Validation of a model to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD: the rotterdam ischemic heart disease and stroke computer simulation (RISC) model

Background: Cardiac rehabilitation (CR) is a comprehensive lifestyle change program proven to reduce cardiovascular disease (CVD) risk and improve quality of life in patients with ischemic heart disease but remains highly underutilized (<20% of eligible patients) due to the inconvenience and cost of attending a facility-based program. We evaluated the efficacy of a home-based, virtual CR program using mobile health (mHealth) in veterans with coronary artery disease (CAD) on improving functional capacity, CVD risk factors, and depressive symptoms. Methods: We enrolled 196 Veterans with a qualifying CR diagnosis between May 2016 and April 2020. All participants underwent baseline functional evaluation with a 6-minute walk test (6MWT), followed by a 12-week home-based, virtual CR program delivered via the Movn smartphone app (Movn by Moving Analytics). The Movn app featured daily alerts to exercise, a digital diary to record activity and vital signs, and connectivity with a health coach who remotely monitored participants through an integrated dashboard and scheduled weekly phone visits. We compared the risk factor profile pre-intervention versus post-intervention with paired t-tests. Results: Among enrolled Veterans, the mean (SD) age was 61 (9) years, 95% were male, and 50% were black. A majority (63%) completed the full 12-week virtual CR program including an exit visit. Participants completed an average of 10.4 ± 1.9 (range 3–13) phone visits with the coach. There were concurrent improvements in 6MWT distance (443.9 vs. 481.9 meters; mean difference [MD], 38 meters; 95% CI, 26.6 – 50.8, P<0.001), low-density lipoprotein cholesterol (80 vs. 69 mg/dL, MD, -10.9; 95% CI, -17.9 to -3.9, P=0.003), body mass index (31.1 vs 30.8; MD, -0.33; 95% CI, -0.60 to -0.06; P=0.001), and PHQ-9 depression scores (7.4 vs. 6; MD, -1.4, 95% CI, -2.4 to -0.44; P=0.005) among program completers. Conclusions: Among veterans with ischemic heart disease, a virtual CR program results in moderate improvements in functional capacity, CVD risk factors, and mood. The durability of these effects and whether virtual CR improves longer-term outcomes such as readmissions, survival, and cost remain to be determined.

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Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey

Journal of the American Heart Association ◽

10.1161/jaha.120.018764 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Victor Okunrintemi ◽

Martin Tibuakuu ◽

Salim S. Virani ◽

Laurence S. Sperling ◽

Annabelle Santos Volgman ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Age At Diagnosis ◽

Panel Survey ◽

Cvd Risk Factors ◽

Cvd Risk

Background Sex differences in the trends for control of cardiovascular disease (CVD) risk factors have been described, but temporal trends in the age at which CVD and its risk factors are diagnosed and sex‐specific differences in these trends are unknown. Methods and Results We used the Medical Expenditure Panel Survey 2008 to 2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease, or stroke, and who reported the age when these conditions were diagnosed, were included. We included 100 709 participants (50.2% women), representing 91.9 million US adults with above conditions. For coronary heart disease and hypercholesterolemia, mean age at diagnosis was 1.06 and 0.92 years older for women, compared with men, respectively (both P <0.001). For stroke, mean age at diagnosis for women was 1.20 years younger than men ( P <0.001). The mean age at diagnosis of CVD risk factors became younger over time, with steeper declines among women (annual decrease, hypercholesterolemia [women, 0.31 years; men 0.24 years] and hypertension [women, 0.23 years; men, 0.20 years]; P <0.001). Coronary heart disease was not statistically significant. For stroke, while age at diagnosis decreased by 0.19 years annually for women ( P =0.03), it increased by 0.22 years for men ( P =0.02). Conclusions The trend in decreasing age at diagnosis for CVD and its risk factors in the United States appears to be more pronounced among women. While earlier identification of CVD risk factors may provide opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD earlier in life, and sex‐specific interventions may be needed.

