scholarly journals Intersection between gonadal function and vascular aging in women

2018 ◽  
Vol 125 (6) ◽  
pp. 1881-1887 ◽  
Author(s):  
Kerrie L. Moreau
Keyword(s):  
Risk Factors ◽  
Sleep Disturbances ◽  
Hot Flashes ◽  
Vascular Wall ◽  
Menopausal Transition ◽  
Vascular Aging ◽  
Gonadal Function ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

Vascular aging, characterized by endothelial dysfunction and large elastic arterial stiffening, is a major risk factor for age-associated cardiovascular disease (CVD). Although women have a lower prevalence of CVD until midlife, prevalence rates increase rapidly coincident with the menopausal transition to match those observed in men. The menopausal transition, or perimenopause, is a chaotic period that is associated with increased symptoms (e.g., hot flashes, depressed mood, anxiety, sleep disturbances) and CVD risk factors due to changes in the hormonal environment. Because these quality of life factors and CVD risk factors also change with aging, the arteries of women appear to endure a double insult. Our laboratory has been investigating how changes in gonadal function and hormone levels with the menopause transition impacts the vascular aging process in healthy women. Our work has shown that vascular endothelial function progressively declines, and large elastic arterial stiffness is greater across the stages of the menopausal transition. This acceleration in vascular aging may be due to the loss of vasodilatory, antioxidant, anti-inflammatory, and antiproliferative effects of estradiol on the vascular wall. This minireview discusses the impact of changes in gonadal function and hormones with the menopausal transition on vascular aging in women and areas for investigations to further our understanding of the intersection between gonadal function and vascular aging.

scholarly journals Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

2017 ◽  
Vol 77 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Cynthia S Crowson ◽  
Silvia Rollefstad ◽  
Eirik Ikdahl ◽  
George D Kitas ◽  
Piet L C M van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Total Cholesterol ◽  
Smoking Prevalence ◽  
Disease Activity Score ◽  
Population Attributable Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

ObjectivesPatients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.MethodsIn 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.Results5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).ConclusionsIn a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

scholarly journals Patterns of Immune Activation in HIV and Non HIV Subjects and Its Relation to Cardiovascular Disease Risk

2021 ◽  
Vol 12 ◽  
Author(s):  
Alinda G. Vos ◽  
Caitlin N. Dodd ◽  
Eveline M. Delemarre ◽  
Stefan Nierkens ◽  
Celicia Serenata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Immune Activation ◽  
Hiv Positive ◽  
Inflammation Markers ◽  
Cvd Risk Factors ◽  
Immune Markers ◽  
Cvd Risk ◽  
The Impact ◽  
Hiv Negative

IntroductionInsight into inflammation patterns is needed to understand the pathophysiology of HIV and related cardiovascular disease (CVD). We assessed patterns of inflammation related to HIV infection and CVD risk assessed with carotid intima media thickness (CIMT).MethodsA cross-sectional study was performed in Johannesburg, South Africa, including participants with HIV who were virally suppressed on anti-retroviral therapy (ART) as well as HIV-negative participants who were family members or friends to the HIV-positive participants. Information was collected on CVD risk factors and CIMT. Inflammation was measured with the Olink panel ‘inflammation’, allowing to simultaneously assess 92 inflammation markers. Differences in inflammation patterns between HIV-positive and HIV-negative participants were explored using a principal component analysis (PCA) and ANCOVA. The impact of differentiating immune markers, as identified by ANCOVA, on CIMT was assessed using linear regression while adjusting for classic CVD risk factors.ResultsIn total, 185 HIV-positive and 104 HIV negative participants, 63% females, median age 40.7 years (IQR 35.4 – 47.7) were included. HIV-positive individuals were older (+6 years, p &lt;0.01) and had a higher CIMT (p &lt;0.01). No clear patterns of inflammation were identified by use of PCA. Following ANCOVA, nine immune markers differed significantly between HIV-positive and HIV-negative participants, including PDL1. PDL1 was independently associated with CIMT, but upon stratification this effect remained for HIV-negative individuals only.ConclusionHIV positive patients on stable ART and HIV negative controls had similar immune activation patterns. CVD risk in HIV-positive participants was mediated by inflammation markers included in this study.

