The Incidence of Coronary Heart Disease and the Population Attributable Fraction of Its Risk Factors in Tehran: A 10-Year Population-Based Cohort Study

Background: High-sensitive (hs) troponin T and I assays as well as ultrasensitive (us) troponin I enable measurement of troponins in 65% to 98% of the general population. We prospectively investigated whether increased concentrations of us-troponin I are associated with an increased risk of coronary heart disease (CHD) after controlling for traditional risk factors. Methods: We conducted a population-based case cohort study in middle-aged healthy men and women within the MONICA/KORA Augsburg studies. Serum levels of us-troponin I (Single Molecule Counting technology, Singulex) were available in 2,745 men and women including 803 incident CHD cases. Geometric mean us-troponin I was 1.56 ng/L. Mean (SD) follow-up was 16.0 (5.8) years. Results: Baseline concentrations of us-troponin I were higher in cases compared to non-cases (geometric mean 2.56 vs. 1.49 ng/L, p<0.0001) and in men compared to women (geometric mean 1.93 vs. 1.27 ng/L, p<0.0001). After adjustment for variables of the Framingham Risk Score, the hazard ratio (HR) with 95% confidence interval (CI) for a CHD event in the top quartile compared to the bottom quartile was 2.76 (95% CI, 1.87-4.09). After additional adjustment for alcohol intake, physical activity, and body mass index, hazard ratios remained essentially unchanged. Conclusions: Troponin I measured by an us-assay was detectable in almost all subjects. This is the first population-based prospective study with long-term follow-up showing that even modestly increased concentrations of us troponin I are strongly associated with incident CHD independently of a variety of traditional risk factors.

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Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction and estimating benefits from novel interventions

10.1101/2020.03.30.20043554 ◽

2020 ◽

Author(s):

Paul Welsh ◽

Claire Welsh ◽

Carlos A Celis-Morales ◽

Rosemary Brown ◽

Lyn D Ferguson ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Risk Prediction ◽

Population Attributable Fraction ◽

Attributable Fraction ◽

Peripheral Vascular ◽

Cvd Risk

AbstractBackgroundLipoprotein (a) (Lp(a)) is a CVD risk factor amenable to intervention and might help guide risk prediction.ObjectivesTo investigate the population attributable fraction due to elevated Lp(a) and its utility in risk prediction.MethodsUsing a prospective cohort study, 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated.ResultsMedian Lp(a) was 19.7nmol/L (interquartile interval 7.6-75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95%CI 1.07-1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%.ConclusionsPopulation screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs, if such drugs prove efficacious, to those with markedly elevated levels.

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Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction and estimating benefits from novel interventions

European Heart Journal ◽

10.1093/ehjci/ehaa946.2833 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Welsh ◽

C Welsh ◽

C.A.C Celis-Morales ◽

R Brown ◽

L.D Ferguson ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Population Attributable Fraction ◽

Attributable Fraction ◽

Funding Source ◽

Peripheral Vascular ◽

Cvd Risk

Abstract Background Lipoprotein (a) (Lp(a)) measurement may help guide CVD risk prediction, is thought to be causal in several CVD outcomes, and phase 3 intervention trials of Lp(a) lowering agents are underway. We aimed to investigate the population attributable fraction due to elevated Lp(a) and its utility in CVD risk prediction. Methods In 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated. Results Median Lp(a) was 19.7nmol/L (interquartile interval 7.6–75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95% CI 1.07–1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may be expected to reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%. Conclusions Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs to those with markedly elevated levels, if such drugs prove efficacious. Population attributable fractions: Lp(a) Funding Acknowledgement Type of funding source: Other. Main funding source(s): Chest, Heart, and Stroke Association Scotland and British Heart Foundation

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Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph6102626 ◽

2009 ◽

Vol 6 (10) ◽

pp. 2626-2638 ◽

Cited By ~ 21

Author(s):

Sara Holmberg ◽

Anders Thelin ◽

Eva-Lena Stiernström

Keyword(s):

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

Food Choices ◽

Population Based

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Prevalence of coronary heart disease and cardiovascular risk factors in a national cross-sectional cohort study of systemic sclerosis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-201176 ◽

2012 ◽

Vol 71 (12) ◽

pp. 1980-1983 ◽

Cited By ~ 52

Author(s):

Gene-Siew Ngian ◽

Joanne Sahhar ◽

Susanna M Proudman ◽

Wendy Stevens ◽

Ian P Wicks ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

Cardiovascular Risk ◽

Systemic Sclerosis ◽

Cardiovascular Risk Factors ◽

Cross Sectional

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Unfavorable and favorable changes in modifiable risk factors and incidence of coronary heart disease: The Whitehall II cohort study

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.07.005 ◽

2018 ◽

Vol 269 ◽

pp. 7-12 ◽

Cited By ~ 7

Author(s):

Marianna Virtanen ◽

Jussi Vahtera ◽

Archana Singh-Manoux ◽

Marko Elovainio ◽

Jane E. Ferrie ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Cohort Study ◽

Heart Disease ◽

Modifiable Risk Factors

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Prevalence of Major Cardiovascular Risk Factors and Coronary Heart Disease in a Sample of Greek Adults: The Saronikos Study

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401610010069 ◽

2016 ◽

Vol 10 (1) ◽

pp. 69-80 ◽

Cited By ~ 9

Author(s):

Aristofanis Gikas ◽

Vaia Lambadiari ◽

Alexios Sotiropoulos ◽

Demosthenes Panagiotakos ◽

Stavros Pappas

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Adult Population ◽

Target Population ◽

Population Based ◽

Cross Sectional Study ◽

Cross Sectional ◽

Geographical Regions ◽

Region Data

Background: Comprehensive data regarding prevalence of coronary heart disease (CHD) and associated factors in different geographical regions are very important to our understanding of global distribution and evolution of CHD. The aim of this study was to assess the current prevalence of self-reported risk factors and CHD in Greek adult population. Methods: A community-based cross-sectional study was conducted in May 2014, during an election day, among residents of Saronikos municipality (Attica region). Data were collected from face-to-face interviews. The study sample included 2636 subjects (men, 49.5%; mean age, 50.5; range 20-95 years), with similar age and sex distribution to the target population. Results: The age-standardized prevalence rates of five major risk factors were as follows: type 2 diabetes 11.1%, hypercholesterolemia (cholesterol>240 mg/dl or using cholesterol-lowering medication) 23.8%, hypertension 27.2%, current smoking 38.9% and physical inactivity 43%. Of the participants, only 21% were free of any of these factors. Clustering of two to five risk factors was more frequent among persons aged 50 years and older as compared with younger ones (60% vs 27%, P=0.000). The age-adjusted prevalence of CHD was 6.3% (in men, 8.9%; in women, 3.8%) and that of myocardial infarction was 3.6% (in men, 5.2%; in women, 2.1%). According to multivariate analysis age, gender, education level, obesity, diabetes, hypercholesterolemia, hypertension and ever smoking were strongly associated with CHD. Conclusion: Classic risk factors are highly prevalent and frequently clustered, especially in adults aged 50 years and older. These findings raise concerns about future trends of already increased rates of CHD. Multifactorial and integrated population-based interventions need to be applied to reduce the burden of cardiovascular conditions.

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