Physical activity without weight loss reduces the development of cardiovascular disease risk factors – a prospective cohort study of more than one hundred thousand adults

PurposeWhether physical activity (PA) might have certain benefits for cardiovascular disease (CVD) primordial prevention even in the absence of clinically significant weight loss is of public health interest. In this study, we examined the independent and combined associations of simultaneous changes in PA and body weight with the subsequent development of major CVD risk factors in adults.MethodsThis prospective analysis included 116,134 healthy men and women, aged ≥18 years, with at least 3 medical examinations from the Taiwan MJ Cohort. Two-year changes in PA and body weight between the first and second examination were linked to subsequent development of hypertension, hypercholesterolemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes mellitus (T2DM), and chronic inflammation, which were assessed by physical examinations and laboratory tests.ResultsDuring an average follow-up of 5.7 ± 4.1 years after the second examination, 10,840 individuals developed hypertension, 10,888 hypercholesterolemia, 6078 atherogenic dyslipidemia, 13,223 metabolic syndrome, 4816 T2DM, and 2027 inflammation. Weight gain was associated with a subsequent higher risk of all CVD risk factors, with HR (95%CI) ranging from 1.11 (1.00–1.23) for inflammation to 1.74 (1.67–1.82) for metabolic syndrome, compared with participants who lost weight. A stable weight was also associated with a higher risk of all CVD risk factors except with inflammation. In combined analyses, participants who simultaneously gained weight and decreased PA levels had the highest risk compared with those who lost weight and increased PA. Increasing or maintaining PA reduced the increased subsequent risk of some CVD risk factors among participants who maintained a stable weight or gained weight. Among participants who lost weight, decreased PA was not associated with an increased risk.ConclusionsAlthough weight loss is crucial for the prevention of CVD risk factors, increasing or maintaining PA is also important to prevent them among adults who gain or maintain their weight.     

Risk reductions for cardiovascular disease with pravastatin treatment by dyslipidemia phenotype: A post hoc analysis of the MEGA Study

BackgroundThe beneficial effect of statins for cardiovascular disease (CVD) prevention has been well established. However, the effectiveness among different phenotypes of dyslipidemia has not been confirmed.ObjectiveWe evaluated the effect of pravastatin on the incidence of CVD in relation to the phenotype of dyslipidemia.MethodsThe MEGA Study evaluated the effect of low-dose pravastatin on primary prevention of CVD in 7832 Japanese patients, who were randomized to diet alone or diet plus pravastatin and followed for more than 5 years. These patients were classified into phenotype IIa (n = 5589) and IIb (n = 2041) based on the electrophoretic pattern for this post hoc analysis.ResultsIn the diet group there was no significant difference in the incidence of coronary heart disease (CHD), stroke, CVD, and total mortality between the two phenotypes. Phenotype IIb patients, compared to phenotype IIa, had lower levels of high-density lipoprotein cholesterol (HDL-C) and a significantly higher incidence of CVD in relation to a low HDL-C level (<47.5 mg/dL; p = 0.02). Furthermore, pravastatin decreased the relative risk for each major endpoint in both type IIa and type IIb dyslipidemia. Significant risk reductions were observed for CHD by 38% (p = 0.04) and CVD by 31% (p = 0.02) in type IIa dyslipidemia but not in phenotype IIb.ConclusionPravastatin therapy provided significant risk reductions for CHD and CVD in patients with phenotype IIa dyslipidemia, but not in those with phenotype IIb dyslipidemia.     

A cross sectional study comparing traditional risk factors with N-terminal pro-BNP in high risk groups for cardiovascular disease in Trinidad,West Indies

