Abstract 16122: Comparative Risk of Incident Coronary Heart Disease Across Multiple Chronic Inflammatory Diseases

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Arjun Sinha ◽  
Adovich Rivera ◽  
Simran Chadha ◽  
Sameer Prasada ◽  
Anna Pawlowski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Coronary Revascularization ◽  
Immune Dysfunction ◽  
Chronic Inflammatory Diseases ◽  
Chd Risk ◽  
Chd Risk Factors

Introduction: Inflammation plays an important role in the pathogenesis of coronary heart disease (CHD). Chronic inflammatory diseases (CIDs) may serve as models to provide insights into the relationships between immune dysfunction, inflammation, and CHD. To investigate this further, we analyzed the risk of incident CHD across different CIDs. Methods: We created a cohort of individuals with CIDs and non-CID controls (frequency-matched on demographics and CHD risk factors), free of baseline CHD, receiving regular outpatient care in a large medical system from 2000 to 2019. CIDs included psoriasis, rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), and inflammatory bowel disease (IBD). CHD was defined as myocardial infarction (MI), angina, or coronary revascularization. We used adjusted hazards models to determine incident CHD risk for each CID relative to controls. We also analyzed incident CHD risk by severity of inflammation (baseline C-reactive protein) or immune dysfunction (baseline CD4 T cell level in HIV). Results: Of 18,129 individuals with CIDs and 18,988 controls, there were 1,011 incident CHD events over a median of 3.5 years. After adjusting for demographics and CHD risk factors, CHD risk was significantly elevated in SLE [hazard ratio (HR) 2.85, 95% confidence interval (CI) 2.19-3.71, p<0.01], SSc (HR 2.14, 95% CI 1.54-2.99, p<0.01), HIV (HR 1.38, 95% CI 1.12-1.69, p<0.01), and RA (HR 1.22, 95% CI 1.00-1.49, p=0.05). Findings were similar with MI as the lone outcome. When CIDs were categorized by inflammation or immune dysfunction, there was a pattern of higher CHD risk with higher levels of inflammation/immune dysfunction across CIDs (Figure). Conclusions: Our results show that SLE, SSc, HIV, and RA were associated with significantly elevated risks of incident CHD and MI. Higher levels of inflammation or immune dysfunction were associated with heightened CHD risk within CIDs.

scholarly journals Comparative Risk of Incident Coronary Heart Disease Across Chronic Inflammatory Diseases

2021 ◽  
Vol 8 ◽  
Author(s):  
Arjun Sinha ◽  
Adovich S. Rivera ◽  
Simran A. Chadha ◽  
Sameer Prasada ◽  
Anna E. Pawlowski ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Severity ◽  
Lupus Erythematosus ◽  
Inflammatory Diseases ◽  
Coronary Revascularization ◽  
Cox Models ◽  
Chronic Inflammatory Diseases ◽  
Adjusted Risk ◽  
Chd Risk

Background: Chronic inflammatory diseases (CIDs) are considered risk enhancing factors for coronary heart disease (CHD). However, sparse data exist regarding relative CHD risks across CIDs.Objective: Determine relative differences in CHD risk across multiple CIDs: psoriasis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), systemic sclerosis (SSc), and inflammatory bowel disease (IBD).Methods: The cohort included patients with CIDs and controls without CID in an urban medical system from 2000 to 2019. Patients with CIDs were frequency-matched with non-CID controls on demographics, hypertension, and diabetes. CHD was defined as myocardial infarction (MI), ischemic heart disease, and/or coronary revascularization based on validated administrative codes. Multivariable-adjusted Cox models were used to determine the risk of incident CHD and MI for each CID relative to non-CID controls. In secondary analyses, we compared CHD risk by disease severity within each CID.Results: Of 17,049 patients included for analysis, 619 had incident CHD (202 MI) over an average of 4.4 years of follow-up. The multivariable-adjusted risk of CHD was significantly higher for SLE [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.2, 3.2] and SSc (HR 2.1, 95% CI 1.2, 3.9). Patients with SLE also had a significantly higher risk of MI (HR 3.6, 95% CI 1.9, 6.8). When CIDs were categorized by markers of disease severity (C-reactive protein for all CIDs except HIV, for which CD4 T cell count was used), greater disease severity was associated with higher CHD risk across CIDs.Conclusions: Patients with SLE and SSc have a higher risk of CHD. CHD risk with HIV, RA, psoriasis, and IBD may only be elevated in those with greater disease severity. Clinicians should personalize CHD risk and treatment based on type and severity of CID.

