Abstract 14731: Association of Longitudinal Changes in CRP, IL-6, and Fibrinogen Level With Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Inflammatory biomarkers have been used for cardiovascular disease (CVD) risk stratification. However, the relevance of longitudinal changes in levels of these biomarkers in relation to CVD is unclear. Methods: MESA is a population-based cohort consisting of 6814 participants free of symptomatic cardiovascular disease at baseline. We included all participants who had blood assayed for measurement of inflammatory biomarkers - C-reactive protein (CRP), Interleukin-6 (IL-6), and fibrinogen measured at baseline and follow-up 2-4 years later (n=1,362). Coronary heart disease (CHD) was assessed as any of myocardial infarction, resuscitated cardiac arrest, definite angina, probable angina (if followed by revascularization) and CHD death. CVD was considered a composite of CHD, stroke, stroke death, atherosclerotic death and CVD death. Cox proportional hazard regression analysis was used to assess the association of annual longitudinal changes in inflammatory biomarker level and time to first CHD and CVD event after adjustment for traditional risk factors and demographics. Results: The mean (SD) age was 61.6 (9.8) years and 55% were male. Over 8.6 median (IQR, 8.4-9.3) years of follow-up, there were 87 CHD and 121 CVD events. The median (IQR) CRP (mg/L), IL-6 (pg/ml) and fibrinogen (mg/dl) levels at baseline were 1.74(0.82-3.95) 1.11(0.71-1.72) and 332(292-382); and at follow-up were 1.4(0.69-3.03), 1.76(1.16-2.72) and 421(371-476). An increase in IL6 of 1 pg/mL/year was associated with a 26% increased risk of total CVD events independent of risk factors, while an increase of 1 mg/L/year of CRP was independently associated with a 7% and 6% increased risk of both CHD and CVD events respectively. There were no significant associations with changes in fibrinogen. Conclusion: Longitudinal increases in the inflammatory biomarkers CRP and IL6 are associated with higher risk of future cardiovascular events in a multi-ethnic population.

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Western dietary pattern increases risk of cardiovascular disease in Iranian adults: a prospective population-based study

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2016-0508 ◽

2017 ◽

Vol 42 (3) ◽

pp. 326-332 ◽

Cited By ~ 9

Author(s):

Parvin Mirmiran ◽

Zahra Bahadoran ◽

Azita Zadeh Vakili ◽

Fereidoun Azizi

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Dietary Patterns ◽

Dietary Pattern ◽

Regression Models ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Western Dietary Pattern ◽

Increased Risk

Limited data are available regarding the association of major dietary patterns and risk of cardiovascular disease (CVD) in Middle Eastern countries. We aimed to evaluate the association of major dietary patterns, using factor analysis, with the risk of CVD. Participants without CVD (n = 2284) were recruited from the Tehran Lipid and Glucose Study and were followed for a mean of 4.7 years. Dietary intake of participants was assessed at baseline (2006–2008); biochemical variables were evaluated at baseline and follow-up examination. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate risk of CVD across tertiles of dietary pattern scores. Linear regression models were used to indicate association of dietary pattern scores with changes of CVD risk factors over the study period. Two major dietary patterns, Western and traditional, were identified. During a mean 4.7 ± 1.4 years of follow-up, 57 participants experienced CVD-related events. In the fully adjusted model, we observed an increased risk of CVD-related events in the highest compared to the lowest tertile category of Western dietary pattern score (HR = 2.07, 95% CI = 1.03–4.18, P for trend = 0.01). Traditional dietary pattern was not associated with incidence of CVD or CVD risk factors. A significant association was observed between the Western dietary pattern and changes in serum insulin (β = 5.88, 95% CI = 0.34–11.4). Our findings confirm that the Western dietary pattern, characterized by higher loads of processed meats, salty snacks, sweets, and soft drinks, is a dietary risk factor for CVD in the Iranian population.

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up.

