scholarly journals Physical fitness and cardiovascular risk factors in the novel diabetes subgroups

2021 ◽  
Author(s):  
Nina Saatmann ◽  
Oana Patricia Zaharia ◽  
Klaus Strassburger ◽  
Dominik Hans Pesta ◽  
Volker Burkart ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Physical Fitness ◽  
Endothelial Function ◽  
Autoimmune Diabetes ◽  
Risk Scores ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Diabetes Diagnosis ◽  
Prospective Longitudinal

Abstract Context Physical inactivity promotes insulin resistance and increases the risk of diabetes and cardiovascular disease. Recently introduced clustering based on simple clinical measures identified diabetes subgroups (clusters) with different risks of diabetes-related comorbidities and complications. Objective This study aims to determine differences in physical fitness and cardiovascular risk between diabetes subgroups and a glucose-tolerant control group (CON). We hypothesized that the severe insulin-resistant diabetes (SIRD) subgroup associates with lower physical fitness and increased cardiovascular risk. Methods Physical fitness and cardiovascular risk of 746 participants with recent-onset diabetes (diabetes duration of <12 months, aged 18-69 years) and 74 CON of the German Diabetes Study (GDS), a prospective longitudinal cohort study, were analyzed. Main outcome measures included physical fitness (VO2max from spiroerogometry), endothelial function (flow- and nitroglycerin-mediated dilation) and cardiovascular risk scores (Framingham Risk Scores for Coronary Heart Disease (FRS-CHD) and Atherosclerotic CardioVascular Disease (ASCVD) risk score). Results VO2max was lower in SIRD than in CON, severe autoimmune diabetes (SAID) (both p<0.001) and mild age-related diabetes (MARD) (p<0.01) subgroups, but not different compared to severe insulin-deficient diabetes (SIDD) (p=0.98) and moderate obesity-related diabetes (MOD) subgroups (p=0.07) after adjustment for age, sex and BMI. Endothelial function was similar among all groups, whereas SAID had lower FRS-CHD and ASCVD than SIRD, MOD and MARD (all p<0.001). Conclusions Despite comparable endothelial function across all groups, SIRD showed the lowest physical fitness. Of note, SAID had the lowest cardiovascular risk within the first year after diabetes diagnosis compared to the other diabetes subgroups.

scholarly journals Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

2020 ◽  
Author(s):  
Felicia C Chow ◽  
Asya Lyass ◽  
Taylor F Mahoney ◽  
Joseph M Massaro ◽  
Virginia A Triant ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Human Immunodeficiency Virus ◽  
Cardiovascular Risk ◽  
Cognitive Function ◽  
Risk Score ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Composite Effect ◽  
Immunodeficiency Virus ◽  
Ascvd Risk

Abstract Background Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with human immunodeficiency virus (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. Methods We constructed linear regression models evaluating the association between baseline 10-year cardiovascular risk scores and cognitive function (measured by a summary z-score, the NPZ-4) at a year 4 follow-up visit. Results Among 988 participants (mean age, 52 years; 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (standard deviation [SD], 7.1%) and FRS was 13.1% (SD, 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, year 4 NPZ-4 was lower by 0.84 [SD, 0.28] overall, P = .003; lower by 2.17 [SD, 0.67] in women, P = .001; lower by 0.78 [SD, 0.32] in men, P = .016). A similar relationship was observed between FRS and year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. Conclusions Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. Cardiovascular risk scores may help to identify PLWH, especially women, who are at risk for worse cognition over time.

scholarly journals COMPARISON OF A FRAILTY INDEX WITH CARDIOVASCULAR RISK SCORES IN PREDICTING CARDIOVASCULAR DISEASE MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S800-S800
Author(s):  
Dustin S Kehler ◽  
Olga Theou ◽  
Kenneth Rockwood
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Risk Score ◽  
Mortality Risk ◽  
Disease Risk ◽  
Frailty Index ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Cvd Mortality

