Abstract 381: Ideal Cardiovascular Health and Cardiovascular Disease: Heterogeneity Across Event Phenotype and Contribution of Multiple Biomarkers

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Bamba Gaye ◽  
Muriel Tafflet ◽  
Dominique Arveil ◽  
Frank Kee ◽  
Alun Evans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Mediating Effect ◽  
Blood Biomarkers ◽  
Disease Heterogeneity ◽  
Ideal Cardiovascular Health

Aims: To investigate whether or not the association between baseline cardiovascular health (CVH) and incident cardiovascular disease (CVD) differs by event phenotypes and to address the mediating effect of inflammatory and haemostatic blood biomarkers. Methods: The association of ideal CVH with outcomes was computed in 9312 middle-aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline blood biomarkers was evaluated in a case control study nested within the cohort after 10 years of follow-up. Results: After a median follow-up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared to those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (HR=0.28; 95% CI: 0.17; 0.46) and a 76% lower risk of stroke (HR=0.24; 95% CI: 0.06; 0.98). No heterogeneity was detected across main CHD and main stroke phenotypes. While significantly lower mean concentrations of hs-CRP, IL-6 (inflammatory markers), and fibrinogen, von Willbrandt factor (haemostatic factors) were noted in the controls with higher CVH status, the association of CVH with incident CHD was not attenuated upon adjustment for these biomarkers. Conclusion: these results support the universal promotion of ideal CVH for CVD in general and suggest that the lower risk of CHD associated with ideal CVH is independent from inflammatory and haemostatic biomarkers.

scholarly journals Excess Cardiovascular Disease and Mortality in Diabetes: Can It Be Offset With Ideal Cardiovascular Health Trajectories?

2021 ◽  
Author(s):  
Bamba Gaye ◽  
Donald Lloyd-Jones ◽  
Eugenie Valentin ◽  
Joshua J Joseph ◽  
Xavier Jouven ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Mortality Risk ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Ideal Cardiovascular Health ◽  
Incidence And Mortality

Abstract Objective: To describe patterns of change in cardiovascular health (CVH) measured by the Life’s Simple 7 (LS7) over 6 years in participants with diabetes, and assess the association of these patterns of change with subsequent cardiovascular disease (CVD) and all-cause mortality.Methods: We conducted a long-term prospective cohort analysis (median follow-up 19 years) using the ARIC study, a community-based, biracial cohort with participants aged 45-64 years at baseline in 1987–1989. The LS7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose, and blood pressure) were collected at baseline and 6 years later. At both time points, participants were classified as low (0-2 ideal metrics), moderate (3-4), and favorable (5-7) CVH, and 6-year CVH change categories were created. Cox proportional hazards regressions were used to estimate the association between change categories and CVD and mortality. Results: The majority (62.2%) of participants with diabetes had a stable-low CVH at both visits, whereas 12.1% had stable-moderate and 0.4% stable-favorable, 14.9% improved, and 10.5% worsened. Compared to participants with stable-low CVH, CVD and mortality risk was lower for those who improved CVH 6 years later, or stable-moderate, or even high- or moderate-to-low CVH. This was driven by favorable changes in blood pressure, cholesterol, physical activity and smoking. Compared to participants free of diabetes with a stable-favorable CVH change, participants with diabetes had higher CVD and mortality risk regardless of their CVH trajectory. However, those with a favorable CVH trajectory displayed the same excess risk as participants without diabetes with stable-low CVH. Conclusions: Among individuals with diabetes, maintaining or reaching ideal levels of LS7 metrics can help reduce the excess CVD incidence and mortality. A favorable CVH trajectory in people with diabetes carried approximately the same excess CVD and mortality risk than an unfavorable CVH trajectory in people free of diabetes.

Abstract P378: Higher Non-exercise Estimated Cardiorespiratory Fitness in Midlife is Associated With Lower Risk of Cardiovascular Disease and Mortality in Later Life: The Framingham Heart Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Joowon Lee ◽  
Ramachandran S Vasan ◽  
Vanessa Xanthakis
Keyword(s):  
Cardiovascular Disease ◽  
Cardiorespiratory Fitness ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Health Indicators ◽  
Later Life ◽  
Cox Proportional Hazards ◽  
All Cause Mortality

