Sex Differences in the Association Between Midlife Cardiovascular Conditions or Risk Factors With Midlife Cognitive Decline

Neurology ◽  
2022 ◽  
pp. 10.1212/WNL.0000000000013174
Author(s):  
Nan Huo ◽  
Prashanthi Vemuri ◽  
Jonathan Graff-Radford ◽  
Jeremy Syrjanen ◽  
Mary Machulda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cognitive Decline ◽  
Neuropsychological Testing ◽  
Z Score ◽  
Domain Specific ◽  
Z Scores ◽  
Multivariable Models

Background and Objectives:The prevalence of mid-life cardiovascular conditions and risk factors are higher in men than women. Associations between mid-life cardiovascular conditions or risk factors and mid-life cognitive decline has been reported, but few studies have assessed sex differences in these associations.Methods:We included 1,857 participants enrolled in the population-based Mayo Clinic Study of Aging who were aged 50-69 years at baseline. Participants were evaluated every 15 months by a coordinator, neurologic evaluation, and neuropsychological testing. The neuropsychological testing used nine tests to calculate global cognitive and domain-specific (memory, language, executive function, and visuospatial skills) z-scores. Nurse abstractors reviewed participant medical records to determine the presence of cardiovascular conditions (coronary heart disease, arrhythmias, congestive heart failure) and risk factors (hypertension, diabetes, dyslipidemia, obesity, ever smoking). Linear mixed-effect models evaluated the association between baseline cardiovascular conditions or risk factors and global and domain-specific cognitive decline. Multivariable models adjusted for demographics, APOE genotype, depression, and other medical conditions. Interactions between sex and each cardiovascular condition or risk factor were examined, and results were stratified by sex.Results:Overall, 1,465 (70.3%) participants had at least one cardiovascular condition or risk factor; the proportion of men was higher than women (767 (83.4%) vs 698 (74.5%), p<0.0001). Cross-sectionally, coronary heart disease and ever smoking were associated with a lower visuospatial z-score in multivariable models. Longitudinally, several cardiovascular conditions and risk factors were associated with declines in global and/or domain-specific z scores, but not visuospatial z-scores. Most cardiovascular conditions were more strongly associated with cognition among women: coronary heart disease, and other cardiovascular conditions were associated with global cognition decline only in women (all p<0.05). Additionally, diabetes, dyslipidemia, and coronary heart disease were associated with language z-score decline only in women (all p<0.05). However, congestive heart failure was associated with language z-score decline only in men (all p<0.05).Conclusions:Mid-life cardiovascular conditions and risk factors are associated with mid-life cognitive decline. Moreover, specific cardiovascular conditions and risk factors have stronger associations with cognition decline in mid-life for women than men despite the higher prevalence of those conditions in men.

P-242 Risk Factors for Heart Failure and Coronary Heart Disease Mortality During 24-Years Follow-Up in Japan: NIPPON DATA 80

2009 ◽  
Vol 4 ◽  
pp. S120-S121
Author(s):  
Yasuyuki Nakamura ◽  
Tanvir C. Turin ◽  
Nahid Rumana ◽  
Katsuyuki Miura ◽  
Yoshikuni Kita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Heart Disease Mortality ◽  
Disease Mortality

P1645Vascular endothelial growth factor-D and mortality in suspected or known coronary heart disease patients with a history of heart failure: a subanalysis of the ANOX study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Iguchi ◽  
M Suzuki ◽  
M Matsuda ◽  
Y Ajiro ◽  
T Shinozaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Growth Factor ◽  
Coronary Angiography ◽  
Cardiovascular Events ◽  
Cardiovascular Death ◽  
History Of ◽  
Endothelial Growth Factor