scholarly journals The Impact of Risk Factors for Coronary Heart Disease on Related Disability in Older Irish Adults

2017 ◽  
Vol 31 (1) ◽  
pp. 165-184 ◽  
Author(s):  
Sharon M. Cruise ◽  
John Hughes ◽  
Kathleen Bennett ◽  
Anne Kouvonen ◽  
Frank Kee
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Northern Ireland ◽  
Physical Inactivity ◽  
Relative Risks ◽  
Chd Risk ◽  
Health And Social Care ◽  
Chd Risk Factors ◽  
The Impact

Objective: The aim of this study is to examine the prevalence of coronary heart disease (CHD)–related disability (hereafter also “disability”) and the impact of CHD risk factors on disability in older adults in the Republic of Ireland (ROI) and Northern Ireland (NI). Method: Population attributable fractions were calculated using risk factor relative risks and disability prevalence derived from The Irish Longitudinal Study on Ageing and the Northern Ireland Health Survey. Results: Disability was significantly lower in ROI (4.1% vs. 8.8%). Smoking and diabetes prevalence rates, and the fraction of disability that could be attributed to smoking (ROI: 6.6%; NI: 6.1%), obesity (ROI: 13.8%; NI: 11.3%), and diabetes (ROI: 6.2%; NI: 7.2%), were comparable in both countries. Physical inactivity (31.3% vs. 54.8%) and depression (10.2% vs. 17.6%) were lower in ROI. Disability attributable to depression (ROI: 16.3%; NI: 25.2%) and physical inactivity (ROI: 27.5%; NI: 39.9%) was lower in ROI. Discussion: Country-specific similarities and differences in the prevalence of disability and associated risk factors will inform public health and social care policy in both countries.

Abstract P192: Metabolomic Profiles Associated with Coronary Heart Disease in Women

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Nina P Paynter ◽  
Raji Balasubramanian ◽  
Shuba Gopal ◽  
Franco Giulianini ◽  
Leslie Tinker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Logistic Regression ◽  
Heart Disease ◽  
Tier 2 ◽  
Validation Data ◽  
Data Set ◽  
Chd Risk ◽  
Tier 1 ◽  
Chd Risk Factors

Background: Prior studies of metabolomic profiles and coronary heart disease (CHD) have been limited by relatively small case numbers and scant data in women. Methods: The discovery set examined 371 metabolites in 400 confirmed, incident CHD cases and 400 controls (frequency matched on age, race/ethnicity, hysterectomy status and time of enrollment) in the Women’s Health Initiative Observational Study (WHI-OS). All selected metabolites were validated in a separate set of 394 cases and 397 matched controls drawn from the placebo arms of the WHI Hormone Therapy trials and the WHI-OS. Discovery used 4 methods: false-discovery rate (FDR) adjusted logistic regression for individual metabolites, permutation corrected least absolute shrinkage and selection operator (LASSO) algorithms, sparse partial least squares discriminant analysis (PLS-DA) algorithms, and random forest algorithms. Each method was performed with matching factors only and with matching plus both medication use (aspirin, statins, anti-diabetics and anti-hypertensives) and traditional CHD risk factors (smoking, systolic blood pressure, diabetes, total and HDL cholesterol). Replication in the validation set was defined as a logistic regression coefficient of p<0.05 for the metabolites selected by 3 or 4 methods (tier 1), or a FDR adjusted p<0.05 for metabolites selected by only 1 or 2 methods (tier 2). Results: Sixty-seven metabolites were selected in the discovery data set (30 tier 1 and 37 tier 2). Twenty-six successfully replicated in the validation data set (21 tier 1 and 5 tier 2), with 25 significant with adjusting for matching factors only and 11 significant after additionally adjusting for medications and CHD risk factors. Validated metabolites included amino acids, sugars, nucleosides, eicosanoids, plasmologens, polyunsaturated phospholipids and highly saturated triglycerides. These include novel metabolites as well as metabolites such as glutamate/glutamine, which have been shown in other populations. Conclusions: Multiple metabolites in important physiological pathways with robust associations for risk of CHD in women were identified and replicated. These results may offer insights into biological mechanisms of CHD as well as identify potential markers of risk.

