Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study.

AIMS: The aim was to determine whether the effect of smoking on the development of peripheral or coronary artery disease might be mediated by other cardiovascular risk factors, including dietary antioxidant vitamin intake, serum low and high density lipoproteins, blood pressure, plasma fibrinogen, blood viscosity and markers of endothelial disturbance and fibrin turnover. METHODS AND RESULTS: 1592 men and women aged 55-74 years were selected at random from 11 general practices in Edinburgh, Scotland and followed-up for 5 years. The incidences of peripheral arterial disease and coronary artery disease were 5.1% and 11.1%, respectively. Both conditions were more common in moderate and heavy smokers than in never smokers: cigarette smoking was a stronger risk factor for peripheral arterial disease than for coronary artery disease. Smoking was associated with reduced dietary antioxidant vitamin intake, serum high density lipoprotein cholesterol and diastolic blood pressure and with increased alcohol intake, serum triglycerides, blood viscosity, plasma fibrinogen, and markers of endothelial disturbance (tissue plasminogen activator and von Willebrand factor antigens). Simultaneous adjustment for these risk factors reduced the relative risk of peripheral arterial disease only slightly, from 3.94 (95% CI 2.04, 7.62) to 2.72 (95% CI 1.13, 6.53) in heavy smokers and from 1.87 (95% CI 0.91, 3.85) to 1.70 (95% CI 0.72, 3.99) in moderate smokers. Similar adjustment also had little effect on the risk of coronary artery disease associated with smoking. CONCLUSION: The combined effect of smoking on the cardiovascular risk factors studied may explain part of its influence on peripheral and coronary arterial disease, but the majority of the effect appears to be due to other mechanisms.     

Associations of blood rheology and interleukin-6 with cardiovascular risk factors and prevalent cardiovascular disease

Haemorheological variables (whole-blood, plasma and relative blood viscosity, haematocrit, red cell aggregation, white cell count and fibrinogen) were measured in 753 men and 821 women aged 25-74 years, and related to cardiovascular risk factors and prevalent cardiovascular disease (CVD). Men had higher levels than women of blood viscosity, haematocrit, corrected viscosity and relative viscosity. Post-menopausal women had higher levels than pre-menopausal women of blood viscosity, haematocrit, corrected blood viscosity, plasma viscosity and fibrinogen: each of these differences was completely or partly abolished by use of hormone replacement therapy. Serum total cholesterol, triglycerides, diastolic blood pressure, body mass index and smoking markers showed positive associations with most rheological variables, whereas HDL-cholesterol, plasma vitamin C and social class showed inverse associations. Rheological variables were associated with prevalent CVD after age-adjustment. However, after multiple risk factor adjustment only plasma viscosity and red cell aggregation showed significant (P<0.04) associations in both men and women (comparing top to bottom quarters). Plasma interleukin-6 (measured in a 25% subsample of 196 men and 221 women) correlated significantly with age, fibrinogen, white cell count, plasma and blood viscosity, current smoking, and (in men) with low serum vitamin C levels; but not with other major risk factors or with prevalent cardiovascular disease.     

Helicobacter pylori infection: relation with cardiovascular risk factors,ischaemic heart disease,and social class.

OBJECTIVE--To determine whether Helicobacter pylori infection is associated with the development of ischaemic heart disease and whether such infection can explain the social class inequality in ischaemic heart disease. DESIGN--Cardiovascular risk factor levels, prevalence of ischaemic heart disease (Rose questionnaire angina, and/or a history of myocardial infarction), and serum antibodies to H pylori (enzyme linked immunosorbent assay) were assessed in a cross sectional population based survey. SETTING--Belfast and surrounding districts, Northern Ireland. PARTICIPANTS--1182 men and 1198 women aged 25-64 years randomly selected from the Central Services Agency''s general practitioner lists. MAIN OUTCOME MEASURES--The relation of H pylori infection with cardiovascular risk factors and ischaemic heart disease. The association of social class with ischaemic heart disease. RESULTS--Systolic and diastolic blood pressure, plasma viscosity, and total cholesterol were not associated with H pylori infection. A weak negative association existed between H pylori infection and fibrinogen (mean (SE) difference in fibrinogen between infected and uninfected individuals -0.09 (0.04) g/l, P = 0.02) and between infection in women and high density lipoprotein (HDL) cholesterol (mean (SE) difference in HDL cholesterol between infected and uninfected individuals -0.06 (0.02) mmol/l, P = 0.006). A potentially important association was demonstrated between H pylori infection and ischaemic heart disease but this did not reach statistical significance (odds ratio (95% confidence interval (CI) 1.51 (0.93 to 2.45), P = 0.1). Social class was associated with ischaemic heart disease independently of cardiovascular risk factors and H pylori infection (odds ratio, manual v non-manual (95% CI) 1.82 (1.14 to 2.91), P = 0.01). CONCLUSION--H pylori may be independently associated with the development of ischaemic heart disease but if this is so the mechanism by which this effect is exerted is not through increased concentration of plasma fibrinogen. H pylori infection does not explain the social class inequality in ischaemic heart disease which exists independently of known cardiovascular risk factors.     

