scholarly journals Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey

10.2196/19028 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e19028
Author(s):  
Carissa Bonner ◽  
Natalie Raffoul ◽  
Tanya Battaglia ◽  
Julie Anne Mitchell ◽  
Carys Batcup ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Experimental Studies ◽  
Emotional Responses ◽  
Lifestyle Changes ◽  
Small Samples ◽  
Cvd Risk ◽  
Web Based ◽  
Heart Age

Background Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. Objective This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. Methods The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. Results There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. Conclusions Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

scholarly journals Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey (Preprint)

2020 ◽  
Author(s):  
Carissa Bonner ◽  
Natalie Raffoul ◽  
Tanya Battaglia ◽  
Julie Anne Mitchell ◽  
Carys Batcup ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Experimental Studies ◽  
Emotional Responses ◽  
Lifestyle Changes ◽  
Small Samples ◽  
Cvd Risk ◽  
Web Based ◽  
Heart Age

BACKGROUND Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. OBJECTIVE This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. METHODS The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. RESULTS There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. CONCLUSIONS Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

Association of cancer treatment with excess heart age among young breast cancer survivors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12081-12081
Author(s):  
Jacqueline B Vo ◽  
Shoshana M. Rosenberg ◽  
Philip Daniel Poorvu ◽  
Kathryn Jean Ruddy ◽  
Rulla Tamimi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Blood Pressure ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Endocrine Therapy ◽  
Breast Cancer Survivors ◽  
Cvd Risk ◽  
Young Breast Cancer ◽  
Heart Age

12081 Background: Young women with breast cancer may be at increased risk for premature development of cardiovascular disease (CVD) in part due to their cancer treatment. Limited data are available on CVD risk among young breast cancer survivors. Methods: Women aged 30-40 years at diagnosis with stage 0-III breast cancer enrolled in a prospective cohort study of women diagnosed with breast cancer at ≤40 were eligible for inclusion in this analysis. Data were obtained from serial surveys and electronic medical records at breast cancer diagnosis and 5-year follow-up. We calculated “excess heart age,” which incorporates a CVD risk-based score (calculated using age, systolic blood pressure, blood pressure medication, diabetes, smoking, body mass index) to estimate the difference in years between an individual’s chronological age and their CVD-risk adjusted age. Multivariable logistic regression models (adjusting for age at diagnosis, stage, and race) were fitted to evaluate associations between treatment (radiation, endocrine therapy, anthracyclines, and trastuzumab) and having a change in excess heart age ≥2 years from baseline to 5 years. Results: Among 372 young breast cancer survivors, mean age at diagnosis was 36.6 (SD 2.89), 93% were white, and 79% were diagnosed with stage I or II breast cancer. Mean excess heart age was.32 (SD: 6.16) years at baseline, which declined to -.07 (SD 6.64) at 5-year follow-up (p=.17). At 5 years, 31% (n=114) of women experienced an increase of at least 2 years in their excess heart age since diagnosis, and their mean excess heart age was 4.34 years (range -9 to 30). In multivariable analyses, receipt of trastuzumab was associated with higher odds (OR: 1.68, 95% CI: 1.02-2.77) of experiencing an increase of ≥2 years in excess heart age between diagnosis and 5 years of follow-up. Endocrine therapy, anthracyclines, and radiation were not significantly associated with a change in excess heart age of ≥2 years at 5 years post-diagnosis. Conclusions: At 5 years post-diagnosis, approximately 1/3 of young breast cancer survivors experienced a change from baseline in their excess heart age of ≥2 years. Further research is warranted to confirm findings regarding trastuzumab and excess heart age, and potential effects on longer-term cardiac outcomes in this population. Extended follow-up of this cohort may further quantify CVD risk over time.[Table: see text]

Abstract P256: Stability of Obesity and Metabolic Health and the Risk of Cardiovascular Disease

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Todd Sponholtz ◽  
Justin B Echouffo-Tcheugui ◽  
Ramachandran S Vasan
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cox Proportional Hazards ◽  
Metabolic Health ◽  
Lipid Lowering ◽  
Cvd Risk ◽  
High Blood Glucose ◽  
Coronary Insufficiency ◽  
Metabolically Healthy

