A novel principled method for the measurement of vascular robustness uncovers hidden risk for premature CVD death

The detection of high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is a major challenge. Systems biology suggests that the vasculature's functional robustness against risk factor challenges may serve as a novel discriminator of mortality risk under similar risk factor loads. However, principled methods to measure vascular robustness are not available. To develop a score for the vasculature's functional robustness we used a recently presented method that applies computational physiological modeling to the quantitation of vascular function. We hypothesized that the expected inverse robustness-mortality association is verifiable as a significant robustness-calendar age trend in a cross-sectional investigation of a population cohort of risk factor-challenged individuals. Using only functional parameters of the cardiovascular system we applied multivariate linear regression to derive from our study population of 372 adults gender-specific multivariate robustness scoring algorithms. For any individual, the deviation of his/her robustness score from the value of the regression function characterizes the deviation of the individual’s fatal CVD event probability from its age-appropriate fatal CVD event probability. Robustness correlated linearly with calendar age in our risk factor-challenged but not in our unchallenged cohorts. This observation supports the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges. We conclude that physiologically principled scoring for vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality. NEW & NOTEWORTHY We developed a principled method for the derivation of a vascular robustness score that we translated into a correction factor for calendar age. We demonstrated the score’s potential to uncover risk for premature cardiovascular death in apparently healthy young adults whose risk elevation remains hidden in conventional risk factor models.

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Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk

Scientific Reports ◽

10.1038/s41598-020-74863-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Javier I. Ottaviani ◽

Abigail Britten ◽

Debora Lucarelli ◽

Robert Luben ◽

Angela A. Mulligan ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Vascular Function ◽

Cardiovascular Health ◽

Vascular Diseases ◽

Inverse Association ◽

Cvd Risk ◽

Lower Systolic Blood Pressure ◽

Cross Sectional ◽

Salt Reduction

Abstract Flavan-3-ols are a group of bioactive compounds that have been shown to improve vascular function in intervention studies. They are therefore of great interest for the development of dietary recommendation for the prevention of cardio-vascular diseases. However, there are currently no reliable data from observational studies, as the high variability in the flavan-3-ol content of food makes it difficult to estimate actual intake without nutritional biomarkers. In this study, we investigated cross-sectional associations between biomarker-estimated flavan-3-ol intake and blood pressure and other CVD risk markers, as well as longitudinal associations with CVD risk in 25,618 participants of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort. High flavan-3-ol intake, achievable as part of an habitual diet, was associated with a significantly lower systolic blood pressure (− 1.9 (− 2.7; − 1.1) mmHg in men and − 2.5 (− 3.3; − 1.8) mmHg in women; lowest vs highest decile of biomarker), comparable to adherence to a Mediterranean Diet or moderate salt reduction. Subgroup analyses showed that hypertensive participants had stronger inverse association between flavan-3-ol biomarker and systolic blood pressure when compared to normotensive participants. Flavanol intake could therefore have a role in the maintenance of cardiovascular health on a population scale.

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Application of the 2014 NICE cholesterol guidelines in the English population: a cross-sectional analysis

British Journal of General Practice ◽

10.3399/bjgp17x692141 ◽

2017 ◽

Vol 67 (662) ◽

pp. e598-e608 ◽

Cited By ~ 10

Author(s):

Peter Ueda ◽

Thomas Wai-Chun Lung ◽

Philip Clarke ◽

Goodarz Danaei

Keyword(s):