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Influence of Conventional Cardiovascular Risk Factors and Lifestyle Characteristics on Cardiovascular Disease After Hematopoietic Cell Transplantation

Journal of Clinical Oncology ◽

10.1200/jco.2013.52.6582 ◽

2014 ◽

Vol 32 (3) ◽

pp. 191-198 ◽

Cited By ~ 53

Author(s):

Eric J. Chow ◽

K. Scott Baker ◽

Stephanie J. Lee ◽

Mary E.D. Flowers ◽

Kara L. Cushing-Haugen ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Cardiovascular Risk Factors ◽

Cell Transplantation ◽

Hematopoietic Cell Transplantation ◽

Ischemic Heart

Purpose To determine the influence of modifiable lifestyle factors on the risk of cardiovascular disease after hematopoietic cell transplantation (HCT). Patients and Methods HCT survivors of ≥ 1 year treated from 1970 to 2010 (n = 3,833) were surveyed from 2010 to 2011 on current cardiovascular health and related lifestyle factors (smoking, diet, recreational physical activity). Responses (n = 2,362) were compared with those from a matched general population sample (National Health and Nutrition Examination Survey [NHANES]; n = 1,192). Results Compared with NHANES participants, HCT survivors (median age, 55.9 years; median 10.8 years since HCT; 71.3% allogeneic) had higher rates of cardiomyopathy (4.0% v 2.6%), stroke (4.8% v 3.3%), dyslipidemia (33.9% v 22.3%), and diabetes (14.3% v 11.7%; P < .05 for all comparisons). Prevalence of hypertension was similar (27.9% v 30.0%), and survivors were less likely to have ischemic heart disease (6.1% v 8.9%; P < .01). Among HCT survivors, hypertension, dyslipidemia, and diabetes were independent risk factors for ischemic heart disease and cardiomyopathy, and smoking was associated with ischemic heart disease and diabetes (odds ratios [ORs], 1.8 to 2.1; P = .02). Obesity was a risk factor for post-transplantation hypertension, dyslipidemia, and diabetes (ORs ≥ 2.0; P < .001). In contrast, lower fruit/vegetable intake was associated with greater risk of dyslipidemia and diabetes (ORs, 1.4 to 1.8; P ≤ .01), and lower physical activity level was associated with greater risk of hypertension and diabetes (ORs, 1.4 to 1.5; P < .05). Healthier lifestyle characteristics among HCT survivors attenuated risk of all cardiovascular conditions assessed. Conclusion Attention of clinicians to conventional cardiovascular risk factors and modifiable lifestyle characteristics offers hope of reducing serious cardiovascular morbidity after HCT.

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Plasma lipoprotein (a), homocysteine, and other cardiovascular disease (CVD) risk factors in Nigerians with CVD

Applied Physiology Nutrition and Metabolism ◽

10.1139/h07-186 ◽

2008 ◽

Vol 33 (2) ◽

pp. 282-289 ◽

Cited By ~ 6

Author(s):

M.O. Ebesunun ◽

E.O. Agbedana ◽

G.O.L. Taylor ◽

O.O. Oladapo

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Body Fat ◽

Plasma Lipoprotein ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Anthropometric Indices ◽

Percentage Body Fat ◽

The Mean

Elevated plasma lipoprotein (a) (Lp(a)) and total homocysteine (tHcy) concentrations, as well as fat distributions, are associated with cardiovascular disease (CVD) risk. The purpose of this study was to evaluate plasma Lp(a), tHcy, percentage body fat, anthropometric indices, and blood pressure (BP) and their relationships with each other in well-defined, hospital-based, CVD patients in a Nigerian African community. One hundred seventy patients suffering from hypertensive heart disease, hypertension, ischaemic heart disease, and myocardial infraction with the mean age of 45.3 ± 1.3 years and 58 apparently healthy volunteers with the mean age of 44.8 ±1.2 years were selected. Anthropometric indices and BP were measured. Percentage body fat, body mass index, and waist-to-hip ratio (WHR) were calculated. Plasma Lp(a) and tHcy concentrations were determined. The results showed significant increases in BP, skinfold thickness (SFT) variables, and WHR in all of the CVD patients. Plasma Lp(a) was also significantly increased (p < 0.001), whereas the slight increase in the mean tHcy was not statistically significant. Positive significant correlations were found between systolic BP, triceps, SFT, and percentage body fat (p < 0.01), whereas significant correlations were found between some body composition variables, tHcy, and systolic BP (p < 0.05). Our findings provide supportive evidence for altered plasma Lp(a) concentration in addition to some other traditional CVD risk factors in Nigerians. The role of homocysteine is not well defined.