Introduction: Metabolic syndrome (MetSyn) reportedly confers higher risk of cardiovascular disease (CVD) than its individual components. Although typically defined as a binary exposure, each of its component factors can vary over time. Little is known about whether CVD risk differs according to MetSyn stability. Methods: We defined longitudinal states of obesity and metabolic health among 2,952 Framingham Offspring Study participants for whom we had sufficient data to define MetSyn at ≥4 exams between Exams 2 (1979-1983) and 9 (2011-2014). Obesity was defined as BMI ≥30 kg/m 2 , high triglycerides as ≥150 mg/dL/taking lipid-lowering medication, low HDL as <40 mg/dL for males/ <50 mg/dL for females; high blood pressure as systolic blood pressure ≥130 mm Hg/diastolic blood pressure ≥85 mm Hg/taking antihypertensive medication, and high blood glucose as ≥100 mg/dL/taking antidiabetic medication. Metabolic health was defined as having <2 metabolic conditions. Obesity and metabolic health were classified as unstable if there was a change from one state to the other in ≥33% of observations occurring before a CVD event or end of follow-up, stable obese/metabolically unhealthy if not unstable and >50% of observations were classified as stable obese/metabolically unhealthy, or stable non-obese/metabolically healthy otherwise. CVD was defined as any of the following coronary death, myocardial infarction, coronary insufficiency, angina pectoris, stroke, transient ischemic attack, intermittent claudication, or congestive heart failure. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards regression with age as the time scale. Results: We classified 332 participants (11.3%) as having unstable metabolic health, and 130 (4.4%) as having unstable obesity. We observed 1,206 events in 75,673 person-years of follow-up (median 30 years). Participants classified as stable metabolically unhealthy had the highest CVD risk (HR 1.77, 95% CI 1.47, 2.13, compared to stable metabolically healthy). Stable obesity was associated with a 48% (95% CI 24, 80) increase in CVD risk relative to stable non-obese. Unstable metabolic health and obesity were associated with moderate increases in risk compared to stable metabolically healthy and stable non-obese (HRs: 1.32, 95% CI 1.03, 1.71 and 1.25, 95% CI 0.88, 1.77, respectively). There was no interaction between obesity- and metabolic health stability (p interaction =0.23). Conclusions: In our sample, stability of obesity and of metabolic health influenced CVD risk, with the highest risk of CVD observed among stable metabolically unhealthy participants. Instability of both obesity and metabolic health convey a risk intermediate between the stable obese/metabolically healthy and stable non-obese/metabolically unhealthy conditions.

Abstract P346: Cohort Identification to Harness the Electronic Health Record for Cardiovascular Disease Prediction

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sheila M Manemann ◽  
Jennifer St Sauver ◽  
Janet E Olson ◽  
Nicholas B Larson ◽  
Paul Y Takahashi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Electronic Health Record ◽  
Risk Prediction ◽  
Health Record ◽  
Next Generation ◽  
Cvd Risk ◽  
Electronic Health

Background: Current cardiovascular disease (CVD) risk scores are derived from research cohorts and are particularly inaccurate in women, older adults, and those with missing data. To overcome these limitations, we aimed to develop a cohort to capitalize on the depth and breadth of clinical data within electronic health record (EHR) systems in order to develop next-generation sex-specific risk prediction scores for incident CVD. Methods: All individuals 30 years of age or older residing in Olmsted County, Minnesota on 1/1/2006 were identified. We developed and validated algorithms to define a variety of risk factors, thus building a comprehensive risk profile for each patient. Outcomes including myocardial infarction (MI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), and CVD death were ascertained through 9/30/2017. Results: We identified 73,069 individuals without CVD (Table). We retrieved a total of 14,962,762 lab results; 14,534,466 diagnoses; 17,062,601 services/procedures; 1,236,998 outpatient prescriptions; 1,079,065 heart rate measurements; and 1,320,115 blood pressure measurements. The median number of blood pressure and heart rate measurements ascertained per individuals were 11 and 9, respectively. The five most prevalent conditions were: hypertension, hyperlipidemia, arthritis, depression, and cardiac arrhythmias. During follow-up 1,455 MIs, 1,581 PCI, 652 CABG, and 2,161 CVD-related deaths occurred. Conclusions: We developed a cohort with comprehensive risk profiles and follow-up for each patient. Using sophisticated machine learning approaches, this electronic cohort will be utilized to develop next-generation sex-specific CVD risk prediction scores. These approaches will allow us to address several challenges with use of EHR data including the ability to 1) deal with missing values, 2) assess and utilize a large number of variables without over-fitting, 3) allow non-linear relationships, and 4) use time-to-event data.

