Total Cardiovascular Disease Research Articles

Associations between specific volatile organic chemical exposures and cardiovascular disease risks: insights from NHANES

IntroductionAn increasing body of research has demonstrated a correlation between pollutants from the environment and the development of cardiovascular diseases (CVD). However, the impact of volatile organic chemicals (VOC) on CVD remains unknown and needs further investigation.ObjectivesThis study assessed whether exposure to VOC was associated with CVD in the general population.MethodsA cross-sectional analysis was conducted utilizing data from five survey cycles (2005–2006, 2011–2012, 2013–2014, 2015–2016, and 2017–2018) of the National Health and Nutrition Examination Survey (NHANES) program. We analyzed the association between urinary VOC metabolites (VOCs) and participants by multiple logistic regression models, further Bayesian Kernel Machine Regression (BKMR) models and Weighted Quantile Sum (WQS) regression were performed for mixture exposure analysis.ResultsTotal VOCs were found to be positively linked with CVD in multivariable-adjusted models (p for trend = 0.025), independent of established CVD risk variables, such as hypertension, diabetes, drinking and smoking, and total cholesterol levels. Compared with the reference quartile of total VOCs levels, the multivariable-adjusted odds ratios in increasing quartiles were 1.01 [95% confidence interval (CI): 0.78–1.31], 1.26 (95% CI: 1.05–1.21) and 1.75 (95% CI: 1.36–1.64) for total CVD. Similar positive associations were found when considering individual VOCs, including AAMA, CEMA, CYMA, 2HPMA, 3HPMA, IPM3 and MHBMA3 (acrolein, acrylamide, acrylonitrile, propylene oxide, isoprene, and 1,3-butadiene). In BKMR analysis, the overall effect of a mixture is significantly related to VOCs when all chemicals reach or exceed the 75th percentile. Moreover, in the WQS models, the most influential VOCs were found to be CEMA (40.30%), DHBMA (21.00%), and AMCC (19.70%).ConclusionThe results of our study indicated that VOC was all found to have a significant association with CVD when comparing results from different models. These findings hold significant potential for public health implications and offer valuable insights for future research directions.

Associations of Long-Term Exposure to Fine Particulate Constituents With Cardiovascular Diseases and Underlying Metabolic Mediations: A Prospective Population-Based Cohort in Southwest China.

The health effects of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) might differ depending on compositional variations. Little is known about the joint effect of PM2.5 constituents on metabolic syndrome and cardiovascular disease (CVD). This study aims to evaluate the combined associations of PM2.5 components with CVD, identify the most detrimental constituent, and further quantify the mediation effect of metabolic syndrome. A total of 14 427 adults were included in a cohort study in Sichuan, China, and were followed to obtain the diagnosis of CVD until 2021. Metabolic syndrome was defined by the simultaneous occurrence of multiple metabolic disorders measured at baseline. The concentrations of PM2.5 chemical constituents within a 1-km2 grid were derived based on satellite- and ground-based detection methods. Cox proportional hazard models showed that black carbon, organic matter (OM), nitrate, ammonium, chloride, and sulfate were positively associated with CVD risks, with hazard ratios (HRs) ranging from 1.24 to 2.11 (all P<0.05). Quantile g-computation showed positive associations with 4 types of CVD risks (HRs ranging from 1.48 to 2.25, all P<0.05). OM and chloride had maximum weights for CVD risks. Causal mediation analysis showed that the positive association of OM with total CVD was mediated by metabolic syndrome, with a mediation proportion of 1.3% (all P<0.05). Long-term exposure to PM2.5 chemical constituents is positively associated with CVD risks. OM and chloride appear to play the most responsible role in the positive associations between PM2.5 and CVD. OM is probably associated with CVD through metabolic-related pathways.