10.21203/rs.3.rs-24011/v2 ◽

2020 ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Cvd Risk ◽

Live Births ◽

Potential Risk Factors

Abstract Background: Most previous studies, conducted in non-Middle Eastern populations, have suggested that increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods: In this population-based cohort study, included 3929 women and 2571 men aged ≥ 30 years, Data for number of parity/live birth(s) were obtained by standard questionnaire. Participants were then annually followed for CVD events. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HRs), and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results: During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with 2 live births. Among women in multivariate analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01-1.10) and having ≥4 parity was associated with a HR of 1.86 (0.97-3.56, p-value=0.061). Among men, in comparison with participants who had 1 child, multivariate HRs of having 2, 3 and ≥4 children were 1.97 (1.24-3.12), 2.08 (1.31-3.31) and 2.08 (1.30-3.34), respectively. Conclusion: To the best of our knowledge, the current study is the first report of this issue in the Middle East and North Africa region, a region with high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up.

10.21203/rs.3.rs-24011/v3 ◽

2020 ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Cvd Risk ◽

Live Births ◽

Potential Risk Factors

Abstract Background: Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women.Methods: In this population-based cohort study, which included 3929 women and 2571 men aged ≥ 30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors.Results: During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariate analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01-1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97-3.56, p-value=0.061). Among men, in comparison with participants who had 1 child, multivariate HRs of having 2, 3, and ≥4 children were 1.97 (1.24-3.12), 2.08 (1.31-3.31), and 2.08 (1.30-3.34), respectively.Conclusion: To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

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Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Nutrients ◽

10.3390/nu12020588 ◽

2020 ◽

Vol 12 (2) ◽

pp. 588

Author(s):

Imran Khan ◽

Minji Kwon ◽

Nitin Shivappa ◽

James R. Hébert ◽

Mi Kyung Kim

Keyword(s):

Cardiovascular Disease ◽

Positive Association ◽

Population Based ◽

Proportional Hazard ◽

Dietary Inflammatory Index ◽

Cvd Risk ◽

Inflammatory Index ◽

Cox Proportional Hazard ◽

Increased Risk

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]Quintile 5 vs. 1 1.43; 95% CI 1.04–1.96) and in women (HRQuintile 5 vs. 1 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HRQuintile 5 vs. 1 1.80; 95% CI 1.03–3.12), obese men (HRQuintile 5 vs. 1 1.77; 95% CI 1.13–2.76) and men who smoked (HRQuintile 5 vs. 1 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HRQuintile 5 vs. 1 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

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Prevalence and Predictors of Delayed Cardiovascular Disease (CVD) Among Survivors of Adults with Hematologic Malignancies

Blood ◽

10.1182/blood.v124.21.857.857 ◽

2014 ◽

Vol 124 (21) ◽

pp. 857-857

Author(s):

Saro Armenian ◽

Lanfang Xu ◽

Can-Lan Sun ◽

Len Farol ◽

Smita Bhatia ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cancer Survivors ◽