Risk Factor ◽

Statin Therapy ◽

Cross Sectional Study ◽

Cvd Risk ◽

Cross Sectional ◽

Nice Guidelines ◽

Risk Threshold ◽

English Population ◽

Males And Females ◽

Using Data

BackgroundThe 2014 guidelines on cardiovascular risk assessment and lipid modification from the National Institute for Health and Care Excellence (NICE) recommend statin therapy for adults with prevalent cardiovascular disease (CVD), and for adults with a 10-year CVD risk of ≥10%, estimated using the QRISK2 algorithm.AimTo determine risk factor levels required to exceed the risk threshold for statin therapy, and to estimate the number of adults in England who would require statin therapy under the guidelines.Design and settingCross-sectional study using a sample representative of the English population aged 30–84 years.MethodTo estimate 10-year CVD risk different combinations of risk factor levels were entered into the QRISK2 algorithm. The NICE guidelines were applied to the sample using data from the Health Survey for England 2011.ResultsEven with optimal risk factor levels, males of different ethnicities would exceed the 10% risk threshold between the ages of 60 and 70 years, and females would exceed the threshold between 65 and 75 years. Under the NICE guidelines, 11.8 million males and females (37% of the adults aged 30–84 years) would require statin therapy, most of them (9.8 million) for primary prevention. When analysed by age, 95% of males and 66% of females without CVD in ages 60–74 years, including all males and females in ages 75–84 years, would require statin therapy.ConclusionUnder the 2014 NICE guidelines, 11.8 million (37%) adults in England aged 30–84 years, including almost all males >60 years and all females >75 years, require statin therapy.

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Non-HDL Cholesterol Versus LDL Cholesterol as a CVD Risk Factor in Diabetic Subjects

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v31i4.21004 ◽

2014 ◽

Vol 31 (4) ◽

pp. 199-203

Author(s):

M Saiedullah ◽

S Begum ◽

S Hayat ◽

SM Kamahuddin ◽

MR Rahman ◽

...

Keyword(s):

Risk Factor ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Upward Trend ◽

Cvd Risk ◽

Cross Sectional

Objective: Serum low density lipoprotein (LDL) cholesterol is considered as the primary target of lipid lowering therapy and non-high density lipoprotein (HDL) cholesterol is the recommended second target. Recent studies claimed that non-HDL cholesterol is a better predictor of cardiovascular diseases (CVD) than LDL cholesterol. In this study we aimed to compare non-HDL cholesterol and LDL cholesterol as a CVD risk factor in confirmed diabetic subjects. Materials and methods: In this cross-sectional observational study, 1042 confirmed diabetic subjects selected randomly were included. HbA1cResults: In the total subjects, 767 (74%) subjects had LDL cholesterol > 100 mg/dL and 822 (79%) subjects had non- HDL cholesterol > 130 mg/dL. HbA1c values were different (p<0.02) in five groups and showed upward trend (p<0.01). All the lipid parameters studied were significantly different in five groups (p<0.0001) and TC, TG and non-HDL cholesterol showed upward trend (p<0.0001), but HDL cholesterol and LDL cholesterol showed downward trend (p<0.0001). Odds ratio (OR) of likelihood of risk individuals regarding non-HDL cholesterol compared to LDL cholesterol were 0.50 (p<0.001), 1.32 (p>0.05), 2.96 (p<0.001), 6.49 (p<0.001) and 9.37 (p<0.001) for TG concentrations of up to 150 mg/dL, 151-200 mg/dL, 201-250 mg/dL, 251-300 mg/dL and 301-400 mg/dL respectively with relative risk of 0.60, 1.24, 2.43, 4.83, 5.10. Conclusion: LDL cholesterol is a better tool for the detection of high-risk individuals than non-HDL cholesterol at TG concentration up to 150 mg/dL, whereas non-HDL cholesterol is better than LDL cholesterol at TG concentration above 200 mg/dL as a CVD risk factor. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21004 J Bangladesh Coll Phys Surg 2013; 31: 199-203

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Prevalence of Cardiovascular Risk Factors among Tile and Ceramic Workers in Yazd, Iran

ISRN Preventive Medicine ◽

10.5402/2013/921860 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Amir Houshang Mehrparvar ◽

Seyyed Jalil Mirmohammadi ◽

Mehrdad Mostaghaci ◽

Maryam Bahaloo ◽

Mohammad Heydari ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cross Sectional Study ◽