Cardiovascular risk profile and type of alcohol beverage consumption: a population-based study

AIMS: To determine the association between several cardiovascular risk factors with total alcohol and types of alcoholic beverage consumption. METHODS: The subjects were Spanish men (n = 2,383) and women (n = 2,535) aged 25-74 years who were examined in 1994-1995 and 1999-2000, in two population-based cross-sectional surveys in the north-east of Spain (Gerona). Information of total amount and type of alcohol consumption, educational level, smoking, leisure-time physical, antihypertensive and hyperlipidemic drug treatment was obtained through structured questionnaires. The cardiovascular risk factors total cholesterol, HDL cholesterol, triglycerides, fasting glucose, fibrinogen, lipoprotein (a), heart rate and systolic and diastolic blood pressures were determined. RESULTS: Men consumed significantly more alcohol than women (19.5 vs. 4.5 g/day, respectively) and the prevalence of elevated alcohol consumption (>2 glasses of wine/day) also was higher in men (35.3%) than women (3.5%). Total alcohol intake was significantly related with HDL cholesterol and fibrinogen improvements in both genders. In contrast, total cholesterol, triglycerides, heart rate, and systolic and diastolic blood pressures were directly and significantly (p < 0.05) associated with total alcohol consumption in men but not in women. Wine drinking, particularly in women, was associated with a healthy cardiovascular risk profile. Most of the observed significant associations between type of alcohol beverage and CHD risk factors disappeared after controlling for total alcohol consumption and other confounders. CONCLUSIONS: Alcohol consumption was favorably related to the cardiovascular risk profile in women but not in men. The relationship of alcohol beverages seems to be mediated by the total alcohol content rather than by the type of beverage itself.     

Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study

We examined the relationships of whole blood viscosity and its major determinants to incident cardiovascular events (ischaemic heart disease and stroke) in a prospective study of a random population sample of 1592 men and women aged 55–74 years (the Edinburgh Artery Study). 272 fatal and non-fatal cardiovascular events occurred during 5 years of follow-up (cumulative incidence 17.1%). Age and sex adjusted mean levels of blood viscosity (3.70 v 3.55 mPa.s), haematocrit (46.2 v 45.7%), haematocrit-corrected blood viscosity (3.57 v 3.48 mPa.s), plasma viscosity (1.35 v 1.33 mPa.s) and fibrinogen (2.88 v 2.67 g/l) were significantly higher in subjects who experienced events than in subjects who did not. The relationships of these rheological variables to cardiovascular events were at least as strong as those of conventional risk factors (smoking habit, diastolic blood pressure, and low-density lipoprotein cholesterol). After adjustment for these conventional risk factors, the associations of blood viscosity and haematocrit remained significant for stroke, but not for total events; whereas the associations of plasma viscosity and fibrinogen remained significant for total events and for stroke.
These findings suggest that increased blood viscosity may be one plausible biological mechanism through which increases in haematocrit and fibrinogen may promote ischaemic heart disease and stroke. Randomized controlled trials of viscosity reduction in the prevention of cardiovascular events (e.g. by lowering high levels of haematocrit or plasma fibrinogen) are suggested.     

Intra-abdominal thickness by ultrasonography to predict risk factors for cardiovascular disease and its correlation with anthropometric measurements