Cardiovascular Risk Factors ◽

Cancer Diagnosis ◽

Hematologic Malignancies ◽

Cvd Risk ◽

Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of long-term survivors of hematologic malignancies. In the general U.S. population, CVD (heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. Childhood (Circulation 2013 22;128) and young adult (<40y at diagnosis; JNCI2014 21;106) cancer survivors have a substantially increased risk of CVD when compared to the general population; this is largely attributable to exposure to cardiotoxic therapies (anthracyclines, radiation) at a young age. Less is known regarding the magnitude of risk of CVD in individuals with hematologic malignancies diagnosed at age ≥40y, a population that accounts for the largest proportion of new cancer diagnoses in the U.S. and has a high prevalence of CVRFs. The few studies addressing this issue have been limited by small sample size, short (<1y) follow-up, varying definitions of cardiovascular outcomes, and lack of comparison to non-cancer controls. The current study overcomes these limitations. Methods: Using a retrospective cohort study design, 2,993 2+y survivors of non-Hodgkin lymphoma (NHL), lymphocytic leukemia (LL), and multiple myeloma (MM) diagnosed at age ≥40y between 2000 to 2007 and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 10-year insurance retention rates for cancer survivors exceeding 70% (JAYAO 2013 2:59). A non-cancer comparison group (N=6,272) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:2) on age at diagnosis, sex, and zip-code. Cumulative incidence of CVD (ICD-9 definition: congestive heart failure, stroke, or myocardial infarction) was calculated, taking into consideration the competing risk of death. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per the National Cholesterol Education Program Adult Treatment Panel III criteria. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CI), adjusted for relevant covariates. Results: Median age at cancer diagnosis was 63y (range: 40-96); 53.6% were male; 68% were non-Hispanic white; diagnoses: NHL (N=1,787 [59.7%]), LL (N=705 [23.6%], MM (N=501 [16.7%]). In cancer survivors, median time from cancer diagnosis to end of follow-up was 6.2 years (range: 2-10), representing 12,622 person-years of follow-up. Comparison with non-cancer cohort: The 8y cumulative incidence of CVD was significantly higher for NHL survivors (17% vs. 14%, p<0.01), LL (19% vs. 16%, p=0.02), and MM (21% vs. 11%, p<0.01), when compared to non-cancer subjects (Figures). Multivariable analysis adjusted for age, sex, race/ethnicity and CVRFs revealed a significantly increased risk of CVD across all cancer diagnoses (NHL: HR=1.3, 95%CI, 1.1-1.6; LL: HR=1.3, 95%CI, 1.0-1.6, MM=1.9, 95%CI, 1.5-2.5) when compared to non-cancer subjects; younger (<65y at diagnosis) MM survivors were at highest risk (HR=3.5, 95%CI, 2.2-5.6). Modifiers of CVD risk among cancer survivors: Hypertension and diabetes were independent modifiers of CVD risk. Hypertension was associated with a 1.9-fold (95%CI,1.1-3.3) increased risk of developing CVD in NHL survivors and a 3.1-fold (95%CI, 1.4-6.7) increased risk in MM survivors. Diabetes was associated with increased CVD risk across all diagnoses (NHL: HR=1.7, 95%CI, 1.2-2.4; LL: HR=1.6, 95%CI, 1.0-2.6; MM: HR=1.6, 95%CI, 1.0-2.3). Conclusions: Survivors of adult-onset NHL, LL and MM are at increased risk for developing cardiovascular disease when compared to a matched non-cancer cohort. Cardiovascular risk factors such as hypertension and diabetes are independent modifiers of risk of delayed cardiovascular disease. Taken together these data form the basis for identifying high-risk individuals for targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: Results of over 15 years of follow-up.

10.21203/rs.3.rs-24011/v4 ◽

2021 ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

P Value ◽

Cvd Risk ◽

Live Births ◽

Potential Risk Factors

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Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN

Journal of the American Heart Association ◽

10.1161/jaha.120.017416 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Rebecca C. Thurston ◽

Helen E. Aslanidou Vlachos ◽

Carol A. Derby ◽

Elizabeth A. Jackson ◽

Maria Mori Brooks ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Reproductive Factors ◽

Cox Proportional Hazards ◽

Vasomotor Symptoms ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Increased Risk

