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Sample records for burden predicts cardiovascular

  1. Models to Predict the Burden of Cardiovascular Disease Risk in a Rural Mountainous Region of Vietnam

    NARCIS (Netherlands)

    Nguyen, Thi Phuong Lan; Schuiling-Veninga, Nynke; Nguyen, Thi Bach Yen; Hang, Vu Thi Thu; Wright, E. Pamela; Postma, M.J.

    2014-01-01

    Objective: To compare and identify the most appropriate model to predict cardiovascular disease (CVD) in a rural area in Northern Vietnam, using data on hypertension from the communities. Methods: A cross-sectional survey was conducted including all residents in selected communities, aged 34 to 65 y

  2. Usefulness of Coronary Atheroma Burden to Predict Cardiovascular Events in Patients Presenting With Acute Coronary Syndromes (from the PROSPECT Study).

    Science.gov (United States)

    Shan, Peiren; Mintz, Gary S; McPherson, John A; De Bruyne, Bernard; Farhat, Naim Z; Marso, Steven P; Serruys, Patrick W; Stone, Gregg W; Maehara, Akiko

    2015-12-01

    We investigated the relation between overall atheroma burden and clinical events in the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study. In PROSPECT, 660 patients (3,229 nonculprit lesions with a plaque burden ≥ 40% and complete intravascular ultrasound data) were divided into tertiles according to baseline percent atheroma volume (PAV: total plaque/vessel volume). Patients were followed for 3.4 years (median); major adverse cardiac events (MACE: death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization because of unstable or progressive angina) were adjudicated to either culprit or nonculprit lesions. Compared with patients in low or intermediate PAV tertiles, patients in the high PAV tertile had the greatest prevalence of plaque rupture and radiofrequency thin-cap fibroatheroma (VH-TCFA) and the highest percentage of necrotic core volume; they were also more likely to have high-risk lesion characteristics: ≥ 1 lesion with minimal luminal area ≤ 4 mm(2), plaque burden >70%, and/or VH-TCFA. Three-year cumulative nonculprit lesion-related MACE was greater in the intermediate and high tertiles than in the low tertile (6.3% vs 14.7% vs 15.1%, low vs intermediate vs high tertiles, p = 0.009). On Cox multivariable analysis, insulin-dependent diabetes (hazard ratio [HR] 3.98, p = 0.002), PAV (HR 1.06, p = 0.03), and the presence of ≥1 VH-TCFA (HR 1.80, p = 0.02) were independent predictors of nonculprit MACE. In conclusion, increasing baseline overall atheroma burden was associated with more advanced, complex, and vulnerable intravascular ultrasound lesion morphology and independently predicted nonculprit lesion-related MACE in patients with acute coronary syndromes after successful culprit lesion intervention.

  3. Cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Graversen, Peter; Abildstrøm, Steen Z; Jespersen, Lasse

    2016-01-01

    (ECG) abnormalities, heart rate, family history (of ischaemic heart disease), body mass index (BMI), waist-hip ratio, walking duration and pace, leisure time physical activity, forced expiratory volume (FEV)1%pred, household income, education, vital exhaustion, high-density lipoprotein (HDL......AIM: European society of cardiology (ESC) guidelines recommend that cardiovascular disease (CVD) risk stratification in asymptomatic individuals is based on the Systematic Coronary Risk Evaluation (SCORE) algorithm, which estimates individual 10-year risk of death from CVD. We assessed...

  4. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

    NARCIS (Netherlands)

    Roth, Gregory A.; Johnson, Catherine; Abajobir, Amanuel; Abd-Allah, Foad; Abera, Semaw Ferede; Abyu, Gebre; Ahmed, Muktar; Aksut, Baran; Alam, Tahiya; Alam, Khurshid; Alla, Francois; Alvis-Guzman, Nelson; Amrock, Stephen; Ansari, Hossein; Arnlov, Johan; Asayesh, Hamid; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Banerjee, Amitava; Barac, Aleksandra; Barnighausen, Till; Barregard, Lars; Bedi, Neeraj; Ketema, Ezra Belay; Bennett, Derrick; Berhe, Gebremedhin; Bhutta, Zulfiqar; Bitew, Shimelash; Carapetis, Jonathan; Carrero, Juan Jesus; Malta, Deborah Carvalho; Andres Castaneda-Orjuela, Carlos; Castillo-Rivas, Jacqueline; Catala-Lopez, Ferran; Choi, Jee-Young; Christensen, Hanne; Cirillo, Massimo; Cooper, Leslie; Criqui, Michael; Cundiff, David; Damasceno, Albertino; Dandona, Lalit; Dandona, Rakhi; Davletov, Kairat; Dharmaratne, Samath; Dorairaj, Prabhakaran; Dubey, Manisha; Ehrenkranz, Rebecca; Zaki, Maysaa El Sayed; Faraon, Emerito Jose A.; Esteghamati, Alireza; Farid, Talha; Farvid, Maryam; Feigin, Valery; Ding, Eric L.; Fowkes, Gerry; Gebrehiwot, Tsegaye; Gillum, Richard; Gold, Audra; Gona, Philimon; Gupta, Rajeev; Habtewold, Tesfa Dejenie; Hafezi-Nejad, Nima; Hailu, Tesfaye; Hailu, Gessessew Bugssa; Hankey, Graeme; Hassen, Hamid Yimam; Abate, Kalkidan Hassen; Havmoeller, Rasmus; Hay, Simon I.; Horino, Masako; Hotez, Peter J.; Jacobsen, Kathryn; James, Spencer; Javanbakht, Mehdi; Jeemon, Panniyammakal; John, Denny; Jonas, Jost; Kalkonde, Yogeshwar; Karimkhani, Chante; Kasaeian, Amir; Khader, Yousef; Khan, Abdur; Khang, Young-Ho; Khera, Sahil; Khoja, Abdullah T.; Khubchandani, Jagdish; Kim, Daniel; Kolte, Dhaval; Kosen, Soewarta; Krohn, Kristopher J.; Kumar, G. Anil; Kwan, Gene F.; Lal, Dharmesh Kumar; Larsson, Anders; Linn, Shai; Lopez, Alan; Lotufo, Paulo A.; Abd El Razek, Hassan Magdy; Malekzadeh, Reza; Mazidi, Mohsen; Meier, Toni; Meles, Kidanu Gebremariam; Mensah, George; Meretoja, Atte; Mezgebe, Haftay; Miller, Ted; Mirrakhimov, Erkin; Mohammed, Shafiu; Moran, Andrew E.; Musa, Kamarul Imran; Narula, Jagat; Neal, Bruce; Ngalesoni, Frida; Grant Nguyen,; Obermeyer, Carla Makhlouf; Owolabi, Mayowa; Patton, George; Pedro, Joao; Qato, Dima; Qorbani, Mostafa; Rahimi, Kazem; Rai, Rajesh Kumar; Rawaf, Salman; Ribeiro, Antonio; Safiri, Saeid; Salomon, Joshua A.; Santos, Itamar; Milicevic, Milena Santric; Sartorius, Benn; Schutte, Aletta; Sepanlou, Sadaf; Shaikh, Masood Ali; Shin, Min-Jeong; Shishehbor, Mehdi; Shore, Hirbo; Santos Silva, Diego Augusto; Sobngwi, Eugene; Stranges, Saverio; Swaminathan, Soumya; Tabares-Seisdedos, Rafael; Atnafu, Niguse Tadele; Tesfay, Fisaha; Thakur, J. S.; Thrift, Amanda; Topor-Madry, Roman; Truelsen, Thomas; Tyrovolas, Stefanos; Ukwaja, Kingsley Nnanna; Uthman, Olalekan; Vasankari, Tommi; Vlassov, Vasiliy; Vollset, Stein Emil; Wakayo, Tolassa; Watkins, David; Weintraub, Robert; Werdecker, Andrea; Westerman, Ronny; Wiysonge, Charles Shey; Wolfe, Charles; Workicho, Abdulhalik; Xu, Gelin; Yano, Yuichiro; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Vos, Theo; Naghavi, Mohsen; Murray, Christopher

    2017-01-01

    BACKGROUND The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world. OBJECTIVES The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

  5. Plasma Total Cysteine and Cardiovascular Risk Burden: Action and Interaction

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    Benedetta De Chiara

    2012-01-01

    Full Text Available We hypothesized that redox analysis could provide sensitive markers of the oxidative pathway associated to the presence of an increasing number of cardiovascular risk factors (RFs, independently of type. We classified 304 subjects without cardiovascular disease into 4 groups according to the total number of RFs (smoking, hypertension, hypercholesterolaemia, hyperhomocysteinaemia, diabetes, obesity, and their combination. Oxidative stress was evaluated by measuring plasma total and reduced homocysteine, cysteine (Cys, glutathione, cysteinylglycine, blood reduced glutathione, and malondialdehyde. Twenty-seven percent of subjects were in group 0 RF, 26% in 1 RF, 31% in 2 RF, and 16% in ≥3 RF. By multivariable ordinal regression analysis, plasma total Cys was associated to a higher number of RF (OR = 1.068; 95% CI = 1.027–1.110, =0.002. Total RF burden is associated with increased total Cys levels. These findings support a prooxidant effect of Cys in conjunction with RF burden, and shed light on the pathophysiologic role of redox state unbalance in preclinical atherosclerosis.

  6. Does early intensive multifactorial treatment reduce total cardiovascular burden in individuals with screen-detected diabetes?

    DEFF Research Database (Denmark)

    Simmons, R K; Sharp, S J; Sandbaek, A

    2012-01-01

    Aims  To describe the total cardiovascular burden (cardiovascular morbidity or mortality, revascularization or non-traumatic amputation) in individuals with screen-detected diabetes in the ADDITION-Europe trial and to quantify the impact of the intervention on multiple cardiovascular events over ...

  7. Prediction of Hepatitis C Burden in Canada

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    Shimian Zou

    2000-01-01

    Full Text Available To assess the risk of hepatitis C in Canada and to predict the burden that this disease may pose to the Canadian society in the near future, expected numbers of persons at different stages of the disease currently and in the next decade were estimated by simulation using a published hepatitis C natural history model with no treatment effect being applied. Based on the estimate of 240,000 persons who are currently infected with the hepatitis C virus in Canada, the simulation analysis demonstrated that the number of hepatitis C cirrhosis cases would likely increase by 92% from 1998 to the year 2008. It was also projected that the number of liver failures and hepatocellular carcinomas related to hepatitis C would increase by 126% and 102%, respectively, in the next decade. The number of liver-related deaths associated with hepatitis C is expected to increase by 126% in 10 years. The medical and social care systems in Canada may not be ready to support these large increases. These results highlight the importance of both the control of disease progression of hepatitis C virus-infected persons and the primary prevention of hepatitis C infections in Canada.

  8. Subclinical organ damage and cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Olsen, Michael H

    2010-01-01

    by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii...

  9. Cardiovascular risk prediction in the Netherlands

    NARCIS (Netherlands)

    Dis, van S.J.

    2011-01-01

    Background: In clinical practice, Systematic COronary Risk Evaluation (SCORE) risk prediction functions and charts are used to identify persons at high risk for cardiovascular diseases (CVD), who are considered eligible for drug treatment of elevated blood pressure and serum cholesterol. These

  10. 30. Cardiovascular risk factors burden in Saudi Arabia: The africa middle east cardiovascular epidemiological (ace study

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    A. Ahmed

    2016-07-01

    Full Text Available Limited data exit on the epidemiology of cardiovascular risk factors in Saudi Arabia particularly in relation to the differences between local citizens and expatriates. The aim of this analysis is to describe the current prevalence of cardiovascular risk factors among patients attending general practice clinics in Saudi Arabia. In a cross- sectional epidemiological study, the presence of cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, obesity, smoking, and abdominal obesity was evaluated in stable adult outpatients attending primary care clinics in Saudi Arabia. Groups comparison were made between local Saudi patients and expatriates. A total of 550 participant were enrolled form different clinics in Saudi Arabia (71% were male, mean age was 43 ± 10 years. Nearly half of the study cohort had more than two cardiovascular risk factors (49.6%. Dyslipidemia had the highest prevalence (68.4%. Furthermore, prevalence of hypertension (47.5% vs. 31.4%, dyslipidaemia (75.2% vs. 55.1% and abdominal obesity (63.9% vs. 52.2% were higher among expatriates compare to Saudis (p-value < 0.001. This analysis clearly shows that there is a high prevalence of cardiovascular risk factors prevalence in Saudi population. In addition, a significant proportion of patients with risk factors have poor overall control. Programmed community based screening is needed for all cardiovascular risk factors in Saudi Arabia. Increased awareness and improved primary care services may decrease incidence of coronary artery disease and improve overall quality of life.

  11. Estimating the cardiovascular mortality burden attributable to the European Common Agricultural Policy on dietary saturated fats.

    Science.gov (United States)

    Lloyd-Williams, Ffion; O'Flaherty, Martin; Mwatsama, Modi; Birt, Christopher; Ireland, Robin; Capewell, Simon

    2008-07-01

    To estimate the burden of cardiovascular disease within 15 European Union countries (before the 2004 enlargement) as a result of excess dietary saturated fats attributable to the Common Agricultural Policy (CAP). A spreadsheet model was developed to synthesize data on population, diet, cholesterol levels and mortality rates. A conservative estimate of a reduction in saturated fat consumption of just 2.2 g was chosen, representing 1% of daily energy intake. The fall in serum cholesterol concentration was then calculated, assuming that this 1% reduction in saturated fat consumption was replaced with 0.5% monounsaturated and 0.5% polyunsaturated fats. The resulting reduction in cardiovascular and stroke deaths was then estimated, and a sensitivity analysis conducted. Reducing saturated fat consumption by 1% and increasing monounsaturated and polyunsaturated fat by 0.5% each would lower blood cholesterol levels by approximately 0.06 mmol/l, resulting in approximately 9800 fewer coronary heart disease deaths and 3000 fewer stroke deaths each year. The cardiovascular disease burden attributable to CAP appears substantial. Furthermore, these calculations were conservative estimates, and the true mortality burden may be higher. The analysis contributes to the current wider debate concerning the relationship between CAP, health and chronic disease across Europe, together with recent international developments and commitments to reduce chronic diseases. The reported mortality estimates should be considered in relation to the current CAP and any future reforms.

  12. Night work, total occupational burden and cancer/cardiovascular risk factors in physicians

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    Nedić Olesja

    2012-01-01

    Full Text Available Introduction. Lifestyle-related risk factors: smoking, obesity, sedentariness and excess alcohol intake are among the most important known causes of cancer and cardiovascular disease. The aim of this study is to examine the relationship between these lifestyle-related risk factors for cancer/cardiovascular disease and working conditions among surgeons/anesthesiologists and other physicians. Material and Methods. The study was carried out among physicians aged 35 to 60, without diagnosed coronary heart disease or other structural heart disease, who were employed at the Novi Sad University Hospital. The participation rate was high (> 90%. The physicians completed the Occupational Stress Index. Low lifestyle-related cancer/cardiovascular risk was defined as: not a current smoker, body mass index < 28, regular recreational physical activity and not consuming alcohol every day. Analysis of covariance was performed. Results. Of 191 physicians included in this study only 23 (12.0% had a low lifestyle- related cancer/cardiovascular risk. Surgeons/anesthesiologists faced a heavier total work stressor burden than physicians in other profiles (87.7±8.8 versus 74.1±10.5, p=0.000. Among the 56 surgeons/anesthesiologists, lower nightshift work scores were associated with low lifestyle-related cancer/cardiovascular risk (F=4.19, p=0.046. A lower overall work stressor burden was associated with low risk among the other 135 physicians (F=4.06, p=0.046. Conclusion. Specific workplace intervention strategies are urgently needed. Among the surgeons/anesthesiologists these should include reduction in the frequency of night call and improvement of the overall conditions of nightshift work. Among other physicians, the total occupational burden needs to be diminished.

  13. Night work, total occupational burden and cancer/cardiovascular risk factors in physicians.

    Science.gov (United States)

    Belkić, Karen; Nedić, Olesja

    2012-01-01

    INTRODUCTION. Lifestyle-related risk factors: smoking, obesity, sedentariness and excess alcohol intake are among the most important known causes of cancer and cardiovascular disease. The aim of this study is to examine the relationship between these lifestyle-related risk factors for cancer/cardiovascular disease and working conditions among surgeons/anesthesiologists and other physicians. MATERIAL AND METHODS. The study was carried out among physicians aged 35 to 60, without diagnosed coronary heart disease or other structural heart disease, who were employed at the Novi Sad University Hospital. The participation rate was high (> 90%). The physicians completed the Occupational Stress Index. Low lifestyle-related cancer/cardiovascular risk was defined as: not a current smoker, body mass index intervention strategies are urgently needed. Among the surgeons/anesthesiologists these should include reduction in the frequency of night call and improvement of the overall conditions of nightshift work. Among other physicians, the total occupational burden needs to be diminished.

  14. [Predictive value of Hodgkin's lymphoma tumor burden in present].

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    Kulyova, S A; Karitsky, A P

    2014-01-01

    Today approximately 70% of patients with Hodgkin lymphoma can be cured with the combined-modality therapy. Tumor burden, the importance of which was demonstrated 15 years ago for the first time, is a powerful prognostic factor. Data of literature of representations on predictive value of Hodgkin's lymphoma tumor burden are shown in the article. The difficult immunological relations between tumor cells and reactive ones lead to development of the main symptoms. Nevertheless, the collective sign of tumor burden shows the greatest influence on survival and on probability of resistance, which relative risk can be predicted on this variable and treatment program. Patients with bulky disease need escalated therapy with high-dose chemotherapy. Integration into predictive models of the variable will change an expected contribution of clinical and laboratory parameters in the regression analyses constructed on patients with Hodgkin's lymphoma. Today the role of diagnostic functional methods, in particular a positron emission tomography, for metabolic active measurement is conducted which allows excluding a reactive component.

  15. Coronary calcification improves cardiovascular risk prediction in the elderly

    NARCIS (Netherlands)

    Vliegenthart, R; Oudkerk, M; Hofman, A; Oei, HHS; van Dijck, W; van Rooij, FJA; Witteman, JCM

    2005-01-01

    Background - Coronary calcification detected by electron beam tomography may improve cardiovascular risk prediction. The technique is particularly promising in the elderly because the predictive power of cardiovascular risk factors weakens with age. We investigated the prognostic value of coronary c

  16. Lipid-related markers and cardiovascular disease prediction

    DEFF Research Database (Denmark)

    Di Angelantonio, Emanuele; Gao, Pei; Pennells, Lisa

    2012-01-01

    The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated.......The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated....

  17. Quantifying Socioeconomic and Lifestyle Related Health Risks: Burden of Cardiovascular Disease Among Indian Males

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    Neetu Purohit

    2015-12-01

    Full Text Available Background: Non-communicable diseases account for a significant disease burden in the South East Asia region. India is facing an increased incidence of lifestyle-related diseases, such as cardiovascular disease. Socioeconomic and lifestyle risk factors for cardiovascular disease (CVD have been under investigated in India. This study was designed to explore risk factors contributing to the development of cardiovascular disease among Indian males.Methods: A population-based cross-sectional study was conducted among 2,235 males in the age group of 18-60 years across three states of India. A household survey was used to collect demographic and socioeconomic status information in addition to lifestyle-related attributes such as smoking, alcohol consumption, diet, and physical activity. Descriptive statistics and logistic regression were performed to identify the role of various factors that may be associated with the development of cardiovascular disease in this population.Results: The prevalence of cardiovascular disease among the male respondents contacted through a household survey was reported to be 9.8%. Logistic regression revealed that males with higher education and higher income were more likely to report CVD. With age as a strong predictor of CVD, the risk of CVD was found to be five times higher in the older age group. Current smokers were 1.3 times more likely to have CVD compared to those who never smoked. Those who were engaged in physical activity were less likely to have CVD; however, the adverse effects of smoking and excessive consumption of red meat showed a stronger association with CVD than the protective effects of physical activity.Conclusion: In developing countries, where the increase in earning capacity and change in lifestyle has been found to be accompanied by substantial risk of heart disease for males, public health measures like health promotion programs need to be implemented to decrease CVD burden.

  18. Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease.

    Science.gov (United States)

    Deek, Hiba; Newton, Phillip; Inglis, Sally; Kabbani, Samer; Noureddine, Samar; Macdonald, Peter S; Davidson, Patricia M

    2015-01-01

    Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. Cardiovascular diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated. To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon. An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search. The search yielded 28 peer-reviewed articles and 15 reports. Cardiovascular diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of cardiovascular diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients' outcomes. Conclusion: Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of cardiovascular risk factors.

  19. Lipid measures and cardiovascular disease prediction

    NARCIS (Netherlands)

    van Wijk, D.F.; Stroes, E.S.G.; Kastelein, J.J.P.

    2009-01-01

    Traditional lipid measures are the cornerstone of risk assessment and treatment goals in cardiovascular prevention. Whereas the association between total, LDL-, HDL-cholesterol and cardiovascular disease risk has been generally acknowledged, the rather poor capacity to distinguish between patients

  20. Advanced age, cardiovascular risk burden, and timed up and go test performance in Parkinson disease.

    Science.gov (United States)

    Kotagal, Vikas; Albin, Roger L; Müller, Martijn L T M; Koeppe, Robert A; Studenski, Stephanie; Frey, Kirk A; Bohnen, Nicolaas I

    2014-12-01

    . Modifiable cardiovascular risk factors and older age may independently exacerbate balance-related disability in Parkinson disease and may exert additive or synergistic pathological effects. The pathophysiology of these impairments cannot be explained completely by nigrostriatal dopaminergic denervation or leukoaraiosis burden and may relate to systemic factors seen with accelerated aging. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. The Burden of Blood-Pressure-Related Cardiovascular Mortality in Mexico

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    Dora E. Cortés-Hernández

    2014-01-01

    Full Text Available This study shows that in Mexico, a country at an advanced stage in the epidemiologic transition, with the national burden of disease dominated by noncommunicable diseases, elevated blood pressure is a major clinical and public health problem. 31.7% of the Mexican individuals aged 50 and over had systolic hypertension, and 47.3% were at systolic prehypertensive levels. Also, approximately half of all cardiovascular deaths that occurred annually in the population of Mexico aged ≥50 years are attributable to above optimal levels of systolic blood pressure. We think these estimates may help order health priorities in Mexico (and other middle-income countries at a time when the costs of medical care take a considerable share of the gross national product in most countries.

  2. Early symptom burden predicts recovery after sport-related concussion

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    Mannix, Rebekah; Monuteaux, Michael C.; Stein, Cynthia J.; Bachur, Richard G.

    2014-01-01

    Objective: To identify independent predictors of and use recursive partitioning to develop a multivariate regression tree predicting symptom duration greater than 28 days after a sport-related concussion. Methods: We conducted a prospective cohort study of patients in a sports concussion clinic. Participants completed questionnaires that included the Post-Concussion Symptom Scale (PCSS). Participants were asked to record the date on which they last experienced symptoms. Potential predictor variables included age, sex, score on symptom inventories, history of prior concussions, performance on computerized neurocognitive assessments, loss of consciousness and amnesia at the time of injury, history of prior medical treatment for headaches, history of migraines, and family history of concussion. We used recursive partitioning analysis to develop a multivariate prediction model for identifying athletes at risk for a prolonged recovery from concussion. Results: A total of 531 patients ranged in age from 7 to 26 years (mean 14.6 ± 2.9 years). The mean PCSS score at the initial visit was 26 ± 26; mean time to presentation was 12 ± 5 days. Only total score on symptom inventory was independently associated with symptoms lasting longer than 28 days (adjusted odds ratio 1.044; 95% confidence interval [CI] 1.034, 1.054 for PCSS). No other potential predictor variables were independently associated with symptom duration or useful in developing the optimal regression decision tree. Most participants (86%; 95% CI 80%, 90%) with an initial PCSS score of concussion is overall symptom burden. PMID:25381296

  3. Economic burden of severe cardiovascular diseases in Brazil: an estimate based on secondary data.

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    Azambuja, Maria Inês Reinert; Foppa, Murilo; Maranhão, Mário Fernando de Camargo; Achutti, Aloyzio Cechella

    2008-09-01

    The scarce amount of data available in Brazil on the economic burden of cardiovascular diseases (CVD) does not justify the growing concern in regard to the economic burden involved. The present study aims at estimating the costs of severe CVD cases in Brazil. Cases of severe CVD were estimated based on hospitalized cases lethality and total CVD mortality rates. National data bases and sample studies were used to estimate costs of hospitalization, outpatient care, and social security benefits. Loss of income was estimated from the Burden of Disease in Brazil data. Approximately two million cases of severe CVD were reported in 2004 in Brazil. That accounts for 5.2% of the population over 35 years of age. The resulting annual cost was at least R$ 30.8 billion (36.4% for health care, 8.4% for social security and employers' reimbursements, and 55.2% due to loss in productivity). That corresponded to R$ 500.00 per capita (considering 35 year-old and older population) and R$ 9,400.00 per patient. Direct costs with health care from severe CVD cases accounted for 8% of total national expenditure on health and 0.52% of 2004 GNP (R$ 1,767 billion = US$ 602 billion). That corresponded to an yearly average direct cost of R$182.00 per capita (R$ 87.00 from public resources) and of R$ 3,514.00 per case. Total annual costs per severe CVD case were estimated to be significant. Costs per capita and total costs corresponding to this sub-group of CVD patients are expected to escalate as the population ages and the prevalence of severe cases increases.

  4. C-reactive protein, fibrinogen, and cardiovascular disease prediction

    DEFF Research Database (Denmark)

    Kaptoge, Stephen; Di Angelantonio, Emanuele; Pennells, Lisa

    2012-01-01

    There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events.......There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events....

  5. Aortic pulse wave velocity improves cardiovascular event prediction

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    Ben-Shlomo, Yoav; Spears, Melissa; Boustred, Chris;

    2014-01-01

    To determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular (CVD) events beyond conventional risk factors.......To determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular (CVD) events beyond conventional risk factors....

  6. Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

    NARCIS (Netherlands)

    Di Angelantonio, Emanuele; Gao, Pei; Khan, Hassan; Butterworth, Adam S.; Wormser, David; Kaptoge, Stephen; Seshasai, Sreenivasa Rao Kondapally; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M.; Barr, Elizabeth L. M.; Khaw, Kay-Tee; Psaty, Bruce M.; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M.; Lawlor, Debbie A.; Daimon, Makoto; Willeit, Johann; Njolstad, Inger; Nissinen, Aulikki; Brunner, Eric J.; Kuller, Lewis H.; Price, Jackie F.; Sundstrom, Johan; Knuiman, Matthew W.; Feskens, Edith J. M.; Verschuren, W. M. M.; Wald, Nicholas; Bakker, Stephan J. L.; Whincup, Peter H.; Ford, Ian; Goldbourt, Uri; Gomez-de-la-Camara, Agustin; Gallacher, John; Simons, Leon A.; Rosengren, Annika; Sutherland, Susan E.; Bjorkelund, Cecilia; Blazer, Dan G.; Wassertheil-Smoller, Sylvia; Onat, Altan; Ibanez, Alejandro Marin; Casiglia, Edoardo; Jukema, J. Wouter; Simpson, Lara M.; Giampaoli, Simona; Nordestgaard, Borge G.; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T.; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B.; Cushman, Mary; D'Agostino, Ralph B.; Umans, Jason G.; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F.; Folsom, Aaron R.; van der Schouw, Yvonne T.; Moons, Karel G.; Griffin, Simon J.; Sattar, Naveed; Wareham, Nicholas J.; Selvin, Elizabeth; Thompson, Simon G.; Danesh, John

    2014-01-01

    IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA(1c)) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA(1c) values to conventional cardiovascular risk factors is associated with improvement in prediction of ca

  7. Addition of a novel, protective family history category allows better profiling of cardiovascular risk and atherosclerotic burden in the general population. The Asklepios Study.

    Science.gov (United States)

    Van daele, Caroline M; De Meyer, Tim; De Buyzere, Marc L; Gillebert, Thierry C; Denil, Simon L I J; Bekaert, Sofie; Chirinos, Julio A; Segers, Patrick; De Backer, Guy G; De Bacquer, Dirk; Rietzschel, Ernst R

    2013-01-01

    Whereas the importance of family history (FH) is widely recognized in cardiovascular risk assessment, its full potential could be underutilized, when applied with its current simple guidelines-based definition (cFH): presence of premature cardiovascular disease (CVD) in a first-degree relative. We tested the added value of a new, extended family history definition (eFH), also taking into account later onset of disease, second-degree relatives and number of affected relatives, on profiling cardiovascular risk and atherosclerotic burden in the general population. Longitudinal population study. Random, representative population sample from Erpe-Mere and Nieuwerkerken (Belgium, primary care). 2524 male/female volunteers, aged 35-55 years, free from overt CVD. Subjects were extensively phenotyped including presence of atherosclerosis (ultrasound) and a newly developed FH questionnaire (4 generations). Compared to cFH, eFH was superior in predicting an adverse risk profile (glycemic state, elevated blood pressure, lipid abnormalities, presence of metabolic syndrome components) and presence of atherosclerosis (all age & sex-adjusted pprofiling cardiovascular risk and atherosclerotic burden in the general population. There remain clear opportunities to refine and increase the performance and informational content of this simple, readily-available inexpensive tool.

  8. Lipid Measures and Cardiovascular Disease Prediction

    OpenAIRE

    van Wijk, Diederik F.; Stroes, Erik S. G.; Kastelein, John J.P.

    2009-01-01

    Traditional lipid measures are the cornerstone of risk assessment and treatment goals in cardiovascular prevention. Whereas the association between total, LDL-, HDL-cholesterol and cardiovascular disease risk has been generally acknowledged, the rather poor capacity to distinguish between patients who will and those who will not develop cardiovascular disease has prompted the search for further refinement of these traditional measures. A thorough understanding of lipid metabolism is mandatory...

  9. Cardiovascular burden and percutaneous interventions in Russian Federation: systematic epidemiological update

    Science.gov (United States)

    2017-01-01

    The situation with cardiovascular (CV) burden in Russian population is alerting, and becomes of interest due to high CV mortality, and shorter lifespan if compare with the Western society amid the absence of the established monitoring or screening system for major CV risk factors. The purpose of this systematic epidemiological update was to explore CV burden in Russia. The study represents pooled results with a systematic epidemiological review of the national mass screening, selected randomized clinical trials and statistical datasets of the national public health CV institutions exploring the trends of the CV burden in all 83 regions of Russia. We overviewed data from a number of the available Russian-speaking national data sources of 2001–2014, and NANOM-FIM trial (NCT01270139) as the only available real-world population study. The CV diseases in Russia accounted for 54.9% of all deaths in 2011–2014. The death rate was 13.3 per 1,000 citizens with CV mortality of 653.9 per 100,000. The life expectancy achieves 64.3 years for male and 76.1 years for female. The mean age of pts in trial was 51.6 years (77.2% males). A total of 175 Russian PCI centers implemented 205,902 angio a year, and 75,378 PCI achieving 531 PCI per 1,000,000 with placement of 101,451 stents (1.37 stents per PCI; 48,057 DES). The smoking (17.3% of screened with a 2,786 cigarettes a year; 70.6% in trial), excessive alcohol consumption (1.8% of screened with a 11.6 L per year; 50.6% in trial), unhealthy Russian diet (abundance of carbohydrates/sugar, saturated and trans fats in 24.3% of screened), psychosocial factors (20%) and physical inactivity (19.6% of screened) remain the major modifiable risk factors. They, in turn, affect such risk factors as dyslipidemia (86.7% in trial), obesity (16.7% of screened; BMI in trial was 28.4), and hypertension (40.8% suffered; 86.1% in trial). CV mortality was not directly associated with a level of poverty (r=0.26, P=0.02) or socio-economic development

  10. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    Science.gov (United States)

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves...

  11. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    NARCIS (Netherlands)

    Schalkwijk, D.B. van; Graaf, A.A. de; Tsivtsivadze, E.; Parnell, L.D.; Werff-van der Vat, B.J.C. van der; Ommen, B. van; Greef, J. van der; Ordovás, J.M.

    2014-01-01

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves

  12. Cardiovascular risk prediction in chronic kidney disease patients.

    Science.gov (United States)

    Cedeño Mora, Santiago; Goicoechea, Marian; Torres, Esther; Verdalles, Úrsula; Pérez de José, Ana; Verde, Eduardo; García de Vinuesa, Soledad; Luño, José

    Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population. Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed. Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, P<.001, HR 3.1 [95% CI: 1.3-7.1] P: 0.006 and ASCVD log-rank 8.5 P<.001, HR 3.2 [95% CI: 1.1-9.4] P: 0.03) were independent predictors adjusted to renal function, albuminuria and previous cardiovascular events. The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Can nocturnal hypertension predict cardiovascular risk?

    OpenAIRE

    Oded Friedman; Logan, Alexander G.

    2009-01-01

    Oded Friedman1, Alexander G Logan21Samuel Lunenfeld Research Institute, Division of Nephrology, Mount Sinai Hospital, 2Mount Sinai Hospital and University Health Network and Department of Medicine, University of Toronto, Toronto, CanadaAbstract: Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blo...

  14. Can nocturnal hypertension predict cardiovascular risk?

    Directory of Open Access Journals (Sweden)

    Oded Friedman

    2009-09-01

    Full Text Available Oded Friedman1, Alexander G Logan21Samuel Lunenfeld Research Institute, Division of Nephrology, Mount Sinai Hospital, 2Mount Sinai Hospital and University Health Network and Department of Medicine, University of Toronto, Toronto, CanadaAbstract: Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.Keywords: blood pressure, sleep, nocturnal hypertension

  15. Addition of a novel, protective family history category allows better profiling of cardiovascular risk and atherosclerotic burden in the general population. The Asklepios Study.

    Directory of Open Access Journals (Sweden)

    Caroline M Van daele

    Full Text Available OBJECTIVES: Whereas the importance of family history (FH is widely recognized in cardiovascular risk assessment, its full potential could be underutilized, when applied with its current simple guidelines-based definition (cFH: presence of premature cardiovascular disease (CVD in a first-degree relative. We tested the added value of a new, extended family history definition (eFH, also taking into account later onset of disease, second-degree relatives and number of affected relatives, on profiling cardiovascular risk and atherosclerotic burden in the general population. DESIGN: Longitudinal population study. SETTING: Random, representative population sample from Erpe-Mere and Nieuwerkerken (Belgium, primary care. SUBJECTS: 2524 male/female volunteers, aged 35-55 years, free from overt CVD. MAIN OUTCOME MEASURES: Subjects were extensively phenotyped including presence of atherosclerosis (ultrasound and a newly developed FH questionnaire (4 generations. RESULTS: Compared to cFH, eFH was superior in predicting an adverse risk profile (glycemic state, elevated blood pressure, lipid abnormalities, presence of metabolic syndrome components and presence of atherosclerosis (all age & sex-adjusted p<0.05. Unlike cFH, eFH remained a significant predictor of subclinical atherosclerosis after adjusting for confounders. Most relations with eFH were not graded but showed clear informational breakpoints, with absence of CVD (including late onset in any first-degree relative being a negative predictor of atherosclerosis, and a particularly interesting phenotype for further study. CONCLUSIONS: A novel, extended FH definition is superior to the conventional definition in profiling cardiovascular risk and atherosclerotic burden in the general population. There remain clear opportunities to refine and increase the performance and informational content of this simple, readily-available inexpensive tool.

