Abstract P256: Stability of Obesity and Metabolic Health and the Risk of Cardiovascular Disease

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Todd Sponholtz ◽  
Justin B Echouffo-Tcheugui ◽  
Ramachandran S Vasan
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cox Proportional Hazards ◽  
Metabolic Health ◽  
Lipid Lowering ◽  
Cvd Risk ◽  
High Blood Glucose ◽  
Coronary Insufficiency ◽  
Metabolically Healthy

Introduction: Metabolic syndrome (MetSyn) reportedly confers higher risk of cardiovascular disease (CVD) than its individual components. Although typically defined as a binary exposure, each of its component factors can vary over time. Little is known about whether CVD risk differs according to MetSyn stability. Methods: We defined longitudinal states of obesity and metabolic health among 2,952 Framingham Offspring Study participants for whom we had sufficient data to define MetSyn at ≥4 exams between Exams 2 (1979-1983) and 9 (2011-2014). Obesity was defined as BMI ≥30 kg/m 2 , high triglycerides as ≥150 mg/dL/taking lipid-lowering medication, low HDL as <40 mg/dL for males/ <50 mg/dL for females; high blood pressure as systolic blood pressure ≥130 mm Hg/diastolic blood pressure ≥85 mm Hg/taking antihypertensive medication, and high blood glucose as ≥100 mg/dL/taking antidiabetic medication. Metabolic health was defined as having <2 metabolic conditions. Obesity and metabolic health were classified as unstable if there was a change from one state to the other in ≥33% of observations occurring before a CVD event or end of follow-up, stable obese/metabolically unhealthy if not unstable and >50% of observations were classified as stable obese/metabolically unhealthy, or stable non-obese/metabolically healthy otherwise. CVD was defined as any of the following coronary death, myocardial infarction, coronary insufficiency, angina pectoris, stroke, transient ischemic attack, intermittent claudication, or congestive heart failure. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards regression with age as the time scale. Results: We classified 332 participants (11.3%) as having unstable metabolic health, and 130 (4.4%) as having unstable obesity. We observed 1,206 events in 75,673 person-years of follow-up (median 30 years). Participants classified as stable metabolically unhealthy had the highest CVD risk (HR 1.77, 95% CI 1.47, 2.13, compared to stable metabolically healthy). Stable obesity was associated with a 48% (95% CI 24, 80) increase in CVD risk relative to stable non-obese. Unstable metabolic health and obesity were associated with moderate increases in risk compared to stable metabolically healthy and stable non-obese (HRs: 1.32, 95% CI 1.03, 1.71 and 1.25, 95% CI 0.88, 1.77, respectively). There was no interaction between obesity- and metabolic health stability (p interaction =0.23). Conclusions: In our sample, stability of obesity and of metabolic health influenced CVD risk, with the highest risk of CVD observed among stable metabolically unhealthy participants. Instability of both obesity and metabolic health convey a risk intermediate between the stable obese/metabolically healthy and stable non-obese/metabolically unhealthy conditions.

scholarly journals Differential Effects of Dietary Fats on Serum Lipids and Risks of Cardiovascular Disease and Diabetes in the Prospective Framingham Offspring Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1508-1508
Author(s):  
Mengjie Yuan ◽  
R Taylor Pickering ◽  
Martha Singer ◽  
Lynn l Moore
Keyword(s):  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dietary Fats ◽  
Sensitivity Analyses ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Particle Sizes ◽  
Cvd Risk ◽  
Increased Risk

