scholarly journals The Role of Atherosclerotic Cardiovascular Risk Enhancers in the Prediction of Cardiovascular Events: Tehran Lipid and Glucose Study

2020 ◽  
Author(s):  
Farzad Hadaegh ◽  
Samaneh Asgari ◽  
Fatemeh Moosaie ◽  
Meysam Orangi ◽  
Farzaneh Sarvghadi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Predictive Power ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
Added Value ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cox Regression Analysis

Abstract Background: To assess the effect of the atherosclerotic cardiovascular disease risk enhancing factors (ASCVD-REFs) on incident cardiovascular disease (CVD) events among non-diabetic individuals with borderline and intermediate ACC/AHA score during 10 and 15-year follow-up. Moreover, the added value of these ASCVD-REFs on the predictive power of the pooled cohort equations (PCE) was examined. Methods: A total of 1204 adults aged 40-75 years, free from CVD at baseline with low-density lipoprotein cholesterol (LDL-C) between 70-189 mg/dl, were included. Unadjusted Cox regression analysis was used. The predictive ability of each significant ASCVD-REFs was estimated using the cut-point-free integrated discrimination improvement (IDI).Results: During 10-year follow up, 181 CVD events (including 73 hard CVD) occurred. For hard CVD events, the high blood pressure (BP) component (i.e. ≥130/85 mmHg) of metabolic syndrome (Mets) (Hazard ratio: HR (95% CI; 1.67(1.03-2.70)) and positive history of preeclampsia (5.06(1.17-22.0)) were significant ASCVD-REFs. During the longer follow-up, Mets and its components of high waist circumference (WC) and high BP significantly increased the risk. As for CVD events, the Mets and its high BP and high WC components significantly increased the risk. However, in the ACC/AHA adjusted score, these covariates did not significantly improve the predictive power of the CVD or hard CVD. Conclusions: The high BP was the most consistent and independent ASCVD-REFs in the prediction of all CVD and hard CVD, among the population with borderline/intermediate risk. Hence, considering pharmacologic therapies for patients with high BP and high LDL-C might be beneficial for preventive initiatives.

scholarly journals Cardiovascular disease risk assessment in patients with familial Mediterranean fever related renal amyloidosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Micol Romano ◽  
David Piskin ◽  
Roberta A. Berard ◽  
Bradley C. Jackson ◽  
Cengizhan Acikel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cox Regression ◽  
Disease Risk ◽  
Kidney Diseases ◽  
Cardiovascular Disease Risk ◽  
Aa Amyloidosis ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Fgf 23

Abstract Chronic inflammation and proteinuria is a risk factor for cardiovascular disease (CVD) in patients with chronic kidney diseases and rheumatologic disorders. Our aim was to investigate the CVD events (CVDEs) and survival between the patients with FMF-related AA amyloidosis and glomerulonephropathies (GN) to define possible predictors for CVDEs. A prospective follow-up study with FMF-amyloidosis and glomerulonephropathy (GN) was performed and patients were followed for CVDEs. Flow-mediated dilatation (FMD), FGF-23, serum lipid, hsCRP levels, BMI and HOMA were assessed. A Cox regression analysis was performed to evaluate the risk factors for CVDEs. There were 107 patients in the FMF-amyloidosis group and 126 patients with GN group. Forty-seven CVDEs were observed during the 4.2-years follow up; all 28 patients in the FMF-amyloidosis group and 14/19 patients with GN developed CVDEs before the age of 40 (p = 0.002). CVD mortality was 2.8 times higher (95% CI 1.02–7.76) in patients with FMF-amyloidosis. Across both groups, FMD and FGF23 (p < 0.001) levels were independently associated with the risk of CVDEs. Patients with FMF-amyloidosis are at increased risk of early CVDEs with premature mortality age. FGF 23, FMD and hsCRP can stratify the risk of early CVD in patients with FMF-related AA amyloidosis.

scholarly journals Circulating Proangiogenic Cell Activity Is Associated with Cardiovascular Disease Risk

2012 ◽  
Vol 17 (9) ◽  
pp. 1163-1170 ◽  
Author(s):  
Kreton Mavromatis ◽  
Konstantinos Aznaouridis ◽  
Ibhar Al Mheid ◽  
Emir Veledar ◽  
Saurabh Dhawan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Bone Marrow ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cell Activity ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
The Relationship