Abstract Background Vascular endothelial growth factor-D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors through binding to its specific receptors, VEGFR-3 (Flt-4) and VEGFR-2 (KDR/Flk-1). VEGF-D signaling via VEGFR-3 plays an important role in lipoprotein metabolisms which may contribute to coronary heart disease (CHD). Recent studies suggest that VEGF-D appears to be a biomarker of pulmonary congestion and heart failure in both dyspnea patients and the general population. However, the prognostic value of VEGF-D in suspected or known CHD patients with a history of heart failure is unknown. Methods Serum VEGF-D levels were measured in 253 suspected or known CHD patients with a history of heart failure undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Results During the follow-up, 54 patients died from any cause, 24 died from cardiovascular disease, and 35 developed MACE. After adjustment for established risk factors, VEGF-D levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.44; 95% confidence interval [CI], 1.18–1.75), cardiovascular death (HR, 1.73; 95% CI, 1.32–2.25), and MACE (HR, 1.49; 95% CI, 1.14–1.89). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-D levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.471; 95% CI, 0.176–0.766; P=0.002; integrated discrimination improvement [IDI], 0.036; 95% CI, 0.008–0.064; P=0.011) and cardiovascular death (NRI, 0.722; 95% CI, 0.326–1.118; P<0.001; IDI, 0.063; 95% CI, 0.005–0.122; P=0.033), but not that of MACE (NRI, 0.453; 95% CI, 0.100–0.805; P=0.012; IDI, 0.028; 95% CI, −0.007–0.063; P=0.116). Conclusions In suspected or known CHD patients with a history of heart failure undergoing elective coronary angiography, elevated VEGF-D levels may predict all-cause and cardiovascular mortality independent of established risk factors and cardiovascular biomarkers. Acknowledgement/Funding The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.

scholarly journals Prognostic Utility of Galectin-3 for Recurrent Cardiovascular Events During Long-term Follow-up in Patients with Stable Coronary Heart Disease: Results of the KAROLA Study

2016 ◽  
Vol 62 (10) ◽  
pp. 1372-1379 ◽  
Author(s):  
Henning Jansen ◽  
Wolfgang Koenig ◽  
Andrea Jaensch ◽  
Ute Mons ◽  
Lutz P Breitling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Stable Coronary Heart Disease ◽  
Galectin 3 ◽  
Long Term Follow Up

Abstract BACKGROUND Galectin-3 has emerged as a potential useful novel biomarker for heart failure and cardiovascular disease (CVD). However, it remains unclear whether galectin-3 is associated with recurrent cardiovascular events during long-term follow-up of patients with stable coronary heart disease (CHD) after adjustment for multiple established and novel risk factors. METHODS We measured galectin-3 at baseline in a cohort consisting of 1035 CHD patients and followed them for 13 years to assess a combined CVD end point. Moreover, we adjusted for multiple traditional and novel risk factors. RESULTS Galectin-3 concentration was positively associated with the number of affected coronary arteries, history of heart failure, and multiple traditional risk factors. Also, galectin-3 correlated significantly with emerging risk factors [e.g., cystatin C, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity (hs)-troponin]. During follow-up (median 12.0 years), 260 fatal and nonfatal CVD events occurred. The top quartile of galectin-3 concentration was significantly associated with CVD events compared to the bottom quartile after adjustment for age and sex [hazard ratio (HR) 1.88 (95% CI, 1.30–2.73), P = 0.001 for trend] as well as for established CVD risk factors (HR 1.67, 95% CI, 1.14–2.46, P = 0.011 for trend). However, after adjustment for other biomarkers available [including eGFR (estimated glomerular filtration rate), sST2 protein, GDF-15 (growth differentiation factor 15), NT-proBNP, and hs-troponin], the association was no longer statistically significant [HR 1.11 (95% CI 0.72–1.70), P = 0.82 for trend]. CONCLUSIONS Galectin-3 does not independently predict recurrent cardiovascular events in patients with established CHD after adjustment for markers of hemodynamic stress, myocardial injury, inflammation, and renal dysfunction.