The aim of this study was to determine if intra-abdominal thickness measured by ultrasonography (IATU) in men and women had a correlation with cardiovascular risk factors, to compare it with anthropometric measures (waist circumference [WC] and abdominal sagittal diameter [SDi]), and to find a cut-off value for IATU to predict risk factors for cardiovascular disease (CVD). In a cross-validation study, intra-abdominal fat tissue measured by CT at L4-L5 was significantly correlated with ultrasonography (US) intra-abdominal thickness. A total of 191 and 231 healthy men and women, respectively, aged 20 to 60 years, were evaluated by anthropometric indexes (body mass index [BMI], WC, and SDi), and systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting total plasma cholesterol (Chol), high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and glucose (Glu) levels. IATU was evaluated by the distance between the internal face of abdominal muscles and posterior wall of the aorta. All measurements were taken by the same physician. The subjects were divided into 3 cardiovascular risk groups, according to the presence of 2 or more risk factors-(1) moderate-risk (MR) group with 2 or more of the following: total Chol > 200 mg/dL, HDL cholesterol < 45 mg/dL, TG > 200 mg/dL, Glu > 126 mg/dL, SBP > 140 mm Hg, DBP > 90 mm Hg, comprising 68 men and 72 women; (2) high-risk (HR) group with 2 or more of the following: total Chol > 240 mg/dL, HDL cholesterol < 35 mg/dL, TG > 200 mg/dL + HDL cholesterol < 35 mg/dL, Glu > 126 mg/dL, SBP > 140 mm Hg, DBP > 90 mm Hg, comprising 34 men and 55 women; and (3) no-risk (NR) group with only 1 or none of the risk factors indicated in the MR and HR groups. IATU presented association with risk factors and presented a higher level of accuracy and specificity than SDi and WC (odds ratio [OR] = 2.27 [95% confidence interval (CI), 1.05 to 4.80] for men and OR = 3.69 [95% CI, 1.98 to 66.90] for women). The cut-off length to predict moderate risk was 7 cm for both sexes (OR = 2.86 [95% CI, 1.44-5.68] for men and OR = 3.01 [95% CI, 11.61 to 5.62] for women), whereas the value of 9 cm predicted high risk for CVD (OR = 5.55 [95% CI, 2.32 to 13.28]) in men and of 8 cm in women (OR = 3.27 [95% CI, 1.63 to 6.56]). In conclusion, IATU is a useful tool to evaluate visceral fat and seems to be predictive of risk factors associated with CVD.     

Prevalence and associated factors of cardiovascular diseases among men and women aged 45 years and above: Analysis of the longitudinal ageing study in India, 2017–2019

ObjectiveEpidemiological studies on the prevalence and associated factors of cardiovascular diseases (CVDs) representative of all states of India among middle-aged and elderly are not much reported. The present study estimates the prevalence and associated factors of cardiovascular diseases across Indian states among men and women aged ≥45 years.MethodsWe used data from the Longitudinal Ageing Study in India wave 1 (2017–2019), which included a final analytical sample size of 56,935 adults and their spouses aged 45 years and above. We estimated CVDs prevalence for sociodemographic and behavioural variables, and multivariable logistic regression was used to assess the association between behavioural factors and CVDs in both men and women.ResultsThe prevalence of CVDs was 5.2% among adults ≥45 years (women: 4.6%; men: 5.9%), hypertension was 46.7% (women:48.9%; men:44%). Men and women have a similar prevalence of diabetes (11.9%) and cholesterol (2.3%). Prevalence of physical inactivity was 30.3% (women:27%; men:34.1%). Hypertension (adjusted odds ratio; aOR women:2.60, 95% CI: 2.08–3.25, men:1.88, 95% CI 1.54–2.29), hypercholesterolemia (aOR women:1.70; 95% CI 1.07–2.69, men 3.55; 95% CI 2.66–4.74), diabetes (aOR women:2.53; 95% CI 1.83–3.51, men:1.77 95% CI 1.44–2.17), obesity, physical inactivity, and smoking in men were significantly associated with CVDs.ConclusionThe prevalence of CVDs and lifestyle risk factors among middle-aged and elderly poses severe concerns regarding noncommunicable disease (NCD) healthcare services provided in a lower-middle-income country like India. The key to preventing CVDs is controlling hypertension, diabetes, hypercholesterolemia, and increasing physical activity among adults aged ≥45 years.     

Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland

BACKGROUND: Coronary heart disease (CHD) is markedly more common in men than in women. In both sexes, CHD risk increases with age, but the increase is sharper in women. We analyzed the extent to which major cardiovascular risk factors can explain the sex difference and the age-related increase in CHD risk. METHODS AND RESULTS: The study cohort consists of 14 786 Finnish men and women 25 to 64 years old at baseline. The following cardiovascular risk factors were determined: smoking, serum total cholesterol, HDL cholesterol, blood pressure, body mass index, and diabetes. Risk factor measurements were done in 1982 or 1987, and the cohorts were followed up until the end of 1994. The Cox proportional hazards model was used to assess the relation between risk factors and CHD risk. CHD incidence in men compared with women was approximately 3 times higher and mortality was approximately 5 times higher. Most of the risk factors were more favorable in women, but the sex difference in risk factor levels diminished with increasing age. Differences in risk factors between sexes, particularly in HDL cholesterol and smoking, explained nearly half of the difference in CHD risk between men and women. Differences in serum total cholesterol level, blood pressure, body mass index, and diabetes prevalence explained about one-third of the age-related increase in CHD risk among men and 50% to 60% among women. CONCLUSIONS: Differences in major cardiovascular risk factors explained a substantial part of the sex difference in CHD risk. An increase in risk factor levels was associated with the age-related increase in CHD incidence and mortality in both sexes but to a larger extent in women.     

Plasma triglyceride and high density lipoprotein cholesterol as predictors of ischaemic heart disease in British men. The Caerphilly and Speedwell Collaborative Heart Disease Studies.

OBJECTIVE--To assess the roles of plasma triglyceride and high density lipoprotein (HDL) cholesterol concentrations in predicting ischaemic heart disease. DESIGN--Two prospective cohort studies with common core protocols. SETTING AND PARTICIPANTS--Both cohorts are 100% samples of middle aged men. In Caerphilly the 2512 men were living within a defined area. In Speedwell the 2348 men were registered with local general practitioners. MAIN OUTCOME MEASURES--Fasting blood samples were taken at initial examination and plasma lipid concentrations were measured. Major ischaemic heart disease events were assessed from hospital notes, death certificates, and electrocardiograms. RESULTS--At first follow up, after an average of 5.1 years in Caerphilly and 3.2 years in Speedwell, 251 major ischaemic heart disease events had occurred. Men with triglyceride concentrations in the top 20% of the distribution had a relative odds value for ischaemic heart disease of 2.3 (95% confidence interval (95% CI) 1.3 to 4.1) compared with men in the bottom 20%, after adjusting for both plasma total and HDL cholesterol, and non-lipid risk factors. Men in the lowest 20% of the distribution of HDL cholesterol concentration had a relative odds value of 1.7 (95% CI 1.0 to 2.8) compared with the top 20%, after adjustment was made for total cholesterol and triglyceride concentrations, and non-lipid risk factors. These relations were not caused by beta blockers, which were being taken by 5% of the men. CONCLUSIONS--Plasma triglyceride concentration predicts major ischaemic events after allowance is made for total and HDL cholesterol concentrations and other risk factors. In these populations, triglyceride is a more important predictor than total cholesterol concentration.     

Determinants of peripheral arterial disease in the elderly: the Rotterdam study

OBJECTIVE: To examine which atherosclerotic risk factors are determinants for peripheral arterial disease (PAD), we performed a population-based study in 6450 subjects (40% men, 60% women) aged 55 years and older. METHODS: The presence of PAD was assessed by measuring the ankle-arm systolic blood pressure index (AAI); PAD was considered present if the AAI was lower than 0.90 in either leg. In addition, a threshold AAI of 0.70 in either leg defined severe PAD. RESULTS: Determinants strongly and independently associated with PAD were age of at least 75 years (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.6), fibrinogen level (OR, 1.5; 95% CI, 1.3-1.7), cigarette smoking (OR, 2.8; 95% CI, 2.3-3.4), diabetes mellitus (OR, 2.0; 95% CI, 1.6-2.5), and systolic blood pressure (OR, 1.2; 95% CI, 1.1-1.2). An inverse relation of high-density lipoprotein cholesterol level with PAD (OR, 0.7; 95% CI, 0.5-0.8) was found. Similar results were demonstrated for severe PAD. Separate analyses for men and women did not demonstrate differences in risk factors for PAD. CONCLUSIONS: Assessment of a wide range of atherosclerotic risk factors enabled us to quantify the relative importance of each factor as determinant for PAD. In total, 69% of the occurrence of PAD is attributable to cardiovascular risk factors measured in our study; smoking accounted for most (etiologic fraction, 18.1%). The results suggest that preventive management of PAD should be directed at systolic blood pressure, fibrinogen level, smoking, high-density lipoprotein cholesterol level, and diabetes mellitus. Arch Intern Med. 2000;160:2934-2938     

