Reducing global risk for cardiovascular disease: using lifestyle changes and pharmacotherapy

Cardiovascular disease (CVD) is the leading cause of death and disability in industrialized societies, due in large part to the lack of a comprehensive approach to control the risk factors for atherosclerosis. One strategy for reducing an individual's global CVD risk relies on a targeted approach that modifies each of the major independent risk factors prevalent in both symptomatic (secondary prevention) and asymptomatic (primary prevention) patients. These interventions include lipid lowering, smoking cessation, blood pressure control, glycemic control, regular exercise, and the use of various medications. This review offers an evidence-based strategy toward reducing an individual's global risk for CVD by addressing the modifiable, major independent risk factors.     

Study of cardiovascular risk factors among tertiary hospital employees and their families

BackgroundThe aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families.Methods and resultsA cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors – current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m² 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%).ConclusionThis indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.     

A pilot comprehensive lifestyle intervention program (CLIP) - Comparison with qualitative lifestyle advice and simvastatin on cardiovascular risk factors in overweight hypercholesterolaemic individuals

Background and Aims

Escalating costs of pharmaceuticals for cardiovascular management highlight the need to develop effective lifestyle intervention programs to reduce reliance on these agents. The aim of this pilot study was to evaluate the efficacy of a Comprehensive Lifestyle Intervention Program (CLIP) compared with qualitative lifestyle advice (L) and Simvastatin plus qualitative lifestyle (S + L) on cardiovascular risk factors.

Methods and Results

Sixty-five overweight adults with hypercholesterolemia were randomised to either L (qualitative advice on diet, exercise), S + L (20 mg/day Simvastatin plus L) or CLIP (6500 kJ structured menu plan: conventional and functional foods contributing <10% energy from saturated fat, ≥3 g soluble fibre, 2.4 g plant sterols, oily fish ≥2 times/week at lunch and dinner, plus exercise advice and self monitoring) for 6 weeks. LDL-cholesterol was lowered in CLIP (−0.57 ± 0.67 mmol/L, 15%) and S + L (−1.43 ± 0.59 mmol/L, 37%), but did not change significantly in L (−0.17 ± 0.59, 4%) (P < 0.001 time-by-treatment interaction). Weight and waist circumference were significantly lowered by CLIP (−4.2 ± 2.2 kg; −5.1 ± 2.3 cm) compared to L (−1.0 ± 1.6 kg; −2.7 ± 3.3 cm) and L + S (−0.7 ± 1.4 kg; −2.4 ± 2.3 cm), (P ≤ 0.003 time-by-treatment interactions). B-carotene levels within treatment groups did not change over time and were not lowered by the CLIP diet compared to L (P > 0.05, all). Blood pressure changes were not different between groups.

Conclusions

The structured CLIP program was more effective than qualitative lifestyle advice in improving weight, waist circumference and LDL-cholesterol without adverse effects on plasma carotenoids over a 6 week period. This program may therefore assist in comprehensive risk factor management, although the sustainability of these benefits needs confirmation.     

老年高同型半胱氨酸血症患者认知功能与心血管因素的关系

目的探讨老年高同型半胱氨酸血症患者认知功能与心血管危险因素的关系。方法选择2011年8月至2013年4月在中国医科大学附属第一医院老年病科住院的患者157例,男75例,女82例,年龄60⁷4〔平均(69.26±4.81)〕岁。根据血浆同型半胱氨酸(Hcy)水平,将患者分为Hcy<16μmol/L组(A组)45例,16μmol/L≤Hcy<30μmol/L组(B组)60例,Hcy≥30μmol/L组(C组)52例。使用Framingham评分(FRS)对心血管因素进行评定;采用简易精神状态量表(MMSE),蒙特利尔认知评估中文版(Mo CA)和日常生活能力量表(ADL)进行认知功能评估。结果与A组比较,B组的血浆Hcy水平显著升高(P<0.05),Mo CA评分显著降低(P<0.05),C组的血浆Hcy水平及FRS显著升高(均P<0.05),MMSE评分、Mo CA评分及ADL评分均显著降低(均P<0.05);与B组相比较,C组的血浆Hcy水平及FRS均显著升高(均P<0.05),MMSE评分及Mo CA评分均显著降低(均P<0.05);高Hcy血症患者的FRS与血浆Hcy水平呈显著正相关(均P<0.05),与MMSE评分及Mo CA评分均呈显著负相关(均P<0.05)。结论老年高同型半胱氨酸血症患者心血管危险因素与认知损害相关,血浆Hcy水平越高,FRS越高,认知功能评分越低。     

库欣综合征患者代谢紊乱及心血管危险因素分析

对173例库欣综合征患者的临床资料进行回顾性分析,并比较35例手术前后资料,发现库欣综合征常合并多种代谢紊乱及心血管危险因素,疾病治愈、皮质醇水平恢复正常后仍可能存在与活动期类似的代谢紊乱和心血管危险因素.     

