Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study

Background and aimsTo describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD)Methods and resultsA total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated.ConclusionsSouth Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.     

Joint association and interaction of birth weight and lifestyle with hypertension: A cohort study in UK Biobank

Low birth weight and unhealthy lifestyle are both associated with an increased risk of hypertension. The authors aimed to assess the joint association and interaction of birth weight and lifestyle with incident hypertension. The authors included 205 522 participants free of hypertension at baseline from UK Biobank. A healthy lifestyle score was constructed using information on body mass index, physical activity, diet, smoking status and alcohol intake. Cox proportional hazard models were used to investigate the impact of birth weight, healthy lifestyle score and their joint effect on hypertension. The authors documented 13 548 (6.59%) incident hypertension cases during a median of 8.6 years of follow-up. The multivariate adjusted hazard ratios and 95% confidence intervals were 1.12 (1.09, 1.15) per kg lower birth weight and 0.76 (0.75, 0.77) per score increment in healthy lifestyle score. Healthy lifestyle reduced the risk of hypertension in any category of different birth weight groups. The preventive effect of healthy lifestyle on hypertension was the most pronounced at lower birth weight with <2500 g and 2500–2999 g, respectively. Addictive interaction between birth weight and healthy lifestyle score was observed with the relative excess risk due to interaction of 0.04 (0.03, 0.05). Our findings emphasized the importance of healthy lifestyle for hypertension prevention, especially among the high-risk population with lower birth weight.     

Association between serum bilirubin and cardiovascular disease in an overweight high risk population from the SCOUT trial

Background and aimsAn inverse relationship between (serum) total bilirubin and risk of cardiovascular disease has been reported previously, but longitudinal data on overweight and obese patients are lacking. We have investigated the relationship between total bilirubin and cardiovascular adverse events in a large group of patients with risk factors for cardiovascular disease who were enrolled in a large weight loss trial.Methods and resultsData from the Sibutramine Cardiovascular Outcomes (SCOUT) trial, including almost 10.000 overweight/obese high cardiovascular risk patients, were used. The relationship between total bilirubin level at screening and the primary outcome (i.e. non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death) for the entire study period was investigated using Cox proportional hazards models. The population was divided into four groups based on total bilirubin levels (normal range 5–25 μmol/L). Time-dependent Cox analyses were also performed to adjust for weight loss over time. Initial analyses adjusted for sex, age and treatment allocation showed significantly reduced hazard ratios of 0.80 (95% confidence interval 0.68–0.94), 0.73 (0.62–0.86) and 0.77 (0.65–0.91), for the three higher total bilirubin groups: >8 and ≤10 μmol/L, >10 and ≤13 μmol/L and >13 μmol/L (5–95 interpercentile range for total bilirubin at screening; 6–19 μmol/L), compared to the lowest total bilirubin group ≤8 μmol/L. When adjusting for classical cardiovascular risk factors, estimates increased towards unity. Additional adjustment for indicators of liver function did not alter the results. A time-dependent Cox model, adjusted for weight loss, demonstrated a similar trend.ConclusionBilirubin was not a risk-factor independent from other traditional cardiovascular risk-factors in our population.     

Birth weight and cardiovascular risk factors in an epidemiological study

Summary Low birth weight has been proposed as a risk factor for development of non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease in the adult. To ascertain the extent to which birth weight was associated with cardiovascular risk factors, we examined 620 subjects (median age 48 years) in a cross-sectional study. Of these 317 were offspring of diabetic patients and 303 were offspring of non-diabetic control subjects. Known risk factors for development of cardiovascular disease were correlated to birth weight and examined as dependent variables by multiple linear regression. Age, body mass index (BMI), subjects gender along with parental gender, diabetes status of the parents, and birth weight were independent variables. The variance of the risk factors as dependent variables explained by age, gender, and BMI as independent variables was examined and birth weight was added as an independent variable. We found birth weight was inconsistently correlated to the different risk factors in the different groups of subjects. When adjusted for age, BMI, subject's gender, parental gender, and the diabetes status of the parents, birth weight was negatively correlated to fasting blood glucose. In offspring of diabetic patients the explained variance of risk factors did not change as we added birth weight to the model. In offspring of non-diabetic subjects we found that the explained variance of diastolic blood pressure, fasting blood glucose, HbA_IC, and cholesterol increased 1–3 % as birth weight was added to the model. We conclude that birth weight may not be a major risk factor for development of hypertension and cardiovascular disease in our population. [Diabetologia (1996) 39: 1598–1602]     