Abstract We compared the predictive and discriminative ability of frailty with traditional cardiovascular risk scores to estimate 10-year cardiovascular disease (CVD) mortality risk. Individuals aged 20-79 years old from the National Health and Nutrition Examination Survey who were free from CVD were included (n= 32,066). A 33-item frailty index (FI) which excluded CVD and diabetes-related variables was calculated. We calculated the Framingham Disease Risk (FDR) Hard Coronary Heart Disease and General CVD risk scores, the American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk equation, and the European Systematic Coronary Risk Estimation tool. A total of 322 individuals died (1.0%) from CVD. There was a low correlation between the FI and CVD risk scores (spearman’s r= 0.19-0.33; p<0.0001) and a weak to strong correlation between CVD risk scores (spearman’s r=0.19-0.88; p<0.0001). The competing-risks hazard ratio for CVD mortality for every 1% increase in the FI was 1.040 (95% CI: 1.032-1.048; p<0.0001) in an age and sex-adjusted model. The FI was independently predictive of CVD mortality when the other CVD risk scores were added to the model. The area under the receiving operating characteristic (ROC) curve was 0.800 (95% CI: 0.789-0.808; p<0.0001) for the FI. ROC values for the CVD risk scores ranged from 0.710 (95% CI: 0.700-0.721; p<0.0001) for the AHA/ACC risk score to 0.779 (95% CI: 0.770-0.789; p<0.0001) for the FDR General CVD risk score. An FI calculated with non-CVD and diabetes variables can predict 10-year CVD mortality risk independently of traditional CVD risk scores.

The Impact of Atherosclerotic Cardiovascular Risk on Graft Failure in Deceased-Donor Renal Transplantation

2021 ◽  
pp. 152692482110246
Author(s):  
Grace Hsu ◽  
Tracy M. Sparkes ◽  
Brent N. Reed ◽  
Stormi E. Gale ◽  
Brian E. Crossley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Renal Transplant ◽  
Cardiovascular Events ◽  
Graft Failure ◽  
Deceased Donor ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease

Introduction: Pretransplant cardiovascular risk may be amplified after renal transplant, but little is known about its impact on graft outcomes. Research question: The purpose of this study was to determine if pretransplant cardiovascular risk was associated with graft outcomes. Design: This retrospective study included deceased-donor renal transplant recipients from 2010-2015. Atherosclerotic cardiovascular disease risk for patients without prior disease was calculated and patients were categorized into high (score >20%), intermediate (7.5-20%), and low risk (<7.5%). Patients with and without prior cardiovascular disease were also compared. The main endpoint was graft failure at 3-years post-transplant. Other outcomes included major adverse cardiovascular events, biopsy-proven rejection, and mortality. Results: In patients without prior atherosclerotic cardiovascular disease (N = 115), graft failure rates (4.5% vs 11.3% vs 12.5%; ( P = 0.64) and major adverse cardiovascular events (9.1% vs 13.2% vs 5.0%; P = 0.52) were similar in the high, intermediate, and low risk groups. In those with prior disease (N = 220), rates of primary nonfunction (6.8% vs 1.7%; P = 0.04), major adverse cardiovascular events (7.3% vs 2.6%; P = 0.01), and heart failure (10.9% vs 3.5%; P = 0.02) were higher than those without cardiovascular; rates of major adverse cardiovascular events and heart failure were insignificant after adjusting for age, gender, and race. Other outcomes were not different. Outcomes did not differ based on pretransplant cardiovascular risk. Discussion: Pretransplant atherosclerotic cardiovascular disease was associated with increased early graft failure but similar outcomes at 3-years, suggesting cardiac risk alone should not exclude transplantation.

Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction

2021 ◽  
pp. 089719002199979
Author(s):  
Roshni P. Emmons ◽  
Nicholas V. Hastain ◽  
Todd A. Miano ◽  
Jason J. Schafer
Keyword(s):  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Blood Cholesterol ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Living With Hiv ◽  
To Receive

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

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