Sex differences in the impact of nonalcoholic fatty liver disease on cardiovascular risk factors

Background and aims

Information on sex differences in the association of nonalcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD) risk factors is scarce. We examined whether men exhibit greater differences in established CVD risk factors between NAFLD and non-NAFLD than women.

Homocysteine lowering and cardiovascular disease risk: lost in translation

Studies of the general population have suggested that high homocysteine levels are associated with cardiovascular morbidity and mortality. In chronic kidney disease, homocysteine levels rise, and cardiovascular risk increases with declining kidney function. While some studies in this population have found an association between elevated homocysteine and cardiovascular risk, others have noted that this association is largely attenuated by adjustment for kidney function, and several studies of patients with kidney failure have found that lower homocysteine levels predict mortality. Homocysteine levels can be lowered with folate, vitamin B6 and vitamin B12. Three large, randomized, controlled trials of patients with pre-existing cardiovascular disease and two smaller, randomized, controlled trials of patients with kidney failure failed to detect any cardiovascular benefit from homocysteine-lowering vitamins. Several more interventional trials are ongoing, but the available data thus far do not support screening for or treatment of hyperhomocysteinemia.     

Risk factors for primary prevention of cardiovascular disease and risk reduction by lipid control: the OMEGA study risk factor sub-analysis

To identify risk factors for cardiovascular disease (CVD) in hypertensive patients with no history of CVD being treated with antihypertensive drugs, we examined subgroup data (n?=?13?052) from the prospective, observational Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement (OMEGA) study. Risk factors for CVD, stroke and coronary heart disease (CHD) were examined using a Cox proportional hazards model. In addition, the effect of statin therapy at baseline on CHD prevention was analyzed in dyslipidemic patients. The factors significantly related to CVD were female (hazard ratio [HR]?=?0.637, 95% confidence interval [CI] 0.428–0.948), older age (65–69 years: HR?=?2.165, 95% CI 1.214–3.861; 70–74 years: HR?=?2.324, 95% CI 1.294–4.174; ≥75 years: HR?=?2.448, 95% CI 1.309–4.578), family history of CHD (HR?=?1.993, 95% CI 1.249–3.179), diabetes (HR?=?2.287, 95% CI 1.700–3.078), current smoking (HR?=?2.289, 95% CI 1.512–3.466) and alcohol drinking socially (HR?=?0.589, 95% CI 0.379–0.913). Diabetes was a risk factor for both stroke and CHD, while age, family history of CHD, and sodium intake score were risk factors for stroke alone. Sex, dyslipidemia, smoking and exercise habits were risk factors for CHD alone. The risk of CHD in dyslipidemic patients on statin treatment was comparable to the risk in patients without dyslipidemia (HR?=?1.134, 95% CI 0.604–2.126). However, in dyslipidemic patients not on statin treatment, the HR increased to 1.807 (95% CI 1.156–2.825). In conclusion, some risk factors for CVD in hypertensive patients being treated with antihypertensive drugs with no history of CVD differed between CHD and stroke. These results suggest the importance of managing dyslipidemia with a statin for primary prevention of CHD, as well as the importance of hypertension therapy.     

Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study.

AIMS: (i) To report associations between cardiovascular risk factors and heart rate variability (HRV) in a general population and (ii) to provide normal values for various HRV measurements in a healthy European general population sample aged >or=50. METHODS AND RESULTS: Twenty-four-hour electrocardiograms were recorded in 1742 randomly selected SAPALDIA (Swiss cohort study on Air Pollution and Lung Diseases in Adults) participants aged >or=50. In multivariate regression analyses, women (n=895) had a 6.1% lower standard deviation of all normal RR (NN) intervals (SDNN), a 11.4% lower total power (TP), and a 27.2% lower low-frequency (LF) power than men (n=847). Per unit increase in BMI, SDNN decreased by 0.7% and TP decreased by 1.2%. Persons with high blood pressure had a 9.2% lower LF than normotensive persons and current smokers a 15.5% lower LF than never smokers. Each hour of heavy physical exercise was associated with a 2.0% increase in SDNN, a 3.6% increase in the high frequency (HF) range power and a 4.2% increase in LF power. Higher levels of uric acid, high-sensitive C-reactive protein and non-HDL-cholesterol were associated with lower TP, HF and LF. Percentiles of TP and LF/HF as a function of age were calculated for an asymptomatic subsample of participants (n=499) free of cardioactive medications. CONCLUSION: Heart rate variability in a general population sample shows expected associations with all known cardiovascular risk factors, although not identically for all HRV domains. Together with our percentile estimates for HRV as a function of age, these findings could assist scientists in interpreting 24 h HRV values and factors influencing them in an ageing population.     

