Childhood socio-economic conditions and risk of cardiovascular disease: results from a pooled sample of 14 011 adults from India

BackgroundSouth Asians are at an increased risk of premature cardiovascular disease, but the reasons for this are unclear. Poor socio-economic conditions in childhood are associated with an increased risk of cardiovascular disease in many high-income countries and may be particularly relevant to South Asia, where socio-economic deprivation is more prevalent and severe. However, evidence from South Asia is limited.MethodsWe pooled data from two large population-based studies in India to provide a geographically representative and adequately powered sample of Indian adults. We used multilevel linear regression models to assess associations between standard of living index (SLI) in childhood (measured by recalled household assets at age 10–12 years) and major cardiovascular risk factors including adiposity, blood pressure, and fasting blood lipids, glucose and insulin.ResultsData on 14 011 adults (median age 39 years, 56% men) were analysed. SLI in childhood was inversely associated with systolic and diastolic blood pressure, independent of socio-economic conditions in adulthood, with beta coefficients (95% CIs) of −0.70 mmHg (−1.17 to −0.23) and −0.56 mmHg (−0.91 to −0.22), respectively, per SD increase in SLI in childhood. There was no strong evidence for an association between SLI in childhood and other risk factors of cardiovascular disease.ConclusionsPoor socio-economic conditions in childhood may contribute to the increased risk of premature cardiovascular disease among South Asians by raising their blood pressure. Elucidating the mechanisms and improving socio-economic conditions for children in South Asia could provide major reductions in the burden of cardiovascular disease.

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Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies

BMJ Open ◽

10.1136/bmjopen-2017-016819 ◽

2017 ◽

Vol 7 (12) ◽

pp. e016819 ◽

Cited By ~ 5

Author(s):

Kjersti S Rabanal ◽

Haakon E Meyer ◽

Grethe S Tell ◽

Jannicke Igland ◽

Romana Pylypchuk ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

New Zealand ◽

South Asians ◽

Excess Risk ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Increased Risk ◽

Traditional Risk Factors

ObjectivesThe objective was to prospectively examine potential differences in the risk of first cardiovascular disease (CVD) events between South Asians and Europeans living in Norway and New Zealand, and to investigate whether traditional risk factors could explain any differences.MethodsWe included participants (30–74 years) without prior CVD in a Norwegian (n=16 606) and a New Zealand (n=129 449) cohort. Ethnicity and cardiovascular risk factor information was linked with hospital registry data and cause of death registries to identify subsequent CVD events. We used Cox proportional hazards regression to investigate the relationship between risk factors and subsequent CVD for South Asians and Europeans, and to calculate age-adjusted HRs for CVD in South Asians versus Europeans in the two cohorts separately. We sequentially added the major CVD risk factors (blood pressure, lipids, diabetes and smoking) to study their explanatory role in observed ethnic CVD risk differences.ResultsSouth Asians had higher total cholesterol (TC)/high-density lipoprotein (HDL) ratio and more diabetes at baseline than Europeans, but lower blood pressure and smoking levels. South Asians had increased age-adjusted risk of CVD compared with Europeans (87%–92% higher in the Norwegian cohort and 42%–75% higher in the New Zealand cohort) and remained with significantly increased risk after adjusting for all major CVD risk factors. Adjusted HRs for South Asians versus Europeans in the Norwegian cohort were 1.57 (95% CI 1.19 to 2.07) in men and 1.76 (95% CI 1.09 to 2.82) in women. Corresponding figures for the New Zealand cohort were 1.64 (95% CI 1.43 to 1.88) in men and 1.39 (95% CI 1.11 to 1.73) in women.ConclusionDifferences in TC/HDL ratio and diabetes appear to explain some of the excess risk of CVD in South Asians compared with Europeans. Preventing dyslipidaemia and diabetes in South Asians may therefore help reduce their excess risk of CVD.

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Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

Acta Endocrinologica ◽

10.1530/eje.1.02065 ◽

2006 ◽

Vol 154 (1) ◽

pp. 131-139 ◽

Cited By ~ 18

Author(s):

Lenora M Camarate S M Leão ◽

Mônica Peres C Duarte ◽

Dalva Margareth B Silva ◽

Paulo Roberto V Bahia ◽

Cláudia Medina Coeli ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Postmenopausal Women ◽

Fat Mass ◽

Visceral Fat ◽

Increased Risk

Background: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. Objective: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. Design: Thirty-seven postmenopausal women aged 42–62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. Methods: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. Results: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. Conclusion: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

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Risk factors mediating the effect of body-mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis

10.1101/2020.07.15.20154096 ◽

2020 ◽

Author(s):

Dipender Gill ◽

Verena Zuber ◽

Jesse Dawson ◽

Jonathan Pearson-Stuttard ◽

Alice R Carter ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Body Mass Index ◽