scholarly journals Risk Factors for Clinical Coronary Heart Disease in Systemic Lupus Erythematosus: The Lupus and Atherosclerosis Evaluation of Risk (LASER) Study

2009 ◽  
Vol 37 (2) ◽  
pp. 322-329 ◽  
Author(s):  
SAHENA HAQUE ◽  
CAROLINE GORDON ◽  
DAVID ISENBERG ◽  
ANISUR RAHMAN ◽  
PETER LANYON ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Lupus Erythematosus ◽  
Clinical Setting ◽  
Organ Involvement ◽  
Systemic Lupus ◽  
Chd Risk ◽  
Control Disease

Objective. Accelerated atherosclerosis and premature coronary heart disease (CHD) are recognized complications of systemic lupus erythematosus (SLE), but the exact etiology remains unclear and is likely to be multifactorial. We hypothesized that SLE patients with CHD have increased exposure to traditional risk factors as well as differing disease phenotype and therapy-related factors compared to SLE patients free of CHD. Our aim was to examine risk factors for development of clinical CHD in SLE in the clinical setting.Methods. In a UK-wide multicenter retrospective case-control study we recruited 53 SLE patients with verified clinical CHD (myocardial infarction or angina pectoris) and 96 SLE patients without clinical CHD. Controls were recruited from the same center as the case and matched by disease duration. Charts were reviewed up to time of event for cases, or the same “dummy-date” in controls.Results. SLE patients with clinical CHD were older at the time of event [mean (SD) 53 (10) vs 42 (10) yrs; p < 0.001], more likely to be male [11 (20%) vs 3 (7%); p < 0.001], and had more exposure to all classic CHD risk factors compared to SLE patients without clinical CHD. They were also more likely to have been treated with corticosteroids (OR 2.46; 95% CI 1.03, 5.88) and azathioprine (OR 2.33; 95% CI 1.16, 4.67) and to have evidence of damage on the pre-event SLICC damage index (SDI) (OR 2.20; 95% CI 1.09, 4.44). There was no difference between groups with regard to clinical organ involvement or autoantibody profile.Conclusion. Our study highlights the need for clinical vigilance to identify modifiable risk factors in the clinical setting and in particular with male patients. The pattern of organ involvement did not differ in SLE patients with CHD events. However, the higher pre-event SDI, azathioprine exposure, and pattern of damage items (disease-related rather than therapy-related) in cases suggests that a persistent active lupus phenotype contributes to CHD risk. In this regard, corticosteroids and azathioprine may not control disease well enough to prevent CHD. Clinical trials are needed to determine whether classic risk factor modification will have a role in primary prevention of CHD in SLE patients and whether new therapies that control disease activity can better reduce CHD risk.

scholarly journals RESULTS OF THE COMPLEX RISK FACTOR ASSESSMENT FOR THE CORONARY HEART DISEASE IN WORKING POPULATION

2018 ◽  
Vol 97 (4) ◽  
pp. 310-314 ◽  
Author(s):  
Sergey A. Maksimov ◽  
M. V. Tabakaev ◽  
A. N. Chigisova ◽  
G. V. Artamonova
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
General Population ◽  
White Collar ◽  
Blue Collar ◽  
Chd Risk ◽  
Working Groups ◽  
Total Burden ◽  
Chd Risk Factors