ObjectiveCardiovascular disease is a leading cause of morbidity and mortality worldwide and traditional risk factors for cardiovascular disease have been well-elaborated. In recent years, the use of biomarkers has emerged for identifying individuals at high risk with the aim of earlier identification and risk mitigation. Among the most promising non-traditional markers are BNP and NT-proBNP. This study aims to compare whether serum NT-proBNP co-segregates with traditional cardiovascular risk factors in elderly type 2 diabetic and non diabetic in a population with high prevalence of CVD.MethodsThis study utilized a cross sectional design. Blood samples collected were analyzed for hs-CRP, total serum cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, fasting glucose, insulin, and NT-proBNP.ResultsMean serum NT-proBNP levels were significantly elevated in diabetics (X = 125.5 ± 49.7) compared to non diabetics (X = 64.3 ± 34.6). In diabetics, NT-proBNP demonstrated statistically significant spearman's coefficients with respect to systolic blood pressure, triglyceride, hs-CRP, fasting glucose and insulin. Among non diabetics there was no relationship between NT-proBNP, blood pressure and insulin. Multivariate logistic regression revealed relation between diabetics; elevated NT-proBNP, blood pressure, triglyceride, CRP, fasting glucose and plasma insulin compared with non diabetics where NT-proBNP showed significant relation only to diastolic blood pressure. Diabetics showed significant correlation with elevated NT-proBNP and traditional risk factors (hypertension, diabetes, dyslipidemia and elevated hs-CRP) as compared with non diabetics.ConclusionsNT-proBNP co-segregates with traditional risk factors for CVD among elderly diabetics and may be a useful additional screening test for those at risk for CVD.     

Cardiovascular disease prevalence and its relation to risk factors in Alaska Eskimos

Background and aimsAlthough Eskimos were thought to be protected from cardiovascular disease (CVD), state health data show a large proportion of deaths from CVD, despite traditional lifestyles and high omega-3 fatty acid intake. This article explores CVD prevalence and its relation to risk factors in Alaska Eskimos.Methods and resultsA population-based cohort of 499 Alaska Eskimos > age 45 from the Norton Sound region was examined in 2000–2004 for CVD and associated risk factors as part of the Genetics of Coronary Artery Disease in Alaska Natives study. CVD and atherosclerosis were evaluated and adjudicated using standardized methods. Average age was 58 years; diabetes prevalence was low and high-density lipoprotein cholesterol (HDL-C) concentrations were high, but a large proportion smoked and had high pathogen burden. CVD was higher in men (12.6%) than in women (5.3%) (prevalence ratio 2.4, CI 1.3–4.4). Rates of stroke (6.1% in men, 1.8% in women) were similar to those for coronary heart disease (CHD) (6.1% men, 2.5% women). MI prevalence was low in both genders (1.9% and 0.7%). CVD was higher in men and in those >60 years. Hypertension, diabetes, high LDL-C, high apoB, and low HDL-C were all strong correlates (<.002) and albuminuria and CRP were also correlated with CVD (p < .05) after adjustment for age and gender. Carotid atherosclerosis was correlated with CVD (p = .0079) independent of other risk factors.ConclusionThese data show high CHD and stroke prevalence in Alaska Eskimos, despite low average LDL-C and high HDL-C. Hypertension and high LDL-C were independent correlates; identifying these risk factors early and treating to target is recommended.     

Evaluation of ABO blood group in subjects with CVD risk factors in a population sample from northeastern Iran

Background and aimsThe ABO blood group system is a genetic polymorphism which can affect the clearance of von Willebrand factor. We aimed to assess the levels of newer biomarkers of cardiovascular disease (CVD) risk; pro-oxidant-antioxidant balance (PAB), high sensitivity C-reactive protein (hs-CRP) and anti-heat-shock protein27 (anti-Hsp27) antibody titers in subjects with various blood groups (A, B, AB and O) and with or without traditional CVD risk factors.MethodsThe cross-sectional study comprised 6910 subjects. Antigen-antibody agglutination was evaluated by the slide test method for identification of ABO blood groups.ResultsAmong three markers, only Serum anti-Hsp27 titers significantly differed between the four blood groups and showed the highest and lowest values in AB and O blood groups (0.26 ± 0.22 and 0.23 ± 0.18 OD, respectively; P < 0.05). Serum anti-Hsp27 was higher in individuals with an AB blood group with metabolic syndrome (MetS), dyslipidemia, hypertension (HTN) and obesity and it was lower in subjects with O blood group; though, two other biomarkers, serum PAB and hs-CRP, were not significantly different between the ABO blood groups. However, they were not different among blood groups in participants with or without diabetes mellitus (DM) (P > 0.05).ConclusionIndividuals with an AB blood group and high levels of anti-Hsp27 antibody titers may be predisposed to CVDs that can be mediated through the traditional CVD risk factors among middle-aged subjects from northeastern Iran. The fact that differences in anti Hsp27 are only found in the subgroup with other risk factors suggest that the difference between ABO blood groups is a consequence rather than a cause.     