Self-reported walking pace,polygenic risk scores and risk of coronary artery disease in UK biobank

Background and aimsBoth polygenic risk scores (PGS) and self-reported walking pace have been shown to predict cardiovascular disease; whether combining both factors produces greater risk differentiation is, however, unknown.Methods and resultsWe estimated the 10-year absolute risk of coronary artery disease (CAD), adjusted for traditional risk factors, and the C-index across nine PGS and self-reported walking pace in UK Biobank study participants between Mar/2006–Feb/2021. In 380,693 individuals (54.8% women), over a median (5th, 95th percentile) of 11.9 (8.3, 13.4) years, 2,603 (1.2%) CAD events occurred in women and 8,259 (4.8%) in men. Both walking pace and genetic risk were strongly associated with CAD. The absolute 10-year risk of CAD was highest in slow walkers at high genetic risk (top 20% of PGS): 2.72% (95% CI: 2.30–3.13) in women; 9.60% (8.62–10.57) in men. The risk difference between slow and brisk walkers was greater at higher [1.26% (0.81–1.71) in women; 3.63% (2.58–4.67) in men] than lower [0.76% (0.59–0.93) and 2.37% (1.96–2.78), respectively] genetic risk. Brisk walkers at high genetic risk had equivalent (women) or higher (men) risk than slow walkers at moderate-to-low genetic risk (bottom 80% of PGS). When added to a model containing traditional risk factors, both factors separately improved risk discrimination; combining them resulted in the greatest discrimination: C-index of 0.801 (0.793–0.808) in women; 0.732 (0.728–0.737) in men.ConclusionSelf-reported slow walkers at high genetic risk had the greatest risk of CAD, identifying a potentially important population for intervention. Both PGS and walking pace contributed to risk discrimination.     

Ethnic differences in metabolic cardiovascular risk among normal weight individuals: Implications for cardiovascular risk screening. The HELIUS study

Background and aims

Cardiovascular disease (CVD) risk factors may occur among a substantial proportion of normal weight individuals, particularly among some ethnic minorities. It is unknown how many of these individuals would be missed by commonly applied eligibility criteria for cardiovascular risk screening. Thus, we aim to determine cardiovascular risk and eligibility for cardiovascular risk screening among normal weight individuals of different ethnic backgrounds.

Fatty liver disease,heart rate and cardiac remodelling: Evidence from the UK Biobank

Background and Aims

Growing evidence supports an association between fatty liver disease (FLD) and cardiac dysfunction and remodelling, leading to cardiovascular disease and heart failure. Herein, we investigated the independent contribution of FLD to cardiac dysfunction and remodelling in participants from the UK Biobank with cardiac magnetic resonance (CMR) data available.

Methods

A total of 18 848 Europeans without chronic viral hepatitis and valvular heart diseases, with liver magnetic resonance imaging and CMR data were included in the analyses. Clinical, laboratory and imaging data were collected using standardized procedures. Multivariable regression models were used to test the association between FLD and CMR endpoints, after adjusting for several cardiometabolic risk factors. Linear regression models with regularization (Least Absolute Shrinkage and Selection Operator [LASSO], Ridge and Elastic Net) were used to generate predictive models for heart-related endpoints.

Results

FLD was independently associated with higher average heart rate, higher cardiac remodelling (higher eccentricity ratio and lower remodelling index), lower left and right ventricular volumes (end-systolic, end-diastolic and stroke volumes) as well as with lower left and right atrial maximal volumes (p < 0.001). FLD was the strongest positive predictor for average heart rate, followed by age, hypertension and type 2 diabetes. Male sex was the strongest positive predictor for eccentricity ratio followed by FLD, age, hypertension and BMI. For LV volumes, FLD was the strongest negative predictor along with age.

Conclusions

FLD is an independent predictor of higher heart rate and early cardiac remodelling associated with reduced ventricular volumes.     

