Ten-year Cardiovascular Disease Risk Amongst Workers in a Tertiary Healthcare Institution in Kuala Lumpur

2020 ◽  
Vol 1 (1) ◽  
pp. 35-45
Author(s):  
Norfazilah Ahmad ◽  
Santhna Letchmi Panduragan ◽  
Chong Hong Soon ◽  
Kalaiarasan Gemini ◽  
Yee San Khor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Diastolic Blood Pressure ◽  
Associated Factors ◽  
Risk Group ◽  
High Risk Group ◽  
Kuala Lumpur ◽  
Cvd Risk ◽  
Tertiary Healthcare

  Strategising, which is an effective workplace intervention to curb cardiovascular disease (CVD), requires understanding of the CVD risk related to a specific working population. The Framingham Risk Score (FRS) is widely used in predicting the ten-year CVD risk of various working populations. This study aimed to use FRS to determine the ten-year CVD risk amongst workers in a tertiary healthcare setting and its associated factors. A cross-sectional study was conducted on workers who participated in the special health check programme at the staff clinic of a tertiary healthcare institution in Kuala Lumpur, Malaysia. A set of data sheets was used to retrieve the workers’ sociodemographic and CVD risk information. The prevalence of high, moderate and low ten-year CVD risk was 12.8%, 20.0% and 67.2%, respectively. Workers in the high-risk group were older [mean age: 54.81 (standard deviation, 5.72) years], male (44%), smokers (72.7%) and having hyperglycaemia (46.7%) and hypertriglyceridemia [median triglycerides: 1.75 (interquartile range, 1.45) mmol/L]. Diastolic blood pressure (aOR 1.07, 95% CI: 1.01,1.14), hyperglycaemia (aOR 8.80, 95% CI: 1.92,40.36) and hypertriglyceridemia (aOR 4.45, 95% CI: 1.78,11.09) were significantly associated with high ten-year CVD risk. Diastolic blood pressure (aOR 1.08, 95% CI: 1.03,1.13) and hypertriglyceridemia (aOR 2.51, 95% CI: 1.12-5.61) were significantly associated with moderate ten-year CVD risk. The prevalence of high and moderate ten-year CVD risk was relatively high. Amongst the workers in the high-risk group, they were older, male, smokers and with high fasting blood sugar and triglyceride. Understanding the ten-year CVD risk and its associated factors could be used to plan periodic workplace health assessment and monitor to prevent CVD.

scholarly journals Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Piko ◽  
Zsigmond Kosa ◽  
Janos Sandor ◽  
Roza Adany
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Average Risk ◽  
Cvd Risk ◽  
Roma Population

AbstractCardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5–3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2–3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

scholarly journals Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1631
Author(s):  
Anna Astarita ◽  
Giulia Mingrone ◽  
Lorenzo Airale ◽  
Fabrizio Vallelonga ◽  
Michele Covella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Assessment ◽  
Multiple Myeloma ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
High Risk Group ◽  
Cardiovascular Risk Assessment

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

scholarly journals Comparison of Cardiovascular Disease Risks of Actual and Perceptions of Men’s that 40-65 Years Old

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
İbrahim Topuz ◽  
Sebahat Gozum
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Perceived Risk ◽  
Risk Perceptions ◽  
Smoking Status ◽  
Cvd Risk ◽  
Related Factors ◽  
Risk Reducing ◽  
Very High

Abstract Background Turkey is among the top countries in Europe in coronary mortality in the 45-74 age range. The highest death due to disorders of the circulatory system (50.8%) that is Amasya province. Objective Determine related factors and to compare with actual and perceived cardiovascular disease (CVD) risks of men aged 40-65 living in Amasya. Methods The sample size of cross-sectional and analytical study consisted of 400 people who met the inclusion criteria. Actual CVD risks of men were calculated using HeartScore. Age, systolic blood pressure, total cholesterol measured by blood taken from the capillary and smoking status were used to calculate CVD risk. Actual CVD risk in next decade has been calculated as low, medium, high or very high. Perceived CVD risk in next decade were identified by participants as low, medium, high and very high responses. They also questioned why evaluation of perceived risk. Results It was determined whereas 8.3% of the males had high, 52.5% had a very high level of CVD risk. The main variables affecting actual CVD risk; diastolic blood pressure, BMI and physical activity. 13.3% of males perceived CVD risks at high and 8% at very high. The main variables affecting perceived CVD risk; age and DM. It was found that 48% and 23.8% of males perceived CVD risks lower and higher than actual CVD risk while 28.2% were accurate. Those who perceived CVD risk at a moderate, high and very high think that this is caused by diseases that increase the risk of CVD and smoking. Conclusions Approximately 1/2 men has very high risk of CVD. It was determined that 1/2 men perceived risks are lower with false optimism and couldn’t accurately identify risks of people older and with diabetes. Key messages It can be ensured that develop risk reducing behaviors and individuals with high risk of CVD can raise their awareness. The risk perceptions of males in the very high-risk group from the past to the present are important because they affect their actual risks and risk-reducing behaviors.