International Standards ◽

Cvd Risk ◽

Cross Sectional ◽

High Prevalence ◽

Low Hdl ◽

Simple Sampling ◽

Ceramic Workers

Introduction. Cardiovascular disorders (CVDs) are among the most important diseases in the world and determination of their risk factors is essential for primary and secondary prevention. This study aimed to evaluate these risk factors in workers of tile and ceramic industry, a main industry in Yazd. Materials and Methods. In a cross-sectional study, 1075 tile and ceramic workers were selected by simple sampling method. BMI, blood pressure, FBS, and lipid profile were measured and compared to international standards. Results. 731 individuals (68%) had at least one risk factor, and 52%, 12%, 3%, and 0.7% had one, two, three, and four risk factors, respectively. The most common risk factor was abnormal BMI (49.6%); low HDL (48.4%) and high TG (14.1%) were in the second and third orders. Conclusion. This study showed a relatively high prevalence for CVD risk factors among tile and ceramic workers. Low HDL, high TG, and overweight were the most frequent risk factors in this population.

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Risk factors associated with cardiovascular disease among adult Nevadans

PLoS ONE ◽

10.1371/journal.pone.0247105 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247105

Author(s):

Dieu-My T. Tran ◽

Nirmala Lekhak ◽

Karen Gutierrez ◽

Sheniz Moonie

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Risk Factor ◽

Healthcare Providers ◽

Population Based ◽

Behavioral Risk ◽

High Cholesterol ◽

Cvd Risk ◽

Cross Sectional ◽

System Data

ObjectiveCardiovascular disease (CVD) remains the number one cause of death in the US and Nevada is ranked 11th highest for CVD mortality. The study sought to examine the association between self-reported risk factors and CVD presence among adult Nevadans, between years 2011 and 2017.MethodsThis is a cross-sectional, population-based study that utilized the 2011 and 2017 Nevada Behavioral Risk Factor Surveillance System data. Data were analyzed between 2019 and 2020.ResultsA total of 5,493 and 3,764 subjects in 2011 and 2017, respectively were included. BMI (overweight/obesity) remained the most prevalent CVD risk factor. The second most common CVD risk factor was high cholesterol, followed by hypertension. Compared to females, males were 1.64 times more likely to have reported CVD in 2011, which increased to 1.92 in 2017. Compared to non-smokers, everyday smokers were 1.96 times more likely in 2011 and 3.62 times more likely in 2017. Individuals with high cholesterol status were 2.67 times more likely to have reported CVD compared to those with normal levels in 2011. In 2011, individuals with hypertension were 3.74 times more likely to have reported CVD compared to those who did not have hypertension. This relationship increased its magnitude of risk to 6.18 times more likely in 2017. In 2011, individuals with diabetes were 2.90 times more likely to have reported CVD compared to those without the condition.ConclusionsPublic health and healthcare providers need to target preventable cardiovascular risk factors and develop recommendations and strategies locally, nationally, and globally.

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Abstract 17306: Primary Prevention Aspirin Use Trends and Associations With Health Beliefs Among African Americans, 2015-2019

Circulation ◽

10.1161/circ.142.suppl_3.17306 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jeremy R Vant Hof ◽

Jeffrey Misialek ◽

Niki C Oldenburg ◽

Russell V Luepker ◽

Milton Eder ◽

...

Keyword(s):

Risk Factor ◽

Primary Prevention ◽

African Americans ◽

Health Beliefs ◽

Total Sample ◽

Health Care Practitioner ◽

National Guidelines ◽

Cvd Risk ◽

Cross Sectional ◽

The Media

Introduction: Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended as an option to reduce cardiovascular events. However, recent clinical trials involving primary prevention aspirin have prompted changes in national guidelines restricting the aspirin recommended population. Hypothesis: Primary prevention aspirin use will decline over the 5 year period 2015-2019. Methods: Using 3 cross-sectional surveys, data were collected from self-identified African Americans in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. Results: A total of 1,491 African Americans adults, ages 45-79, 61% women and no prior CVD completed surveys and were included in this analysis. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019--75% vs 84% in 2015 (p<0.05). In the total sample (n=1,491) aspirin discussions with a health care practitioner were highly associated with aspirin use (aRR 2.97, 95% CI 2.49-3.54), as were several health beliefs and social norms that affirm preventive behaviors and aspirin use (Figure). Conclusion: Despite major changes in national guidelines and negative perceptions of aspirin effectiveness in the media, overall primary prevention aspirin use did not significantly change in this African American sample from 2015 to 2019.