Vascular injury mobilizes bone marrow–derived proangiogenic cells into the circulation, where these cells can facilitate vascular repair and new vessel formation. We sought to determine the relationship between a new biomarker of circulating bone marrow–derived proangiogenic cell activity, the presence of atherosclerotic cardiovascular disease (CVD) and its risk factors, and clinical outcomes. Circulating proangiogenic cell activity was estimated using a reproducible angiogenic colony-forming unit (CFU-A) assay in 532 clinically stable subjects aged 20 to 90 years and ranging in the CVD risk spectrum from those who are healthy without risk factors to those with active CVD. CFU-A counts increased with the burden of CVD risk factors ( p < 0.001). CFU-A counts were higher in subjects with symptomatic CVD than in those without ( p < 0.001). During follow-up of 232 subjects with CVD, CFU-A counts were higher in those with death, myocardial infarction, or stroke than in those without (110 [70–173] vs 84 [51–136], p = 0.01). Therefore, we conclude that circulating proangiogenic cell activity, as estimated by CFU-A counts, increases with CVD risk factor burden and in the presence of established CVD. Furthermore, higher circulating proangiogenic cell activity is associated with worse clinical outcome in those with CVD.

scholarly journals Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association

2021 ◽  
Author(s):  
Gissette Reyes-Soffer ◽  
Henry N. Ginsberg ◽  
Lars Berglund ◽  
P. Barton Duell ◽  
Sean P. Heffron ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
Major Protein ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipoprotein A ◽  
Scientific Statement ◽  
Genetically Determined

High levels of lipoprotein(a) [Lp(a)], an apoB100-containing lipoprotein, are an independent and causal risk factor for atherosclerotic cardiovascular diseases through mechanisms associated with increased atherogenesis, inflammation, and thrombosis. Lp(a) is predominantly a monogenic cardiovascular risk determinant, with ≈70% to ≥90% of interindividual heterogeneity in levels being genetically determined. The 2 major protein components of Lp(a) particles are apoB100 and apolipoprotein(a). Lp(a) remains a risk factor for cardiovascular disease development even in the setting of effective reduction of plasma low-density lipoprotein cholesterol and apoB100. Despite its demonstrated contribution to atherosclerotic cardiovascular disease burden, we presently lack standardization and harmonization of assays, universal guidelines for diagnosing and providing risk assessment, and targeted treatments to lower Lp(a). There is a clinical need to understand the genetic and biological basis for variation in Lp(a) levels and its relationship to disease in different ancestry groups. This scientific statement capitalizes on the expertise of a diverse basic science and clinical workgroup to highlight the history, biology, pathophysiology, and emerging clinical evidence in the Lp(a) field. Herein, we address key knowledge gaps and future directions required to mitigate the atherosclerotic cardiovascular disease risk attributable to elevated Lp(a) levels.

scholarly journals Association between metabolically healthy obesity/overweight and cardiovascular disease risk: A representative cohort study in Taiwan

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246378
Author(s):  
Tzu-Lin Yeh ◽  
Hsin-Yin Hsu ◽  
Ming-Chieh Tsai ◽  
Le-Yin Hsu ◽  
Lee-Ching Hwang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Normal Weight ◽  
Metabolically Healthy Obesity ◽  
Cox Regression Analysis ◽  
The Metabolic Syndrome ◽  
Metabolically Healthy

Objectives To investigate the relationship between metabolically healthy obesity and cardiovascular disease risk in Taiwanese individuals. Methods Taiwanese individuals were recruited from a nationwide, representative community-based prospective cohort study and classified according to body mass index as follows: normal weight (18.5–23.9 kilogram (kg)/meter(m)2) and obesity/overweight (≥24 kg/m2). Participants without diabetes, hypertension, and hyperlipidemia and who did not meet the metabolic syndrome without waist circumference criteria were considered metabolically healthy. The study end points were cardiovascular disease morbidity and mortality. Multivariable adjusted hazard ratios and 95% confidence intervals were obtained from a Cox regression analysis. Results Among 5 358 subjects (mean [standard deviation] age, 44.5 [15.3] years; women, 48.2%), 1 479 were metabolically healthy with normal weight and 491 were metabolically healthy with obesity. The prevalence of metabolically healthy obesity/overweight was 8.6% in the Taiwanese general population, which included individuals who were >20 years old, not pregnant, and did not have CVD (n = 5,719). In the median follow-up period of 13.7 years, 439 cardiovascular disease events occurred overall and 24 in the metabolically healthy obesity group. Compared with the reference group, the metabolically healthy obesity group had a significantly higher cardiovascular disease risk (adjusted hazard ratio: 1.74, 95% confidence interval: 1.02, 2.99). Conclusions Individuals with metabolically healthy obesity have a higher risk of cardiovascular disease and require aggressive body weight control for cardiovascular disease control.

scholarly journals Associations Between High-Density Lipoprotein Particles and Ischemic Events by Vascular Domain, Sex, and Ethnicity

Circulation ◽  
2020 ◽  
Vol 142 (7) ◽  
pp. 657-669 ◽  
Author(s):  
Kavisha Singh ◽  
Alvin Chandra ◽  
Thomas Sperry ◽  
Parag H. Joshi ◽  
Amit Khera ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
High Density Lipoprotein ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Large Population ◽  
Density Lipoprotein ◽  
High Density ◽  
Cholesterol Concentration ◽  
Atherosclerotic Cardiovascular Disease