scholarly journals Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: the Tromsø Study 2015–2016

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001777
Author(s):  
Amalie Nilsen ◽  
Tove Aminda Hanssen ◽  
Knut Tore Lappegård ◽  
Anne Elise Eggen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Systolic Blood Pressure ◽  
Total Cholesterol ◽  
Diastolic Blood Pressure ◽  
Ldl Cholesterol ◽  
National Guidelines ◽  
Population Proportion ◽  
Total Proportion

AimsTo compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017.MethodsWe included participants from the Norwegian population-based Tromsø Study (2015–2016) aged 40–69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg).ResultsThe total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk.ConclusionThe population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.

Abstract P177: Potential Value of Intensive Blood-Pressure Treatment Based on Predicted Lifetime Cardiovascular Disease at Age 40: Computer Simulation Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Anusorn Thanataveerat ◽  
Sonia Singh ◽  
Ciaran Kohli-Lynch ◽  
Yiyi Zhang ◽  
Eric Vittinghoff ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Computer Simulation ◽  
High Risk ◽  
Cost Effective ◽  
Intensive Treatment ◽  
Lifetime Risk ◽  
Cvd Risk ◽  
Risk Patients ◽  
Intensive Blood Pressure

Introduction: In the SPRINT trial, intensive blood pressure (BP) treatment saved lives and was cost-effective in high-risk older adults. It is unclear if intensive BP treatment should be extended to high-risk adults aged 40-49 years. Objectives: We used individual patient computer simulation to assess the incremental value of extending intensive BP treatment to adults as young as age 40 with high cardiovascular disease (CVD) risk. We selected patients aged <60 years with high lifetime risk because few have high ten-year risk. Methods: Male and female cohorts of 100,000 individuals were assembled from NHANES surveys 1999-2010 using sampling weights. BP and other risk factor trajectories were projected for ages 40 to 69 years based on Framingham Offspring Cohort analyses. The “standard of care” treatment scenario simulated treating BP <140/90 mmHg in all patients ≥140/90 mmHg. Two alternative scenarios were simulated: add intensive treatment (goal <130/90 mmHg) from age 40-69 or from age 50-59 in patients with high lifetime risk. The lifetime risk thresholds (Table 1) were chosen in order to capture patients with forecasted ten-year CVD risk ≥ 10% at age 60. Costs included added treatment and side-effect costs and avoided CVD costs; indexed to 2016. Incremental cost-effectiveness ratios (ICERs) assessed changes in costs and quality-adjusted life years due to adding intensive BP goals. Results: Over a 30-year time horizon, adding intensive treatment in high lifetime risk patients at age 40 would prevent 2,880 additional CVD events in males and 2,958 in females compared to treating only BP <140/90 mmHg. Intensive treatment in high lifetime risk patients before age 60 appeared generally cost-effective except in females aged 40 years (ICER $59,000). Conclusion: Our results suggest that over the long term, intensive BP treatment may be cost-effective in high-risk men as young as 40 and high-risk women as young as 50. Lifetime cardiovascular disease risk might be used to select high risk middle-aged adults for intensive BP treatment.

Abstract P836: Barbershop Mediator-Ship: A Pilot Study of a Grass-Root Community Based Stroke Awareness Campaign

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michael Omoniyi Ayanbadejo ◽  
Nancy M Stoll ◽  
Syntyia Taylor ◽  
Lee R Guterman
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
High Risk ◽  
Black Men ◽  
Risk Group ◽  
The United States ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Health Campaign ◽  
Grass Root