High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age

BACKGROUND: A high total serum cholesterol level does not carry a risk of cardiovascular mortality among people 85 years and older and is related to decreased all-cause mortality. At this old age, there are few data on fractionated lipoprotein levels in the determination of cardiovascular disease risk. The aim of this study was to evaluate the relationships between low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels and mortality from specific causes among people in the oldest age categories. METHODS: Between September 1, 1997, and September 1, 1999, a total of 705 inhabitants in the community of Leiden, the Netherlands, reached the age of 85 years. Among these old people, we initiated a prospective follow-up study to investigate determinants of successful aging. A total of 599 subjects participated (response rate, 87%) and all were followed up to September 2001. Serum levels of total, LDL, and HDL cholesterol were assessed at baseline along with detailed information on comorbid conditions. The main outcome measure was all-cause and specific mortality risk. RESULTS: During 4 years of follow-up, 152 subjects died. The leading cause of death was cardiovascular disease, with similar mortality risks in all tertiles of LDL cholesterol level. In contrast, low HDL cholesterol level was associated with a 2.0-fold higher risk of fatal cardiovascular disease (95% confidence interval [CI], 1.2-3.2). The mortality risk of coronary artery disease was 2.0 (95% CI, 1.0-3.9) and for stroke it was 2.6 (95% CI, 1.0-6.6). Both low LDL cholesterol and low HDL cholesterol concentrations were associated with an increased mortality risk of infection: 2.7 (95% CI, 1.2-6.2) and 2.4 (95% CI, 1.1-5.6), respectively. The risks were unaffected by comorbidity. CONCLUSION: In contrast to high LDL cholesterol level, low HDL cholesterol level is a risk factor for mortality from coronary artery disease and stroke in old age.     

Biochemical indicators of coronary arteriosclerosis]

In 251 patients undergoing cardiac catheterization, plasma levels of lipids, lipoproteins, apoproteins and nonlipid risk factors as fibrinogen, fibrinolysis time, glucose and uric acid in blood were correlated with the incidence and severity of coronary artery disease (CAD). There were significant differences between CAD group and controls and between men and women with CAD with respect to the mean lipid values. Among the nonlipid risk factors fibrinogen concentration in CAD patients was significantly higher than in controls. In univariate analysis in men, score for the severity of atherosclerosis was strongly related to the apoB and LDL concentration, less to the HDL and fibrinogen levels and to ratios of total cholesterol/HDL and LDL/HDL. In women severity of the disease correlated with apoB, fibrinolysis time, fibrinogen and triglyceride levels. By stepwise multivariate analysis, in both men and women, apoB was selected as the best discriminator between CAD patients and controls. The results of the study indicate that the levels of apoB may be a more accurate predictor of the severity of CAD than the other biochemical risk factors. The presented data also suggests an association between increased fibrinogen concentration, reduced fibrinolytic capacity and CAD. The values of apoB and fibrinogen as indicators of cardiovascular risk should be assessed in prospective studies.     

Gender differences in the prevalence and determinants of the metabolic syndrome in screened subjects at risk for coronary heart disease

Background: The metabolic syndrome is prevalent among individuals with coronary heart disease (CHD) risk factors. This study's goal was to compare gender differences in the prevalence and determinants of the metabolic syndrome in subjects who were re-examined after a cardiovascular risk factor screening program. Methods: In a population-based cross-sectional study of 14,811 screened men and women aged 30, 40, 45, and 59 to 60 years, 1,491 subjects in the predetermined risk categories of high glucose (n = 64, 69% male), cholesterol (n = 496, 66.3% male), and blood pressure (n = 362, 63.5% male) or Framingham risk score (n = 253, 93.7% male) or low HDL cholesterol (n = 316, 79.1% male) underwent further examination. Results: The metabolic syndrome was more prevalent among women than among men in the same risk categories with the exception of the blood pressure category. Women with the metabolic syndrome had a higher BMI and C reactive protein (CRP) levels, and were more likely to meet the waist circumference criterion than men (92% versus 70%; P < 0.0001). In multivariate analysis, BMI (odds ration(OR) 25.8, 95% CI 14.3-46.3 for >/=30 kg/m(2) versus < 25 kg/m(2)), CRP (OR 1.9, 95% CI 1.3-2.7 for the highest versus the lowest tertile) and female gender (OR 1.7, 95% CI 1.2-2.3 versus male) were associated with the metabolic syndrome after adjustment for age, physical activity, smoking, and family history of premature cardiovascular disease. Conclusion: The metabolic syndrome was more prevalent and more strongly characterized by obesity and low grade inflammation in women than men. These findings underscore the need to study gender-specific approaches to screen for CHD risk.     