Abstract Objectives Few studies have estimated the independent effects of butter and margarine on risk of cardiovascular disease (CVD). Our goal was to examine these effects as well as that of other fats and oils on risk of CVD and markers of cardiometabolic risk in subjects in the prospective Framingham Offspring Study. Methods Data from 2038 adults, who were free of CVD and diabetes through exam 5 were included. Intakes of butter, margarine, mayonnaise, oils, and shortening were assessed using 3-day diet records at exams 3 and 5. Concentrations of low-density lipoproteins (LDL), high-density lipoproteins (HDL), and their particle sizes were analyzed cross-sectionally at exam 5. Subjects were followed from exam 5 to 9 for incident CVD and type 2 diabetes (T2DM) (median follow-up, 16.9 years). Cox proportional hazards models were used to estimate risk of CVD and T2DM and generalized linear models were used to evaluate effects on other cardiometabolic outcomes, while adjusting for age, sex, pack-years of smoking, BMI, physical activity, intakes of other fats, hypertension and use of lipid-lowering medication. Intake of each type of dietary fat was categorized as low, moderate, or high using sensitivity analyses. Results Intake of &gt;5 g/day of butter (vs. non-consumers) had no effect on CVD risk but was associated with a non-statistically significant 24% lower risk of T2DM. In men, higher butter intake was linked with larger LDL and HDL particles sizes (P &lt; 0.01 for both) and a lower LDL: HDL ratio (P &lt; 0.01). Consuming &gt;7 g/day (vs. ≤2) of margarine was associated with a 48% (95% CI: 1.03–2.13) increased risk of CVD and a 68% (95% CI: 1.00–2.82) higher risk of T2DM in women. In men, higher margarine intake was associated with much weaker, non-statistically significant increased risks of CVD and T2DM. Finally, total intake of oils (&gt;7 vs. ≤2 g/day) was associated with a strong reduced risk of T2DM (HR: 0.55; 95% CI: 0.36–0.85) in men but not women. There was no effect of margarine or oils on lipid particle sizes in either men or women. Conclusions While butter intake had no adverse effect on risk of CVD in either men or women, it was beneficially associated with lipid profiles in men. In women, higher intakes of margarine but not butter were associated with increased risks of both CVD and T2DM. Finally greater oil consumption led to lower risks of T2DM in men. Funding Sources NHLBI National Dairy Council.

scholarly journals Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey (Preprint)

2020 ◽  
Author(s):  
Carissa Bonner ◽  
Natalie Raffoul ◽  
Tanya Battaglia ◽  
Julie Anne Mitchell ◽  
Carys Batcup ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Experimental Studies ◽  
Emotional Responses ◽  
Lifestyle Changes ◽  
Small Samples ◽  
Cvd Risk ◽  
Web Based ◽  
Heart Age

BACKGROUND Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. OBJECTIVE This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. METHODS The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. RESULTS There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. CONCLUSIONS Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

Abstract MP27: Saturated Fat Intake From Dairy Sources Is Associated With Reduced Cardiovascular Risk In Framingham Offspring Study Women

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Mengjie Yuan ◽  
Richard Pickering ◽  
Martha Singer ◽  
Lynn L Moore
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Proportional Hazards ◽  
Dietary Assessment ◽  
Saturated Fat ◽  
Cox Proportional Hazards ◽  
Food Sources ◽  
Lipid Lowering ◽  
Cvd Risk ◽  
Diet Records