高动物蛋白饮食对高血压患者血管功能及心血管危险因素的影响

目的 调查高血压患者的生活方式,了解高动物蛋白饮食对血管功能和颈动脉内膜中层厚度等心血管危险因素的影响。方法 在我院心血管门诊选取符合纳入标准的高血压患者88例,通过问卷调查方式获取参与者的一般生活方式,检测肱动脉血流介导的血管舒张功能（FMD）和肱踝脉搏波传导速度,同时收集患者颈动脉内膜中层厚度（IMT）等一般临床资料,分析高动物蛋白饮食与血管功能及颈动脉内膜中层厚度等心血管危险因素的相关性。结果 男性52例,女性36例,年龄中位数42 (38, 53)岁。平均动脉压中位数106 (97, 112) mmHg,最高平均动脉压中位数123 (116, 132) mmHg。FMD中位数5.1 (3.8, 7.3)%,IMT中位数0.9 (0.8, 1.2) mm。在日常饮食中,偏向于高动物蛋白饮食的39例,比较均衡的36例;高动物蛋白饮食与FMD显著负相关,与IMT显著正相关;而且,动物蛋白摄入量较大的受试者倾向于存在更大的心血管风险。结论 高血压患者在接受有效降压治疗的同时,应采取健康的生活方式,均衡饮食,避免过高的动物蛋白摄入量,可能有助于降低心血管疾病风险。     

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study

ObjectiveTo investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS).Material and MethodsThis cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65–74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high–density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity.ResultsAfter adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (β = 3.81, 95 %CI: 0.97–6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (β = 1.61, 95 % CI: 0.72–3.02, p-value <0.05).ConclusionFrailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.     

Interventions that cause weight loss and the impact on cardiovascular risk factors: a systematic review and meta‐analysis

Overweight and obesity increase the risks of diabetes and cardiovascular disease (CVD). This has been shown to be reversed with weight loss. A systematic review and meta‐analysis were performed to determine the effect of weight loss in the primary prevention of CVD. PubMed, Embase and the Cochrane Library databases were searched electronically through to May 2013. Randomized controlled trials assessing weight loss and cardiovascular risk factors and outcomes were included. A random effects meta‐analysis, with sub‐group analyses for degree of weight loss, and age were performed. Because few studies reported clinical outcomes of CVD, analyses were limited to cardiovascular risk factors (83 studies). Interventions that caused any weight loss significantly reduced systolic blood pressure (?2.68 mmHg, 95% CI ?3.37, ?2.11), diastolic blood pressure (?1.34 mmHg, 95% CI ?1.71, ?0.97), low‐density lipoprotein cholesterol (?0.20 mmol L^?1, 95% CI ?0.29, ?0.10), triglycerides (?0.13 mmol L^?1, 95% CI ?0.22, ?0.03), fasting plasma glucose (?0.32 mmol L^?1, 95% CI ?0.43, ?0.22) and haemoglobin A1c(?0.40%, 95% CI ?0.52, ?0.28) over 6–12 months. Significant changes remained after 2 years for several risk factors. Similar results were seen in sub‐group analyses. Interventions that cause weight loss are effective at improving cardiovascular risk factors at least for 2 years. © 2016 World Obesity     