Socioeconomic disadvantage in pregnancy and postpartum risk of cardiovascular disease

Pregnancy is an educable and actionable life stage to address social determinants of health (SDOH) and lifelong cardiovascular disease (CVD) prevention. However, the link between a risk score that combines multiple neighborhood-level social determinants in pregnancy and the risk of long-term CVD remains to be evaluated. To examine whether neighborhood-level socioeconomic disadvantage measured by the Area Deprivation Index (ADI) in early pregnancy is associated with a higher 30-year predicted risk of CVD postpartum, as measured by the Framingham Risk Score. An analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. Participant home addresses during early pregnancy were geocoded at the Census-block level. The exposure was neighborhood-level socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]) measured in the first trimester. Outcomes were the predicted 30-year risks of atherosclerotic cardiovascular disease (ASCVD, composite of fatal and nonfatal coronary heart disease and stroke) and total CVD (composite of ASCVD plus coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication, and heart failure) using the Framingham Risk Score measured 2 to 7years after delivery. These outcomes were assessed as continuous measures of absolute estimated risk in increments of 1%, and, secondarily, as categorical measures with high-risk defined as an estimated probability of CVD ≥10%. Multivariable linear regression and modified Poisson regression models adjusted for baseline age and individual-level social determinants, including health insurance, educational attainment, and household poverty. Among 4309 nulliparous individuals at baseline, the median age was 27years (interquartile range [IQR]: 23-31) and the median ADI was 43 (IQR: 22-74). At 2 to 7years postpartum (median: 3.1years, IQR: 2.5, 3.7), the median 30-year risk of ASCVD was 2.3% (IQR: 1.5, 3.5) and of total CVD was 5.5% (IQR: 3.7, 7.9); 2.2% and 14.3% of individuals had predicted 30-year risk ≥10%, respectively. Individuals living in the highest ADI tertile had a higher predicted risk of 30-year ASCVD % (adjusted ß: 0.41; 95% confidence interval [CI]: 0.19, 0.63) compared with those in the lowest tertile; and those living in the top 2 ADI tertiles had higher absolute risks of 30-year total CVD % (T2: adj. ß: 0.37; 95% CI: 0.03, 0.72; T3: adj. ß: 0.74; 95% CI: 0.36, 1.13). Similarly, individuals living in neighborhoods in the highest ADI tertile were more likely to have a high 30-year predicted risk of ASCVD (adjusted risk ratio [aRR]: 2.21; 95% CI: 1.21, 4.02) and total CVD ≥10% (aRR: 1.35; 95% CI: 1.08, 1.69). Neighborhood-level socioeconomic disadvantage in early pregnancy was associated with a higher estimated long-term risk of CVD postpartum. Incorporating aggregated SDOH into existing clinical workflows and future research in pregnancy could reduce disparities in maternal cardiovascular health across the lifespan, and requires further study.

Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China

Cardiovascular disease (CVD) has been found to be particularly vulnerable to climate change and temperature variability. This study aimed to assess the extent to which human-induced climate change contributes to future heat-related CVD burdens. Daily data on CVD mortality and temperature were collected in 161 Chinese communities from 2007 to 2013. The association between heat and CVD mortality was established using a two-stage time-series design. Under the natural forcing, human-induced, and combined scenarios, we then separately projected excess cause-/age-/region-/education-specific mortality from future high temperature in 2010-2100, assuming no adaptation and population changes. Under shared socioeconomic pathway with natural forcing scenario (SSP2-4.5-nat), heat-related attributable fraction of CVD deaths decreased slightly from 3.3% [95% empirical confidence interval (eCI): 0.3, 5.8] in the 2010s to 2.8% (95% eCI: 0.1, 5.2) in the 2090s, with relative change of-0.4% (95% eCI:-0.8, 0.0). However, for combined natural and human-induced forcings, this estimate would surge to 8.9% (95% eCI: 1.5, 15.7), 14.4% (95% eCI: 1.5, 25.3), 21.3% (95% eCI:-0.6, 39.4), and 28.7% (95% eCI:-3.3, 48.0) in the 2090s under SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5 scenarios, respectively. When excluding the natural forcing, the number of human-induced heat-related CVD deaths would increase from approximately eight thousand (accounting for 31% of total heat-related CVD deaths) in the 2010s to 33,052 (68%), 63,283 (80%), 101,091 (87%), and 141,948 (90%) in the 2090s under SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5 scenarios, respectively. Individuals with stroke, females, the elderly, people living in rural areas, and those with lower education level would exhibit heightened susceptibility to future high temperature. In addition, Southern and Eastern regions of China were expected to experience a faster increase in heat-related attributable fraction of CVD deaths. Human activities would significantly amplify the future burden of heat-related CVD. Our study findings suggested that active adaptation and mitigation measures towards future warming could yield substantial health benefits for the patients with CVD. National Natural Science Foundation of China.

