Abstract 020: Heartbreaking Careers in Old Age: Retirement Sequences as a Non-Traditional Risk Factor for Cardiovascular Diseases

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Felipe Diaz-Toro ◽  
Ignacio Madero-Cabib ◽  
Esteban Calvo ◽  
Ursula Staudinger
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Heart Disease ◽  
Labor Force ◽  
Traditional Risk Factor ◽  
Full Time ◽  
Stroke Work ◽  
Stroke Incidence ◽  
Traditional Risk Factors ◽  
State Pension

Background: Traditional factors leave substantial risk for incident cardiovascular disease (CVD) unexplained. Recent literature addressing this limitation identifies non-traditional risk factors, such as depression and clinical biomarkers. This study explored retirement sequences as a new non-traditional risk factor for CVD among older Americans. Methods: Heart disease and stroke incidence were measured for 7,880 Health and Retirement Study participants age 70 and over. Non-parametric survival curves and time-discrete survival models were used to compare the succeeding incidence of CVD across the retirement sequences that individuals followed between ages 60-61 and 70-71. We employed six holistic types of retirement sequences: (i) early for individuals who completely retired at or before age 62; (ii) complete for the conventional normative model of retirement by which people who are working in full-time jobs completely retire at the legally established age; (iii) ambiguous for people out of the labor force who shifted into retirement; (iv) partial for subjects with full-time jobs that claimed partial pension benefits in their early 60s; (v) compact for individuals moving from part-time positions into partial retirement; and (vi) late for individuals with full-time employments until their late 60s. These sequences were measured as longitudinal pathways of labor-force statuses and transitions measured in two-year intervals between the ages 60-61 to 70-71 years. Models were fitted for the whole sample, as well as males and females separately, adjusting for the probability of dying before CVD onset, sociodemographics, traditional risk factors, and clinical characteristics. Results: Out of all participants, 78.1% (6154/7880) reported at least one adverse cardiovascular event after age 70. Individuals following retirement sequences characterized by a progression from full-time jobs to either early retirement (heart disease, HR 3.07 CI95% 2.89-3.26 p<.001; stroke, HR:2.75 CI95% 2.53-2.96 p<.001) or retirement at the state pension age (heart disease, HR:3.73 CI95% 3.52-3.93 p<.001; stroke, HR:2.30 CI95% 2.07-2.54 p<.001), as well as people out of the labor force who move into retirement (heart disease, HR:2.36 CI95% 2.12-2.60 p<.001; stroke, HR:2.72 CI95% 2.44-3.01 p<.001) experienced a higher risk for heart disease and stroke relative to individuals who kept on working past the retirement age. However, the effects are stronger for heart disease among women and stroke among men. Conclusions: Retirement sequences may indeed be regarded as a non-traditional risk factor for CVD in aging populations. Keywords: Retirement-Heart disease-Stroke-Work

A STUDY OF RHEUMATOID FACTOR AND ITS RELATION TO ISCHEMIC HEART DISEASE

2021 ◽  
pp. 91-93
Author(s):  
M. Ajith Kumar ◽  
Nikitha Shirine Todeti
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Rheumatoid Factor ◽  
Traditional Risk Factor ◽  
Ischemic Heart ◽  
Special Role ◽  
Cross Sectional ◽  
Traditional Risk Factors

INTRODUCTION : Ischemic heart disease (IHD) is a leading cause of death in the world. Most of the subjects with IHD may have traditional risk factors including diabetes,smoking, hypertension,obesity. Rheumatoid Factor (RF) has been associated with an increased likelihood of developing IHD.Presence of RF in general population may identify the subjects with a similar immune pathology to patients with RA, who may also share an increased likelihood of developing IHD and that RF may have special role in the pathogenisis of IHD . MATERIALS AND METHODS: Cross sectional observational study done from September 2020 to August 2021 in Kamineni institute of medical sciences Narketpally, included 100 patients, who were all RF positive.During the study period they were evaluated for IHD by E CG and ECHO.Those who are included in the study were evaluated for traditional risk factors h/o Diabetes, smoking,family h/o IHD and hypertension,BMI for Obesity and features of RA. A resting 12 lead ECG was carried out for features of IHD.The following ch anges in the ECG were taken as marker of ischemia: 1)The combination of ST elevation in a set of leads and reciprocal ST depression in a set of leads.2) Inversion of T with ST still being elevated.3) Presence of pathological Q waves RESULTS : Of the 100 patients with RF positivity, there were 65 females and 35 males. Ischemic changes in ECG in presence of RF with traditional risk factor is n=12 (75%) M 8(50%) F-- 4(25%) and RF without traditional risk factor is n=4 (25%) M-4(25%) F-0.In the present study there were 16 patients who had RF positivity with Ischemic changes in ECG. 12 were males and 4 were females. CONCLUSIONS: RF per se can be considered as one of the risk factor for Ischemic heart disease in males. Ÿ RF associated with traditional risk factors increase the prevalence of IHD. Ÿ Though more female patients have positive RF, they are not vulnerable to IHD.