  16. Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

    DEFF Research Database (Denmark)

    Di Angelantonio, Emanuele; Gao, Pei; Khan, Hassan

    2014-01-01

    of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS: Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES: Measures of risk......,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values......IMPORTANCE: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE: To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction...

  17. Reliability of blood pressure measurement and cardiovascular risk prediction

    OpenAIRE

    van der Hoeven, N.V.

    2016-01-01

    High blood pressure is one of the leading risk factors for cardiovascular disease, but difficult to reliably assess because there are many factors which can influence blood pressure including stress, exercise or illness. The first part of this thesis focuses on possible ways to improve the reliability of blood pressure measurement for proper cardiovascular risk prediction, both in and out of the doctor’s office. We show that it is possible to obtain a reliable blood pressure without the use o...

  18. Risk prediction of cardiovascular death based on the QTc interval

    DEFF Research Database (Denmark)

    Nielsen, Jonas B; Graff, Claus; Rasmussen, Peter V

    2014-01-01

    .1 years, 6647 persons died from cardiovascular causes. Long-term risks of CVD were estimated for subgroups defined by age, gender, cardiovascular disease, and QTc interval categories. In general, we observed an increased risk of CVD for both very short and long QTc intervals. Prolongation of the QTc......AIMS: Using a large, contemporary primary care population we aimed to provide absolute long-term risks of cardiovascular death (CVD) based on the QTc interval and to test whether the QTc interval is of value in risk prediction of CVD on an individual level. METHODS AND RESULTS: Digital...... interval resulted in the worst prognosis for men whereas in women, a very short QTc interval was equivalent in risk to a borderline prolonged QTc interval. The effect of the QTc interval on the absolute risk of CVD was most pronounced in the elderly and in those with cardiovascular disease whereas...

  19. Development of Prediction System for Environmental Burden for Machine Tool Operation

    Science.gov (United States)

    Narita, Hirohisa; Kawamura, Hiroshi; Norihisa, Takashi; Chen, Lian-Yi; Fujimoto, Hideo; Hasebe, Takao

    Recently, some activities for environmental protection have been attempted to reduce environmental burdens in many fields. The manufacturing field also requires such reduction. Hence, a prediction system for environmental burden for machining operation is proposed based on the Life Cycle Assessment (LCA) policy for the future manufacturing system in this research. This system enables the calculation of environmental burden (equivalent CO2 emission) due to the electric consumption of machine tool components, cutting tool status, coolant quantity, lubricant oil quantity and metal chip quantity, and provides accurate information of environmental burden of the machining process by considering some activities related to machine tool operation. In this paper, the development of the prediction system is described. As a case study, two Numerical Control (NC) programs that manufacture a simple shape are evaluated to show the feasibility of the proposed system.

  20. Reducing US cardiovascular disease burden and disparities through national and targeted dietary policies: A modelling study.

    Science.gov (United States)

    Pearson-Stuttard, Jonathan; Bandosz, Piotr; Rehm, Colin D; Penalvo, Jose; Whitsel, Laurie; Gaziano, Tom; Conrad, Zach; Wilde, Parke; Micha, Renata; Lloyd-Williams, Ffion; Capewell, Simon; Mozaffarian, Dariush; O'Flaherty, Martin

    2017-06-01

    Large socio-economic disparities exist in US dietary habits and cardiovascular disease (CVD) mortality. While economic incentives have demonstrated success in improving dietary choices, the quantitative impact of different dietary policies on CVD disparities is not well established. We aimed to quantify and compare the potential effects on total CVD mortality and disparities of specific dietary policies to increase fruit and vegetable (F&V) consumption and reduce sugar-sweetened beverage (SSB) consumption in the US. Using the US IMPACT Food Policy Model and probabilistic sensitivity analyses, we estimated and compared the reductions in CVD mortality and socio-economic disparities in the US population potentially achievable from 2015 to 2030 with specific dietary policy scenarios: (a) a national mass media campaign (MMC) aimed to increase consumption of F&Vs and reduce consumption of SSBs, (b) a national fiscal policy to tax SSBs to increase prices by 10%, (c) a national fiscal policy to subsidise F&Vs to reduce prices by 10%, and (d) a targeted policy to subsidise F&Vs to reduce prices by 30% among Supplemental Nutrition Assistance Program (SNAP) participants only. We also evaluated a combined policy approach, combining all of the above policies. Data sources included the Surveillance, Epidemiology, and End Results Program, National Vital Statistics System, National Health and Nutrition Examination Survey, and published meta-analyses. Among the individual policy scenarios, a national 10% F&V subsidy was projected to be most beneficial, potentially resulting in approximately 150,500 (95% uncertainty interval [UI] 141,400-158,500) CVD deaths prevented or postponed (DPPs) by 2030 in the US. This far exceeds the approximately 35,100 (95% UI 31,700-37,500) DPPs potentially attributable to a 30% F&V subsidy targeting SNAP participants, the approximately 25,800 (95% UI 24,300-28,500) DPPs for a 1-y MMC, or the approximately 31,000 (95% UI 26,800-35,300) DPPs for a 10% SSB

  1. C-Reactive Protein, fibrinogen and cardiovascular disease prediction

    NARCIS (Netherlands)

    Kromhout, D.

    2012-01-01

    Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Full Text of Background... Methods We analyzed data from 52 prospective studies that included 246,669 participants

  2. C-Reactive Protein, Fibrinogen, and Cardiovascular Disease Prediction

    NARCIS (Netherlands)

    Kaptoge, Stephen; Di Angelantonio, Emanuele; Pennells, Lisa; Wood, Angela M.; White, Ian R.; Gao, Pei; Walker, Matthew; Thompson, Alexander; Sarwar, Nadeem; Caslake, Muriel; Butterworth, Adam S.; Amouyel, Philippe; Assmann, Gerd; Bakker, Stephan J. L.; Barr, Elizabeth L. M.; Barrett-Connor, Elizabeth; Benjamin, Emelia J.; Bjorkelund, Cecilia; Brenner, Hermann; Brunner, Eric; Clarke, Robert; Cooper, Jackie A.; Cremer, Peter; Cushman, Mary; Dagenais, Gilles R.; D'Agostino, Ralph B.; Dankner, Rachel; Davey-Smith, George; Deeg, Dorly; Dekker, Jacqueline M.; Engstrom, Gunnar; Folsom, Aaron R.; Fowkes, F. Gerry R.; Gallacher, John; Gaziano, J. Michael; Giampaoli, Simona; Gillum, Richard F.; Hofman, Albert; Howard, Barbara V.; Ingelsson, Erik; Iso, Hiroyasu; Jorgensen, Torben; Kiechl, Stefan; Kitamura, Akihiko; Kiyohara, Yutaka; Koenig, Wolfgang; Kromhout, Daan; Kuller, Lewis H.; Lawlor, Debbie A.; Meade, Tom W.; Nissinen, Aulikki; Nordestgaard, Borge G.; Onat, Altan; Panagiotakos, Demosthenes B.; Psaty, Bruce M.; Rodriguez, Beatriz; Rosengren, Annika; Salomaa, Veikko; Kauhanen, Jussi; Salonen, Jukka T.; Shaffer, Jonathan A.; Shea, Steven; Ford, Ian; Stehouwer, Coen D. A.; Strandberg, Timo E.; Tipping, Robert W.; Tosetto, Alberto; Wassertheil-Smoller, Sylvia; Wennberg, Patrik; Westendorp, Rudi G.; Whincup, Peter H.; Wilhelmsen, Lars; Woodward, Mark; Lowe, Gordon D. O.; Wareham, Nicholas J.; Khaw, Kay-Tee; Sattar, Naveed; Packard, Chris J.; Gudnason, Vilmundur; Ridker, Paul M.; Pepys, Mark B.; Thompson, Simon G.; Danesh, John

    2012-01-01

    Background There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. Methods We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascul

  3. C-reactive protein, fibrinogen, and cardiovascular disease prediction

    NARCIS (Netherlands)

    S. Kaptoge (Stephen); E. di Angelantonio (Emanuele); L. Pennells (Lisa); A.M. Wood (Angela); I.R. White (Ian); P. Gao (Pei); M. Walker (Mark); A. Thompson (Alexander); S. Sarwar (Sheryar); M. Caslake (Muriel); A.S. Butterworth (Adam); P. Amouyel (Philippe); G. Assmann (Gerd); S.J.L. Bakker (Stephan); E.L.M. Barr; E. Barrett-Connor (Elizabeth); E.J. Benjamin (Emelia); C. Björkelund (Cecilia); H. Brenner (Hermann); E. Brunner (Eric); R. Clarke (Robert); J.A. Cooper (Jackie); P. Cremer; M. Cushman (Mary Ann); G.R. Dagenais (Gilles R); R.B. D'Agostino (Ralph); R. Dankner (Rachel); G. Davey-Smith (George); D.J.H. Deeg (Dorly); J.M. Dekker (Jacqueline); G. Engström; A.R. Folsom (Aaron); F.G.R. Fowkes (F. Gerald R.); J. Gallacher (John); J.M. Gaziano (J. Michael); S. Giampaoli (Simona); R.F. Gillum (Richard); A. Hofman (Albert); B.V. Howard (Barbara); E. Ingelsson (Erik); H. Iso (Hiroyasu); T. Jorgensen (Torben); S. Kiechl (Stefan); A. Kitamura; Y. Kiyohara (Yutaka); W. Koenig (Wolfgang); D. Kromhout (Daan); L.H. Kuller (Lewis); D.A. Lawlor (Debbie); T. Meade (Tom); A. Nissinen (Aulikki); B.G. Nordestgaard (Børge); A. Onat (Altan); D.B. Panagiotakos (Demosthenes); B.M. Psaty (Bruce); B. Rodriguez (Beatriz); A. Rosengren (Annika); V. Salomaa (Veikko); J. Kauhanen (Jussi); J.T. Salonen; J.A. Shaffer (Jonathan); S. Shea (Steven); I. Ford (Ian); C.D. Stehouwer (Coen); T.E. Strandberg (Timo); A. Tipping (Alex); A. Tosetto (Alberto); S. Wassertheil-Smoller (Sylvia); P. Wennberg (Patrik); R.G.J. Westendorp (Rudi); P.H. Whincup (Peter); L. Wilhelmsen (Lars); M. Woodward (Mark); G.D.O. Lowe (Gordon); N.J. Wareham (Nick); K-T. Khaw (Kay-Tee); N. Sattar (Naveed); C. Packard (Chris); V. Gudnason (Vilmundur); P.M. Ridker (Paul); M.B. Pepys (Mark); S.G. Thompson (Simon); J. Danesh (John)

    2012-01-01

    textabstractBACKGROUND: There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. METHODS: We analyzed data from 52 prospective studies that included 246,669 participants without a history o

  4. Lipid-related markers and cardiovascular disease prediction

    NARCIS (Netherlands)

    E. di Angelantonio (Emanuele); P. Gao (Pei); L. Pennells (Lisa); S. Kaptoge (Stephen); M. Caslake (Muriel); A. Thompson (Alexander); A.S. Butterworth (Adam); S. Sarwar (Sheryar); D. Wormser (David); D. Saleheen; C. Ballantyne (Christie); B.M. Psaty (Bruce); J. Sundstrom (Johan); P.M. Ridker (Paul); D. Nagel (Dorothea); R.F. Gillum (Richard); I. Ford (Ian); P. Ducimetiere (Pierre); S. Kiechl (Stefan); W. Koenig (Wolfgang); R.P.F. Dullaart (Robin); G. Assmann (Gerd); R.B. D'Agostino (Ralph); G.R. Dagenais (Gilles R); J.A. Cooper (Jackie); D. Kromhout (Daan); A. Onat (Altan); A. Tipping (Alex); A. Gómez-de-la-Cámara (Agustín); A. Rosengren (Annika); S.E. Sutherland (Susan); J. Gallacher (John); F.G.R. Fowkes (F. Gerald R.); E. Casiglia (Edoardo); A. Hofman (Albert); V. Salomaa (Veikko); E. Barrett-Connor (Elizabeth); R. Clarke (Robert); E. Brunner (Eric); J.W. Jukema (Jan Wouter); L.A. Simons (Leon); M.S. Sandhu (Manjinder); N.J. Wareham (Nick); K-T. Khaw (Kay-Tee); J. Kauhanen (Jussi); J.T. Salonen; W.J. Howard (William); B.G. Nordestgaard (Børge); A.M. Wood (Angela); S.G. Thompson (Simon); S.M. Boekholdt (Matthijs); N. Sattar (Naveed); C. Packard (Chris); V. Gudnason (Vilmundur); J. Danesh (John)

    2012-01-01

    textabstractContext: The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. Objective: To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to to

  5. New perspectives on cardiovascular risk prediction in old age

    NARCIS (Netherlands)

    Poortvliet, Rosalinde Klazina Elisabeth

    2015-01-01

    With increasing age, incidence and prevalence of cardiovascular disease increase. Many physicians face the dilemma whether or not to start preventive treatment in old age. To help physicians decide whether to advise preventive medication to their older patients, prediction of those at highest or

  6. Plasma levels of resistin predict cardiovascular events

    Directory of Open Access Journals (Sweden)

    Vida-Simiti Luminița

    2014-03-01

    .0616, p=0.0299 au fost independent asociate cu noi evenimente cardiovasculare. Concluzii: La pacienţi cu ateroscleroză clinic manifestă nivelele plasmatice ale resistinei pot prezice noi evenimente ischemice.

  7. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial

    DEFF Research Database (Denmark)

    Skielboe, Ane Katrine; Bandholm, Thomas Quaade; Hakmann, Stine

    2017-01-01

    BACKGROUND: Physical activity at moderate-high intensity is recommended to prevent lifestyle diseases. Patients with atrial fibrillation are at risk of a sedentary lifestyle due to fear of exercise-induced episodes of atrial fibrillation. The burden of arrhythmia can be reduced by physical exercise....... The effect of exercise intensity on burden of atrial fibrillation needs to be studied further. METHODS AND RESULTS: In a 12-week randomized controlled trial, 76 patients with paroxysmal/persistent atrial fibrillation were allocated to perform exercise at either low intensity or high intensity (50% and 80......% of maximal perceived exertion, respectively). Primary outcome was burden of AF measured by daily electrocardiography-reporting during 12 weeks. Secondarily, change in maximal oxygen uptake (peak VO2) and 1-year hospitalization was compared between low and high intensity exercise. Sixty-three patients...

  8. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial

    Science.gov (United States)

    Bandholm, Thomas Quaade; Hakmann, Stine; Mourier, Malene; Kallemose, Thomas; Dixen, Ulrik

    2017-01-01

    Background Physical activity at moderate-high intensity is recommended to prevent lifestyle diseases. Patients with atrial fibrillation are at risk of a sedentary lifestyle due to fear of exercise-induced episodes of atrial fibrillation. The burden of arrhythmia can be reduced by physical exercise. The effect of exercise intensity on burden of atrial fibrillation needs to be studied further. Methods and results In a 12-week randomized controlled trial, 76 patients with paroxysmal/persistent atrial fibrillation were allocated to perform exercise at either low intensity or high intensity (50% and 80% of maximal perceived exertion, respectively). Primary outcome was burden of AF measured by daily electrocardiography-reporting during 12 weeks. Secondarily, change in maximal oxygen uptake (peak VO2) and 1-year hospitalization was compared between low and high intensity exercise. Sixty-three patients completed the follow-up. In the intention-to-treat analysis, we found no statistical difference in burden of atrial fibrillation between low and high intensity exercise (incidence rate ratio 0.742, 95% CI 0.29–1.91, P = 0.538). No serious adverse events were reported and there was no difference in hospitalization between the two exercise groups. Both exercise groups improved significantly in peak VO2 (low intensity: 3.62 mL O2/kg/min, SD 3.77; high intensity: 2.87 mL O2/kg/min, SD 4.98), with no statistical difference between-groups (mean difference: 0.76 mL O2/kg/min, 95% CI -3.22–1.7). Conclusions High intensity physical exercise was not superior to low intensity physical exercise in reducing burden of atrial fibrillation. HI exercise was well tolerated; no evidence of an increased risk was found for HI compared to LI exercise. Larger studies are required to further prove our findings. Trial registration ClinicalTrials.gov NCT01817998 PMID:28231325

  9. Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

    Science.gov (United States)

    Angelantonio, Emanuele Di; Gao, Pei; Khan, Hassan; Butterworth, Adam S.; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L.M.; Khaw, Kay-Tee; Psaty, Bruce M.; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M.; Lawlor, Debbie A.; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J.; Kuller, Lewis H.; Price, Jackie F.; Sundström, Johan; Knuiman, Matthew W.; Feskens, Edith J. M.; Verschuren, W. M. M.; Wald, Nicholas; Bakker, Stephan J. L.; Whincup, Peter H.; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A.; Rosengren, Annika; Sutherland, Susan E.; Björkelund, Cecilia; Blazer, Dan G.; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J. Wouter; Simpson, Lara M.; Giampaoli, Simona; Nordestgaard, Børge G.; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T.; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B.; Cushman, Mary; D’Agostino, Ralph B.; Umans, Jason G.; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F.; Folsom, Aaron R.; van der Schouw, Yvonne T.; Moons, Karel G.; Griffin, Simon J.; Sattar, Naveed; Wareham, Nicholas J.; Selvin, Elizabeth; Thompson, Simon G.; Danesh, John

    2015-01-01

    IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5%to <7.5%), and high (≥7.5%) risk. RESULTS During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20 840 incident fatal and nonfatal CVD outcomes (13 237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (−0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for

  10. Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

    Science.gov (United States)

    Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2014-10-01

    Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis.

  11. The burden of hyperkalemia in patients with cardiovascular and renal disease.

    Science.gov (United States)

    Dunn, Jeffrey D; Benton, Wade W; Orozco-Torrentera, Ernesto; Adamson, Robert T

    2015-11-01

    Hyperkalemia is a potentially serious condition that can result in life-threatening cardiac arrhythmias and is associated with an increased mortality risk. Patients older than 65 years who have an advanced stage of chronic kidney disease (stage 3 or higher), diabetes, and/or chronic heart failure are at higher risk for hyperkalemia. To reduce disease progression and improve outcomes in these groups of patients, modulation of the renin-angiotensin-aldosterone system (RAAS) is recommended by guidelines. One limiting factor of RAAS inhibitors at proven doses is the increased risk for hyperkalemia associated with their use. Although there are effective therapeutic options for the short-term, acute management of hyperkalemia, the available strategies for chronic control of high potassium levels have limited effectiveness. The management of high potassium in the long term often requires withdrawing or reducing the doses of drugs proven to reduce cardiovascular and renal outcomes (eg, RAAS inhibitors) or implementing excessive and often intolerable dietary restrictions. Furthermore, withholding RAAS inhibitors may lead to incremental healthcare costs associated with poor outcomes, such as end-stage renal disease, hospitalizations due to cardiovascular causes, and cardiovascular mortality. As such, there is an important unmet need for novel therapeutic options for the chronic management of patients at risk for hyperkalemia. Potential therapies in development may change the treatment landscape in the near future.

  12. Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

    Directory of Open Access Journals (Sweden)

    Martí Sebastián

    2010-10-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL. The aim of the study was to estimate the burden of acute coronary heart disease (CHD and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$. Incremental cost-effectiveness ratios (ICER were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved, mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved, and lowering cholesterol with

  13. Improving prediction of ischemic cardiovascular disease in the general population using apolipoprotein B

    DEFF Research Database (Denmark)

    Benn, Marianne; Nordestgaard, Børge G; Jensen, Gorm Boje

    2007-01-01

    Apolipoprotein B (apoB) levels predict fatal myocardial infarction. Whether apoB also predicts nonfatal ischemic cardiovascular events is unclear. We tested the following hypotheses: apoB predicts ischemic cardiovascular events, and apoB is a better predictor of ischemic cardiovascular events tha...

  14. The Burden of Cardiovascular Disease Attributable to Major Modifiable Risk Factors in Indonesia

    Science.gov (United States)

    Hussain, Mohammad Akhtar; Al Mamun, Abdullah; Peters, Sanne AE; Woodward, Mark; Huxley, Rachel R.

    2016-01-01

    Background In Indonesia, coronary heart disease (CHD) and stroke are estimated to cause more than 470 000 deaths annually. In order to inform primary prevention policies, we estimated the sex- and age-specific burden of CHD and stroke attributable to five major and modifiable vascular risk factors: cigarette smoking, hypertension, diabetes, elevated total cholesterol, and excess body weight. Methods Population attributable risks for CHD and stroke attributable to these risk factors individually were calculated using summary statistics obtained for prevalence of each risk factor specific to sex and to two age categories (Indonesian population. PMID:27021286

  15. Cardiovascular change during encoding predicts the nonconscious mere exposure effect.

    Science.gov (United States)

    Ladd, Sandra L; Toscano, William B; Cowings, Patricia S; Gabrieli, John D E

    2014-01-01

    These studies examined memory encoding to determine whether the mere exposure effect could be categorized as a form of conceptual or perceptual implicit priming and, if it was not conceptual or perceptual, whether cardiovascular psychophysiology could reveal its nature. Experiment 1 examined the effects of study phase level of processing on recognition, the mere exposure effect, and word identification implicit priming. Deep relative to shallow processing improved recognition but did not influence the mere exposure effect for nonwords or word identification implicit priming for words. Experiments 2 and 3 examined the effect of study-test changes in font and orientation, respectively, on the mere exposure effect and word identification implicit priming. Different study-test font and orientation reduced word identification implicit priming but had no influence on the mere exposure effect. Experiments 4 and 5 developed and used, respectively, a cardiovascular psychophysiological implicit priming paradigm to examine whether stimulus-specific cardiovascular reactivity at study predicted the mere exposure effect at test. Blood volume pulse change at study was significantly greater for nonwords that were later preferred than for nonwords that were not preferred at test. There was no difference in blood volume pulse change for words at study that were later either identified or not identified at test. Fluency effects, at encoding or retrieval, are an unlikely explanation for these behavioral and cardiovascular findings. The relation of blood volume pulse to affect suggests that an affective process that is not conceptual or perceptual contributes to the mere exposure effect.

  16. Restless Legs Syndrome/Willis-Ekbom Disease Morbidity: Burden, Quality of Life, Cardiovascular Aspects, and Sleep.

    Science.gov (United States)

    Stevens, Mary Suzanne

    2015-09-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) has a significant negative effect on quality of life. The decreased quality of life is similar to that of other chronic diseases, such as diabetes type 2, depression, and osteoarthritis. RLS/WED disrupts sleep length, sleep quality, and daytime alertness. Sleep disruption can contribute to depression. RLS/WED has been associated with cardiovascular disease and high blood pressure, possibly because of increased sympathetic tone caused by periodic limb movements of sleep. RLS/WED is underdiagnosed, leading to chronic sleep disruption and daytime consequences. Patients with RLS/WED have decreased productivity at work, which potentially has far-reaching economic consequences.

  17. Association of cardiovascular burden with mobility limitation among elderly people: a population-based study.

    Directory of Open Access Journals (Sweden)

    Anna-Karin Welmer

    Full Text Available BACKGROUND: Cardiovascular risk factors (CRFs such as smoking and diabetes have been associated with mobility limitations among older adults. We seek to examine to what extent individual and aggregated CRFs and cardiovascular diseases (CVDs are associated with mobility limitation. METHODS: The study sample included 2725 participants (age ≥60 years, mean age 72.7 years, 62% women in the Swedish National Study on Aging and Care in the Kungsholmen district of central Stockholm, Sweden, who were living either at their own home or in institutions. Data on demographic features, CRFs, and CVDs were collected through interview, clinical examination, self-reported history, laboratory tests, and inpatient register. Mobility limitation was defined as walking speed <0.8 m/s. Data were analyzed using multiple logistic models controlling for potential confounders. RESULTS: Of the 2725 participants, 581 (21.3% had mobility limitation. The likelihood of mobility limitation increased linearly with the increasing number of CRFs (i.e., hypertension, high C-reactive protein, obesity, diabetes and smoking (p for linear trend<0.010 and of CVDs (i.e., ischemic heart disease, atrial fibrillation, heart failure and stroke (p for linear trend<0.001. There were statistical interactions of aggregated CRFs with age and APOE ε4 allele on mobility limitation (p interaction<0.05, such that the association of mobility limitation with aggregated CRFs was statistically evident only among people aged <80 years and among carriers of the APOE ε4 allele. CONCLUSION: Aggregations of multiple CRFs and CVDs are associated with an increased likelihood of mobility limitation among older adults; however the associations of CRFs with mobility limitation vary by age and genetic susceptibility.

  18. Is blood pressure during the night more predictive of cardiovascular outcome than during the day?

    DEFF Research Database (Denmark)

    Li, Yan; Boggia, Jose; Thijs, Lutgarde;

    2008-01-01

    in relation to Cardiovascular Outcome. Using Cox models, we calculated hazard ratios (HR) adjusted for cohort and cardiovascular risk factors. Over 9.6 years (median), 983 deaths and 943 cardiovascular events occurred. Nighttime BP predicted mortality outcomes (HR, 1.18-1.24; P.... Conversely, daytime systolic (HR, 0.84; Ppredicted only noncardiovascular mortality after adjustment for nighttime BP. Both daytime BP and nighttime BP consistently predicted all cardiovascular events (HR, 1.11-1.33; P....01). Daytime BP lost its prognostic significance for cardiovascular events in patients on antihypertensive treatment. Adjusted for the 24-h BP, NDR predicted mortality (P

  19. Improving prediction of ischemic cardiovascular disease in the general population using apolipoprotein B

    DEFF Research Database (Denmark)

    Benn, M; Nordestgaard, B; Jensen, Gorm Boje

    2007-01-01

    than low-density lipoprotein cholesterol in the prediction of ischemic heart disease, myocardial infarction, any ischemic cardiovascular event, and any nonfatal ischemic cardiovascular event in both genders (P=0.03 to years with systolic blood pressure >160 mm...... Hg, apoB contributed 11% in women and 15% in men to the increase in absolute 10-year risk from the lower to the upper apoB tertile. Conclusion- ApoB predicts ischemic cardiovascular events in both genders, and is better than low-density lipoprotein cholesterol in this respect. We suggest......Background- Apolipoprotein B (apoB) levels predict fatal myocardial infarction. Whether apoB also predicts nonfatal ischemic cardiovascular events is unclear. We tested the following hypotheses: apoB predicts ischemic cardiovascular events, and apoB is a better predictor of ischemic cardiovascular...

  20. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Pauly John M

    2008-04-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM. Results We consecutively studied 86 patients with ICM (LVEF Conclusion Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.

  1. Prevalence and economic burden of cardiovascular diseases in France in 2013 according to the national health insurance scheme database.

    Science.gov (United States)

    Tuppin, Philippe; Rivière, Sébastien; Rigault, Alexandre; Tala, Stéphane; Drouin, Jérôme; Pestel, Laurence; Denis, Pierre; Gastaldi-Ménager, Christelle; Gissot, Claude; Juillière, Yves; Fagot-Campagna, Anne

    2016-01-01

    Cardiovascular diseases (CVDs) constitute the second leading cause of death in France. The Système national d'information interrégimes de l'assurance maladie (SNIIRAM; national health insurance information system) can be used to estimate the national medical and economic burden of CVDs. To describe the rates, characteristics and expenditure of people reimbursed for CVDs in 2013. Among 57 million general health scheme beneficiaries (86% of the French population), people managed for CVDs were identified using algorithms based on hospital diagnoses either during the current year (acute phase) or over the previous 5 years (chronic phase) and long-term diseases. The reimbursed costs attributable to CVDs were estimated. A total of 3.5 million people (mean age, 71 years; 42% women) were reimbursed by the general health scheme for CVDs (standardized rate, 6.5%; coronary heart disease, 2.7%; arrhythmias/conduction disorders, 2.1%; stroke, 1.1%; heart failure, 1.1%). These frequencies increased with age and social deprivation, and were higher in Northern and Eastern France and Réunion Island. The total sum reimbursed by all schemes for CVDs was € 15.1 billion (50% for hospital care and 43% for outpatient care [including 15% for drugs and 12% for nurses/physiotherapists]); coronary heart disease accounted for € 4 billion, stroke for € 3.5 billion and heart failure for € 2.5 billion (i.e. 10% of the total expenditure reimbursed by all national health insurance schemes for all conditions). CVDs constitute the leading group in terms of numbers of patients reimbursed and total reimbursed expenditure, despite a probable underestimation of both numbers and expenditure. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Is obesity predictive of cardiovascular dysfunction independent of cardiovascular risk factors?

    Science.gov (United States)

    DeVallance, E; Fournier, S B; Donley, D A; Bonner, D E; Lee, K; Frisbee, J C; Chantler, P D

    2015-02-01

    Obesity is thought to exert detrimental effects on the cardiovascular (CV) system. However, this relationship is impacted by the co-occurrence of CV risk factors, type 2 diabetes (T2DM) and overt disease. We examined the relationships between obesity, assessed by body mass index (BMI) and waist circumference (WC), and CV function in 102 subjects without overt CV disease. We hypothesized that obesity would be independently predictive of CV remodeling and functional differences, especially at peak exercise. Brachial (bSBP) and central (cSBP) systolic pressure, carotid-to-femoral pulse wave velocity (PWVcf) augmentation index (AGI; by SphygmoCor), and carotid remodeling (B-mode ultrasound) were examined at rest. Further, peak exercise cardiac imaging (Doppler ultrasound) was performed to measure the coupling between the heart and arterial system. In backward elimination regression models, accounting for CV risk factors, neither BMI nor WC were predictors of carotid thickness or PWVcf; rather age, triglycerides and hypertension were the main determinants. However, BMI and WC predicted carotid cross-sectional area and lumen diameter. When examining the relationship between body size and SBP, BMI (β=0.32) and WC (β=0.25) were predictors of bSBP (Pdisease, and after accounting for CV risk factors, is susceptible to pathophysiological adaptations that may predispose individuals to an increased risk of CV events.

  3. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan

    2015-01-01

    BACKGROUND: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be reca...

  4. Predictive role of different dimensions of burden for risk of complicated grief in caregivers of terminally ill patients.

    Science.gov (United States)

    Lai, Carlo; Luciani, Massimiliano; Morelli, Emanuela; Galli, Federico; Cappelluti, Roberta; Penco, Italo; Aceto, Paola; Lombardo, Luigi

    2014-03-01

    The aim of the study was to test whether high levels of caregiver burden, as other confirmed predictors, are associated with the risk of prolonged grief disorder in caregivers of terminally ill patients. A predictive study was carried out in order to test the hypothesis. A demographic schedule, the Prolonged Grief 12 (PG-12), the Toronto Alexithymia Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Caregiver Burden Inventory were administered to 60 caregivers of 51 patients who were admitted in Hospice. In the regression analysis, difficulty in recognizing emotions, total burden, depression, and developmental burden dimension were significant predictors of PG-12 levels. Findings showed that feeling of deprivation of existential expectations represents the greater risk factor for the prolonged grief disorder, among the burden dimensions.

  5. Cholecystokinin in plasma predicts cardiovascular mortality in elderly females

    DEFF Research Database (Denmark)

    Gøtze, Jens P.; Rehfeld, Jens F; Alehagen, Urban

    2016-01-01

    observed a marked difference between the genders, where CCK concentrations in the 4th quartile were associated with a higher 5-year cardiovascular mortality in female patients (HR 8.99, 95% C.I.: 3.49-102.82, p=0.0007) compared to men (1.47, 95% C.I.: 0.7-3.3, p=0.35). In contrast, no significant...... information was obtained from 4th quartile gastrin concentrations on 5-year cardiovascular mortality risk. CONCLUSIONS: CCK in plasma is an independent marker of cardiovascular mortality in elderly female patients. The study thus introduces measurement of plasma CCK in gender-specific cardiovascular risk......BACKGROUND: Cholecystokinin (CCK) and gastrin are related gastrointestinal hormones with documented cardiovascular effects of exogenous administration. It is unknown whether measurement of endogenous CCK or gastrin in plasma contains information regarding cardiovascular mortality. METHODS...

  6. Age- and Sex-Specific Burden of Cardiovascular Disease Attributable to 5 Major and Modifiable Risk Factors in 10 Asian Countries of the Western Pacific Region.

    Science.gov (United States)

    Huxley, Rachel R; Hirakawa, Yoichiro; Hussain, Mohammad Akhtar; Aekplakorn, Wichai; Wang, Xin; Peters, Sanne A E; Mamun, Abdullah; Woodward, Mark

    2015-01-01

    Cardiovascular disease (CVD) is the leading cause of mortality worldwide, causing an estimated 18 million deaths annually. Much of the burden of CVD resides in lower- and middle-income countries, particularly those Asian countries comprising the Western Pacific Region. Epidemiological studies have convincingly shown that up to 90% of all CVD can be explained by a small number of modifiable risk factors, including blood pressure, smoking, diabetes, total cholesterol and excess body weight. However, the relationship between these risk factors and coronary artery disease and stroke often differ by age and sex, and yet these differences are often overlooked in burden of disease estimations. As such, that can result in either an over- or under-estimation of the disease burden in specific population subgroups, which may affect resource allocation of healthcare. In this review, we derive the most reliable and previously unpublished estimates of the age- and sex-specific burden of vascular disease attributable to the aforementioned risk factors for 10 of the most populous Asian countries in the Western Pacific Region. Understanding how the burden of vascular disease is distributed within and between populations is crucial for developing appropriate health policies and effective treatment strategies, particularly in resource-poor settings.

  7. Accuracy of Pooled-Cohort Equation and SCORE cardiovascular risk calculators to identify individuals with high coronary atherosclerotic burden - implications for statin treatment.

    Science.gov (United States)

    Tralhão, António; Ferreira, António M; Gonçalves, Pedro de Araújo; Rodrigues, Rita; Costa, Cátia; Guerreiro, Sara; Cardim, Nuno; Marques, Hugo

    2016-11-01

    Different cardiovascular risk calculators and risk-based thresholds for initiating statin therapy are currently in use. Using coronary computed tomography angiography, we sought to compare the Pooled-Cohort Equation [atherosclerotic cardiovascular disease (ASCVD) score] with the Systematic COronary Risk Evaluation (SCORE) in the identification of patients with high coronary atherosclerotic burden. In a single-center prospective registry of patients undergoing coronary computed tomography angiography, we identified individuals aged 40-75 years without diabetes or known cardiovascular disease. Cardiovascular risk and eligibility for statin therapy were determined individually on the basis of the two calculators and the guidelines that endorse them. Coronary atherosclerotic burden was assessed by coronary calcium score, presence of stenosis greater than or equal to 50%, and several measures of plaque severity and extension. In the 327 patients assessed (181 men, mean age 59±9 years), the median SCORE and ASCVD values were 2.6 and 9.7%, respectively. Compared with SCORE, the ASCVD calculator showed greater discriminative power to identify patients with calcium score greater than or equal to 300 [C-statistic 0.74, 95% confidence interval (CI) 0.67-0.82 vs. 0.69, 95% CI 0.61-0.78, P=0.008] and showed a trend toward better identification of patients with obstructive stenosis (C-statistic 0.72, 95% CI 0.64-0.80 vs. 0.68, 95% CI 0.60-0.76, P=0.053). The proportion of statin-eligible patients would be higher with the SCORE-based criteria, particularly among individuals with little or no detectable coronary atherosclerosis. The SCORE calculator seems to be less discriminative than the ASCVD equation in identifying patients with high atherosclerotic burden. Current SCORE-based criteria would assign statin therapy to a larger proportion of patients with low-risk features, which could result in a lower yield of cholesterol-reducing strategies.