Associations of serum 25-hydroxyvitamin D and vitamin D receptor polymorphisms with risks of cardiovascular disease and mortality among patients with chronic kidney disease: a prospective study

BackgroundEvidence regarding the relationships of serum 25-hydroxyvitamin D [25(OH)D] with cardiovascular diseases (CVD) and mortality among patients with chronic kidney disease (CKD) is limited and inconsistent. ObjectivesThis study aimed to investigate the associations between serum 25(OH)D and CVD incidence and mortality among patients with CKD. MethodsThis prospective study included 21,507 participants with CKD and free of CVD in the UK Biobank. Incidences of total and subtypes of CVD and mortality were ascertained via electronic health records. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and 95% confidential intervals (CIs) for CVD incidence and mortality. ResultsThe median serum 25(OH)D concentration was 44.0 nmol/L (interquartile range: 30.1, 60.6 nmol/L). After multivariable adjustment, compared with CKD patients with serum 25(OH)D concentrations of <25 nmol/L, those with serum 25(OH)D ≥75 nmol/L had HRs (95% CIs) of 0.80 (0.71, 0.90) for total CVD incidence, 0.82 (0.69, 0.97) for ischemic heart disease, 0.56 (0.41, 0.77) for stroke, 0.64 (0.46, 0.88) for myocardial infarction, 0.62 (0.49, 0.80) for heart failure, 0.60 (0.43, 0.85) for CVD mortality, and 0.62 (0.52, 0.74) for all-cause mortality. In addition, these associations were not modified by vitamin D receptor polymorphisms, with no significant interaction detected. ConclusionsHigher serum 25(OH)D concentrations were significantly associated with lower risks of total and subtypes of CVD incidence and mortality among individuals with CKD. These findings highlight the importance of maintaining adequate vitamin D status in the prevention of CVD and mortality in patients with CKD.

Obesity paradox of cardiovascular mortality in older adults in the United States: A cohort study using 1997–2018 National Health Interview Survey data linked with the National Death Index

BackgroundLarge-scale, population-based investigations primarily investigating the association between body mass index (BMI) and cardiovascular disease (CVD) mortality among older and younger adults in the United States (U.S.) are lacking. ObjectiveTo evaluate the relationship between BMI and CVD mortality in older (≥65 years) and younger (<65 years) adults and to identify the nadir for CVD mortality. DesignThis cohort study used serial cross-sectional data from the 1997 to 2018 National Health Interview Survey (NHIS) linked with the National Death Index. NHIS is an annual nationally representative household interview survey of the civilian noninstitutionalized U.S. population. SettingResidential units of the civilian noninstitutionalized population in the U.S. ParticipantsThe target population for the NHIS is the civilian noninstitutionalized U.S. population at the time of the interview. We included all adults who had BMI data collected at 18 years and older and with mortality data being available. To minimize the risk of reverse causality, we excluded adults whose survival time was ≤2 years of follow-up after their initial BMI was recorded and those with prevalent cancer and/or CVD at baseline. MethodsWe used the BMI record obtained in the year of the NHIS survey. Total CVD mortality used the NHIS data linked to the latest National Death Index data from the survey inception to December 31, 2019. We performed multivariable Cox proportional hazards regression models to estimate adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs). ResultsThe study included 425,394 adults; the mean (SD) age was 44 (16.7) years. During a median follow-up period of 11 years, 12,089 CVD-related deaths occurred. In older adults, having overweight was associated with a lower risk of CVD mortality (aHR 0.92 [95 % CI, 0.87–0.97]); having class I obesity (1.04 [0.97–1.12]) and class II obesity (1.12 [1.00–1.26]) was not significantly associated with an increased CVD mortality; and having class III obesity was associated with an increased risk of CVD mortality (1.63 [1.35–1.98]), in comparison with adults who had a normal BMI. Yet, in younger adults, having overweight, class I, II, and III obesity was associated with a progressively higher risk of CVD mortality. The nadir for CVD mortality is 28.2 kg/m2 in older adults and 23.6 kg/m2 in younger adults. ConclusionThis U.S. population-based cohort study highlights the significance of considering age as a crucial factor when providing recommendations and delivering self-care educational initiatives for weight loss to reduce CVD mortality.

Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women

Background and aimObesity and metabolic abnormalities were associated with an increased risk of cardiovascular disease. However, it is unclear how metabolic weight phenotypes relate to cardiovascular diseases in postmenopausal women. This study aimed to explore the relationships in postmenopausal women. Methods and resultsWe included 15,575 postmenopausal women aged 35–75 years (median age, 60.6) without cardiovascular disease at baseline from a subcohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. Metabolically unhealthy phenotype was defined as having ≥2 risk factors of metabolic syndrome: blood pressure ≥130/85 mm Hg or current use of antihypertensive drugs, fasting glucose ≥5.6 mmol/L or current use of antidiabetic agents, triglycerides ≥1.7 mmol/L, and high-density lipoprotein cholesterol <1.3 mmol/L. Cox regression analysis was used to evaluate the risks of cardiovascular diseases. Over a median follow-up period of 3.55 (interquartile range, 2.59–4.44) years, a total of 1354 cardiovascular events occurred. Compared to metabolically healthy normal weight, the multivariate-adjusted hazard ratios and their 95% confidence intervals were 1.41 (1.16–1.72) for metabolically unhealthy normal weight, 1.42 (1.16–1.73) for metabolically healthy overweight/obesity, and 1.75 (1.48–2.08) for metabolically unhealthy overweight/obesity. Subdividing overweight/obesity into separate groups revealed higher total cardiovascular disease risk only in metabolically unhealthy individuals across body mass index categories. ConclusionIn postmenopausal women, both metabolically healthy overweight/obesity and metabolically unhealthy normal weight were associated with a higher risk of cardiovascular disease compared to metabolically healthy normal weight, and the greatest risk was observed in the metabolically unhealthy overweight/obesity category.

Associations of urinary volatile organic compounds with cardiovascular disease among the general adult population

ABSTRACT This study was to estimate the associations of volatile organic compounds (VOCs) exposure with the prevalence of total and specific cardiovascular disease (CVD) among the general adult population. This cross-sectional study analyzed 15 urinary VOC metabolites in the general population using the 2011–2016 National Health and Nutrition Examination Survey (n = 5,213). The weighted study population with 47.0 years median age, was primarily female (51.2%). The prevalence of total CVD in the overall population was 7.9%. The single-exposure analyzes of AAMA, ATCA, CEMA, CYMA, DHBMA, 3HPMA, and 3MHA +4MHA were significantly associated with increased prevalence of total CVD. Qgcomp regression consistently showed that urinary VOCs-mixed exposure was positively correlated with the prevalence of total and specific CVDs (chronic heart failure, angina, and stroke), and highlighted each VOCs metabolite weights and direction. The similar results were observed for the WQS regression using mixed analysis methods. In conclusion, exposure to VOCs increases CVD prevalence and advances the identification of risk factors for CVD for environmental study.

Abstract 2238: Reducing cardiovascular disease risk in cancer survivors: Impact of a 16-week circuit-based interval exercise intervention

Abstract Introduction: Obesity and physical inactivity pose a significant health concern for cancer survivors in developing comorbid conditions such as type 2 diabetes, hypertension, and metabolic syndrome that lead to a heightened risk of cardiovascular disease (CVD). Therefore, regular physical activity plays a central role in reducing the risk of CVD. The Framingham risk score (FRS) is an established assessment of CVD risk that combines six risk factors including age, gender, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, diabetes, and smoking status. The objective of the study was to investigate the effects of a 16-week circuit, interval-based exercise training intervention on FRS and the 10-year FRS-predicted risk of developing CVD among breast, prostate, and colorectal cancer survivors. Methods: This single center, pilot randomized controlled trial consisted of 90 sedentary, overweight or obese (BMI &amp;gt; 25.0 kg/m2) survivors of breast, prostate or colorectal cancers, randomized to exercise (n=60) or usual care (n=30). The 16-week intervention comprised supervised moderate to vigorous intensity aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise sessions conducted in a circuit-based interval fashion, occurring three times per week. Blood samples were obtained at baseline and post-intervention time points to measure fasting plasma levels of HDL-C and LDL-C, along with resting systolic blood pressure and diagnosis of diabetes. Paired t-test and repeated measure ANOVA were used to determine between-group differences. Results: Participants (age 63.2 ± 10.8 years) were diagnosed with breast (35%), prostate (30%), and colorectal (35%) cancers and consisted of 55% female participants, participants had a mean BMI of 34.7±5.9, and 85% were obese. Chemotherapy and/or radiation therapy was completed by 75% of participants. Retention and adherence rates to exercise were high (100% and 92%, respectively). Compared to usual care, circuit, interval-based exercise significantly reduced total FRS (between group mean difference, -12.0 points p&amp;lt;0.001) and 10-year CVD risk (-10.0%; p&amp;lt;0.001). Conclusions: This study underscores the critical role of circuit-based, interval exercise interventions in mitigating the elevated cardiovascular risk faced by sedentary, overweight, or obese cancer survivors. The significant reduction in FRS components highlights the potential of structured exercise programs to enhance cardiovascular health, thereby reducing the burden of comorbid conditions and CVD risk in cancer survivors. Citation Format: Amber J. Normann, Rebekah L. Wilson, Cami N. Christopher, Mary K. Norris, Simone Cuomo, Christina M. Dieli-Conwright. Reducing cardiovascular disease risk in cancer survivors: Impact of a 16-week circuit-based interval exercise intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2238.