Background: Minorities in the United States have disproportionately higher risk of stroke, early-onset, and more severe strokes than non-Hispanic Whites. Hypertension (HTN) is an independent and modifiable risk factor for stroke. Recent prevalence estimates of HTN in minorities in Niagara Region is not available. Health campaign to barbershops is well-established to be effective for HTN management in black men. This pilot study was conducted to screen for HTN in Barbershops to determine the prevalence of HTN in black men in the Niagara Region. Methods: Barbershops were randomly selected by convenience, and patron’s participation (≥18 years) were voluntary. Blood pressure (BP) screening and stroke education campaign were conducted concurrently in partnership with 7 barbershop owners in the Niagara Region from September 13, 2019 to February 10, 2020. Participant’s age, race, gender, and BP using automated BP machine were recorded. BP readings were stratified into 3 groups based on severity: High risk (BP ≥ 140/90mmHg), intermediate risk/caution (BP 120-139/80-89mmHg) and low risk (BP ≤ 120/< 80mmHg). Hypertension was defined as BP ≥ 140/90. Data was stored in Excel and analysis performed with SPSS (Statistical Package for the Social Sciences). Results: Of the 57 that participated in this study, approximately 75.4% (n=43) were male; 89.4% (n=51) were Black, 5.3% (n=3) were Hispanic and 5.3% (n=3) were other race/ethnicity. Participants’ ages ranged between 18-71 years with a mean age of 36.4 years (95% CI [32.9, 39.8]). Mean systolic BP was 132.14 mmHg (95% CI [128.00, 136.28]) and mean diastolic BP was 86.35 mmHg (95% CI [81.21, 91.50). Approximately 70.0% of total participants were in the high and intermediate risk group categories, with participants younger patients (i.e. age ≤ 40 years) accounted for 73.0% of the high risk group. Conclusion: The prevalence of high blood pressure among minorities in Niagara Region is high and above previous estimates reported in the 2017 ACC/AHA guideline (41% to 55%). Barbershops may provide future opportunities for screening and recruiting subjects for interventions that reduce BP and its risk factors. Further studies should be conducted in larger populations to reduce the uncertainties around the prevalence estimate of HTN

scholarly journals Cardiovascular Risk Assessment: A Comparison of the Framingham, PROCAM, and DAD Equations in HIV-Infected Persons

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Max Weyler Nery ◽  
Celina Maria Turchi Martelli ◽  
Erika Aparecida Silveira ◽  
Clarissa Alencar de Sousa ◽  
Marianne de Oliveira Falco ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Group ◽  
Cross Sectional Study ◽  
High Risk Group ◽  
Cardiovascular Risk Assessment ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Group Data ◽  
Low Hdl

This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered.

scholarly journals Risk Factors of Cardiovascular Disease among Ghanaian Police Officers

2019 ◽  
pp. 1-9
Author(s):  
Miriam Essien ◽  
Herman Erick Lutterodt ◽  
Reginald Adjetey Annan
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Waist Circumference ◽  
Diastolic Blood Pressure ◽  
Police Officers ◽  
Density Lipoprotein ◽  
Dietary Factors ◽  
Cvd Risk Factors ◽  
Cvd Risk

Background: Cardiovascular diseases continue to be a global public health burden among occupational groups like Police officers. Police officers play important roles to ensure law and order in countries. However, the nature of police work exposes them to violence and stress. Again, irregular food habits, irregular exercise, inadequate sleep, smoking and drinking are lifestyles which makes police officers prone to high incidence of cardiovascular disease (CVD). Aim: This study looked at the prevalence of CVD risk factors among police officers in Kumasi, Ghana. Study Design: Cross- sectional. Place and Duration of study: Ashanti Regional Police Headquarters, Kumasi, Ghana, between September, 2017 to July, 2018. Methodology: Weight, height, Body Mass Index (BMI), waist circumference, lipid profile, systolic and diastolic blood pressure of 120 officers were measured. Additionally, lifestyle and dietary factors such as exercise and intake of fruits of Police officers were assessed. Data were analyzed by SPSS version 22.0. Results: Slightly more than half (63, 52.5%) of the officers were females and the remaining (57,47.5%) were males. The mean of the various CVD risk factors among the total study participants are as follows; BMI 28.184±4.461 kg/m2, waist circumference 92.702±10.941 cm, systolic blood pressure (SBP) 128.121±17.047 mmHg, diastolic blood pressure (DBP) 85.569±10.854 mmHg, fasting blood sugar 5.387±1.756 mmol/l, high density lipoprotein (HDL) 1.546±0.211 mmol/l, low density lipoprotein 2.321±0.706 mmol/l (LDL) and total cholesterol (TC) 4.362±0.906 mmol/L.  Prevalence of obesity among male and female officers were 43.9% and 36.5% respectively. With regards to hypertension, policemen and women recorded 31.6% and 20.6% respectively and dyslipidemia among males and females were 43.9% and 85.7% respectively. Conclusion: The officers were generally overweight, with over a quarter having hypertension and about two-thirds having dyslipidemia, making their risk for CVDs high. Further studies to elucidate the causes are required, routine medical screening and nutritional support are recommended.

