Abstract 12440: Does Low Diastolic Blood Pressure Contribute to the Risk of Recurrent Cardiovascular Disease Events? The Framingham Heart Study

Background: The clinical significance of low diastolic blood pressure (DBP) as a risk for recurrent cardiovascular disease (CVD) events in persons with isolated systolic hypertension (ISH) is controversial. Methods: We examined risk for recurrent CVD events in 791 individuals (age 75 years, 47% female, mean follow-up time: 8±6 years) with DBP<70 (N=225) versus 70-89 mmHg (N=566) following initial CVD events in the original and offspring cohorts of the Framingham Heart Study. Results: Recurrent CVD events occurred in 153 (68%) participants with lower DBP and 271 (48%) with higher DBP (p<0.0001). Risk of recurrent CVD events in risk factor-adjusted Cox regression was higher in those with DBP<70 mmHg versus DBP 70-89 mmHg in both treated [HR, 5.1 (95% CI: 3.8-6.9) p<0.0001] and untreated individuals [HR, 11.7 (6.5-21.1) p<0.0001] (treatment interaction: p=0.10). Individually, coronary heart disease, heart failure, and stroke recurrent events were more likely with DBP<70 mmHg versus 70-89 mmHg (p<0.0001). To judge the potential modifying effect of wide pulse pressure (PP) on excess risk associated with low DBP, we defined 4 binary groupings of median PP (≥ 68 verses <68 mmHg) and categorical DBP (<70 versus 70-89 mmHg), and found that CVD event rates were higher only in the group with wide PP and DBP<70 mmHg (Chi Square = 32.6, p<0.001, see Figure). Conclusions: Persons with ISH and initial CVD events have increased risk for recurrent CVD events in the presence of DBP<70 mmHg versus DBP 70-89 mmHg, supporting wide PP as an important risk modifier of the adverse effect of low DBP; we postulate increased CVD risk is related to the pernicious effects of faulty microvascular function resulting from increased elastic artery stiffness in combination with low diastolic perfusion pressure.

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Aortic Root Diameter and Arterial Stiffness: Conjoint Relations to the Incidence of Cardiovascular Disease in the Framingham Heart Study

Hypertension ◽

10.1161/hypertensionaha.121.17702 ◽

2021 ◽

Author(s):

Ramachandran S. Vasan ◽

Rebecca J. Song ◽

Vanessa Xanthakis ◽

Gary F. Mitchell

Keyword(s):

Cardiovascular Disease ◽

Pulse Pressure ◽

Aortic Root ◽

Cox Regression ◽

Prognostic Significance ◽

Root Diameter ◽

Cvd Risk ◽

Heart Study ◽

Increased Risk ◽

Central Pulse Pressure

Higher central pulse pressure is associated with higher carotid-femoral pulse wave velocity (CFPWV) and an increased risk of cardiovascular disease (CVD). A smaller aortic root diameter (AoR) is associated with higher central pulse pressure. We hypothesized that the combination of a smaller AoR and higher CFPWV is associated with increased CVD risk (relative to a larger AoR and lower CFPWV). We tested this hypothesis in the community-based Framingham Study (N=1970, mean age 60 years, 57% women). We created sex-specific longitudinal echocardiographic AoR trajectories over 2 decades, categorizing participants into smaller versus larger AoR groups. We cross-classified participants based on their AoR trajectory and CFPWV (dichotomized at the sex-specific median). We used Cox regression to relate the cross-classified groups to CVD incidence on follow-up (median 17 years): lower CFPWV, larger AoR (referent group; 6.4/1000 person-years); lower CFPWV, smaller AoR (6.9/1000 person-years); higher CFPWV, larger AoR (23.1/1000 person-years); and higher CFPWV, smaller AoR (21.9/1000 person-years). In sex-pooled analyses, groups with higher CFPWV were associated with a multivariable-adjusted 1.8-fold risk of CVD ( P <0.01) regardless of AoR size. We observed effect modification by sex ( P for sex×AoR-CFPWV group interaction 0.04). In men, the group with smaller AoR and higher CFPWV was associated with a 2.5- to 2.8-fold risk of CVD ( P <0.001). In women, the group with larger AoR and higher CFPWV experienced a statistically nonsignificant 70% to 80% higher CVD risk. Our observations indicate that the prognostic significance of a smaller versus larger AoR varies in men versus women. Additional studies are warranted to confirm our findings.