Precocious virulent coronary atherosclerosis in the very young

2011 ◽  
Vol 22 (2) ◽  
pp. 184-187
Author(s):  
Robert Chait ◽  
Rajesh Ramineni ◽  
Erin A. Fender
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Atherosclerotic Lesion ◽  
Traditional Risk Factor ◽  
Risk Factor Modification ◽  
Risk Patients ◽  
Traditional Risk Factors ◽  
Artery Disease ◽  
Cardiac Catheterizations ◽  
Angioplasty And Stenting

AbstractBackgroundThe incidence of Myocardial Infarction (MI) in patients under the age of 30 has been rarely addressed. Moreover, it is not understood why these patients develop symptomatic Coronary Artery Disease (CAD) at such an early age. Traditional risk factor assessment has not been successful in identifying these patients before they present with MI.MethodsRetrospective, single cohort, observational study of 14,704 cardiac catheterizations performed in a community hospital between January 2006–January 2010 identified 12 cases age <30 with MI secondary to a fixed atherosclerotic lesion requiring angioplasty and stenting. The angiograms and charts were reviewed to assess the incidence and frequency of traditional risk factors such as smoking, dyslipidemia and diabetes and family history.ResultsAll the patients had single vessel disease. Many of the patients were noted to have traditional CAD risk factors. 2 patients had an intervention and then months later sustained another acute MI secondary to a new culprit lesion despite aggressive risk factor modification.ConclusionEvaluating patients for premature CAD by screening for traditional risk factors has not effectively identified at risk patients prior to presentation with MI. There is a role for studies evaluating new and novel risk factors and imaging modalities so that these patients can be identified prior to experiencing MI.

scholarly journals Screening for Ischemic Heart Disease with Cardiac CT: Current Recommendations

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Matthew J. Budoff
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Events ◽  
Traditional Risk Factor ◽  
Robust Test ◽  
Risk Factor Assessment ◽  
Framingham Risk ◽  
The Us ◽  
Incremental Information ◽  
Traditional Risk Factors

Cardiovascular disease remains the leading cause of mortality in the US and worldwide, and no widespread screening for this number one killer has been implemented. Traditional risk factor assessment does not fully account for the coronary risk and underestimates the prediction of risk even in patients with established risk factors for atherosclerosis. Coronary artery calcium (CAC) represents calcified atherosclerosis in the coronary arteries. It has been shown to be the strongest predictor of adverse future cardiovascular events and provides incremental information to the traditional risk factors. CAC consistently outperforms traditional risk factors, including models such as Framingham risk to predict future CV events. It has been incorporated into both the European and American guidelines for risk assessment. CAC is the most robust test today to reclassify individuals based on traditional risk factor assessment and provides the opportunity to better strategize the treatments for these subjects (converting patients from intermediate to high or low risk). CAC progression has also been identified as a risk for future cardiovascular events, with markedly increased events occurring in those patients exhibiting increases in calcifications over time. The exact intervals for rescanning is still being evaluated.

scholarly journals CHD Risk Factors In African-Americans

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1347-1347
Author(s):  
Daniel W Jones ◽  
Lloyd E Chambless ◽  
Aaron R Folsom ◽  
Richard G Hutchinson ◽  
Richey A Sharrett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Black Women ◽  
African Americans ◽  
Racial Differences ◽  
Ldl Cholesterol ◽  
Traditional Risk Factors ◽  
Chd Risk Factors