Background Cardiovascular disease (CVD) in women has unique features, including associations with reproductive factors that are incompletely understood. Vasomotor symptoms (VMS), the classic menopausal symptom, are linked to CVD risk factors and subclinical CVD. Evidence linking VMS to CVD events is limited. We tested whether frequent and/or persistent VMS were associated with increased risk for fatal and nonfatal CVD events in SWAN (Study of Women’s Health Across the Nation). Methods and Results A total of 3083 women, aged 42 to 52 years at baseline, underwent up to 16 in‐person visits over 22 years. Assessments included questionnaires on VMS frequency (0, 1–5, or ≥6 days/2 weeks), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). A subset of events was adjudicated via medical record. Death certificates were obtained. Relationships between baseline VMS or persistent VMS over the follow‐up (proportion of visits with frequent VMS) with combined incident nonfatal and fatal CVD were tested in Cox proportional hazards models adjusted for demographics, medication use, and CVD risk factors. Participants experienced 231 CVD events over the follow‐up. Women with frequent baseline VMS had an elevated risk of subsequent CVD events (relative to no VMS; ≥6 days: hazard ratio [HR] [95% CI], 1.51 [1.05–2.17], P =0.03; 1–5 days: HR [95% CI], 1.02 [0.75–1.39], P =0.89, multivariable). Women with frequent VMS that persisted over time also had an increased CVD event risk (>33% versus ≤33% of visits: HR [95% CI], 1.77 [1.33–2.35], P <0.0001, multivariable). Conclusions Frequent and persistent VMS were associated with increased risk of later CVD events. VMS may represent a novel female‐specific CVD risk factor.

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Cardiovascular Disease in Adolescents and Young Adults with Hematologic Malignancies

Blood ◽

10.1182/blood.v126.23.880.880 ◽

2015 ◽

Vol 126 (23) ◽

pp. 880-880

Author(s):

Chun Chao ◽

Lanfang Xu ◽

Cooper Robert ◽

Smita Bhatia ◽

Saro Armenian

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cancer Survivors ◽

Cardiovascular Risk Factors ◽

Cancer Diagnosis ◽

Hematologic Malignancies ◽

Cvd Risk ◽

Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of survivors of adolescents and young adults (AYA: diagnosed 15-39y) with hematologic malignancies. In the general U.S. population, cardiovascular disease (CVD: heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. While considerable effort has been made to characterize long-term CVD outcomes in survivors of childhood (<21y) cancer, there is a paucity of information on the magnitude and modifiers of CVD risk, as well as outcomes after onset of CVD in survivors of AYA cancers. AYAs diagnosed with hematologic malignancies may be at a higher risk of CVD when compared to the general population because of exposure to cardiotoxic therapies (anthracyclines, radiation), and the development of new CVRFs as they age. Methods: Using a retrospective cohort study design, 779 2+y survivors of non-Hodgkin lymphoma (NHL: N=274), Hodgkin lymphoma (HL: N=323), and acute leukemia (Leuk: N=182), diagnosed at age 15-39y between 1998 to 2009, and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 5-year insurance retention rates for AYA cancer survivors approaching 80% (J Adolesc Young Adult Oncol 2013 2:59). A non-cancer comparison group (N=8,062) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:10) on age at diagnosis, sex, health plan membership and calendar year. Time-dependent Poisson regression was used to derive incidence rate ratio (IRR) estimates and 95% confidence intervals (CI) for CVD (ICD-9 definition: heart failure, stroke, or myocardial infarction), adjusted for relevant covariates. Kaplan-Meier curves were generated for cancer survivors, stratified by CVD status. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per an algorithm developed by KPSC's case management system, which uses a combination of ICD-9 codes, laboratory test results, and documentation of receipt of medications for these conditions (Am J Epidemiol. 2014 179:27). Results: Median age at cancer diagnosis was 29y (range: 15-39 years); 53.4% were male; 58.2% were non-Hispanic white; diagnoses: HL (41.5%), NHL (35.2%), Leuk (23.4%). In cancer survivors, median time from cancer diagnosis to end of follow-up was 5.4y (range: 2-14.9y), representing 4,961 person-years of follow-up. Comparison with non-cancer controls: Multivariable analysis adjusted for age, sex, race/ethnicity, CVRFs, smoking history and overweight/obesity, revealed a significantly increased risk of CVD across all cancer diagnoses (Overall: IRR=3.5, 95%CI, 2.0-6.1) and by certain cancer types (Leuk: IRR=4.5, 95%CI, 1.8-11.2; HL: IRR=3.0, 95%CI, 1.0-8.9; NHL: IRR=2.0, 95%, 0.7-5.6) when compared to non-cancer controls. Modifiers of CVD risk: Hypertension, diabetes, and dyslipidemia were independent modifiers of CVD risk. Hypertension was associated with a 5.1-fold (95%CI, 2.1-12.1) increased risk, diabetes was associated with a 4.4-fold (95%CI, 1.9-9.9) increased risk, and dyslipidemia was associated with a 2.8-fold (95%CI, 1.2-6.6) increased risk of CVD in AYA survivors when compared to survivors without these CVRFs. Outcomes by CVD status among cancer survivors: Overall survival was significantly worse (5y: 64%, 10y: 56%) among cancer survivors who developed CVD when compared to survivors without CVD (5y: 95%, 10y: 91%), p<0.01 (Figure). Conclusions: Survivors of AYA hematologic malignancies are at increased risk for developing cardiovascular disease when compared to a matched non-cancer controls. In these survivors, overall survival following onset of CVD is especially poor, and cardiovascular risk factors are independent modifiers of delayed cardiovascular disease risk. Taken together these data form the basis for identifying high-risk individuals for population-based targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03499-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Seyyed Saeed Moazzeni ◽