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Ten-year Cardiovascular Disease Risk Amongst Workers in a Tertiary Healthcare Institution in Kuala Lumpur

Borneo Epidemiology Journal ◽

10.51200/bej.v1i1.2435 ◽

2020 ◽

Vol 1 (1) ◽

pp. 35-45

Author(s):

Norfazilah Ahmad ◽

Santhna Letchmi Panduragan ◽

Chong Hong Soon ◽

Kalaiarasan Gemini ◽

Yee San Khor ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

High Risk ◽

Diastolic Blood Pressure ◽

Associated Factors ◽

Risk Group ◽

High Risk Group ◽

Kuala Lumpur ◽

Cvd Risk ◽

Tertiary Healthcare

Strategising, which is an effective workplace intervention to curb cardiovascular disease (CVD), requires understanding of the CVD risk related to a specific working population. The Framingham Risk Score (FRS) is widely used in predicting the ten-year CVD risk of various working populations. This study aimed to use FRS to determine the ten-year CVD risk amongst workers in a tertiary healthcare setting and its associated factors. A cross-sectional study was conducted on workers who participated in the special health check programme at the staff clinic of a tertiary healthcare institution in Kuala Lumpur, Malaysia. A set of data sheets was used to retrieve the workers’ sociodemographic and CVD risk information. The prevalence of high, moderate and low ten-year CVD risk was 12.8%, 20.0% and 67.2%, respectively. Workers in the high-risk group were older [mean age: 54.81 (standard deviation, 5.72) years], male (44%), smokers (72.7%) and having hyperglycaemia (46.7%) and hypertriglyceridemia [median triglycerides: 1.75 (interquartile range, 1.45) mmol/L]. Diastolic blood pressure (aOR 1.07, 95% CI: 1.01,1.14), hyperglycaemia (aOR 8.80, 95% CI: 1.92,40.36) and hypertriglyceridemia (aOR 4.45, 95% CI: 1.78,11.09) were significantly associated with high ten-year CVD risk. Diastolic blood pressure (aOR 1.08, 95% CI: 1.03,1.13) and hypertriglyceridemia (aOR 2.51, 95% CI: 1.12-5.61) were significantly associated with moderate ten-year CVD risk. The prevalence of high and moderate ten-year CVD risk was relatively high. Amongst the workers in the high-risk group, they were older, male, smokers and with high fasting blood sugar and triglyceride. Understanding the ten-year CVD risk and its associated factors could be used to plan periodic workplace health assessment and monitor to prevent CVD.

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Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.mp65 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John N Booth ◽

Keith M Diaz ◽

Samantha Seals ◽

Mario Sims ◽

Joseph Ravenell ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Blood Pressure Monitoring ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Cvd Risk ◽

Nocturnal Hypertension ◽

Heart Study ◽

All Cause Mortality

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

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Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

European Heart Journal ◽

10.1093/eurheartj/ehaa132 ◽

2020 ◽

Vol 41 (17) ◽

pp. 1673-1683 ◽

Cited By ~ 5

Author(s):

Michael Böhm ◽

João Pedro Ferreira ◽

Felix Mahfoud ◽

Kevin Duarte ◽

Bertram Pitt ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cox Regression ◽

Cardiovascular Death ◽

Left Ventricular ◽

Coronary Perfusion ◽

Increased Risk ◽

The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP <70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P < 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P < 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P < 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

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Exercise Blood Pressure and the Risk of Incident Cardiovascular Disease (from the Framingham Heart Study)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2008.01.046 ◽

2008 ◽

Vol 101 (11) ◽

pp. 1614-1620 ◽

Cited By ~ 58

Author(s):

Gregory D. Lewis ◽

Philimon Gona ◽

Martin G. Larson ◽

Jonathan F. Plehn ◽

Emelia J. Benjamin ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Framingham Heart Study ◽

Heart Study ◽

Exercise Blood Pressure ◽

Incident Cardiovascular Disease

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Cardiovascular disease risk in survivors of 20 adult cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11571 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11571-11571

Author(s):

Helen Strongman ◽

Sarah Gadd ◽

Anthony Matthews ◽

Kathryn Mansfield ◽

Susannah Jane Stanway ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cancer Survivors ◽

Cox Regression ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cancer Site ◽

