scholarly journals Hyperphosphatemia and Cardiovascular Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Chao Zhou ◽  
Zhengyu Shi ◽  
Nan Ouyang ◽  
Xiongzhong Ruan
Keyword(s):  
Cardiovascular Disease ◽  
Ventricular Hypertrophy ◽  
Randomized Clinical Trials ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Therapeutic Strategies ◽  
Left Ventricular ◽  
Serum Phosphate ◽  
Promising Therapeutic Target ◽  
Normal Laboratory

Hyperphosphatemia or even serum phosphate levels within the “normal laboratory range” are highly associated with increased cardiovascular disease risk and mortality in the general population and patients suffering from chronic kidney disease (CKD). As the kidney function declines, serum phosphate levels rise and subsequently induce the development of hypertension, vascular calcification, cardiac valvular calcification, atherosclerosis, left ventricular hypertrophy and myocardial fibrosis by distinct mechanisms. Therefore, phosphate is considered as a promising therapeutic target to improve the cardiovascular outcome in CKD patients. The current therapeutic strategies are based on dietary and pharmacological reduction of serum phosphate levels to prevent hyperphosphatemia in CKD patients. Large randomized clinical trials with hard endpoints are urgently needed to establish a causal relationship between phosphate excess and cardiovascular disease (CVD) and to determine if lowering serum phosphate constitutes an effective intervention for the prevention and treatment of CVD.

scholarly journals Left Ventricular Mass Index Is Associated With Cognitive Function in Middle-Age

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Alexander C. Razavi, ◽  
Camilo Fernandez ◽  
Jiang He ◽  
Tanika N. Kelly ◽  
Marie Krousel-Wood ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cognitive Function ◽  
Systolic Blood Pressure ◽  
Middle Age ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Left Ventricular ◽  
Lv Mass ◽  
Lv Remodeling

Background: Elevated cardiovascular disease risk factor burden is a recognized contributor to poorer cognitive function; however, the physiological mechanisms underlying this association are not well understood. We sought to assess the potential mediation effect of left ventricular (LV) remodeling on the association between lifetime systolic blood pressure and cognitive function in a community-based cohort of middle-aged adults. Methods: Nine hundred sixty participants of the Bogalusa Heart Study (59.2% women, 33.8% black, aged 48.4±5.1 years) received 2-dimensional echocardiography to quantify relative wall thickness, LV mass, and diastolic and systolic LV function; and a standardized neurocognitive battery to assess memory, executive functioning, and language processing. Multivariable linear regression assessed the association of cardiac structure and function with a global composite cognitive function score, adjusting for traditional cardiovascular disease risk factors. Mediation analysis assessed the effect of LV mass index on the association between lifetime systolic blood pressure burden and cognitive function. Results: There were 233 (24.3%) and 136 (14.2%) individuals with concentric LV remodeling and concentric LV hypertrophy, respectively. Each g/m 2.7 increment in LV mass index was associated with a 0.03 standardized unit decrement in global cognitive function ( P =0.03). Individuals with concentric LV remodeling and isolated diastolic dysfunction had the poorest cognitive function, and a greater ratio between early mitral inflow velocity and early diastolic mitral annular velocity (E/e’) was associated with poorer cognitive function, even after adjustment for LV mass index (B=−0.12; P =0.03). A total of 18.8% of the association between lifetime systolic blood pressure burden and midlife cognitive function was accounted for by LV mass index. Conclusions: Cardiac remodeling partially mediates the association between lifespan systolic blood pressure burden and adult cognition in individuals without dementia or clinical cardiovascular disease. Slowing or reversing the progression of cardiac remodeling in middle-age may be a novel therapeutic approach to prevent cognitive decline.