  8. The atherosclerosis burden score (ABS): a convenient ultrasound-based score of peripheral atherosclerosis for coronary artery disease prediction.

    Science.gov (United States)

    Yerly, Patrick; Marquès-Vidal, Pedro; Owlya, Reza; Eeckhout, Eric; Kappenberger, Lukas; Darioli, Roger; Depairon, Michèle

    2015-03-01

    Ultrasonographic detection of subclinical atherosclerosis improves cardiovascular risk stratification, but uncertainty persists about the most discriminative method to apply. In this study, we found that the "atherosclerosis burden score (ABS)", a novel straightforward ultrasonographic score that sums the number of carotid and femoral arterial bifurcations with plaques, significantly outperformed common carotid intima-media thickness, carotid mean/maximal thickness, and carotid/femoral plaque scores for the detection of coronary artery disease (CAD) (receiver operating characteristic (ROC) curve area under the curve (AUC) = 0.79; P = 0.027 to ABS was also more correlated with CAD extension (R = 0.55; P ABS was weakly correlated with the European Society of Cardiology chart risk categories (R(2) = 0.21), indicating that ABS provided information beyond usual cardiovascular risk factor-based risk stratification. Pending prospective studies on hard cardiovascular endpoints, ABS appears as a promising tool in primary prevention.

  9. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective

    Directory of Open Access Journals (Sweden)

    Degboe Arnold N

    2009-09-01

    Full Text Available Abstract Background Sub-Saharan African (SSA countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD. This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. Methodology We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included. Results The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and

  10. Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study

    Science.gov (United States)

    Guzman-Castillo, Maria; Hyseni, Lirije; Hickey, Graeme L; Bandosz, Piotr; Buchan, Iain; Capewell, Simon; O'Flaherty, Martin

    2017-01-01

    Objective To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England. Design A microsimulation study of a close-to-reality synthetic population. In the first period, 2003–2015, we compared the impact of current policy against a counterfactual ‘no intervention’ scenario, which assumed salt consumption persisted at 2003 levels. For 2016–2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. Setting Synthetic population with similar characteristics to the non-institutionalised population of England. Participants Synthetic individuals with traits informed by the Health Survey for England. Main measure CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation. Results Since 2003, current salt policies have prevented or postponed ∼52 000 CVD cases (IQR: 34 000–76 000) and 10 000 CVD deaths (IQR: 3000–17 000). In addition, the current policies have prevented ∼5000 new cases of GCa (IQR: 2000–7000) resulting in about 2000 fewer deaths (IQR: 0–4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone ∼19 000 CVD cases (IQR: 8000–30 000) and 3600 deaths by 2030 (IQR: −400–8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: −200–3000) and 700 deaths (IQR: −900–2300) could be prevented or postponed with a neutral impact on inequalities. Conclusions Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved

  11. Estimated reductions in cardiovascular and gastric cancer disease burden through salt policies in England: an IMPACTNCD microsimulation study.

    Science.gov (United States)

    Kypridemos, Chris; Guzman-Castillo, Maria; Hyseni, Lirije; Hickey, Graeme L; Bandosz, Piotr; Buchan, Iain; Capewell, Simon; O'Flaherty, Martin

    2017-01-24

    To estimate the impact and equity of existing and potential UK salt reduction policies on primary prevention of cardiovascular disease (CVD) and gastric cancer (GCa) in England. A microsimulation study of a close-to-reality synthetic population. In the first period, 2003-2015, we compared the impact of current policy against a counterfactual 'no intervention' scenario, which assumed salt consumption persisted at 2003 levels. For 2016-2030, we assumed additional legislative policies could achieve a steeper salt decline and we compared this against the counterfactual scenario that the downward trend in salt consumption observed between 2001 and 2011 would continue up to 2030. Synthetic population with similar characteristics to the non-institutionalised population of England. Synthetic individuals with traits informed by the Health Survey for England. CVD and GCa cases and deaths prevented or postponed, stratified by fifths of socioeconomic status using the Index of Multiple Deprivation. Since 2003, current salt policies have prevented or postponed ∼52 000 CVD cases (IQR: 34 000-76 000) and 10 000 CVD deaths (IQR: 3000-17 000). In addition, the current policies have prevented ∼5000 new cases of GCa (IQR: 2000-7000) resulting in about 2000 fewer deaths (IQR: 0-4000). This policy did not reduce socioeconomic inequalities in CVD, and likely increased inequalities in GCa. Additional legislative policies from 2016 could further prevent or postpone ∼19 000 CVD cases (IQR: 8000-30 000) and 3600 deaths by 2030 (IQR: -400-8100) and may reduce inequalities. Similarly for GCa, 1200 cases (IQR: -200-3000) and 700 deaths (IQR: -900-2300) could be prevented or postponed with a neutral impact on inequalities. Current salt reduction policies are powerfully effective in reducing the CVD and GCa burdens overall but fail to reduce the inequalities involved. Additional structural policies could achieve further, more equitable health benefits. Published by the BMJ

  12. Predicting caregiving status and caregivers' burden in multiple sclerosis. A short report.

    Science.gov (United States)

    Katsavos, Serafeim; Artemiadis, Artemios K; Zacharis, Markos; Argyrou, Paraskevi; Theotoka, Ilia; Chrysovitsanou, Chrysa; Anagnostouli, Maria

    2017-01-01

    Predicting caregiving status (CS) in multiple sclerosis (MS) is of both clinical and health policy-making value. The aim of this cross-sectional study was to assess the clinical predictors of CS, along with factors related to caregivers' stress. A sample of 342 clinically definite MS patients (67.5% females, 67.8% relapsing MS, mean age 43.1 ± 11.4 year-old, mean disease duration 147 ± 105.4 months, median Expanded Disability Status Scale -EDSS-3.0) was screened for CS. The Multiple Sclerosis Quality of Life-54 and Zarit Burden Interview were used to measure quality of patients' life and the their caregivers' burden, respectively. In total, 57.9% of patients reported at least one caregiver, 97% of which were relatives or friends. Higher EDSS was associated with higher chance of reporting a caregiver. Two EDSS cut-offs were recognized; 2.0 and 4.5, the former with increased sensitivity (78.8%) and the latter with increased specificity (82.3%) to predict CS. Patients in the mild disability group (EDSS: 0-1.5) needing a caregiver had higher subjective cognitive function, implying presumably a beneficial role of care in cognition. Age and education were showed to affect CS in the moderate disability group (EDSS: 2.0-4.5). Physical and mental disability was more pronounced in patients reporting at least one caregiver in the high disability group (EDSS above 4.5). Caregivers' stress was significantly positively correlated with age, EDSS, and duration of the disease and negatively with cognitive, physical, and mental health. In conclusion, the clinical predictors of CS are known to serve well both the researchers and the clinicians.

  13. Endothelial Progenitor Cells Predict Cardiovascular Events after Atherothrombotic Stroke and Acute Myocardial Infarction. A PROCELL Substudy.

    Directory of Open Access Journals (Sweden)

    Elisa Cuadrado-Godia

    Full Text Available The aim of this study was to determine prognostic factors for the risk of new vascular events during the first 6 months after acute myocardial infarction (AMI or atherothrombotic stroke (AS. We were interested in the prognostic role of endothelial progenitor cells (EPC and circulating endothelial cells (CEC.Between February 2009 and July 2012, 100 AMI and 50 AS patients were consecutively studied in three Spanish centres. Patients with previously documented coronary artery disease or ischemic strokes were excluded. Samples were collected within 24h of onset of symptoms. EPC and CEC were studied using flow cytometry and categorized by quartiles. Patients were followed for up to 6 months. NVE was defined as new acute coronary syndrome, transient ischemic attack (TIA, stroke, or any hospitalization or death from cardiovascular causes. The variables included in the analysis included: vascular risk factors, carotid intima-media thickness (IMT, atherosclerotic burden and basal EPC and CEC count. Multivariate survival analysis was performed using Cox regression analysis.During follow-up, 19 patients (12.66% had a new vascular event (5 strokes; 3 TIAs; 4 AMI; 6 hospitalizations; 1 death. Vascular events were associated with age (P = 0.039, carotid IMT≥0.9 (P = 0.044, and EPC count (P = 0.041 in the univariate analysis. Multivariate Cox regression analysis showed an independent association with EPC in the lowest quartile (HR: 10.33, 95%CI (1.22-87.34, P = 0.032] and IMT≥0.9 [HR: 4.12, 95%CI (1.21-13.95, P = 0.023].Basal EPC and IMT≥0.9 can predict future vascular events in patients with AMI and AS, but CEC count does not affect cardiovascular risk.

  14. Can machine-learning improve cardiovascular risk prediction using routine clinical data?

    Science.gov (United States)

    Weng, Stephen F; Reps, Jenna; Kai, Joe; Garibaldi, Jonathan M; Qureshi, Nadeem

    2017-01-01

    Current approaches to predict cardiovascular risk fail to identify many people who would benefit from preventive treatment, while others receive unnecessary intervention. Machine-learning offers opportunity to improve accuracy by exploiting complex interactions between risk factors. We assessed whether machine-learning can improve cardiovascular risk prediction. Prospective cohort study using routine clinical data of 378,256 patients from UK family practices, free from cardiovascular disease at outset. Four machine-learning algorithms (random forest, logistic regression, gradient boosting machines, neural networks) were compared to an established algorithm (American College of Cardiology guidelines) to predict first cardiovascular event over 10-years. Predictive accuracy was assessed by area under the 'receiver operating curve' (AUC); and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) to predict 7.5% cardiovascular risk (threshold for initiating statins). 24,970 incident cardiovascular events (6.6%) occurred. Compared to the established risk prediction algorithm (AUC 0.728, 95% CI 0.723-0.735), machine-learning algorithms improved prediction: random forest +1.7% (AUC 0.745, 95% CI 0.739-0.750), logistic regression +3.2% (AUC 0.760, 95% CI 0.755-0.766), gradient boosting +3.3% (AUC 0.761, 95% CI 0.755-0.766), neural networks +3.6% (AUC 0.764, 95% CI 0.759-0.769). The highest achieving (neural networks) algorithm predicted 4,998/7,404 cases (sensitivity 67.5%, PPV 18.4%) and 53,458/75,585 non-cases (specificity 70.7%, NPV 95.7%), correctly predicting 355 (+7.6%) more patients who developed cardiovascular disease compared to the established algorithm. Machine-learning significantly improves accuracy of cardiovascular risk prediction, increasing the number of patients identified who could benefit from preventive treatment, while avoiding unnecessary treatment of others.

  15. Troponin I and cardiovascular risk prediction in the general population

    DEFF Research Database (Denmark)

    Blankenberg, Stefan; Salomaa, Veikko; Makarova, Nataliya;

    2016-01-01

    implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality......-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals

  16. Computed Tomography Coronary Artery Calcium Scoring Review of Evidence Base and Cost-effectiveness in Cardiovascular Risk Prediction

    NARCIS (Netherlands)

    Vliegenthart, Rozemarijn; Morris, Pamela B.

    2012-01-01

    Cardiovascular risk factor-scoring algorithms may fall short in identifying asymptomatic individuals who will subsequently suffer a coronary event. It is generally thought that evaluation of the extent of the atherosclerotic plaque and total plaque burden can improve cardiovascular risk stratificati

  17. Cardiovascular disease prediction: do pulmonary disease-related chest CT features have added value?

    Energy Technology Data Exchange (ETDEWEB)

    Jairam, Pushpa M. [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Jong, Pim A. de; Mali, Willem P.T.M. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Isgum, Ivana [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: PROVIDI study-group

    2015-06-01

    Certain pulmonary diseases are associated with cardiovascular disease (CVD). Therefore we investigated the incremental predictive value of pulmonary, mediastinal and pleural features over cardiovascular imaging findings. A total of 10,410 patients underwent diagnostic chest CT for non-cardiovascular indications. Using a case-cohort approach, we visually graded CTs from the cases and from an approximately 10 % random sample of the baseline cohort (n = 1,203) for cardiovascular, pulmonary, mediastinal and pleural findings. The incremental value of pulmonary disease-related CT findings above cardiovascular imaging findings in cardiovascular event risk prediction was quantified by comparing discrimination and reclassification. During a mean follow-up of 3.7 years (max. 7.0 years), 1,148 CVD events (cases) were identified. Addition of pulmonary, mediastinal and pleural features to a cardiovascular imaging findings-based prediction model led to marginal improvement of discrimination (increase in c-index from 0.72 (95 % CI 0.71-0.74) to 0.74 (95 % CI 0.72-0.75)) and reclassification measures (net reclassification index 6.5 % (p < 0.01)). Pulmonary, mediastinal and pleural features have limited predictive value in the identification of subjects at high risk of CVD events beyond cardiovascular findings on diagnostic chest CT scans. (orig.)

  18. High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

    Science.gov (United States)

    Acosta-Cázares, Benjamín; Escobedo-de la Peña, Jorge

    2010-08-01

    Whereas developed nations have witnessed a drop in the occurrence and mortality of ischemic heart disease, developing nations have recorded a constant rise. The burden of cardiovascular disease risk factors may explain this increase. We conducted a population-based cross-sectional survey to estimate the prevalence of cardiovascular risk factors in the population protected by the Mexican Social Security Institute. A total of 20,062 Mexicans, aged >or=20 years, 43.5% (8,727) male and 56.5% (11,335) female, randomly selected in a 4-stage stratified population-based sampling process were included. The most prevalent cardiovascular risk factor in men was smoking (31.9%), whereas in women, it was obesity (26.6%) and central obesity (49.7%). A similar high age-adjusted prevalence was observed in women and men for hypertension (29.7% and 28.8%), diabetes (12.94% and 12.66%), and hypercholesterolemia (13.81% and 12.36%). There was a clear age effect on the prevalence of diabetes, hypertension, and hypercholesterolemia, with increasing prevalence with aging. Smoking also had an age effect, but its prevalence increases as age diminishes. More than half of the subjects in reproductive age (20-44 years old) have at least 1 cardiovascular risk factor, mainly smoking. Cardiovascular risk factors are highly prevalent in the Mexican population, which seems to be between the second and third stages of the tobacco epidemic. The increased prevalence of risk factors clustering indicates the need for comprehensive integrated management of cardiovascular risk factors in Mexicans, with special emphasis on individuals at younger ages. Copyright 2010 Mosby, Inc. All rights reserved.

  19. Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events.

    Science.gov (United States)

    Xie, Wuxiang; Liang, Lirong; Zhao, Liancheng; Shi, Ping; Yang, Ying; Xie, Gaoqiang; Huo, Yong; Wu, Yangfeng

    2011-08-01

    Several indices of carotid atherosclerosis have been studied to investigate their associations with the risk of cardiovascular disease. However, the best index of carotid atherosclerosis that predicts the risk of cardiovascular disease remains unclear. To investigate the index that best reflects the relationship between carotid atherosclerosis and subsequent ischaemic cardiovascular disease (ICVD) events. An observational longitudinal study with a 5-year follow-up. 1734 Chinese subjects (623 men, 1111 women) aged 43-79 years at baseline. ICVD events, including coronary heart disease and ischaemic stroke. Carotid intima-media thickness (IMT) at baseline was significantly associated with the risk of ICVD among participants without carotid plaque (multivariable adjusted HR=1.59, 95% CI 1.04 to 2.45) but not among those with plaque (HR=1.04, 95% CI 0.78 to 1.39). However, the total area of plaques (HR=1.29, 95% CI 1.08 to 1.55), the number of plaques (HR=1.14, 95% CI 1.02 to 1.27) and the number of segments with plaque (HR=1.45, 95% CI 1.09 to 1.93) were all significantly associated with ICVD in participants with plaque. Thus, carotid IMT and the number of segments with plaque were combined to establish a summary index-the total burden score (TBS) of carotid atherosclerosis-which was shown to improve the prediction of the 5-year risk of ICVD significantly compared with IMT or the number of segments with plaque alone. The c-statistics and net reclassification index showed that TBS improved the risk prediction by increases of 6.0% and 17.1%, respectively, compared with the conventional risk score. The TBS could significantly improve the prediction of ICVD risk and should be used in clinical practice and future studies.

  20. Resting State Functional Connectivity within the Cingulate Cortex Jointly Predicts Agreeableness and Stressor-Evoked Cardiovascular Reactivity

    OpenAIRE

    Ryan, John P.; Sheu, Lei K.; Peter J Gianaros

    2010-01-01

    Exaggerated cardiovascular reactivity to stress confers risk for cardiovascular disease. Further, individual differences in stressor-evoked cardiovascular reactivity covary with the functionality of cortical and limbic brain areas, particularly within the cingulate cortex. What remains unclear, however, is how individual differences in personality traits interact with cingulate functionality in the prediction of stressor-evoked cardiovascular reactivity. Accordingly, we tested the association...

  1. Burden of upper gastrointestinal symptoms in patients receiving low-dose acetylsalicylic acid for cardiovascular risk management

    DEFF Research Database (Denmark)

    Bytzer, Peter; Pratt, Stephen; Elkin, Eric

    2013-01-01

    Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users.......Continuous low-dose acetylsalicylic acid (aspirin; ASA) is a mainstay of cardiovascular (CV) risk management. It is well established, however, that troublesome upper gastrointestinal (GI) symptoms are commonly experienced among low-dose ASA users....

  2. In-treatment stroke volume predicts cardiovascular risk in hypertension

    DEFF Research Database (Denmark)

    Lønnebakken, Mai T; Gerdts, Eva; Boman, Kurt

    2011-01-01

    To evaluate whether lower stroke volume during antihypertensive treatment is a predictor of cardiovascular events independent of left ventricular geometric pattern. Methods: The association between left ventricular stroke volume and combined cardiovascular death, stroke and myocardial infarction......, the prespecified primary study endpoint, was assessed in Cox regression analysis using data from baseline and annual follow-up visits in 855 patients during 4.8 years of randomized losartan-based or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography...... resistance, more concentric left ventricular geometry and impaired diastolic relaxation (all P treatment left ventricular stroke volume indexed for height2.04 was associated...

  3. Predictive factors for latent tuberculosis infection among adolescents in a high-burden area in South Africa

    NARCIS (Netherlands)

    H. Mahomed; T. Hawkridge; S. Verver; L. Geiter; M. Hatherill; D.A. Abrahams; R. Ehrlich; W.A. Hanekom; G.D. Hussey

    2011-01-01

    SETTING: A high tuberculosis (TB) burden area in South Africa (notification rate for all TB cases 1400 per 100 000 population). OBJECTIVE: To determine the prevalence of and predictive factors associated with latent TB infection in adolescents. DESIGN: Adolescents aged 12-18 years were recruited fro

  4. Biomarkers of cardiovascular disease: contributions to risk prediction in individuals with diabetes.

    Science.gov (United States)

    Bachmann, Katherine N; Wang, Thomas J

    2017-09-28

    Cardiovascular disease is a leading cause of death, especially in individuals with diabetes mellitus, whose risk of morbidity and mortality due to cardiovascular disease is markedly increased compared with the general population. There has been growing interest in the identification of biomarkers of cardiovascular disease in people with diabetes. The present review focuses on the current and potential contributions of these biomarkers to predicting cardiovascular risk in individuals with diabetes. At present, certain biomarkers and biomarker combinations can lead to modest improvements in the prediction of cardiovascular disease in diabetes beyond traditional cardiovascular risk factors. Emerging technologies may enable the discovery of novel biomarkers and generate new information about known biomarkers (such as new combinations of biomarkers), which could lead to significant improvements in cardiovascular disease risk prediction. A critical question, however, is whether improvements in risk prediction will affect processes of care and decision making in clinical practice, as this will be required to achieve the ultimate goal of improving clinical outcomes in diabetes.

  5. Reliability of blood pressure measurement and cardiovascular risk prediction

    NARCIS (Netherlands)

    van der Hoeven, N.V.

    2016-01-01

    High blood pressure is one of the leading risk factors for cardiovascular disease, but difficult to reliably assess because there are many factors which can influence blood pressure including stress, exercise or illness. The first part of this thesis focuses on possible ways to improve the reliabili

  6. Mind the gap : predicting cardiovascular risk during drug development

    NARCIS (Netherlands)

    Chain, Anne S. Y.

    2012-01-01

    Cardiovascular safety issues, specifically drug-induced QT/QTc-interval prolongation, remain a major cause of drug attrition during clinical development and is one of the main causes for post-market drug withdrawals accounting for 15-34% of all drug discontinuation. Given the potentially fatal conse

  7. Reliability of blood pressure measurement and cardiovascular risk prediction

    NARCIS (Netherlands)

    van der Hoeven, N.V.

    2016-01-01

    High blood pressure is one of the leading risk factors for cardiovascular disease, but difficult to reliably assess because there are many factors which can influence blood pressure including stress, exercise or illness. The first part of this thesis focuses on possible ways to improve the

  8. Health-related quality of life is poor but does not vary with cardiovascular disease burden among patients operated for severe atherosclerotic disease

    NARCIS (Netherlands)

    Haitjema, Saskia; de Borst, Gert Jan; de Vries, Jean Paul; Moll, Frans; Pasterkamp, Gerard; den Ruijter, Hester

    2014-01-01

    Background: Patients with cardiovascular disease (CVD) are reported to have a poorer health-related quality of life (HRQoL) compared to healthy age- and gender-matched individuals. Moreover, HRQoL seems to predict survival in CVD populations. We studied HRQoL and the association with outcome during

  9. Mind the gap: predicting cardiovascular risk during drug development

    OpenAIRE

    Chain, Anne S Y

    2012-01-01

    Cardiovascular safety issues, specifically drug-induced QT/QTc-interval prolongation, remain a major cause of drug attrition during clinical development and is one of the main causes for post-market drug withdrawals accounting for 15-34% of all drug discontinuation. Given the potentially fatal consequences of this concentration-dependent adverse drug reaction, regulatory authorities have reacted to this “pharmacoepidemic” by denying or delaying the approval of a number of new drugs and placin...

  10. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery.

    Science.gov (United States)

    Patelis, Nikolaos; Kouvelos, George N; Koutsoumpelis, Andreas; Moris, Demetrios; Matsagkas, Miltiadis I; Arnaoutoglou, Eleni

    2016-09-01

    Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.

  11. Barriers to apply cardiovascular prediction rules in primary care: a postal survey

    Science.gov (United States)

    Eichler, Klaus; Zoller, Marco; Tschudi, Peter; Steurer, Johann

    2007-01-01

    Background Although cardiovascular prediction rules are recommended by guidelines to evaluate global cardiovascular risk for primary prevention, they are rarely used in primary care. Little is known about barriers for application. The objective of this study was to evaluate barriers impeding the application of cardiovascular prediction rules in primary prevention. Methods We performed a postal survey among general physicians in two Swiss Cantons by a purpose designed questionnaire. Results 356 of 772 dispatched questionnaires were returned (response rate 49.3%). About three quarters (74%) of general physicians rarely or never use cardiovascular prediction rules. Most often stated barriers to apply prediction rules among rarely- or never-users are doubts concerning over-simplification of risk assessment using these instruments (58%) and potential risk of (medical) over-treatment (54%). 57% report that the numerical information resulting from prediction rules is often not helpful for decision-making in practice. Conclusion If regular application of cardiovascular prediction rules in primary care is in demand additional interventions are needed to increase acceptance of these tools for patient management among general physicians. PMID:17201905

  12. Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes

    Science.gov (United States)

    Cha, Seon-Ah; Yun, Jae-Seung; Lim, Tae-Seok; Min, Kyoungil; Song, Ki-Ho; Yoo, Ki-Dong; Park, Yong-Moon; Ahn, Yu-Bae

    2016-01-01

    Cardiovascular autonomic neuropathy (CAN) is a risk factor for cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2%) of the 206 patients enrolled completed the follow up, and 78 (49.1%) patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004), diabetic nephropathy (P = 0.012), higher mean systolic blood pressure (P = 0.006), urinary albumin excretion (P = 0.015), and mean triglyceride level (P = 0.035) than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39−6.60; P = 0.005). Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event. PMID:27741306

  13. Combined effects of thrombosis pathway gene variants predict cardiovascular events.

    Directory of Open Access Journals (Sweden)

    Kirsi Auro

    2007-07-01

    Full Text Available The genetic background of complex diseases is proposed to consist of several low-penetrance risk loci. Addressing this complexity likely requires both large sample size and simultaneous analysis of different predisposing variants. We investigated the role of four thrombosis genes: coagulation factor V (F5, intercellular adhesion molecule 1 (ICAM1, protein C (PROC, and thrombomodulin (THBD in cardiovascular diseases. Single allelic gene variants and their pair-wise combinations were analyzed in two independently sampled population cohorts from Finland. From among 14,140 FINRISK participants (FINRISK-92, n = 5,999 and FINRISK-97, n = 8,141, we selected for genotyping a sample of 2,222, including 528 incident cardiovascular disease (CVD cases and random subcohorts totaling 786. To cover all known common haplotypes (>10%, 54 single nucleotide polymorphisms (SNPs were genotyped. Classification-tree analysis identified 11 SNPs that were further analyzed in Cox's proportional hazard model as single variants and pair-wise combinations. Multiple testing was controlled by use of two independent cohorts and with false-discovery rate. Several CVD risk variants were identified: In women, the combination of F5 rs7542281 x THBD rs1042580, together with three single F5 SNPs, was associated with CVD events. Among men, PROC rs1041296, when combined with either ICAM1 rs5030341 or F5 rs2269648, was associated with total mortality. As a single variant, PROC rs1401296, together with the F5 Leiden mutation, was associated with ischemic stroke events. Our strategy to combine the classification-tree analysis with more traditional genetic models was successful in identifying SNPs-acting either in combination or as single variants--predisposing to CVD, and produced consistent results in two independent cohorts. These results suggest that variants in these four thrombosis genes contribute to arterial cardiovascular events at population level.

  14. Cardiovascular mortality prediction in veterans with arm exercise vs pharmacologic myocardial perfusion imaging.

    Science.gov (United States)

    Martin, Wade H; Xian, Hong; Chandiramani, Pooja; Bainter, Emily; Klein, Andrew J P

    2015-08-01

    No data exist comparing outcome prediction from arm exercise vs pharmacologic myocardial perfusion imaging (MPI) stress test variables in patients unable to perform treadmill exercise. In this retrospective study, 2,173 consecutive lower extremity disabled veterans aged 65.4 ± 11.0years (mean ± SD) underwent either pharmacologic MPI (1730 patients) or arm exercise stress tests (443 patients) with MPI (n = 253) or electrocardiography alone (n = 190) between 1997 and 2002. Cox multivariate regression models and reclassification analysis by integrated discrimination improvement (IDI) were used to characterize stress test and MPI predictors of cardiovascular mortality at ≥10-year follow-up after inclusion of significant demographic, clinical, and other variables. Cardiovascular death occurred in 561 pharmacologic MPI and 102 arm exercise participants. Multivariate-adjusted cardiovascular mortality was predicted by arm exercise resting metabolic equivalents (hazard ratio [HR] 0.52, 95% CI 0.39-0.69, P heart rate recovery (HR 0.61, 95% CI 0.44-0.86, P exercise delta (peak-rest) heart rate (both P exercise MPI prognosticated cardiovascular death by multivariate Cox analysis (HR 1.98, 95% CI 1.04-3.77, P exercise MPI defect number, type, and size provided IDI over covariates for prediction of cardiovascular mortality (IDI = 0.074-0.097). Only pharmacologic defect size prognosticated cardiovascular mortality (IDI = 0.022). Arm exercise capacity, heart rate recovery, and pharmacologic and arm exercise heart rate responses are robust predictors of cardiovascular mortality. Arm exercise MPI results are equivalent and possibly superior to pharmacologic MPI for cardiovascular mortality prediction in patients unable to perform treadmill exercise. Published by Elsevier Inc.

  15. Aldosterone does not predict cardiovascular events following acute coronary syndrome in patients initially without heart failure

    OpenAIRE

    Pitts, Reynaria; Gunzburger, Elise; Ballantyne, Christie M.; Barter, Philip J.; Kallend, David; Leiter, Lawrence A.; Leitersdorf, Eran; Nicholls, Stephen J.; Prediman K Shah; Tardif, Jean-Claude; Olsson, Anders G.; McMurray, John J.V.; Kittelson, John; Schwartz, Gregory G.

    2017-01-01

    Background: Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk.\\ud \\ud Methods and Results: To address this question, we exa...

  16. Extreme lipoprotein(a) levels and improved cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Kamstrup, Pia R; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2013-01-01

    The study tested whether extreme lipoprotein(a) levels and/or corresponding LPA risk genotypes improve myocardial infarction (MI) and coronary heart disease (CHD) risk prediction beyond conventional risk factors.......The study tested whether extreme lipoprotein(a) levels and/or corresponding LPA risk genotypes improve myocardial infarction (MI) and coronary heart disease (CHD) risk prediction beyond conventional risk factors....

  17. An update on the burden of cardiovascular disease risk factors in Jamaica: findings from the Jamaica Health and Lifestyle Survey 2007-2008.

    Science.gov (United States)

    Ferguson, T S; Francis, D K; Tulloch-Reid, M K; Younger, N O M; McFarlane, S R; Wilks, R J

    2011-07-01

    Previous studies have documented a high burden of cardiovascular disease (CVD) risk factors in Jamaica and suggest that mortality from CVD may be increasing. This paper provides an update on the burden of CVD risk factors in Jamaica using data from the most recent national health survey and evaluates the impact of obesity and physical activity on other CVD risk factors. The Jamaica Health and Lifestyle Survey 2007-2008 (JHLS-2) recruited a nationally representative sample of 2848 Jamaicans, 15-74 years old between November 2007 and March 2008. An interviewer administered questionnaire was used to obtain data on demographic characteristics, medical history and health behaviour Blood pressure and anthropometric measurements were made using standardized protocols and capillary blood samples were obtained to measure fasting glucose and total cholesterol. Prevalence estimates for the various CVD risk factors were obtained within and across sex and other demographic categories. Data were weighted for the complex survey design, nonresponse to questionnaire items or failure to complete some segments of the evaluation. Prevalence estimates for traditional CVD risk factors were: hypertension, 25%; diabetes, 8%; hypercholesterolaemia, 12%; obesity, 25%; smoking 15%. In addition, 35% of Jamaicans had prehypertension, 3% had impaired fasting glucose and 27% were overweight. A higher proportion of women had diabetes, obesity and hypercholesterolaemia while the prevalence of prehypertension and cigarette smoking was higher in men. Approximately 50% of persons with hypertension, 25% of persons with diabetes and 86% of persons with hypercholesterolaemia were unaware of their risk status. In multivariate analysis, obesity was associated with increased odds of hypertension, diabetes and hypercholesterolaemia while physical inactivity was associated with higher odds of diabetes. The burden of CVD risk factors in Jamaica remains very high and warrants interventions to reduce CVD risk.

  18. The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services.

    Science.gov (United States)

    Divala, Oscar H; Amberbir, Alemayehu; Ismail, Zahra; Beyene, Teferi; Garone, Daniela; Pfaff, Colin; Singano, Victor; Akello, Harriet; Joshua, Martias; Nyirenda, Moffat J; Matengeni, Alfred; Berman, Josh; Mallewa, Jane; Chinomba, Gift S; Kayange, Noel; Allain, Theresa J; Chan, Adrienne K; Sodhi, Sumeet K; van Oosterhout, Joep J

    2016-12-12

    Hypertension and diabetes prevalence is high in Africans. Data from HIV infected populations are limited, especially from Malawi. Integrating care for chronic non-communicable co-morbidities in well-established HIV services may provide benefit for patients by preventing multiple hospital visits but will increase the burden of care for busy HIV clinics. Cross-sectional study of adults (≥18 years) at an urban and a rural HIV clinic in Zomba district, Malawi, during 2014. Hypertension and diabetes were diagnosed according to stringent criteria. Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores (Framingham and World Health Organization/International Society for Hypertension) were determined. The association of patient characteristics with diagnoses of hypertension and diabetes was studied using multivariable analyses. We explored the additional burden of care for integrated drug treatment of hypertension and diabetes in HIV clinics. We defined that burden as patients with diabetes and/or stage II and III hypertension, but not with stage I hypertension unless they had proteinuria, previous stroke or high Framingham CVD risk. Nine hundred fifty-two patients were enrolled, 71.7% female, median age 43.0 years, 95.9% on antiretroviral therapy (ART), median duration 47.7 months. Rural and urban patients' characteristics differed substantially. Hypertension prevalence was 23.7% (95%-confidence interval 21.1-26.6; rural 21.0% vs. urban 26.5%; p = 0.047), of whom 59.9% had stage I (mild) hypertension. Diabetes prevalence was 4.1% (95%-confidence interval 3.0-5.6) without significant difference between rural and urban settings. Prevalence of proteinuria, elevated total/high-density lipoprotein-cholesterol ratio and high CVD risk score was low. Hypertension diagnosis was associated with increasing age, higher body mass index, presence of proteinuria, being on regimen zidovudine/lamivudine/nevirapine and inversely with World Health

  19. Actual Versus Predicted Cardiovascular Demands in Submaximal Cycle Ergometer Testing.

    Science.gov (United States)

    Hoehn, Amanda M; Mullenbach, Megan J; Fountaine, Charles J

    The Astrand-Rhyming cycle ergometer test (ARCET) is a commonly administered submaximal test for estimating aerobic capacity. Whereas typically utilized in clinical populations, the validity of the ARCET to predict VO2max in a non-clinical population, especially female, is less clear. Therefore, the purpose of this study was to determine the accuracy of the ARCET in a sample of healthy and physically active college students. Subjects (13 females, 10 males) performed a maximal cycle ergometer test to volitional exhaustion to determine VO2max. At least 48 hours later, subjects performed the ARCET protocol. Predicted VO2max was calculated following the ARCET format using the age corrected factor. There was no significant difference (p=.045) between actual (41.0±7.97 ml/kg/min) and predicted VO2max (40.3±7.58 ml/kg/min). When split for gender there was a significant difference between actual and predicted VO2 for males, (45.1±7.74 vs. 42.7±8.26 ml/kg/min, p=0.029) but no significant difference observed for females, (37.9±6.9 vs. 38.5±6.77 ml/kg/min, p=0.675). The correlation between actual and predicted VO2 was r=0.84, pVO2max in a healthy college population of both male and female subjects. Implications of this study suggest the ARCET can be used to assess aerobic capacity in both fitness and clinical settings where measurement via open-circuit spirometry is either unavailable or impractical.