Introduction: While saturated fat (SFA) intake has long been considered as an important risk factor for cardiovascular disease (CVD), some evidence in recent years has called these findings into question. There is limited evidence examining the separate effects of SFAs from different food sources on cardiovascular risk. Objective: The goal of this study was to determine whether higher (vs. lower) intakes of SFA from dairy and non-dairy sources were associated with risk of incident cardiovascular disease. Methods: Data from 1991 adults, ages 30 and older, who were free of CVD at the time of baseline dietary assessment in the prospective Framingham Offspring Study were included in these analyses. Dairy and non-dairy SFA was assessed using 3-day diet records at exams 3 and 5; intakes were adjusted for body weight using the residual method. Subjects were followed from exam 5 to exam 9 for CVD events (median follow-up 16.9 years). Cox proportional hazards models were used to adjust for confounding by sex, age, BMI, physical activity, smoking (pack-years), non-dairy SFA (in dairy SFA models, and vice versa for non-dairy models), and time dependent occurrence of hypertension or use of lipid-lowering medications. Results: Subjects were classified into 3 categories of sex-specific intake of dairy SFA (<9, 9-<13, and ≥13 g/day for men; <6, 6-<9, ≥9 g/day for women) and non-dairy SFA (<15, 15-<18 and ≥18 g/day for men; <12, 12-<15, and ≥15 g/day for women). Women with moderate (vs. low) and high (vs. low) dairy SFA intakes had 56% (95% CI: 0.27-0.71) and 20% (95% CI: 0.56-1.14) lower CVD risks, respectively, while women consuming high (vs. low) non-dairy SFA had 22% (CI: 0.52-1.16) lower risks. Neither dairy-based SFA nor non-dairy SFA intake was associated with CVD occurrence in men. To determine whether the combined effects of SFA from dairy and non-dairy sources were associated with CVD risk, we cross-classified SFA intakes from the two sources (i.e., high/low dairy SFA intake: <9 vs. ≥9 g/day for men, <6 vs ≥6 g/day for women; high/low non-dairy SFA intake: <15 vs. ≥15 g/day for both men & women). Overall, subjects with higher intakes of dairy SFA combined with lower intakes of non-dairy SFA had the lowest risks of CVD (HR:0.73; 95% CI: 0.54-0.98). These effects were stronger in women (HR:0.60; 95% CI: 0.41-0.88), and non-statistically significant in men (HR: 0.88; 95% CI: 0.54-1.43). Women with higher combined intakes of SFA from both dairy and non-dairy sources still had 44% lower risks of CVD. However, higher intakes of SFA from non-dairy sources alone was not associated with CVD risk in either men or women. Conclusions: Saturated fats derived from dairy sources were associated with a reduced risk of incident CVD in women. For both men and women, those who had higher intakes of dairy-derived SFA combined with lower intakes of non-dairy SFA tended to have lower risks of CVD than those with lower intakes of SFA from both sources.

The effects of transitions in metabolic health and obesity status on incident cardiovascular disease: Insights from a general Chinese population

2020 ◽  
pp. 204748732093555 ◽  
Author(s):  
Xiaofan Guo ◽  
Zhao Li ◽  
Ying Zhou ◽  
Shasha Yu ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Confidence Interval ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Metabolic Health ◽  
Metabolically Healthy Obesity ◽  
Obesity Status ◽  
Metabolically Healthy ◽  
Incident Cardiovascular Disease

Background Recent studies have investigated the association of transitions in metabolic health and obesity status over time with the risk of cardiovascular disease, focusing on the subgroup demonstrating metabolically healthy obesity. However, these studies have produced inconsistent results. This study evaluates the relation in a general Chinese population. Methods We conducted a prospective cohort study in a general population in Northeast China, with examinations of cardiovascular health from 2012–2015 and follow-up for incident cardiovascular disease until 2018. Cox proportional hazards and logistic regression models were used to investigate the association of baseline metabolic health and obesity status and transitions in those statuses with cardiovascular disease risk. Results A total of 7472 participants aged ≥35 years who were free of cardiovascular disease at baseline were included in this analysis. Over a median follow-up of 4.66 years, a total of 344 cardiovascular disease events occurred. Among the 3380 participants who were obese at baseline, 37.1% were metabolically healthy. Metabolically healthy obesity was associated with a 48% increased risk of cardiovascular disease (hazard ratio: 1.48; 95% confidence interval: 1.07–2.06) compared with the metabolically healthy non-obese group at baseline. Transition from metabolically healthy obesity to metabolically unhealthy obesity was associated with elevated cardiovascular disease risk with an odds ratio of 1.82 (95% confidence interval: 1.06–3.14) compared with metabolically healthy non-obesity throughout after adjustment. Even maintaining metabolically healthy obesity over time was associated with a higher risk of cardiovascular disease (odds ratio: 1.72; 95% confidence interval: 1.00–2.97). Conclusions Weight control and management of existing metabolic disorders should be prioritized in all obese population.

scholarly journals Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey

10.2196/19028 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e19028
Author(s):  
Carissa Bonner ◽  
Natalie Raffoul ◽  
Tanya Battaglia ◽  
Julie Anne Mitchell ◽  
Carys Batcup ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Experimental Studies ◽  
Emotional Responses ◽  
Lifestyle Changes ◽  
Small Samples ◽  
Cvd Risk ◽  
Web Based ◽  
Heart Age