Abstract P377: Association Between Area Deprivation and Premature Cardiovascular Mortality in South Korea

Background: The underlying factors for regional disparities in cardiovascular disease (CVD) have yet to be fully understood. There is limited research on the effect of regional-level socioeconomic conditions on CVD mortality. This ecological study aims to investigate the association between area deprivation and premature death from CVD. Methods: The deprivation index was formulated with 10 socioeconomic indicators across all the 250 municipalities in Korea. Mortality rates from total CVD, ischemic heart disease, and cerebrovascular disease in adults &lt;65 years were directly standardized for sex and age using the total population structure. Municipalities are stratified by urbanicity, and the number of hospitals and the size of an area were adjusted in log-linear regression models. Results: The most deprived municipalities showed 41.6% excess mortality for total CVD, 30.3% for ischemic heart disease, and 36.9% for cerebrovascular disease, compared to the least deprived ones. Even after adjusting for the number of hospitals per unit area, the association of area deprivation was more significant in metropolitan areas than in other provinces. As one increment of the deprivation index increased, the adjusted rate ratios for total CVD were 1.031 (1.020-1.043) in metropolitans and 1.009 (1.000-1.019) in other provinces. Additional multilevel analyses showed consistent findings of higher risks in deprived areas. Conclusions: This study highlights a higher risk of premature cardiovascular death in socioeconomically disadvantaged areas. The CVD prevention strategies should reflect regional characteristics, with a particular focus on reducing the burden in deprived metropolitan areas.

Abstract 27: Chronotype, Life’s Essential 8, and Risk of Cardiovascular Disease: A Prospective Cohort Study in UK Biobank

Introduction: Individuals with evening chronotype often experience circadian misalignment, which may disrupt health behaviors and circadian regulation of cardiometabolic functions such as blood pressure and heart rate. However, the association of chronotype with cardiovascular disease (CVD) and the interplay with other CVD risk factors are not fully understood. Hypothesis: We assessed the hypothesis that individuals with an evening chronotype, compared to those with a morning chronotype, have a poorer cardiovascular health as measured by the Life’s Essential 8 (LE8), and consequently an increased CVD risk. We further explored if the associations differed by sex. Methods: We conducted a prospective study in the UK Biobank among 477,878 adults aged 39-74 years and free of CVD at baseline in 2006-2010. Chronotype was self-reported using a single representative question from the Morningness-Eveningness Questionnaire. The LE8 score was calculated based on 8 modifiable CVD risk factors, and ranged from 0 to 100 with higher scores indicating better cardiovascular health. Incident CVD was defined as first myocardial infarction (MI) or stroke leading to hospitalization or death, identified via validated algorithms that mapped national medical records and death certificates to ICD-10 codes until May 2022. We used Cox proportional hazards models to estimate the association between chronotype and CVD risk. Models were adjusted for demographics, shift work, and family history of CVD. We applied causal mediation framework to decompose the total chronotype-CVD effect into estimated natural direct effect (i.e., independent of LE8) and natural indirect effect (i.e., mediated by LE8; NIE). Results: Participants with a “definite evening” chronotype were 75% more likely to have a low LE8 score (&lt;50) compared to “intermediate” type (prevalence ratio 95% CI: 1.67, 1.84). This association was notably stronger among women ( P -interaction: 0.0001). Over 12.7 years of follow-up, there were 27,346 documented incident CVD events (17,180 MI; 11,329 stroke). The hazard ratio (HR) for total CVD was 1.03 (95% CI: 1.00, 1.06) for the “definite morning” and 1.15 (95% CI: 1.10, 1.20) for “definite evening” compared with “intermediate” chronotype ( P -trend: 0.06). This association was stronger in women ( P -interaction: 0.05), and similar for MI and stroke. The NIE of the chronotype-CVD association comparing “definite evening” to “intermediate” was 1.11 (95% CI: 1.09, 1.13), equivalent to 95% of the association being mediated by LE8. Conclusions: Evening chronotype was associated with a modest increase in CVD risk, compared to intermediate chronotype, which appeared to be mainly explained by overall poor cardiovascular health. Our results suggest potential benefits of targeted interventions in evening chronotype for CVD prevention. Ongoing work is exploring potential effect modification by night shift work.