Body Mass ◽

European Ancestry ◽

Standard Deviation Increase ◽

Waist To Hip Ratio ◽

Increased Risk ◽

Artery Disease

Background: Higher body-mass index (BMI) and waist-to-hip ratio (WHR) increase the risk of cardiovascular disease, but the extent to which this is mediated by blood pressure, diabetes, lipid traits and smoking is not fully understood. Methods: Using consortia and UK Biobank genetic association summary data from 140,595 to 898,130 participants predominantly of European ancestry, MR mediation analysis was performed to investigate the degree to which genetically predicted systolic blood pressure (SBP), diabetes, lipid traits and smoking mediated an effect of genetically predicted BMI and WHR on risk of coronary artery disease (CAD), peripheral artery disease (PAD) and stroke. Results: The 49% (95% confidence interval [CI] 39%-60%) increased risk of CAD conferred per 1-standard deviation increase in genetically predicted BMI attenuated to 34% (95% CI 24%-45%) after adjusting for genetically predicted SBP, to 27% (95% CI 17%-37%) after adjusting for genetically predicted diabetes, to 47% (95% CI 36%-59%) after adjusting for genetically predicted lipids, and to 46% (95% CI 34%-58%) after adjusting for genetically predicted smoking. Adjusting for all the mediators together, the increased risk attenuated to 14% (95% CI 4%-26%). A similar pattern of attenuation was observed when considering genetically predicted WHR as the exposure, and PAD or stroke as the outcomes. Conclusions: Measures to reduce obesity will lower risk of cardiovascular disease primarily by impacting on downstream metabolic risk factors, particularly diabetes and hypertension. Reduction of obesity prevalence alongside control and management of its mediators is likely to be most effective for minimizing the burden of obesity.

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Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽

10.1136/heartjnl-2018-313453 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1273-1278 ◽

Cited By ~ 19

Author(s):

Laura Benschop ◽

Johannes J Duvekot ◽

Jeanine E Roeters van Lennep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hypertensive Disorder ◽

Cardiovascular Risk Assessment ◽

Increased Risk

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.

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Hypertension

10.1093/med/9780199755691.003.0393 ◽

2012 ◽

Author(s):

Gary L. Schwartz

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Normal Pressure ◽

Premature Cardiovascular Disease ◽

Increased Risk ◽

Treatment Of Hypertension ◽

Definition Of ◽

Over Time

Because blood pressure is a continuously distributed trait in the population and the risk of cardiovascular disease associated with the level of pressure increases progressively as it exceeds 115 mm Hg systolic or 75 mm Hg diastolic, the definition of hypertension is somewhat arbitrary. Currently for adults, it is defined as systolic pressure 140 mm Hg or higher or diastolic pressure 90 mm Hg or higher. Systolic pressures between 120 and 139 mm Hg or diastolic pressures between 80 and 89 mm Hg are classified as prehypertension. Persons who have prehypertension are at increased risk of premature cardiovascular disease and progression to hypertension over time compared with persons who have normal pressure. Epidemiology, diagnosis, and treatment of hypertension are also reviewed.

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Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038013 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038013

Author(s):

Braden O’Neill ◽

Sumeet Kalia ◽

Babak Aliarzadeh ◽

Frank Sullivan ◽

Rahim Moineddin ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Primary Care ◽

Cohort Study ◽

Cardiovascular Risk ◽

Electronic Medical Records ◽

Medical Records ◽

Retrospective Cohort ◽

Increased Risk

ObjectivesIn order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.DesignRetrospective cohort study.SettingEMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.Participants197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.Primary and secondary outcome measuresDocumentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).ResultsDocumentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70–75 vs 45–49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3–5 visits=1.53, 95% CI 1.46 to 1.60).ConclusionsDocumentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.

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Pathophysiological Mechanisms Underlying Excess Risk for Diabetes and Cardiovascular Disease in South Asians: The Perfect Storm

Current Diabetes Reviews ◽

10.2174/1573399816666200703182458 ◽

2020 ◽

Vol 16 ◽

Author(s):

Anurag Mehta ◽

Sumitabh Singh ◽

Anum Saeed ◽

Dhruv Mahtta ◽

Vera A. Bittner ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

South Asians ◽

Severe Disease ◽

Excess Risk ◽

Cvd Risk ◽

Pathophysiological Mechanisms ◽

Ldl Particles ◽

Increased Risk ◽

Shared Risk

Background: South Asians are at a significantly increased risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), are diagnosed at relatively younger ages, and exhibit more severe disease phenotypes as compared with other ethnic groups. The pathophysiological mechanisms underlying T2D and CVD risk in South Asians are multifactorial and intricately related. Method: Narrative review of the pathophysiology of excess risk of T2D and CVD in South Asians. Result: T2D and CVD have shared risk factors that encompass biological factors [early life influences, impaired glucose metabolism, and adverse body composition] as well as behavioral and environmental risk factors (diet, sedentary behavior, tobacco use, and social determinants of health). Genetics and epigenetics also play a role in explaining the increased risk of T2D and CVD among South Asians. Additionally, South Asians harbor several lipid abnormalities including high concentration of small-dense low-density lipoprotein (LDL) particles, elevated triglycerides, low highdensity lipoprotein (HDL)-cholesterol levels, dysfunctional HDL particles, and elevated lipoprotein(a) that predispose them to CVD. Conclusion: In this comprehensive review, we have discussed risk factors that provide insights into the pathophysiology of excess risk of T2D and CVD in South Asians.