从心血管危险因素看空腹血糖受损切点下调

目的在不同空腹血糖水平下分析心血管危险因素的聚集情况,探讨我国成人空腹血糖受损(IFG)切点下调的合理性.方法对1994年全国25岁以上22.4万人群糖尿病普查中15 564例经口服75克葡萄糖耐量试验检查的人群资料进行分析.结果 (1)将人群按空腹血糖(FPG)0.56 mmol/L间隔分组,BMI≥25 kg/m2、高甘油三酯、高血压及代谢综合征的比率随FPG逐渐上升,FPG 5.0～5.6 mmol/L组超重比率出现明显升高(P=0.001),FPG 5.6～6.1 mmol/L组其余各组分及代谢综合征比率均有明显升高(P＜0.001).(2) 餐后2 h血糖＜7.8 mmol/L时,FPG 5.6～6.1 mmol/L组与FPG＜5.6 mmol/L组比较,BMI≥25 kg/m2、高血压、代谢综合征患病率分别升高25%,15%,46%;糖尿病家族史阳性率增高.(3) 按照1999年WHO诊断分型标准及2003年ADA专家委员会建议将非糖尿病人群分为正常糖耐量(NGT),单纯IFG,单纯糖耐量受损(IGT)及IFG合并IGT(IFG+IGT)组.IFG诊断切点下调至5.6 mmol/L后,糖调节受损各组仍具有FPG 6.1 mmol/L为切点时临床特点.IFG+IGT组代谢异常较单纯IFG及单纯IGT为重.单纯IFG与单纯IGT组比较IFG组年轻、糖尿病家族史阳性多,相对肥胖,总代谢综合征比率高;IGT组收缩压、甘油三酯、餐后胰岛素水平高,女性比例高.结论 (1)糖尿病前心血管危险因素已开始随空腹血糖水平增高而增加,自FPG 5.6 mmol/L组以上代谢综合征及单组分比率均有显著升高.(2)以FPG≥5.6mmol/L为切点划分的新IFG人群表现为年轻,糖尿病家族史阳性率高,代谢综合征比率高于NGT及单纯IGT人群.FPG可能对年轻者更有诊断价值.     

Recommendations for the management of cardiovascular risk in patients with rheumatoid arthritis: Scientific evidence and expert opinion

Objectives

Last recommendations regarding cardiovascular risk (CVR) in rheumatoid arthritis (RA) patients were developed by the EULAR group in 2010. The aim is to update evidence-based recommendations about this worrying health problem.

Methods

We assembled a multidisciplinary workgroup (rheumatologists, endocrinologist, cardiologist, and epidemiologist) and a panel of 28 expert rheumatologists. The study was carried out in two big phases: identifying key areas in the prevention and management of CVR and developing a set of recommendations based on a review of the available scientific evidence and use of the Delphi consensus technique. All this has been developed according to an updating process of evidence-based recommendations.

Results

Overall, 25 recommendations were made addressing three complementary areas: CVR assessment tools, patient eligibility for assessment, and treatment strategies for control of CVR. The grade of the recommendations was not substantially modified compared to the original EULAR recommendations, except in two of them, which were upgraded from C to B. These two recommendations are the ones related to the use of corticosteroids and smoking cessation. The new developed recommendations address these two areas: CVR assessment and treatment strategies for control of CVR.

Conclusions

There are substantial gaps in the current knowledge that do not allow classifying properly RA patients based on their actual CVR and to accurately identify those patients who would benefit from CVR assessment. Consequently, studies designed to determine the causal effects of RA disease characteristics on cardiovascular morbidity/mortality and to identify patients at high risk of cardiovascular disease are still needed.     

Comprehensive risk profiles of family history and lifestyle and metabolic risk factors in relation to diabetes: A prospective cohort study

BackgroundFamily history of diabetes, unhealthy lifestyles, and metabolic disorders are individually associated with higher risk of diabetes, but how different combinations of the three risk categories are associated with incident diabetes remains unclear. We aimed to estimate the associations of comprehensive risk profiles of family history and lifestyle and metabolic risk factors with diabetes risk.MethodsThis study included 5290 participants without diabetes at baseline with a mean follow‐up of 4.4 years. Five unhealthy lifestyles and five metabolic disorders were each allocated a score, resulting in an aggregated lifestyle and metabolic risk score ranging from 0 to 5. Eight risk profiles were constructed from combinations of three risk categories: family history of diabetes (yes, no), lifestyle risk (high, low), and metabolic risk (high, low).ResultsCompared with the profile without any risk category, other profiles exhibited incrementally higher risks of diabetes with increasing numbers of categories: the hazard ratio (HR, 95% confidence interval [CI]) for diabetes ranged from 1.34 (1.01–1.79) to 2.33 (1.60–3.39) for profiles with one risk category, ranged from 2.42 (1.45–4.04) to 4.18 (2.42–7.21) for profiles with two risk categories, and was 4.59 (2.85–7.39) for the profile with three risk categories. The associations between the numbers of risk categories and diabetes risk were more prominent in women (p _interaction = .025) and slightly more prominent in adults <55 years (p _interaction = .052).ConclusionsThis study delineated associations between comprehensive risk profiles with diabetes risk, with stronger associations observed in women and slightly stronger associations in adults younger than 55 years.