The clinical value of carotid plaque score in patients with metabolic syndrome and cardiovascular diseases

ObjectiveTo investigate the relationship between carotid plaque load score (CPS) and metabolic syndrome (MS) and cardiovascular diseases (CVD), in order to provide theoretical basis for the precaution and control of MS and CVD.MethodsA total of 1962 patients were incorporated into the study and divided into MS group and non-MS group, CVD group and non-CVD group. CPS and CIMT were obtained by carotid artery ultrasound, and the data of each group were statistically analyzed.ResultsAge, BMI, basal metabolic rate, body fat rate, gender, and the incidence of central obesity, hypertension, diabetes and dyslipidemia are statistical different between MS group and non-MS group (P < 0.05). CIMT between CVD group and non-CVD group are statistical different (1.040 ± 0.239 VS 0.972 ± 0.297, P < 0.001).CPS was statistically significant between MS group and non-MS group(2.254 ± 2.728 VS 1.548 ± 2.219, P = 0.003) and between CVD group and non-CVD group (2.322 ± 2.760 VS 1.688 ± 2.347, P = 0.004).ConclusionPatients in MS group and CVD group have higher carotid plaque burden than those in non-MS group and non-CVD group. The higher the CPS was, the higher the incidence of MS and CVD was, and the distribution of CPS in MS and CVD population was consistent.     

Dietary patterns and cardiovascular risk markers in the UK Low Income Diet and Nutrition Survey

Background and aimDietary patterns have been associated with various disease risk markers. There is presently little representative data about the dietary patterns of adults on low income. The objective was therefore to identify dietary patterns and how they relate to cardiovascular (CVD) risk markers in this specific population.Methods and resultsExploratory factor analysis was performed to examine dietary patterns in participants from the UK Low Income Diet and Nutrition Survey (n = 2931, aged 49.4 ± 20.2 years, 65% female). Dietary intake was assessed from three 24 h dietary recalls and blood was drawn for the assessment of CVD risk markers (C-reactive protein [CRP], total and high density lipoprotein [HDL] cholesterol, triglycerides, homocysteine). Results of the factor analysis revealed four interpretable principle components accounting for approximately 16.5% of the total variance, with similar patterns across gender. A ‘fast food’ diet pattern explained the greatest proportion of the variance (5.5%), followed by ‘health aware’ (4.1%), ‘traditional’ (3.6%), and ‘sweet’ (3.3%) factors. Participants consuming more items from the fast food pattern were younger, more likely to be smokers and employed, but not partnered. The ‘health aware’ diet pattern was inversely associated with concentrations of CRP and homocysteine, and positively with HDL-cholesterol.ConclusionsA fast food dietary pattern, high in saturated fat, explained the greatest proportion of the variance in a representative sample of adults on low income from the UK. There was, however, considerable heterogeneity in dietary intake among this socially deprived group and healthy eating was associated with lower CVD risk markers.     

Physical activity level (PAL) and risk factors of cardiovascular disease in the MASHAD study cohort

Background and aimThe relationship between physical activity levels (PAL) and the presence of cardiovascular disease (CVD) risk factors such as anthropometric and biochemical indices and heat shock proteins 27 antibody (anti-HSP-27) concentration, and serum inflammatory markers, was investigated in the MASHAD cohort study.MethodsThe overall study population consisted of 9,684 subjects (3,858 men, 5,826 women) with a mean age of 47.73 ± 8.08 to 48.87 ± 9.26 years respectively. They were divided into four categories based on their PAL. Biochemical parameters were determined for all participants. Also, serum anti-HSP-27 levels were measured using an in-house enzyme-linked immune sorbent assay method. Multiple regression analysis was used to explore the association between the anti-HSP antibody titers and physical activity after adjusting for confounding factors. The level of statistical significance was set at p < 0.05.ResultsSeveral CVD risk factors were associated with the level of PAL including: body mass index, waist hip ratio, systolic and diastolic blood pressure, serum HDL-C and TG (p < 0.001) and also fasting blood glucose (0.004). Also, serum anti-HSP-27 titers were significantly higher in inactive subjects (P > 0.05).ConclusionWe found that PAL was significantly associated with several established CVD risk factors. Also, the level of anti-HSP-27 was lower in individuals with moderate and high PAL.     

