater Athens area, Greece. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices. Results Among obese participants, MHO prevalence was 9.8% (n=277). Only half of the MHO subjects retained their metabolically healthy status one decade later. NAFLD was an important predictor of this transition; MHO participants with NAFLD at baseline had about two times higher odds to develop unhealthy metabolic status compared with their non-NAFLD counterparts. Subsequently, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio=2.90 95%Confidence Interval (1.35, 5.40)) in contrast to their non-NAFLD MHO counterparts. C-statistics revealed that NAFLD significantly increased the discriminative ability of the standardly defined metabolic status (p for C-index change=0.002), yet in the total sample its contribution to the model seemed to be similar with the common metric of central obesity i.e. waist circumference (CNAFLD=0.711 vs. Cwc=0.710). When the analysis was restricted to the obese subset, it was revealed that the discriminative ability of the model adjusted for NAFLD was significantly higher compared with the one adjusted for waist circumference (CNAFLD=0.719 vs. Cwc=0.702). Conclusions Taking under consideration NAFLD – via validated indices – in the clinical assessment of an apparently healthy obese individual contributes to better defining future risk of conversion to metabolically unhealthy obesity and future cardiometabolic risk. Funding Acknowledgement Type of funding sources: None.