Abstract 65: Association Between Life’s Essential 8 and Incident Cardiovascular Disease in Women With a History of Adverse Pregnancy Outcomes

Background: Women with a history of adverse pregnancy outcomes (APOs) are at increased risk of developing cardiovascular disease (CVD). Whether maintaining higher cardiovascular health is associated with a lower risk of CVD in this population is not known. Aims: To evaluate the association between Life’s Essential 8 (LE8) and incident CVD in women with a history of APOs. Methods: We included 2,263 participants with a prior diagnosis of APOs (including hypertensive disorders of pregnancy, gestational diabetes, placental abruption, small for gestational age, or preterm birth) and 107,260 parous participants without a history of APOs from the UK Biobank, all of whom were free of CVD at baseline. LE8 was calculated at baseline (range 0-100). Multivariable-adjusted Cox models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) between LE8 score and incident total and subtypes of CVD. We also examined the interaction between LE8 score and incident CVD among individuals with and without a history of APOs. Results: Over a mean 13.5 years of follow-up, 197 incident CVD events were documented in women with a history of APOs. Compared to women in the bottom tertile of LE8 score (&lt;67), those in the top tertile (&gt;76) had a lower incidence of total CVD, HR (95% CI) of 0.43 (0.29, 0.65), CHD [0.31 (0.17, 0.56)] and AF [0.46 (0.23, 0.91)]. We observed a significant interaction between history of APOs, LE8 score, and incident CVD ( Table 1 ). Women with a history of APO who maintained high LE8 score were at similar risk as those without APO with a high LE8 score, 0.95 (0.63-1.43), whereas there was an excess risk observed for those with an intermediate (HR with vs. without APO: 1.73 vs 1.25) and low LE8 scores (HR with vs. without APO: 2.48 vs 1.81). Conclusion: Among women with a history of APOs, better cardiovascular health as assessed using the LE8 score was associated with a significantly lower incidence of incident CVD. Additionally, women with a history of APOs who maintained high LE8 scores had similar risk of CVD as women without a history of APOs.

Blood pressure status, trajectories and cardiovascular disease: the CoLaus|PsyCoLaus prospective study

BackgroundHigh blood pressure (BP) is a major risk factor for cardiovascular disease (CVD). Adequate treatment of high BP should reduce the risk of CVD, but this association has seldom been...

Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts.

Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear. We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models. We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54-0.85) for >18 months versus 0 months and 0.94 (0.91-0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]) but not with stroke (0.96 [0.91-1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28-0.86) for total CVD. Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.

Contrasting Evidences Between High Cholesterol Levels and The Risk of Cardiovascular Disease: A Review

Introduction: The cholesterol hypothesis had been kept alive for decades by reviewers who used statistics that excluded the results from unsuccessful trials and ignored numerous contradictory observations. High dietary cholesterol intake had been associated with development of cardiovascular diseases (CVD) and mortality, for over several decades, without a direct link between the CVD and high serum cholesterol level. Hence, people avoided healthy cholesterol-rich diets due to the fear of developing CVD. The relationship between elevated plasma cholesterol and CVD and criteria for appropriate methods for screening patients with elevated cholesterol had remained a source of medical debates. Lack of decrease in overall mortality rates in patients without clinical coronary disease in whom aggressive lowering of cholesterol was achieved might have contributed to the lack of consensus on this most important issue.&#x0D; Methodology: With information derived from search engines, such as Elsevier, Springer, PubMed, Science Direct, Medline, Google Scholar and a library search for articles published in peer-reviewed journals.&#x0D; Results: Several research results showed that association between total serum cholesterol, its components and CVD is weak, absent or inverse implying that consuming healthy high cholesterol diets may not be harmful to health.&#x0D; Conclusion: This review provides evidence contrasting the links between elevated plasma cholesterol and CVD, and demonstrated that elevated cholesterol concentrations, rather, improve quality of life and life expectancy. In addition, most prevalent methods for cholesterol quantification in biological samples and foods, utilizing new technologies, such as Ambient Ionization Mass Spectrometry are summarized, along with other components of cholesterol.&#x0D; Keywords: Cholesterol, CVD, Quantification

Associations of Abdominal Muscle Density and Area and Incident Cardiovascular Disease, Coronary Heart Disease, and Stroke: The Multi-Ethnic Study of Atherosclerosis.

