Abstract P371: Incremental Changes in Systolic Blood Pressure Post-mild Exercise, in Normotensive Subjects, is Associated With Significant Structural and Functional Cardiovascular Abnormalities

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Susan Tucker ◽  
Arjun Byju ◽  
Mahfouz El Shahawy
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Risk Score ◽  
Health Care Practitioner ◽  
Cvd Risk ◽  
Cardiovascular Abnormalities ◽  
Artery Stiffness ◽  
Normotensive Subjects ◽  
Asymptomatic Subjects ◽  
Retinal Photography

Background: Abnormal rise in systolic blood pressure (SBP) post-mild exercise (PME) has been associated with early structural and functional cardiovascular abnormalities. Purpose: To determine if the differential amount of rise in SBP PME, in normotensive subjects, effected the risk of early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 996 subjects were normotensive. Of those subjects, 30 subjects had an abnormal rise in SBP PME between 30-40mmHg and 14 had an abnormal rise in SBP PME >40 mmHg. Focus was placed on the three tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, an abnormal rise in SBP PME greater than 40mmHg is associated with a statistically significant increase in risk of early structural and functional cardiovascular abnormalities in untreated, asymptomatic, normotensive subjects opposed to those who only had an increase between 30-40mmHg. Conclusion: Assessment of SBP PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Based on the severity of the increase in SBP PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

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

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Susan Tucker ◽  
Mahfouz El Shahawy
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Risk Score ◽  
Health Care Practitioner ◽  
Cvd Risk ◽  
Cardiovascular Abnormalities ◽  
Increased Risk ◽  
Artery Stiffness ◽  
Asymptomatic Subjects ◽  
Retinal Photography

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

scholarly journals General Practitioners’ adherence to prescribing guidelines for statins in the United Kingdoms

2019 ◽  
Author(s):  
Federico Ricciardi ◽  
Irwin Nazareth ◽  
Irene Petersen
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Statin Therapy ◽  
Risk Score ◽  
Smoking Status ◽  
Risk Scores ◽  
List Type ◽  
Cvd Risk ◽  
Nice Guideline ◽  
Clinical Records

ABSTRACTObjectiveIn this retrospective cohort study we aimed to assess, in 202,247 people who started a statin therapy between 2007-2014, the factors that led to the initiation of the drug. To do this we explored CVD risk factors singularly and in combinations as recorded in electronic health records in the year before they receive their first prescription and we compared the risk scores with that suggested by the NICE guideline at that time.MethodsWe summarised demographic characteristics and proportions of people with a risk score below the threshold. Regression-based analyses are performed to evaluate the association between the missingness of the risk score and relevant risk score components.Results45,364 individuals (22.4%) were prescribed statins without a record of a risk score being available in the year prior to the prescription date. When the risk score was available, 68,174 out of 156,883 patients were prescribed statins even with a score below the 20% threshold. Smoking status was the most frequently recorded variable (74.9% of the instances), followed by systolic blood pressure (71.6%) and total cholesterol (70%), while HDL cholesterol was the least recorded (34.1%). Cholesterol levels are positively associated with the missingness of the risk score, while systolic blood pressure shows a negative association.ConclusionsGPs often start statins on people with no risk score recorded in their clinical records or in those with risk scores below the recommended threshold. Higher cholesterol values may result in a GP starting statin therapy without recording the other relevant components required to calculate a risk score.STRENGTHS AND LIMITATIONS OF THIS STUDYOur cohort contains a large number of individuals: the study provide a representative picture of initiation of statins in UK primary care.We specifically focus on which variables and factors GPs record in electronic databases in the year prior statin treatment initiation: this is the first study to directly tackle the issue of statins prescribing in the absence of all the information required by the NICE guidelineWe are not able to verify if GPs actually used the records of the individual health indicators, when these were available, to calculate the risk score.

scholarly journals Urinary sodium excretion and the risk of cardiovascular disease: A community-based cohort study in Taiwan

2021 ◽  
pp. 1-42
Author(s):  
Yi-Jie Wang ◽  
Kuo-Lioug Chien ◽  
Hsiu-Ching Hsu ◽  
Hung-Ju Lin ◽  
Ta-Chen Su ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Systolic Blood Pressure ◽  
Sodium Excretion ◽  
Urinary Sodium Excretion ◽  
Salt Sensitivity ◽  
Urinary Sodium ◽  
Mediating Effect ◽  
Cvd Risk ◽  
Media Thickness

