Abstract P150: Association of Non-Framingham Stroke Risk Factors With Incident Stroke Among Individuals With and Without Diabetes

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
John N Booth ◽  
Samantha Bromfield ◽  
April P Carson ◽  
Suzanne E Judd ◽  
George Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Obesity ◽  
Stroke Risk ◽  
Serum Glucose ◽  
C Reactive Protein ◽  
Fasting Serum ◽  
Risk Equation ◽  
Stroke Risk Factors ◽  
Reactive Protein ◽  
Framingham Risk

Diabetes is a pro-inflammatory state characterized by a high burden of non-traditional risk factors not included in the Framingham stroke risk equation. We assessed the association between factors absent from the Framingham stroke risk equation with incident stroke among individuals with and without diabetes, separately, using the US population-based REasons for Geographic and Racial Differences in Stroke study. Diabetes was defined by self-report with concurrent insulin or oral hypoglycemic medication use, fasting serum glucose ≥126 mg/dL or non-fasting serum glucose ≥200 mg/dL. Non-Framingham risk factors included high sensitivity c-reactive protein >3.0 mg/dL, low high-density-lipoprotein (HDL-C; men: <40 mg/dL, women: <50 mg/dL), triglycerides >150 mg/dL, abdominal obesity (waist circumference: men >102 cm, women >88 cm), urinary albumin-to-creatinine-ratio (ACR) >30 mg/dL, and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 . Bi-annual telephone contacts were used to identify incident stroke events that were subsequently adjudicated. During a median follow-up of 5.9 years, there were 329 and 697 incident strokes among individuals with (n = 6,258) and without (n = 22,226) diabetes, respectively. For individuals with and without diabetes, the prevalence of ≥3 non-Framingham risk factors was 50.4% and 23.9%, respectively. C-reactive protein >3.0 mg/dL and eGFR <60 ml/min/1.73 m 2 were associated with stroke among individuals with but not those without diabetes (Figure 1). In addition, ACR >30 mg/dL had a stronger association with stroke among individuals with versus without diabetes [HR (95% CI), 2.08 (1.65[[Unable to Display Character: &#8211;]]2.63) versus 1.36 (1.12[[Unable to Display Character: &#8211;]]1.66), respectively; p-interaction=0.04]. Low HDL-C, triglycerides >150 mg/dL and abdominal obesity were not associated with stroke among individuals with or without diabetes. In conclusion, non-Framingham stroke risk factors are common and associated with increased stroke risk among individuals with diabetes.

C-Reactive Protein and Anti-Chlamydia Pneumoniae Antibodies as Risk Factors of Cardiovascular Death in Incident Patients on Peritoneal Dialysis

2003 ◽  
Vol 23 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Ramón Paniagua ◽  
Yolanda Frías ◽  
Maria De Jesús Ventura ◽  
Ernesto Rodríguez ◽  
María Elena Hurtado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Chlamydia Pneumoniae ◽  
Clinical Signs ◽  
Cardiovascular Death ◽  
Serum Glucose ◽  
C Reactive Protein ◽  
Reactive Protein

Objective Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti- Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). Design Single-cohort, prospective observational study. Setting Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. Patients A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. Primary Outcome Mortality. Methods Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. Results Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. Conclusion These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.

Abstract MP054: Coronary Calcification, C-reactive Protein and Prediction of Cardiovascular and All-Cause Mortality in Diabetes: Diabetes Heart Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Subhashish Agarwal ◽  
Amanda J Cox ◽  
David M Herrington ◽  
Neal Jorgensen ◽  
Jianzhao Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
P Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
C Statistic ◽  
Framingham Risk ◽  
Heart Study ◽  
All Cause Mortality ◽  
Diabetes Heart Study ◽  
Cvd Mortality