0017 Few studies have reported the incidence of coronary heart disease and its relationship to risk factors in African-Americans. As part of the Atherosclerosis Risk in Communities Study, baseline risk factors were tested as predictors of incident coronary heart disease over 7-10 years of follow-up, 1987-1997, in four U.S. communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland). The sample included 14,026 men and women (2,298 black women [BW]; 5,686 white women [WW]; 1,396 black men [BM]; and 4,682 white men [WM] aged 45-64 who were free of clinical coronary heart disease at baseline. Age-adjusted incidence rates for the 7-10 year period (95% confidence interval) for coronary heart disease were BW 5.0(4.1-6.1), WW 4.0(3.5-4.6), BM 10.7(8.9-12.8), and WM 12.6(11.5-13.8). In multivariate analysis, traditional risk factors were generally predictive in blacks as in whites. Hypertension was a particularly strong risk factor in black women, with hazard rate ratios (HR) being: BW 4.12, WW 2.0, BM 1.85, and WM 1.59. Diabetes was predictive, but HRs were somewhat less in blacks than in whites: BW 1.88, WW 3.34, BM 1.70, and WW 2.14. LDL cholesterol was similarly predictive in all race/gender groups, HR 1.19-1.36 per S.D. LDL cholesterol increment. HDL cholesterol appeared somewhat more protective in whites than in blacks. Although black/white differences in risk factor associations exist, there were more similarities than differences in coronary heart disease risk factors and incidence. Findings from this study, along with clinical trial evidence showing efficacy, support aggressive management of traditional risk factors in blacks as in whites. Understanding of the intriguing racial differences in risk factor prediction may be an important part of further understanding the causes of coronary heart disease and may lead to better methods of prevention and treatment.

scholarly journals Women’s Cardiac Health in 2020: A Systematic Review

2020 ◽  
Vol 4 (02) ◽  
pp. 104-110
Author(s):  
Fabiola B. Sozzi ◽  
Marta Belmonte ◽  
Marco Schiavone ◽  
Ciro Canetta ◽  
Rakesh Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Cardiovascular Health ◽  
The Novel ◽  
Cvd Risk ◽  
Disease Manifestation ◽  
Substantial Progress ◽  
Diagnostic Approaches ◽  
Traditional Risk Factors ◽  
Gender Specific

AbstractAlthough substantial progress has been made toward improving gender- and sex-specific cardiovascular disease (CVD) management and outcomes, contemporary reports indicate a persistent knowledge gap with regard to optimal risk-stratification and management in female cardiac heart disease (CHD) patients. Prominent patient and system delays in diagnosing CHD are, in part, due to the limited awareness for the latent CVD risk in women, a lack of sex-specific thresholds within clinical guidelines, and subsequent limited performance of contemporary diagnostic approaches in women. Several traditional risk factors for CHD affect both women and men. But other factors can play a bigger role in the development of heart disease in women. In addition, little is known about the influence of socioenvironmental and contextual factors on gender-specific disease manifestation and outcomes. It is imperative that we understand the mechanisms that contribute to worsening risk factors profiles in young women to reduce future atherosclerotic CVD morbidity and mortality. This comprehensive review focuses on the novel aspects of cardiovascular health in women and sex differences as they relate to clinical practice and prevention, diagnosis, and treatment of CVD. Increased recognition of the prevalence of traditional cardiovascular risk factors and their differential impact in women, as well as emerging nontraditional risk factors unique to or more common in women, contribute to new understanding mechanisms, leading to worsening outcome for women.