Material and methods. Three groups of men working in Kemerovo region were formed: 694 “white-collar”, 1674 “blue-collar” and 1612 “coal-miners”. To form the comparison group we used data from the Russian research ESSE-RF in the Kemerovo region (700 men). The following cardiovascular risk factors were assessed: hypercholesterolemia, hypertriglyceridemia, hyperglycemia, obesity, hypertension, smoking, and education level. The coronary heart disease (CHD) was diagnosed on the basis of ECG changes on the Minnesota code, Rose questionnaire, and myocardial infarction. According to the frequency of risk factors and their contribution to the probability of developing the coronary heart disease, there was calculated the total burden of CHD risk factors (Maksimov S.A. et al., 2015). Results .The burden of CHD risk factors in the general population up to 51 years accounts for 308 conventional units. There is a variety of risk factors frequency in the working groups, both inside the groups and in comparison with the general population. Consequently, there are differences in values of CHD risk factors burdens. The “blue-collar” burdens of CHD risk factors corresponding to the general population (304 conventional units). In “white-collar” and “miners” this parameter is lower, respectively, 266 and 259 conventional units. After 50 years, the total burden of CHD risk factors in the population increased to 472 conventional units (1.5 times). Differences of this index in the working groups to the general population after 50 years also increased. Conclusion. The working population is characterized by the low total burden of CHD risk factors compared with the general population. After 50 years, these differences increase, which indicates the deterioration of health with age, stimulates the individual to the termination of employment or the ongoing the work as the healthiest individuals. The lowest rates of CHD risk factors burden have been reported in “miners”, the average - in “white collar”, maximum - in “blue-collar”.

Longitudinal Evolution of Risk of Coronary Heart Disease in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (5) ◽  
pp. 968-973 ◽  
Author(s):  
IGOR KARP ◽  
MICHAL ABRAHAMOWICZ ◽  
PAUL R. FORTIN ◽  
LOUISE PILOTE ◽  
CAROLYN NEVILLE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Blood Glucose ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Chd Risk ◽  
Over Time

Objective.To produce evidence on the longitudinal evolution of risk factors for coronary heart disease (CHD) in patients with systemic lupus erythematosus (SLE).Methods.Based on data for 115 patients from the Montreal General Hospital Lupus Clinic (1971–2003) and for 4367 control subjects from the Framingham Offspring Study (1971–1994), we investigated the temporal evolution of total serum cholesterol, systolic blood pressure (SBP), body mass index (BMI), blood glucose, and estimated risk for CHD (reflecting the balance of changes in different risk factors). In analyses limited to patients with SLE, we assessed the effect of SLE duration on each risk factor, adjusting for age, calendar time, sex, baseline level of the risk factor, and medication use. Next, we assessed how the adjusted difference in the values of the risk factors between SLE and controls changes over time.Results.Among patients with SLE, longer disease duration was independently associated with higher SBP and blood glucose levels. Compared with controls, these patients appeared to have accelerated rates of increase in total cholesterol, blood glucose, and overall estimated CHD risk. The rate of increase in BMI was lower in patients with SLE than in controls.Conclusion.Elevated CHD risk in patients with SLE appears to be at least partially mediated by accelerated increases in some CHD risk factors, longitudinal trajectories of which increasingly diverge over time from those of population controls.

Relationship of Fitness, Fatness, and Coronary-Heart-Disease Risk Factors in 12- to 13-Year-Olds

2007 ◽  
Vol 19 (1) ◽  
pp. 93-101 ◽  
Author(s):  
Non-Eleri Thomas ◽  
Stephen-Mark Cooper ◽  
Simon P. Williams ◽  
Julien S. Baker ◽  
Bruce Davies
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Disease Risk ◽  
Reactive Protein ◽  
Chd Risk ◽  
Heart Disease Risk Factors ◽  
Chd Risk Factors ◽  
Lipids And Lipoproteins

The purpose of this study was to examine relationships between aerobic fitness (AF), fatness, and coronary-heart-disease (CHD) risk factors in 12- to 13-year-olds. The data were obtained from 208 schoolchildren (100 boys; 108 girls) ages 12.9 ± 0.3 years. Measurements included AF, indices of obesity, blood pressure, blood lipids and lipoproteins, fibrinogen, homocysteine, and C-reactive protein. An inverse relationship was found between AF and fatness (p < .05). Fatness was related to a greater number of CHD risk factors than fitness was (p < .05). Further analysis revealed fatness to be an independent predictor of triglyceride and blood-pressure levels (p < .05). Our findings indicate that, for young people, fatness rather than fitness is independently related to CHD risk factors.