scholarly journals Risk Factors for Cardiovascular Disease (CVD) in Adults with Type 1 Diabetes: Findings from Prospective Real-life T1D Exchange Registry

2020 ◽  
Vol 105 (5) ◽  
pp. e2032-e2038 ◽  
Author(s):  
Viral N Shah ◽  
Ryan Bailey ◽  
Mengdi Wu ◽  
Nicole C Foster ◽  
Rodica Pop-Busui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
The United States ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

Abstract Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

scholarly journals Cardiovascular Risk Factors Impact on the Severity of Coronary Artery Disease among Acute ST-Elevation Myocardial Infarction Patients in the United Arab Emirates

2021 ◽  
pp. 1-9
Author(s):  
Vijay Chander Vinod ◽  
Vijay Chander Vinod ◽  
Zuhair Eltayeb Yousif
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Coronary Artery ◽  
Multivessel Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Vessel Disease ◽  
St Elevation ◽  
Artery Disease ◽  
The Impact

Objective: To define the impact of the cardiovascular risk factors on the extent of Coronary Artery Disease in STEMI patients and to identify the common prevalent risk factors that are unrecognized or poorly treated resulting in STEMI among the UAE population. Methods: Retrospective cohort on patients presented to Mediclinic City Hospital from 2011-2016 who underwent Primary Percutaneous Coronary Intervention (PCI) for confirmed ST-Elevation Myocardial Infarction (STEMI). Results: Of the total 104 STEMI patients, 91% were males. Mean (+SD) of 53 (+12.5) years of age. 73% were less than 60 years old. The most prevalent risk factor was hypertension (42%). 38% of diabetics had an HbA1C of >7%. 14% of the dyslipidemic had above target lipid levels in spite of Statin. 100% of the study population had at least 1 risk factor, ≥2 risk factors (97%), ≥3 risk factors (82%). 50% had 1 or more incidental risk factors diagnosed after admission. Dyslipidemia (36%) was the commonest incidental risk factor. The total risk factor counts increased significantly when the incidental or poorly treated risk factors were added to the initial risk factors on admission. Anterior Wall STEMI (38%) was the commonest. Left Anterior Descending Coronary Artery (48%) was the commonest culprit vessel. The majority had Triple Vessel Disease (37%). 37% developed in-hospital complications. Multivessel disease patients had more risk factors than in single-vessel disease but the association between the number of risk factors and disease severity was not statistically significant. The odds of multivessel disease increased with cumulative risk factor categories, but there was no significant trend association. Conclusion: Our study attempted to determine the impact of CVD risk factors on the severity of CAD among STEMI patients who underwent primary PCI. Contrary to other studies, there was no statistical difference noted in the prevalence of CVD risk factors between the single-vessel and multivessel disease. The study did prove that the incidental or under-diagnosed or inadequately treated risk factors had an impact on the severity of CAD. The study stress that every single CVD risk factor should be treated with equal importance. Statistically significant associations need to be confirmed in future studies with a larger number of patients.

Abstract P013: Prevalence, Correlates and Prognosis of Healthy Vascular Aging in a Western Community-dwelling Population

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Teemu Niiranen ◽  
Asya Lyass ◽  
Martin Larson ◽  
Naomi Hamburg ◽  
Emelia Benjamin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Regression Models ◽  
Cardiovascular Health ◽  
Vascular Aging ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Health Score ◽  
Unit Increase ◽  
Life’S Simple 7