Cvd Risk ◽

Increased Risk ◽

Wide Range

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p<0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]

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Abstract 14043: Association of Non-Alcoholic Steatohepatitis Assessed by Fib-4 Index and Risk of Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.142.suppl_3.14043 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Aliza Hussain ◽

VIJAY NAMBI ◽

Elizabeth Selvin ◽

Wensheng Sun ◽

Kunihiro Matsushita ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cox Regression ◽

Advanced Fibrosis ◽

Cvd Risk ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study ◽

Cvd Mortality

Introduction: Cardiovascular disease (CVD) is the most common cause of death in nonalcoholic steatohepatitis (NASH). While these conditions share many cardio-metabolic risk factors including metabolic syndrome, diabetes and dyslipidemia, limited data exist on whether NASH is independently and prospectively associated with incident CVD beyond traditional risk factors. Fibrosis-4 (FIB-4) index is a scoring system based on platelet count, age, AST and ALT, shown to be comparable to magnetic resolution elastography for predicting advanced fibrosis in biopsy-proven NASH. We sought to evaluate the association of elevated FIB-4 with global CVD events and CVD mortality in the Atherosclerosis Risk in Communities (ARIC) Study Methods: We studied 5531 individuals, mean age of 76 (SD 5.2) years, 58% female, 22% black, at ARIC visit 5 (2011-2013). FIB-4 was categorized as low risk of advanced fibrosis for score <1.45, intermediate for 1.45-3.25 and high for >3.25. Cox regression was used to estimate the association of FIB-4 with time to first global CVD event (CHD, ischemic stroke or heart failure hospitalization) and CVD mortality adjusted for pooled cohort equation risk factors. Results: Over a median follow up of 6.2 (5.3-6.8) years, there were 1108 global CVD events and 457 CVD deaths. In adjusted models, compared to participants with low FIB-4 (<1.45), those with elevated FIB-4 >3.25, had significantly increased risk for global CVD events (HR 1.58, 95% CI 1.23-2.02) and CVD mortality (HR 1.70, 95% CI 1.16-2.50). Conclusions: In a large prospective cohort, presence of advanced liver fibrosis, as assessed by elevated FIB-4 index >3.25, was associated with increased risk for CVD events and CVD mortality, beyond traditional CVD risk factors. Future clinical trials of candidate medications under study for NASH should examine whether effective NASH treatment will impact CV outcomes.

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Abstract 20038: Maternal Pre-Pregnancy Overweight is Associated with Increased Cardiovascular Disease Mortality in the Framingham Heart Study

Circulation ◽

10.1161/circ.130.suppl_2.20038 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michael Mendelson ◽

Asya Lyass ◽

Sarah D de Ferranti ◽

Charlotte Andersson ◽

Caroline Fox ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Framingham Heart Study ◽

Maternal Body Mass Index ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Heart Study ◽

All Cause Mortality ◽

Maternal Overweight ◽

Cvd Mortality

Introduction: In the U.S., obesity among women of childbearing age is highly prevalent. Maternal obesity is associated with offspring obesity and cardiovascular disease (CVD) risk factors, potentially through epigenetic and early developmental mechanisms. There is limited evidence on the association of maternal overweight with offspring CVD events and mortality. Methods: We analyzed prospectively collected data from 1971 to 2012 on 879 Framingham Heart Study Offspring cohort participants with either directly measured pre-pregnancy maternal body mass index (BMI) (n=361) or offspring-reported maternal pre-pregnancy overweight status (n=518). Our outcomes included a composite measure of any CVD event or mortality, CVD mortality and all-cause mortality. Cox proportional hazard models were conducted, initially age and sex adjusted, and then additionally adjusted for potential mediators including traditional CVD risk factors. Pharmacologic treatments for diabetes, hypertension, and/or dyslipidemia were included as time-varying covariates. Results: Maternal pre-pregnancy overweight (BMI >= 85th percentile or self-report) was available for 879 Framingham Offspring Study participants (mean age [SD] at baseline 30 [5] years; 49% female; mean follow-up [SD] 32 [8] years). There were 193 CVD events, 28 CVD deaths, and 138 total deaths among the offspring. Maternal overweight was associated with an increased hazard ratio (HR) with CVD mortality (HR 10.5 [2.6-43]; p=0.001), all-cause mortality (HR 3.1 [1.5-6.4]; p=0.002), and marginally associated with the composite endpoint of CVD events and mortality (HR 1.7 [95% CI 0.99-2.8]; p=0.05). Adjustment for offspring BMI, diabetes, hypertension, and dyslipidemia attenuated the associations. In sensitivity analyses restricted to only those with directly measured maternal pre-pregnancy BMI, effect estimates remained robust (similar hazard ratios but larger confidence intervals). Conclusions: Maternal pre-pregnancy overweight is associated with offspring CVD mortality. The association is likely mediated in part through classical CVD risk factors such as offspring obesity, hypertension, diabetes, and dyslipidemia.