Association of myeloperoxidase with cardiovascular disease risk factors in prediabetic subjects

IntroductionPrediabetes is a chronic low-grade inflammatory disease and considered as a risk factor for the development of diabetes mellitus and cardiovascular disease. Myeloperoxidase (MPO) is a leukocyte-derived enzyme, linked to both oxidative stress and inflammation and has been proposed as a possible mediator of atherosclerosis, the major cause of cardiovascular disease. The objective of the present study was to evaluate the level of MPO in prediabetic subjects and correlate it with other cardiovascular disease risk factors.Materials and methodsIn this cross-sectional study, a total of 400 subjects were recruited. Of them, 200 were prediabetic subjects and 200 were age and gender-matched controls. For each subject, blood pressure, weight, height, waist circumference, hip circumference and lipid parameters were measured. In addition, MPO was determined.ResultsMPO was significantly increased in prediabetic subjects as compared to controls. In correlation analysis, MPO was found to be significantly and positively correlated with all the cardiovascular disease risk factors i.e. age, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure [both systolic blood pressure (SBP) and diastolic blood pressure (DBP)], lipid parameters except high density lipoprotein (HDL) to which it was negatively correlated.ConclusionIn conclusion, MPO is well correlated with cardiovascular disease risk factors in prediabetes. Hence, MPO could be used to detect cardiovascular risk among prediabetic subjects and also can be used as an early biomarker of oxidative stress and inflammation in prediabetes.     

Association between periodontitis and cardiovascular health in rheumatoid arthritis patients: Prospective effect of periodontal treatment on cardiovascular risk

BackgroundRheumatoid arthritis (RA) patients are more likely to develop cardiovascular disease (CVD), which increases the risk of morbidity and mortality. Periodontitis is known to be associated with CVD, yet its relationship with CVD in RA is limited.Aim of the workTo examine the relationship between periodontitis with subclinical atherosclerosis and with long term CVD risk. Examining if periodontitis treatment can be associated with CVD improvement was well thought out.Patients and methodsThis prospective interventional study included 49 adults with RA. Demographic, clinical and therapeutic data and laboratory markers were assessed. Dental examination for periodontitis was performed. The carotid intima media thickness (CIMT) and Framingham risk score (FRS) were evaluated. Medical treatment was provided to RA patients with periodontitis, and assessments were repeated after 6 months.ResultsThe mean age of the patients was 46.4 ± 12.4 years, disease duration 10.9 ± 5.4 years and 79.6% were females. 25 (51%) patients had subclinical atherosclerosis, 30 (61.2%) had periodontitis and 25 (51%) had both. RA patients with subclinical atherosclerosis had higher clinical attachment loss (CAL) (3.12 ± 1.45) and higher probing depth (PD) (4.96 ± 1.37) compared to those without (p < 0.001). CAL (β = 0.01, 95 %CI: 0–0.01, p < 0.001), and PD (β = 0.01, 95% CI: 0–0.01; p < 0.001) were independently associated with CIMT. The 30 patients after treatment of periodontitis showed an average improvement in the mean CIMT (0.14 mm, p < 0.001).ConclusionPeriodontitis is associated with subclinical atherosclerosis in RA. Treatment of periodontitis could improve the cardiovascular health in RA patients and prompts physicians to early diagnose and treat periodontitis.     

代谢综合征与心血管疾病的关系及其组分间的交互作用

目的 探讨代谢综合征(MS)与心血管疾病(CVD)的关系及其组分问的交互作用.方法 采用队列研究的方法,以江苏省多代谢异常和MS综合防治研究(35～74岁)中随访时间满5年的人群为研究对象,共3598例,其中男性1451例.采用2005年美国胆固醇教育计划成人教育组Ⅲ(ATPm)亚洲人群修订标准诊断MS;运用COX比例风险模型分析MS及其组分与CVD的关系;以logistic回归模型中纳入乘积项的方法来评价MS组分之间的相乘交互作用,计算相加交互作用指标相对超危险度比(RERI),归因比(AP)和交互作用指数(S)的点估计值及其95%CI以评价MS组分之间的相加交互作用.结果 调整CVD一般危险因素后,基线MS患者与非MS患者相比发生CVD的调整相对危险度(αRR)为2.49(95%(CI:1.59～3.90).MS各组分与CVD的αRR分别为:腰围1.44(95%CI:0.88～2.37),血压2.84(95%CI:1.73～4.68),低高密度脂蛋白胆固醇1.31(95%CI:0.83～2.07),甘油三酯1.84(95%CI:1.19～2.85),空腹血糖1.55(95%CI:0.98～2.45);进一步进行组分间互相调整后,发现仅血压仍与CVD有联系[αRR=2.58(1.55～4.29)].交互作用分析结果显示:当血压合并2、3或4项MS其余组分时,发生CVD的危险明显增加[αOR=4.47(2.35～8.51)];logistic回归模型中乘积项血压×合并2、3、4项MS其余组分无统计学意义(P>0.05);相加交互作用指标RER/和AP的95%CI包含O,S的95%CI包含1.结论 MS组分中仅血压是CVD的独立危险因素,当血压合并其他MS组分时,MS患者发生CVD事件的风险明显增加,但MS不独立于血压和MS其余组分增加CVD的风险,血压与其他MS组分对CVD未发现明显的增效作用.     