Abstract P391: Clinically Significant Blood Pressure Reduction Among Participants of a Lifestyle intervention Improvement Program strongly associated with Reduced Systemic Inflammation in a High Risk Working Population

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Henry Guzman ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Khurram Nasir ◽  
Josette Bou-Khalil ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Lifestyle Intervention ◽  
Systemic Inflammation ◽  
South Florida ◽  
Working Population ◽  
Cvd Risk ◽  
Short Period ◽  
Clinically Significant

Background: In this study we aim to assess the short term effects of clinically significant Blood Pressure (BP) reduction after a behavioral intervention on systemic inflammation, measured by elevated high sensitivity c-reactive protein (HSCRP), in a high cardiovascular disease (CVD) risk cohort. Methods: The study was conducted among 180 employees of Baptist Health South Florida who had 2 or more CVD risk factors such as obesity, diabetes, hypertension or elevated total cholesterol and was involved in a three-month workplace lifestyle intervention. The intervention focused on nutritional and physical activity modifications. At baseline and at 3 months follow-up, anthropometric, clinical, and laboratory measures were obtained. Significant BP reduction was defined as systolic blood pressure (SBP) reduction ≥ 10mmHg or diastolic blood pressure (DBP) reduction ≥ 5mmHg at 3 months of follow-up. A HSCRP >3mg/L was considered elevated. Results: Over the 3-month study period the median SBP decline was 16mmHg (IQR 4 -23mmHg) while the median reduction in DBP was 10mmHg (IQR 6 -16mmHg). 87% (156 participants) experienced significant BP reduction. Among those without significant BP reduction, the prevalence of elevated HSCRP at baseline was 58% and at follow-up it was 75% (p = 0.125). However, among those who had significant BP reduction, there was significant reduction in the prevalence of elevated HSCRP from 66.7% to 57.1% (p<0.001). In unadjusted conditional logistic regression analyses significant BP reduction was associated with 94% reduction in the risk of elevated HSCRP at follow-up. In a fully adjusted model, this association persisted. Conclusion: Clinically significant reduction in blood pressure over a short period in a high cardiovascular disease risk working population is independently associated with markedly diminished risk of elevate hs-CRP. Longer follow-up intervention studies are required to further understand if these effects are sustained.

Integration of absolute cardiovascular disease risk assessment into routine blood cholesterol testing at pathology services

2020 ◽  
Vol 37 (5) ◽  
pp. 675-681 ◽  
Author(s):  
Niamh Chapman ◽  
Ricardo Fonseca ◽  
Leigh Murfett ◽  
Kevin Beazley ◽  
Rebekah E McWhirter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
General Practice ◽  
Medical Practitioner ◽  
Blood Cholesterol ◽  
Cvd Risk ◽  
Usual Practice ◽  
Computer Based

Abstract Background Absolute cardiovascular disease (CVD) risk assessment is recommended for primary prevention of CVD, yet uptake in general practice is limited. Cholesterol requests at pathology services provide an opportunity to improve uptake by integrating absolute CVD risk assessment with this service. Objective This study aimed to assess the feasibility of such an additional service. Methods Two-hundred and ninety-nine patients (45–74 years) referred to pathology services for blood cholesterol had measurement of all variables required to determine absolute CVD risk according to Framingham calculator (blood pressure, age, sex, smoking and diabetes status via self-report). Data were recorded via computer-based application. The absolute risk score was communicated via the report sent to the referring medical practitioner as per usual practice. Evaluation questionnaires were completed immediately post visit and at 1-, 3- and 6-month follow-up via telephone (n = 262). Results Absolute CVD risk reports were issued for 90% of patients. Most patients (95%) reported that the length of time for the pathology service assessment was acceptable, and 91% that the self-directed computer-based application was easy to use. Seventy-eight per cent reported a preference for pathology services to conduct absolute CVD risk assessment. Only 2% preferred a medical practitioner. Of follow-up patients, 202 (75%) had a consultation with a medical practitioner, during which, aspects of CVD risk prevention were discussed (cholesterol and blood pressure 74% and 69% of the time, respectively). Conclusions Measurement of absolute CVD risk in pathology services is feasible, highly acceptable among middle-to-older adults and may increase uptake of guideline-directed care in general practice.

