Prevalence and predictors of different patterns of hypertension among adults aged 20–60 years in rural communities of Southeast Nigeria: a cross-sectional study

Background Hypertension, a major cardiovascular disease risk factor exists several years without symptoms. Few data exist on prevalence and predictors of hypertension among apparently healthy Nigerian adults. This makes it difficult for policy-makers to concentrate efforts to control emerging health burden of the disease. This study assessed prevalence and predictors of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined systolic and diastolic hypertension (CSDH). Methods Cross-sectional survey design was employed in the study of 517 adult participants (20–60 years) in a rural setting. Selection of the respondents was through multistage sampling which involved systematic, proportionate and simple random sampling. Data on socio-demographic characteristics, blood pressure, height, weight, and waist circumference were collected. Frequencies, T-test, analysis of variance and Chi square were used in statistical analysis. Bivariate and multivariate logistic regressions were used to evaluate variables associated with different patterns of hypertension with significance accepted at P < 0.05. Frequencies, percentages, crude and adjusted odd ratios were reported. Statistical Product and Service Solutions version 21.0 was used in statistical analysis. Results ISH (10.6%), IDH (18.2%) and CSDH (37.8%) were observed among the participants. ISH was less likely among 20–29 year-olds (adjusted odds ratio (aOR) = 0.35, 95% confidence interval (C.I.) = 0.13–0.94), 30–39 year-olds (aOR = 0.30, 95% C.I. = 0.11–0.82) and those with abdominal obesity (aOR = 0.12, 95% C.I. = 0.03–0.56). Participants who perceived their health status as good (aOR = 3.80, 95% C.I. = 1.29–11.18) and excellent (aOR = 5.28, 95% C.I. = 1.54–18.07) were respectively 3.80 and 5.28 times more likely to have ISH. Those with secondary education had significantly higher likelihood for IDH (aOR = 2.05, 95% = 1.02–4.14) whereas self-perceived poor health status (aOR = 0.24, 95% C.I. = 0.09–0.65), absence of obesity (aOR = 0.10, 95% C.I. = 0.01–0.81) and general obesity (aOR = 0.35, 95% C.I. = 0.17–0.72) were associated with reduced risk for IDH. Secondary (aOR = 0.60, 95% C.I. = 0.36–0.99) and tertiary (aOR = 0.49, 95% C.I. = 0.28–0.85) education were associated with reduced risk for CSDH but combined obesity (aOR = 4.39, 95% C.I. = 2.25–8.58) increased the risk for CSDH by 4. Conclusion ISH, IDH and CSDH were problems among the adults with age, obesity, self-perception of good/excellent health status and low education level as significant predictors. Health and nutrition education to prevent comorbidities and cerebrovascular accidents are recommended.

Identification of Endothelial Proteins in Plasma Associated With Cardiovascular Risk Factors

Objective: Endothelial cell (EC) dysfunction is a well-established response to cardiovascular disease risk factors, such as smoking and obesity. Risk factor exposure can modify EC signaling and behavior, leading to arterial and venous disease development. Here, we aimed to identify biomarker panels for the assessment of EC dysfunction, which could be useful for risk stratification or to monitor treatment response. Approach and Results: We used affinity proteomics to identify EC proteins circulating in plasma that were associated with cardiovascular disease risk factor exposure. Two hundred sixteen proteins, which we previously predicted to be EC-enriched across vascular beds, were measured in plasma samples (n=1005) from the population-based SCAPIS (Swedish Cardiopulmonary Bioimage Study) pilot. Thirty-eight of these proteins were associated with body mass index, total cholesterol, low-density lipoprotein, smoking, hypertension, or diabetes. Sex-specific analysis revealed that associations predominantly observed in female- or male-only samples were most frequently with the risk factors body mass index, or total cholesterol and smoking, respectively. We show a relationship between individual cardiovascular disease risk, calculated with the Framingham risk score, and the corresponding biomarker profiles. Conclusions: EC proteins in plasma could reflect vascular health status.

Daily Triglyceride Kinetics When Consuming a Realistic Western Diet in at-Risk Individuals across the Metabolic Spectrum: A Case Study

High postprandial triglycerides are a strong cardiovascular disease risk factor. However, the extent triglycerides rise during daily living due to multiple meals remains poorly defined, especially in at-risk individuals. The aim of this case study was to quantify 24-h triglycerides in an individual with normal-weight obesity (NWO), metabolic syndrome (MetS), and type 2 diabetes (T2D) consuming a Western-style diet. In the morning, an indwelling catheter was inserted into a forearm vein and metabolic markers were measured hourly for 18-h and every 3-h for the last 6-h. The participants with NWO and T2D both experienced peak triglycerides ~280 mg/dL, which is considered an adverse response. The participant MetS had a similar relative change in triglycerides, but only reached 214 mg/dL. Interestingly, The participant with NWO displayed the greatest triglyceride area under the curve. Overall, we report that all three participants’ triglycerides nearly tripled with Western diet consumption, despite considerably different risk-profiles.