Abstract Urinary sodium excretion is a potential risk factor for cardiovascular diseases (CVD). However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterize the relative contribution of biological factors to the sodium-CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour sodium excretion was estimated using a single overnight urine sample. Hypertension, metabolic syndrome, and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary sodium excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (standard deviation) of the 2112 participants was 54.5 (12.2) years, and they were followed up for a mean of 14.1 [8.1] years. Compared with those in the lowest quartile, the highest baseline urinary sodium excretion (>4.2g/24 hours) was associated with a 43% higher CVD risk (hazard ratio, 1.43; 95% confidence interval, 1.02-1.99). Participants with high urinary sodium excretion, hypertension, or metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35% of the sodium-CVD association), followed by systolic blood pressure (33%), left ventricular mass (28%), and diastolic blood pressure (14%). Higher urinary sodium excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic blood pressure.

scholarly journals Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Javier I. Ottaviani ◽  
Abigail Britten ◽  
Debora Lucarelli ◽  
Robert Luben ◽  
Angela A. Mulligan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Vascular Function ◽  
Cardiovascular Health ◽  
Vascular Diseases ◽  
Inverse Association ◽  
Cvd Risk ◽  
Lower Systolic Blood Pressure ◽  
Cross Sectional ◽  
Salt Reduction

Abstract Flavan-3-ols are a group of bioactive compounds that have been shown to improve vascular function in intervention studies. They are therefore of great interest for the development of dietary recommendation for the prevention of cardio-vascular diseases. However, there are currently no reliable data from observational studies, as the high variability in the flavan-3-ol content of food makes it difficult to estimate actual intake without nutritional biomarkers. In this study, we investigated cross-sectional associations between biomarker-estimated flavan-3-ol intake and blood pressure and other CVD risk markers, as well as longitudinal associations with CVD risk in 25,618 participants of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort. High flavan-3-ol intake, achievable as part of an habitual diet, was associated with a significantly lower systolic blood pressure (− 1.9 (− 2.7; − 1.1) mmHg in men and − 2.5 (− 3.3; − 1.8) mmHg in women; lowest vs highest decile of biomarker), comparable to adherence to a Mediterranean Diet or moderate salt reduction. Subgroup analyses showed that hypertensive participants had stronger inverse association between flavan-3-ol biomarker and systolic blood pressure when compared to normotensive participants. Flavanol intake could therefore have a role in the maintenance of cardiovascular health on a population scale.

Abstract P261: Intensive Systolic Blood Pressure Lowering Will Prevent Over 100,000 Deaths Annually

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Holly Kramer ◽  
Adam Bress ◽  
Srinivasan Beddhu ◽  
Paul Muntner ◽  
Richard S Cooper
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Systolic Blood Pressure ◽  
Mortality Rates ◽  
Mortality Data ◽  
Blood Pressure Lowering ◽  
Cvd Risk ◽  
Pressure Lowering ◽  
Annual Mortality ◽  
The U.S

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) trial randomized 9,361 adults aged ≥50 years at high cardiovascular disease (CVD) risk without diabetes or stroke to intensive systolic blood pressure (SBP) lowering (≤120 mmHg) or standard SBP lowering (≤140 mmHg). After a median follow up of 3.26 years, all-cause mortality was 27% (95% CI 40%, 10%) lower with intensive SBP lowering. We estimated the potential number of prevented deaths with intensive SBP lowering in the U.S. population meeting SPRINT criteria. Methods: SPRINT eligibility criteria were applied to the National Health and Nutrition Examination Survey 1999-2006, a representative survey of the U.S. population, linked with the mortality data through December 2011. Eligibility included (1) age ≥50 years with (2) SBP 130-180 mmHg depending on number of antihypertensive classes being taken, and (3) presence of ≥1 CVD risk conditions (history of coronary heart disease, estimated glomerular filtration rate (eGFR) 20 to 59 ml/min/1.73 m 2 , 10-year Framingham risk score ≥15%, or age ≥75 years). Adults with diabetes, stroke history, >1 g/day proteinuria, heart failure, on dialysis, or eGFR<20 ml/min/1.73m 2 were excluded. Annual mortality rates for adults meeting SPRINT criteria were calculated using Kaplan-Meier methods and the expected reduction in mortality rates with intensive SBP lowering in SPRINT was used to determine the number of potential deaths prevented. Analyses accounted for the complex survey design. Results: An estimated 18.1 million U.S. adults met SPRINT criteria with 7.4 million taking blood pressure lowering medications. The mean age was 68.6 years and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.2% (95% CI 1.9%, 2.5%) and intensive SBP lowering was projected to prevent 107,453 deaths per year (95% CI 45,374 to 139,490). Among adults with SBP ≥145 mmHg, the annual mortality rate was 2.5% (95% CI 2.1%, 3.0%) and intensive SBP lowering was projected to prevent 60,908 deaths per year (95% CI 26, 455 to 76, 792). Conclusions: We project intensive SBP lowering could prevent over 100,000 deaths per year of intensive treatment.

Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nancy S Jenny ◽  
Nels C Olson ◽  
Alicia M Ellis ◽  
Margaret F Doyle ◽  
Sally A Huber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Nk Cells ◽  
Nk Cell ◽  
Agatston Score ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

Abstract 14819: Excess Epicardial Fat Volume is Associated With Increased Cardiovascular Structural and Functional Abnormalities in Menopausal Women Regardless of Body Weight: The Higher the Epicardial Fat Volume, the Higher the Abnormalities

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mahfouz EL SHAHAWY ◽  
Susan Tucker ◽  
Lillee Izadi ◽  
Antonella Sabatini
Keyword(s):  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Significant Risk ◽  
Epicardial Fat ◽  
Ct Scanner ◽  
Cvd Risk ◽  
Artery Stiffness ◽  
Epicardial Fat Volume ◽  
Asymptomatic Subjects ◽  
Fat Volume

Background: It has been reported that an increase in epicardial fat volume (EFV) has been associated with an increase in cardiovascular structural and functional abnormalities (CVSFA). Purpose: The purpose of this study is to assess whether a step-wise increase in EFV is associated with a proportional increase in CVSFA. Methods: We screened 2,756 asymptomatic subjects, ages 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), which consists of 10 tests; 7 are vascular and 3 are cardiac. The vascular tests are: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post-mild protocol exercise (PME), CIMT, abdominal aorta ultrasound, retinal photography, and microalbuminuria. The 3 cardiac tests are: Pro-BNP, ECG, and LV ultrasound. Additional tests are waist circumference, BMI, fasting blood sugar, lipid profile, and CRP. 596 out of the total subjects were asymptomatic, and out of these 220 (37%) underwent cardiac CT for coronary artery calcium scoring (CACS) and EFV determination using Siemens Somatom Definition Dual source CT scanner 64x2. 107 out of the 220 were females (48%). These females were divided into 5 groups based on their EFV: 24 with < 69cm 3 ; 33 between 70cm 3 and 94cm 3 ; 16 between 95cm 3 and 119cm 3 ; 20 between 120cm 3 and 144cm 3 ; and 14 >145cm 3 . Results: As noted in the table, a step-wise increase in EFV was associated with proportional increases in CVSFA, specifically CACS, resting BP, abnormal rise in BP-PME, CRP, and triglycerides. An increase in EFV was noticeably associated with an increase in resting blood BP by a 10mmHg difference between the group whose EFV < 120cm 3 and those whose EFV is > 120cm 3 . Conclusions: Based on our data, we feel that excess EFV appears to be the villain for most CVSFA. Accordingly, we urge all healthcare professionals that it is time to focus on early and accurate assessment of this significant risk marker, which is the culprit for many CVD risk factors. Early detect to protect.

Abstract 85: Pre-Hypertension is a Disease Associated with Significant Structural and Functional Cardiovascular Abnormalities. It is Time to Lower the Bar.

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Mahfouz El Shahawy ◽  
Miglena Entcheva ◽  
Arjun Padalia
Keyword(s):  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
P Value ◽  
Cvd Risk ◽  
Structural Abnormalities ◽  
Prevalent Disease ◽  
Artery Stiffness ◽  
Group A ◽  
Group B ◽  
Asymptomatic Subjects

Purpose: To examine whether pre-HTN is a risk factor for CV structural and functional abnormalities. METHODS: We screened 2233 asymptomatic subjects, age 23-80, for CVD risk using Early CVD Risk Score (ECVDRS). ECVDRS consists of 10 tests: large (C1) and small (C2) artery stiffness, BP at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro-BNP. Pre-HTN and normotension (NT) was defined according to the JNC VII criteria. Results: Among the subjects screened, 38% (855 of 2233) were NT; 70% (596 of 855) were not taking CV medication. 42% (942 of 2233) of subjects were pre-HTN; 55% (521 of 942) were not taking CV medication. The untreated, NT group was split into Group A 82% (491 of 596) with norm. BP rise PME and Group B 18% (105 of 596) with abn. BP rise PME. The untreated, pre-HTN group was split into Group C 61% (318 of 521) with norm. BP rise PME and Group D 39% (203 of 521) with abn. BP rise PME. The presence of structural abnormalities in the groups is shown on Table 1. Conclusions: Based on our data, pre-HTN is a prevalent disease (42%), exceeding NT (38%) in the subjects screened. Pre-HTN is associated with greater functional and structural abnormalities than the NT group. The structural abnormalities, particularly CIMT (statistically significant p value of <0.0016), may be accounted for by the greater abn. BP rise PME in the pre-HTN group (39%). Based on our data, pre-HTN justifies ECVDRS screening for appropriate risk stratification and treatment. These findings may warrant lowering the bar for the definitions of HTN and pre-HTN in future guidelines.

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