Introduction: Studies have demonstrated that higher cardiorespiratory fitness (CRF) is associated with a lower risk of cardiovascular disease (CVD) and mortality. However, exercise CRF test is not routinely performed in clinical settings because it requires specialized equipment and trained personnel. Therefore, non-exercise estimated CRF (eCRF) using easily accessible health indicators in clinical practice may be a time- and cost-effective alternative for evaluating fitness. Hypothesis: We hypothesized that higher eCRF in midlife will be associated with a lower risk of CVD and all-cause mortality in later life. Methods: We evaluated 2,501 Framingham Offspring cohort participants (mean age 65 yrs., 52% women). We used a longitudinal non-exercise algorithm that includes age, sex, body mass index, waist circumference, resting heart rate, physical activity, and smoking status. We then used SAS PROC TRAJ to identify sex-specific latent patterns of eCRF (low, moderate, and high eCRF categories) between exam 2 and 8 (1979-2008). Multivariable Cox proportional hazards regression models were used to relate the long-term trajectories of eCRF to incident CVD and all-cause mortality on follow-up. Results: We identified three distinct trajectories of eCRF (Low [n=268, 10.7%] vs. moderate [n=1,273, 50.9%] vs. high [n=960, 38.4%]). Overall, 265 participants developed CVD and 429 died during 10 years of median follow-up. Participants in the “high eCRF” group were at lower risk of CVD and all-cause mortality compared to those in the “low eCRF” group, after adjustment for potential confounders ( Table ). Conclusions: Our findings suggest that lower eCRF during midlife may be a marker of risk of CVD and mortality in older adulthood.

Consumption of flavonoid-rich fruits, flavonoids from fruits, and stroke risk: a prospective cohort study

2021 ◽  
pp. 1-26
Author(s):  
Qi Gao ◽  
Jia-Yi Dong ◽  
Renzhe Cui ◽  
Isao Muraki ◽  
Kazumasa Yamagishi ◽  
...  
Keyword(s):  
Lower Risk ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dietary Factors ◽  
Citrus Fruits ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Index Study

Abstract We sought to examine the prospective associations of specific fruit consumption, in particular flavonoid-rich fruit (FRF) consumption, with the risk of stroke and subtypes of stroke in a Japanese population. A study followed a total of 39,843 men and 47,334 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline since 1995 and 1998 to the end of 2009 and 2012, respectively. Data on total and specific FRF consumption for each participant were obtained using a self-administrated food frequency questionnaire. The hazard ratios (HRs) of stroke in relation to total and specific FRF consumption were estimated through Cox proportional hazards regression models. During a median follow-up of 13.1 years, 4092 incident stroke cases (2557 cerebral infarctions and 1516 hemorrhagic strokes) were documented. After adjustment for age, body mass index, study area, lifestyles, dietary factors, and other risk factors, it was found that total FRF consumption was associated with a significantly lower risk of stroke in women (HR= 0.70; 95% CI, 0.58-0.84), while the association in men was not significant (HR= 0.93; 95% CI, 0.79-1.09). As for specific FRFs, consumptions of citrus fruits, strawberries, and grapes were found associated with a lower stroke risk in women. Higher consumptions of FRFs, in particular citrus fruits, strawberries, and grapes, were associated with a lower risk of developing stroke in Japanese women.

Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Joshua J Joseph ◽  
Aleena Bennett ◽  
Justin B Echouffo Tcheugui ◽  
Valery S Effoe ◽  
James Odei ◽  
...  
Keyword(s):  
Racial Differences ◽  
Impaired Fasting Glucose ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Glycemic Status ◽  
Ideal Cardiovascular Health ◽  
Normal Fasting Glucose ◽  
Prevention Of Diabetes

Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

scholarly journals Cardiovascular health, genetic risk, and risk of dementia in the Framingham Heart Study

Neurology ◽  
2020 ◽  
Vol 95 (10) ◽  
pp. e1341-e1350 ◽  
Author(s):  
Gina M. Peloso ◽  
Alexa S. Beiser ◽  
Claudia L. Satizabal ◽  
Vanessa Xanthakis ◽  
Ramachandran S. Vasan ◽  
...  
Keyword(s):  
Genetic Risk ◽  
Framingham Heart Study ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Genetic Risk Score ◽  
Cox Proportional Hazards ◽  
Ideal Cardiovascular Health ◽  
Heart Study ◽  
Common Genetic Variants ◽  
Ε4 Allele

ObjectiveTo determine the joint role of ideal cardiovascular health (CVH) and genetic risk on risk of dementia.MethodsWe categorized CVH on the basis of the American Heart Association Ideal CVH Index and genetic risk through a genetic risk score (GRS) of common genetic variants and the APOE ε4 genotype in 1,211 Framingham Heart Study (FHS) offspring cohort participants. We used multivariable Cox proportional hazards regression models to examine the association between CVH, genetic risk, and incident all-cause dementia with up to 10 years of follow-up (mean 8.4 years, 96 incident dementia cases), adjusting for age, sex, and education.ResultsWe observed that a high GRS (>80th percentile) was associated with a 2.6-fold risk of dementia (95% confidence interval [CI] of hazard ratio [HR] 1.23–5.29; p = 0.012) compared with having a low GRS (<20th percentile); carrying at least 1 APOE ε4 allele was associated with a 2.3-fold risk of dementia compared with not carrying an APOE ε4 allele (95% CI of HR 1.49–3.53; p = 0.0002), and having a favorable CVH showed a 0.45-fold lower risk of dementia (95% CI of HR 0.20–1.01; p = 0.0527) compared to having an unfavorable CVH when all 3 components were included in the model. We did not observe an interaction between CVH and GRS (p = 0.99) or APOE ε4 (p = 0.16).ConclusionsWe observed that both genetic risk and CVH contribute additively to dementia risk.