Background: High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C. Methods: We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA (Multi-Ethnic Study of Atherosclerosis; n=6632), and PREVEND (Prevention of Renal and Vascular Endstage Disease; n=5022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke. Results: In the overall population (n=15 784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors (hazard ratio [HR] for quartile 4 [Q4] versus quartile 1 [Q1], 0.64 [95% CI, 0.52–0.78]), as was HDL-C (HR for Q4 versus Q1, 0.76 [95% CI, 0.61–0.94]). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and atherosclerotic cardiovascular disease, whereas adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual end points of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR for Q4 versus Q1 for Whites, 0.49 [95% CI, 0.35–0.69]; for Blacks, 1.22 [95% CI, 0.76–1.98]; P interaction =0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR for Q4 versus Q1, 0.53 [95% CI, 0.36–0.78]) but had a weak direct association with MI among Black participants (HR for Q4 versus Q1, 1.75 [95% CI, 1.08–2.83]; P interaction <0.0001). Conclusions: Compared with HDL-C, HDL-P was consistently associated with MI and ischemic stroke in the overall population. Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that atherosclerotic cardiovascular disease risk may differ by vascular domain and ethnicity. Future studies should examine individual outcomes separately.

scholarly journals Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Nwora Lance Okeke ◽  
Katherine R Schafer ◽  
Eric G Meissner ◽  
Jan Ostermann ◽  
Ansal D Shah ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
National Commission ◽  
Cardiovascular Disease Risk Factor ◽  
Atherosclerotic Cardiovascular Disease ◽  
Southeastern Us ◽  
The Impact

Abstract Background The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. Methods PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non–high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance. Results Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75–0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88–1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68–1.15). Conclusions Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.

scholarly journals The risk and added values of the atherosclerotic cardiovascular risk enhancers on prediction of cardiovascular events: Tehran lipid and glucose study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Farzad Hadaegh ◽  
Samaneh Asgari ◽  
Fatemeh Moosaie ◽  
Meysam Orangi ◽  
Farzaneh Sarvghadi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Multivariable Analysis ◽  
Density Lipoprotein ◽  
Predictive Ability ◽  
Heart Association ◽  
Premature Menopause ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cox Regression Analysis ◽  
History Of

Abstract Background In 2013 American College of Cardiology and the American Heart Association released a guideline on the management of atherosclerotic cardiovascular disease (ASCVD) including a composite of death from CVD, non-fatal myocardial infarction, or non-fatal stroke (hard CVD). This guideline recommended a risk score that was calculated using pooled cohort equations (ASCVD-PCE). The guideline was updated in 2018/2019 and further risk discussion was suggested for deciding whether to continue or initiate statin therapy among non-diabetic individuals with ASCVD-PCE score ranged 5–20%. They recommended a risk discussion with considering risk enhancing factors (ASCVD-REFs) including family history of premature CVD, chronic kidney disease, triglycerides ≥ 175 mg/dl, low-density lipoprotein cholesterol (LDL-C) ≥ 160 mg/dl, metabolic syndrome (Mets), and for women premature menopause, and hypertensive disorders of pregnancy (HDP). In the current study, we aimed to examine the predictability of recommended ASCVD-REFs on incident hard CVD in non-diabetic individuals with LDL-C 70-189 mg/dl, with ASCVD-PCE risk 5–20% during 10 and 15-year follow-up. Methods Among a total of 3546 non-diabetic individuals aged 40-75 years, after excluding those with ASCVD-PCE score < 5% and ≥ 20% (n = 2342), 1204 individuals (women = 332) were included. The univariable and multivariable (further adjusted for ASCVD-PCE) Cox regression analysis were used to evaluate the association of each potential ASCVD-REFs with hard CVD. Additionnaly, the role of different components of Mets and a history of gestational diabetes (GDM)/macrosomia was also examined. The predictive ability of each significant ASCVD-REFs, then was evaluated by the discrimination accuracy and risk reclassification index. Results During the 10-year follow-up, 73 hard CVD events occurred. Although in univariable analysis, high blood pressure (BP) component of Mets, GDM/macrosomia, and HDP remained as significant ASCVD-REFs, in the multivariable analysis, only the history of HDP (5.35 (1.22–23.38)) and GDM/macrosomia (3.18 (1.05–9.65)) showed independent risks. During the 15-year follow-up, Mets (1.47 (1.05–2.06)) and its components of high waist circumference (1.40 (1.0–1.95)) and high BP (1.52 (1.07–2.15)) significantly increased the risk. These ASCVD-REFs did not improve discrimination or predictive ability. Conclusions In a decade follow-up, only conditions specific for women and in longer follow-up, the presence of Mets perse, and its components of high WC and high BP were shown as significant ASCVD-REFs.

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