  20. Poor Response to Periodontal Treatment May Predict Future Cardiovascular Disease.

    Science.gov (United States)

    Holmlund, A; Lampa, E; Lind, L

    2017-07-01

    Periodontal disease has been associated with cardiovascular disease (CVD), but whether the response to the treatment of periodontal disease affects this association has not been investigated in any large prospective study. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Poor response to treatment was defined as having >10% sites with probing pocket depth >4 mm deep and bleeding on probing at ≥20% of the sites 1 y after active treatment. Fatal/nonfatal incidence rate of CVD (composite end point of myocardial infarction, stroke, and heart failure) was obtained from the Swedish cause-of-death and hospital discharge registers. Poisson regression analysis was performed to analyze future risk of CVD. During a median follow-up of 16.8 y (89,719 person-years at risk), those individuals who did not respond well to treatment (13.8% of the sample) had an increased incidence of CVD ( n = 870) when compared with responders (23.6 vs. 15.3%, P 4 mm, and number of teeth, the incidence rate ratio for CVD among poor responders was 1.28 (95% CI, 1.07 to 1.53; P = 0.007) as opposed to good responders. The incidence rate ratio among poor responders increased to 1.39 (95% CI, 1.13 to 1.73; P = 0.002) for those with the most remaining teeth. Individuals who did not respond well to periodontal treatment had an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.

  1. Predictive genetic testing for cardiovascular diseases: impact on carrier children.

    Science.gov (United States)

    Meulenkamp, Tineke M; Tibben, Aad; Mollema, Eline D; van Langen, Irene M; Wiegman, Albert; de Wert, Guido M; de Beaufort, Inez D; Wilde, Arthur A M; Smets, Ellen M A

    2008-12-15

    We studied the experiences of children identified by family screening who were found to be a mutation carrier for a genetic cardiovascular disease (Long QT Syndrome (LQTS), Hypertrophic Cardiomyopathy (HCM), Familial Hypercholesterolemia (FH)). We addressed the (a) manner in which they perceive their carrier status, (b) impact on their daily lives, and (c) strategy used to cope with these consequences. Children (aged 8-18) who tested positive for LQTS (n=11), HCM (n=6) or FH (n=16), and their parents participated in semi-structured audiotaped interviews. Interview topics included illness perception, use of medication, lifestyle modifications, worries, and coping. Each interview was coded by two researchers. The qualitative analysis was guided by Leventhal's model of self-regulation. The children were overall quite articulate about the disease they were tested for, including its mode of inheritance. They expressed positive future health perceptions, but feelings of controllability varied. Adherence and side-effects were significant themes with regard to medication-use. Refraining from activities and maintaining a non-fat diet were themes concerning lifestyle modifications. Some children spontaneously reported worries about the possibility of dying and frustration about being different from peers. Children coped with these worries by expressing faith in the effectiveness of medication, trying to be similar to peers or, in contrast, emphasizing their "being different." Children generally appeared effective in the way they coped with their carrier status and its implications. Nevertheless, dealing with the daily implications of their condition remains difficult in some situations, warranting continued availability of psychosocial support.

  2. Caregiver burden and emotional problems in partners of stroke patients at two months and one year post-stroke : Determinants and prediction

    NARCIS (Netherlands)

    Kruithof, Willeke J.; Post, Marcel W. M.; van Mierlo, Maria L.; van den Bos, Geertrudis A. M.; de Man-van Ginkel, Janneke M.; Visser-Meily, Johanna M. A.

    2016-01-01

    Objectives: (a) To determine levels of and factors explaining partners' burden, anxiety and depressive symptoms at two months post-stroke, (b) to predict partners' burden, anxiety and depressive symptoms at one year post-stroke based on patient and partner characteristics available at two months

  3. Prediction models for cardiovascular disease risk in the general population : Systematic review

    NARCIS (Netherlands)

    Damen, Johanna A A G; Hooft, Lotty; Schuit, Ewoud; Debray, Thomas P A; Collins, Gary S.; Tzoulaki, Ioanna; Lassale, Camille M.; Siontis, George C M; Chiocchia, Virginia; Roberts, Corran; Schlüssel, Michael Maia; Gerry, Stephen; Black, James A.; Heus, Pauline; Van Der Schouw, Yvonne T.; Peelen, Linda M.; Moons, Karel G M

    2016-01-01

    OBJECTIVE: To provide an overview of prediction models for risk of cardiovascular disease (CVD) in the general population. DESIGN: Systematic review. DATA SOURCES: Medline and Embase until June 2013. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies describing the development or external validation

  4. Do obesity and parental history of myocardial infaction improve cardiovascular risk prediction?

    NARCIS (Netherlands)

    Dis, van I.; Geleijnse, J.M.; Kromhout, D.; Boer, J.M.; Boshuizen, H.C.; Verschuren, W.M.

    2013-01-01

    Background: In clinical practice, individuals at increased risk of cardiovascular diseases (CVD) are identified on the basis of age, sex, smoking, blood pressure, and serum total and high-density lipoprotein cholesterol. We examined whether CVD risk prediction improved when obesity (body mass index

  5. The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions

    DEFF Research Database (Denmark)

    Ferrario, Marco M; Veronesi, Giovanni; Chambless, Lloyd E

    2014-01-01

    OBJECTIVE: To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. METHODS: In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47...

  6. Cardiovascular risk prediction: the old has given way to the new but at what risk-benefit ratio?

    Directory of Open Access Journals (Sweden)

    Yeboah J

    2014-10-01

    Full Text Available Joseph Yeboah Heart and Vascular Center of Excellence, Wake Forest University School of Medicine, Winston-Salem, NC, USA Abstract: The ultimate goal of cardiovascular risk prediction is to identify individuals in the population to whom the application or administration of current proven lifestyle modifications and medicinal therapies will result in reduction in cardiovascular disease events and minimal adverse effects (net benefit to society. The use of cardiovascular risk prediction tools dates back to 1976 when the Framingham coronary heart disease risk score was published. Since then a lot of novel risk markers have been identified and other cardiovascular risk prediction tools have been developed to either improve or replace the Framingham Risk Score (FRS. In 2013, the new atherosclerotic cardiovascular disease risk estimator was published by the American College of Cardiology and the American Heart Association to replace the FRS for cardiovascular risk prediction. It is too soon to know the performance of the new atherosclerotic cardiovascular disease risk estimator. The risk-benefit ratio for preventive therapy (lifestyle modifications, statin +/− aspirin based on cardiovascular disease risk assessed using the FRS is unknown but it was assumed to be a net benefit. Should we also assume the risk-benefit ratio for the new atherosclerotic cardiovascular disease risk estimator is also a net benefit? Keywords: risk prediction, prevention, cardiovascular disease

  7. cardiovasculares

    Directory of Open Access Journals (Sweden)

    Cristina Guerrero

    2006-01-01

    Full Text Available Uno de los aspectos que más discusión ha suscitado en los últimos tiempos entre quienes nos dedicamos al estudio de la emoción tiene que ver con la eventual asociación entre percepción, valoración y respuesta fisiológica. Esto es, siguiendo la máxima aristotélica, cabría cuestionar si las cosas son como son o son como cada quien las percibe. El objetivo de este experimento ha sido establecer la existencia de una conexión entre percepción de control y responsividad cardiovascular. La muestra estudiada ha estado conformada por estudiantes de la Universidad de Castellón; todos ellos han participado de forma voluntaria. La prueba de estrés ha consistido en un examen real de una asignatura troncal de la titulación que cursaban los participantes. Así pues, utilizando una situación de estrés real, hipotetizamos que las respuestas cardiovasculares (medidas a través de la tasa cardiaca, la presión sanguínea sistólica y la presión sanguínea diastólica dependen de la percepción de control que el individuo tiene, o cree tener, sobre la situación.

  8. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, K.; Coresh, J.; Sang, Y.; Chalmers, J.; Fox, C.; Guallar, E.; Jafar, T.; Jassal, S.K.; Landman, G.W.; Muntner, P.; Roderick, P.; Sairenchi, T.; Schottker, B.; Shankar, A.; Shlipak, M.; Tonelli, M.; Townend, J.; Zuilen, A. van; Yamagishi, K.; Yamashita, K.; Gansevoort, R.; Sarnak, M.; Warnock, D.G.; Woodward, M.; Arnlov, J.; Wetzels, J.F.M.

    2015-01-01

    BACKGROUND: The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a

  9. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes : a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, Kunihiro; Coresh, Josef; Sang, Yingying; Chalmers, John; Fox, Caroline; Guallar, Eliseo; Jafar, Tazeen; Jassal, Simerjot K.; Landman, Gijs W. D.; Muntner, Paul; Roderick, Paul; Sairenchi, Toshimi; Schoettker, Ben; Shankar, Anoop; Shlipak, Michael; Tonelli, Marcello; Townend, Jonathan; van Zuilen, Arjan; Yamagishi, Kazumasa; Yamashita, Kentaro; Gansevoort, Ron; Sarnak, Mark; Warnock, David G.; Woodward, Mark; Arnlov, Johan; de Zeeuw, Dick

    Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a

  10. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes : a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, Kunihiro; Coresh, Josef; Sang, Yingying; Chalmers, John; Fox, Caroline; Guallar, Eliseo; Jafar, Tazeen; Jassal, Simerjot K.; Landman, Gijs W. D.; Muntner, Paul; Roderick, Paul; Sairenchi, Toshimi; Schoettker, Ben; Shankar, Anoop; Shlipak, Michael; Tonelli, Marcello; Townend, Jonathan; van Zuilen, Arjan; Yamagishi, Kazumasa; Yamashita, Kentaro; Gansevoort, Ron; Sarnak, Mark; Warnock, David G.; Woodward, Mark; Arnlov, Johan; de Zeeuw, Dick

    2015-01-01

    Background The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-

  11. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data

    NARCIS (Netherlands)

    Matsushita, K.; Coresh, J.; Sang, Y.; Chalmers, J.; Fox, C.; Guallar, E.; Jafar, T.; Jassal, S.K.; Landman, G.W.; Muntner, P.; Roderick, P.; Sairenchi, T.; Schottker, B.; Shankar, A.; Shlipak, M.; Tonelli, M.; Townend, J.; Zuilen, A. van; Yamagishi, K.; Yamashita, K.; Gansevoort, R.; Sarnak, M.; Warnock, D.G.; Woodward, M.; Arnlov, J.; Wetzels, J.F.M.

    2015-01-01

    BACKGROUND: The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta

  12. In Utero Exposure to a Cardiac Teratogen Causes Reversible Deficits in Postnatal Cardiovascular Function, But Altered Adaptation to the Burden of Pregnancy.

    Science.gov (United States)

    Aasa, Kristiina L; Maciver, Rebecca D; Ramchandani, Shyamlal; Adams, Michael A; Ozolinš, Terence R S

    2015-11-01

    Congenital heart defects (CHD) are the most common birth anomaly and while many resolve spontaneously by 1 year of age, the lifelong burden on survivors is poorly understood. Using a rat model of chemically induced CHD that resolve postnatally, we sought to characterize the postnatal changes in cardiac function, and to investigate whether resolved CHD affects the ability to adapt to the increased the cardiovascular (CV) burden of pregnancy. To generate rats with resolved CHD, pregnant rats were administered distilled water or dimethadione (DMO) [300 mg/kg b.i.d. on gestation day (gd) 9 and 10] and pups delivered naturally. To characterize structural and functional changes in the heart, treated and control offspring were scanned by echocardiography on postnatal day 4, 21, and 10-12 weeks. Radiotelemeters were implanted for continuous monitoring of hemodynamics. Females were mated and scanned by echocardiography on gd12 and gd18 during pregnancy. On gd18, maternal hearts were collected for structural and molecular assessment. Postnatal echocardiography revealed numerous structural and functional differences in treated offspring compared with control; however, these resolved by 10-12 weeks of age. The CV demand of pregnancy revealed differences between treated and control offspring with respect to mean arterial pressure, CV function, cardiac strain, and left ventricular gene expression. In utero exposure to DMO also affected the subsequent generation. Gd18 fetal and placental weights were increased in treated F2 offspring. This study demonstrates that in utero chemical exposure may permanently alter the capacity of the postnatal heart to adapt to pregnancy and this may have transgenerational effects.

  13. Cardiovascular magnetic resonance of scar and ischemia burden early after acute ST elevation and non-ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Sparrow Patrick

    2008-10-01

    Full Text Available Abstract Background The acute coronary syndrome diagnosis includes different classifications of myocardial infarction, which have been shown to differ in their pathology, as well as their early and late prognosis. These differences may relate to the underlying extent of infarction and/or residual myocardial ischemia. The study aim was to compare scar and ischemia mass between acute non-ST elevation myocardial infarction (NSTEMI, ST-elevation MI with Q-wave formation (Q-STEMI and ST-elevation MI without Q-wave formation (Non-Q STEMI in-vivo, using cardiovascular magnetic resonance (CMR. Methods and results This was a prospective cohort study of twenty five consecutive patients with NSTEMI, 25 patients with thrombolysed Q-STEMI and 25 patients with thrombolysed Non-Q STEMI. Myocardial function (cine imaging, ischemia (adenosine stress first pass myocardial perfusion and scar (late gadolinium enhancement were assessed by CMR 2–6 days after presentation and before any invasive revascularisation procedure. All subjects gave written informed consent and ethical committee approval was obtained. Scar mass was highest in Q-STEMI, followed by Non-Q STEMI and NSTEMI (24.1%, 15.2% and 3.8% of LV mass, respectively; p Conclusion Prior to revascularisation, the ratio of scar to ischemia differs between NSTEMI, Non-Q STEMI and Q-STEMI, whilst the combined scar and ischemia mass is similar between these three types of MI. These results provide in-vivo confirmation of the diverse pathophysiology of different types of acute myocardial infarction and may explain their divergent early and late prognosis.

  14. Cardiovascular Disease Burden: Evolving Knowledge of Risk Factors in Myocardial Infarction and Stroke through Population-Based Research and Perspectives in Global Prevention

    Directory of Open Access Journals (Sweden)

    GUSTAVO B.F. OLIVEIRA

    2015-08-01

    Full Text Available Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.e., ischemic heart disease and cerebrovascular diseases have developed rapidly. In fact, until recently, it was considered that only half of the myocardial infarctions were due to traditional risk factors such as hypertension, hypercholesterolemia, smoking and diabetes. In addition, most of the available evidence of incidence, risk factors, and clinical outcomes, if not all of it, was derived from studies conducted in developed countries, which included lower proportion of female individuals and with low ethnic diversity. Recent reports by the WHO have provided striking public health information, i.e., the global burden of cardiovascular mortality for the next decades is expected to predominantly occur among developing countries. Therefore, multi-ethnic population-based research including prospective cohorts and, when appropriate, case-control studies, is warranted. These studies should be specifically designed to ascertain key public health measures such as geographic variations in noncommunicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention (both primary and secondary and specific treatments. As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology (PURE study, which is the largest global initiative of 150,000 adults aged 35-70 yrs, looking at environmental, societal and biological influences on obesity and chronic health conditions such as ischemic heart disease, stroke and cancer among urban and rural communities in low-, middle-, and high-income countries, with national, community, household and individual-level data. Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity

  15. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardio-metabolic risk factors between 1980 and 2010: comparative risk assessment

    Science.gov (United States)

    2015-01-01

    Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some

  16. Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry

    DEFF Research Database (Denmark)

    Sundbøll, Jens; Adelborg, Kasper; Munch, Troels;

    2016-01-01

    medical record review as the reference standard, we examined the PPV for cardiovascular diagnoses in the DNPR, coded according to the International Classification of Diseases, 10th Revision. RESULTS: A total of 2153 medical records (97% of the total sample) were available for review. The PPVs ranged from......OBJECTIVE: The majority of cardiovascular diagnoses in the Danish National Patient Registry (DNPR) remain to be validated despite extensive use in epidemiological research. We therefore examined the positive predictive value (PPV) of cardiovascular diagnoses in the DNPR. DESIGN: Population...... pectoris, pulmonary hypertension, bradycardia, ventricular tachycardia/fibrillation, endocarditis, cardiac tumours, first-time venous thromboembolism and between 70% and 80% for first-time and recurrent admission due to heart failure, first-time dilated cardiomyopathy, restrictive cardiomyopathy...

  17. Predicting the Future Burden of Esophageal Cancer by Histological Subtype: International Trends in Incidence up to 2030.

    Science.gov (United States)

    Arnold, Melina; Laversanne, Mathieu; Brown, Linda Morris; Devesa, Susan S; Bray, Freddie

    2017-08-01

    Rapid increases in the incidence of esophageal adenocarcinoma (EAC) in high-income countries in the past decades have raised public health concerns. This study is the first to predict the future burden of esophageal cancer by histological subtype using international incidence data. Data on esophageal cancer incidence by year of diagnosis, sex, histology, and age group were extracted from 42 registries in 12 countries included in the last three volumes (VIII-X) of Cancer Incidence in Five Continents, contributing at least 15 years of consecutive data. Numbers of new cases and incidence rates were predicted up to 2030 by fitting and extrapolating age-period-cohort models; the differential impact of demographic vs. risk changes on future cases were examined. The number of new AC cases is expected to increase rapidly 2005-2030 in all studied countries as a combined result of increasing risk and changing demographics. In contrast, the incidence of esophageal squamous cell carcinoma (ESCC) is predicted to continue decreasing in most countries. By 2030, 1 in 100 men in the Netherlands and the United Kingdom are predicted to be diagnosed with EAC during their lifetime. The burden from EAC is expected to rise dramatically across high-income countries and has already or will surpass ESCC incidence in the coming years, especially among men. Notwithstanding the inherent uncertainties in trend-based predictions and in subtype misclassification, these findings highlight an ongoing transition in the epidemiology of esophageal cancer that is highly relevant to future cancer control planning and clinical practice.

  18. Uric acid measurement improves prediction of cardiovascular mortality in later life.

    Science.gov (United States)

    Dutta, Ambarish; Henley, William; Pilling, Luke C; Wallace, Robert B; Melzer, David

    2013-03-01

    To estimate the association between uric acid and cardiovascular mortality in older adults, independent of traditional risk factors, and to estimate the risk prediction gain by adding uric acid measurements to the Framingham Cardiovascular Risk Score (FCRS). Longitudinal observational study of two population-based cohorts. The Established Populations for Epidemiologic Studies of the Elderly, Iowa (Iowa-EPESE) and the Third National Health and Nutritional Examination Survey (NHANES III). One thousand twenty-eight Iowa-EPESE participants and 1,316 NHANES III participants. Selected participants were aged 70 and older without overt cardiovascular disease, renal dysfunction, or diuretic use who lived for 3 years or longer after baseline. Outcome was age at cardiovascular death during follow-up (12–20 years). Uric acid and cardiovascular risk factors such as smoking, systolic blood pressure, diabetes mellitus, obesity, serum cholesterol, and high-density lipoprotein cholesterol were measured at baseline. High serum uric acid (>7.0 mg/dL) was associated with male sex, obesity, lipid levels, and estimated glomerular filtration rate at baseline. Fully adjusted hazard ratios (HRs) for cardiovascular death with high uric acid versus normal were 1.36 (95% confidence interval (CI) = 1.10–1.69) in Iowa-EPESE and 1.43 (95% CI = 1.04–1.99) in NHANES III; pooled HR was 1.38 (95% CI = 1.16–1.61). The net reclassification improvement achieved by adding uric acid measurement to the FCRS was 9% to 20%. In individuals aged 70 and older without overt CVD, renal dysfunction, or diuretic use, serum uric acid greater than 7.0 mg/dL was associated with greater CVD mortality independent of classic CVD risk factors. Adding uric acid measurement to the FCRS would improve prediction in older adults.

  19. Cardiovascular reactivity and prediction of the high blood pressure in the community.

    Directory of Open Access Journals (Sweden)

    Mikhail Benet Rodríguez

    2006-12-01

    Full Text Available Background: The development of strategies to reduce the prevalence of high blood pressure is an important challenge for all countries, populations, and governments. For this reason, the search of method in the prediction of the high blood pressure is an appropriate way, and a very important objective to get. Objetive: This study expects to show that cardiovascular hyperreactivity determined by the sustained weight test is a predictor of the high blood pressure independently from other cardiovascular risk factors. Methods: A five year cohort study was carried out (from 1998 to 2003 in which two groups were created. The 1st one with CHR (n = 41 and the 2nd one with (n= 127 of cardiovascular normoreactivity (CNR. Variables such as cardiovascular hyperreactivity high blood pressure, obesity, family history of high blood pressure, body mass index rate, smoking habit, salt consumption and alcohol consumption. An evaluation of the HBP risk was performed in each group, and the values of incidence of high blood pressure in each of them were compared. The chi square test was used as a statistic method. The stratified analysis and the determination of relative risk with a confidence interval of the 95 percent. The statistical significance was 95%. Results: The incidence of hypertension in the cohort of HRC was of 34,15/100 people and in the CNR of 10,24/100 people chi square = 13,3 GL= 1 P= 0,007, on the other hand, when we made adjustments according to different cardiovascular risk markers to determine the relationship between hypertension and hyperreactivity, it was observed that the relationship exists in spite of the risk marks mentioned before. Conclusions: The individuals whit HRC determined by the SWT have a risk to develop higher significant sustained hypertension then the cardiovascular normorreactivos ones this is an evidence that this method is useful to predict HBP.

  20. Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease

    Science.gov (United States)

    Barquera, Simon; Pedroza-Tobias, Andrea; Medina, Catalina

    2016-01-01

    Purpose of review There are today 11 mega-countries with more than 100 million inhabitants. Together these countries represent more than 60% of the world's population. All are facing noncommunicable chronic disease (NCD) epidemic where high cholesterol, obesity, diabetes, and cardiovascular diseases are becoming the main public health concerns. Most of these countries are facing the double burden of malnutrition where undernutrition and obesity coexist, increasing the complexity for policy design and implementation. The purpose of this study is to describe diverse sociodemographic characteristics of these countries and the challenges for prevention and control in the context of the nutrition transition. Recent findings Mega-countries are mostly low or middle-income and are facing important epidemiologic, nutrition, and physical activity transitions because of changes in food systems and unhealthy lifestyles. NCDs are responsible of two-thirds of the 57 million global deaths annually. Approximately, 80% of these are in low and middle-income countries. Only developed countries have been able to reduce mortality rates attributable to recognized risk factors for NCDs, in particular high cholesterol and blood pressure. Summary Mega-countries share common characteristics such as complex bureaucracies, internal ethnic, cultural and socioeconomic heterogeneity, and complexities to implement effective health promotion and education policies across population. Priorities for action must be identified and successful lessons and experiences should be carefully analyzed and replicated. PMID:27389629

  1. Red Blood Cell Eicosapentaenoic Acid Inversely Relates to MRI-Assessed Carotid Plaque Lipid Core Burden in Elders at High Cardiovascular Risk

    Directory of Open Access Journals (Sweden)

    Núria Bargalló

    2017-09-01

    Full Text Available Supplemental marine omega-3 eicosapentaenoic acid (EPA has an anti-atherosclerotic effect. Clinical research on EPA supplied by the regular diet and atherosclerosis is scarce. In the framework of the PREvención con DIeta MEDiterránea (PREDIMED trial, we conducted a cross-sectional study in 161 older individuals at high vascular risk grouped into different stages of carotid atherosclerosis severity, including those without ultrasound-detected atheroma plaque (n = 38, with plaques <2.0 mm thick (n = 65, and with plaques ≥2.0 mm (n = 79. The latter were asked to undergo contrast-enhanced 3T magnetic resonance imaging (MRI and were subsequently grouped into absence (n = 31 or presence (n = 27 of MRI-detectable plaque lipid, a main feature of unstable atheroma plaques. We determined the red blood cell (RBC proportion of EPA (a valid marker of long-term EPA intake at enrolment by gas chromatography. In multivariate models, EPA related inversely to MRI-assessed plaque lipid volume, but not to maximum intima-media thickness of internal carotid artery, plaque burden, or MRI-assessed normalized wall index. The inverse association between EPA and plaque lipid content in patients with advanced atherosclerosis supports the notion that this fatty acid might improve cardiovascular health through stabilization of advanced atheroma plaques.

  2. Atherosclerosis of the descending aorta predicts cardiovascular events: a transesophageal echocardiography study

    Directory of Open Access Journals (Sweden)

    Havasi Kálmán

    2004-10-01

    Full Text Available Abstract Purpose Previous studies have shown that atherosclerosis of the descending aorta detected by transesophageal echocardiography (TEE is a good marker of coexisting coronary artery disease. The aim of our study was to evaluate whether the presence of atherosclerosis on the descending aorta during TEE has any prognostic impact in predicting cardiovascular events. Material and Methods The study group consisted of 238 consecutive in-hospital patients referred for TEE testing (135 males, 103 females, mean age 58 +/- 11 years with a follow up of 24 months. The atherosclerotic lesions of the descending aorta were scored from 0 (no atherosclerosis to 3 (plaque >5 mm and/or "complex" plaque with ulcerated or mobile parts. Results Atherosclerosis was observed in 102 patients, (grade 3 in 16, and grade 2 in 86 patients whereas 136 patients only had an intimal thickening or normal intimal surface. There were 57 cardiovascular events in the follow-up period. The number of events was higher in the 102 patients with (n = 34 than in the 136 patients without atherosclerosis (n = 23, p =2 (HR 2.4, CI 1.0–5.5 predicted hard cardiovascular events. Conclusion Atherosclerosis of the descending aorta observed during transesophageal echocardiography is a useful predictor of cardiovascular events.

  3. Selecting the minimum prediction base of historical data to perform 5-year predictions of the cancer burden: The GoF-optimal method.

    Science.gov (United States)

    Valls, Joan; Castellà, Gerard; Dyba, Tadeusz; Clèries, Ramon

    2015-06-01

    Predicting the future burden of cancer is a key issue for health services planning, where a method for selecting the predictive model and the prediction base is a challenge. A method, named here Goodness-of-Fit optimal (GoF-optimal), is presented to determine the minimum prediction base of historical data to perform 5-year predictions of the number of new cancer cases or deaths. An empirical ex-post evaluation exercise for cancer mortality data in Spain and cancer incidence in Finland using simple linear and log-linear Poisson models was performed. Prediction bases were considered within the time periods 1951-2006 in Spain and 1975-2007 in Finland, and then predictions were made for 37 and 33 single years in these periods, respectively. The performance of three fixed different prediction bases (last 5, 10, and 20 years of historical data) was compared to that of the prediction base determined by the GoF-optimal method. The coverage (COV) of the 95% prediction interval and the discrepancy ratio (DR) were calculated to assess the success of the prediction. The results showed that (i) models using the prediction base selected through GoF-optimal method reached the highest COV and the lowest DR and (ii) the best alternative strategy to GoF-optimal was the one using the base of prediction of 5-years. The GoF-optimal approach can be used as a selection criterion in order to find an adequate base of prediction. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

    OpenAIRE

    Tin Tin Su; Mohammadreza Amiri; Farizah Mohd Hairi; Nithiah Thangiah; Awang Bulgiba; Hazreen Abdul Majid

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS mode...

  5. Plasma lipidomic profiling of treated HIV-positive individuals and the implications for cardiovascular risk prediction.

    Science.gov (United States)

    Wong, Gerard; Trevillyan, Janine M; Fatou, Benoit; Cinel, Michelle; Weir, Jacquelyn M; Hoy, Jennifer F; Meikle, Peter J

    2014-01-01

    The increased risk of coronary artery disease in human immunodeficiency virus (HIV) positive patients is collectively contributed to by the human immunodeficiency virus and antiretroviral-associated dyslipidaemia. In this study, we investigate the characterisation of the plasma lipid profiles of treated HIV patients and the relationship of 316 plasma lipid species across multiple lipid classes with the risk of future cardiovascular events in HIV-positive patients. In a retrospective case-control study, we analysed plasma lipid profiles of 113 subjects. Cases (n = 23) were HIV-positive individuals with a stored blood sample available 12 months prior to their diagnosis of coronary artery disease (CAD). They were age and sex matched to HIV-positive individuals without a diagnosis of CAD (n = 45) and with healthy HIV-negative volunteers (n = 45). Association of plasma lipid species and classes with HIV infection and cardiovascular risk in HIV were determined. In multiple logistic regression, we identified 83 lipids species and 7 lipid classes significantly associated with HIV infection and a further identified 74 lipid species and 8 lipid classes significantly associated with future cardiovascular events in HIV-positive subjects. Risk prediction models incorporating lipid species attained an area under the receiver operator characteristic curve (AUC) of 0.78 (0.775, 0.785)) and outperformed all other tested markers and risk scores in the identification of HIV-positive subjects with increased risk of cardiovascular events. Our results demonstrate that HIV-positive patients have significant differences in their plasma lipid profiles compared with healthy HIV-negative controls and that numerous lipid species were significantly associated with elevated cardiovascular risk. This suggests a potential novel application for plasma lipids in cardiovascular risk screening of HIV-positive patients.

  6. Predictive Value of Cardiovascular Risk Factors for Risk Assessment in Cohort of Shiraz Heart Study

    Directory of Open Access Journals (Sweden)

    MJ ZibaeeNezhad

    2010-03-01

    Full Text Available Background: Risk assessment for fast growing burden of cardiovascular diseases is very important and dif- ficult. As a response to this challenge, in particular, genetic risk factors which potentially modify risk, we conducted a survey of primary data registry of Shiraz Heart Study on integration and application of family history data in prevention of cardiovascular disorders.Method: This study is a longitudinal cohort project to be extended from subpopulations of different job groups to the community.Results: Parental family history of MI, diabetes mellitus (DM, hyperlipidemia (HPL, hypertension (HTN was reported more frequently among females than males. Histories of MI, DM, HPL, and HTN in both parents were respectively positive in 2.6%, 2%, 4.6%, and 7.9 % of the participants. Odd ratios (OR for risk of MI from family history of MI were 2.7; risk of DM from family history of DM 4.5; risk of HPL from family history of HPL 2.04; and risk of HTN from family history HTN 4.7. Also, family history of MI modifies risk of HPL (OR=1.7, P<0.0001; and family history of DM modifies risk of HPL (OR=2.04, P<0.0001.Conclusion: Our primary result shows potent application of family history data in risk assessment of cardiovascular outcome. In particular, HTN appears as a silent and leading risk modifier. In regard to the course of continuing Shiraz Heart Study integration of family history of risk factors crucial in public health we suggest to adopt a network of electronic health records from the “Health House” to the “Heart House”.

  7. A systematic review on the application of cardiovascular risk prediction models in pharmacoeconomics, with a focus on primary prevention

    NARCIS (Netherlands)

    Stevanovic, Jelena; Postma, Maarten J.; Pechlivanoglou, Petros

    Background: Long-term trials on the effectiveness of pharmacological treatment for primary cardiovascular disease prevention are scant. For that reason risk prediction models are used as a tool to project changes in cardiovascular disease incidence due to changes in risk factor levels observed in

  8. A systematic review on the application of cardiovascular risk prediction models in pharmacoeconomics, with a focus on primary prevention

    NARCIS (Netherlands)

    Stevanovic, Jelena; Postma, Maarten J.; Pechlivanoglou, Petros

    2012-01-01

    Background: Long-term trials on the effectiveness of pharmacological treatment for primary cardiovascular disease prevention are scant. For that reason risk prediction models are used as a tool to project changes in cardiovascular disease incidence due to changes in risk factor levels observed in sh

  9. Basic fibroblast growth factor predicts cardiovascular disease occurrence in participants from the Veterans Affairs Diabetes Trial

    Directory of Open Access Journals (Sweden)

    Mark B Zimering

    2013-11-01

    Full Text Available Aim: Cardiovascular disease is a leading cause of morbidity and mortality in adults with type 2 diabetes mellitus. The aim of the present study was to test whether plasma basic fibroblast growth factor (bFGF levels predict future cardiovascular disease (CVD occurrence in adults from the Veterans Affairs Diabetes Trial. Methods: Nearly four- hundred veterans, 40 years of age or older, having a mean baseline diabetes duration of 11.4 years were recruited from outpatient clinics at six geographically distributed sites in the Veterans Affairs Diabetes Trial (VADT. Within the VADT, they were randomly assigned to intensive or standard glycemic treatment, with follow-up as much as seven and one-half years. Cardiovascular disease occurrence was examined at baseline in the patient population and during randomized treatment. Plasma bFGF was determined with a sensitive, specific two-site enzyme-linked immunoassay at the baseline study visit in all 399 subjects. Results: One hundred-five first cardiovascular events occurred in these 399 subjects. The best fit model of risk factors associated with the time to first cardiovascular disease occurrence (in the study over a seven and one-half year period had as significant predictors: prior cardiovascular event, (hazard ratio [HR] 3.378; 95% confidence intervals [CI] 3.079- 3.807; P < .0001, baseline plasma bFGF (HR 1.008; 95% CI 1.002-1.014; P =.01, age, (HR 1.027; 95% CI 1.004-1.051; P =.019, baseline plasma triglycerides, (HR 1.001; 95% CI 1.000-1.002; P =.02 and diabetes duration-treatment interaction (P =.03. Intensive glucose-lowering was associated with significantly decreased hazard ratios for CVD occurrence (0.38-0.63 in patients with known diabetes duration of 0-10 years, and non-significantly increased hazard ratios for CVD occurrence (0.82-1.78 in patients with longer diabetes duration. Conclusion: High level ofplasma basic fibroblast growth factor is a predictive biomarker of future cardiovascular

  10. Burden of Disease predicts response to isolated limb infusion with melphalan and actinomycin D in melanoma

    Science.gov (United States)

    Muilenburg, Diego J.; Beasley, Georgia M.; Thompson, Zachary J.; Lee, Ji-Hyun; Tyler, Douglas S.; Zager, Jonathan S.

    2015-01-01

    Background Isolated limb infusion (ILI) with melphalan is a minimally invasive, effective treatment for in transit melanoma. We hypothesized that burden of disease (BOD) would correlate to treatment response. Methods We retrospectively analyzed a prospectively collected database from two academic centers. BOD was stratified as high or low (less than 10 lesions, none > 2cm). Response rates were measured 3 months post-ILI. Multivariable analysis (MV) was used to evaluate the association between the response rate and BOD. Kaplan-Meier methods with log-rank tests and multivariable Cox proportional hazard models were used to analyze overall survival (OS) and progression free survival (PFS) Results Sixty (38%) patients had low and 100 (62%) high BOD. Patients with low BOD had an overall response rate (ORR) of 73%, and 50% CR; compared to an ORR of 47% and 24% CR in patients with high BOD (p= 0.002). MV analysis of preoperative, intraoperative, and postoperative parameters showed no significant impact on 3-month response. Patients with a CR at 3 months demonstrated improved PFS over the remainder of the cohort, but OS was equal. Low BOD patients had an increased median PFS of 6.9 vs 3.8 months (p= 0.047), and a non-statistically significantly increased median OS, 38.4 vs. 30.9 months (p=0.146). Conclusions Lower BOD is associated with an increased ORR and CR rate with statistically significantly improved PFS in patients undergoing ILI for in transit extremity melanoma. BOD provides useful prognostic information for patient counseling and serves as a marker to stratify patient risk groups. PMID:25192683

  11. Predictions Burden of Diabetes and Economics Cost: Contributing Risk Factors of Changing Disease Prevalence and its Pandemic Impact to Qatar.