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Diabetes Mellitus in Patients with Coronary Heart Disease

Medicine Today ◽

10.3329/medtoday.v25i2.17923 ◽

2014 ◽

Vol 25 (2) ◽

pp. 67-68

Author(s):

Chaklader Md Kamal Jinnah ◽

Md Aminul Haque Khan ◽

Golam Morshed Molla ◽

Md Rezwanur Rahman ◽

M Iqbal Arslan

Keyword(s):

Diabetes Mellitus ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Premature Death ◽

Developed Countries ◽

Cross Sectional Study ◽

Modifiable Risk Factor ◽

Cross Sectional ◽

Medicine Today

Coronary heart disease is the most common form of heart disease and single most important cause of premature death in developed countries. It is estimated that coronary heart disease will become the major cause of death in all regions of the world by 2020. There are several modifiable risk factors of coronary heart disease. Among those diabetes mellitus is one major modifiable risk factor. So we designed this study to see the frequency of diabetes mellitus in patients with coronary heart disease in three tertiary hospitals in Bangladesh with an objective to see the frequency of diabetes mellitus in patients with coronary heart disease. This observational cross-sectional study was conducted in the department of Biochemistry of Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2006 to June 2007. The study was done among 300 purposively selected diagnosed patients of coronary heart disease of both sexes. Diabetes mellitus was diagnosed according to WHO criteria. In this study we found that 23.7% of study subjects had diabetes mellitus. From this study, it can be concluded that the prevalence of diabetes (an important modifiable risk factor) is high in coronary heart disease patients. DOI: http://dx.doi.org/10.3329/medtoday.v25i2.17923 Medicine Today 2013 Vol.25(2): 67-68

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AST/ALT Ratio and Peripheral Artery Disease in a Chinese Hypertensive Population: A Cross-Sectional Study

Angiology ◽

10.1177/00033197211004410 ◽

2021 ◽

pp. 000331972110044

Author(s):

Hui Liu ◽

Xiaoyuan Zha ◽

Congcong Ding ◽

Lihua Hu ◽

Minghui Li ◽

...

Keyword(s):

Risk Factor ◽

Peripheral Artery Disease ◽

Reference Group ◽

Cardiovascular Death ◽

Cross Sectional Study ◽

Peripheral Artery ◽

Chinese Adults ◽

Cross Sectional ◽

Increased Risk ◽

Artery Disease

Previous studies reported that the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) was a risk factor in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular death. However, only a few studies investigated the correlations between the AST/ALT ratio and PAD. We analyzed data from 10 900 patients with hypertension from the Chinese Hypertension Registry Study; 350 patients had PAD (prevalence 3.2%). After adjusting for potential confounders, the AST/ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI, 1.13-1.59), and a significant increased risk of PAD for the third AST/ALT ratio tertile (T3) compared with the first tertile (T1; OR: 1.49, 95% CI, 1.09-2.04, P trend = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.

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Postprandial Triglycerides, Flow-Mediated Dilation, and the Inflammatory Cytokine Milieu in Metabolically Healthy Obesity: A Cross-Sectional Pilot Study

Obesities ◽

10.3390/obesities1010006 ◽

2021 ◽

Vol 1 (1) ◽

pp. 58-71

Author(s):

Bryant H. Keirns ◽

Samantha M. Hart ◽

Christina M. Sciarrillo ◽

Kara L. Poindexter ◽

Stephen L. Clarke ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Vascular Function ◽