Introduction: Although hypertension in the elderly is no longer considered harmless, increasing arterial stiffness and blood pressure (BP) are still widely seen as inevitable parts of the aging process. However, these phenomena may not be unavoidable as they are nearly absent in populations leading traditional hunter-gatherer lifestyles. Our study had 3 aims: 1) to define a new concept - healthy vascular aging (HVA); 2) to assess prevalence and correlates of HVA in a sample acculturated to a western life-style; and 3) to estimate the magnitude of cardiovascular (CVD) risk associated with HVA vs. absence of HVA. Methods: We studied 3197 Framingham Heart Study participants aged ≥50 years (62±9 years, 56% women) who underwent physical examination, interviews, and measurement of carotid-femoral pulse wave velocity (PWV) in 1999-2008. We defined HVA as no hypertension (BP <140/90 mmHg without antihypertensive treatment) and PWV <7.6 m/s (equivalent to +2 SD above mean of non-hypertensive reference sample aged <30 years with no CVD risk factors). We used logistic regression models that included physical activity, caloric intake, and classical CVD factors as covariates to assess the correlates of HVA. For each participant, we constructed a cardiovascular health score based on presence vs. absence of 6 modifiable risk factors (cholesterol, plasma glucose, healthy diet score, physical activity, body mass index (BMI), and smoking) defined as dichotomous variables according to the American Heart Association’s Life’s Simple 7 score (modified to exclude hypertension). We estimated odds ratios (OR) per 1-unit increase in cardiovascular health score for HVA. We used Cox regression models adjusted for classical CVD risk factors, including systolic BP, to assess the relationship between HVA and incident CVD events (CVD death, myocardial infarction, heart failure, stroke, and unstable angina). Results: In our sample, only 566 (17.7%) had HVA. Lower age (OR per 1-SD increase 0.18, 95% confidence interval [CI] 0.14-0.23), female sex (OR 2.03; 95% CI 1.54-2.68), lower BMI (OR per 1-SD increase 0.54; 95% CI 0.47-0.63) and no diabetes (OR 0.09; 95% CI 0.02-0.36) were significantly associated with HVA. A 1-unit increase in the cardiovascular health score conferred 1.55-fold (95% CI 1.38-1.74) odds of HVA. During follow-up (median 9.6 years), 391 participants had CVD events. HVA was associated with an age- and sex-adjusted hazard ratio (HR) of 0.36 (95% CI, 0.22-0.60) and a multivariable-adjusted HR of 0.45 (95% CI, 0.26-0.77) for CVD relative to absence of HVA. Conclusions: One in 6 individuals experiences HVA in our sample. Individuals with HVA are at a considerably low risk of CVD. Prevention strategies targeting modifiable factors and behaviors included in Life’s Simple 7 are important for preventing or delaying vascular aging and the associated risk of CVD.

Abstract 17276: Impact of Cardiovascular Comorbidities on COVID-19 Infection Risk

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Tofovic ◽  
Minji Seok ◽  
Logan S Schwarzman ◽  
Sreenivas Konda ◽  
Noreen T Nazir
Keyword(s):  
Risk Factors ◽  
Cohort Analysis ◽  
Age Groups ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Age Group ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Patient Demographics ◽  
The Impact

Introduction: A disproportionate amount of COVID-19 infections has occurred in minority populations and in individuals with comorbid disease. We sought to evaluate the impact of patient demographics, cardiovascular disease (CVD), and known CVD risk factors on the incidence of COVID-19 infection. Methods: Between April 1st to May 1st, 2020, 844 adult patients (mean age 51.4±17.7 years, mean BMI 29.6±8.3, 50% male) admitted for any reason and tested for COVID-19 based on CDC criteria were studied in this large, metropolitan, single-center retrospective cohort analysis. Bivariate and multivariate analysis between patient demographics, CVD, and CVD risk factors with COVID-19 were evaluated. The nonlinear effects of age on COVID-19 test results were further analyzed. Results: Prevalence of COVID-19 was 21.7%. African Americans, Latinos, and Caucasian were 463(55%), 216(25%), 165(20%) respectively. Unadjusted, diabetes mellitus (DM) was significantly related with the COVID-19 positivity (OR 1.83, 95% CI 1.30-2.58, P=0.0005), but age adjusted DM was insignificant (OR 1.35, 95% CI 0.93-1.97, P=0.12). Similar results were found with other CVD risk factors (see Tables 1,2). Stratified analysis by age groups (18-40 years, ≥40 years), DM in the younger age group was the most significant risk factor for the COVID-19 positivity (OR 4.52, 95% CI 1.95-10.52, P=0.0002) but not in older inpatients (OR 1.23, 95% CI 0.85-1.81, P=0.2763). In the older age group, Latinos were significantly higher risk for COVID-19 compared to Caucasian (OR 2.27, 95% CI 1.26-4.07, P=0.005). Conclusions: Increased resources for testing in younger individuals with DM and the Hispanic population may be merited.

