Traditional Risk Factors and Newly Recognized Emerging Risk Factors for Cardiovascular Disease

In this article, Andy Richardson, BANCC Educational Advisor, examines several important environmental and individual risk factors for cardiovascular disease. Following on from the meeting of Global Leaders at COP26 in Glasgow, he considers the impact of, and exposure to, environmental factors, including pollution and noise.

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Abstract P345: Prediction of Cardiovascular Disease Events and Death using Multiple Biomarkers in African Americans: the Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p345 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Solomon K Musani ◽

Ramachandran Vasan ◽

Aurelian Bidulescu ◽

Jung Lee ◽

Gregory Wilson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

African Americans ◽

High Sensitivity ◽

Serum Cortisol ◽

Jackson Heart Study ◽

Cvd Risk ◽

Risk Reclassification ◽

Heart Study ◽

Traditional Risk Factors

Background: The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood. Methods: We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors. Results: On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors. Conclusions: In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.

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Global Risk Stratification to Improve Cardiovascular Prevention: Integration of Traditional Risk Factors, Emerging Risk Factors, and New, Noninvasive Cardiovascular Imaging

The American Heart Hospital Journal ◽

10.1111/j.1541-9215.2005.04688.x ◽

2005 ◽

Vol 3 (4) ◽

pp. 265-268

Author(s):

Neil L. Coplan ◽

Alexander Chernobelsky

Keyword(s):

Risk Factors ◽

Risk Stratification ◽

Cardiovascular Prevention ◽

Cardiovascular Imaging ◽

Global Risk ◽

Emerging Risk ◽

Traditional Risk Factors

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Medicolegal Reflections about a Case of Cardiac Death after Renal Transplantation

The International Journal of Artificial Organs ◽

10.1177/039139880703000713 ◽

2007 ◽

Vol 30 (7) ◽

pp. 649-655

Author(s):

M. Di Paolo ◽

B. Guidi

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Renal Transplant ◽

Cardiac Death ◽

Graft Loss ◽

Left Ventricular ◽

Renal Transplant Recipients ◽

Post Transplantation ◽

Coronary Syndrome ◽

Traditional Risk Factors

Cardiovascular disease is the most common cause of death in patients with renal transplant. Acute coronary syndrome due to coronary artery disease, and left ventricular hypertrophy leading to chronic heart failure account for the majority of sudden arrhythmic deaths after transplantation. Furthermore death with functioning graft represents the main cause of graft loss, particularly after the first post-transplantation year. Although cardiovascular disease leads to morbidity and mortality in renal transplant recipients, its pathogenesis is poorly understood. The high incidence of cardiovascular disease in patients after renal transplant is chiefly due to high occurence and accumulation of traditional risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus and hyperlipidemia increase the risk for cardiovascular events. Also “non traditional” risk factors are associated with cardiovascular disease. Moreover several immunosuppressive drugs interfere with the cardiovascular system. The authors present a case of cardiac death following renal transplant in a patient with history of cardiovascular disease prior transplantation. Initially treated by hemodialysis, after 3 years he received a cadaveric renal transplant. The post-transplantation period was without surgery complications, immunological or infectious, except for a scarce control of blood pressure. A month after the operation, the patient developed thrombophlebitis, plus extra-peritoneal swelling. After ten days in hospital he suddenly died. The aim of the manuscript is to remark on the legal relevance of patient's consensus to transplant. It is necessary to well inform patients of an operation's risks and complications. Furthermore, the exceeding demand with respect to organ availability raises ethical issues about organ allocation. (Int J Artif Organs 2007; 30: 649–55)

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