Hossein Toreyhi ◽

Samaneh Asgari ◽

Fereidoun Azizi ◽

Fahimeh Ramezani Tehrani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Live Birth ◽

Middle Eastern ◽

Population Based ◽

Cvd Risk ◽

Live Births ◽

Unit Increase ◽

Potential Risk Factors

Abstract Background Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods In this population-based cohort study, which included 3929 women and 2571 men aged ≥30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariable analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01–1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97–3.56, p-value = 0.061). Among men, in comparison with participants who had 1 child, multivariable HRs of having 2, 3, and ≥ 4 children were 1.97 (1.24–3.12), 2.08 (1.31–3.31), and 2.08 (1.30–3.34), respectively. Conclusion To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors.

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Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/11795441211028751 ◽

2021 ◽

Vol 14 ◽

pp. 117954412110287

Author(s):

Mir Sohail Fazeli ◽

Vadim Khaychuk ◽

Keith Wittstock ◽

Boris Breznen ◽

Grace Crocket ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cardiovascular Disease ◽

Literature Review ◽

Rheumatoid Factor ◽

Qualitative Evidence Synthesis ◽

Cvd Risk ◽

Rheumatoid Arthritis Risk ◽

Published Evidence ◽

Increased Risk

Objective: To scope the current published evidence on cardiovascular risk factors in rheumatoid arthritis (RA) focusing on the role of autoantibodies and the effect of antirheumatic agents. Methods: Two reviews were conducted in parallel: A targeted literature review (TLR) describing the risk factors associated with cardiovascular disease (CVD) in RA patients; and a systematic literature review (SLR) identifying and characterizing the association between autoantibody status and CVD risk in RA. A narrative synthesis of the evidence was carried out. Results: A total of 69 publications (49 in the TLR and 20 in the SLR) were included in the qualitative evidence synthesis. The most prevalent topic related to CVD risks in RA was inflammation as a shared mechanism behind both RA morbidity and atherosclerotic processes. Published evidence indicated that most of RA patients already had significant CV pathologies at the time of diagnosis, suggesting subclinical CVD may be developing before patients become symptomatic. Four types of autoantibodies (rheumatoid factor, anti-citrullinated peptide antibodies, anti-phospholipid autoantibodies, anti-lipoprotein autoantibodies) showed increased risk of specific cardiovascular events, such as higher risk of cardiovascular death in rheumatoid factor positive patients and higher risk of thrombosis in anti-phospholipid autoantibody positive patients. Conclusion: Autoantibodies appear to increase CVD risk; however, the magnitude of the increase and the types of CVD outcomes affected are still unclear. Prospective studies with larger populations are required to further understand and quantify the association, including the causal pathway, between specific risk factors and CVD outcomes in RA patients.

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