    Science.gov (United States)

    Bener, A; Al-Hamaq, A O A A

    2016-09-01

    Background: The Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. The risk of diabetes continues to increase worldwide and its public health burden is unevenly distributed across socioeconomic strata. This burden is not only related to health care costs, but also to indirect costs caused by loss of productivity from disability and premature mortality. Aim: This study aims to estimate the economics cost of type 2 Diabetes Mellitus [T2DM] among adults in Qatar using national data, and to quantify the potential effect of a suggested preventive intervention program. Design: It is an observational cohort study. Setting: The survey was based on registry at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar. Subject: This study consisted of patients above 25 years of age with diagnosed diabetes mellitus registered at Hamad General Hospital and Primary Health Care (PHC) centers during January 2004 to July 2014. Methods: We developed a dynamic model in which actual incidence, prevalence, and life expectancy data are used and alternative assumptions about future trends in these parameters can be incorporated. Linear regression model has been performed to forecast the burden of diabetes in oil-rich country. Results: According to the dynamic model, a 10% increased in the number of diabetic patients in the State of Qatar from 33 610 in 2005 to 122 000 in 2012 (about 1% annually). The annual diabetes incidence rate was higher in women than in men during a period between 2005 to 2015 years. The static model forecasted as 10% increase over 10 years. The relative increase in prevalence of diabetes and number of diabetic people are higher in women than in men (16.6%; 17.5% and 18.4% in men vs. 22.6%; 23.8% and 25.1% in women). Most of the increase in prevalence of diabetes is projected to occur in younger age groups where it is estimated to increase among age groups of 50-59 years and

  12. Total and High Molecular Weight Adiponectin Levels and Prediction of Cardiovascular Risk in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Dagmar Horáková

    2015-01-01

    Full Text Available The study aimed at assessing the potential use of lower total and HMW adiponectin levels for predicting cardiovascular risk in patients with type 2 diabetes mellitus (T2DM. Concentrations of total adiponectin or high molecular weight (HMW adiponectin decrease in association with the development of metabolic dysfunction such as obesity, insulin resistance, or T2DM. Increased adiponectin levels are associated with a lower risk for coronary heart disease. A total of 551 individuals were assessed. The first group comprised metabolically healthy participants (143 females, and 126 males and the second group were T2DM patients (164 females, and 118 males. Both total adiponectin and HMW adiponectin in diabetic patients were significantly lower when compared with the group of metabolically healthy individuals. There was a weak monotonic correlation between HMW adiponectin levels and triglycerides levels. Binary logistic regression analysis, gender adjusted, showed a higher cardiovascular risk in diabetic persons when both total adiponectin (OR = 1.700 and HMW adiponectin (OR = 2.785 levels were decreased. A decrease in total adiponectin levels as well as a decrease in its HMW adiponectin is associated with a higher cardiovascular risk in individuals with T2DM. This association suggests that adiponectin levels may be potentially used as an epidemiological marker for cardiovascular risk in diabetic patients.

  13. Vascular function assessed with cardiovascular magnetic resonance predicts survival in patients with advanced chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Steedman Tracey

    2008-08-01

    Full Text Available Abstract Background Increased arterial stiffness is associated with mortality in patients with chronic kidney disease. Cardiovascular magnetic resonance (CMR permits assessment of the central arteries to measure aortic function. Methods We studied the relationship between central haemodynamics and outcome using CMR in 144 chronic kidney disease patients with estimated glomerular filtration rate Results Median follow up after the scan was 24 months. There were no significant differences in aortic distensibilty or aortic volumetric arterial strain between pre-dialysis and dialysis patients. Aortic distensibilty and volumetric arterial strain negatively correlated with age. Aortic distensibilty and volumetric arterial strain were lower in diabetics, patients with ischaemic heart disease and peripheral vascular disease. During follow up there were 20 deaths. Patients who died had lower aortic distensibilty than survivors. In a survival analysis, diabetes, systolic blood pressure and aortic distensibilty were independent predictors of mortality. There were 12 non-fatal cardiovascular events during follow up. Analysing the combined end point of death or a vascular event, diabetes, aortic distensibilty and volumetric arterial strain were predictors of events. Conclusion Deranged vascular function measured with CMR correlates with cardiovascular risk factors and predicts outcome. CMR measures of vascular function are potential targets for interventions to reduce cardiovascular risk.

  14. Analysis of cardiovascular oscillations: A new approach to the early prediction of pre-eclampsia

    Science.gov (United States)

    Malberg, H.; Bauernschmitt, R.; Voss, A.; Walther, T.; Faber, R.; Stepan, H.; Wessel, N.

    2007-03-01

    Pre-eclampsia (PE) is a serious disorder with high morbidity and mortality occurring during pregnancy; 3%-5% of all pregnant women are affected. Early prediction is still insufficient in clinical practice. Although most pre-eclamptic patients show pathological uterine perfusion in the second trimester, this parameter has a positive predictive accuracy of only 30%, which makes it unsuitable for early, reliable prediction. The study is based on the hypothesis that alterations in cardiovascular regulatory behavior can be used to predict PE. Ninety-six pregnant women in whom Doppler investigation detected perfusion disorders of the uterine arteries were included in the study. Twenty-four of these pregnant women developed PE after the 30th week of gestation. During pregnancy, additional several noninvasive continuous blood pressure recordings were made over 30 min under resting conditions by means of a finger cuff. The time series extracted of systolic as well as diastolic beat-to-beat pressures and the heart rate were studied by variability and coupling analysis to find predictive factors preceding genesis of the disease. In the period between the 18th and 26th weeks of pregnancy, three special variability and baroreflex parameters were able to predict PE several weeks before clinical manifestation. Discriminant function analysis of these parameters was able to predict PE with a sensitivity and specificity of 87.5% and a positive predictive value of 70%. The combined clinical assessment of uterine perfusion and cardiovascular variability demonstrates the best current prediction several weeks before clinical manifestation of PE.

  15. A high burden of hypertension in the urban black population of Cape Town: the cardiovascular risk in Black South Africans (CRIBSA study.

    Directory of Open Access Journals (Sweden)

    Nasheeta Peer

    Full Text Available OBJECTIVE: To determine the prevalence, associations and management of hypertension in the 25-74-year-old urban black population of Cape Town and examine the change between 1990 and 2008/09 in 25-64-year-olds. METHODS: In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiovascular disease risk factors were determined by administered questionnaires, clinical measurements and fasting biochemical analyses. Logistic regression models evaluated the associations with hypertension. RESULTS: There were 1099 participants, 392 men and 707 women (response rate 86% in 2008/09. Age-standardised hypertension prevalence was 38.9% (95% confidence interval (CI: 35.6-42.3 with similar rates in men and women. Among 25-64-year-olds, hypertension prevalence was significantly higher in 2008/09 (35.6%, 95% CI: 32.3-39.0 than in 1990 (21.6%, 95% CI: 18.6-24.9. In 2008/09, hypertension odds increased with older age, family history of hypertension, higher body mass index, problematic alcohol intake, physical inactivity and urbanisation. Among hypertensive participants, significantly more women than men were detected (69.5% vs. 32.7%, treated (55.7% vs. 21.9% and controlled (32.4% vs. 10.4% in 2008/09. There were minimal changes from 1990 except for improved control in 25-64-year-old women (1990∶14.1% vs. 2008/09∶31.5%. CONCLUSIONS: The high and rising hypertension burden in this population, its association with modifiable risk factors and the sub-optimal care provided highlight the urgent need to prioritise hypertension management. Innovative solutions with efficient and cost-effective healthcare delivery as well as population-based strategies are required.

  16. Multimarker proteomic profiling for the prediction of cardiovascular mortality in patients with chronic heart failure.

    Directory of Open Access Journals (Sweden)

    Gilles Lemesle

    Full Text Available Risk stratification of patients with systolic chronic heart failure (HF is critical to better identify those who may benefit from invasive therapeutic strategies such as cardiac transplantation. Proteomics has been used to provide prognostic information in various diseases. Our aim was to investigate the potential value of plasma proteomic profiling for risk stratification in HF. A proteomic profiling using surface enhanced laser desorption ionization - time of flight - mass spectrometry was performed in a case/control discovery population of 198 patients with systolic HF (left ventricular ejection fraction <45%: 99 patients who died from cardiovascular cause within 3 years and 99 patients alive at 3 years. Proteomic scores predicting cardiovascular death were developed using 3 regression methods: support vector machine, sparse partial least square discriminant analysis, and lasso logistic regression. Forty two ion m/z peaks were differentially intense between cases and controls in the discovery population and were used to develop proteomic scores. In the validation population, score levels were higher in patients who subsequently died within 3 years. Similar areas under the curves (0.66 - 0.68 were observed for the 3 methods. After adjustment on confounders, proteomic scores remained significantly associated with cardiovascular mortality. Use of the proteomic scores allowed a significant improvement in discrimination of HF patients as determined by integrated discrimination improvement and net reclassification improvement indexes. In conclusion, proteomic analysis of plasma proteins may help to improve risk prediction in HF patients.

  17. Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study

    Science.gov (United States)

    Sundbøll, Jens; Adelborg, Kasper; Munch, Troels; Frøslev, Trine; Sørensen, Henrik Toft; Bøtker, Hans Erik; Schmidt, Morten

    2016-01-01

    Objective The majority of cardiovascular diagnoses in the Danish National Patient Registry (DNPR) remain to be validated despite extensive use in epidemiological research. We therefore examined the positive predictive value (PPV) of cardiovascular diagnoses in the DNPR. Design Population-based validation study. Setting 1 university hospital and 2 regional hospitals in the Central Denmark Region, 2010–2012. Participants For each cardiovascular diagnosis, up to 100 patients from participating hospitals were randomly sampled during the study period using the DNPR. Main outcome measure Using medical record review as the reference standard, we examined the PPV for cardiovascular diagnoses in the DNPR, coded according to the International Classification of Diseases, 10th Revision. Results A total of 2153 medical records (97% of the total sample) were available for review. The PPVs ranged from 64% to 100%, with a mean PPV of 88%. The PPVs were ≥90% for first-time myocardial infarction, stent thrombosis, stable angina pectoris, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, takotsubo cardiomyopathy, arterial hypertension, atrial fibrillation or flutter, cardiac arrest, mitral valve regurgitation or stenosis, aortic valve regurgitation or stenosis, pericarditis, hypercholesterolaemia, aortic dissection, aortic aneurysm/dilation and arterial claudication. The PPVs were between 80% and 90% for recurrent myocardial infarction, first-time unstable angina pectoris, pulmonary hypertension, bradycardia, ventricular tachycardia/fibrillation, endocarditis, cardiac tumours, first-time venous thromboembolism and between 70% and 80% for first-time and recurrent admission due to heart failure, first-time dilated cardiomyopathy, restrictive cardiomyopathy and recurrent venous thromboembolism. The PPV for first-time myocarditis was 64%. The PPVs were consistent within age, sex, calendar year and hospital categories. Conclusions The validity of

  18. Arterial stiffness and endothelial dysfunction independently and synergistically predict cardiovascular and renal outcome in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Theilade, S; Lajer, Maria Stenkil; Jorsal, Anders;

    2012-01-01

    To evaluate whether pulse pressure alone or with placental growth factor as estimates of arterial stiffness and endothelial dysfunction, predicts mortality, cardiovascular disease and progression to end-stage renal disease in patients with Type 1 diabetes.......To evaluate whether pulse pressure alone or with placental growth factor as estimates of arterial stiffness and endothelial dysfunction, predicts mortality, cardiovascular disease and progression to end-stage renal disease in patients with Type 1 diabetes....

  19. Measurable urinary albumin predicts cardiovascular risk among normoalbuminuric patients with type 2 diabetes.

    Science.gov (United States)

    Ruggenenti, Piero; Porrini, Esteban; Motterlini, Nicola; Perna, Annalisa; Ilieva, Aneliya Parvanova; Iliev, Ilian Petrov; Dodesini, Alessandro Roberto; Trevisan, Roberto; Bossi, Antonio; Sampietro, Giuseppe; Capitoni, Enrica; Gaspari, Flavio; Rubis, Nadia; Ene-Iordache, Bogdan; Remuzzi, Giuseppe

    2012-10-01

    Micro- or macroalbuminuria is associated with increased cardiovascular risk factors among patients with type 2 diabetes, but whether albuminuria within the normal range predicts long-term cardiovascular risk is unknown. We evaluated the relationships between albuminuria and cardiovascular events in 1208 hypertensive, normoalbuminuric patients with type 2 diabetes from the BErgamo NEphrologic Diabetes Complication Trial (BENEDICT), all of whom received angiotensin-converting enzyme inhibitor (ACEI) therapy at the end of the trial and were followed for a median of 9.2 years. The main outcome was time to the first of fatal or nonfatal myocardial infarction; stroke; coronary, carotid, or peripheral artery revascularization; or hospitalization for heart failure. Overall, 189 (15.6%) of the patients experienced a main outcome event (2.14 events/100 patient-years); 24 events were fatal. Albuminuria independently predicted events (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02-1.08). Second-degree polynomial multivariable analysis showed a continuous nonlinear relationship between albuminuria and events without thresholds. Considering the entire study population, even albuminuria at 1-2 μg/min was significantly associated with increased risk compared with albuminuria <1 μg/min (HR, 1.04; 95% CI, 1.02-1.07). This relationship was similar in the subgroup originally randomly assigned to non-ACEI therapy. Among those originally receiving ACEI therapy, however, the event rate was uniformly low and was not significantly associated with albuminuria. Taken together, among normoalbuminuric patients with type 2 diabetes, any degree of measurable albuminuria bears significant cardiovascular risk. The association with risk is continuous but is lost with early ACEI therapy.

  20. ADAMTS13 predicts renal and cardiovascular events in type 2 diabetic patients and response to therapy.

    Science.gov (United States)

    Rurali, Erica; Noris, Marina; Chianca, Antonietta; Donadelli, Roberta; Banterla, Federica; Galbusera, Miriam; Gherardi, Giulia; Gastoldi, Sara; Parvanova, Aneliya; Iliev, Ilian; Bossi, Antonio; Haefliger, Carolina; Trevisan, Roberto; Remuzzi, Giuseppe; Ruggenenti, Piero

    2013-10-01

    In patients with diabetes, impaired ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) proteolysis of highly thrombogenic von Willebrand factor (VWF) multimers may accelerate renal and cardiovascular complications. Restoring physiological VWF handling might contribute to ACE inhibitors' (ACEi) reno- and cardioprotective effects. To assess how Pro618Ala ADAMTS13 variants and related proteolytic activity interact with ACEi therapy in predicting renal and cardiovascular complications, we genotyped 1,163 normoalbuminuric type 2 diabetic patients from BErgamo NEphrologic DIabetes Complications Trial (BENEDICT). Interaction between Pro618Ala and ACEi was significant in predicting both renal and combined renal and cardiovascular events. The risk for renal or combined events versus reference Ala carriers on ACEi progressively increased from Pro/Pro homozygotes on ACEi (hazard ratio 2.80 [95% CI 0.849-9.216] and 1.58 [0.737-3.379], respectively) to Pro/Pro homozygotes on non-ACEi (4.77 [1.484-15.357] and 1.99 [0.944-4.187]) to Ala carriers on non-ACEi (8.50 [2.416-29.962] and 4.00 [1.739-9.207]). In a substudy, serum ADAMTS13 activity was significantly lower in Ala carriers than in Pro/Pro homozygotes and in case subjects with renal, cardiovascular, or combined events than in diabetic control subjects without events. ADAMTS13 activity significantly and negatively correlated with all outcomes. In patients with diabetes, ADAMTS13 618Ala variant associated with less proteolytic activity, higher risk of chronic complications, and better response to ACEi therapy. Screening for Pro618Ala polymorphism may help identify patients with diabetes at highest risk who may benefit the most from early reno- and cardioprotective therapy.

  1. Speckle tracking echocardiography detects uremic cardiomyopathy early and predicts cardiovascular mortality in ESRD.

    Science.gov (United States)

    Kramann, Rafael; Erpenbeck, Johanna; Schneider, Rebekka K; Röhl, Anna B; Hein, Marc; Brandenburg, Vincent M; van Diepen, Merel; Dekker, Friedo; Marx, Nicolaus; Floege, Jürgen; Becker, Michael; Schlieper, Georg

    2014-10-01

    Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P<0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

  2. Identification of Predictive Early Biomarkers for Sterile-SIRS after Cardiovascular Surgery.

    Science.gov (United States)

    Stoppelkamp, Sandra; Veseli, Kujtim; Stang, Katharina; Schlensak, Christian; Wendel, Hans Peter; Walker, Tobias

    2015-01-01

    Systemic inflammatory response syndrome (SIRS) is a common complication after cardiovascular surgery that in severe cases can lead to multiple organ dysfunction syndrome and even death. We therefore set out to identify reliable early biomarkers for SIRS in a prospective small patient study for timely intervention. 21 Patients scheduled for planned cardiovascular surgery were recruited in the study, monitored for signs of SIRS and blood samples were taken to investigate biomarkers at pre-assigned time points: day of admission, start of surgery, end of surgery, days 1, 2, 3, 5 and 8 post surgery. Stored plasma and cryopreserved blood samples were analyzed for cytokine expression (IL1β, IL2, IL6, IL8, IL10, TNFα, IFNγ), other pro-inflammatory markers (sCD163, sTREM-1, ESM-1) and response to endotoxin. Acute phase proteins CRP, PCT and pro-inflammatory cytokines IL6 and IL8 were significantly increased (pSIRS group at the end of surgery. Soluble TREM-1 plasma concentrations were significantly increased in patients with SIRS (pSIRS after cardiovascular surgery. A combination of normalized IL1β plasma levels, responses to endotoxin and soluble TREM-1 plasma concentrations at the end of surgery are predictive markers of SIRS development in this small scale study and could act as an indicator for starting early therapeutic interventions.

  3. Tissue Doppler echocardiography predicts acute myocardial infarction, heart failure, and cardiovascular death in the general population

    DEFF Research Database (Denmark)

    Mogelvang, Rasmus; Biering-Sørensen, Tor; Jensen, Jan Skov

    2015-01-01

    AIMS: To improve risk prediction of cardiovascular morbidity and mortality, we need sensitive markers of cardiac dysfunction; Echocardiographic Tissue Doppler Imaging (TDI) is feasible and harmless and may be ideal for this purpose. METHODS AND RESULTS: Within the community-based Copenhagen City...... by TDI was associated with increased risk of the combined end point, even in the subgroup of persons with a normal conventional echocardiographic examination [per 1 cm/s decrease: s': HR 1.32 (1.12-1.57), P ... in persons with a normal conventional echocardiographic examination....

  4. Cardiovascular Magnetic Resonance Relaxometry Predicts Regional Functional Outcome After Experimental Myocardial Infarction.

    Science.gov (United States)

    Haberkorn, Sebastian M; Jacoby, Christoph; Ding, Zhaoping; Keul, Petra; Bönner, Florian; Polzin, Amin; Levkau, Bodo; Schrader, Jürgen; Kelm, Malte; Flögel, Ulrich

    2017-08-01

    Cardiovascular magnetic resonance with gadolinium-based contrast agents has established as gold standard for tissue characterization after myocardial infarction (MI). Beyond accurate diagnosis, the value of cardiovascular magnetic resonance to predict the outcome after MI has yet to be substantiated. Recent cardiovascular magnetic resonance approaches were systematically compared for quantification of tissue injury and functional impairment after MI using murine models with permanent left anterior descending coronary artery ligation (n=14) or 50 minutes ischemia/reperfusion (n=13). Cardiovascular magnetic resonance included native/postcontrast T1 maps, T2 maps, and late gadolinium enhancement at days 1 and 21 post-MI. For regional correlation of parametric and functional measures, the left ventricle was analyzed over 200 sectors. For T1 mapping, we used retrospective triggering with variable flip angle analysis. Sectoral analysis of native T1 maps already revealed in the acute phase after MI substantial discrepancies in myocardial tissue texture between the 2 MI models (native T1 day 1: permanent ligation, 1280.0±162.6 ms; ischemia/reperfusion, 1115.0±140.5 ms; Pfunctional outcome (left ventricular ejection fraction day 21: permanent ligation, 24.5±7.0%; ischemia/reperfusion, 33.7±11.6%; Pfunction in corresponding areas at day 21 demonstrated for early native T1 values the best correlation with the later functional impairment (R(2) =0.94). The present T1 mapping approach permits accurate characterization of local tissue injury and holds the potential for sensitive and graduated prognosis of the functional outcome after MI without gadolinium-based contrast agents. © 2017 American Heart Association, Inc.

  5. Low ankle-brachial index predicts cardiovascular risk after acute ischemic stroke or transient ischemic attack.

    Science.gov (United States)

    Busch, Markus A; Lutz, Katrin; Röhl, Jens-Eric; Neuner, Bruno; Masuhr, Florian

    2009-12-01

    A low ankle-brachial blood pressure index (ABI) is an established risk marker for cardiovascular disease and mortality in the general population, but little is known about its prognostic value in individuals with acute ischemic stroke or transient ischemic attack (TIA). An inception cohort of 204 patients with acute ischemic stroke or TIA was followed up for a mean of 2.3 years. At baseline, patients underwent ABI measurement and were assessed for risk factors, cardiovascular comorbidities, and cervical or intracranial artery stenosis. The association between low ABI (stroke, myocardial infarction, or death was examined by Kaplan-Meier and Cox regression analyses. A low ABI was found in 63 patients (31%) and was associated with older age, current smoking, hypertension, peripheral arterial disease, and cervical or intracranial stenosis. During a total of 453.0 person-years of follow-up, 37 patients experienced outcome events (8.2% per person-year), with a higher outcome rate per person-year in patients with low ABI (12.8% vs 6.3%, P=0.03). In survival analysis adjusted for age and stroke etiology, patients with a low ABI had a 2 times higher risk of stroke, myocardial infarction, or death than those with a normal ABI (hazard ratio=2.2; 95% CI, 1.1 to 4.5). Additional adjustment for risk factors and cardiovascular comorbidities did not attenuate the association. A low ABI independently predicted subsequent cardiovascular risk and mortality in patients with acute stroke or TIA. ABI measurement may help to identify high-risk patients for targeted secondary stroke prevention.

  6. Identification of Predictive Early Biomarkers for Sterile-SIRS after Cardiovascular Surgery.

    Directory of Open Access Journals (Sweden)

    Sandra Stoppelkamp

    Full Text Available Systemic inflammatory response syndrome (SIRS is a common complication after cardiovascular surgery that in severe cases can lead to multiple organ dysfunction syndrome and even death. We therefore set out to identify reliable early biomarkers for SIRS in a prospective small patient study for timely intervention. 21 Patients scheduled for planned cardiovascular surgery were recruited in the study, monitored for signs of SIRS and blood samples were taken to investigate biomarkers at pre-assigned time points: day of admission, start of surgery, end of surgery, days 1, 2, 3, 5 and 8 post surgery. Stored plasma and cryopreserved blood samples were analyzed for cytokine expression (IL1β, IL2, IL6, IL8, IL10, TNFα, IFNγ, other pro-inflammatory markers (sCD163, sTREM-1, ESM-1 and response to endotoxin. Acute phase proteins CRP, PCT and pro-inflammatory cytokines IL6 and IL8 were significantly increased (p<0.001 at the end of surgery in all patients but could not distinguish between groups. Normalization of samples revealed significant increases in IL1β changes (p<0.05 and decreased responses to endotoxin (p<0.01 in the SIRS group at the end of surgery. Soluble TREM-1 plasma concentrations were significantly increased in patients with SIRS (p<0.01. This small scale patient study could show that common sepsis markers PCT, CRP, IL6 and TNFα had low predictive value for early diagnosis of SIRS after cardiovascular surgery. A combination of normalized IL1β plasma levels, responses to endotoxin and soluble TREM-1 plasma concentrations at the end of surgery are predictive markers of SIRS development in this small scale study and could act as an indicator for starting early therapeutic interventions.

  7. Impacto econômico dos casos de doença cardiovascular grave no Brasil: uma estimativa baseada em dados secundários Economic burden of severe cardiovascular diseases in Brazil: an estimate based on secondary data

    Directory of Open Access Journals (Sweden)

    Maria Inês Reinert Azambuja

    2008-09-01

    Full Text Available FUNDAMENTO: Há escassez de dados no Brasil para subsidiar a crescente preocupação sobre o impacto econômico das doenças cardiovasculares (DCV. OBJETIVO: Estimar os custos referentes aos casos de DCV grave no Brasil. MÉTODOS: O número de casos de DCV grave foi estimado a partir das taxas de letalidade e mortalidade dos pacientes hospitalizados. Estudos observacionais e bancos de dados nacionais foram utilizados para estimar os custos referentes à hospitalização, atendimento ambulatorial e benefícios pagos pela previdência. A perda da renda foi estimada com base nos dados do estudo de Carga de Doenças no Brasil. RESULTADOS: Aproximadamente dois milhões de casos de DCV grave foram relatados em 2004 no Brasil, representando 5,2% da população acima de 35 anos de idade. O custo anual foi de, pelo menos, R$ 30,8 bilhões (36,4% para a saúde, 8,4% para o seguro social e reembolso por empregadores e 55,2% como resultado da perda de produtividade, correspondendo a R$ 500,00 per capita (para a população de 35 anos e acima e R$ 9.640,00 por paciente. Somente nesse subgrupo, os custos diretos em saúde corresponderam por 8% do gasto total do país com saúde e 0,52% do PIB (R$ 1.767 bilhões = 602 bilhões de dólares, o que corresponde a uma média anual de R$ 182,00 para os custos diretos per capita (R$ 87,00 de recursos públicos e de R$ 3.514,00 por caso de DCV grave. CONCLUSÃO: Os custos anuais totais para cada caso de DCV grave foram significativos. Estima-se que tanto os custos per capita como aqueles correspondentes ao subgrupo de pacientes com DCV grave aumentem significativamente à medida que a população envelhece e a prevalência de casos graves aumente.BACKGROUND: The scarce amount of data available in Brazil on the economic burden of cardiovascular diseases (CVD does not justify the growing concern in regard to the economic burden involved. OBJECTIVE: The present study aims at estimating the costs of severe CVD cases in

  8. Remote health monitoring: predicting outcome success based on contextual features for cardiovascular disease.

    Science.gov (United States)

    Alshurafa, Nabil; Eastwood, Jo-Ann; Pourhomayoun, Mohammad; Liu, Jason J; Sarrafzadeh, Majid

    2014-01-01

    Current studies have produced a plethora of remote health monitoring (RHM) systems designed to enhance the care of patients with chronic diseases. Many RHM systems are designed to improve patient risk factors for cardiovascular disease, including physiological parameters such as body mass index (BMI) and waist circumference, and lipid profiles such as low density lipoprotein (LDL) and high density lipoprotein (HDL). There are several patient characteristics that could be determining factors for a patient's RHM outcome success, but these characteristics have been largely unidentified. In this paper, we analyze results from an RHM system deployed in a six month Women's Heart Health study of 90 patients, and apply advanced feature selection and machine learning algorithms to identify patients' key baseline contextual features and build effective prediction models that help determine RHM outcome success. We introduce Wanda-CVD, a smartphone-based RHM system designed to help participants with cardiovascular disease risk factors by motivating participants through wireless coaching using feedback and prompts as social support. We analyze key contextual features that secure positive patient outcomes in both physiological parameters and lipid profiles. Results from the Women's Heart Health study show that health threat of heart disease, quality of life, family history, stress factors, social support, and anxiety at baseline all help predict patient RHM outcome success.

  9. Prediction of First Cardiovascular Disease Event in Type 1 Diabetes Mellitus

    DEFF Research Database (Denmark)

    Vistisen, Dorte; Andersen, Gregers Stig; Hansen, Christian Stevns

    2016-01-01

    BACKGROUND: Patients with type 1 diabetes mellitus are at increased risk of developing cardiovascular disease (CVD), but they are currently undertreated. There are no risk scores used on a regular basis in clinical practice for assessing the risk of CVD in type 1 diabetes mellitus. METHODS...... AND RESULTS: From 4306 clinically diagnosed adult patients with type 1 diabetes mellitus, we developed a prediction model for estimating the risk of first fatal or nonfatal CVD event (ischemic heart disease, ischemic stroke, heart failure, and peripheral artery disease). Detailed clinical data including...... range, 2.9-10.9) a total of 793 (18.4%) patients developed CVD. The final prediction model included age, sex, diabetes duration, systolic blood pressure, low-density lipoprotein cholesterol, hemoglobin A1c, albuminuria, glomerular filtration rate, smoking, and exercise. Discrimination was excellent...

  10. Dietary Patterns Are Associated with Predicted Cardiovascular Disease Risk in an Urban Mexican Adult Population.

    Science.gov (United States)

    Denova-Gutiérrez, Edgar; Tucker, Katherine L; Flores, Mario; Barquera, Simón; Salmerón, Jorge

    2016-01-01

    Dietary patterns may predict cardiovascular disease (CVD) risk more accurately than does consumption of specific nutrients or foods. We evaluated the association between Mexican adults' dietary patterns and development of a >10% risk of 10-y CVD (using the Framingham risk score) over 7 y of follow-up. This prospective cohort study included 1196 men and women aged 20-80 y with a 10-y predicted risk risk of elevated 10-y CVD (RR: 2.98; 95% CI: 1.46, 6.10; P-trend = 0.020) than did those in the lowest quintile. Finally, the meat/fish dietary pattern was not significantly associated with 10-y CVD. Our data suggest that the prudent pattern is associated with a reduced risk of 10-y CVD, whereas the refined-foods pattern may increase 10-y CVD in Mexican adults. © 2016 American Society for Nutrition.

  11. [Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?

    Science.gov (United States)

    Esteban-Fernández, Alberto; Coma-Canella, Isabel; Bastarrika, Gorka; Barba-Cosials, Joaquín; Azcárate-Agüero, Pedro M

    The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28). Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  12. Non-linear feature extraction from HRV signal for mortality prediction of ICU cardiovascular patient.

    Science.gov (United States)

    Karimi Moridani, Mohammad; Setarehdan, Seyed Kamaledin; Motie Nasrabadi, Ali; Hajinasrollah, Esmaeil

    2016-01-01

    Intensive care unit (ICU) patients are at risk of in-ICU morbidities and mortality, making specific systems for identifying at-risk patients a necessity for improving clinical care. This study presents a new method for predicting in-hospital mortality using heart rate variability (HRV) collected from the times of a patient's ICU stay. In this paper, a HRV time series processing based method is proposed for mortality prediction of ICU cardiovascular patients. HRV signals were obtained measuring R-R time intervals. A novel method, named return map, is then developed that reveals useful information from the HRV time series. This study also proposed several features that can be extracted from the return map, including the angle between two vectors, the area of triangles formed by successive points, shortest distance to 45° line and their various combinations. Finally, a thresholding technique is proposed to extract the risk period and to predict mortality. The data used to evaluate the proposed algorithm obtained from 80 cardiovascular ICU patients, from the first 48 h of the first ICU stay of 40 males and 40 females. This study showed that the angle feature has on average a sensitivity of 87.5% (with 12 false alarms), the area feature has on average a sensitivity of 89.58% (with 10 false alarms), the shortest distance feature has on average a sensitivity of 85.42% (with 14 false alarms) and, finally, the combined feature has on average a sensitivity of 92.71% (with seven false alarms). The results showed that the last half an hour before the patient's death is very informative for diagnosing the patient's condition and to save his/her life. These results confirm that it is possible to predict mortality based on the features introduced in this paper, relying on the variations of the HRV dynamic characteristics.

  13. Worldwide burden of gastric cancer in 2010 attributable to high sodium intake in 1990 and predicted attributable burden for 2030 based on exposures in 2010.

    Science.gov (United States)

    Peleteiro, Bárbara; Barros, Susana; Castro, Clara; Ferro, Ana; Morais, Samantha; Lunet, Nuno

    2016-08-01

    Assessing the impact that patterns of Na intake may have on gastric cancer will provide a more comprehensive estimation of Na reduction as a primary prevention approach. We aimed to estimate the proportion of gastric cancer cases that are attributable to Na intake above the recommendation by the WHO (≤2 g/d) throughout the world in 2010, as well as expected values for 2030. Population attributable fractions (PAF) were computed for 187 countries, using Na intakes in 1990 and 2010 and estimates of the association between Na intake and gastric cancer, assuming a time lag of 20 years. Median PAF ranged from 10·1% in low to 22·5 % in very high Human Development Index (HDI) countries in men (P2030 is expected in most settings, except for countries classified as low HDI, in both sexes. High Na intakes account for a large proportion of gastric cancer cases, and proportions are expected to increase in almost all of the countries. Intensified efforts to diminish Na intake in virtually all populations are needed to further reduce gastric cancer burden.

  14. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses.

    Directory of Open Access Journals (Sweden)

    Thijs C van Holten

    Full Text Available BACKGROUND: Cardiovascular disease is one of the major causes of death worldwide. Assessing the risk for cardiovascular disease is an important aspect in clinical decision making and setting a therapeutic strategy, and the use of serological biomarkers may improve this. Despite an overwhelming number of studies and meta-analyses on biomarkers and cardiovascular disease, there are no comprehensive studies comparing the relevance of each biomarker. We performed a systematic review of meta-analyses on levels of serological biomarkers for atherothrombosis to compare the relevance of the most commonly studied biomarkers. METHODS AND FINDINGS: Medline and Embase were screened on search terms that were related to "arterial ischemic events" and "meta-analyses". The meta-analyses were sorted by patient groups without pre-existing cardiovascular disease, with cardiovascular disease and heterogeneous groups concerning general populations, groups with and without cardiovascular disease, or miscellaneous. These were subsequently sorted by end-point for cardiovascular disease or stroke and summarized in tables. We have identified 85 relevant full text articles, with 214 meta-analyses. Markers for primary cardiovascular events include, from high to low result: C-reactive protein, fibrinogen, cholesterol, apolipoprotein B, the apolipoprotein A/apolipoprotein B ratio, high density lipoprotein, and vitamin D. Markers for secondary cardiovascular events include, from high to low result: cardiac troponins I and T, C-reactive protein, serum creatinine, and cystatin C. For primary stroke, fibrinogen and serum uric acid are strong risk markers. Limitations reside in that there is no acknowledged search strategy for prognostic studies or meta-analyses. CONCLUSIONS: For primary cardiovascular events, markers with strong predictive potential are mainly associated with lipids. For secondary cardiovascular events, markers are more associated with ischemia. Fibrinogen is a

  15. Metabolic tumour burden assessed by {sup 18}F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Hua-Xiang; Chen, Tao; Wang, Wen-Quan; Wu, Chun-Tao; Liu, Chen; Long, Jiang; Xu, Jin; Liu, Liang; Yu, Xian-Jun [Fudan University, Shanghai Cancer Center, Pancreatic Cancer Institute and Department of Pancreatic and Hepatobiliary Surgery, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Zhang, Ying-Jian [Fudan University, Shanghai Cancer Center, Department of Nuclear Medicine, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Chen, Run-Hao [Fudan University, Department of General Surgery, Jinshan Hospital, Shanghai (China)

    2014-06-15

    Tumour burden is one of the most important prognosticators for pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate the predictive significance of metabolic tumour burden measured by {sup 18}F-FDG PET/CT in patients with resectable PDAC. Included in the study were 122 PDAC patients who received preoperative {sup 18}F-FDG PET/CT examination and radical pancreatectomy. Metabolic tumour burden in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), pathological tumour burden (tumour size), serum tumour burden (baseline serum CA19-9 level), and metabolic activity (maximum standard uptake value, SUVmax) were determined, and compared for their performance in predicting overall survival (OS) and recurrence-free survival (RFS). MTV and TLG were significantly associated with baseline serum CA19-9 level (P = 0.001 for MTV, P < 0.001 for TLG) and tumour size (P < 0.001 for MTV, P = 0.001 for TLG). Multivariate analysis showed that MTV, TLG and baseline serum CA19-9 level as either categorical or continuous variables, but not tumour size or SUVmax, were independent risk predictors for both OS and RFS. Time-dependent receiving operating characteristics analysis further indicated that better predictive performances for OS and RFS were achieved by MTV and TLG compared to baseline serum CA19-9 level, SUVmax and tumour size (P < 0.001 for all). MTV and TLG showed strong consistency with baseline serum CA19-9 level in better predicting OS and RFS, and might serve as surrogate markers for prediction of outcome in patients with resectable PDAC. (orig.)

