Cardiovascular disease and trace metals

Cardiovascular disease is a major cause of morbidity and mortality in the U. K. and other developed countries. In the U. K., mortality from coronary heart disease has increased progressively over the past 25 years, particularly in males. This paper examines the possible role of trace metals in the development of cardiovascular disease, with particular reference to the effects of cobalt, cadmium and lead in myocardial disease, atherosclerosis and hypertension. It is concluded that cobalt is an unimportant factor in community levels of cardiovascular disease, that cadmium has striking effects on blood pressure in animals and that there is some evidence for an association between environmental lead and high blood pressure.

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What explains the effect of education on cardiovascular disease? Applying Mendelian randomization to identify the consequences of education inequality

10.1101/488254 ◽

2018 ◽

Cited By ~ 2

Author(s):

Alice R Carter ◽

Dipender Gill ◽

Neil M Davies ◽

Amy E Taylor ◽

Taavi Tillmann ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Coronary Heart Disease ◽

Heart Disease ◽

Systolic Blood Pressure ◽

Body Mass ◽

Mendelian Randomization

Key PointsQuestionWhat is the role of body mass index, systolic blood pressure and smoking in mediating the effect of education on cardiovascular disease risk?FindingWe find consistent evidence that body mass index, systolic blood pressure and smoking mediate the effect of education, explaining up to 18%, 27% and 33% respectively. Including all three risk factors in a model together explains around 40% of the effect of education.MeaningIntervening on body mass index, systolic blood pressure and smoking would lead to reductions in cases of CVD attributable to lower levels of education. Over half of the effect of education on risk of cardiovascular disease is not mediated through these risk factors.ImportanceLower levels of education are causally related to higher cardiovascular risk, but the extent to which this is driven by modifiable risk factors also associated with education is unknown.ObjectiveTo investigate the role of body mass index, systolic blood pressure and smoking in explaining the effect of education on risk of cardiovascular disease outcomes.DesignMultivariable regression analysis of observational data and Mendelian randomization (MR) analysis of genetic data.SettingUK Biobank and international genome-wide association study consortia.ParticipantsPredominantly individuals of European ancestry.Main outcomes and measuresThe effects of education (per 1-standard deviation increase, equivalent to 3.6 years) on coronary heart disease, cardiovascular disease (all subtypes), myocardial infarction and stroke risk (all measured in odds ratio, OR), and the degree to which this is mediated through body mass index, systolic blood pressure and smoking.ResultsEach additional standard deviation of education associated with 13% lower risk of coronary heart disease (OR 0.87, 95% confidence interval [CI] 0.84 to 0.89) in observational analysis and 37% lower risk (OR 0.63, 95% CI 0.60 to 0.67) in Mendelian randomization analysis. As a proportion of the total risk reduction, body mass index mediated 15% (95% CI 13% to 17%) and 18% (95% CI 14% to 23%) in the observational and Mendelian randomization estimates, respectively. Corresponding estimates for systolic blood pressure were 11% (95% CI 9% to 13%) and 21% (95% CI 15% to 27%), and for smoking, 19% (15% to 22%) and 33% (95% CI 17% to 49%). All three risk factors combined mediated 42% (95% CI 36% to 48%) and 36% (95 % CI 16% to 63%) of the effect of education on coronary heart disease in observational and Mendelian randomization respectively. Similar results were obtained when investigating risk of stroke, myocardial infarction and all-cause cardiovascular disease.Conclusions and relevanceBMI, SBP and smoking mediate a substantial proportion of the protective effect of education on risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of CVD attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.

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High Blood Pressure and Cardiovascular Disease

Hypertension ◽

10.1161/hypertensionaha.119.14240 ◽

2020 ◽

Vol 75 (2) ◽

pp. 285-292 ◽

Cited By ~ 20

Author(s):

