High Brown Fat Activity Correlates With Cardiovascular Risk Factor Levels Cross-Sectionally and Subclinical Atherosclerosis at 5-Year Follow-Up

Objective: To investigate whether preterm birth and placental evidence of malperfusion is associated with subclinical atherosclerosis and a higher cardiovascular risk factor burden 4 to 12 years after pregnancy. Methods: A cohort of women with preterm (n=119) and term births (n=242), mean age 38 years, was examined on average eight years after pregnancy for carotid artery intima-media thickness (IMT), fasting lipids, blood pressure and inflammatory markers (C-reactive protein [hsCRP] and Interleukin-6 [IL-6]). Pregnancy characteristics included placental pathology evidence of malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition), infection (chorioamnionitis, funisitis, deciduitus), villitis (chronic inflammation), fetal thrombosis or chorangiosis. Vascular-mediated preterm births were those with malperfusion lesions, and by design, those with preeclampsia were excluded. Results: Women with malperfusion lesions had a higher mean carotid IMT (+0.055 cm), total cholesterol (+17.49 mg/dl), LDL-C (+11.44), triglycerides (+17%), apolipoprotein-B (+8.95) and systolic and diastolic blood pressure (+4.58/+2.62 mmHg) compared to women with term births, independent of age, race, smoking and adiposity assessed before and after pregnancy (all p<0.05). Women with preterm birth and evidence of malperfusion accompanied by other lesions related to infection or chronic inflammation had the most atherogenic profile after pregnancy, and carotid IMT differences were independent of traditional risk factors (+0.04 cm; p=0.027). Conclusions: Vascular-mediated preterm birth is associated with maternal subclinical atherosclerosis and a higher cardiovascular risk factor burden in the decade after pregnancy compared to term birth. The placenta may offer unique insight into how pregnancy complications can portend the emergence of maternal cardiovascular disease.

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Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care

European Journal of Preventive Cardiology ◽

10.1177/2047487315618794 ◽

2015 ◽

Vol 23 (11) ◽

pp. 1195-1201

Author(s):

Anna W de Boer ◽

Renée de Mutsert ◽

Martin den Heijer ◽

Frits R Rosendaal ◽

Johan W Jukema ◽

...

Keyword(s):

Primary Care ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factor ◽

Factor Screening ◽

Advantages And Disadvantages ◽

Risk Factor Screening

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Abstract 12127: Integrated Flow-Mediated Vasodilation Response Predicts Cardiovascular Events in Elderly Patients at Cardiovascular Risk Factor

Circulation ◽

10.1161/circ.130.suppl_2.12127 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tomoyuki Kabutoya ◽

Satoshi Hoshide ◽

Yukiyo Ogata ◽

Kazuo Eguchi ◽

Kazuomi Kario

Keyword(s):

Risk Factor ◽

Cardiovascular Risk ◽

Elderly Patients ◽

Cardiovascular Risk Factor ◽

Cardiovascular Events ◽

The Elderly ◽

Detection Algorithm ◽

Younger Patients ◽

Flow Mediated Vasodilation

Introduction: The integrated flow-mediated vasodilation (FMD) response was shown to be associated with cardiovascular risk factors, but the association between the integrated FMD response and consequent cardiovascular events has been unclear. Hypothesis: We assessed the hypothesis that the integrated FMD response predicts consequent cardiovascular events. Methods: We enrolled 575 patients who had at least one cardiovascular risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the FMD magnitude of the percentage change in peak diameter (ΔFMD), and we measured the integrated FMD response calculated as the area under the dilation curve during a 120-sec dilation period (FMD-AUC 120 ) using a semiautomatic edge-detection algorithm. The primary outcome was defined as any cardiovascular event (a composite of cardiovascular death, and hospitalization for myocardial infarction, stroke, or heart failure). Results: The mean duration of follow-up was 35±22 months (range: 1-74 months). During the follow-up period, 34 cardiovascular events were recorded. Among the elderly patients (age[[Unable to Display Character:  ]]≥[[Unable to Display Character:  ]]65 yrs, n[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]281), the patients with the lowest tertile of FMD-AUC 120 (FMD-AUC 120 <[[Unable to Display Character:  ]]5.6) suffered a higher incidence of cardiovascular events compared with the patients with the higher two tertiles (FMD-AUC 120 ≥[[Unable to Display Character:  ]]5.6) (log rank 4.16, p=0.041). The association remained significant after adjusting for age, gender and office systolic blood pressure (hazard ratio 1.25, p=0.039). In the younger patients (age[[Unable to Display Character:  ]]<[[Unable to Display Character:  ]]65 yrs, n[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]294), cardiovascular events were similar among the patients with the lowest tertile and those with the higher two tertiles of FMD-AUC 120 . Cardiovascular events were also similar in the patients with the lowest tertile and the higher two tertiles of ΔFMD in both the elderly and younger patients. Conclusions: The integrated FMD response, but not ΔFMD, predicted cardiovascular events in elderly patients with a cardiovascular risk factor.

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