  16. Can Dental Pulp Calcification Predict the Risk of Ischemic Cardiovascular Disease?

    Directory of Open Access Journals (Sweden)

    Leila Khojastepour

    2013-01-01

    Full Text Available Objective: To report the association of pulp calcification with that of cardiovascular disease (CVD using digital panoramic dental radiographs.Materials and Methods: Digital panoramic radiographs of patients referred from the angiography department were included if the patient was under 55 years old and had non-restored or minimally restored molars and canines. An oral and maxillofacial radiologist evaluated the images for pulpal calcifications in the selected teeth. The sensitivity, specificity, positive predictive value and negative predictive value of panoramic radiography in predicting CVD were calculated.Results: Out of 122 patients who met the criteria, 68.2% of the patients with CVD had pulp chamber calcifications. Pulp calcification in panoramic radiography had a sensitivity of 68.9% to predict CVD.Conclusion: This study demonstrates that patients with CVD show an increased incidence of pulp calcification compared with healthy patients. The findings suggest that pulp calcification on panoramic radiography may have possibilities for use in CVD screening.

  17. Beatquency domain and machine learning improve prediction of cardiovascular death after acute coronary syndrome.

    Science.gov (United States)

    Liu, Yun; Scirica, Benjamin M; Stultz, Collin M; Guttag, John V

    2016-10-06

    Frequency domain measures of heart rate variability (HRV) are associated with adverse events after a myocardial infarction. However, patterns in the traditional frequency domain (measured in Hz, or cycles per second) may capture different cardiac phenomena at different heart rates. An alternative is to consider frequency with respect to heartbeats, or beatquency. We compared the use of frequency and beatquency domains to predict patient risk after an acute coronary syndrome. We then determined whether machine learning could further improve the predictive performance. We first evaluated the use of pre-defined frequency and beatquency bands in a clinical trial dataset (N = 2302) for the HRV risk measure LF/HF (the ratio of low frequency to high frequency power). Relative to frequency, beatquency improved the ability of LF/HF to predict cardiovascular death within one year (Area Under the Curve, or AUC, of 0.730 vs. 0.704, p machine learning to learn frequency and beatquency bands with optimal predictive power, which further improved the AUC for beatquency to 0.753 (p machine learning provide valuable tools in physiological studies of HRV.

  18. Framingham Risk Score for Prediction of Cardiovascular Diseases: A Population-Based Study from Southern Europe

    Science.gov (United States)

    Artigao-Rodenas, Luis M.; Carbayo-Herencia, Julio A.; Divisón-Garrote, Juan A.; Gil-Guillén, Vicente F.; Massó-Orozco, Javier; Simarro-Rueda, Marta; Molina-Escribano, Francisca; Sanchis, Carlos; Carrión-Valero, Lucinio; López de Coca, Enrique; Caldevilla, David; López-Abril, Juan; Carratalá-Munuera, Concepción; Lopez-Pineda, Adriana

    2013-01-01

    Background The question about what risk function should be used in primary prevention remains unanswered. The Framingham Study proposed a new algorithm based on three key ideas: use of the four risk factors with the most weight (cholesterol, blood pressure, diabetes and smoking), prediction of overall cardiovascular diseases and incorporating the concept of vascular age. The objective of this study was to apply this new function in a cohort of the general non Anglo-Saxon population, with a 10-year follow-up to determine its validity. Methods The cohort was studied in 1992-94 and again in 2004-06. The sample comprised 959 randomly-selected persons, aged 30-74 years, who were representative of the population of Albacete, Spain. At the first examination cycle, needed data for the new function were collected and at the second examination, data on all events were recorded during the follow-up period. Discrimination was studied with ROC curves. Comparisons of prediction models and reality in tertiles (Hosmer-Lemeshow) were performed, and the individual survival functions were calculated. Results The mean risks for women and men, respectively, were 11.3% and 19.7% and the areas under the ROC curve were 0.789 (95%CI, 0.716-0.863) and 0.780 (95%CI, 0.713-0.847) (P<0.001, both). Cardiovascular disease events occurred in the top risk tertiles. Of note were the negative predictive values in both sexes, and a good specificity in women (85.6%) and sensitivity in men (79.1%) when their risk for cardiovascular disease was high. This model overestimates the risk in older women and in middle-aged men. The cumulative probability of individual survival by tertiles was significant in both sexes (P<0.001). Conclusions The results support the proposal for “reclassification” of Framingham. This study, with a few exceptions, passed the test of discrimination and calibration in a random sample of the general population from southern Europe. PMID:24039972

  19. Family history predicts major adverse cardiovascular events (MACE) in young adults with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Bruun, Louise E; Mallbris, Lotus

    2016-01-01

    BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a fami....... The findings call for increased focus on a family history of CVD in CV risk assessment of patients with psoriasis.......BACKGROUND: Patients with psoriasis may have increased risk of major adverse cardiovascular (CV) events (MACE), and a family history of CV disease (CVD) is an independent risk factor for MACE. OBJECTIVE: We investigated the risk of first-time MACE in patients with psoriasis with or without a family...... and severe disease, respectively. In patients with psoriasis but without a family history of CVD, there was no increased risk of MACE. LIMITATIONS: Results may not apply to late-onset psoriasis. CONCLUSIONS: A family history of CVD predicted the risk of first-time MACE in young adults with psoriasis...

  20. A Malaria Ecology Index Predicted Spatial and Temporal Variation of Malaria Burden and Efficacy of Antimalarial Interventions Based on African Serological Data.

    Science.gov (United States)

    McCord, Gordon C; Anttila-Hughes, Jesse K

    2017-03-01

    AbstractReducing the global health burden of malaria is complicated by weak reporting systems for infectious diseases and a paucity of vital statistics registration. This limits our ability to predict changes in malaria health burden intensity, target antimalarial resources where needed, and identify malaria impacts in retrospective data. We refined and deployed a temporally and spatially varying Malaria Ecology Index (MEI) incorporating climatological and ecological data to estimate malaria transmission strength and validate it against cross-sectional serology data from 39,875 children from seven sub-Saharan African countries. The MEI is strongly associated with malaria burden; a 1 standard deviation higher MEI is associated with a 50-117% increase in malaria risk and a 3-5 g/dL lower level of Hg. Results show that the relationship between malaria ecology and disease burden is attenuated with sufficient coverage of insecticide treated nets (ITNs) or indoor residual spraying (IRS). Having both ITNs and IRS reduce the added risk from adverse malaria ecology conditions by half. Readily available climate and ecology data can be used to estimate the spatial and temporal variation in malaria disease burden, providing a feasible alternative to direct surveillance. This will help target resources for malaria programs in the absence of national coverage of active case detection systems, and facilitate malaria research using retrospective health data.

  1. Impact of High Calcium Intake from Calcium Carbonate or Dairy on Cardiovascular Function, Coronary Artery Calcification and Coronary Artery Disease Burden in Ossabaw Miniature Swine

    OpenAIRE

    Phillips, Alyssa K.

    2013-01-01

    Recent secondary analyses have associated supplemental calcium use with increased risk for myocardial infarction and cardiovascular-related death in healthy, older adults. Subsequent concern over the safety of calcium supplements has spurred a calcium controversy, because calcium is a shortfall essential nutrient that is critical for bone health and a mainstay of osteoporosis prevention and treatment. The proposed mechanism by which calcium intake may detriment cardiovascular health is throug...

  2. Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

    DEFF Research Database (Denmark)

    Christiansen, Merete S; Hommel, E; Magid, E

    2002-01-01

    AIMS/HYPOTHESIS: Urinary orosomucoid excretion rate is increased in a substantial proportion of patients with Type II (non-insulin-dependent) diabetes mellitus and normal urinary albumin excretion rate. The aim of this study was to determine whether increased urinary orosomucoid excretion rate...... is predictive of increased mortality in patients with Type II diabetes. METHODS: In a cohort study including 430 patients with Type II diabetes, baseline urinary samples were analysed for orosomucoid and albumin. Mean follow-up was 2.4 years. RESULTS: We found that 188 (44 %) patients had normal and 242 (56...... urinary orosomucoid excretion rate was not included in the analysis. Subgroup analysis revealed that 39 % of the patients with normal urinary albumin excretion rate (n = 251) had increased urinary orosomucoid excretion rates and that these patients had a higher cardiovascular mortality (p = 0.007) than...

  3. Prognostic value of tissue Doppler imaging for predicting ventricular arrhythmias and cardiovascular mortality in ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Olsen, Flemming Javier; Storm, Katrine;

    2016-01-01

    AIMS: Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention receive appropriately therapy. We sought to investigate the value of tissue Doppler imaging (TDI) to predict ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiovascular...... mortality (CVD) in patients with primary prevention ICD. METHODS AND RESULTS: In total, 151 ICD patients meeting primary prevention criteria and with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal...... systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates. Forty patients experienced the combined endpoint of VT, VF, or CVD during a median follow-up of 2.3 years. Left ventricular...

  4. Can exaggerated stress reactivity and prolonged recovery predict negative health outcomes? The case of cardiovascular disease.

    Science.gov (United States)

    Lovallo, William R

    2015-04-01

    Researchers and laypersons have long argued that stress is bad for health, particularly when responses are large, prolonged, and frequent. By extension, individuals who have the largest and the most prolonged responses are assumed to have worse outcomes than do less reactive persons. Research in animals has been supportive of the connection between stress and poor health, but evidence in humans has been slow to accumulate. The current issue of Psychosomatic Medicine presents a meta-analysis of 33 studies of delayed recovery from stress and its association with poor cardiovascular disease outcomes and all-cause mortality. The analysis supports the contention that slower recovery to baseline after exercise or psychological stress may predict earlier death due to all causes. This finding raises questions for psychosomatic theories of disease and points the direction for further study of how or whether to incorporate reactivity measures into standard risk profiles.

  5. Lipidomics: potential role in risk prediction and therapeutic monitoring for diabetes and cardiovascular disease.

    Science.gov (United States)

    Meikle, Peter J; Wong, Gerard; Barlow, Christopher K; Kingwell, Bronwyn A

    2014-07-01

    Lipidomics has developed rapidly over the past decade to the point where clinical application may soon be possible. Developments including high throughput technologies enable the simultaneous quantification of several hundred lipid species, thereby providing a global assessment of lipid metabolism. Given the key role of lipids in the pathophysiology of diabetes and cardiovascular disease, lipidomics has the potential to: i) Significantly improve prediction of future disease risk, ii) Inform on mechanisms of disease pathogenesis, iii) Identify patient groups responsive to particular therapies and iv) More closely monitor response to therapy. Lipidomic analyses of both whole plasma and lipoprotein subfractions are integral to the current initiative to understand the relationships between lipoprotein composition and function and how these are affected by disease and treatment. This approach will not only aid in appropriate targeting of existing lipid lowering therapies such as statins and fibrates, but will be important in unravelling the controversies surrounding HDL-based therapies which have failed in clinical trials to date. The ultimate utility of lipidomics to clinical practice will depend firstly on the ability of risk prediction models incorporating lipidomic parameters to significantly improve upon conventional clinical risk markers in predicting future disease risk. Secondly, for widespread application, lipidomic-based measurements must be practical and accessible through standard pathology laboratories. This review will cover developments in lipidomics including methodology, bioinformatics/statistics, insights into disease pathophysiology, the effect of therapeutic interventions, the role of large clinical outcome trials in validating lipidomic approaches to patient management and potential applications in clinical practice.

  6. Body Composition Indices and Predicted Cardiovascular Disease Risk Profile among Urban Dwellers in Malaysia

    Directory of Open Access Journals (Sweden)

    Tin Tin Su

    2015-01-01

    Full Text Available Objectives. This study aims to compare various body composition indices and their association with a predicted cardiovascular disease (CVD risk profile in an urban population in Kuala Lumpur, Malaysia. Methods. A cross-sectional survey was conducted in metropolitan Kuala Lumpur, Malaysia, in 2012. Households were selected using a simple random-sampling method, and adult members were invited for medical screening. The Framingham Risk Scoring algorithm was used to predict CVD risk, which was then analyzed in association with body composition measurements, including waist circumference, waist-hip ratio, waist-height ratio, body fat percentage, and body mass index. Results. Altogether, 882 individuals were included in our analyses. Indices that included waist-related measurements had the strongest association with CVD risk in both genders. After adjusting for demographic and socioeconomic variables, waist-related measurements retained the strongest correlations with predicted CVD risk in males. However, body mass index, waist-height ratio, and waist circumference had the strongest correlation with CVD risk in females. Conclusions. The waist-related indicators of abdominal obesity are important components of CVD risk profiles. As waist-related parameters can quickly and easily be measured, they should be routinely obtained in primary care settings and population health screens in order to assess future CVD risk profiles and design appropriate interventions.

  7. Vitamin D deficiency in postmenopausal, healthy women predicts increased cardiovascular events

    DEFF Research Database (Denmark)

    Schierbeck, Louise Lind; Rejnmark, Lars; Tofteng, Charlotte Landbo;

    2012-01-01

    To investigate the relationship between vitamin D status in healthy women and cardiovascular outcome.......To investigate the relationship between vitamin D status in healthy women and cardiovascular outcome....

  8. Management of type 2 diabetes mellitus and prediction of cardiovascular complications

    NARCIS (Netherlands)

    van Dieren, S.

    2013-01-01

    Cardiovascular disease is the leading complication of type 2 diabetes and approximately half of the patients with type 2 diabetes will die of a cardiovascular cause. To prevent the occurrence of cardiovascular disease, effective diabetes treatment is necessary. Up-titrating diabetes medication by

  9. Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?

    Directory of Open Access Journals (Sweden)

    Grigory Sidorenkov

    Full Text Available BACKGROUND: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes. METHODS: A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure- and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR with 95% confidence intervals. RESULTS: Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94. Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93. Treatment intensification with glucose-lowering but not with lipid-, blood pressure- and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89. CONCLUSION: Treatment quality indicators measuring lipid- and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient

  10. Prediction of cardiovascular disease risk among low-income urban dwellers in metropolitan Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Su, Tin Tin; Amiri, Mohammadreza; Mohd Hairi, Farizah; Thangiah, Nithiah; Bulgiba, Awang; Majid, Hazreen Abdul

    2015-01-01

    We aimed to predict the ten-year cardiovascular disease (CVD) risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS) models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM). Altogether 882 adults (≥30 years old with no CVD history) were randomly selected. The classic FRS model (figures in parentheses are from the modified model) revealed that 20.5% (21.8%) and 38.46% (38.9%) of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  11. Prediction of Cardiovascular Disease Risk among Low-Income Urban Dwellers in Metropolitan Kuala Lumpur, Malaysia

    Directory of Open Access Journals (Sweden)

    Tin Tin Su

    2015-01-01

    Full Text Available We aimed to predict the ten-year cardiovascular disease (CVD risk among low-income urban dwellers of metropolitan Malaysia. Participants were selected from a cross-sectional survey conducted in Kuala Lumpur. To assess the 10-year CVD risk, we employed the Framingham risk scoring (FRS models. Significant determinants of the ten-year CVD risk were identified using General Linear Model (GLM. Altogether 882 adults (≥30 years old with no CVD history were randomly selected. The classic FRS model (figures in parentheses are from the modified model revealed that 20.5% (21.8% and 38.46% (38.9% of respondents were at high and moderate risk of CVD. The GLM models identified the importance of education, occupation, and marital status in predicting the future CVD risk. Our study indicated that one out of five low-income urban dwellers has high chance of having CVD within ten years. Health care expenditure, other illness related costs and loss of productivity due to CVD would worsen the current situation of low-income urban population. As such, the public health professionals and policy makers should establish substantial effort to formulate the public health policy and community-based intervention to minimize the upcoming possible high mortality and morbidity due to CVD among the low-income urban dwellers.

  12. Unrequested information from routine diagnostic chest CT predicts future cardiovascular events

    Energy Technology Data Exchange (ETDEWEB)

    Jacobs, Peter C. [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Universiteitsweg 100, P.O. Box 85500, GA, Utrecht (Netherlands); University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, CX, Utrecht (Netherlands); Gondrie, Martijn J.; Grobbee, Diederick E.; Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Universiteitsweg 100, P.O. Box 85500, GA, Utrecht (Netherlands); Mali, Willem P. [University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, CX, Utrecht (Netherlands); Oen, Ayke L. [Elkerliek Medical Center Helmond, Department of Radiology, Wesselmanlaan 25, HA, Helmond (Netherlands); Prokop, Mathias [Radboud University Nijmegen Medical Center, Department of Radiology, Geert Grooteplein Zuid 10, GA, Nijmegen (Netherlands)

    2011-08-15

    An increase in the number of CT investigations will likely result in a an increase in unrequested information. Clinical relevance of these findings is unknown. This is the first follow-up study to investigate the prognostic relevance of subclinical coronary (CAC) and aortic calcification (TAC) as contained in routine diagnostic chest CT in a clinical care population. The follow-up of 10,410 subjects (>40 years) from a multicentre, clinical care-based cohort of patients included 240 fatal to 275 non-fatal cardiovascular disease (CVD) events (mean follow-up 17.8 months). Patients with a history of CVD were excluded. Coronary (0-12) and aortic calcification (0-8) were semi-quantitatively scored. We used Cox proportional-hazard models to compute hazard ratios to predict CVD events. CAC and TAC were significantly and independently predictive of CVD events. Compared with subjects with no calcium, the adjusted risk of a CVD event was 3.7 times higher (95% CI, 2.7-5.2) among patients with severe coronary calcification (CAC score {>=}6) and 2.7 times higher (95% CI, 2.0-3.7) among patients with severe aortic calcification (TAC score {>=}5). Subclinical vascular calcification on CT is a strong predictor of incident CVD events in a routine clinical care population. (orig.)

  13. Individualized prediction of the effect of angiotensin receptor inhibition on renal and cardiovascular outcomes in patients with diabetic nephropathy

    NARCIS (Netherlands)

    van der Sande, Nicolette G C; Dorresteijn, Jannick A N; Visseren, Frank L J; Dwyer, Jamie P; Blankestijn, Peter J; van der Graaf, Yolanda; Heerspink, Hiddo L

    2016-01-01

    Aims Angiotensin receptor blockers (ARBs) reduce cardiovascular and renal complications in patients with diabetic nephropathy but treatment effects may vary across patients. Predicting individualized treatment effect of ARBs on both outcomes may help clinicians and patients to assess the benefit of

  14. The plasma leptin/adiponectin ratio predicts first cardiovascular event in men : A prospective nested case-control study

    NARCIS (Netherlands)

    Kappelle, Paul J.W.H.; Dullaart, Robin P. F.; van Beek, Andre P.; Hillege, Hans L.; Wolffenbuttel, Bruce H. R.

    2012-01-01

    Objective: The plasma leptin/adiponectin (L/A) ratio has been proposed as a preferential marker of atherosclerosis susceptibility compared to leptin and adiponectin alone. We determined the extent to which the L/A ratio predicts incident cardiovascular disease (CVD) taking account of clinical risk f

  15. A systematic review on the application of cardiovascular risk prediction models in pharmacoeconomics, with a focus on primary prevention

    NARCIS (Netherlands)

    Stevanovic, J.; Postma, M.J.; Pechlivanoglou, P.

    2012-01-01

    OBJECTIVES: In the absence of long-term randomized clinical trials (RCTs) on the effectiveness of pharmacological treatment for primary cardiovascular disease (CVD) prevention, risk prediction models are used to project changes in CVD incidence due to changes on risk factor levels observed in short-

  16. Individualized prediction of the effect of angiotensin receptor inhibition on renal and cardiovascular outcomes in patients with diabetic nephropathy

    NARCIS (Netherlands)

    van der Sande, N. G. C.; Dorresteijn, J. A. N.; Visseren, F. L. J.; Dwyer, J. P.; Blankestijn, P. J.; van der Graaf, Y.; Heerspink, H. L. J.

    2016-01-01

    Aims: To predict individualized treatment effects of angiotensin receptor blockers (ARBs) on cardiovascular and renal complications in order to help clinicians and patients assess the benefit of treatment (or adherence) and estimate remaining disease risk. Materials and methods: In patients with dia

  17. PCSK9 Plasma Concentrations Are Independent of GFR and Do Not Predict Cardiovascular Events in Patients with Decreased GFR.

    Directory of Open Access Journals (Sweden)

    Kyrill S Rogacev

    Full Text Available Impaired renal function causes dyslipidemia that contributes to elevated cardiovascular risk in patients with chronic kidney disease (CKD. The proprotein convertase subtilisin/kexin type 9 (PCSK9 is a regulator of the LDL receptor and plasma cholesterol concentrations. Its relationship to kidney function and cardiovascular events in patients with reduced glomerular filtration rate (GFR has not been explored.Lipid parameters including PCSK9 were measured in two independent cohorts. CARE FOR HOMe (Cardiovascular and Renal Outcome in CKD 2-4 Patients-The Forth Homburg evaluation enrolled 443 patients with reduced GFR (between 90 and 15 ml/min/1.73 m2 referred for nephrological care that were prospectively followed for the occurrence of a composite cardiovascular endpoint. As a replication cohort, PCSK9 was quantitated in 1450 patients with GFR between 90 and 15 ml/min/1.73 m2 enrolled in the Ludwigshafen Risk and Cardiovascular Health Study (LURIC that were prospectively followed for cardiovascular deaths.PCSK9 concentrations did not correlate with baseline GFR (CARE FOR HOMe: r = -0.034; p = 0.479; LURIC: r = -0.017; p = 0.512. 91 patients in CARE FOR HOMe and 335 patients in LURIC reached an endpoint during a median follow-up of 3.0 [1.8-4.1] years and 10.0 [7.3-10.6] years, respectively. Kaplan-Meier analyses showed that PCSK9 concentrations did not predict cardiovascular events in either cohort [CARE FOR HOMe (p = 0.622; LURIC (p = 0.729]. Sensitivity analyses according to statin intake yielded similar results.In two well characterized independent cohort studies, PCSK9 plasma levels did not correlate with kidney function. Furthermore, PCSK9 plasma concentrations were not associated with cardiovascular events in patients with reduced renal function.

  18. Cardiovascular disease risk score prediction models for women and its applicability to Asians

    Directory of Open Access Journals (Sweden)

    Goh LGH

    2014-03-01

    Full Text Available Louise GH Goh,1 Satvinder S Dhaliwal,1 Timothy A Welborn,2 Peter L Thompson,2–4 Bruce R Maycock,1 Deborah A Kerr,1 Andy H Lee,1 Dean Bertolatti,1 Karin M Clark,1 Rakhshanda Naheed,1 Ranil Coorey,1 Phillip R Della5 1School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Harry Perkins Institute for Medical Research, Perth, WA, Australia; 5School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia Purpose: Although elevated cardiovascular disease (CVD risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were

  19. A method to construct a points system to predict cardiovascular disease considering repeated measures of risk factors

    Science.gov (United States)

    Carbayo-Herencia, Julio Antonio; Vigo, Maria Isabel; Gil-Guillén, Vicente Francisco

    2016-01-01

    Current predictive models for cardiovascular disease based on points systems use the baseline situation of the risk factors as independent variables. These models do not take into account the variability of the risk factors over time. Predictive models for other types of disease also exist that do consider the temporal variability of a single biological marker in addition to the baseline variables. However, due to their complexity these other models are not used in daily clinical practice. Bearing in mind the clinical relevance of these issues and that cardiovascular diseases are the leading cause of death worldwide we show the properties and viability of a new methodological alternative for constructing cardiovascular risk scores to make predictions of cardiovascular disease with repeated measures of the risk factors and retaining the simplicity of the points systems so often used in clinical practice (construction, statistical validation by simulation and explanation of potential utilization). We have also applied the system clinically upon a set of simulated data solely to help readers understand the procedure constructed. PMID:26893963

  20. Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease: An Individual Participant Data Meta-Analysis.

    Science.gov (United States)

    Ohkuma, Toshiaki; Ninomiya, Toshiharu; Tomiyama, Hirofumi; Kario, Kazuomi; Hoshide, Satoshi; Kita, Yoshikuni; Inoguchi, Toyoshi; Maeda, Yasutaka; Kohara, Katsuhiko; Tabara, Yasuharu; Nakamura, Motoyuki; Ohkubo, Takayoshi; Watada, Hirotaka; Munakata, Masanori; Ohishi, Mitsuru; Ito, Norihisa; Nakamura, Michinari; Shoji, Tetsuo; Vlachopoulos, Charalambos; Yamashina, Akira

    2017-06-01

    An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend analysis clearly established baPWV as an independent predictor of the risk of development of CVD in Japanese subjects without preexisting CVD. Thus, measurement of the baPWV could enhance the efficacy of prediction of the risk of development of CVD over that of the Framingham risk score, which is based on the traditional cardiovascular risk factors. © 2017 American Heart Association, Inc.

  1. Transthyretin Predicts Cardiovascular Outcome In Hemodialysis Patients With Diabetes Mellitus Type 2

    Directory of Open Access Journals (Sweden)

    Andrea Henze

    2012-06-01

    A low TTR concentration was associated with an increased risk for CVE for the total study cohort (HR 1.65; 95% CI 1.27-2.14, patients with BMI ≥23kg/m² (HR 1.70; 95% CI 1.22–2.37, albumin ≥3.8g/dL (HR 1.68; 95% CI 1.17–2.42 and the combination of both (HR 1.69; 95% CI 1.13-2.53. Additionally, a low TTR concentration predicted all-cause mortality for the total study cohort (HR 1.79; 95% CI 1.43–2.24 and patients with BMI ≥23kg/m² (HR 1.46; 95% CI 1.09–1.95. In conclusion, the present study demonstrated that TTR is a useful predictor for cardiovascular outcome and mortality in hemodialysis patients. TTR was particularly useful in patients who were not identified to be at risk by BMI or albumin status.

  2. Cardiovascular events in acromegaly: distinct role of Agatston and Framingham score in the 5-year prediction.

    Science.gov (United States)

    Ragonese, Marta; Alibrandi, Angela; Di Bella, Gianluca; Salamone, Ignazio; Puglisi, Soraya; Cotta, Oana Ruxandra; Torre, Maria Luisa; Ferrau, Francesco; Ruggeri, Rosaria Maddalena; Trimarchi, Francesco; Cannavo, Salvatore

    2014-09-01

    Prediction of ischemic cardiovascular events (ICE) in acromegalic patients stratified accordingly with Framingham (FS) and Agatston score (AS). 32 patients with active (group A (0)) and 20 with controlled (group B (0)) acromegaly have been enrolled. During the 5-year follow-up, 19 out of 32 patients in group A (0) reached disease control. At entry, FS and AS, by an eight-slice MDCT scanner, were calculated in all patients. ICE were diagnosed by autopsy, if lethal, and by electrocardiography and/or echocardiography, if non-lethal. Overall, 9.6 % of patients died for lethal ICE. AS >400, but not high FS at entry, was associated with increased risk of lethal ICE. Lethal ICE had occurred in two patients of group A (0) and three of group B (0) (p NS), while a non-lethal ICE had occurred in two cases of the former and in other two of the latter group (p NS). Either FS or AS was correlated with the risk for ICE overall (p 400 is associated with increased risk of lethal ICE, while high FS is associated with reduced life expectancy, regardless of disease control.

  3. Physical activity predicts gray matter volume in late adulthood: the Cardiovascular Health Study.

    Science.gov (United States)

    Erickson, K I; Raji, C A; Lopez, O L; Becker, J T; Rosano, C; Newman, A B; Gach, H M; Thompson, P M; Ho, A J; Kuller, L H

    2010-10-19

    Physical activity (PA) has been hypothesized to spare gray matter volume in late adulthood, but longitudinal data testing an association has been lacking. Here we tested whether PA would be associated with greater gray matter volume after a 9-year follow-up, a threshold could be identified for the amount of walking necessary to spare gray matter volume, and greater gray matter volume associated with PA would be associated with a reduced risk for cognitive impairment 13 years after the PA evaluation. In 299 adults (mean age 78 years) from the Cardiovascular Health Cognition Study, we examined the association between gray matter volume, PA, and cognitive impairment. Physical activity was quantified as the number of blocks walked over 1 week. High-resolution brain scans were acquired 9 years after the PA assessment on cognitively normal adults. White matter hyperintensities, ventricular grade, and other health variables at baseline were used as covariates. Clinical adjudication for cognitive impairment occurred 13 years after baseline. Walking amounts ranged from 0 to 300 blocks (mean 56.3; SD 69.7). Greater PA predicted greater volumes of frontal, occipital, entorhinal, and hippocampal regions 9 years later. Walking 72 blocks was necessary to detect increased gray matter volume but walking more than 72 blocks did not spare additional volume. Greater gray matter volume with PA reduced the risk for cognitive impairment 2-fold. Greater amounts of walking are associated with greater gray matter volume, which is in turn associated with a reduced risk of cognitive impairment.

  4. Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sung Woo [Division of Cardiology - Department of Internal Medicine - Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Division of Cardiology - Department of Medicine - Samsung Medical Center, Seoul (Korea, Republic of); Kim, Byung Gyu; Kim, Byung Ok; Byun, Young Sup; Goh, Choong Won; Rhee, Kun Joo [Division of Cardiology - Department of Internal Medicine - Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Kwon, Hyuck Moon; Lee, Byoung Kwon, E-mail: cardiobk@yuhs.ac [Division of Cardiology - Department of Internal Medicine - Gangnam Severance Hospital - Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-01-15

    Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.

  5. Cardiovascular disease risk score prediction models for women and its applicability to Asians.

    Science.gov (United States)

    Goh, Louise Gh; Dhaliwal, Satvinder S; Welborn, Timothy A; Thompson, Peter L; Maycock, Bruce R; Kerr, Deborah A; Lee, Andy H; Bertolatti, Dean; Clark, Karin M; Naheed, Rakhshanda; Coorey, Ranil; Della, Phillip R

    2014-01-01

    Although elevated cardiovascular disease (CVD) risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation) risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20-69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence. In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation.

  6. Predictive Value of Cumulative Blood Pressure for All-Cause Mortality and Cardiovascular Events

    Science.gov (United States)

    Wang, Yan Xiu; Song, Lu; Xing, Ai Jun; Gao, Ming; Zhao, Hai Yan; Li, Chun Hui; Zhao, Hua Ling; Chen, Shuo Hua; Lu, Cheng Zhi; Wu, Shou Ling

    2017-02-01

    The predictive value of cumulative blood pressure (BP) on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has hardly been studied. In this prospective cohort study including 52,385 participants from the Kailuan Group who attended three medical examinations and without CCE, the impact of cumulative systolic BP (cumSBP) and cumulative diastolic BP (cumDBP) on all-cause mortality and CCEs was investigated. For the study population, the mean (standard deviation) age was 48.82 (11.77) years of which 40,141 (76.6%) were male. The follow-up for all-cause mortality and CCEs was 3.96 (0.48) and 2.98 (0.41) years, respectively. Multivariate Cox proportional hazards regression analysis showed that for every 10 mm Hg·year increase in cumSBP and 5 mm Hg·year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029). Using natural spline function analysis, cumSBP and cumDBP showed a J-curve relationship with CCEs; and a U-curve relationship with stroke (ischemic stroke and hemorrhagic stroke). Therefore, increases in cumSBP and cumDBP were predictive for all-cause mortality, CCEs, and stroke.

  7. Reduced functional measure of cardiovascular reserve predicts admission to critical care unit following kidney transplantation.

    Directory of Open Access Journals (Sweden)

    Stephen M S Ting

    Full Text Available BACKGROUND: There is currently no effective preoperative assessment for patients undergoing kidney transplantation that is able to identify those at high perioperative risk requiring admission to critical care unit (CCU. We sought to determine if functional measures of cardiovascular reserve, in particular the anaerobic threshold (VO₂AT could identify these patients. METHODS: Adult patients were assessed within 4 weeks prior to kidney transplantation in a University hospital with a 37-bed CCU, between April 2010 and June 2012. Cardiopulmonary exercise testing (CPET, echocardiography and arterial applanation tonometry were performed. RESULTS: There were 70 participants (age 41.7±14.5 years, 60% male, 91.4% living donor kidney recipients, 23.4% were desensitized. 14 patients (20% required escalation of care from the ward to CCU following transplantation. Reduced anaerobic threshold (VO₂AT was the most significant predictor, independently (OR = 0.43; 95% CI 0.27-0.68; p<0.001 and in the multivariate logistic regression analysis (adjusted OR = 0.26; 95% CI 0.12-0.59; p = 0.001. The area under the receiver-operating-characteristic curve was 0.93, based on a risk prediction model that incorporated VO₂AT, body mass index and desensitization status. Neither echocardiographic nor measures of aortic compliance were significantly associated with CCU admission. CONCLUSIONS: To our knowledge, this is the first prospective observational study to demonstrate the usefulness of CPET as a preoperative risk stratification tool for patients undergoing kidney transplantation. The study suggests that VO₂AT has the potential to predict perioperative morbidity in kidney transplant recipients.