Objective: Does coronary artery calcium (CAC) and C-reactive protein (CRP) improve discrimination and risk stratification of cardiovascular (CVD) and all-cause mortality in diabetes. Background: Inflammation is associated in the pathogenesis and progression of atherosclerosis. Since diabetes is characterized by both atherosclerosis and high CRP levels, we hypothesized that CAC and CRP will predict CVD and all-cause mortality in diabetes beyond Framingham risk factors (FRS). Method: A total of 961 participants, ages 39-86, with complete data on diabetes, vascular imaging, and inflammation in the Diabetes Heart Study were followed for an average of 7.4 years. CAC was assessed by CT at baseline. CRP was measured using enzyme-linked immunosorbent assay. Risk estimates for CVD and all-cause mortality were obtained using logistic regression models. Model 1 included FRS; age, gender, smoking, systolic blood pressure, antihypertensive medication use, total and HDL cholesterol, and ethnicity. Model 2 included FRS plus CRP or CAC. Model 3 included FRS plus CRP and CAC. Models for CVD and all-cause mortality were compared using c-statistics. Results: During follow-up there were 183 (19%) deaths of which 80 (8%) were CVD deaths. In FRS adjusted models both CRP and CAC were independently associated with all-cause mortality, however only CAC was associated with CVD mortality. The addition of CAC to a model with FRS and CRP improves discrimination for CVD and all-cause mortality (both p=0.001). However, the addition of CRP to a model with FRS and CAC only improves discrimination in all-cause mortality (p=0.001) ( Table 1 ). Conclusion: In participants with T2DM, measures of CAC and CRP are significantly associated with CVD (CAC only) and all-cause (CAC and CRP) mortality independent of the FRS; however, the improvement in CVD and all-cause mortality prediction was predominantly driven by CAC. Table 1 C-Statistics for the Combined Assessment of Framingham Risk Factors, CAC and CRP in Predicting Cardiovascular and All-Cause Mortality CVD Mortality All-Cause Mortality C-Statistic p-value C-Statistic p-value Model 1 FRS Only 0.715 -- 0.701 -- Model 2 vs. Model 1 Adding CRP to FRS Adding CAC to FRS 0.715 0.768 P=0.737 P=0.001 0.709 0.760 p=0.002 P=0.001 Model 3 vs. Model 2 Adding CAC to FRS + CRP Adding CRP to FRS + CAC 0.769 0.769 P=0.001 P=0.981 0.765 0.765 P=0.001 P=0.001

scholarly journals Effect of cardiac rehabilitation program on the Framingham risk score and C-reactive protein after CABG

2017 ◽  
Vol 15 (4) ◽  
pp. 539-546
Author(s):  
Elizabeth Do Canto Brancher ◽  
Dannuey Machado Cardoso ◽  
Tiago José Nardi Gomes ◽  
Tamires Daros dos Santos ◽  
Marília Severo Vicente ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Risk Score ◽  
Framingham Risk Score ◽  
Artery Bypass ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Framingham Risk ◽  
Cad Risk

Introduction: Coronary artery bypass grafting (CABG) does not have an effect on the etiopathogenic factors of atherosclerosis, thus, it is crucial to control risk factors. Objective: To analyze the effect of a cardiac rehabilitation (CR) program on cardiovascular risk factors, the Framingham risk score (FRS) and levels of C-reactive protein (CRP) of patients undergoing CABG. Methods: A descriptive, cross-sectional and retrospective study was conducted with a sample of 49 patients, who were participating in a program (24 weeks). Body mass index (BMI), waist circumference (WC), FRS, risk (%) of developing coronary artery disease in 10 years (CAD risk), serum levels of LDL-c, triglycerides (TG) and CRP were assessed. Results: The variables BMI, WC, LDL-c, TG, CRP levels, FRS and CAD risk showed significant reductions (p

Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

2012 ◽  
Vol 82 (1) ◽  
pp. 41-52 ◽  
Author(s):  
P. Earnest ◽  
S. Kupper ◽  
M. Thompson ◽  
Guo ◽  
S. Church
Keyword(s):  
Risk Factors ◽  
Cardiovascular Health ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
C Reactive Protein ◽  
Fatty Acid Supplementation ◽  
Omega 3 Fatty Acid ◽  
Reactive Protein ◽  
Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

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