Cardiac biomarkers for cardiovascular risk prediction among women and men from the general population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
F Zhu ◽  
B Arshi ◽  
E Aribas ◽  
MA Ikram ◽  
MK Ikram ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Predictive Value ◽  
Troponin T ◽  
Cardiac Biomarkers ◽  
C Statistic ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Health Research and Development (ZonMw); Purpose To evaluate the sex-specific predictive value of two cardiac biomarkers; N-terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT), alongside traditional cardiovascular risk factors, for 10-year cardiovascular risk prediction in general population. Methods A total of 5430 participants (mean age 68.1 years; 59.9% women) free of cardiovascular disease (CVD), with blood sample measurements between 1997 and 2001 were included. We developed a ‘base’ model using cardiovascular risk factors used in the Pooled Cohort Equation (includes age, sex, systolic blood pressure, treatment of hypertension, total and high-density lipoprotein cholesterol levels, smoking, and diabetes) and then extended the ‘base’ model with NT-proBNP or hs-cTnT. These models were developed for coronary heart disease (CHD), stroke, and heart failure (HF) and also for composite CVD outcomes. To evaluate biomarkers’ added predictive value, c-statistic, and net reclassification improvement index (NRI) for events and non-events were calculated. NRI was calculated using cutoffs of 5%, 7.5% and 20% to categorize participants as low, borderline, intermediate, or high risk. Results Adding NT-proBNP to the ‘base’ model significantly improved c-statistic for all outcomes (increases ranged between 0.012-0.047), with the largest improvement in HF [0.026 (95% CI, 0.013, 0.040) for women and 0.047 (95% CI, 0.026, 0.069) for men]. Adding hs-TnT to ‘base’ model increased the c-statistic for CHD in women by 0.040 (95% CI, 0.013, 0.067) and for HF in men by 0.032 (95% CI, 0.005, 0.059). Improvments in reclassification by both biomarkers were mostly limited to modest improvemetns in reclassification of non-events [largest non-event NRI for global CVD in women (NT-proBNP: 11.8%; hs-cTnT: 10.5%) and for HF in men (NT-proBNP: 9.6%; hs-cTnT: 8.4%)]. Conclusion NT-proBNP improved model performance for prediction of all cardiovascular outcomes, in particular for HF, beyond traditional risk factors for both women and men. Hs-cTnT showed modest added predictive value beyond traditional risk factors for CHD among women and for HF among men. Imropovements in reclassification by both biomarkers were modest and not clinically relevant. Improvements of 10-year risk predictions Events Adding NT-proBNP Adding troponin T Delta c-statistic* Event NRI, % Non-event NRI, % Delta c-statistic* Event NRI, % Non-event NRI, % WomenASCVD Global CVD 0.012 (0.004, 0.020) 0.018 (0.010, 0.026) -1.7 (-5.0, 1.5)-0.8 (-3.8, 2.2) 5.4 (3.5, 7.2)11.8 (9.6, 14.1) 0.028 (0.009, 0.048)0.025 (0.009, 0.040) -0.4 (-7.1, 6.2)2.9 (-2.4, 8.3) 6.9 (3.9, 9.9)10.5 (7.3, 13.8) MenASCVD Global CVD 0.016 (0.005, 0.027)0.023 (0.012, 0.033) 0.7 (-2.3, 3.7)-0.3 (-3.0, 2.4) 5.2 (3.2, 7.2)7.2 (4.9, 9.4) 0.007 (-0.002, 0.016)0.011 (0.000, 0.021) -1.1 (-5.0, 2.7)-1.6 (-6.0, 2.8) 4.0 (1.2, 6.9)6.4 (3.1, 9.7) ASCVD comprises coronary heart disease and stroke; Global CVD comprises coronary heart disease, stroke and heart failure.

Abstract 14760: Myocardial Scarring by Magnetic Resonance Predicts Sudden Cardiac Death in Pediatric Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lars Grosse-Wortmann ◽  
Laurine van der Wal ◽  
Aswathy Vaikom House ◽  
Lee Benson ◽  
Raymond Chan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Pediatric Patients ◽  
Risk Markers ◽  
C Statistic ◽  
Increased Risk ◽  
Traditional Risk Factors