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Anti-gout Medications and Risk of Cardiovascular Disease: A Nested Case-Control Study

Frontiers in Medicine ◽

10.3389/fmed.2021.739680 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tsung-Ju Chuang ◽

Yu-Hsun Wang ◽

James Cheng-Chung Wei ◽

Chih-Jung Yeh

Keyword(s):

Cardiovascular Disease ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Health Care Providers ◽

Conditional Logistic Regression ◽

Ischemic Heart ◽

Adherence Rate ◽

Research Database ◽

Care Providers ◽

Cvd Risk

Introduction: Gout is the leading cause of inflammatory arthritis and is also correlated with multiple comorbidities, including cardiovascular disease (CVD), whose future risk can be lowered by urate-lowering therapy (ULT) in gout patients. It is, however, still not clear whether its effect is associated with the days of usage and the adherence rate of ULT.Methods: Data were collected from Taiwan's National Health Insurance Research Database. The study period was from 1999/1/1 to 2013/12/31. In addition, patients with newly diagnosed gout from 2000 to 2012 and usage of antigout preparations (allopurinol or benzbromarone) within half a year among age ≥20 years old were enrolled in the study. The outcome of interest is CVD. New diagnosis of CVD after half a year of diagnosis of gout was included in the CVD group. Moreover, conditional logistic regression was used to evaluate the odds ratio of CVD in relation to the days of usage and to the adherence rate of ULT after the adjustment for potentially confounding variables.Results: A total of 3,706 gout patients with and without CVD have been included in the final analysis after a 1:1 propensity score that matched for age, sex, comorbidities, aspirin, and statin. The days of usage of allopurinol was <180 days and benzbromarone, in its turn, presupposed a higher risk of CVD. The adherence rate of allopurinol and benzbromarone at ≥ 0.7 both have a lower CVD risk: allopurinol (adjusted OR: 0.66 95% CI: 0.46–0.96), benzbromarone (adjusted OR: 0.68 95% CI: 0.50–0.91). The subgroup analysis revealed an adherence rate of ≥0.7 of ULT with a lower CVD was only found to be present in males and at age <65. Furthermore, the correlations were more pronounced in the ischemic heart disease subgroup than in the cerebrovascular disease group.Conclusion: This study reveals that gout patients taking ULT (allopurinol and benzbromarone) with an adherence rate of ≥0.7 are at a lower risk of developing CVD, especially with a younger age (<65) and if they are male. On top of this, the benefit is more pronounced in ischemic heart disease. Despite further prospective trials needing to be warranted to confirm our findings, health care providers may, bearing these conclusions in mind, emphasize the importance of adherence to ULT in gout patients.

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Impact of Pre-existing Cardiovascular Disease and Risk Factors for Cardiovascular Disease in Pregnancy on Maternal Mortality

10.21203/rs.3.rs-1012728/v1 ◽

2021 ◽

Author(s):

Sher Bahadar ◽

Malik Faisal Iftikhar ◽

Fahad raja khan ◽

fouzia fahim ◽

Gul Lakhta ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Maternal Mortality ◽