HDL cholesterol efflux capacity and incident cardiovascular events

Background It is unclear whether high-density lipoprotein(HDL) cholesterol concentration plays a causal role in atherosclerosis. A more important factor may be HDL cholesterol efflux capacity, the ability of HDL to accept cholesterol from macrophages, which is a key step in reverse cholesterol transport. We investigated the epidemiology of cholesterol efflux capacity and its association with incident atherosclerotic cardiovascular disease outcomes in a large, multiethnic population cohort.Methods We measured HDL cholesterol level, HDL particle concentration, and cholesterol efflux capacity at baseline in 2924 adults free from cardiovascular disease who were participants in the Dallas Heart Study, a probabilitybased population sample. The primary end point was atherosclerotic cardiovascular disease, defined as a first nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization or death from cardiovascular causes. The median follow-up period was 9.4 years.Results In contrast to HDL cholesterol level, which was associated with multiple traditional risk factors and metabolic variables, cholesterol efflux capacity had minimal association with these factors. Baseline HDL cholesterol level was not associated with cardiovascular events in an adjusted analysis(hazard ratio, 1.08;95% confidence interval [CI], 0.59 to 1.99). In a fully adjusted model that included traditional risk factors,HDL cholesterol level, and HDL particle concentration, there was a 67% reduction in cardiovascular risk in the highest quartile of cholesterol efflux capacity versus the lowest quartile(hazard ratio, 0.33; 95% CI, 0.19 to 0.55). Adding cholesterol efflux capacity to traditional risk factors was associated with improvement in discrimination and reclassification indexes.Conclusions Cholesterol efflux capacity, a new biomarker that characterizes a key step in reverse cholesterol transport,was inversely associated with the incidence of cardiovascular events in a population-based cohort.(From: N Engl J Med 2014; 371:2383-2393 December 18, 2014DOI: 10.1056 / NEJMoa1409065)     

Femoral atherosclerosis in an older British population: prevalence and risk factors

Most estimates of the prevalence of peripheral atherosclerosis have been based on intermittent claudication or lower limb blood flow. The aim of this study was therefore to determine the prevalence of underlying femoral plaque, and to determine its association with other cardiovascular disease and risk factors. Presence of plaque was identified using ultrasound in a random sample of men (n=417) and women (n=367) aged 56-77 years. Coexistent cardiovascular disease, exercise and smoking were determined by questionnaire, blood pressure was recorded, and serum cholesterol and plasma fibrinogen were determined. Of the 784 subjects that were scanned, 502 (64%) demonstrated atherosclerotic plaque. Disease prevalence increased significantly with age (P<0.0001), and was more common in men (67.1 vs. 59.4%, P<0.05). Subjects with femoral plaque had a significantly greater odds of previous ischaemic heart disease (OR 2. 2, 95% CI 1.3, 3.7) and angina (OR 1.7, 95% CI 1.03, 2.7), but not of stroke or leg pain on exercise. Current and ex-smoking, raised serum total cholesterol and plasma fibrinogen levels, but not blood pressure, were associated with an increased risk of femoral plaque, independent of age and sex. Frequent exercise and a high HDL cholesterol were significantly associated with lower risk. In conclusion, therefore, atherosclerotic disease of the femoral artery affects almost two-thirds of the population in late middle age. It is associated with an increased prevalence of ischaemic heart disease and angina, but whether detecting at risk individuals using ultrasound offers advantages over simpler and less expensive risk factor scoring requires evaluation in trials.     

Direct, progressive association of cardiovascular risk factors with incident proteinuria: results from the Korea Medical Insurance Corporation (KMIC) study