Risk factors for heart failure and coronary heart disease mortality over 24-year follow-up period in Japan: NIPPON DATA80

2010 ◽  
Vol 5 (3) ◽  
pp. 97-103 ◽  
Author(s):  
Yasuyuki Nakamura ◽  
Tanvir C. Turin ◽  
Nahid Rumana ◽  
Katsuyuki Miura ◽  
Yoshikuni Kita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Heart Disease Mortality ◽  
Disease Mortality

Abstract 47: Subclinical Atherosclerosis and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Shelly-Ann M Love ◽  
Priya Palta ◽  
Corey A Kalbaugh ◽  
A.Richey Sharrett ◽  
Alden L Gross ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Decline ◽  
Subclinical Atherosclerosis ◽  
Word Recall ◽  
Digit Symbol Substitution Test ◽  
Z Score ◽  
Domain Specific ◽  
Z Scores ◽  
Global Cognition ◽  
Rate Of Decline

Introduction: Cardiovascular risk factors are reportedly predictive of cognitive decline and dementia but the association between the extent and severity of subclinical atherosclerosis with cognitive decline remains understudied. Hypothesis: The systemic burden of atherosclerosis measured non-invasively is associated with the rate of decline in domain-specific (memory, executive function and language) and global cognition from mid-life to late life. Methods: Members of the ARIC cohort (N=12313; 58% women, 24% African American (AA), 76% white) aged 46-70 years at their 1990-1992 examination were followed through 2011-2013. Participants with prevalent stroke, myocardial infarction or coronary heart disease were excluded. Atherosclerosis at baseline (n=5217) was assessed by carotid artery b-mode ultrasound (presence and number of plaques, bilaterally) and by ankle-brachial index <0.9 measured with an oscillometric device. Tests of memory (Delayed Word Recall Test), executive function (Digit Symbol Substitution Test), and language (Word Fluency Test) were administered in 1990-92, 1996-98 and 2011-13. Test-specific z scores were calculated at each exam based on the means and standard deviations at baseline. A global cognition z score was estimated by averaging the 3 test-specific z scores and standardizing to baseline. Race-stratified linear random effects regression was used to estimate the association between subclinical atherosclerosis and 20-year declines in domain-specific cognition and global cognition. We adjusted for age, sex and level of education. Inverse probability weighting (IPW) was used to limit bias due to attrition. Results: In AA, the presence of carotid plaque and/or ABI <0.90 (n=490) was associated with a lower memory z score (Beta=-0.10, 95% confidence interval, CI: -0.18, -0.02), a lower language z score (Beta=-0.07, 95% CI: -0.14,-0.002) and a lower global cognition z score at baseline (Beta=-0.09, 95% CI: -0.16, -0.02), but not with rates of change in any cognitive score. Among whites at baseline, individuals with subclinical atherosclerosis (n=4099) exhibited lower executive function (Beta=-0.05, 95% CI: -0.08, -0.02) and global cognition (Beta=-0.04, 95% CI: -0.07, -0.01). White participants with subclinical atherosclerosis had a greater 20-year rate of decline in global cognition (Beta=-0.06, 95% CI: -0.10, -0.00) compared to those without subclinical atherosclerosis. Conclusions: Baseline memory, language, and global cognition in AA and executive function and global cognition in whites were lower among those with non-invasively ascertained atherosclerosis compared to those without, independent of covariates in the model. Among whites, subclinical clinical measures of atherosclerosis in mid-life may be indicative of modest, but measurable declines in cognition after additional adjustment for potential bias due to attrition.

Heart Failure And Diabetes: Perspective Of A Dangerous Association

2021 ◽  
Vol 17 ◽  
Author(s):  
Liliana Ehtel Favaloro ◽  
Roxana Daniela Ratto ◽  
Carla Musso
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Mechanisms Of Action ◽  
Sglt2 Inhibitors ◽  
Diabetic Patients ◽  
Heart Failure Patients ◽  
The Relationship

: The relationship between diabetes and risk of heart failure has been described in previous trials, releasing the importance of the hyperglycemic state that added to other risk factors, favors the development of coronary heart disease. The mechanism by which in the absence of hypertension, obesity and/or dyslipidemia, diabetic patients develop cardiomyopathyhas been less studied. Recently, the Sodium Glucose Co-transporter type 2 inhibitors (SGLT2 inhibitors) used for the treatment of heart failure patients with or without diabetes has been a breakthrough in the field of medicine. This review describes the established pathophysiology of diabetic cardiomyopathy and SGLT2 inhibitors, their mechanisms of action, and benefits in this group of patients.

scholarly journals Clinical Characteristics of Coronary Heart Disease as Predictors of Ischemic Stroke: A Long-term Prospective Follow-up in the BIP Study.