scholarly journals Skin autofluorescence predicts new cardiovascular disease and mortality in people with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henderikus E. Boersma ◽  
Robert P. van Waateringe ◽  
Melanie M. van der Klauw ◽  
Reindert Graaff ◽  
Andrew D. Paterson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Fasting Blood Glucose ◽  
Multivariable Analysis ◽  
Oral Glucose ◽  
Skin Autofluorescence ◽  
Z Score

Abstract Background Skin autofluorescence (SAF) is a non-invasive marker of tissue accumulation of advanced glycation endproducts (AGE). Recently, we demonstrated in the general population that elevated SAF levels predict the development of type 2 diabetes (T2D), cardiovascular disease (CVD) and mortality. We evaluated whether elevated SAF may predict the development of CVD and mortality in individuals with T2D. Methods We included 2349 people with T2D, available baseline SAF measurements (measured with the AGE reader) and follow-up data from the Lifelines Cohort Study. Of them, 2071 had no clinical CVD at baseline. 60% were already diagnosed with diabetes (median duration 5, IQR 2–9 years), while 40% were detected during the baseline examination by elevated fasting blood glucose ≥7.0 mmol/l) and/or HbA1c ≥6.5% (48 mmol/mol). Results Mean (±SD) age was 57 ± 12 yrs., BMI 30.2 ± 5.4 kg/m2. 11% of participants with known T2D were treated with diet, the others used oral glucose-lowering medication, with or without insulin; 6% was using insulin alone. Participants with known T2D had higher SAF than those with newly-detected T2D (SAF Z-score 0.56 ± 0.99 vs 0.34 ± 0.89 AU, p < 0.001), which reflects a longer duration of hyperglycaemia in the former group. Participants with existing CVD and T2D had the highest SAF Z-score: 0.78 ± 1.25 AU. During a median follow-up of 3.7 yrs., 195 (7.6%) developed an atherosclerotic CVD event, while 137 (5.4%) died. SAF was strongly associated with the combined outcome of a new CVD event or mortality (OR 2.59, 95% CI 2.10–3.20, p < 0.001), as well as incidence of CVD (OR 2.05, 95% CI 1.61–2.61, p < 0.001) and death (OR 2.98, 2.25–3.94, p < 0.001) as a single outcome. In multivariable analysis for the combined endpoint, SAF retained its significance when sex, systolic blood pressure, HbA1c, total cholesterol, eGFR, as well as antihypertensive and statin medication were included. In a similar multivariable model, SAF was independently associated with mortality as a single outcome, but not with incident CVD. Conclusions Measuring SAF can assist in prediction of incident cardiovascular disease and mortality in individuals with T2D. SAF showed a stronger association with future CVD events and mortality than cholesterol or blood pressure levels.

scholarly journals Effects of a Paleolithic Diet on Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 10 (4) ◽  
pp. 634-646 ◽  
Author(s):  
Ehsan Ghaedi ◽  
Mohammad Mohammadi ◽  
Hamed Mohammadi ◽  
Nahid Ramezani-Jolfaie ◽  
Janmohamad Malekzadeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Lipid Profile ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cvd Risk Factors ◽  
Paleolithic Diet ◽  
Cvd Risk ◽  
Randomized Controlled