BACKGROUND: Proteinuria is a major risk factor for the progression of kidney disease and the development of cardiovascular disease. Little is known, however, about risk factors for incident proteinuria. METHODS: We conducted a 10-year prospective cohort study of 104,523 Korean men and 52,854 women, aged 35 to 59 years, who attended Korea Medical Insurance Corporation health examinations and who did not have proteinuria at baseline. Incident proteinuria was assessed at biennial examinations during the next 10 years. We performed Cox proportional hazards analyses. RESULTS: During 10 years of follow-up, proteinuria developed in 3951 men (3.8%) and 1527 women (2.9%). The adjusted relative risk (RR) of proteinuria associated with diabetes was 3.27 (95% confidence interval [CI], 2.98-3.58) in men and 2.60 (95% CI, 1.98-3.43) in women; with body mass index (calculated as weight in kilograms divided by the square of height in meters), it was 1.43 (95% CI, 1.35-1.50) in men and 1.45 (95% CI, 1.35-1.55) in women per 5-U increment. Compared with subjects with serum cholesterol levels of less than 200 mg/dL (< 5.18 mmol/L), the adjusted RRs associated with serum cholesterol levels of 200 to 239 mg/dL (5.18-6.19 mmol/L) and 240 mg/dL or more (> or = 6.22 mmol/L) were 1.13 (95% CI, 1.05-1.21) and 1.40 (95% CI, 1.27-1.54), respectively, in men and 1.14 (95% CI, 1.01-1.28) and 1.22 (95% CI, 1.00-1.37), respectively, in women. Persons with stages 1 and 2 hypertension had a greater adjusted RR of incident proteinuria compared with those with normal blood pressure (1.62 [95% CI, 1.47-1.79] and 2.06 [95% CI, 1.81-2.34], respectively, in men and 1.37 [95% CI, 1.14-1.65] and 2.10 [95% CI, 1.59-2.76], respectively, in women). CONCLUSIONS: Fasting glucose and cholesterol levels, body mass index, and blood pressure were direct and independent predictors of incident proteinuria in Korean adults. These associations were present even at low levels of exposure, emphasizing the importance of early detection and management of these modifiable risk factors.     

Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk

OBJECTIVES: This prospective population study was conducted to assess the role of elevated lipoprotein(a) [Lp(a)] as a coronary risk factor. BACKGROUND: The role of elevated Lp(a) as a risk factor for coronary heart disease is controversial. In addition, little attention has been paid to the interaction of Lp(a) with other risk factors. METHODS: A total of 788 male participants of the Prospective Cardiovascular Münster (PROCAM) study aged 35 to 65 years were followed for 10 years. Both Lp(a) and traditional cardiovascular risk factors (e.g., age, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, systolic blood pressure, cigarette smoking, diabetes mellitus, angina pectoris, and family history of myocardial infarction) were evaluated in 44 men who suffered from myocardial infarction, and in 744 men who survived without major coronary events or stroke. A multiple logistic function algorithm was used to estimate global cardiovascular risk by the combined effects of traditional risk factors. RESULTS: Overall, the risk of a coronary event in men with an Lp(a) > or =0.2 g/liter was 2.7 times that of men with lower levels (95% confidence interval [CI]: 1.4 to 5.2). This increase in risk was most prominent in men with LDL cholesterol level > or =4.1 mmol/liter (relative risk [RR]: 2.6; 95% CI: 1.2 to 5.7), with HDL cholesterol < or =0.9 mmol/liter (RR 8.3; 95% CI: 2.0 to 35.5), with hypertension (RR 3.2; 95% CI: 1.4 to 7.2), or within the two highest global risk quintiles (relative risk: 2.7; 95% CI: 1.3 to 5.7). CONCLUSIONS: Lp(a) increases the coronary risk, especially in men with high LDL cholesterol, low HDL cholesterol, hypertension and/or high global cardiovascular risk.     

Action levels for obesity treatment in 40 to 42-y-old men and women compared with action levels for prevention of coronary heart disease.

BACKGROUND: Guidelines for treating overweight and obesity have been suggested by the World Health Organization and other expert groups. We asked whether most men and women targeted in obesity guidelines would already be included in existing clinical recommendations for the prevention of coronary heart disease (CHD) or whether a new group of patients would be added to current workloads. SUBJECTS AND METHODS: In 1997 the Norwegian National Health Screening Service examined CHD risk factors in subjects aged 40-42 y living in three counties. We studied 6911 men and 7992 women who did not report treatment for diabetes, hypertension or the presence of cardiovascular disease. Estimated 10 y risk of CHD was calculated using the Framingham equation. RESULTS: The prevalence of single risk factors (systolic blood pressure > or =160 mmHg, diastolic blood pressure > or =95 mmHg, total cholesterol level > or =7.8 mmol/l and nonfasting glucose > or =11.1 mmol/l) ranged between 0 and 11% among subjects with body mass index > or =25 kg/m2. Adding low HDL cholesterol (<1.0 mmol/l for men, <1.1 mmol/l for women) and 10 y risk CHD risk to the classical risk factors increased prevalence to 16-50% (one or more risk factors or 10 y risk > or =10%). Sensitivities and specificities of using body mass index (BMI) or BMI and waist circumference as a screen for elevated CHD risk ranged between 22 and 91%. Screening for 10 y CHD risk of > or =10% or one or more risk factors among men and screening for one or more risk factors among women gave positive predictive values of 19-50%; however, the positive predictive value of screening for 10 y CHD risk of > or =10% was only 1-2% among women. Compared with men with BMI<30 kg/m2 or waist circumference <102 cm, those with measurements equal to or above these levels had statistically significantly higher adjusted odds ratios of elevated CHD risk (1.49, 95% CI 1.24-1.79 and 1.48, 95% CI 1.22-1.80, respectively); these associations were not observed among women. CONCLUSION: Using BMI and waist circumference to screen for CHD risk yields low positive prediction values, thus doubling the number of men and adding even more to the number of women seen by the practitioner for prevention of CHD.     