Background Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. Objective This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. Methods The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. Results There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. Conclusions Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

Abstract P346: Cohort Identification to Harness the Electronic Health Record for Cardiovascular Disease Prediction

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sheila M Manemann ◽  
Jennifer St Sauver ◽  
Janet E Olson ◽  
Nicholas B Larson ◽  
Paul Y Takahashi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Electronic Health Record ◽  
Risk Prediction ◽  
Health Record ◽  
Next Generation ◽  
Cvd Risk ◽  
Electronic Health

Background: Current cardiovascular disease (CVD) risk scores are derived from research cohorts and are particularly inaccurate in women, older adults, and those with missing data. To overcome these limitations, we aimed to develop a cohort to capitalize on the depth and breadth of clinical data within electronic health record (EHR) systems in order to develop next-generation sex-specific risk prediction scores for incident CVD. Methods: All individuals 30 years of age or older residing in Olmsted County, Minnesota on 1/1/2006 were identified. We developed and validated algorithms to define a variety of risk factors, thus building a comprehensive risk profile for each patient. Outcomes including myocardial infarction (MI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), and CVD death were ascertained through 9/30/2017. Results: We identified 73,069 individuals without CVD (Table). We retrieved a total of 14,962,762 lab results; 14,534,466 diagnoses; 17,062,601 services/procedures; 1,236,998 outpatient prescriptions; 1,079,065 heart rate measurements; and 1,320,115 blood pressure measurements. The median number of blood pressure and heart rate measurements ascertained per individuals were 11 and 9, respectively. The five most prevalent conditions were: hypertension, hyperlipidemia, arthritis, depression, and cardiac arrhythmias. During follow-up 1,455 MIs, 1,581 PCI, 652 CABG, and 2,161 CVD-related deaths occurred. Conclusions: We developed a cohort with comprehensive risk profiles and follow-up for each patient. Using sophisticated machine learning approaches, this electronic cohort will be utilized to develop next-generation sex-specific CVD risk prediction scores. These approaches will allow us to address several challenges with use of EHR data including the ability to 1) deal with missing values, 2) assess and utilize a large number of variables without over-fitting, 3) allow non-linear relationships, and 4) use time-to-event data.

Abstract P391: Clinically Significant Blood Pressure Reduction Among Participants of a Lifestyle intervention Improvement Program strongly associated with Reduced Systemic Inflammation in a High Risk Working Population

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Henry Guzman ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Khurram Nasir ◽  
Josette Bou-Khalil ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Lifestyle Intervention ◽  
Systemic Inflammation ◽  
South Florida ◽  
Working Population ◽  
Cvd Risk ◽  
Short Period ◽  
Clinically Significant

Background: In this study we aim to assess the short term effects of clinically significant Blood Pressure (BP) reduction after a behavioral intervention on systemic inflammation, measured by elevated high sensitivity c-reactive protein (HSCRP), in a high cardiovascular disease (CVD) risk cohort. Methods: The study was conducted among 180 employees of Baptist Health South Florida who had 2 or more CVD risk factors such as obesity, diabetes, hypertension or elevated total cholesterol and was involved in a three-month workplace lifestyle intervention. The intervention focused on nutritional and physical activity modifications. At baseline and at 3 months follow-up, anthropometric, clinical, and laboratory measures were obtained. Significant BP reduction was defined as systolic blood pressure (SBP) reduction ≥ 10mmHg or diastolic blood pressure (DBP) reduction ≥ 5mmHg at 3 months of follow-up. A HSCRP >3mg/L was considered elevated. Results: Over the 3-month study period the median SBP decline was 16mmHg (IQR 4 -23mmHg) while the median reduction in DBP was 10mmHg (IQR 6 -16mmHg). 87% (156 participants) experienced significant BP reduction. Among those without significant BP reduction, the prevalence of elevated HSCRP at baseline was 58% and at follow-up it was 75% (p = 0.125). However, among those who had significant BP reduction, there was significant reduction in the prevalence of elevated HSCRP from 66.7% to 57.1% (p<0.001). In unadjusted conditional logistic regression analyses significant BP reduction was associated with 94% reduction in the risk of elevated HSCRP at follow-up. In a fully adjusted model, this association persisted. Conclusion: Clinically significant reduction in blood pressure over a short period in a high cardiovascular disease risk working population is independently associated with markedly diminished risk of elevate hs-CRP. Longer follow-up intervention studies are required to further understand if these effects are sustained.