Flávio D. Fuchs ◽

Paul K. Whelton

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Cohort Studies ◽

High Blood Pressure ◽

Population Distribution ◽

Meta Analysis ◽

Age Related

Fragmented investigation has masked the overall picture for causes of cardiovascular disease (CVD). Among the risk factors for CVD, high blood pressure (BP) is associated with the strongest evidence for causation and it has a high prevalence of exposure. Biologically, normal levels of BP are considerably lower than what has typically been characterized as normal in research and clinical practice. We propose that CVD is primarily caused by a right-sided shift in the population distribution of BP. Our view that BP is the predominant risk factor for CVD is based on conceptual postulates that have been tested in observational investigations and clinical trials. Large cohort studies have demonstrated that high BP is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, heart valve diseases, aortic syndromes, and dementia, in addition to coronary heart disease and stroke. In multivariate modeling, the presumed attributable risk of high BP for stroke and coronary heart disease has increased steadily with progressive use of lower values for normal BP. Meta-analysis of BP-lowering randomized controlled trials has demonstrated a benefit which is almost identical to that predicted from BP risk relationships in cohort studies. Prevention of age-related increases in BP would, in large part, reduce the vascular consequences usually attributed to aging, and together with intensive treatment of established hypertension would eliminate a large proportion of the population burden of BP-related CVD.

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Abstract WP192: Secular Trends in the Incidence, Mortality and Survival Rates of Cardiovascular Disease in a General Japanese Population: the Hisayama Study, 1961-2009

Stroke ◽

10.1161/str.44.suppl_1.awp192 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jun Hata ◽

Toshiharu Ninomiya ◽

Yasufumi Doi ◽

Yoichiro Hirakawa ◽

Masayo Fukuhara ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Survival Rates ◽

The Past ◽

Past Half Century ◽

Incidence And Mortality ◽

Clear Change ◽

Past Half

Background: Changes in lifestyle and advances in medical technology during the past half century have been likely to affect the incidence and mortality of cardiovascular diseases and the prevalence of their risk factors in Japan. Methods: We established 5 cohorts consisting of residents of the town of Hisayama, Fukuoka, Japan, aged 40 years or older without a history of cardiovascular disease in 1961, 1974, 1983, 1993, and 2002. Each cohort was followed up for 7 years. Results: The age-adjusted incidence and mortality rates of ischemic stroke decreased significantly in men and women over the past half century. These decreasing trends were the greatest in the earlier period (from the 1960s to the 1970s) and slowed down in the recent period (from the 1980s to the 2000s). The incidence and mortality of intracerebral hemorrhage decreased significantly in men but not in women. The incidence and mortality of coronary heart disease decreased in women, but did not show a clear change in men. Five-year survival rates of stroke and acute myocardial infarction increased significantly with time. While the prevalence of hypertension did not show a drastic secular change, the proportion of individuals with antihypertensive treatment increased consistently, and mean systolic and diastolic blood pressures among hypertensive participants significantly decreased over the study period. On the other hand, the prevalence of glucose intolerance, hypercholesterolemia, and obesity increased steeply. Conclusions: The incidence and mortality rates of ischemic stroke in both sexes, intracerebral hemorrhage in men, and coronary heart disease in women decreased significantly, probably owing to better management of hypertension. However, the decreasing trends in ischemic stroke slowed down recently and there was no clear change for coronary heart disease in men, probably because the benefits of hypertension control were negated by increasing prevalence of metabolic risk factors. In addition to strict control of hypertension, urgent management of metabolic disorders is needed for further prevention of cardiovascular disease in Japan.

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Relation of urinary albumin excretion to coronary heart disease and low renal function: Role of blood pressure

Kidney International ◽

10.1111/j.1523-1755.2004.00652.x ◽

2004 ◽

Vol 65 (6) ◽

pp. 2290-2297 ◽

Cited By ~ 13

Author(s):

Massimo Cirillo ◽

Martino Laurenzi ◽

Paolo Panarelli ◽

Mario Mancini ◽

Alberto Zanchetti ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Renal Function ◽

Heart Disease ◽

Urinary Albumin Excretion ◽

Urinary Albumin ◽

Albumin Excretion

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A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/01.hjr.0000170264.84820.8e ◽

2005 ◽

Vol 12 (5) ◽

pp. 484-491 ◽

Cited By ~ 59

Author(s):