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Circadian misalignment increases cardiovascular disease risk factors in humans

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1516953113 ◽

2016 ◽

Vol 113 (10) ◽

pp. E1402-E1411 ◽

Cited By ~ 171

Author(s):

Christopher J. Morris ◽

Taylor E. Purvis ◽

Kun Hu ◽

Frank A. J. L. Scheer

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Shift Work ◽

Disease Risk ◽

Excretion Rate ◽

Cardiovascular Disease Risk ◽

Circadian Misalignment ◽

Increased Risk ◽

The Impact

Shift work is a risk factor for hypertension, inflammation, and cardiovascular disease. This increased risk cannot be fully explained by classic risk factors. One of the key features of shift workers is that their behavioral and environmental cycles are typically misaligned relative to their endogenous circadian system. However, there is little information on the impact of acute circadian misalignment on cardiovascular disease risk in humans. Here we show—by using two 8-d laboratory protocols—that short-term circadian misalignment (12-h inverted behavioral and environmental cycles for three days) adversely affects cardiovascular risk factors in healthy adults. Circadian misalignment increased 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 3.0 mmHg and 1.5 mmHg, respectively. These results were primarily explained by an increase in blood pressure during sleep opportunities (SBP, +5.6 mmHg; DBP, +1.9 mmHg) and, to a lesser extent, by raised blood pressure during wake periods (SBP, +1.6 mmHg; DBP, +1.4 mmHg). Circadian misalignment decreased wake cardiac vagal modulation by 8–15%, as determined by heart rate variability analysis, and decreased 24-h urinary epinephrine excretion rate by 7%, without a significant effect on 24-h urinary norepinephrine excretion rate. Circadian misalignment increased 24-h serum interleukin-6, C-reactive protein, resistin, and tumor necrosis factor-α levels by 3–29%. We demonstrate that circadian misalignment per se increases blood pressure and inflammatory markers. Our findings may help explain why shift work increases hypertension, inflammation, and cardiovascular disease risk.

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Comparison of the Effect of Aerobic and Resistance Training on Cardiovascular Risk Factors in Parkinson's Women

The Open Nursing Journal ◽

10.2174/1874434601913010186 ◽

2019 ◽

Vol 13 (1) ◽

pp. 186-192

Author(s):

Hamideh Yaghoobi ◽

Sahar Mohammadi ◽

Samaneh Sardashti ◽

Seddigheh Abbaspour ◽

Tahere Sarboozi Hossein-Abadi

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Heart Rate ◽

Oxygen Consumption ◽

Cardiovascular Risk ◽

Resistance Training ◽

Cardiovascular Risk Factors ◽

Maximum Oxygen Consumption ◽

Increased Risk

Background: People with low-mobility are at increased risk for cardiovascular disease. Patients with Parkinson's Disease (PD) are less interested in participating in exercise activities due to the nature of the disease. Regular exercise and physical activity can play protective roles against heart disease by reducing risk factors. This study aimed to compare the effects of aerobic and resistance training on cardiovascular risk factors in women with PD. Materials and Methods: This quasi-experimental study was carried out on 45 women with PD who were randomly assigned to one of three groups: aerobic, resistance groups, and control group. Before and after training sessions, variables of weight, Body Mass Index (BMI), heart rate at rest state, maximum oxygen consumption, blood pressure, and lipid profiles of participants were measured. Data were analyzed using SPSS software version 21 and Paired Sample t-test, ANOVA and Bonferroni post-hoc test. A significant level of P≤0.05 was considered. Results: Demographics of physiological characteristics of subjects was congruent in all three groups in the baseline. After aerobic and resistance training, levels of triglyceride, LDL, total cholesterol, fat percentage, resting heart rate, weight, BMI and systolic blood pressure were significantly decreased (p<0.05). This change was more pronounced in the aerobic group; in contrast, variables of maximum oxygen consumption and HDL were meaningfully increased in participants of both experimental groups (p<0.05). Conclusion: The results showed that both types of aerobic and resistance training can reduce the risk factors of cardiovascular disease in women with PD, while the effect of aerobic training on reducing risk factors was more than resistance training.

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The role of cardiovascular risk factors in maternal cardiovascular disease according to offspring birth characteristics in the HUNT study

Scientific Reports ◽

10.1038/s41598-021-99478-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eirin B. Haug ◽

Amanda R. Markovitz ◽

Abigail Fraser ◽

Håvard Dalen ◽

Pål R. Romundstad ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Preterm Birth ◽

Cardiovascular Risk Factors ◽

Hazard Ratios ◽

Increased Risk ◽

Birth Characteristics ◽

History Of

AbstractA history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ≈12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.

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