Modelling total coronary heart disease burden and long-term benefit of cholesterol lowering in middle aged men with and without a history of cardiovascular disease

Several studies have demonstrated a positive relationship between vital exhaustion and incident coronary heart disease (CHD), but the association of exhaustion with recurrent cardiac events has not been established in large, epidemiologic studies. Vital exhaustion is considered the end-stage of prolonged psychological distress and is characterized by excessive fatigue, increased irritability, and a sense of demoralization. We assessed the hypothesis that vital exhaustion predicts recurrent cardiac events (myocardial infarction and CHD-related mortality) among middle-aged men and women with documented CHD. Participants were 589 black or white men and women (mean age = 59.8; range = 47 - 69 years) with a history of CHD at the 1990-1992 clinical examination of the ARIC Study. Vital exhaustion was measured at the same ARIC examination using the 21-item Maastricht Questionnaire, and scores were categorized into quartiles. Recurrent cardiac events were monitored in short term (0-5 years), mid- term (6-13 years), and long-term (14-19 years) follow-up. Cox proportional hazards regression models were adjusted for age, sex, race-center, educational level, body mass index, plasma LDL-and HDL-cholesterol levels, hypertension status, and pack-years of cigarette smoking. During short term follow-up, the risk for recurrent cardiac events among participants in the highest quartile of vital exhaustion was twice that of participants in the remainder of the sample (HR = 2.08; 95% C.I: 1.24 to 3.48). The risk was less strong but remained statistically significant in mid-term (HR = 1.77; 95% C.I: 1.26 to 2.48) and long-term (HR = 1.54; 95% C.I: 1.12 to 2.11) follow-up. In conclusion, vital exhaustion is positively associated with short-term and long-term risks for recurrent cardiac events among middle-aged men and women with established coronary heart disease, independent of the traditional biomedical risk factors.

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Improving long-term prediction of first cardiovascular event: The contribution of family history of coronary heart disease and social status

Preventive Medicine ◽

10.1016/j.ypmed.2014.04.007 ◽

2014 ◽

Vol 64 ◽

pp. 75-80 ◽

Cited By ~ 15

Author(s):

G. Veronesi ◽

F. Gianfagna ◽

S. Giampaoli ◽

L.E. Chambless ◽

G. Mancia ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Family History ◽

Social Status ◽

Cardiovascular Event ◽

Term Prediction ◽

History Of ◽

Long Term Prediction

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Interim Report on Clinical Experiences with Long-Term Estrogen Administration to Middle-Aged Men with Coronary Heart Disease

Hormones and Atherosclerosis ◽

10.1016/b978-1-4832-2880-8.50035-1 ◽

1959 ◽

pp. 423-442

Author(s):

J. STAMLER ◽

R. PICK ◽

L.N. KATZ ◽

A. PICK ◽

B.M. KAPLAN

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Interim Report ◽

Clinical Experiences ◽

Middle Aged ◽

Estrogen Administration

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Abstract P252: Passive Smoking in Childhood and Mortality From Coronary Heart Disease in Adulthood Among Japanese Men and Women: The Jacc Study

Circulation ◽

10.1161/circ.141.suppl_1.p252 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Masayuki Teramoto ◽

Hiroyasu Iso ◽

Isao Muraki ◽

Kokoro Shirai ◽

Akiko Tamakoshi

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Family Member ◽

Secondhand Smoke ◽

Passive Smoking ◽

Family Members ◽

Middle Aged ◽

Japanese Men ◽

Men And Women ◽

History Of

Background: Secondhand smoke exposure among adults is an established risk factor for cardiovascular disease, but little is known about the impact of passive smoking in childhood on risk of adverse cardiovascular outcome in adulthood. We examined whether childhood exposure to secondhand smoke is associated with mortality from coronary heart disease(CHD) in adulthood among Japanese men and women. Methods: We analyzed the data for 71,459 participants ( 31,027 men and 40,432 women) aged 40-79 years, with no history of CHD, stroke, or cancer at the baseline (1988-1990) and who completed a lifestyle questionnaire including the number of family members who smoked at home in childhood(0,1,2 and 3+ members) under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: The sex-specific proportions of current smokers were 49.0% for 0 member, 54.3% for 1 member, 56.8% for 2 members and 59.3% for 3+members among men, and the respective proportions among women were 3.3%, 5.2%, 7.2%, and 11.2%.During the median follow-up of 18.9 years, a total of 955 (589 men and 366 women) deaths from CHD were reported. There was a dose-response relationship between the number of smoking family members at home and CHD mortality at adulthood among the middle aged (40-59 years); the multivariable HRs, adjusting for age, sex, history of hypertension and diabetes, body mass index, smoking status, alcohol consumption, hours of exercise and walking, perceived mental stress, educational level and employment status, were 1.05 (95% CI: 0.74, 1.48) for 1 family member, 1.27(0.83, 1.94) for 2 family members and 2.34(1.17, 4.68) for 3+ family members compared with no family member(p for trend=0.04). Such an association was not observed for the older persons aged 60-79 years.The excess CHD mortality associated with 3+ family members among the middle-aged was more evident among never or ex-smokers than among current smokers: the respective multivariable HRs were 3.74(1.40, 10.01) and 1.90(0.72, 5.06). Conclusions: Passive smoking exposure in childhood was associated with increased risk of mortality from CHD in adulthood, primarily for the middle aged men and non-current smokers.

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P3639Vascular endothelial growth factor-C and mortality in patients with suspected but no history of coronary heart disease: a subanalysis of the ANOX study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0496 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Unoki ◽

M Suzuki ◽

M Matsuda ◽

Y Ajiro ◽

T Shinozaki ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Events ◽

Cardiovascular Death ◽

All Cause Mortality ◽

History Of ◽

Factor C ◽

Endothelial Growth Factor

Abstract Background The lymphatic system has been suggested to play an important role in cholesterol metabolism and cardiovascular disease. Recently, we demonstrated that serum levels of vascular endothelial growth factor-C (VEGF-C), a central player of lymphangiogenesis, are inversely and independently associated with the risk of all-cause mortality in patients with suspected or known coronary heart disease (CHD). However, the prognostic value of VEGF-C in patients with suspected but no history of CHD is still unclear. Methods Serum VEGF-C levels were measured in 1,717 patients with suspected but no history of CHD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Results During the follow-up, 161 patients died from any cause, 50 died from cardiovascular disease, and 104 developed MACE. After adjustment for established risk factors, VEGF-C levels were significantly and inversely associated with all-cause death (hazard ratio [HR] for 1-SD increase, 0.69; 95% confidence interval [CI], 0.58–0.83) and cardiovascular death (HR, 0.72; 95% CI, 0.52–0.998), but not with MACE (HR, 0.91; 95% CI, 0.74–1.13). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-C levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.282; 95% CI, 0.121–0.443; P<0.001; integrated discrimination improvement [IDI], 0.009; 95% CI, 0.003–0.016; P=0.005), but not that of cardiovascular death (NRI, 0.178; 95% CI, r=−0.103–0.458; P=0.214; IDI, 0.004; 95% CI, r=−0.002–0.009; P=0.194) or MACE (NRI, 0.037; 95% CI, r=−0.162–0.235; P=0.717; IDI, 0.000; 95% CI, r=−0.0004–0.0005; P=0.872). Conclusions In patients with suspected but no history of CHD undergoing elective coronary angiography, a low VEGF-C value may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers. Acknowledgement/Funding The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization

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