Muscle density is inversely associated with all-cause mortality, but associations with cardiovascular disease (CVD) risk are not well understood. This study evaluated the association between muscle density and muscle area and incident total CVD, coronary heart disease (CHD), and stroke in diverse men and women. Adult participants (N=1869) in the Multi-Ethnic Study of Atherosclerosis Ancillary Body Composition Study underwent computer tomography scans of the L2-L4 region of the abdomen. Muscle was quantified by density (Hounsfield units) and area in cm2. Sex-stratified Cox proportional hazard models assessed associations between incident total CVD, incident CHD, and incident stroke across sex-specific percentiles of muscle area and density, which were entered simultaneously into the model. Mean age for men and women at baseline were 64.1 and 65.1 years, respectively, and median follow-up time was 10.3 years. For men, associations between muscle density and incident CVD were inverse but not significant in fully adjusted models (P trend=0.15). However, there was an inverse association between density and CHD (P trend=0.02; HR, 0.26 for 95th versus 10th percentile), and no association with stroke (P trend=0.78). Conversely, for men, there was a strong positive association between muscle area and incident CVD (HR, 4.19 for 95th versus 10th percentile; P trend<0.001). Associations were stronger for CHD (HR, 6.18 for 95th versus 10th percentile; P trend<0.001), and null for stroke (P trend=0.67). Associations for women were mostly null. For men, abdominal muscle density is associated with lower CHD risk, whereas greater muscle area is associated with markedly increased risk of CHD.

Exposure to BTEX is associated with cardiovascular disease, dyslipidemia and leukocytosis in national US population

BackgroundComprehensive research on the effects of individual benzene, toluene, ethylbenzene, and xylenes (BTEX) and their mixture measured in blood samples, on cardiovascular diseases (CVD) and related risk factors among the general population is limited. ObjectivesTo investigate the effects of blood individual and mixed BTEX on total CVD and its subtypes, lipid profiles, and white blood cell (WBC) count. MethodsSurvey-weighted multivariate logistic regression was used to examine the associations between blood individual and mixed BTEX with CVD and its subtypes in 17,007 participants from NHANES 1999–2018. The combined effect of BTEX mixture on CVD was estimated using weighted quantile sum modeling and quantile g-computation. Weighted multivariate linear regression assessed the effects of BTEX on lipid profiles and WBC, including its five-part differential count. ResultsIn comparison to the reference quartile of BTEX mixture, individuals in the highest quartile had a significantly increased adjusted odds ratio of CVD risk (1.64, 95 % CI: 1.23 to 2.19, P for trend = 0.008). Positive associations were observed for benzene, toluene, ethylbenzene, and m−/p-xylene, demonstrating a monotonically increasing exposure-response relationship. Mixed BTEX was associated with congestive heart failure (CHF), angina pectoris, and heart attack. Individual benzene, toluene, and ethylbenzene were associated with CHF, while toluene, ethylbenzene, and all xylene isomers were linked to angina pectoris. Benzene, toluene, and o-xylene were associated with heart attack. Both mixed and individual BTEX showed positive associations with triglycerides, cholesterol, low-density lipoprotein, and WBC, including its five-part differential count, but a negative relationship with high-density lipoprotein. Subgroup analyses identified modifying effects of smoking, drinking, exercise, BMI, hypertension, and diabetes on the associations between specific toxicants and CVD risk. ConclusionsExposure to BTEX was associated with cardiovascular diseases and cardiovascular risk factors. These findings emphasize the importance of considering blood BTEX levels when assessing cardiovascular health risks.

Association of glycaemic index and glycaemic load with type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality: a meta-analysis of mega cohorts of more than 100 000 participants

There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality. We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689. From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21-1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11-1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02-1·08]; p=0·0010), and all-cause mortality (1·08 [1·05-1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09-1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10-1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets. Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain. Banting and Best and the Karuna Foundation.

Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries.

Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.

Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: ASimulation Study.

Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults. The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200. As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.