scholarly journals The impact of acetylsalicylic acid dosed at bedtime on circadian rhythms of blood pressure in the high-risk group of cardiovascular patients—a randomized, controlled trial

2020 ◽  
Vol 77 (1) ◽  
pp. 35-43
Author(s):  
Beata Krasińska ◽  
Lech Paluszkiewicz ◽  
Ewa Miciak-Ławicka ◽  
Maciej Krasinski ◽  
Piotr Rzymski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Arterial Hypertension ◽  
Risk Group ◽  
High Risk Group ◽  
Control Group ◽  
Cardiovascular Patients ◽  
The Impact

Abstract Purpose Time of drug administration may significantly influence its effect. The aim of the present study was to investigate the effect of ASA (administrated in the morning or in the evening) on the anti-hypertensive effect and diurnal blood pressure profile in the high-risk group of cardiovascular patients. Methods All patients (n = 114) had been diagnosed with coronary heart disease and arterial hypertension prior to the enrolment and had been treated with 75 mg per day of ASA in the morning. The patients were randomly assigned to one of the two study groups receiving 75 mg of ASA per day in a single antiplatelet therapy for 3 months in the morning (n = 58) or in the evening (n = 56). The control group (n = 61) consisted of patients with arterial hypertension but without coronary heart disease, not receiving ASA. In all the patients, during each visit, clinical blood pressure (BP) and ambulatory blood pressure measurements (ABPM) were performed. Results There was a significant reduction in 24-h BP and blood pressure at night in the ASA group evening group compared with the ASA morning group and the control group. Conclusions The present study demonstrated that compared with the use of ASA in the morning, its administration in the evening may lead to favourable drop in the ABPM and an improvement of the diurnal profile in the high-risk group of cardiovascular patients who are not naïve to ASA.

Abstract 12440: Does Low Diastolic Blood Pressure Contribute to the Risk of Recurrent Cardiovascular Disease Events? The Framingham Heart Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Stanley S Franklin ◽  
Sohum G Gokhale ◽  
Vincent H Chow ◽  
Nathan D Wong ◽  
Daniel Levy ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Diastolic Blood Pressure ◽  
Framingham Heart Study ◽  
Recurrent Events ◽  
Cox Regression ◽  
Cvd Risk ◽  
Chi Square ◽  
Heart Study ◽  
Increased Risk

Background: The clinical significance of low diastolic blood pressure (DBP) as a risk for recurrent cardiovascular disease (CVD) events in persons with isolated systolic hypertension (ISH) is controversial. Methods: We examined risk for recurrent CVD events in 791 individuals (age 75 years, 47% female, mean follow-up time: 8±6 years) with DBP<70 (N=225) versus 70-89 mmHg (N=566) following initial CVD events in the original and offspring cohorts of the Framingham Heart Study. Results: Recurrent CVD events occurred in 153 (68%) participants with lower DBP and 271 (48%) with higher DBP (p<0.0001). Risk of recurrent CVD events in risk factor-adjusted Cox regression was higher in those with DBP<70 mmHg versus DBP 70-89 mmHg in both treated [HR, 5.1 (95% CI: 3.8-6.9) p<0.0001] and untreated individuals [HR, 11.7 (6.5-21.1) p<0.0001] (treatment interaction: p=0.10). Individually, coronary heart disease, heart failure, and stroke recurrent events were more likely with DBP<70 mmHg versus 70-89 mmHg (p<0.0001). To judge the potential modifying effect of wide pulse pressure (PP) on excess risk associated with low DBP, we defined 4 binary groupings of median PP (≥ 68 verses <68 mmHg) and categorical DBP (<70 versus 70-89 mmHg), and found that CVD event rates were higher only in the group with wide PP and DBP<70 mmHg (Chi Square = 32.6, p<0.001, see Figure). Conclusions: Persons with ISH and initial CVD events have increased risk for recurrent CVD events in the presence of DBP<70 mmHg versus DBP 70-89 mmHg, supporting wide PP as an important risk modifier of the adverse effect of low DBP; we postulate increased CVD risk is related to the pernicious effects of faulty microvascular function resulting from increased elastic artery stiffness in combination with low diastolic perfusion pressure.

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