ABSTRACTThere is some evidence supporting the beneficial effects of a Paleolithic diet (PD) on cardiovascular disease (CVD) risk factors. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts and avoiding intake of grains, dairy products, processed foods, and added sugar and salt. This study was performed to assess the effects of a PD on CVD risk factors including anthropometric indexes, lipid profile, blood pressure, and inflammatory markers using data from randomized controlled trials. A comprehensive search was performed in the PubMed, Scopus, ISI Web of Science, and Google Scholar databases up to August 2018. A meta-analysis was performed using a random-effects model to estimate the pooled effect size. Meta-analysis of 8 eligible studies revealed that a PD significantly reduced body weight [weighted mean difference (WMD) = −1.68 kg; 95% CI: −2.86, −0.49 kg], waist circumference (WMD = −2.72 cm; 95% CI: −4.04, −1.40 cm), BMI (in kg/m2) (WMD = −1.54; 95% CI: −2.22, −0.87), body fat percentage (WMD = −1.31%; 95% CI: −2.06%, −0.57%), systolic (WMD = −4.75 mm Hg; 95% CI: −7.54, −1.96 mm Hg) and diastolic (WMD = −3.23 mm Hg; 95% CI: −4.77, −1.69 mm Hg) blood pressure, and circulating concentrations of total cholesterol (WMD = −0.23 mmol/L; 95% CI: −0.42, −0.04 mmol/L), triglycerides (WMD = −0.30 mmol/L; 95% CI: −0.55, −0.06 mmol/L), LDL cholesterol (WMD = −0.13 mmol/L; 95% CI: −0.26, −0.01 mmol/L), and C-reactive protein (CRP) (WMD = −0.48 mg/L; 95% CI: −0.79, −0.16 mg/L) and also significantly increased HDL cholesterol (WMD = 0.06 mmol/L; 95% CI: 0.01, 0.11 mmol/L). However, sensitivity analysis revealed that the overall effects of a PD on lipid profile, systolic blood pressure, and circulating CRP concentrations were sensitive to removing some studies and to the correlation coefficients, hence the results must be interpreted with caution. Although the present meta-analysis revealed that a PD has favorable effects on CVD risk factors, the evidence is not conclusive and more well-designed trials are still needed.

scholarly journals Association between Soy Food and Dietary Soy Isoflavone Intake and the Risk of Cardiovascular Disease in Women: A Prospective Cohort Study in Korea

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1407
Author(s):  
Jihyun Im ◽  
Kyong Park
Keyword(s):  
Cardiovascular Disease ◽  
Postmenopausal Women ◽  
Premenopausal Women ◽  
Soy Isoflavones ◽  
Korean Women ◽  
Cvd Risk ◽  
Soy Isoflavone ◽  
Soy Foods ◽  
Cardiovascular Disease In Women

The association between soy food and soy isoflavone intake and cardiovascular disease (CVD) risk is uncertain, especially in women. We aimed to investigate this association in Korean women. We analyzed data from the Korean Genome and Epidemiology Study, including 4713 Korean women aged 40–69 years with no CVD or cancer at baseline. Dietary information was obtained using a validated semi-quantitative food frequency questionnaire, and the incidence of CVD was assessed using biennial self-reported questionnaires on medical history. The mean follow-up time was 7.4 years, during which 82 premenopausal and 200 postmenopausal women reported CVD incidence. The highest tofu, total soy foods, and dietary soy isoflavone intake groups were significantly associated with a decreased CVD risk in premenopausal women (tofu: hazard ratio (HR) 0.39; 95% confidence interval (CI), 0.19–0.80; total soy food: HR 0.36; 95% CI, 0.18–0.70; dietary soy isoflavones: HR 0.44; 95% CI, 0.22–0.89), whereas no association was observed in postmenopausal women. Other soy foods showed no association with CVD incidence. Dietary soy isoflavones and total soy foods are associated with a decreased CVD risk in premenopausal women. Among soy foods, only tofu showed significant health benefits.

scholarly journals Multi-trajectories of lipid indices with incident cardiovascular disease, heart failure, and all-cause mortality: 23 years follow-up of two US cohort studies

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fatemeh Koohi ◽  
Davood Khalili ◽  
Mohammad Ali Mansournia ◽  
Farzad Hadaegh ◽  
Hamid Soori
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Lipid Levels ◽  
Cvd Risk ◽  
All Cause Mortality ◽  
Over Time

Abstract Background Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment. Methods We investigated 14,373 participants (45.5% men) aged 45–84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model. Results Seven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02–2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07–2.06). Conclusions The trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.

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