The relation of leptin and insulin with obesity-related cardiovascular risk factors in US adults

Previous studies of leptin with cardiovascular disease (CVD) risk factors have been limited by clinical samples or lack of representation of the general population. This cross-sectional study, designed to examine whether leptin or insulin may mediate the endogenous relation of obesity with metabolic, inflammatory, and thrombogenic cardiovascular risk factors, included 522 men and 514 women aged ≥40 years who completed a physical examination during the third National Health and Nutrition Examination Survey. Participants were free of existing CVD, cancer (except non-melanoma skin cancer), diabetes, or respiratory disease. In multivariable analyses adjusted for race/ethnicity and lifestyle factors, waist circumference (WC) was positively associated with blood pressure, triglyceride, LDL cholesterol, total cholesterol:HDL ratio, apolipoprotein B, C-reactive protein (CRP), and fibrinogen concentrations, and negatively associated with HDL cholesterol and apolipoprotein A1 levels. The associations of WC with the metabolic CVD risk factors were largely attenuated after adjustment for insulin levels, while the associations of WC with the inflammatory and thrombogenic factors (CRP and fibrinogen, respectively) were largely explained by adjustment for leptin concentrations. However, leptin levels were not independently associated with CRP and fibrinogen in men and CRP in women when adjusted for WC. Positive associations of leptin and insulin with fibrinogen in women, independent of WC, were noted. These results suggest that insulin may be an important mediator of the association of obesity with metabolic but not inflammatory or thrombogenic CVD risk factors, while leptin does not appear to influence cardiovascular risk through a shared association with these risk factors. However, we cannot rule out the possibility that leptin and insulin influence cardiovascular risk in women through independent effects on fibrinogen concentrations.     

Nontraditional risk factors for coronary heart disease incidence among persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND: Major risk factors explain much of the excess risk for coronary heart disease produced by diabetes, but nontraditional factors may also relate to incident coronary heart disease. OBJECTIVE: To examine the association of traditional and nontraditional risk factors with incidence of coronary heart disease in adults with diabetes. DESIGN: Prospective cohort study. SETTING: The Atherosclerosis Risk in Communities (ARIC) Study. PARTICIPANTS: 1676 middle-aged persons who had diabetes but no history of prevalent coronary heart disease. MEASUREMENTS: Multiple risk factors were recorded at baseline. Follow-up was from 1987 through 1995. RESULTS: 186 participants developed incident coronary heart disease events during follow-up. As expected, the incidence of coronary heart disease in participants with diabetes was associated positively with traditional risk factors (hypertension, smoking, total cholesterol level, and low high-density lipoprotein [HDL] cholesterol level). After adjustment for sex, age, ethnicity, and ARIC field center, incident coronary heart disease was also significantly associated with waist-to-hip ratio; levels of HDL3 cholesterol, apolipoproteins A-I and B, albumin, fibrinogen, and von Willebrand factor factor VIII activity; and leukocyte count. However, after adjustment for traditional risk factors for coronary heart disease, only levels of albumin, fibrinogen, and von Willebrand factor; factor VIII activity; and leukocyte count remained independently associated with coronary heart disease (P < 0.03). The relative risks associated with the highest compared with lowest groupings of albumin, fibrinogen, factor VIII, and von Willebrand factor values and leukocyte count were 0.64 (95% CI, 0.44 to 0.92), 1.75 (CI, 1.12 to 2.73), 1.58 (CI, 1.02 to 2.42), 1.71 (CI, 1.11 to 2.63), and 1.90 (CI, 1.16 to 3.13), respectively. Adjustment for diabetes treatment status attenuated these associations somewhat. CONCLUSIONS: Levels of albumin, fibrinogen, and von Willebrand factor; factor VIII activity; and leukocyte count were predictors of coronary heart disease among persons with diabetes. These associations may reflect 1) the underlying inflammatory reaction or microvascular injury related to atherosclerosis and a tendency toward thrombosis or 2) common antecedents for both diabetes and coronary heart disease.