Valvular Heart Disease ◽

Ischemic Heart ◽

Premature Coronary Artery Disease ◽

Care Hospital ◽

In Pregnancy

Abstract BackgroundCardiovascular disease (CVD) and risk factors for CVD are important indirect causes of maternal mortality in lower-middle-income countries (LMIC). The purpose of this research was to assess the prevalence of pre-existing CVD and risk factors for CVD in pregnant women and their relationship to maternal mortality in LMIC.ResultsThis was a cross-sectional study conducted on 3190 pregnant patients with pre-existing CVD and risk factors for CVD from 1st January 2018 through 31st December 2020 at a tertiary care hospital of Pakistan-a LMIC. A two-tailed Mann-Whitney two-sample rank-sum test, fisher’s exact test, and binary logistic regression were used for statistical analysis.Of 3190 patients, 517 (16.21%) individuals had risk factors for CVD, whereas 533 had pre-existing CVD (16.71 %). Diabetes mellitus type II was the most common risk factor for CVD, accounting for 238 (7.46 %) of all patients, followed by dyslipidemia in 162 (5.08 %), obesity in 153 (4.8 %), chronic hypertension in 151 (4.73 %), and family history (FH) of premature coronary artery disease (CAD) in 56 (1.76 %). Among patients with pre-existing CVD, 197 (6.18%) had ischemic heart disease (IHD), 182 (5.71%) had valvular heart disease (VHD), and 146 (4.58%) had cardiomyopathy. In this study majority of maternal deaths occurred in patients with diabetes (128(54%), p<.001) and ischemic heart disease (87(37%), p<.001). A one-unit rise in BMI increased maternal mortality by 13%. In contrast, the absence of Pre-existing CVD and risk factors for CVD conferred a protective effect from the adverse outcome i.e. maternal death. Maternal mortality was reduced by 66% in normoglycemic pregnant patients, 47% in patients without chronic HTN, 90% in patients without valvular heart disease, 97% without ischemic heart disease, and 99% without cardiomyopathy.ConclusionCVD and risk factors for CVD are major determinants of maternal mortality in pregnancy. Identifying such patients is imperative so that prompt measures can be taken beforehand to prevent adverse outcomes.

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Psoriasis as an Independent Risk Factor for Cardiovascular Disease

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475415602842 ◽

2015 ◽

Vol 20 (4) ◽

pp. 327-333 ◽

Cited By ~ 17

Author(s):

Yi Chun Lai ◽

Yik Weng Yew

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Risk Factor ◽

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Cardiovascular Risk Factors ◽

Independent Risk Factor ◽

Ischemic Heart

Background: Psoriasis is known to be associated with metabolic syndrome, a well-established risk factor for ischemic heart disease and stroke. Emerging evidence indicates that psoriasis is an independent risk factor for cardiovascular disease and stroke. Objective: To evaluate whether psoriasis is independently associated with myocardial infarction (MI), ischemic heart disease (MI, angina pectoris, or coronary heart disease), and stroke, we conducted a cross-sectional study using the US National Health and Nutrition Examination Survey (NHANES) database. Methods: Data on clinical history of psoriasis, MI, angina pectoris, coronary heart disease, and stroke from the questionnaire as well as laboratory parameters on serum lipid and uric acid levels in the cycle years 2003-2006 and 2009-2012 were analyzed. Multivariate analysis with logistic regression modelling was performed with the aforementioned cardiovascular events or stroke as the dependent variables and with risk factors such as age, gender, ethnic group, current smoking status, alcohol consumption, metabolic syndrome, hyperuricemia, and psoriasis as independent variables. Results: There were 520 cases of psoriasis, and 108 of them had metabolic syndrome (20.8%). Well-established cardiovascular risk factors such as age, gender, ethnic group, smoking, alcohol consumption, metabolic syndrome, and hyperuricemia were also found to have significant associations with MI and ischemic heart disease (all P values <.001). Psoriatic patients were at significantly higher risks of developing MI (odds ratio [OR] 2.24; 95% CI: 1.27-3.95; P = .005) and ischemic heart disease (OR 1.90; 95% CI: 1.18-3.05; P = .008), but not stroke (OR 1.01; 95% CI: 0.48-2.16; P = .744), after adjustment was made for major cardiovascular risk factors. Conclusion: This study provides epidemiological evidence that psoriasis may be independently associated with the development of MI and ischemic heart disease. Physicians should be cognizant of any underlying cardiovascular risk factors, especially among psoriatic patients with metabolic syndrome, and manage them according to national guidelines.