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 362-362
Author(s):  
David Tanne ◽  
Avraham Shotan ◽  
Uri Goldbourt ◽  
Valentina Boyko ◽  
Henrietta Reicher-Reiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Unstable Angina ◽  
Vascular Risk ◽  
Increased Risk ◽  
Conventional Risk Factors

P126 Objective: To assess characteristics and severity of coronary heart disease (CHD) predisposing to ischemic stroke, beyond conventional vascular risk factors. Methods: We prospectively followed up 3,122 patients with documented CHD included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. Patients had CHD documented by a history of myocardial infarction ≥6 months and <5 years before enrollment and/or stable angina pectoris confirmed by ancillary diagnostic testing, and a selected lipid profile. Patients with severe heart failure or unstable angina upon enrollment were excluded. Results: During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The rate of ischemic stroke was 8.8% among patients with an active anginal syndrome[class ≥2 according to the Canadian Cardiovascular Society angina Classification, (CCSC)]vs. 5.1% in patients with a CCSC class of 1 (p<0.001). Patients with heart failure according to class ≥2 of the New York Heart Association classification had a 7.7% rate of ischemic stroke vs. 5.5% among patients with a class of 1 (no limitation of physical activity; p=0.03). In a Cox Proportional Hazard model adjusting for conventional risk factors, CCSC angina class ≥2 remained an independent predictor of ischemic stroke (Hazard ratio 1.43; 95%CI 1.05–1.96) and hospitalization for a confirmed diagnosis of unstable angina during follow-up conferred an additional independent increased risk (Hazard ratio 1.7; 95%CI 1.04–2.87). Hazard ratios of conventional risk factors, for comparison, where 1.49 for a 10 year age increment, 2.29 for diabetes mellitus, 1.75 for current smoking, 1.81 for peripheral vascular disease, and 1.14 for a 10 mmHg increase in systolic blood pressure. Conclusion: Active angina (CCSC class ≥2)and hospitalization for unstable angina during follow-up among CHD patients,confer an independent increased risk of ischemic stroke, beyond conventional vascular risk factors.

scholarly journals Association Between Coffee Intake and Incident Heart Failure Risk

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Laura M. Stevens ◽  
Erik Linstead ◽  
Jennifer L. Hall ◽  
David P. Kao
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Patient Adherence ◽  
Coffee Consumption ◽  
Cardiovascular Risks ◽  
Coffee Intake ◽  
Factors Associated ◽  
Heart Study

Background: Coronary heart disease, heart failure (HF), and stroke are complex diseases with multiple phenotypes. While many risk factors for these diseases are well known, investigation of as-yet unidentified risk factors may improve risk assessment and patient adherence to prevention guidelines. We investigated the diet domain in FHS (Framingham Heart Study), CHS (Cardiovascular Heart Study), and the ARIC study (Atherosclerosis Risk in Communities) to identify potential lifestyle and behavioral factors associated with coronary heart disease, HF, and stroke. Methods: We used machine learning feature selection based on random forest analysis to identify potential risk factors associated with coronary heart disease, stroke, and HF in FHS. We evaluated the significance of selected variables using univariable and multivariable Cox proportional hazards analysis adjusted for known cardiovascular risks. Findings from FHS were then validated using CHS and ARIC. Results: We identified multiple dietary and behavioral risk factors for cardiovascular disease outcomes including marital status, red meat consumption, whole milk consumption, and coffee consumption. Among these dietary variables, increasing coffee consumption was associated with decreasing long-term risk of HF congruently in FHS, ARIC, and CHS. Conclusions: Higher coffee intake was found to be associated with reduced risk of HF in all three studies. Further study is warranted to better define the role, possible causality, and potential mechanism of coffee consumption as a potential modifiable risk factor for HF.

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