  8. New measure of insulin sensitivity predicts cardiovascular disease better than HOMA estimated insulin resistance.

    Directory of Open Access Journals (Sweden)

    Kavita Venkataraman

    Full Text Available CONTEXT: Accurate assessment of insulin sensitivity may better identify individuals at increased risk of cardio-metabolic diseases. OBJECTIVES: To examine whether a combination of anthropometric, biochemical and imaging measures can better estimate insulin sensitivity index (ISI and provide improved prediction of cardio-metabolic risk, in comparison to HOMA-IR. DESIGN AND PARTICIPANTS: Healthy male volunteers (96 Chinese, 80 Malay, 77 Indian, 21 to 40 years, body mass index 18-30 kg/m(2. Predicted ISI (ISI-cal was generated using 45 randomly selected Chinese through stepwise multiple linear regression, and validated in the rest using non-parametric correlation (Kendall's tau τ. In an independent longitudinal cohort, ISI-cal and HOMA-IR were compared for prediction of diabetes and cardiovascular disease (CVD, using ROC curves. SETTING: The study was conducted in a university academic medical centre. OUTCOME MEASURES: ISI measured by hyperinsulinemic euglycemic glucose clamp, along with anthropometric measurements, biochemical assessment and imaging; incident diabetes and CVD. RESULTS: A combination of fasting insulin, serum triglycerides and waist-to-hip ratio (WHR provided the best estimate of clamp-derived ISI (adjusted R(2 0.58 versus 0.32 HOMA-IR. In an independent cohort, ROC areas under the curve were 0.77±0.02 ISI-cal versus 0.76±0.02 HOMA-IR (p>0.05 for incident diabetes, and 0.74±0.03 ISI-cal versus 0.61±0.03 HOMA-IR (p<0.001 for incident CVD. ISI-cal also had greater sensitivity than defined metabolic syndrome in predicting CVD, with a four-fold increase in the risk of CVD independent of metabolic syndrome. CONCLUSIONS: Triglycerides and WHR, combined with fasting insulin levels, provide a better estimate of current insulin resistance state and improved identification of individuals with future risk of CVD, compared to HOMA-IR. This may be useful for estimating insulin sensitivity and cardio-metabolic risk in clinical and

  9. Variation in GYS1 interacts with exercise and gender to predict cardiovascular mortality.

    Directory of Open Access Journals (Sweden)

    Jenny Fredriksson

    Full Text Available BACKGROUND: The muscle glycogen synthase gene (GYS1 has been associated with type 2 diabetes (T2D, the metabolic syndrome (MetS, male myocardial infarction and a defective increase in muscle glycogen synthase protein in response to exercise. We addressed the questions whether polymorphism in GYS1 can predict cardiovascular (CV mortality in a high-risk population, if this risk is influenced by gender or physical activity, and if the association is independent of genetic variation in nearby apolipoprotein E gene (APOE. METHODOLOGY/PRINCIPAL FINDINGS: Polymorphisms in GYS1 (XbaIC>T and APOE (-219G>T, epsilon2/epsilon3/epsilon4 were genotyped in 4,654 subjects participating in the Botnia T2D-family study and followed for a median of eight years. Mortality analyses were performed using Cox proportional-hazards regression. During the follow-up period, 749 individuals died, 409 due to CV causes. In males the GYS1 XbaI T-allele (hazard ratio (HR 1.9 [1.2-2.9], T2D (2.5 [1.7-3.8], earlier CV events (1.7 [1.2-2.5], physical inactivity (1.9 [1.2-2.9] and smoking (1.5 [1.0-2.3] predicted CV mortality. The GYS1 XbaI T-allele predicted CV mortality particularly in physically active males (HR 1.7 [1.3-2.0]. Association of GYS1 with CV mortality was independent of APOE (219TT/epsilon4, which by its own exerted an effect on CV mortality risk in females (2.9 [1.9-4.4]. Other independent predictors of CV mortality in females were fasting plasma glucose (1.2 [1.1-1.2], high body mass index (BMI (1.0 [1.0-1.1], hypertension (1.9 [1.2-3.1], earlier CV events (1.9 [1.3-2.8] and physical inactivity (1.9 [1.2-2.8]. CONCLUSIONS/SIGNIFICANCE: Polymorphisms in GYS1 and APOE predict CV mortality in T2D families in a gender-specific fashion and independently of each other. Physical exercise seems to unmask the effect associated with the GYS1 polymorphism, rendering carriers of the variant allele less susceptible to the protective effect of exercise on the risk of CV death

  10. Resting state functional connectivity within the cingulate cortex jointly predicts agreeableness and stressor-evoked cardiovascular reactivity.

    Science.gov (United States)

    Ryan, John P; Sheu, Lei K; Gianaros, Peter J

    2011-03-01

    Exaggerated cardiovascular reactivity to stress is a risk factor for cardiovascular disease. Further, individual differences in stressor-evoked cardiovascular reactivity covary with the functionality of corticolimbic brain systems, particularly areas of the cingulate cortex. What remains unclear, however, is how individual differences in personality traits interact with cingulate functionality in the prediction of stressor-evoked cardiovascular reactivity. Accordingly, we tested the associations between (i) a particular personality trait, Agreeableness, which is associated with emotional reactions to conflict, (ii) resting state functional connectivity within the cingulate cortex, and (iii) stressor-evoked blood pressure (BP) reactivity. Participants (N=39, 19 men, aged 20-37 years) completed a resting functional connectivity MRI protocol, followed by two standardized stressor tasks that engaged conflict processing and evoked BP reactivity. Agreeableness covaried positively with BP reactivity across individuals. Moreover, connectivity analyses demonstrated that a more positive functional connectivity between the posterior cingulate (BA31) and the perigenual anterior cingulate (BA32) covaried positively with Agreeableness and with BP reactivity. Finally, statistical mediation analyses demonstrated that BA31-BA32 connectivity mediated the covariation between Agreeableness and BP reactivity. Functional connectivity within the cingulate appears to link Agreeableness and a risk factor for cardiovascular disease, stressor-evoked BP reactivity.

  11. The predictive value of vitamin B12 concentrations and hyperhomocysteinaemia for cardiovascular disease.

    NARCIS (Netherlands)

    Oijen, M.G.H. van; Laheij, R.J.F.; Jansen, J.B.M.J.; Verheugt, F.W.A.

    2007-01-01

    BACKGROUND: Cardiovascular disease has been associated with both homocysteine and vitamin B12 levels. However, little information is available about the mutual relation in cardiovascular patients. The aim of this study was to assess the prevalence of vitamin B12 deficiency in patients with

  12. Sex hormone-binding globulin levels predict insulin sensitivity, disposition index, and cardiovascular risk during puberty

    DEFF Research Database (Denmark)

    Sørensen, Kaspar; Aksglaede, Lise; Munch-Andersen, Thor

    2009-01-01

    Early puberty is associated with increased risk of subsequent cardiovascular disease. Low sex hormone-binding globulin (SHBG) levels are a feature of early puberty and of conditions associated with increased cardiovascular risk. The aim of the present study was to evaluate SHBG as a predictor...... of glucose metabolism and metabolic risk during puberty....

  13. The predictive value of vitamin B12 concentrations and hyperhomocysteinaemia for cardiovascular disease.

    NARCIS (Netherlands)

    Oijen, M.G.H. van; Laheij, R.J.F.; Jansen, J.B.M.J.; Verheugt, F.W.A.

    2007-01-01

    BACKGROUND: Cardiovascular disease has been associated with both homocysteine and vitamin B12 levels. However, little information is available about the mutual relation in cardiovascular patients. The aim of this study was to assess the prevalence of vitamin B12 deficiency in patients with cardiovas

  14. High Triglycerides Predicts Arteriogenic Erectile Dysfunction and Major Adverse Cardiovascular Events in Subjects With Sexual Dysfunction.

    Science.gov (United States)

    Corona, Giovanni; Cipriani, Sarah; Rastrelli, Giulia; Sforza, Alessandra; Mannucci, Edoardo; Maggi, Mario

    2016-09-01

    The atherogenic role of triglycerides (TG) remains controversial. The aim of the present study is to analyze the contribution of TG in the pathogenesis of erectile dysfunction (ED) and to verify the value of elevated TG in predicting major adverse cardiovascular events (MACE). An unselected series of 3,990 men attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (n = 1,687) was enrolled in a longitudinal study. Several clinical, biochemical, and instrumental (penile color Doppler ultrasound; PCDU) factors were evaluated. Among the patients studied, after adjustment for confounders, higher TG levels were associated with arteriogenic ED and a higher risk of clinical and biochemical hypogonadism. Conversely, no association between TG and other sexual dysfunctions was observed. When pathological PCDU parameters-including flaccid acceleration (<1.17 m/sec(2)) or dynamic peak systolic velocity (PSV <35 cm/sec)-were considered, the negative association between impaired penile flow and higher TG levels was confirmed, even when subjects taking lipid-lowering drugs or those with diabetes were excluded from the analysis (OR = 6.343 [1.243;32.362], P = .026 and 3.576 [1.104;11.578]; P = .34 for impaired acceleration and PSV, respectively). Similarly, when the same adjusted models were applied, TG levels were associated with a higher risk of hypogonadism, independently of the definition criteria (OR = 2.892 [1.643;5.410], P < .0001 and 4.853 [1.965;11.990]; P = .001 for total T <12 and 8 nM, respectively). In the longitudinal study, after adjusting for confounders, elevated TG levels (upper quartile: 162-1686 mg/dL) were independently associated with a higher incidence of MACE (HR = 2.469 [1.019;5.981]; P = .045), when compared to the rest of the sample. Our data suggest an association between elevated TG and arteriogenic ED and its cardiovascular (CV) risk stratification. Whether the use of TG lowering drugs

  15. Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease.

    Science.gov (United States)

    Larsen, Sanne Bøjet; Grove, Erik Lerkevang; Neergaard-Petersen, Søs; Würtz, Morten; Hvas, Anne-Mette; Kristensen, Steen Dalby

    2017-08-05

    Increased platelet aggregation during antiplatelet therapy may predict cardiovascular events in patients with coronary artery disease. The majority of these patients receive aspirin monotherapy. We aimed to investigate whether high platelet-aggregation levels predict cardiovascular events in stable coronary artery disease patients treated with aspirin. We included 900 stable coronary artery disease patients with either previous myocardial infarction, type 2 diabetes mellitus, or both. All patients received single antithrombotic therapy with 75 mg aspirin daily. Platelet aggregation was evaluated 1 hour after aspirin intake using the VerifyNow Aspirin Assay (Accriva Diagnostics) and Multiplate Analyzer (Roche; agonists: arachidonic acid and collagen). Adherence to aspirin was confirmed by serum thromboxane B2. The primary end point was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. At 3-year follow-up, 78 primary end points were registered. The primary end point did not occur more frequently in patients with high platelet-aggregation levels (first versus fourth quartile) assessed by VerifyNow (hazard ratio: 0.5 [95% CI, 0.3-1.1], P=0.08) or Multiplate using arachidonic acid (hazard ratio: 1.0 [95% CI, 0.5-2.1], P=0.92) or collagen (hazard ratio: 1.4 [95% CI, 0.7-2.8], P=0.38). Similar results were found for the composite secondary end point (nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and all-cause death) and the single end points. Thromboxane B2 levels did not predict any end points. Renal insufficiency was the only clinical risk factor predicting the primary and secondary end points. This study is the largest to investigate platelet aggregation in stable coronary artery disease patients receiving aspirin as single antithrombotic therapy. We found that high platelet-aggregation levels did not predict cardiovascular events. © 2017 The Authors. Published on behalf of the American Heart

  16. Worldwide burden of gastric cancer in 2012 that could have been prevented by increasing fruit and vegetable intake and predictions for 2025.

    Science.gov (United States)

    Peleteiro, Bárbara; Padrão, Patrícia; Castro, Clara; Ferro, Ana; Morais, Samantha; Lunet, Nuno

    2016-03-14

    The regional and temporal variation in patterns of fruit and vegetable intake contributes to differences in the impact on gastric cancer burden across regions and over the years. We aimed to estimate the proportion and absolute number of gastric cancer cases that could have been prevented in 2012 with an increase in fruit and vegetable intake up to the levels defined by the Global Burden of Disease as the theoretical minimum-risk exposure distribution (300 and 400 g/d, respectively), as well as the corresponding figures expected for 2025. Preventable fractions (PF) were computed for 161 countries, using data on fruit and vegetable availability in 1997 and 2010 and published estimates of the magnitude of the association between fruit and vegetable intake and gastric cancer, assuming a time lag of approximately 15 years. Countries classified as very high Human Development Index (HDI) presented median PF in 2012 much lower than low-HDI countries for both fruits (3·0 v. 10·2%, Pcancer cases in less than half of the countries. Increasing fruit and vegetable intake would allow preventing a relatively high proportion of gastric cancer cases, mostly in developing countries. Although declines in PF are predicted in the near future, changes in order to achieve healthier lifestyles may be insufficient to overcome the load of demographic variation to further reduce the gastric cancer burden.

  17. Plasma concentration of asymmetric dimethylarginine (ADMA) predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy

    DEFF Research Database (Denmark)

    Lajer, M.; Tarnow, L.; Jorsal, A.

    2008-01-01

    ), decline in GFR, ESRD, and all-cause mortality. RESULTS: Among patients with diabetic nephropathy, 37 patients (19.4%) with ADMA levels below the median, compared with 79 patients (43.4%) above the median, suffered a major cardiovascular event during the follow-up period (P ... after adjustment for conventional CVD risk factors including baseline GFR (adjusted hazard ratio [HR] for elevated ADMA 2.05 [95% CI 1.31-3.20], P = 0.002). Furthermore, elevated ADMA levels predicted an increased rate of decline in GFR, development of ESRD, and all-cause mortality (P ... adjustment for well-known progression promoters, including baseline GFR, the HR (adjusted) was 1.85 (95% CI 0.99-3.46, P = 0.055) for ESRD comparing upper and lower median ADMA levels. CONCLUSIONS: Plasma ADMA levels predict fatal and nonfatal cardiovascular events in patients with type 1 diabetic...

  18. SuPAR Predicts Cardiovascular Events and Mortality in Patients With Asymptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Hodges, Gethin W; Bang, Casper N; Eugen-Olsen, Jesper

    2016-01-01

    BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory marker associated with subclinical cardiovascular damage and cardiovascular events. Whether suPAR is of prognostic value in asymptomatic patients with aortic stenosis (AS) remains unknown. METHODS: Plasma su......PAR levels were measured in 1503 patients with a mean age of 68 years who were recruited in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox regression analysis was performed to evaluate associations between suPAR and the composite end points of ischemic cardiovascular events (ICEs), aortic...

  19. Deficient cardiovascular stress reactivity predicts poor executive functions in adults with attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Hirvikoski, Tatja; Olsson, Erik M G; Nordenstrom, Anna; Lindholm, Torun; Nordstrom, Anna-Lena; Lajic, Svetlana

    2011-01-01

    Associations between cardiovascular stress markers, subjective stress reactivity, and executive functions were studied in 60 adults (30 with attention-deficit/hyperactivity disorder, ADHD, and 30 controls) using the Paced Auditory Serial Addition Test (PASAT, a test of executive functions) as a cognitive stressor. Despite higher self-perceived stress, the adults with ADHD showed lower or atypical cardiovascular stress reactivity, which was associated with poorer performance on PASAT. Using cardiovascular stress markers, subjective stress, and results on PASAT as predictors in a logistic regression, 83.3% of the ADHD group and 86.9% of the controls could be classified correctly.

  20. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends.

    Science.gov (United States)

    Franco, Manuel; Bilal, Usama; Orduñez, Pedro; Benet, Mikhail; Morejón, Alain; Caballero, Benjamín; Kennelly, Joan F; Cooper, Richard S

    2013-04-09

    To evaluate the associations between population-wide loss and gain in weight with diabetes prevalence, incidence, and mortality, as well as cardiovascular and cancer mortality trends, in Cuba over a 30 year interval. Repeated cross sectional surveys and ecological comparison of secular trends. Cuba and the province of Cienfuegos, from 1980 to 2010. Measurements in Cienfuegos included a representative sample of 1657, 1351, 1667, and 1492 adults in 1991, 1995, 2001, and 2010, respectively. National surveys included a representative sample of 14 304, 22 851, and 8031 participants in 1995, 2001, and 2010, respectively. Changes in smoking, daily energy intake, physical activity, and body weight were tracked from 1980 to 2010 using national and regional surveys. Data for diabetes prevalence and incidence were obtained from national population based registries. Mortality trends were modelled using national vital statistics. Rapid declines in diabetes and heart disease accompanied an average population-wide loss of 5.5 kg in weight, driven by an economic crisis in the mid-1990s. A rebound in population weight followed in 1995 (33.5% prevalence of overweight and obesity) and exceeded pre-crisis levels by 2010 (52.9% prevalence). The population-wide increase in weight was immediately followed by a 116% increase in diabetes prevalence and 140% increase in diabetes incidence. Six years into the weight rebound phase, diabetes mortality increased by 49% (from 9.3 deaths per 10 000 people in 2002 to 13.9 deaths per 10 000 people in 2010). A deceleration in the rate of decline in mortality from coronary heart disease was also observed. In relation to the Cuban experience in 1980-2010, there is an association at the population level between weight reduction and death from diabetes and cardiovascular disease; the opposite effect on the diabetes and cardiovascular burden was seen on population-wide weight gain.

  1. Application of cardiovascular disease risk prediction models and the relevance of novel biomarkers to risk stratification in Asian Indians

    OpenAIRE

    S Kanjilal; Rao, VS; Mukherjee, M.; Natesha, BK; Renuka, KS; Sibi, K; Iyengar, SS; Kakkar, Vijay V

    2008-01-01

    The increasing pressure on health resources has led to the emergence of risk assessment as an essential tool in the management of cardiovascular disease (CVD). Concern exists regarding the validity of their generalization to all populations. Existing risk scoring models do not incorporate emerging ‘novel’ risk factors. In this context, the aim of the study was to examine the relevance of British, European, and Framingham predictive CVD risk scores to the asymptomatic high risk Indian populati...

  2. Sonographic Prediction of Body Fat Volume (Subcutaneous and Visceral Fat in Cardiovascular Patients

    Directory of Open Access Journals (Sweden)

    Maryam Soleymanzadeh

    2010-05-01

    Full Text Available Background: Inappropriate body composition represents impaired energy and nutrient intake and can be a risk factor for many diseases, especially for cardiovascular disease. Different methods have been suggested for the estimation of body fat volume and its distribution. However, they may be either expensive or hazardous for some groups of patients. Sonography is a very accessible technique, which may be used for the evaluation of visceral and subcutaneous fat volume. The purpose of this study was to evaluate the sonographic prediction of body fat and its distribution in subcutaneous and visceral compartments.Methods: During a three-month period, we conducted sonographic evaluations for visceral and subcutaneous fat in 106 patients who were admitted to our hospital. The subcutaneous fat was measured at the para-umbilical region and visceral fat was measured in the right para-renal space. The results were compared with the data obtained from the body mass index(BMI and bioelectric impedance analysis.Results: The mean age of the patients was 58.8 years, and the mean BMI was26.48 ± 0.33. The mean values of fat percent and fat mass obtained by the electric-method were 31.07 ± 0.81% and 22.12 ± 0.68 kg, respectively. The respective mean values of subcutaneous and visceral fat obtained by sonography were 20.50±0.56 mm and 24.14 ± 0.58 mm. The correlationbetween BMI and subcutaneous fat was 0.85 (p value < 0.0001 and the correlation between BMI and visceral fat was0.46(p value < 0.0001.Conclusion: Sonography is a reliable and available method for the estimation of body fat and its distribution in cardiovascularpatients, in subcutaneous and visceral compartments.

  3. Protocol for Evaluating the Cardio-Ankle Vascular Index to Predict Cardiovascular Events in Japan: A Prospective Multicenter Cohort Study

    Science.gov (United States)

    Miyoshi, Toru; Ito, Hiroshi; Horinaka, Shigeo; Shirai, Kohji; Higaki, Jitsuo; Orimio, Hajime

    2017-01-01

    Introduction The cardio-ankle vascular index (CAVI) was developed in Japan and is a blood pressure-independent index of arterial stiffness from the origin of the aorta to the ankle. In recent years, it has been studied by many researchers worldwide, and it is strongly anticipated that it will play a role as a predictive factor for arteriosclerotic diseases. The objective of this study was to examine the benefits of using CAVI as a predictor of cardiovascular events in high-risk patients. Methods and Design This prospective multicenter study to evaluate the usefulness of the CAVI to predict cardiovascular events in Japan (CAVI-J) is a cohort study with central registration. Participants (n = 3,000) will be scheduled to enroll and data will be collected for up to 5 years from entry of participants into the study. To be eligible to participate in the CAVI-J study, individuals have to be aged between 40 and 74 years and have at least one of the following risk factors for arteriosclerosis: (1) type 2 diabetes mellitus; (2) high-risk hypertension; (3) metabolic syndrome; (4) chronic kidney disease (stage 3), or (5) history of coronary artery disease or noncardiogenic cerebral infarction. The primary endpoints of this study are cardiovascular death, nonfatal myocardial infarction, and stroke. The secondary endpoints are composite cardiovascular events including all cause death, angina pectoris with revascularization, new incidence of peripheral artery disease, abdominal aortic aneurysm, aortic dissection, heart failure requiring hospitalization, and deterioration in renal function. The cutoff for CAVI against the incidence of cardiovascular events will be determined. PMID:28275590

  4. Aortic Arch Calcification Predicts Cardiovascular and All-Cause Mortality in Maintenance Hemodialysis Patients

    OpenAIRE

    Mizuki Komatsu; Masayuki Okazaki; Ken Tsuchiya; Hiroshi Kawaguchi; Kosaku Nitta

    2014-01-01

    Background/Aim: Vascular calcification is associated with cardiovascular risk in maintenance hemodialysis (MHD) patients. Previous reports have shown that simple assessment of aortic arch calcification (AoAC) using plain radiography is associated with cardiovascular mortality in the general population. We conducted a prospective study to investigate factors associated with the presence at baseline and progression of AoAC in MHD patients and examined its prognostic value in a short-term outcom...

  5. High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients

    Science.gov (United States)

    Xiong, Ruifang

    2017-01-01

    The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality.

  6. Reduction in trunk fat predicts cardiovascular exercise training-related reductions in C-reactive protein.

    Science.gov (United States)

    Vieira, V J; Hu, L; Valentine, R J; McAuley, E; Evans, E M; Baynard, T; Woods, J A

    2009-05-01

    C-reactive protein (CRP) is an independent risk factor for cardiovascular disease. We sought to determine (1) if 10 months of cardiovascular exercise training (Cardio) reduces CRP in a group of older adults, (2) if such a reduction is related to improvements in trunk fat, fitness, and/or psychosocial variables, and (3) if the effect of Cardio on CRP differs between men and women. Community-dwelling residents (n=127; 60-83 yrs) were randomized to a Flex group (n=61) where they participated in 2-75 min supervised sessions per wk during which they performed non-cardiovascular flexibility and balance exercises or a Cardio group (n=66) where they participated in three supervised sessions per wk during which they performed cardiovascular exercises for approximately 45-60 min at 60-70% maximal oxygen uptake. The main outcome measures were serum CRP, cardiovascular fitness, total and central adiposity, and self-reported psychosocial function. Cardio experienced a reduction in CRP (-0.5mg/L), as well as improvements in fitness (+7%) and total (-1.5%) and central (i.e., trunk) (-2.5%) adiposity. These relationships were not modified by sex. Regression analyses indicated that only the reduction in trunk fat was significantly related to the reduction in CRP. Ten months of cardiovascular exercise training reduced CRP in previously sedentary older adults and this effect was partially mediated by a reduction in trunk fat.

  7. Functional cardiovascular reserve predicts survival pre-kidney and post-kidney transplantation.

    Science.gov (United States)

    Ting, Stephen M S; Iqbal, Hasan; Kanji, Hemali; Hamborg, Thomas; Aldridge, Nicolas; Krishnan, Nithya; Imray, Chris H E; Banerjee, Prithwish; Bland, Rosemary; Higgins, Robert; Zehnder, Daniel

    2014-01-01

    Exercise intolerance is an important comorbidity in patients with CKD. Anaerobic threshold (AT) determines the upper limits of aerobic exercise and is a measure of cardiovascular reserve. This study investigated the prognostic capacity of AT on survival in patients with advanced CKD and the effect of kidney transplantation on survival in those with reduced cardiovascular reserve. Using cardiopulmonary exercise testing, cardiovascular reserve was evaluated in 240 patients who were waitlisted for kidney transplantation between 2008 and 2010, and patients were followed for ≤5 years. Survival time was the primary endpoint. Cumulative survival for the entire cohort was 72.6% (24 deaths), with cardiovascular events being the most common cause of death (54.2%). According to Kaplan-Meier estimates, patients with AT ratio, 4.48; 95% confidence interval, 1.78 to 11.38; P=0.002). Survival did not differ significantly among patients with AT ≥40%, with one death in the nontransplanted group and no deaths in the transplanted group. In summary, this is the first prospective study to demonstrate a significant association of AT, as the objective index of cardiovascular reserve, with survival in patients with advanced CKD. High-risk patients with reduced cardiovascular reserve had a better survival rate after receiving a kidney transplant.

  8. Cardiovascular risk prediction in the general population with use of suPAR, CRP, and Framingham Risk Score

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Marott, Jacob L; Sehestedt, Thomas

    2013-01-01

    BACKGROUND: The inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR) and C-reactive protein (CRP) independently predict cardiovascular disease (CVD). The prognostic implications of suPAR and CRP combined with Framingham Risk Score (FRS) have not been determined. METHODS...... for men (p=0.034) and borderline significant for women (p=0.054), while the integrated discrimination improvement was highly significant (P≤0.001) for both genders. CONCLUSIONS: suPAR provides prognostic information of CVD risk beyond FRS and improves risk prediction substantially when combined with CRP...

  9. Modelo predictivo de "score" de calcio alto en pacientes con factores de riesgo cardiovascular Predictive model of high calcium score in patients with cardiovascular risk factors

    Directory of Open Access Journals (Sweden)

    Gloria Franco

    2007-12-01

    prueba del score de calcio coronario a un paciente con factores de riesgo cardiovascular. Se puede observar que muchos de los factores de riesgo que se correlacionan con un valor elevado de "score" de calcio coronario pueden ser modificables: cesar el hábito de fumar o realizar ejercicio.Introduction: it has been found through multiple studies that coronary calcium score is a good predictor of coronary disease in asymptomatic individuals with one or more cardiovascular risk factors; therefore it would be ideal to perform this test in order to stratify its risk, but due to economic factors this is not possible in most cases. The model presented allows predicting the probability that a patient may have a high coronary calcium score by means of his cardiovascular risk factors. The originality of the model is that it also comprises "protector" factors that diminish such probability. Methods: study of cases and controls in asymptomatic patients with cardiovascular risk factors to whom a PCC had been performed. The cases are patients with coronary calcium score greater than percentile 75 for his age and gender; the control case relationship is 2:1. Results: ages ranged between 35 and 75 years; 14.4% were female; 44.4% had family history of CHD; 34.4% were hypertensive; 38.9% had high total cholesterol; 24.4% had HDL cholesterol under 40 mg/dl; 33.3% had LDL cholesterol greater than 160 mg/dl; 25.6% were cigarette smokers; 23.3% were sedentary; 13.3% were periodical alcohol consumers; 15.6% were obese (BMI > 30; 18.9% exercised periodically and 34.4% received statins. Cardiovascular risk factors correlated with high coronary calcium score are recorded in table 1. In the logistic regression model, factors having a p table 2 are obtained. Expression for the model would be: The values of ci values are 1, if the factor is present and 0 if it is not. Conclusions: this model does not pretend to replace stratification through Framinghan model; on the contrary, it is a complement that

  10. Predictive value of ovarian stroma measurement for cardiovascular risk in polycyctic ovary syndrome: a case control study

    Directory of Open Access Journals (Sweden)

    Loverro Giuseppe

    2010-11-01

    Full Text Available Abstract Background To verify the feasibility of ovarian stromal evaluation and correlate ovarian parameteres (echogenicity and volume with hyperandrogenism, and both cardiovascular and metabolic risk factors in PCOS. Methods Twenty four young PCOS patients and twelve age-matched control women were enrolled. Diagnosis of PCOS was based on the Rotterdam criteria. Ultrasound ovarian study included ovarian volume, stromal volume, stromal area and stromal area/total ovarian area ratio (S/A. Concerning hormones, insulin, LH, FSH, estradiol, androstenedione, testosterone, DHEAS, 17-hydroxy-progesterone, and SHBG were measured during the early follicular phase (days 2-5. Cardiovascular risk factors were represented by fasting plasma levels of glucose, lipids (total and HDL-cholesterol, plasminogen activator inhibitor 1 (PAI-1, von-Willebrand factor (vWF, and adiponectin. Carotid intima-media thickness (C-IMT was measured as a parameter of cardiovascular risk. Results A positive correlation between the S/A ratio and plasma levels of testosterone (p Conclusions This study shows that the ultrasound measurement of ovarian stroma is a predicting factor of hyperandrogenism degree, prothrombotic factors and cardiovascular risk in patients with PCOS.

  11. Body Fat Equations and Electrical Bioimpedance Values in Prediction of Cardiovascular Risk Factors in Eutrophic and Overweight Adolescents

    Directory of Open Access Journals (Sweden)

    Franciane Rocha Faria

    2013-01-01

    Full Text Available The aim of this study was to analyze body fat anthropometric equations and electrical bioimpedance analysis (BIA in the prediction of cardiovascular risk factors in eutrophic and overweight adolescents. 210 adolescents were divided into eutrophic group (G1 and overweight group (G2. The percentage of body fat (% BF was estimated using 10 body fat anthropometric equations and 2 BIA. We measured lipid profiles, uric acid, insulin, fasting glucose, homeostasis model assessment-insulin resistance (HOMA-IR, and blood pressure. We found that 76.7% of the adolescents exhibited inadequacy of at least one biochemical parameter or clinical cardiovascular risk. Higher values of triglycerides (TG (P=0.001, insulin, and HOMA-IR (P<0.001 were observed in the G2 adolescents. In multivariate linear regression analysis, the % BF from equation (5 was associated with TG, diastolic blood pressure, and insulin in G1. Among the G2 adolescents, the % BF estimated by (5 and (9 was associated with LDL, TG, insulin, and the HOMA-IR. Body fat anthropometric equations were associated with cardiovascular risk factors and should be used to assess the nutritional status of adolescents. In this study, equation (5 was associated with a higher number of cardiovascular risk factors independent of the nutritional status of adolescents.

  12. High-molecular-weight adiponectin does not predict cardiovascular events in patients with type 2 diabetes.

    Science.gov (United States)

    Krzyzanowska, Katarzyna; Aso, Yoshimasa; Mittermayer, Friedrich; Inukai, Toshihiko; Brix, Johanna; Schernthaner, Guntram

    2009-04-01

    Low circulating high-molecular-weight (HMW) adiponectin might be associated with increased cardiovascular risk. This study aimed to investigate the relationship between HMW adiponectin and cardiovascular events in patients with type 2 diabetes mellitus (T2DM) with an adverse cardiovascular risk profile. The investigation took place in a specialized outpatient clinic for metabolic diseases and included 147 patients with T2DM following a cross-sectional and a prospective study protocol. Ninety patients had macrovascular disease at baseline defined as preexisting coronary artery disease, previous stroke, or peripheral artery disease. HMW adiponectin measured by enzyme-linked immunosorbent assay (Fujirebio, Tokyo, Japan) and routine clinical parameters were determined in all patients at baseline. The occurrence of new cardiovascular events (myocardial infarction, stroke, and all-cause mortality) during the follow-up period was evaluated. No significant correlations between traditional cardiovascular risk markers and HMW adiponectin could be detected. HMW adiponectin did not differ between subjects with and without macrovascular disease at baseline (3.5 [interquartile range [IQR]: 2.2-5.7] mg/L vs 4.0 [IQR: 2.5-7.1] mg/L). During a follow-up of 19.3 (IQR: 16-25) months, 61 endpoints (41 myocardial infarctions, 10 strokes, and 10 deaths) were observed. A 1-standard-deviation increment of log-transformed HMW adiponectin was not significantly associated with the occurrence of cardiovascular events (Adjusted hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.58-1.54; P = 0.835). In conclusion, HMW adiponectin was not related to present macrovascular disease and is not associated with future cardiovascular events in high-risk patients with T2DM. It is unlikely that HMW adiponectin has significant vasoprotective effects in these patients.

  13. Usefulness of Left Ventricular Mass and Geometry for Determining 10-Year Prediction of Cardiovascular Disease in Adults Aged >65 Years (from the Cardiovascular Health Study).

    Science.gov (United States)

    Desai, Chintan S; Bartz, Traci M; Gottdiener, John S; Lloyd-Jones, Donald M; Gardin, Julius M

    2016-09-01

    Left ventricular (LV) mass and geometry are associated with risk of cardiovascular disease (CVD). We sought to determine whether LV mass and geometry contribute to risk prediction for CVD in adults aged ≥65 years of the Cardiovascular Health Study. We indexed LV mass to body size, denoted as LV mass index (echo-LVMI), and we defined LV geometry as normal, concentric remodeling, and eccentric or concentric LV hypertrophy. We added echo-LVMI and LV geometry to separate 10-year risk prediction models containing traditional risk factors and determined the net reclassification improvement (NRI) for incident coronary heart disease (CHD), CVD (CHD, heart failure [HF], and stroke), and HF alone. Over 10 years of follow-up in 2,577 participants (64% women, 15% black, mean age 72 years) for CHD and CVD, the adjusted hazards ratios for a 1-SD higher echo-LVMI were 1.25 (95% CI 1.14 to 1.37), 1.24 (1.15 to 1.33), and 1.51 (1.40 to 1.62), respectively. Addition of echo-LVMI to the standard model for CHD resulted in an event NRI of -0.011 (95% CI -0.037 to 0.028) and nonevent NRI of 0.034 (95% CI 0.008 to 0.076). Addition of echo-LVMI and LV geometry to the standard model for CVD resulted in an event NRI of 0.013 (95% CI -0.0335 to 0.0311) and a nonevent NRI of 0.043 (95% CI 0.011 to 0.09). The nonevent NRI was also significant with addition of echo-LVMI for HF risk prediction (0.10, 95% CI 0.057 to 0.16). In conclusion, in adults aged ≥65 years, echo-LVMI improved risk prediction for CHD, CVD, and HF, driven primarily by improved reclassification of nonevents.

  14. Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Groha Philip

    2009-07-01

    Full Text Available Abstract Objectives and Background Tissue factor (TF contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS. Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS. Methods and Results One-hundred seventy-four patients with unstable Angina pectoris (uAP and 112 patients with acute myocardial infarction (AMI were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF ≤ 24 pmol/L. Fifteen cardiovascular deaths occurred in the uAP group and 16 in the AMI group. In AMI TF activity was 24,9 ± 2,78 pmol/l (mean ± SEM in survivors and 40,9 ± 7,96 pmol/l in nonsurvivors (P = 0.024. In uAP no differences were observed (25.0 ± 8.04 pmol/L nonsurvivors vs. 25.7 ± 2.14 pmol/L survivors; P = 0.586. Kaplan-Meier estimates of survival at 3.26 years regarding TF activity in AMI were 81.3% and 92.2% with an hazard ratio of 3.02 (95% CI [1.05–8.79], P = 0.03. The Cox proportional hazards model adjusting for correlates of age and risk factors showed that plasma TF activity was an independent correlate of survival (hazard ratio 9.27, 95% CI [1.24–69.12], P = 0.03. In an additional group of patients with uAP and AMI, we identified circulating microparticles as the prevailing reservoir of plasma TF activity in acute coronary syndromes. Conclusion Systemic TF activity in AMI has an unfavorable prognostic value and as a marker for dysregulated coagulation may add to predict the atherothrombotic risk.