scholarly journals Sampling Trial Showed S-equol Supplementation Helped Relieve Menopausal Symptoms (P06-111-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
LeeCole Legette ◽  
Chioma Ikonte ◽  
Susan Mitmesser
Keyword(s):  
Weight Gain ◽  
Hair Loss ◽  
Sexual Desire ◽  
Sleep Disturbances ◽  
Hot Flashes ◽  
Menopausal Symptoms ◽  
Menopausal Transition ◽  
Memory Problems ◽  
Night Sweats ◽  
The Impact

Abstract Objectives Women experience a variety of symptoms during each stage of the menopausal transition (perimenopause, menopause, and post menopause) and search out various approaches for relief including complementary and alternative treatments such as phytoestrogens. Phytoestrogens are plant compounds that have a similar chemical structure to that of estrogen. Common examples include red clover and soy isoflavones. S-equol, a metabolite of soy isoflavone daidzein, is naturally produced by intestinal bacteria following soy consumption. However, only 20–30% of the US population are equol producers, indicating that many may benefit from S-equol supplementation. The aim of this sampling trial was to assess the impact of a dietary S-equol supplement on menopausal symptoms. Methods Perimenopausal and menopausal women were recruited into an open label trial on a rolling basis; subjects were provided a four week supply of a S-equol supplement 3 times resulting in 12 week supplementation. Participants were instructed to consume a 5 mg S-equol tablet twice daily for total of 10 mg S-equol daily. Participants completed an online survey at weeks 0, 3, 7, and 12 during the trial. They reported on the occurrence of various menopausal symptoms including: anxiety, change in sexual desire, depression, fatigue, hair loss, hot flashes, mood swings, memory problems, night sweats, sleep disturbances, and weight gain. Results Baseline survey (n = 1164) showed common menopausal transition symptoms include: anxiety (78%), change in sexual desire (83%), depression (70%), fatigue (89%), hair loss (57%), hot flashes (97%), mood swings (85%), memory problems (86%), night sweats (95%), sleep disturbances (95%), and weight gain (81%). After 12 weeks of S-equol supplementation (n = 247), 90% of women noted a difference in one or more menopausal symptoms. Among individuals that noted any difference in one or more symptoms (n = 223), 82%, 71% and 40% noticed a difference in hot flashes, night sweats, and sleep disturbances, respectively. Over 90% of the differences observed for hot flashes, night sweats, and sleep disturbances were reported as improvements. Conclusions Following 12 week supplementation of 10 mg S-equol per day, over 90% of women identified an effect on 1 or more menopausal symptom. For the most common symptoms (hot flashes, night sweats, and sleep disturbances), over 90% were reported as improved. Funding Sources This study was funded by Pharmavite LLC.

scholarly journals Increased Arterial Stiffness Is Associated With Reduced Diastolic Function in Youth With Obesity and Type 2 Diabetes

2021 ◽  
Vol 9 ◽  
Author(s):  
Nicolas L. Madsen ◽  
Jessica E. Haley ◽  
Ryan A. Moore ◽  
Philip R. Khoury ◽  
Elaine M. Urbina
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Arterial Stiffness ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Stiffness Index ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

Background: Increased arterial stiffness is associated with diastolic dysfunction in adults. Data in youth are lacking, so we examined the impact of arterial stiffness on diastolic function in youth.Methods: We obtained diastolic function and augmentation index, pulse wave velocity, brachial artery distensibility, and carotid stiffness on 612 youth [10–24 years, 65% female, 38% normal weight, 36% obese, and 26% with type 2 diabetes mellitus (T2DM)]. Participants were classified as compliant (C) vs. stiff (S) arteries based on seven arterial stiffness parameters [Global Stiffness Index (GSI), S = GSI &gt; 4). Mean differences in covariates were evaluated by Student's t-tests. A stepwise regression analysis was performed to determine if GSI was an independent predictor of diastolic function.Results: Lower diastolic function and more adverse cardiovascular disease (CVD) risk factors were present in the S group (n = 67) than the C group (n = 545) (p &lt; 0.001). Covariates that were associated with diastolic dysfunction were higher GSI, male sex, higher body mass index (BMI), and systolic blood pressure (SBP) z-score (R2 = 0.18 to 0.25; p ≤ 0.05).Conclusion: Adverse diastolic function is seen in youth with increased arterial stiffness independent of CVD risk factors. Interventions to improve arterial stiffness prior to clinical onset of diastolic dysfunction are needed to prevent development of heart failure.

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