Association of circulating visfatin concentrations with insulin resistance and low-grade inflammation after dietary energy restriction in Spanish obese non-diabetic women: Role of body composition changes

Background and AimsTo assess the influence of body composition changes on circulating serum visfatin after following 12 weeks of energy restricted diet intervention. We also examined the possible role of visfatin in glucose metabolism and in obesity-associated low-grade inflammation.Methods and ResultsA total of 78 obese (BMI 34.0 ± 2.8 kg/m²) women aged 36.7±7 y volunteered to participate in the study. We measured by DXA body fat mass (FM) and lean mass (LM). Fasting serum visfatin, glucose, insulin, adiponectin, leptin, IL-1β, IL-6, IL-8, TNF-α and CRP concentrations were analyzed before and after the intervention and HOMA and QUIKI indexes were calculated. Mean weight loss 7.7 ± 3.0 kg and HOMA decreased in 24 ± 35%. Serum visfatin concentration change was negatively associated with LM difference (P < 0.05), whereas no significant relationship was observed with FM changes after energy restricted diet intervention. Changes in circulating serum visfatin levels were significantly and inversely associated with HOMA-IR (P < 0.01) and positively with QUICKI index (P < 0.02) after energy restricted diet intervention, regardless of achieved body weight loss. We did not find any significant association between changes in visfatin levels and IL-1β, IL-6, IL-8, TNF-α and CRP levels after dietary intervention (all P > 0.2).ConclusionCirculating visfatin concentration is associated with sensitivity improvement achieved after energy restricted diet intervention induced weight loss. Furthermore, LM changes could be an influencing factor on visfatin concentrations and consequently, on the improvement of insulin sensitivity after weight loss in obese non-diabetic women. Our findings did not provide any evidence for a role of visfatin increase on low-grade inflammation after weight loss.     

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh

ObjectivesThere is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting.MethodsThis cross-sectional study recruited 265 postmenopausal women aged 40–70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the ‘noncommunicable disease risk factors survey Bangladesh 2010’. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis.ResultsOverall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist–hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = −1.044, p < 0.001), and metabolic equivalent of tasks (β = −0.171, p = 0.003) showed a significant association with AIP.ConclusionHigh AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.     

HDL-C levels modify the association between C-reactive protein and coronary artery calcium score

Backgrounds and aimsC-reactive protein (CRP) levels predict incident and recurrent cardiovascular disease (CVD) events; however, associations between CRP and pre-clinical atherosclerosis is less certain. Since high concentrations of high-density lipoprotein cholesterol (HDL-C) are inversely associated with CVD risk, we investigated whether HDL-C modified the association between CRP concentration and measures of preclinical atherosclerosis.Methods and resultsData were analyzed from a Korean occupational cohort of 12,030 male subjects who underwent a cardiac computed tomography (CT) estimation of coronary artery calcification (CAC) score and an assessment of CVD risk factors. Logistic regression was used to describe associations between CRP and measures of pre-clinical atherosclerosis, such as CAC scores >0. As many as 1351 (11.2%) participants had a CAC score>0. CRP was stratified into 3 groups based on clinical category: <1 mg/L, 1 to <2 mg/L, and ≥ 2 mg/dL. In the bottom CRP group, 907/8697 (10.4%) of subjects had a CAC score >0, compared with 242/1943 (12.5%) in the middle group and 202/1396 (14.5%) in the top CRP group (p < 0.0001). After adjustment for multiple CVD risk factors, there was a positive association between CRP and CAC score>0 (OR between top and bottom CRP groups, 1.41 [1.04, 1.90], p = 0.027) in the lowest HDL-C quartile but not in the highest HDL-C (OR between top and bottom CRP group, 0.80 [0.46, 1.39], p = 0.425).ConclusionThe association between CRP concentration and CAC score differed according to HDL-C levels.     

Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults

Background and aimsSimple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk.Methods and resultsBlack South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m², men 20.9 ± 4.3 kg/m²); median WC women 81.9 cm (interquartile range 61–103), men 74.7 cm (63–87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men.ConclusionsThe WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa.     

Using urinary metabolomics to identify metabolic pathways linked to cardiac structural alterations in young adults: The African-PREDICT study

Background and aimsRisk factor exposure from young ages was shown to contribute to cardiovascular events - cardiac hypertrophy, which may be accompanied by an altered metabolism. To determine how early metabolic alterations associate with myocardial structural changes, we profiled urinary metabolites in young adults with cardiovascular disease (CVD) risk factor(s) and a control group without CVD risk factors.Methods and resultsWe included healthy adults (N = 1202), aged 20–30 years, stratified based on risk factors, i.e., obesity, physical inactivity, elevated blood pressure (BP), hyperglycemia, dyslipidemia, low socio-economic status, smoking and excessive alcohol use - forming the CVD risk group (N = 1036) and the control group (N = 166). Relative wall thickness (RWT) and left ventricular mass index (LVMi) were measured using echocardiography. Targeted metabolomics data were obtained using a liquid chromatography-tandem mass spectrometry method. Clinic systolic BP, 24 h BP and RWT were higher in the CVD risk group compared to the control group (all P ≤ 0.031). Exclusively in the CVD risk group, RWT associated with creatine and dodecanoylcarnitine; while LVMi associated with glycine, serine, glutamine, threonine, alanine, citrulline, creatine, proline, pyroglutamic acid and glutamic acid (all P ≤ 0.040). Exclusively in the control group, LVMi associated with propionylcarnitine and butyrylcarnitine (all P ≤ 0.009).ConclusionIn young adults without CVD, but with CVD risk factors, LVMi and RWT associated with metabolites linked energy metabolism (shifting from solely fatty acid oxidation to glycolysis, with impaired creatine kinase activity) and oxidative stress. Our findings support early onset metabolic changes accompanying cardiac structural alterations due to lifestyle and behavioural risk factors.     

Dietary patterns and their association with cardiovascular risk factors in a population undergoing lifestyle changes: The Strong Heart Study

Background and aimsRates of cardiovascular disease (CVD) are disproportionately high in American Indians (AI), and changes in lifestyle may be responsible. It is not known whether diverse dietary patterns exist in this population and whether the patterns are associated with CVD risk factors. This article describes the relationships between dietary patterns and CVD risk factors in this high-risk population.Methods and resultsNutrition data were collected via food frequency questionnaire from 3438 Strong Heart Study (SHS) participants, ≥ age 15 y. All participants were members of 94 extended families. The final sample consisted of 3172 men and women. Diet patterns were ascertained using factor analysis with the principal component factoring method. We derived four predominant dietary patterns: Western, traditional AI/Mexican, healthy, and unhealthy. Participants following the Western pattern had higher LDL cholesterol (LDL-C) (p < 0.001), slightly higher systolic blood pressure (BP) (p < 0.001), lower HDL cholesterol (HDL-C) (p < 0.001), and slightly lower homeostasis model assessment estimates of insulin resistance (HOMA-IR) in the lowest vs. highest deciles of adherence to this pattern (p < 0.001). The traditional diet was associated with higher HDL-C (p < 0.001), but higher body mass index (BMI) (p < 0.001) and HOMA-IR (p < 0.001). Followers of the healthy pattern had lower systolic BP, LDL-C, BMI, and HOMA-IR in increasing deciles (p < 0.001). The unhealthy pattern was associated with higher LDL-C.ConclusionsDietary patterns reflect the changing lifestyle of AI and several of the patterns are associated with CVD risk factors. Evolving methods of food preparation have made the traditional pattern less healthy.     

