Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction

Abstract Background Currently used models to predict cardiovascular event risk have limited value. It has been shown repetitively that the addition of single biomarkers has modest impact. Recently we observed that a model consisting of a larger array of plasma proteins performed very well in predicting the presence of vulnerable plaques in primary prevention patients. However, the validation of this protein panel in predicting cardiovascular outcomes remains to be established. Purpose This study investigated the ability of a 384 preselected protein biomarkers to predict acute myocardial infarction, using state-of-the-art machine learning techniques. Secondly, we compared the performance of this multi-protein risk model to traditional risk engines. Methods We selected 822 subjects from the EPIC-Norfolk prospective cohort study, of whom 411 suffered a myocardial infarction during follow-up (median 15 years) compared to 411 controls who remained event-free (median follow-up 20 years). The 384 proteins were measured using proximity extension assay technology. Machine learning algorithms (random forests) were used for the prediction of acute myocardial infarction (ICD code I21–22). Performance of the model was tested against and on top of traditional risk factors for cardiovascular disease (refit Framingham). All performance measurements were averaged over several stability selection routines. Results Prediction of myocardial infarction using a machine-learning model consisting of 50 plasma proteins resulted in a ROC AUC of 0.74±0.14, in comparison to 0.69±0.17 using traditional risk factors (refit Framingham. Combining the proteins and refit Framingham resulted in a ROC AUC of 0.74±0.15. Focussing on events occurring within 3 years after baseline blood withdrawal, the ROC AUC increased to 0.80±0.09 using 50 plasma proteins, as opposed to 0.67±0.22 using refit Framingham (figure). Combining the protein model with refit Framingham resulted in a ROC AUC of 0.82±0.11 for these events. Diagnostic performance events <3yrs Conclusion High-throughput proteomics outperforms traditional risk factors in prediction of acute myocardial infarction. Prediction of myocardial infarction occurring within 3 years after inclusion showed highest performance. Availability of affordable proteomic approaches and developed machine learning pave the path for clinical implementation of these models in cardiovascular risk prediction. Acknowledgement/Funding This study was funded by an ERA-CVD grant (JTC2017) and EU Horizon 2020 grant (REPROGRAM, 667837)

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Traditional Risk Factors and Subclinical Disease Measures as Predictors of First Myocardial Infarction in Older Adults

Archives of Internal Medicine ◽

10.1001/archinte.159.12.1339 ◽

1999 ◽

Vol 159 (12) ◽

pp. 1339 ◽

Cited By ~ 117

Author(s):

Bruce M. Psaty ◽

Curt D. Furberg ◽

Lewis H. Kuller ◽

Diane E. Bild ◽

Pentti M. Rautaharju ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Older Adults ◽

Subclinical Disease ◽

Traditional Risk Factors ◽

First Myocardial Infarction

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Challenges of Statins in HIV Hyperlipidemia

US Endocrinology ◽

10.17925/use.2013.09.02.157 ◽

2013 ◽

Vol 09 (02) ◽

pp. 157 ◽

Cited By ~ 1

Author(s):

Carlos D Malvestutto ◽

Judith A Aberg ◽

◽

Keyword(s):

Risk Factors ◽

Drug Interactions ◽

Cardiovascular Complications ◽

Lipid Lowering ◽

Virologic Suppression ◽

Lifestyle Modifications ◽

Negative Effects ◽

Reductase Inhibitors ◽

Increased Risk ◽

Traditional Risk Factors

As a result of access to potent antiretroviral therapy (ART), HIV-infected adults with virologic suppression are living longer, but unfortunately are at increased risk for developing comorbid conditions. It is postulated that this increased risk seen at all ages is partly due to the effects of viral-mediated chronic inflammation in addition to the traditional risk factors. One of the more common traditional risk factors, hyperlipidemia, may be worsened by ART. However, the benefits of ART greatly outweigh the possible negative effects of ART agents on lipid parameters. As the HIV-infected patient population ages, it is critical to control hyperlipidemia in ART-treated patients in order to reduce the risk for long-term cardiovascular complications. If hyperlipidemia cannot be managed through lifestyle modifications, clinical guidelines recommend the use of lipid-lowering medication, particularly HMG Co-A reductase inhibitors (statins), to reduce low-density lipoproteins-cholesterol. However, many ART agents inhibit or induce major metabolic pathways of statins, creating potentially serious drug–drug interactions. In this article, we present a review of the various challenges in managing hyperlipidemia with a focus on drug–drug interactions.