scholarly journals Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242930
Author(s):  
Carmen Arroyo-Quiroz ◽  
Martin O’Flaherty ◽  
Maria Guzman-Castillo ◽  
Simon Capewell ◽  
Eduardo Chuquiure-Valenzuela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Heart Disease Mortality ◽  
Population Level ◽  
Impact Model ◽  
Chd Risk ◽  
Chd Risk Factors ◽  
Surgical Treatments ◽  
The Impact

Background Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. Methods We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. Results From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. Conclusions CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.

scholarly journals Addition of Risk Factors of Coronary Heart Disease in Diagnostic Value of Treadmill Score for Detecting Complexity of Coronary Arterial Lesions

2018 ◽  
Vol 4 (2) ◽  
pp. 88
Author(s):  
Mariyetty K.S. Nasution ◽  
Abdullah A. Siregar ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
Abdul H. Raynaldo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Diagnostic Value ◽  
Coronary Artery Lesions ◽  
Treadmill Test ◽  
Chd Risk ◽  
Chd Risk Factors

Background: Coronary heart disease (CHD) is still the leading cause of death in the world. There are various risk factors for atherosclerosis leading to CHD. Duke Treadmill Score (DTS) is known to demonstrate prognostic stratification and has a diagnostic value in predicting the number of coronary arteries involved in patient populations with ischemic heart disease. However, DTS does not describe the role of risk factors for coronary heart disease to the complexity of coronary artery lesions. This study aims to add risk factors for coronary heart disease on DTS to detect the complexity of coronary artery lesions with stable angina pectoris.Methods: This study was a cross-sectional study in stable angina pectoris patient who comes to Haji Adam Malik Hospital Medan from January 2017 until February 2018. Patients who have done treadmill test and coronary angiography, and fulfill inclusion and exclusion criteria are included in the study. ECG examination and recording of risk factors for coronary heart disease were done. DTS assessment was performed based on a treadmill test and Syntax score based on coronary angiography results. Diagnostic tests were performed to assess the sensitivity and specificity of the addition of CHD risk factors to detect the complexity of coronary artery lesions.Results: Of the 76 people with stable angina pectoris, 55 people were found with low SYNTAX and 21 people with high Syntax. DTS is divided into 3 groups: mild (> -10), moderate (-10 to - 13.5), and severe (≤-13.6) based on the cut off of the ROC curve. Risk factors for CHD are divided into 3 groups, mild (≤3 CHD risk factors), moderate (4-6 CHD risk factors), and severe (7 CHD risk factors) based on the cut off of the ROC curve, then assessed the relationship with Syntax which has been divided into 2 groups, low Syntax, and high Syntax. Diagnostic test shows the addition of risk factors of CHD to DTS to detect the complexity of coronary artery lesions have greater sensitivity and specificity than DTS without the addition of risk factors of CHD, 95%, and 89%.Conclusion: The addition of risk factors for coronary heart disease on DTS can detect the complexity of coronary artery lesions.

Analysis of risk factors for coronary heart disease

2020 ◽  
pp. 43-47
Author(s):  
Elvina Mukharamovna Nagimova ◽  
Yaroslav Grigorievich Mazin ◽  
Chingiskhan Daudavich Merzhoev ◽  
Emil Rushanovich Badamshin ◽  
Marina Yuryevna Pavlova
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Arterial Hypertension ◽  
Significant Risk ◽  
Circulatory System ◽  
Common Diseases ◽  
Chd Risk ◽  
Chd Risk Factors

At the present time the most common diseases are diseases of the circulatory system, among which the leading place belongs to coronary heart disease (CHD). Risk factors for CHD were studied and evaluated. It was found that in women the most significant risk factors are arterial hypertension (54.5 %), hypodynamia (54.5 %) and stress (41.9 %), and in men — stress (58.1 %), arterial hypertension (40.7 %) and smoking (37.0 %).

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