Increased CRP: An extended biomarker of microvascular risk in men with type 2 diabetes

BackgroundThe usefulness of C-reactive protein (CRP) to predict cardiovascular disease (CVD) in type 2 diabetes (T2DM) remains controversial. As many factors linked to obesity can modulate CRP in T2DM, we comprehensively revisited the cardiometabolic phenotype of patients with normal or raised CRP, taking into account the sexual dimorphism of its serum value.Methods1005 T2DM patients (651 males, 354 females; macroangiopathy 38%; coronary artery disease 26%; microangiopathy 47%) were divided depending on whether CRP level was ≤ or >3 mg/L. Thirty percent of men (n = 195) and 39% of women (n = 137) had raised CRP. Their cardiometabolic phenotype and presence of micro- and macrovascular complications were compared to those with normal CRP.ResultsIn both gender, patients with elevated CRP had higher body mass index, waist circumference, fat mass, visceral fat, insulinemia, HbA1c, and lower muscle mass and insulin sensitivity. They had more atherogenic dyslipidemia, higher non-HDL-C and apolipoprotein B₁₀₀, and more lipoprotein(a) (+59% in men and +38% in women). In both sexes, there was no difference between patients with normal or high CRP regarding overall macroangiopathy (42% vs. 45% [men]; 27% vs. 28% [women]), coronary and peripheral artery disease, or stroke. Only in men, microangiopathy was more prevalent when CRP was raised (61% vs 44%; p < 0.0001).ConclusionsThis study shows major sex-related differences in microangiopathies in T2DM patients with high CRP levels. The latter are unrelated to prevalent CVD despite an unfavorable metabolic phenotype. By contrast, increased CRP may represent an extended biomarker of microvascular risk in men with T2DM.     

Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex – Results from two community based cohort studies

AimTo study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off ≥25).Methods and resultsA cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmö Diet and Cancer study – cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35–2.70), WC; 1.81 (95% CI 1.02–3.20), SAD; 1.25 (95% CI 0.74–2.11), and WHHR; 1.97 (95% CI 1.40–2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04–1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04–1.47), WC 1.19 (95% CI 1.00–1.42), SAD 1.21 (95% CI 1.00–1.46), and WHHR; 1.23 (95% CI 1.05–1.44). Only the findings in men with BMI ≥ 25 were verified in MDCC.ConclusionIn normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.     

Low β-carotene concentrations increase the risk of cardiovascular disease mortality among Finnish men with risk factors

Background & aimsHealthy diet rich in fruits and vegetables is an important factor in prevention of cardiovascular diseases (CVD). Some previous epidemiological studies have suggested that dietary and serum carotenoids are associated with decreased CVD mortality, but the results have been inconsistent. We assessed relations between the concentrations of serum carotenoids and CVD mortality among Eastern Finnish men.Methods & resultsThe study population consisted of 1031 Eastern Finnish men aged 46–65 years in the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) cohort. Subjects were classified quartiles according to concentrations of carotenoids and subgroups according to risk factors. Hazard ratios of serum lycopene, α-carotene and β-carotene were estimated by the Cox proportional hazard model after adjusting for potential confounding factors. During the median 15.9-year follow-up, 122 deaths from CVDs, were identified among the cohort subjects. Low serum concentrations of β-carotene were strongly related to an increased CVD mortality risk after adjustment for confounders. For β-carotene, the hazard ratio (95% confidence interval) for the lowest versus highest quartile was 2.23 (1.26–3.93; P = 0.006). However, the strongest risk of CVD mortality was observed among smokers with lowest levels of β-carotene (HR = 3.15, 95%, CI: 1.19–8.33; P = 0.020). Other carotenoids and the sum of carotenoids were not significantly related to increased risk of CVD mortality.ConclusionsLow concentrations of serum β-carotene concentrations may increase the risk for CVD mortality among Eastern Finnish men; thus elevated serum concentrations of β-carotene may have clinical and public health relevance.     