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Associations of Arachidonic Acid Synthesis with Cardiovascular Risk Factors and Relation to Ischemic Heart Disease and Stroke: A Univariable and Multivariable Mendelian Randomization Study

Nutrients ◽

10.3390/nu13051489 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1489

Author(s):

Ting Zhang ◽

Shiu-Lun Au Yeung ◽

C. Mary Schooling

Keyword(s):

Risk Factors ◽

Arachidonic Acid ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Mendelian Randomization ◽

Density Lipoprotein ◽

Plasma Phospholipid ◽

Ischemic Heart ◽

Cvd Risk ◽

Markers Of Inflammation

Arachidonic acid (AA), a major long-chain omega-6 polyunsaturated fatty acid, is associated with ischemic heart disease (IHD) and stroke. We assessed bi-directional associations of AA synthesis reflected by plasma phospholipid AA with CVD risk factors, and identified mediators of associations of AA with IHD and stroke using Mendelian randomization (MR). We used two-sample MR to assess bi-directional associations of AA synthesis with lipids, blood pressure, adiposity, and markers of inflammation and coagulation. We used multivariable MR to assess mediators of associations of AA with IHD and stroke. Genetically predicted AA (% of total fatty acids increase) was positively associated with apolipoprotein B (ApoB, 0.022 standard deviations (SD), 95% confidence interval (CI) 0.010, 0.034), high-density (0.030 SD, 95% CI 0.012, 0.049) and low-density lipoprotein cholesterol (LDL-C, 0.016 SD, 95% CI 0.004, 0.027) and lower triglycerides (−0.031 SD, 95% CI −0.049, −0.012) but not with other traits. Genetically predicted these traits gave no association with AA. The association of AA with IHD was attenuated adjusting for ApoB or LDL-C. Genetically predicted AA was associated with lipids but not other traits. Given ApoB is thought to be the key lipid in IHD, the association of AA with IHD is likely mediated by ApoB.

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The role of cortisol in ischemic heart disease, ischemic stroke, type 2 diabetes, and cardiovascular disease risk factors: a bi-directional Mendelian randomization study

BMC Medicine ◽

10.1186/s12916-020-01831-3 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Man Ki Kwok ◽

Ichiro Kawachi ◽

David Rehkopf ◽

Catherine Mary Schooling

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Mendelian Randomization ◽

Cvd Risk Factors ◽

Cvd Risk

Abstract Background Cortisol, a steroid hormone frequently used as a biomarker of stress, is associated with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). To clarify whether cortisol causes these outcomes, we assessed the role of cortisol in ischemic heart disease (IHD), ischemic stroke, T2DM, and CVD risk factors using a bi-directional Mendelian randomization (MR) study. Methods Single nucleotide polymorphisms (SNPs) strongly (P < 5 × 10−6) and independently (r2 < 0.001) predicting cortisol were obtained from the CORtisol NETwork (CORNET) consortium (n = 12,597) and two metabolomics genome-wide association studies (GWAS) (n = 7824 and n = 2049). They were applied to GWAS of the primary outcomes (IHD, ischemic stroke and T2DM) and secondary outcomes (adiposity, glycemic traits, blood pressure and lipids) to obtain estimates using inverse variance weighting, with weighted median, MR-Egger, and MR-PRESSO as sensitivity analyses. Conversely, SNPs predicting IHD, ischemic stroke, and T2DM were applied to the cortisol GWAS. Results Genetically predicted cortisol (based on 6 SNPs from CORNET; F-statistic = 28.3) was not associated with IHD (odds ratio (OR) 0.98 per 1 unit increase in log-transformed cortisol, 95% confidence interval (CI) 0.93–1.03), ischemic stroke (0.99, 95% CI 0.91–1.08), T2DM (1.00, 95% CI 0.96–1.04), or CVD risk factors. Genetically predicted IHD, ischemic stroke, and T2DM were not associated with cortisol. Conclusions Contrary to observational studies, genetically predicted cortisol was unrelated to IHD, ischemic stroke, T2DM, or CVD risk factors, or vice versa. Our MR results find no evidence that cortisol plays a role in cardiovascular risk, casting doubts on the cortisol-related pathway, although replication is warranted.

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