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Abstract P115: Increased Diastolic Blood Pressure Post-mild Exercise is Associated With Early Structural and Functional Cardiovascular Abnormalities

Hypertension ◽

10.1161/hyp.70.suppl_1.p115 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Susan Tucker ◽

Mahfouz El Shahawy

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Risk Score ◽

Health Care Practitioner ◽

Cvd Risk ◽

Cardiovascular Abnormalities ◽

Increased Risk ◽

Artery Stiffness ◽

Asymptomatic Subjects ◽

Retinal Photography

Background: Previous research has suggested that an increase in SBP post-mild exercise is correlated with early structural and functional cardiovascular abnormalities. Purpose: To determine if an increase in diastolic blood pressure post-mild exercise (DBP PME) is associated with early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 267 subjects were normotensive. Of those subjects, 12 had a increase in DBP PME, 23 had no change in DBP PME, and 232 had a decline in DBP PME. Focus was placed on the three known tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, a rise in diastolic blood pressure PME is statistically evident for an increased risk of early structural and functional cardiovascular abnormalities. A significant increase in abnormalities was noted with C2 and CIMT with subjects whose DBP increased PME. Conclusion: Assessment of diastolic blood pressure PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Any increase in diastolic blood pressure PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

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Abstract P337: Lifetime Burden of Traditional Cardiovascular Disease Risk Factors and Incidence of Cancer: The Bogalusa Heart Study

Circulation ◽

10.1161/circ.141.suppl_1.p337 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Alexander C Razavi ◽

Tanika N Kelly ◽

Jiang He ◽

Camilo Fernandez ◽

Tekada Ferguson ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cancer Risk ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Bogalusa Heart Study ◽

Incidence Of Cancer ◽

Incident Cancer ◽

Heart Study

Introduction: Cardiovascular disease (CVD) and cancer remain the leading causes of death globally. While these diseases have traditionally been regarded as separate entities, recent evidence points towards shared biological pathways, underlying a need to study CVD and cancer conjointly. We examined the association between CVD risk factors and the incidence of cancer over the life course in a biracial community-based cohort. Methods: The analysis included 1,368 participants of the Bogalusa Heart Study who had at least 3 measurements of CVD risk factors throughout life (57.6% women, 32.8% black, baseline age=10.5 + 3.6 years, median follow-up=38.2 years). CVD risk factors assessed included systolic and diastolic blood pressure, LDL-C, HDL-C, plasma glucose, serum triglycerides, and body mass index (BMI). Cancer cases were ascertained via the Louisiana Tumor Registry. Cox proportional hazards regression assessed the association between CVD risk factors and cancer incidence, adjusting for race, sex, smoking, and blood pressure-, lipid-, and glucose-lowering medications. Results: There were 88 incident cases of cancer, with breast (22.7%), cervical (11.4%), and prostate (9.1%) being the most highly represented cancers. BMI (kg/m 2 ) had the most robust association with incident cancer (HR=5.83, 95% CI: 2.24, 15.19; p=3.0x10 -4 ). We observed a strong association between annualized change in blood pressure per mmHg and hazard of all cancers (for systolic, HR=2.24, 95% CI: 1.50, 3.35; p<0.0001 and diastolic, HR=4.86, 95% CI: 2.86, 8.27; p<0.0001). Race and sex significantly modified the relationship of incident cancer with lipids and blood pressure, respectively ( Figure ). Conclusion: Subclinical increases in adiposity and blood pressure associate with an increased cancer risk, while HDL-C inversely associates with cancer risk, more consistently in women versus men and in blacks versus whites. Control of CVD risk factors beginning in childhood may lead to improved overall cancer prevention in the general population.

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