scholarly journals The Association of Stage 1 Hypertension, Defined by the 2017 ACC/AHA Guidelines, With Cardiovascular Events Among Rural Women in Liaoning Province, China

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiake Wu ◽  
Weili Duan ◽  
Yundi Jiao ◽  
SiTong Liu ◽  
LiQiang Zheng ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Rural Women ◽  
Cox Proportional Hazards ◽  
Liaoning Province ◽  
Baseline Survey ◽  
Increased Risk ◽  
Stage 1 ◽  
Cvd Mortality

Background: The recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines redefined blood pressure levels 130-139/80-89 mmHg as stage 1 hypertension. However, the association of stage 1 hypertension with cardiovascular disease (CVD) and its age-specific differences among the rural women in Liaoning province remains unclear. It needs to be quantified in considering guideline adoption in China.Methods: In total, 19,374 women aged ≥35 years with complete data and no cardiovascular disease at baseline were followed in a rural community-based prospective cohort study of Liaoning province, China. Follow-up for the new cases of CVD was conducted from the end of the baseline survey to the end of the third follow-up survey (January 1, 2008–December 31, 2017). Adjusted Cox proportional hazards models were applied to estimate the Hazard Ratios (HR) and 95% Confidence Intervals (CI) with the normal blood pressure as a reference.Results: During the median follow-up period of 12.5 years, 1,419 subjects suffered all-cause death, 748 developed CVD, 1,224 participants suffered stroke and 241 had Myocardial Infarction (MI). Compared with normal BP, Stage 1 hypertension had a HR (95% CI) of 1.694 (1.202–2.387) in CVD mortality, 1.575 (1.244–1.994) in the incidence of stroke. The results obtained that the risk of CVD mortality and incidence of stroke was significantly associated with stage 1 hypertension in rural women aged ≥45 years after adjusting for other potential factors. However, in participants aged 35–44 years, stage 1 hypertension was not associated with an increased risk of cardiovascular disease.Conclusions: The newly defined stage 1 hypertension is associated with an increased risk of CVD mortality and also incidence of stroke in the rural women aged ≥45 years population of Liaoning province. This study can be a good reference for health policy makers and clinicians workers to make evidence-based decisions toward lowering burden of cardiovascular disease more efficient, timely measures on prevention and control of stage 1 hypertension in China.

scholarly journals Hypertension Subtype Defined by the 2017 ACC/AHA Blood Pressure Guidelines and Risk of Cardiovascular Disease: A Large Prospective Cohort Study

2020 ◽  
Author(s):  
Fu-Rong Li ◽  
Xian-Bo Wu
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Blood Pressure Level ◽  
Cox Proportional Hazards ◽  
Cvd Risk ◽  
Increased Risk ◽  
Diastolic Hypertension ◽  
The Uk