Introduction: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has been shown to be an independent predictor of sudden cardiac death (SCD) in adults with hypertrophic cardiomyopathy (HCM). The clinical significance of LGE in pediatric HCM patients is unknown. Hypothesis: LGE improves the SCD risk prediction in children with HCM. Methods: We retrospectively analyzed the CMR images and reviewed the outcomes pediatric HCM patients. Results: Amongst the 720 patients from 30 centers, 73% were male, with a mean age of 14.2±4.8 years. During a mean follow up of 2.6±2.7 years (range 0-14.8 years), 34 experienced an episode of SCD or equivalent. LGE (Figure 1A) was present in 34%, with a mean burden of 14±21g, or 2.5±8.2g/m2 (6.2±7.7% of LV myocardium). The presence of ≥1 adult traditional risk factor (family history of SCD, syncope, LV thickness >30mm, non-sustained ventricular tachycardia on Holter) was associated with an increased risk of SCD (HR=4.6, p<0.0001). The HCM Risk-Kids score predicted SCD (p=0.002). The presence of LGE was strongly associated with an increased risk (HR=3.8, p=0.0003), even after adjusting for traditional risk factors (HR adj =3.2, p=0.003) or the HCM Risk-Kids score (HR adj =3.5, p=0.003). Furthermore, the burden of LGE was associated with increased risk (HR=2.1/10% LGE, p<0.0001). LGE burden remained independently associated with an increased risk for SCD after adjusting for traditional risk factors (HRadj=1.5/10% LGE, p=0.04) or HCM Risk-Kids (HRadj=1.9/10% LGE, p=0.0018, Figure 1B). The addition of LGE burden improved the predictive model using traditional risk markers (C statistic 0.67 vs 0.77, p=0.003) and HCM Risk-Kids (C statistic 0.68 vs 0.74, p=0.045). Conclusions: Quantitative LGE is an independent risk factor for SCD in pediatric patients with HCM and improves the performance of traditional risk markers and the HCM Risk-Kids Score for SCD risk stratification in this population.

Abstract P115: How Many Coronary Heart Disease Deaths In Poland In 2020 Might Be Prevented By Further Reductions In Population Risk Factor Levels?

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Piotr Bandosz ◽  
Maria Guzman-Castillo ◽  
Simon Capewell ◽  
Tomasz Zdrojewski ◽  
Julia Critchley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Smoking Prevalence ◽  
Mortality Rates ◽  
Mortality Reduction ◽  
Scenario Reduction ◽  
Saturated Fats ◽  
Changes In Risk

Background: Poland has experienced one of the most dramatic declines in coronary heart disease (CHD) mortality rates in recent decades. This decline reflects the use of evidence based treatments and, crucially, population wide changes in diet. Our aim is to explore the potential for further gains in Poland by achieving population wide reductions in smoking, dietary salt and saturated fat intake and physical inactivity levels. Methods: A validated and updated policy model was used to forecast potential decreases in CHD deaths by 2020 as consequence of lifestyle and dietary changes in the population. Data from the most recent Polish risk factor survey was used for the baseline (2011). We modeled two different policy scenarios regarding possible future changes in risk factors: A) conservative scenario: reduction of smoking prevalence and physically inactivity rates by 5% between 2011 and 2020, and reduction of dietary consumption of energy from saturated fats by 1% and of salt by 10%. B) ideal scenario: reduction of smoking and physically inactivity prevalence by 15%, and dietary reduction of energy from saturated fats by 3% and of salt by 30%. We also conducted extensive sensitivity analysis using different counterfactual scenarios of future mortality trends. Results: Baseline scenarios. By assuming continuing declines in mortality and no future improvements in risk factors the predicted number of CHD deaths in 2020 would be approximately 13,600 (9,838-18,184) while if mortality rates remain stable, the predicted number of deaths would approximate 22,200 (17,792-26,688). Conservative scenario. Assuming continuing declines in mortality, small changes in risk factors could result in approximately 1,500 (688-2,940) fewer deaths. This corresponds to a 11% mortality reduction. Under the ideal scenario, our model predicted some 4,600 (2,048-8,701) fewer deaths (a 34% mortality reduction). Reduction in smoking prevalence by 5% (conservative scenario) or 15% (ideal scenario) could result in mortality reductions of 4.5% and 13.8% respectively. Decreases in salt intake by 10% or 30% might reduce CHD deaths by 3.0% and 8.6% respectively. Replacing 1% or 3% of dietary saturated fats by poly-unsaturates could reduce CHD deaths by 2.6% or 7.7% Lowering the prevalence of physically inactive people by 5%-15% could decrease CHD deaths by 1.2%-3.7%. Conclusion: Small and eminently feasible population reductions in lifestyle related risk factors could substantially decrease future number of CHD deaths in Poland, thus consolidating the earlier gains.

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