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Comparison of Traditional Risk Factors, Angiographic Findings, and In-Hospital Mortality between Smoking and Nonsmoking Turkish Men and Women With Acute Myocardial Infarction

Clinical Cardiology ◽

10.1002/clc.20716 ◽

2010 ◽

Vol 33 (6) ◽

pp. E49-E54 ◽

Cited By ~ 5

Author(s):

Nazif Aygul ◽

Kurtulus Ozdemir ◽

Adnan Abaci ◽

Meryem Ulku Aygul ◽

Mehmet Akif Duzenli ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Men And Women ◽

Traditional Risk Factors ◽

Angiographic Findings

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Incident myocardial infarction associated with major types of arthritis in the general population: a systematic review and meta-analysis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-210275 ◽

2017 ◽

Vol 76 (8) ◽

pp. 1396-1404 ◽

Cited By ~ 52

Author(s):

Orit Schieir ◽

Cedomir Tosevski ◽

Richard H Glazier ◽

Sheilah Hogg-Johnson ◽

Elizabeth M Badley

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Meta Analysis ◽

Population Based ◽

Case Control Studies ◽

Increased Risk ◽

Traditional Risk Factors ◽

Meta Analyses ◽

Review Criteria ◽

Age And Sex

ObjectiveTo synthesise, quantify and compare risks for incident myocardial infarction (MI) across five major types of arthritis in population-based studies.MethodsA systematic search was performed in MEDLINE, EMBASE and CINAHL databases with additional manual/hand searches for population-based cohort or case-control studies published in English of French between January 1980 and January 2015 with a measure of effect and variance for associations between incident MI and five major types of arthritis: rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), gout or osteoarthritis (OA), adjusted for at least age and sex. All search screening, data abstraction quality appraisals were performed independently by two reviewers. Where appropriate, random-effects meta-analysis was used to pool results from studies with a minimum of 10 events.ResultsWe identified a total of 4, 285 articles; 27 met review criteria and 25 criteria for meta-analyses. In studies adjusting for age and sex, MI risk was significantly increased in RA (pooled relative risk (RR): 1.69, 95% CI 1.50 to 1.90), gout (pooled RR: 1.47, 95% CI 1.24 to 1.73), PsA (pooled RR: 1.41, 95% CI 1.17 to 1.69), OA (pooled RR: 1.31, 95% CI 1.01 to 1.71) and tended towards increased risk in AS (pooled RR: 1.24, 95% CI 0.93 to 1.65). Traditional risk factors were more prevalent in all types of arthritis. MI risk was attenuated for each type of arthritis in studies adjusting for traditional risk factors and remained significantly increased in RA, PsA and gout.ConclusionsMI risk was consistently increased in multiple types of arthritis in population-based studies, and was partially explained by a higher prevalence of traditional risk factors in all types of arthritis. Findings support more integrated cardiovascular (CV) prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional CV risk factors.

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Hypertension and Metabolic Syndrome in Persons with HIV

Current Hypertension Reports ◽

10.1007/s11906-020-01089-3 ◽

2020 ◽

Vol 22 (10) ◽

Author(s):

Sepiso K. Masenga ◽

Fernando Elijovich ◽

John R. Koethe ◽

Benson M. Hamooya ◽

Douglas C. Heimburger ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Metabolic Syndrome ◽

T Cell Activation ◽

Highly Active Antiretroviral Therapy ◽

Cell Activation ◽

Cardiovascular Complications ◽

Highly Active ◽

The Metabolic Syndrome ◽

Traditional Risk Factors

Abstract Purpose of Review With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. Recent Findings Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Summary Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population.

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