scholarly journals Metformin vs sulfonylurea use and risk of dementia in US veterans aged ≥65 years with diabetes

Neurology ◽  
2017 ◽  
Vol 89 (18) ◽  
pp. 1877-1885 ◽  
Author(s):  
Ariela R. Orkaby ◽  
Kelly Cho ◽  
Jean Cormack ◽  
David R. Gagnon ◽  
Jane A. Driver
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Confounding By Indication ◽  
Cox Proportional Hazards Models ◽  
Incident Dementia ◽  
Us Veterans

Objective:To determine whether metformin is associated with a lower incidence of dementia than sulfonylureas.Methods:This was a retrospective cohort study of US veterans ≥65 years of age with type 2 diabetes who were new users of metformin or a sulfonylurea and had no dementia. Follow-up began after 2 years of therapy. To account for confounding by indication, we developed a propensity score (PS) and used inverse probability of treatment weighting (IPTW) methods. Cox proportional hazards models estimated the hazard ratio (HR) of incident dementia.Results:We identified 17,200 new users of metformin and 11,440 new users of sulfonylureas. Mean age was 73.5 years and mean HbA1c was 6.8%. Over an average follow-up of 5 years, 4,906 cases of dementia were diagnosed. Due to effect modification by age, all analyses were conducted using a piecewise model for age. Crude hazard ratio [HR] for any dementia in metformin vs sulfonylurea users was 0.67 (95% confidence interval [CI] 0.61–0.73) and 0.78 (95% CI 0.72–0.83) for those <75 years of age and ≥75 years of age, respectively. After PS IPTW adjustment, results remained significant in veterans <75 years of age (HR 0.89; 95% CI 0.79–0.99), but not for those ≥75 years of age (HR 0.96; 95% CI 0.87–1.05). A lower risk of dementia was also seen in the subset of younger veterans who had HbA1C values ≥7% (HR 0.76; 95% CI 0.63–0.91), had good renal function (HR 0.86; 95% CI 0.76–0.97), and were white (HR 0.87; 95% CI 0.77–0.99).Conclusions:After accounting for confounding by indication, metformin was associated with a lower risk of subsequent dementia than sulfonylurea use in veterans <75 years of age. Further work is needed to identify which patients may benefit from metformin for the prevention of dementia.

scholarly journals Copeptin Associates with Cause-Specific Mortality in Patients with Impaired Renal Function: Results from the LURIC and the 4D Study

2017 ◽  
Vol 63 (5) ◽  
pp. 997-1007 ◽  
Author(s):  
Vera Krane ◽  
Bernd Genser ◽  
Marcus E Kleber ◽  
Christiane Drechsler ◽  
Winfried März ◽  
...  
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Infectious Complications ◽  
Cox Proportional Hazards ◽  
Coronary Death ◽  
All Cause Mortality ◽  
Specific Mortality

Abstract BACKGROUND In chronic kidney disease (CKD) arginine vasopressin (AVP) cannot efficiently act via renal V2-receptors. AVP is upregulated leading to augmented activation of V1a- and V1b-receptors, which might contribute to the increase in cardiovascular and infectious complications in CKD. Here, we evaluate copeptin, a surrogate of AVP, and its association with cause specific mortality among patients within the whole spectrum of renal function. METHODS Copeptin was measured in baseline samples from the LURIC (n = 3131 patients with coronary angiograms) and the 4D-Study (n = 1241 type 2 diabetic hemodialysis patients). Patients were stratified into 4 groups: estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2, 60–89 mL/min/1.73 m2, &lt;60 mL/min/1.73 m2, and hemodialysis. The association of copeptin with mortality was assessed by Cox proportional hazards regression during 9.9 years of median follow-up in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study and 4 years of median follow-up in the German Diabetes Dialysis Study (4D-Study). RESULTS Median copeptin increased with decreasing eGFR: 5.6 [interquartile range (IQR), 3.1–8.1] pmol/L (eGFR ≥90 mL/min/1.73 m2), 6.7 (2.9–10.5) pmol/L (eGFR 60–89 mL/min/1.73 m2), 15.3 (6.7–23.9) pmol/L (eGFR &lt;60 mL/min/1.73 m2), and 80.8 (51.2–122) pmol/L (hemodialysis), respectively. Per SD increase in copeptin, the risk of coronary, infectious, and all-cause mortality increased by 25, 30, and 15% [hazard ratios (HR), 1.25; 95% CI, 1.13–1.39; HR, 1.30; 95% CI, 0.98–1.71; and HR, 1.15; 95% CI, 1.05–1.25], respectively, in patients with eGFR 60–89 mL/min/1.73 m2. Except for coronary death, results were similar among patients with more advanced renal disease. No significant association was found in patients with normal renal function. CONCLUSIONS Copeptin concentrations were independently associated with coronary, infectious, and all-cause mortality in patients with renal impairment. In patients with normal renal function no significant association was found.

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