Compositional and functional properties of high-density lipoproteins in relation to coronary in-stent restenosis

IntroductionIn-stent restenosis (ISR) is an unfavorable outcome that occurs in patients after coronary stenting. Using of drugs like statins as well as drug-eluting stents has only been partially effective in reducing the rate of ISR. Since low high-density lipoprotein cholesterol (HDL-C) concentration is a pivotal cardiovascular disease risk factor, this study aimed the evaluation of the compositional and functional alterations of HDL in individuals with ISR.Material and methodsThis case-control study comprised 21 ISR, 26 non-ISR, 16 angiography-negative, and 18 healthy subjects. Serum HDL2 (d: 1.063-1.125 g/mL) and HDL3 (d: 1.125-1.210 g/mL) subfractions were extracted from each subject using sequential ultracentrifugation. The capacity of HDL to efflux cellular cholesterol from lipid-loaded macrophages as well as to uptake free cholesterol (FC) from triglyceride-rich lipoproteins (TGRL) during lipolysis were assessed.ResultsNo difference was found in the HDL2 and HDL3 content of free cholesterol and total protein among the groups. NISR group showed reduced triglyceride content in HDL2 and increased phospholipid content in HDL3 relative to healthy subjects. Strong positive correlations were found between the cholesterol efflux capacity (CEC) of HDL2 and its phospholipid content in the healthy (r=0.50), angiography-negative (r=0.55) and ISR (r=0.52) groups. The capacity of apolipoprotein B (apoB)-depleted serum to uptake free cholesterol was not different among the groupsConclusionsDespite some compositional alterations, the capacity of HDL to efflux cholesterol from lipid-loaded macrophages as well as to uptake free cholesterol from TGRLs during lipolysis were not associated with ISR in this study

A precision medicine approach to sex-based differences in ideal cardiovascular health

Cardiovascular disease risk factor profiles and health behaviors are known to differ between women and men. Sex-based differences in ideal cardiovascular health were examined in the My Research Legacy study, which collected cardiovascular health and lifestyle data via Life’s Simple 7 survey and digital health devices. As the study overenrolled women (n = 1251) compared to men (n = 310), we hypothesized that heterogeneity among women would affect comparisons of ideal cardiovascular health. We identified 2 phenogroups of women in our study cohort by cluster analysis. The phenogroups differed significantly across all 7 cardiovascular health and behavior domains (all p < 0.01) with women in phenogroup 1 having a lower Life’s Simple 7 Health Score than those in phenogroup 2 (5.9 ± 1.3 vs. 7.6 ± 1.3, p < 0.01). Compared to men, women in phenogroup 1 had a higher burden of cardiovascular disease risk factors, exercised less, and had lower ideal cardiovascular health scores (p < 0.01). In contrast, women in phenogroup 2 had fewer cardiovascular risk factors but similar exercise habits and higher ideal cardiovascular health scores than men (p < 0.01). These findings suggest that heterogeneity among study participants should be examined when evaluating sex-based differences in ideal cardiovascular health.

Racial disparities in prevalence of cardiovascular disease risk factors in head and neck cancer patients

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): American Heart Association Pre-doctoral Fellowship Background Cancer patients and survivors have higher burden of cardiovascular diseases than the age-adjusted general population. However, evidence on distribution of cardiovascular disease risk factors in cancer patients is limited. Purpose Our aim was to assess if racial disparities exist in prevalence of cardiovascular disease risk factors in head and neck cancer patients. Methods In this clinical cohort, we included 2299 head neck squamous cell carcinoma (HNSCC) patients diagnosed between 2012-2018 at a National Cancer Institute-designated Cancer Center. We used a combination of ICD-9/10 codes, medication use and pharmacy records from electronic medical records data, to identify cardiovascular disease risk factors (hypertension, dyslipidemia and diabetes mellitus). We reported prevalence of cardiovascular disease risk factors at and one year-post HNSCC diagnosis, by race, using Chi-square or Wilcoxon test, as appropriate. Results Black HNSCC patients were diagnosed at a slightly younger age (median: 60.0 vs 62.0 years, p-value 0.0745), had a higher proportion of males (p-value 0.0221) and advanced cancer stage at diagnosis (p-value 0.0033), than white HNSCC patients. At diagnosis, 32.63% of black HNSCC patients had hypertension and 34.44% had at least one cardiovascular disease risk factor, compared to 24.59% and 27.74% in whites, respectively (p-values 0.0020 and 0.0127, respectively). At one-year post HNSCC diagnosis, 84.73% of all HNSCC patients had at least one cardiovascular disease risk factor. No statistically significant racial differences were observed for hypertension and diabetes mellitus at one-year post HNSCC diagnosis, however, 37.74% of white HNSCC patients had dyslipidemia compared to 27.49% black patients (p-value 0.003). Conclusion Higher prevalence of hypertension and advanced cancer stage at HNSCC diagnosis in black patients highlights issues of racial disparity and unequal access to care. High prevalence of cardiovascular disease risk factors at one-year post HNSCC diagnosis and increase in dyslipidemia in white patients emphasizes the impact of therapeutic agents and need for routine personalized monitoring of cardiovascular disease risk factors and cardiovascular disease preventive services in high risk HNSCC patients.