Abstract 009: Incremental Predictive Utility Of Subclinical Disease Measures For Cardiovascular Disease Risk

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Rebecca J Song ◽  
Vasan S Ramachandran ◽  
Vanessa Xanthakis
Keyword(s):  
Cardiovascular Disease ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Cvd Risk ◽  
Subclinical Disease

Introduction: The Framingham Risk Score (FRS) has been widely used to predict cardiovascular disease (CVD) risk. However, a comparison of the incremental prognostic utility of different subclinical disease (SubDz) measures is not clear. Methods: We evaluated participants aged 40-79 years (mean age 55 years, 56% women) from the Framingham Offspring (Exam 8, 2005-2008) and Third Generation cohorts (Exam 1, 2002-2005), free of CVD and diabetes, with data on coronary artery calcium (CAC, n=2497), and two measures of target organ damage: urine albumin-to-creatinine ratio (UACR, n=4011) and left ventricular mass (LVM, n=3770). We categorized FRS: <10%, 10-19%, and ≥20% and defined high CAC as CAC≥100, microalbuminuria (MA) as UACR ≥25mg/g in men and ≥35mg/g in women, and left ventricular hypertrophy (LVH) as LVM/body surface area>115 g/m 2 (men) and >95g/m 2 (women). We created 6 cross-classified groups: FRS <10%-No SubDz; FRS <10% + SubDz; FRS 10-19%-No SubDz; FRS 10-19% + SubDz; FRS ≥20%-No SubDz; and FRS ≥20% + SubDz. We related the groups to CVD risk using Cox regression adjusting for age, sex, and cohort and plotted Kaplan-Meier curves to display CVD cumulative incidence by each SubDz cross-classified group. Results: Over a median follow-up of 12 years, 7% of participants developed CVD. Comparing FRS 10-19%-No SubDz and FRS 10-19% + SubDz to FRS <10%-No SubDz (referent), we observed hazards ratios (95% CI) for CVD of 1.68 (0.99-2.83) and 6.50 (3.64-11.61) for high CAC; 1.33 (0.95-1.85) and 2.15 (1.10-4.18) for MA; and 1.43 (0.99-2.07) and 2.18 (1.33-3.57) for LVH. Each SubDz measure predicted CVD risk incrementally over the FRS. In a sub-sample with all three SubDz measures, the model c-statistic with FRS only was 0.725, increasing to 0.773, 0.726, and 0.728 when adding CAC, MA, and LVH, respectively. Conclusion: Presence of a high CAC score outperformed other measures of target organ damage (MA or LVH) for predicting CVD risk, regardless of FRS. Additional studies of larger multi-ethnic samples are warranted to confirm our findings.

Hypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the Community

Hypertension ◽  
2021 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Rebecca J. Song ◽  
Vanessa Xanthakis ◽  
Alexa Beiser ◽  
Charles DeCarli ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pulse Wave Velocity ◽  
Kidney Function ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Ankle Brachial Index ◽  
Intima Media Thickness ◽  
Left Ventricular

We characterized the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in the community-based Framingham Study. 7898 participants (mean age 51.6 years, 54% women) underwent assessment for the following HMOD: electrocardiographic and echocardiographic left ventricular hypertrophy, abnormal brain imaging findings consistent with vascular injury, increased carotid intima-media thickness, elevated carotid-femoral pulse wave velocity, reduced kidney function, microalbuminuria, and low ankle-brachial index. We characterized HMOD prevalence according to blood pressure (BP) categories defined by four international BP guidelines. Participants were followed up for incidence of cardiovascular disease. The prevalence of HMOD varied positively with systolic BP and pulse pressure but negatively with diastolic BP; it increased with age, was similar in both sexes, and varied across BP guidelines based on their thresholds defining hypertension. Among participants with hypertension, elevated carotid-femoral pulse wave velocity was the most prevalent HMOD (40%–60%), whereas low ankle-brachial index was the least prevalent (<5%). left ventricular hypertrophy, reduced kidney function, microalbuminuria, increased carotid intima-media thickness, and abnormal brain imaging findings had an intermediate prevalence (20%–40%). HMOD frequently clustered within individuals. On follow-up (median, 14.1 years), there were 384 cardiovascular disease events among 5865 participants with concurrent assessment of left ventricular mass, carotid-femoral pulse wave velocity, kidney function, and microalbuminuria. For every BP category above optimal (referent group), the presence of HMOD increased cardiovascular disease risk compared with its absence. The prevalence of HMOD varies across international BP guidelines based on their different thresholds for defining hypertension. The presence of HMOD confers incremental prognostic information regarding cardiovascular disease risk at every BP category.

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