AbstractBackgroundThe 2017 American College of Cardiology/American Heart Association (ACC/ AHA) blood pressure (BP) guideline lowered the hypertension threshold from a systolic blood pressure/diastolic blood pressure level of ≥140/90 mm Hg to ≥130/80 mm Hg. The significance of hypertension subtype under the new definition has not been fully explored.ObjectiveTo examine the associations of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) by the 2017 ACC/AHA guidelines with risk of cardiovascular disease (CVD) among the UK population.DesignProspective population-based cohort studySettingUK BiobankParticipants and MethodsWe included 470,625 participants who were free of CVD at baseline and had available data on BP measures. Of these, 13,157 CVD events were recorded (median follow-up 8.1 years), including 6,865 nonfatal myocardial infarctions (MI), 3,415 nonfatal ischemic strokes (ISs), 1,118 nonfatal hemorrhagic strokes (HSs), and 2,971 CVD deaths. Participants were categorized into 5 groups: normal BP, normal high BP, ISH, IDH and systolic and diastolic hypertension (SDH). The associations of each type of hypertension for the risk of CVD were estimated using a Cox proportional hazards regression model with adjustment for potential confounding factors.ResultsAccording to the hypertension threshold of ≥130/80 mm Hg by ACC/AHA guideline, both ISH (HR 1.35, 95% CI 1.24-1.46) and IDH (HR 1.22, 95% CI 1.11-1.36) were significantly associated with higher risk of overall CVD risk, compared with those with normal BP. ISH was predictive of most CVD risk, except for IS; while the excess CVD risk associated with IDH appeared to be driven mainly by MI. We found heterogeneity by sex and age regarding the effects of IDH on overall CVD risk, with the associations stronger in women and younger adults (age < 60 years) and null in men and older adults (age ≥60 years).ConclusionsISH and IDH by the ACC/AHA BP guideline were both associated with increased risk of CVD, highlighting the justification to lower the criteria of hypertension definition in the UK. Further research is needed to identify participants with IDH who are at especially greater risk for developing CVD.

Abstract P329: Prospective Association of Serum Uromodulin and Cardiovascular Disease in Chronic Kidney Transplant Receipents

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Charles B Eaton ◽  
Dominik Steubl ◽  
Mary Roberts ◽  
Pranav Garimella ◽  
Theresa Shireman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Kidney Transplant ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Tubular Function ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
Total N ◽  
Baseline Serum

Serum levels of the exclusively renal-derived glycoprotein, uromodulin, a putative tubular function index, were recently associated with the development of fatal and non-fatal cardiovascular disease [CVD] outcomes during longitudinal surveillance of two cohorts undergoing diagnostic coronary angiography (Leiherer A et al. Int J Cardiol. 2017; 231:6-12; Delgado GE et al. 2017; 28: 2201-10). Using a case-cohort design (total n=685; random subcohort n=433) from the completed FAVORIT trial of chronic, stable kidney transplant recipients [KTRs], we examined the association between baseline serum uromodulin (mean ± standard deviation [SD]: 67.8 ±39.7 ng/mL), and the development of CVD (myocardial infarction, CVD death, stroke, & major revascularization procedures, pooled, n=311 events), during a median 3.7 years of follow-up. Unadjusted, weighted Cox proportional hazards modeling, based upon the subcohort uromodulin level SD (±39.7), revealed that each SD higher was associated with a 23% decreased risk for CVD (hazards ratio [HR]= 0.77; 95% confidence interval [CI]=0.65-0.92). This association was attenuated after adjustment for age, sex, smoking status, graft type, prevalent diabetes & CVD, systolic blood pressure gt140, diastolic blood pressure lt 70, estimated glomerular filtration rate [eGFR] gt=45 mL/min per 1.73m 2 , & natural log urinary albumin/creatinine [UACR]: (HR=0.83; 95% CI=0.67-1.04). Comparing subcohort uromodulin [ng/mL] quartile ranges (Q1=5.6-39.1; Q2=39.2-58.8; Q3=58.9-82.9; Q4=83.0-309.6), with the lowest quartile as referent, unadjusted Cox models demonstrated that the risks for CVD were as follows: Q2 v. Q1 (HR=0.92; 95% CI=0.62-1.38); Q3 v. Q1 (HR=0.69; 95% CI= 0.46-1.03); Q4 v. Q1 (HR=0.56; 95% CI=0.37-0.85). Full adjustment yielded: Q2 v. Q1 (HR=1.16; 95% CI= 0.70-1.92); Q3 v. Q1 (HR= 0.77; 95% CI=0.44-1.37); Q4 v. Q1 (HR=0.76; 95% CI=0.44-1.31). Higher serum uromodulin, an ostensible indicator of better preserved tubular function, was associated with reduced risk for the development of CVD in a large cohort of chronic, stable KTRs, but this association did not persist upon adjustment for major CVD risk factors, eGFR, & UACR.

Sign in / Sign up

Export Citation Format

Share Document