Faculty Opinions recommendation of Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.

Background: The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood. Methods: We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors. Results: On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors. Conclusions: In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.

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P1755Plasma proteomics in healthy individuals predict myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0508 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Hoogeveen ◽

J P Belo Pereira ◽

V Zampoleri ◽

M J Bom ◽

W Koenig ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plasma Proteins ◽

Risk Model ◽

Machine Learning Algorithms ◽

Machine Learning Techniques ◽

Traditional Risk Factors

Abstract Background Currently used models to predict cardiovascular event risk have limited value. It has been shown repetitively that the addition of single biomarkers has modest impact. Recently we observed that a model consisting of a larger array of plasma proteins performed very well in predicting the presence of vulnerable plaques in primary prevention patients. However, the validation of this protein panel in predicting cardiovascular outcomes remains to be established. Purpose This study investigated the ability of a 384 preselected protein biomarkers to predict acute myocardial infarction, using state-of-the-art machine learning techniques. Secondly, we compared the performance of this multi-protein risk model to traditional risk engines. Methods We selected 822 subjects from the EPIC-Norfolk prospective cohort study, of whom 411 suffered a myocardial infarction during follow-up (median 15 years) compared to 411 controls who remained event-free (median follow-up 20 years). The 384 proteins were measured using proximity extension assay technology. Machine learning algorithms (random forests) were used for the prediction of acute myocardial infarction (ICD code I21–22). Performance of the model was tested against and on top of traditional risk factors for cardiovascular disease (refit Framingham). All performance measurements were averaged over several stability selection routines. Results Prediction of myocardial infarction using a machine-learning model consisting of 50 plasma proteins resulted in a ROC AUC of 0.74±0.14, in comparison to 0.69±0.17 using traditional risk factors (refit Framingham. Combining the proteins and refit Framingham resulted in a ROC AUC of 0.74±0.15. Focussing on events occurring within 3 years after baseline blood withdrawal, the ROC AUC increased to 0.80±0.09 using 50 plasma proteins, as opposed to 0.67±0.22 using refit Framingham (figure). Combining the protein model with refit Framingham resulted in a ROC AUC of 0.82±0.11 for these events. Diagnostic performance events <3yrs Conclusion High-throughput proteomics outperforms traditional risk factors in prediction of acute myocardial infarction. Prediction of myocardial infarction occurring within 3 years after inclusion showed highest performance. Availability of affordable proteomic approaches and developed machine learning pave the path for clinical implementation of these models in cardiovascular risk prediction. Acknowledgement/Funding This study was funded by an ERA-CVD grant (JTC2017) and EU Horizon 2020 grant (REPROGRAM, 667837)

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Session 4: CVD, diabetes and cancer Evidence for the use of the Mediterranean diet in patients with CHD

Proceedings of The Nutrition Society ◽

10.1017/s0029665109991856 ◽

2009 ◽

Vol 69 (1) ◽

pp. 45-60 ◽

Cited By ~ 10

Author(s):

Pascal P. McKeown ◽

Karen Logan ◽

Michelle C. McKinley ◽

Ian S. Young ◽

Jayne V. Woodside

Keyword(s):

Mediterranean Diet ◽

Controlled Trial ◽

Meta Analysis ◽

Pharmacological Therapy ◽

European Countries ◽

Mediterranean Populations ◽

Lyon Diet Heart Study ◽

Heart Study ◽

The Mediterranean ◽

Randomised Controlled

Diet is associated with the development of CHD. The incidence of CHD is lower in southern European countries than in northern European countries and it has been proposed that this difference may be a result of diet. The traditional Mediterranean diet emphasises a high intake of fruits, vegetables, bread, other forms of cereals, potatoes, beans, nuts and seeds. It includes olive oil as a major fat source and dairy products, fish and poultry are consumed in low to moderate amounts. Many observational studies have shown that the Mediterranean diet is associated with reduced risk of CHD, and this result has been confirmed by meta-analysis, while a single randomised controlled trial, the Lyon Diet Heart study, has shown a reduction in CHD risk in subjects following the Mediterranean diet in the secondary prevention setting. However, it is uncertain whether the benefits of the Mediterranean diet are transferable to other non-Mediterranean populations and whether the effects of the Mediterranean diet will still be feasible in light of the changes in pharmacological therapy seen in patients with CHD since the Lyon Diet Heart study was conducted. Further randomised controlled trials are required and if the risk-reducing effect is confirmed then the best methods to effectively deliver this public health message worldwide need to be considered.

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Traditional Risk Factors and Subclinical Disease Measures as Predictors of First Myocardial Infarction in Older Adults

Archives of Internal Medicine ◽

10.1001/archinte.159.12.1339 ◽

1999 ◽

Vol 159 (12) ◽

pp. 1339 ◽

Cited By ~ 117

Author(s):

Bruce M. Psaty ◽

Curt D. Furberg ◽

Lewis H. Kuller ◽

Diane E. Bild ◽

Pentti M. Rautaharju ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Older Adults ◽

Subclinical Disease ◽

Traditional Risk Factors ◽

First Myocardial Infarction

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Challenges of Statins in HIV Hyperlipidemia

US Endocrinology ◽

10.17925/use.2013.09.02.157 ◽

2013 ◽

Vol 09 (02) ◽

pp. 157 ◽

Cited By ~ 1

Author(s):

Carlos D Malvestutto ◽

Judith A Aberg ◽

◽

Keyword(s):

Risk Factors ◽

Drug Interactions ◽

Cardiovascular Complications ◽

Lipid Lowering ◽

Virologic Suppression ◽

Lifestyle Modifications ◽

Negative Effects ◽

Reductase Inhibitors ◽

Increased Risk ◽

Traditional Risk Factors

As a result of access to potent antiretroviral therapy (ART), HIV-infected adults with virologic suppression are living longer, but unfortunately are at increased risk for developing comorbid conditions. It is postulated that this increased risk seen at all ages is partly due to the effects of viral-mediated chronic inflammation in addition to the traditional risk factors. One of the more common traditional risk factors, hyperlipidemia, may be worsened by ART. However, the benefits of ART greatly outweigh the possible negative effects of ART agents on lipid parameters. As the HIV-infected patient population ages, it is critical to control hyperlipidemia in ART-treated patients in order to reduce the risk for long-term cardiovascular complications. If hyperlipidemia cannot be managed through lifestyle modifications, clinical guidelines recommend the use of lipid-lowering medication, particularly HMG Co-A reductase inhibitors (statins), to reduce low-density lipoproteins-cholesterol. However, many ART agents inhibit or induce major metabolic pathways of statins, creating potentially serious drug–drug interactions. In this article, we present a review of the various challenges in managing hyperlipidemia with a focus on drug–drug interactions.

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