Neck circumference predicts development of carotid intima-media thickness and carotid plaque: A community-based longitudinal study

Background and aimsCarotid intima-media thickness (C-IMT) is an important index for evaluating subclinical atherosclerosis. Neck circumference (NC), a new anthropometric index of the upper body fat, is closely related to cardiovascular disease (CVD) and CVD risk factors. This study investigated the relationship between NC, C-IMT, and carotid plaque in a community-based cohort.Methods and resultsParticipants recruited from Shanghai communities were followed up for 1.1–2.9 years. All participants underwent anthropometric and biochemical measurements. Elevated NC was defined as NC ≥ 38.5 cm and NC ≥ 34.5 cm in men and women, respectively. Elevated C-IMT, determined by ultrasound, was defined as a level higher than the 75th percentile in the study population (>0.75 mm). In total, 1189 participants without carotid plaque at baseline were included, with an average age of 59.6 ± 7.3 years. After a mean follow-up of 2.1 ± 0.2 years, 203 participants developed carotid plaques. After adjusting for various atherosclerosis risk factors, the logistic regression showed that the higher NC group had a significantly greater risk of developing carotid plaque than the lower NC group (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.12–2.14; P = 0.008). Of those without carotid plaque at follow-up, 495 participants developed elevated C-IMT. Compared to the lower NC group, the higher NC group had a significantly increased risk of elevated C-IMT (OR, 1.49; 95% CI, 1.14–1.95; P = 0.003).ConclusionHigher NC was significantly positively correlated with the risk of carotid plaque and elevated C-IMT.     

Clinical correlates of serum pigment epithelium-derived factor in type 2 diabetes patients

AimTo determine if serum pigment epithelium-derived factor (PEDF) levels in Type 2 diabetes are related to vascular risk factors and renal function.MethodsPEDF was quantified by ELISA in a cross-sectional study of 857 male Veterans Affairs Diabetes Trial (VADT) subjects, and associations with cardiovascular risk factors and renal function were determined. In a subset (n = 246) in whom serum was obtained early in the VADT (2.0 ± 0.3 years post-randomization), PEDF was related to longitudinal changes in renal function over 3.1 years.ResultsCross-sectional study: In multivariate regression models, PEDF was positively associated with serum triglycerides, waist-to-hip ratio, serum creatinine, use of ACE inhibitors or angiotensin receptor blockers, and use of lipid-lowering agents; it was negatively associated with HDL-C (all p < 0.05).Longitudinal study: PEDF was not associated with changes in renal function over 3.1 years (p > 0.09).ConclusionsSerum PEDF in Type 2 diabetic men was cross-sectionally associated with dyslipidemia, body habitus, use of common drugs for blood pressure and dyslipidemia, and indices of renal function; however, PEDF was not associated with renal decline over 3.1 years.     

Potential role of high sensitivity cardiac troponin T in subclinical coronary atherosclerosis in systemic lupus erythematosus patients

Aim of the workTo determine the role of high sensitivity cardiac troponin T (HS cTnT) in subclinical coronary atherosclerosis in SLE patients at an apparent low risk for CVD according to traditional risk factors.Patients and methodsThe presence of subclinical coronary atherosclerosis was assessed by non-contract coronary computerized tomography and calcium score was measured using Agatston score in 30 SLE patients asymptomatic for CVD and 30 age and sex matched apparently healthy controls. SLE disease activity index (SLEDAI) was assessed. Serum HScTnT concentration was measured using enzyme-linked immunosorbent assay (ELISA).ResultsThe mean age of the patients was 33 ± 5.7 years, disease duration of 33.7 ± 22 months and mean SLEDAI 8.1 ± 5.02. The mean HS cTnT level was 12.8 ± 11.3 ng/L (1–36 ng/L). Their Framingham score was 4.8 ± 3.1 (1–12). Framingham score was low in both SLE patients (range 1–12%) and controls (1–9%) (p = 0.12). 11 (36.7%) patients, but none of the controls, had coronary artery calcification (CAC). Serum HScTnT concentration was detectable (>3 ng/L) in 16 (53.3%) patients and 2 (6.7%) control (p < 0.001). Interestingly, it was detectable in all patients with CAC, but in only 26.3% of patients without (p < 0.001). HScTnT significantly correlated with Agatston (r = 0.63, p = 0.04), with erythrocyte sedimentation rate (r = ?0.65, p = 0.03), and with C-reactive protein (r = 0.76, p = 0.03) in SLE patients with CAC.ConclusionSerum HScTnT level is high and associated with CAC in SLE patients who are at an apparently low risk for CVD according to the Framingham risk score. HS cTnT may be a useful biomarker for SLE-associated subclinical atherosclerosis.