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

New Zealand ◽

Treatment Strategies ◽

Haemorrhagic Stroke ◽

Vascular Risk ◽

Prevention And Treatment

Background Cardiovascular disease is already the leading cause of death in many Asian populations. Relationships between vascular risk factors and cardiovascular disease may differ in Asian and western populations. Previously, a lack of prospective data has prevented the reliable quantification of such differences, which, if they were shown to exist, would suggest that novel cardiovascular prevention and treatment strategies are required for Asia. Design An individual participant data meta-analysis of 32 studies from the Asia-Pacific region involving 331 100 subjects (75% from Asia; 25% from the predominantly Caucasian populations of Australia and New Zealand). Methods Outcomes were death from coronary heart disease, ischaemic and haemorrhagic stroke. Hazard ratios were estimated from Cox models for systolic blood pressure (SBP), total cholesterol, triglycerides, body mass index, diabetes and current cigarette smoking, stratified by study and sex and adjusted for age, the other risk factors and regression dilution. Results After an average period of follow-up of 4 years there were 2082 deaths from coronary heart disease, 600 from haemorrhagic stroke and 420 from ischaemic stroke. The direction and strength of the associations between risk factors and cardiovascular outcomes were similar in the two regions, although in two cases there were significant differences. Triglycerides were more strongly associated with coronary heart disease in Australia and New Zealand ( P = 0.03), whereas SBP showed a stronger relationship with haemorrhagic stroke in Asia ( P = 0.04). Conclusions Classical vascular risk factors act similarly in Asian and Caucasian populations; prevention and treatment strategies should thus be similar. Blood pressure reduction should be particularly effective in Asia.

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Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study

BMJ ◽

10.1136/bmj.l1855 ◽

2019 ◽

pp. l1855 ◽

Cited By ~ 39

Author(s):

Alice R Carter ◽

Dipender Gill ◽

Neil M Davies ◽

Amy E Taylor ◽

Taavi Tillmann ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Systolic Blood Pressure ◽

Odds Ratio ◽

Lower Risk ◽

Smoking Behaviour ◽

Mendelian Randomisation

AbstractObjectivesTo investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes.DesignMendelian randomisation study.SettingUK Biobank and international genome-wide association study data.ParticipantsPredominantly participants of European ancestry.ExposureEducational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation.Main outcomes measureThe risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively.ResultsEach additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease.ConclusionsBMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.

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The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

Journal of Human Hypertension ◽

10.1038/sj.jhh.1002043 ◽

2006 ◽

Vol 20 (9) ◽

pp. 672-678 ◽

Cited By ~ 10

Author(s):

S L Bacon ◽

K L Lavoie ◽

T S Campbell ◽

R Fleet ◽

A Arsenault ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Stress Testing ◽

Blood Pressure Response ◽

Pressure Response ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Response To Exercise

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Morning Blood Pressure Surge and Cardiovascular Disease Events and All-Cause Mortality in Blacks

Hypertension ◽

10.1161/hypertensionaha.119.14233 ◽

2020 ◽

Vol 75 (3) ◽

pp. 835-843 ◽

Cited By ~ 2

Author(s):

John N. Booth ◽

Byron C. Jaeger ◽

Lei Huang ◽

Marwah Abdalla ◽

Mario Sims ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cvd Risk ◽

Black Adults ◽

Morning Blood Pressure Surge ◽

Morning Blood Pressure ◽

The Individual ◽

Multivariable Adjustment

The cardiovascular disease (CVD) and mortality risk associated with morning blood pressure (BP) surge and its components among black adults, a population with high BP during the asleep period, is unknown. We studied Jackson Heart Study participants who completed 24-hour ambulatory BP monitoring at the baseline exam in 2000 to 2004 (n=761). The sleep-trough morning surge was calculated as the mean 2-hour postawakening systolic BP (SBP) minus the lowest nighttime SBP, preawakening morning surge as mean 2-hour postawakening SBP minus mean 2-hour preawakening SBP, and rising morning surge as the first postawakening SBP minus the last preawakening SBP. The primary outcome was the occurrence of CVD events including the composite of coronary heart disease or stroke. Over a median follow-up of 14.0 years, there were 74 CVD (coronary heart disease or stroke) events and 144 deaths. Higher tertiles of sleep-trough, preawakening, and rising SBP surge were not associated with CVD risk after multivariable adjustment. In contrast, the highest tertile of the individual components of morning surge, including postawakening SBP (tertiles 2 and 3 versus 1: hazard ratio [95% CI]: 1.58 [0.71–3.53] and 4.04 [1.91–8.52], respectively), lowest nighttime SBP (1.29 [0.59–2.84] and 2.87 [1.41–5.83]), preawakening SBP (1.26 [0.57–2.80] and 2.79 [1.32–5.93]), first postawakening SBP (1.60 [0.73–3.51] and 2.93 [1.40–6.16]), and last preawakening SBP (1.23 [0.57–2.68] and 2.99 [1.46–6.12]), was associated with increased CVD risk after multivariable adjustment. Among black adults, the components of morning SBP surge, but not morning SBP surge itself, were associated with increased CVD risk.

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