Normal Weight ◽

Flow Mediated Dilation ◽

Metabolically Healthy Obesity ◽

Cvd Risk ◽

Cross Sectional ◽

P Values ◽

Postprandial Triglycerides ◽

Metabolically Healthy

The cardiovascular disease (CVD) risk of metabolically healthy obesity (MHO) remains controversial. We sought to further characterize the CVD risk profile in MHO by evaluating postprandial triglycerides, vascular function, and systemic inflammatory markers. Control individuals that were normal-weight and metabolically healthy (Con), MHO, and metabolic syndrome (MetS) were recruited (n = 10–11/group). Each participant underwent an abbreviated fat tolerance test, fasting and postprandial flow-mediated dilation (FMD), and had a panel of inflammatory cytokines measured. MHO displayed postprandial triglycerides similar to those in Con and both MHO and Con had lower values than those for MetS (p < 0.01). Fasting FMD was lower in MHO and MetS compared to that of Con (p < 0.01), but during the postprandial period the vasodilatory response of MHO was similar to that while fasting (p = 0.39), while FMD in Con and MetS decreased after the high-fat meal (p values < 0.01). MHO displayed a number of inflammatory cytokines greater than those of Con and MetS (all p values < 0.05), while MetS and MHO had higher TNF-α than did Con (p < 0.05). In conclusion, MHO was associated with lower fasting FMD and a greater inflammatory burden but did not suffer the same negative postprandial effects as did MetS.

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Trends in cardiovascular disease risk factors by body mass index category among adults in England 2003-18: analysis of repeated cross-sectional national health surveys

10.1101/2020.09.02.20186619 ◽

2020 ◽

Cited By ~ 1

Author(s):

Shaun Scholes ◽

Linda Ng Fat ◽

Jennifer S Mindell

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Risk Factor ◽

Total Cholesterol ◽

Normal Weight ◽

Overweight And Obesity ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Cross Sectional ◽

Risk Factor Prevalence

Objective. Favourable trends in cardiovascular disease (CVD) risk factors at the population level potentially mask differences within high- and low-risk groups. Data from annual, repeated cross-sectional surveys (Health Survey for England 2003-18) was used to examine trends in the prevalence of key CVD risk factors by body mass index (BMI) category among adults aged 16 years or older (n=115,860). Methods. Six risk factors were investigated: (i) current cigarette smoking; (ii) physical inactivity (<30 minutes of moderate-to-vigorous physical activity per week); (iii) drinking above recommended daily alcohol limits; (iv) hypertension (measured blood pressure ≥140/90mmHg or use of medicine prescribed for high blood pressure); (v) total diabetes (reported diagnosed or elevated glycated haemoglobin); and (vi) raised total cholesterol (≥5mmol/L). Age-standardised risk factor prevalence was computed in each four-year time period (2003-06; 2007-10; 2011-14; 2015-18) in all adults and by BMI category (normal-weight; overweight; obesity). Change in risk factor prevalence on the absolute scale was computed as the difference between the first and last time-periods, expressed in percentage points (PP). Results. Risk factor change varied by BMI category in a number of cases. Current smoking prevalence fell more sharply for normal-weight men (-8.1 PP; 95% CI: -10.3, -5.8) versus men with obesity (-3.8 PP; 95% CI: -6.2, -1.4). Hypertension remained at a stable level among normal-weight men but decreased among men with obesity (-4.1 PP; 95% CI: -7.1, -1.0). Total diabetes remained at a stable level among normal-weight adults, but increased among adults with obesity (men: 3.5 PP; 95% CI: 1.2, 5.7; women: 3.6 PP; 95% CI: 1.8, 5.4). Raised total cholesterol decreased in all BMI groups, but fell more sharply among women with obesity (-21 PP; 95% CI: -25, -17) versus their normal-weight counterparts (-16 PP; 95% CI: -18, -14). Conclusions. Relative to adults with normal weight, greater reductions in hypertension and raised total cholesterol among adults with overweight and obesity reflect at least in part improvements in screening, treatment and control among those at highest cardiovascular risk. Higher levels of risk factor prevalence among adults with overweight and obesity, in parallel with rising diabetes, highlight the importance of national prevention efforts to combat the public health impact of excess adiposity.

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