The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies

AimsObesity is an important public health issue because of its high prevalence and concomitant increase in risk of cardiovascular diseases. Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse cardiovascular risk profile. To clarify the effects of a low-carbohydrate diet for weight loss on cardiovascular disease risk factors as compared to a low fat diet for weight loss, we systematically reviewed data from randomized controlled clinical trials and large observational studies.Data synthesisWe searched the MEDLINE database (Jan 1966–Nov 2013) to identify studies that examined a low-carbohydrate diet as compared to a low-fat diet for weight loss or the improvement of cardiovascular disease risk factors.ConclusionsRecent randomized controlled trials document that low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and cardiovascular disease risk factors.     

Ethnic differences in the association of birth weight and blood pressure: the Georgia cardiovascular twin study

BACKGROUND: African Americans (AAs) not only have higher blood-pressure levels, but also an increased risk of low weight at birth, compared with European Americans (EAs). In light of fetal programming theories, it has been suggested that ethnic differences in blood pressure originate in utero. However, most previous studies in biethnic samples have not found a significant inverse association between birth weight and blood pressure in AAs. METHODS: In 562 EA and 465 AA adolescent twins of the Georgia Cardiovascular Twin Study, we investigated the potential ethnic difference in the association of blood pressure and birth weight, with the ability to control for potential confounding by familial factors. RESULTS: Blood-pressure levels were significantly higher in AAs compared to EAs, independent of birth weight (P < .01). After adjustment for parental factors and body mass index, the difference in systolic blood pressure per kg birth weight was -1.1 mm Hg (95% confidence interval, -2.7 to 0.48, P = .17) in EAs, and -2.5 mm Hg (95% confidence interval, -4.7 to -0.40, P = .02) in AAs. A significant ethnic interaction was revealed in paired analysis, where the inverse association remained in AAs, but not in EAs. Associations with diastolic blood pressure were generally weaker and nonsignificant. CONCLUSIONS: We showed that low birth weight was associated with an elevated systolic blood pressure in AAs, independent of familial factors. The results also suggest that the association between birth weight and blood pressure may be more pronounced in AAs in adolescence.     

Dietary pattern derived by reduced-rank regression and cardiovascular disease: A cross-sectional study

Background and aimsDiet can affect cardiovascular health by changing lipid profiles or obesity levels. However, the association of dietary patterns reflecting lipid metabolism and adiposity measures with cardiovascular disease (CVD) is unclear. This study aimed to derive dietary patterns that explained variation in blood lipids and adiposity and investigate their associations with prevalent CVD.Methods and resultsA cross-sectional study was constructed in Beijing MJ Health Screening Center from 2008 to 2018. A dietary pattern was derived using reduced-rank regression among 75,159 participants without CVD. The dietary pattern explained the largest in predicting lipid profiles and adiposity measures. The dietary pattern was associated with a higher level of LDL-cholesterol and triglyceride, and high body mass index and waist circumference, but lower HDL-cholesterol. The dietary pattern was characterized by high intakes of staple food, red meat, processed food, fried food, edible offal, and less intakes of jam or honey, fruits, milk, and dairy products. Among 89,633 participants, we evaluated its association with prevalent CVD using multivariate logistic regression with adjustment for age, sex, annual income, education attainment, marital status, family history of CVD, smoking status, alcohol use, physical activity, and daily energy intake. Individuals with the highest quintile of dietary pattern score were 1%–38% more likely to have prevalent CVD than the lowest quintile (OR = 1.18, 95% CI = 1.01–1.38).ConclusionA diet pattern reflecting lipid profiles and obesity level was positively related to prevalent CVD, which could provide new insights in optimizing blood lipids and body shape for the prevention of CVD through dietary approaches among the Chinese population.     

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