  15. Abdominal obesity in Japanese-Brazilians: which measure is best for predicting all-cause and cardiovascular mortality?

    Directory of Open Access Journals (Sweden)

    Marselle Rodrigues Bevilacqua

    Full Text Available This study aimed to verify which anthropometric measure of abdominal obesity was the best predictor of all-cause and cardiovascular mortality in Japanese-Brazilians. The study followed 1,581 subjects for 14 years. Socio-demographic, lifestyle, metabolic, and anthropometric data were collected. The dependent variable was vital status (alive or dead at the end of the study, and the independent variable was presence of abdominal obesity according to different baseline measures. The mortality rate was estimated, and Poisson regression was used to obtain mortality rate ratios with abdominal obesity, adjusted simultaneously for the other variables. The mortality rate was 10.68/thousand person-years. Male gender, age > 60 years, and arterial hypertension were independent risk factors for mortality. The results indicate that prevalence of abdominal obesity was high among Japanese-Brazilians, and that waist/hip ratio was the measure with the greatest capacity to predict mortality (especially cardiovascular mortality in this group.

  16. Depressive Symptom Clusters Differentially Predict Cardiovascular Hospitalization in People With Type 2 Diabetes

    DEFF Research Database (Denmark)

    Nefs, Giesje; Pop, Victor Jozef Marie; Denollet, Johan;

    2015-01-01

    BACKGROUND: Depression has been associated with the development of cardiovascular disease in people with type 2 diabetes. OBJECTIVE: We examined whether symptoms related to the 2 core features of depression--dysphoria and anhedonia--and anxiety were differentially associated with cardiovascular...... hospitalization and whether there were symptom-specific mechanisms (alcohol, smoking, physical activity, body mass index, glucose, cholesterol, and blood pressure) in play. METHOD: A total of 1465 people in Dutch primary care completed the Edinburgh Depression Scale in 2005 and were followed up until first...

  17. Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes.

    Science.gov (United States)

    Chae, David H; Lincoln, Karen D; Adler, Nancy E; Syme, S Leonard

    2010-09-01

    Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive

  18. Comparison of SCORE-predicted risk of death due to cardiovascular events in women before and after menopause

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    Anna Piskorz

    2015-09-01

    Full Text Available Introduction : Approximately 55% of women in Europe die from cardiovascular events, mostly as a result of coronary diseases and cerebral stroke. There is a 10-year shift in the cardiovascular risk between women and men. The risk in a 55-year-old female patient is similar to that of a 45-year-old man, thus the risk among women increases rapidly around the age of 50, when menopause prevails to occur. The purpose of the study was to assess and compare the SCORE-predicted risk of a fatal cardiovascular incident in pre- and postmenopausal women. Material and methods : The cross-sectional study was conducted as part of community nursing practice. It covered 219 women – inhabitants of Krakow, aged from 30 to 65, without clinically validated cardiovascular diseases of arteriosclerotic and/or diabetic origin, who volunteered to take part in the study. The group was divided into three subgroups: K1 – menstruating women (n = 113, K2a – women after natural menopause (n = 88, and K2b – women after surgical menopause (n = 18. The study made use of a lifestyle questionnaire, which concerned the social and economic status, and lifestyle habits including tobacco smoking. Arterial blood pressure was measured, and total cholesterol concentration in blood (mmol/l was recorded. Results : A high (≥ 5% level of the SCORE risk was discovered in 14.3% of postmenopausal women, as compared to 0.9% in the group of menstruating women. An average risk of a fatal cardiovascular incident during the following 10 years was significantly higher among women from groups K2a (2.61% and K2b (2.32% as compared to K1 – menstruating women (0.38%. No difference was, however, discovered between groups of naturally (K2a and surgically menopausal women (K2b. Conclusions : A significantly higher risk of SCORE-predicted death caused by a cardiovascular incident, as compared to the group of women in the premenopausal period, is characteristic of women in the postmenopausal period.

  19. Lifestyle in Cardiovascular Disease

    NARCIS (Netherlands)

    J.O. Younge (John)

    2015-01-01

    markdownabstract__Abstract__ Globally, the burden of cardiovascular disease (CVD) is still increasing. However, in recent decades, better treatment modalities have led to less cardiovascular related deaths. After years of research, we now generally accept that lifestyle factors are the most importa

  20. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital.

    Science.gov (United States)

    Jenks, P J; Laurent, M; McQuarry, S; Watkins, R

    2014-01-01

    Although surgical site infections (SSIs) are known to be associated with increased length of stay (LOS) and additional cost, their impact on the profitability of surgical procedures is unknown. To determine the clinical and economic burden of SSI over a two-year period and to predict the financial consequences of their elimination. SSI surveillance and Patient Level Information and Costing System (PLICS) datasets for patients who underwent major surgical procedures at Plymouth Hospitals NHS Trust between April 2010 and March 2012 were consolidated. The main outcome measures were the attributable postoperative length of stay (LOS), cost, and impact on the margin differential (profitability) of SSI. A secondary outcome was the predicted financial consequence of eliminating all SSIs. The median additional LOS attributable to SSI was 10 days [95% confidence interval (CI): 7-13 days] and a total of 4694 bed-days were lost over the two-year period. The median additional cost attributable to SSI was £5,239 (95% CI: 4,622-6,719) and the aggregate extra cost over the study period was £2,491,424. After calculating the opportunity cost of eliminating all SSIs that had occurred in the two-year period, the combined overall predicted financial benefit of doing so would have been only £694,007. For seven surgical categories, the hospital would have been financially worse off if it had successfully eliminated all SSIs. SSI causes significant clinical and economic burden. Nevertheless the current system of reimbursement provided a financial disincentive to their reduction. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  1. Does change in hip circumference predict cardiovascular disease and overall mortality in Danish and Swedish women?

    DEFF Research Database (Denmark)

    Lanfer, Anne; Mehlig, Kirsten; Heitmann, Berit L

    2014-01-01

    Accumulating evidence consistently shows that small hip circumference (HC) is related to increased risk of cardiovascular disease (CVD), coronary heart disease, diabetes, and premature death in women. This study aims to clarify whether this inverse association can be found in both normal...

  2. Baseline albuminuria predicts the efficacy of blood pressure-lowering drugs in preventing cardiovascular events

    NARCIS (Netherlands)

    Boersma, C.; Postma, M.J.; Visser, S.T.; Atthobari, J.; de Jong, P.E.; de Jong-van den Berg, L.T.; Gansevoort, R.T.

    2008-01-01

    AIMS Albuminuria has been proven to be associated with cardiovascular (CV) events in specific patient populations, but also in the general population. This study aimed to investigate whether the efficacy of blood pressure-lowering agents in preventing CV events depends on baseline urinary albumin ex

  3. LDL electronegativity index: a potential novel index for predicting cardiovascular disease

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    Ivanova EA

    2015-08-01

    Full Text Available Ekaterina A Ivanova,1 Yuri V Bobryshev,2,3 Alexander N Orekhov2,4,5 1Department of Pediatric Nephrology and Growth and Regeneration, Katholieke Universiteit Leuven and University Hospitals Leuven, Leuven, Belgium; 2Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, Moscow, Russia; 3Faculty of Medicine, School of Medical Sciences, University of New South Wales, Kensington, Sydney, NSW, Australia; 4Institute for Atherosclerosis Research, Skolkovo Innovative Center, Moscow, Russia; 5Department of Biophysics, Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia Abstract: High cardiovascular risk conditions are frequently associated with altered plasma lipoprotein profile, such as elevated low-density lipoprotein (LDL and LDL cholesterol and decreased high-density lipoprotein. There is, however, accumulating evidence that specific subclasses of LDL may play an important role in cardiovascular disease development, and their relative concentration can be regarded as a more relevant risk factor. LDL particles undergo multiple modifications in plasma that can lead to the increase of their negative charge. The resulting electronegative LDL [LDL(−] subfraction has been demonstrated to be especially atherogenic, and became a subject of numerous recent studies. In this review, we discuss the physicochemical properties of LDL(−, methods of its detection, atherogenic activity, and relevance of the LDL electronegativity index as a potential independent predictor of cardiovascular risk. Keywords: low-density lipoprotein, LDL, LDL electronegativity index, cardiovascular disease, atherosclerosis

  4. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population

    NARCIS (Netherlands)

    Hillege, HL; Fidler, [No Value; Diercks, GFH; van Gilst, WH; de Zeeuw, D; van Veldhuisen, DJ; Gans, ROB; Janssen, WMT; Grobbee, DE; de Jong, PE

    2002-01-01

    Background-For the general population, the clinical relevance of an increased urinary albumin excretion rate is still debated. Therefore, we examined the relationship between urinary albumin excretion and all-cause mortality and mortality caused by cardiovascular (CV) disease and non-CV disease in t

  5. Development of patient specific cardiovascular models predicting dynamics in response to orthostatic stress challenges

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2013-01-01

    Physiological realistic models of the controlled cardiovascular system are constructed and validated against clinical data. Special attention is paid to the control of blood pressure, cerebral blood flow velocity, and heart rate during postural challenges, including sit-to-stand and head-up tilt...

  6. Burden of Cardiovascular Disease among Multi-Racial and Ethnic Populations in the United States: An Update from the National Health Interview Surveys

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    Longjian eLiu

    2014-11-01

    Full Text Available Purpose: The study aimed to provide new evidence of health disparities in cardiovascular disease (CVD and diabetes mellitus (DM, and to examine their associations with lifestyle-related risk factors across the U.S. multi-racial and ethnic groups. Methods: The analysis included a randomized population sample of 68,321 subjects aged ≥18 years old who participated in the U.S. 2012 and 2013 National Health Interview Surveys. Hypertension, coronary heart disease (CHD, stroke and DM were classified according to participants’ self-report of physician diagnosis. Assessments of risk factors were measured using standard survey instruments. Associations of risk factors with hypertension, CHD, stroke and DM were analyzed using univariable and multivariable analysis methods. Results: Non-Hispanic (NH-Blacks had significantly higher odds of hypertension, stroke and DM, while NH-Asians and Hispanics had significantly lower odds of stroke and higher odds of stroke and higher odds of DM than NH-Whites (p<0.001. NH-Whites had higher odds of CHD than NH-Black, NH-Asians and Hispanics (p<0.001. Increased body weight, cigarette smoking and physical inactivity were significantly associated with increased odds of hypertension, CHD, stroke and DM (p<0.001. However, the strengths of associations between lifestyle-related factors and the study outcomes were different across racial and ethnic groups. NH-Asians with BMI ≥30 kg/m2 had the highest odds ratios (OR, 95%CI for hypertension (5.37, 4.01-7.18, CHD (2.93, 1.90-4.52 and stroke (2.23, 1.08-4.61, and had the second highest odd ratios for DM (3.78, 2.68-5.35 than NH-Whites, NH-Blacks and Hispanics. Conclusion: CVD and DM disproportionately affect the U.S. multi-racial and ethnic population. Although lifestyle-related risk factors are significantly associated with increased odds of CVD and DM, the impacts of risk factors on the study outcomes are different by race and ethnicity.

  7. Arsenic Exposure and Predicted 10-Year Atherosclerotic Cardiovascular Risk Using the Pooled Cohort Equations in U.S. Hypertensive Adults.

    Science.gov (United States)

    Nong, Qingjiao; Zhang, Yiyi; Guallar, Eliseo; Zhong, Qiuan

    2016-11-07

    This study was to evaluate the association of urine arsenic with predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in U.S. adults with hypertension. Cross-sectional analysis was conducted in 1570 hypertensive adults aged 40-79 years in the 2003-2012 National Health and Nutrition Examination Survey (NHANES) with determinations of urine arsenic. Predicted 10-year ASCVD risk was estimated by the Pooled Cohort Equations, developed by the American College of Cardiology/American Heart Association in 2013. For men, after adjustment for sociodemographic factors, urine dilution, ASCVD risk factors and organic arsenic intake from seafood, participants in the highest quartiles of urine arsenic had higher 10-year predicted ASCVD risk than in the lowest quartiles; the increases were 24% (95% confidence interval (CI): 2%, 53%) for total arsenic, 13% (95% CI: 2%, 25%) for dimethylarsinate and 22% (95% CI: 5%, 40%) for total arsenic minus arsenobetaine separately. For women, the corresponding increases were 5% (95% CI: -15%, 29%), 10% (95% CI: -8%, 30%) and 0% (95% CI: -15%, 19%), respectively. Arsenic exposure, even at low levels, may contribute to increased ASCVD risk in men with hypertension. Furthermore, our findings suggest that particular circumstances need urgently to be considered while elucidating cardiovascular effects of low inorganic arsenic levels.

  8. Predictable And SuStainable Implementation Of National Cardiovascular Registries Infrastructure: A Think Tank Report from MDEpiNet

    Science.gov (United States)

    Zeitler, Emily P.; Al-Khatib, Sana M.; Drozda, Joseph P.; Kessler, Larry G.; Kirtane, Ajay J.; Kong, David F.; Laschinger, John; Marinac-Dabic, Danica; Morice, Marie-Claude; Reed, Terrie; Sedrakyan, Art; Stein, Kenneth M.; Tcheng, James; Krucoff, Mitchell W.

    2015-01-01

    The Medical Device Epidemiological Network Initiative (MDEpiNet) is a public-private partnership between the US Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) and participating partners. The Predictable and SuStainable Implementation of National Cardiovascular Registries (PASSION) program is an MDEpiNet-sponsored program which aims to demonstrate the goals of MDEpiNet by using cardiovascular medical device registries to bridge evidence gaps across the medical device total product life cycle (TPLC). To this end, a PASSION Think Tank meeting took place in October 2014 in Silver Spring, MD, to facilitate discussion between stakeholders about the successes, challenges, and future novel applications of medical device registries, with particular emphasis on identifying pilot projects. Participants spanned a broad range of groups including patients, device manufacturers, regulators, physicians/academicians, professional societies, providers, and payers. The meeting focus included four areas of cardiovascular medicine intended to cultivate interest in four MDEpiNet Disease Specific/Device Specific Working Groups: coronary intervention, electrophysiology, valvular disease, and peripheral vascular disease. In addition, more general issues applying to registry-based infrastructure and analytical methodologies for assessing device benefit/risk were considered to provide context for the Working Groups as PASSION programs going forward. This article summarizes the discussions at the meeting and the future directions of the PASSION program. PMID:26699602

  9. Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women

    DEFF Research Database (Denmark)

    Klingberg, Sofia; Mehlig, Kirsten; Lanfer, Anne

    2015-01-01

    and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample. METHODS: Baseline WC and 6-year change in WC as predictors of mortality and CVD......OBJECTIVE: Despite solid evidence of an association between centralized body fatness and subsequent disease risk, little is known about the consequences of changes in body fat distribution. Recently it was shown that large hip circumference (HC), measured once, was protective against total...

  10. Comparison between European and Iranian cutoff points of triglyceride/high-density lipoprotein cholesterol concentrations in predicting cardiovascular disease outcomes.

    Science.gov (United States)

    Gharipour, Mojgan; Sadeghi, Masoumeh; Dianatkhah, Minoo; Nezafati, Pouya; Talaie, Mohammad; Oveisgharan, Shahram; Golshahi, Jafar

    2016-01-01

    High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors. The exact prognostic value of the TG/HDL-C ratio, a marker for cardiovascular events, is currently unknown among Iranians so this study sought to determine the optimal cutoff point for the TG/HDL-C ratio in predicting cardiovascular disease events in the Iranian population. The Isfahan Cohort Study (ICS) is an ongoing, longitudinal, population-based study that was originally conducted on adults aged ≥ 35 years, living in urban and rural areas of three districts in central Iran. After 10 years of follow-up, 5431 participants were re-evaluated using a standard protocol similar to the one used for baseline. At both measurements, participants underwent medical interviews, physical examinations, and fasting blood measurements. "High-risk" subjects were defined by the discrimination power of indices, which were assessed using receiver operating characteristic (ROC) analysis; the optimal cutoff point value for each index was then derived. The mean age of the participants was 50.7 ± 11.6 years. The TG/HDL-C ratio, at a threshold of 3.68, was used to screen for cardiovascular events among the study population. Subjects were divided into two groups ("low" and "high" risk) according to the TG/HDL-C concentration ratio at baseline. A slightly higher number of high-risk individuals were identified using the European cutoff points of 63.7% in comparison with the ICS cutoff points of 49.5%. The unadjusted hazard ratio (HR) was greatest in high-risk individuals identified by the ICS cutoff points (HR = 1.54, 95% CI [1.33-1.79]) vs European cutoff points (HR = 1.38, 95% [1.17-1.63]). There were no remarkable changes after adjusting for differences in sex and age (HR = 1.58, 95% CI [1.36-1.84] vs HR = 1.44, 95% CI [1.22-1.71]) for the ICS and European cutoff points, respectively. The threshold of TG/HDL ≥ 3.68 is the optimal cutoff point for predicting

  11. Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease

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    Luciana Carvalho Martins

    2016-04-01

    Full Text Available Abstract Background: Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy. Objective: To determine the risk factors associated with cardiovascular and neonatal complications. Methods: We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG, was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories. Results: Rheumatic heart disease was the most prevalent (62.12%. The most frequent complications were heart failure (11.36% and arrhythmias (6.82%. Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009, previous cardiac complications (p = 0.013 and NYHA class III on the first prenatal visit (p = 0.041. The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity. Conclusion: The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated

  12. Insulin resistance predicts early cardiovascular morbidity in men without diabetes mellitus, with effect modification by physical activity.

    Science.gov (United States)

    Hellgren, Margareta I; Daka, Bledar; Jansson, Per-Anders; Lindblad, Ulf; Larsson, Charlotte A

    2015-07-01

    to assess how well insulin resistance predicts cardiovascular disease (CVD) in non-diabetic men and women and to explore the influence of physical activity. in this prospective study 2563 men and women without diabetes were examined with an oral glucose tolerance test, anthropometric measurements and blood pressure assessment. Questionnaires about lifestyle and physical activity were completed. Insulin resistance was estimated by fasting concentrations of plasma insulin and by HOMA index for insulin resistance. Participants were followed up for cardiovascular morbidity and mortality during an 8-year period, using information from the National Swedish Inpatient and Mortality registers. at follow-up, HOMAir predicted CVD morbidity in males (50 events) and females (28 events) combined (HRage/sex-adj 1.4, 95% CI 1.1-1.7); however, when stratified by gender HOMAir was predictive solely in men (HRage-adj 1.8, 95% CI 1.3-2.4), whereas no association was found in women (HRage-adj 1.1, 95% CI 0.8-1.5). When stratifying the data for high and low physical activity, the predictive value of insulin resistance became stronger in sedentary men (HRage-adj 2.3, 95% CI 1.5-3.4) but was abolished in men performing moderate to vigorous physical activity (HRage-adj 1.0, 95% CI 0.6-1.6). The results remained when step-wise adjusted also for BMI, ApoB/ApoA1 and hypertension, as well as for smoking, alcohol consumption and education. Outcome for fasting plasma insulin was similar to HOMAir. insulin resistance predicts CVD in the general population; however, men may be more vulnerable to increased insulin resistance than women, and physically inactive men seem to be at high risk. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Relevance of uric acid and asymmetric dimethylarginine for modeling cardiovascular risk prediction in chronic kidney disease patients.

    Science.gov (United States)

    Kanbay, Mehmet; Afsar, Baris; Siriopol, Dimitrie; Unal, Hilmi Umut; Karaman, Murat; Saglam, Mutlu; Eyileten, Tayfun; Gezer, Mustafa; Verim, Samet; Oguz, Yusuf; Vural, Abdulgaffar; Ortiz, Alberto; Johnson, Richard J; Covic, Adrian; Yilmaz, Mahmut Ilker

    2016-07-01

    Both elevated serum uric acid and serum asymmetric dimethylarginine (ADMA) are risk factors for cardiovascular disease. We hypothesized that combined elevation of uric acid and ADMA amplifies the risk of all-cause mortality and/or cardiovascular events (CVE) in patients with chronic kidney disease (CKD). A total of 259 patients with CKD stages 1-5 were followed up in a time-to-event analysis for all-cause mortality and fatal and non-fatal CVE (including death, stroke, and myocardial infarction). Baseline measurements included serum uric acid and ADMA and endothelial function [ultrasound determined flow-mediated dilatation (FMD)]. As a measure of endothelial function, log FMD value was positively associated with log eGFR, but negatively associated with log ADMA and log uric acid levels. During follow-up (median 38 months), 24 (9.3 %) deaths, 90 (34.7 %) CVE, and 95 (36.7 %) deaths and CVE (composite outcome) occurred. In the univariate Cox analysis, patients with both serum uric acid and ADMA levels above the median had an increased risk of all-cause mortality, CVE, and the composite outcome (HR 5.06, 95 % CI 2.01-12.76; HR 4.75, 95 % CI 2.98-7.59; and HR 4.13, 95 % CI 2.66-6.43, respectively). However, after adjustment for renal-specific risk factors (glomerular filtration rate, proteinuria, and hsCRP), this association was maintained only for CVE and the composite outcome. The addition of both biomarkers into a model with traditional and renal-specific risk factors did not increase the prediction abilities of the model for none of the three outcomes. Elevated serum uric acid and ADMA levels are associated with an increased cardiovascular risk, but their combination does not improve risk prediction. The effects are not additive, possibly because uric acid may lie in the causal pathway by which ADMA acts.

  14. Flow cytometry-based platelet function testing is predictive of symptom burden in a cohort of bleeders.

    Science.gov (United States)

    Boknäs, Niklas; Ramström, Sofia; Faxälv, Lars; Lindahl, Tomas L

    2017-09-12

    Platelet function disorders (PFDs) are common in patients with mild bleeding disorders (MBDs), yet the significance of laboratory findings suggestive of a PFD remain unclear due to the lack of evidence for a clinical correlation between the test results and the patient phenotype. Herein, we present the results from a study evaluating the potential utility of platelet function testing using whole-blood flow cytometry in a cohort of 105 patients undergoing investigation for MBD. Subjects were evaluated with a test panel comprising two different activation markers (fibrinogen binding and P-selectin exposure) and four physiologically relevant platelet agonists (ADP, PAR1-AP, PAR4-AP, and CRP-XL). Abnormal test results were identified by comparison with reference ranges constructed from 24 healthy controls or with the fifth percentile of the entire patient cohort. We found that the abnormal test results are predictive of bleeding symptom severity, and that the greatest predictive strength was achieved using a subset of the panel, comparing measurements of fibrinogen binding after activation with all four agonists with the fifth percentile of the patient cohort (p = 0.00008, hazard ratio 8.7; 95% CI 2.5-40). Our results suggest that whole-blood flow cytometry-based platelet function testing could become a feasible alternative for the investigation of MBDs. We also show that platelet function testing using whole-blood flow cytometry could provide a clinically relevant quantitative assessment of platelet-related hemostasis.

  15. Waist Circumference, Body Mass Index, and Other Measures of Adiposity in Predicting Cardiovascular Disease Risk Factors among Peruvian Adults

    Directory of Open Access Journals (Sweden)

    K. M. Knowles

    2011-01-01

    Full Text Available Objectives. To examine the extent to which measures of adiposity can be used to predict selected components of metabolic syndrome (MetS and elevated C-reactive protein (CRP. Methods. A total of 1,518 Peruvian adults were included in this study. Waist circumference (WC, body mass index (BMI, waist-hip ratio (WHR, waist-height ratio (WHtR, and visceral adiposity index (VAI were examined. The prevalence of each MetS component was determined according to tertiles of each anthropometric measure. ROC curves were used to evaluate the extent to which measures of adiposity can predict cardiovascular risk. Results. All measures of adiposity had the strongest correlation with triglyceride concentrations (TG. For both genders, as adiposity increased, the prevalence of Mets components increased. Compared to individuals with low-BMI and low-WC, men and women with high-BMI and high- WC had higher odds of elevated fasting glucose, blood pressure, TG, and reduced HDL, while only men in this category had higher odds of elevated CRP. Overall, the ROCs showed VAI, WC, and WHtR to be the best predictors for individual MetS components. Conclusions. The results of our study showed that measures of adiposity are correlated with cardiovascular risk although no single adiposity measure was identified as the best predictor for MetS.

  16. Music therapy-induced changes in salivary cortisol level are predictive of cardiovascular mortality in patients under maintenance hemodialysis

    Science.gov (United States)

    Hou, Yi-Chou; Lin, Yen-Ju; Lu, Kuo-Cheng; Chiang, Han-Sun; Chang, Chia-Chi; Yang, Li-King

    2017-01-01

    Background Music therapy has been applied in hemodialysis (HD) patients for relieving mental stress. Whether the stress-relieving effect by music therapy is predictive of clinical outcome in HD patients is still unclear. Methods We recruited a convenience sample of 99 patients on maintenance HD and randomly assigned them to the experimental (n=49) or control (n=50) group. The experimental group received relaxing music therapy for 1 week, whereas the control group received no music therapy. In the experimental group, we compared cardiovascular mortality in the patients with and without cortisol changes. Results The salivary cortisol level was lowered after 1 week of music therapy in the experimental group (−2.41±3.08 vs 1.66±2.11 pg/mL, P0.6 pg/mL (83.8% vs 63.6%, Pmusic during HD is an effective complementary therapy to relieve the frequency and severity of adverse reactions, as well as to lower salivary cortisol levels. Differences in salivary cortisol after music therapy may predict cardiovascular mortality in patients under maintenance HD. PMID:28260913

  17. An Update on the Utility of Coronary Artery Calcium Scoring for Coronary Heart Disease and Cardiovascular Disease Risk Prediction.

    Science.gov (United States)

    Kianoush, Sina; Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Umapathi, Priya; Graham, Garth; Blumenthal, Roger S; Nasir, Khurram; Blaha, Michael J

    2016-03-01

    Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction.

  18. Aortic Arch Calcification Predicts Cardiovascular and All-Cause Mortality in Maintenance Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mizuki Komatsu

    2014-12-01

    Full Text Available Background/Aim: Vascular calcification is associated with cardiovascular risk in maintenance hemodialysis (MHD patients. Previous reports have shown that simple assessment of aortic arch calcification (AoAC using plain radiography is associated with cardiovascular mortality in the general population. We conducted a prospective study to investigate factors associated with the presence at baseline and progression of AoAC in MHD patients and examined its prognostic value in a short-term outcome. Methods: We prospectively evaluated chest X-rays in 301 asymptomatic MHD patients. The extent of AoAC was divided into three Grades (0, 1, 2+3. Demographic data including age, gender, dialysis vintage, co-morbidity and biochemical data were assessed and the patients were then followed for 3 years. Results: AoAC was observed in 126 patients (41.9% as Grade 0, in 112 patients (37.2% as Grade 1, and in 63 patients (20.9% as Grade 2 and 3 at baseline. An increase in the severity of calcification was associated with older male patients who had lower serum albumin levels. During the follow-up period of 3 years, multivariate Cox proportional hazards analysis revealed that high-grade calcification was associated with cardiovascular and all-cause mortality. Patients with AoAC were associated with a worse outcome in survival analysis and the grade of AAC also influenced their survival. Moreover, all-cause death rates were significantly higher in the progression groups than in the non-progression groups. Conclusions: The presence and progression of AoAC assessed by chest X-ray were independently associated with mortality in MHD patients. Regular follow-up by chest X-ray could be a simple and useful method to stratify mortality risk in MHD patients.

  19. History of preeclampsia is more predictive of cardiometabolic and cardiovascular risk factors than obesity.

    Science.gov (United States)

    Heidema, Wieteke M; Scholten, Ralph R; Lotgering, Fred K; Spaanderman, Marc E A

    2015-11-01

    To determine to what extent a history of preeclampsia affects traditional cardiometabolic (insulin resistance and dyslipidemia) and cardiovascular (hypertension and micro-albuminuria) risk factors of the metabolic syndrome irrespective of BMI. In a retrospective case-control study we compared 90 formerly preeclamptic women, divided in 3 BMI-classes (BMI 19.5-24.9, 25.0-29.9, ≥30.0kg/m(2)) to 30 controls, matched for BMI, age and parity. Cardiometabolic and cardiovascular risk factors (WHO-criteria) were tested 6-18 months post partum. Statistical analysis included unpaired t-tests, Mann-Whitney U test, or Chi square test and two-way ANOVA. Constituents of the metabolic syndrome (glucose, insulin, HOMAIR, HDL-cholesterol, triglycerides, blood pressure, micro-albuminuria) were higher in formerly preeclamptic women than in BMI-matched controls. Resultantly, traditional risk factors were more prevalent in formerly preeclamptic women than in controls (insulin resistance 80% vs 30%, dyslipidemia 52% vs 3%, hypertension 24% vs 0%, micro-albuminuria 30% vs 0%). Cardiometabolic risk factors increased with BMI, to the same extent in both groups. Formerly preeclamptic women had metabolic syndrome more often than their BMI-matched controls (38% vs 3%, prisk factors of the metabolic syndrome are more prevalent in formerly preeclamptic women than in BMI-matched controls and increase with BMI to the same extent in both groups. A history of preeclampsia seems to be a stronger indicator of cardiovascular risk than obesity per se. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Exome mutation burden predicts clinical outcome in ovarian cancer carrying mutated BRCA1 and BRCA2 genes

    DEFF Research Database (Denmark)

    Birkbak, Nicolai Juul; Kochupurakkal, Bose; Gonzalez-Izarzugaza, Jose Maria;

    2013-01-01

    Reliable biomarkers predicting resistance or sensitivity to anti-cancer therapy are critical for oncologists to select proper therapeutic drugs in individual cancer patients. Ovarian and breast cancer patients carrying germline mutations in BRCA1 or BRCA2 genes are often sensitive to DNA damaging...... drugs and relative to non-mutation carriers present a favorable clinical outcome following therapy. Genome sequencing studies have shown a high number of mutations in the tumor genome in patients carrying BRCA1 or BRCA2 mutations (mBRCA). The present study used exome-sequencing and SNP 6 array data...... had either germlines or somatic mutations of BRCA1 or BRCA2 genes. The results revealed that the Nmut was significantly lower in the chemotherapy-resistant mBRCA HGSOC defined by progression within 6 months after completion of first line platinum-based chemotherapy. We found a significant association...

  1. Valvular calcifications at the start of dialysis predict the onset of cardiovascular events in the course of follow-up.

    Science.gov (United States)

    Sánchez-Perales, Carmen; Vázquez Ruiz de Castroviejo, Eduardo; García-Cortés, Ma José; Biechy, Ma del Mar; Gil-Cunquero, Jose Manuel; Borrego-Hinojosa, Josefa; del Barrio, Pilar Pérez; Borrego-Utiel, Francisco; Liébana, Antonio

    2015-01-01

    To analyse the presence of VC at the start of dialysis and its relationship with events and/or death from cardiovascular causes in the course of follow-up. In the study, we included patients who started dialysis between November 2003 and September 2007. In the first month of treatment, we assessed the presence of VC by Doppler echocardiography, along with demographic factors and risk factors for cardiovascular disease, coronary artery disease, stroke, atrial fibrillation (AF), and cardiac dimensional and functional electrocardiographic and echocardiographic parameters. The biochemistry values assessed were: haemoglobin, calcium/phosphorous/iPTH metabolism, cholesterol and fractions, triglycerides, troponin I, albumin, CRP and glycosylated haemoglobin. We analysed the association between VC and the presence of myocardial infarction (MI), stroke and/or death from cardiovascular causes up to transplantation, death or the end of the study (December 2012). Of 256 enrolled patients (83% haemodialysis, 17% peritoneal dialysis), 128 (50%) had VC (mitral: 39, aortic: 20, both: 69). In the multivariate analysis, VC was associated with older age (OR: 1.110; 95% CI: 1.073-1.148; p = 0.000) and lower albumin levels (OR: 0.29; 95% CI: 0.14-0.61; p = 0.001). In a follow-up lasting 42.1 ± 30.2 months (898.1 patient-years), 68 patients suffered MI, stroke and/or died from cardiovascular causes. In the Cox regression analysis, older age (HR: 1.028; 95% CI: 1.002-1.055; p = 0.037), coronary artery disease and/or stroke (HR: 1.979; 95% CI: 1.111-3.527; p = 0.021), AF (HR: 2.474; 95% CI: 1.331-4.602; p = 0.004), and the presence of VC at the start of dialysis (HR: 1.996; 95% CI: 1.077-3.700; p = 0.028) were the predictor variables for the occurrence of the analysed events. The prevalence of VC at the start of dialysis is high and its presence predicts the occurrence of events and/or cardiovascular death in the course of follow-up. Copyright © 2015. Published by Elsevier España, S.L.U.

  2. Waist circumference cut-off values for the prediction of cardiovascular risk factors clustering in Chinese school-aged children: a cross-sectional study

    OpenAIRE

    Xu Ying; Du Lin; Li Yanping; Hu Xiaoqi; Hills Andrew P; Liu Ailing; Byrne Nuala M; Ma Guansheng

    2010-01-01

    Abstract Background Waist circumference has been identified as a valuable predictor of cardiovascular risk in children. The development of waist circumference percentiles and cut-offs for various ethnic groups are necessary because of differences in body composition. The purpose of this study was to develop waist circumference percentiles for Chinese children and to explore optimal waist circumference cut-off values for predicting cardiovascular risk factors clustering in this population. Met...

  3. Prediction of PSA Progression in Castration-Resistant Prostate Cancer Based on Treatment-Associated Change in Tumor Burden Quantified by 18F-Fluorocholine PET/CT.

    Science.gov (United States)

    Lee, Joohee; Sato, Miles M; Coel, Marc N; Lee, Kyung-Han; Kwee, Sandi A

    2016-07-01

    Measurements of metabolically active tumor volume (MATV) can be applied to (18)F-fluorocholine PET/CT to quantify whole-body tumor burden. This study evaluated the serial application of these measurements as systemic treatment response markers and predictors of disease progression in patients with castration-resistant prostate cancer (CRPC). Forty-two patients completed sequential (18)F-fluorocholine PET/CT scans before and 1-3 mo after starting treatment for CRPC. Whole-body tumor segmentation was applied to determine net MATV from each scan. Changes in net MATV were evaluated as predictors of time to prostate-specific antigen (PSA) progression by Kaplan-Meier and proportional hazards regression analysis. Treatments consisted of chemotherapy in 16 patients, antiandrogens in 19 patients, (223)Ra-dichloride in 5 patients, and sipuleucel-T in 2 patients. A significant MATV response (defined as a ≥30% decrease in net MATV) was observed in 20 patients on the basis of in-treatment PET/CT performed an average of 51 d (median, 49 d) into treatment. Significantly longer times to PSA progression were observed in patients who exhibited an MATV response (418 d vs. 116 d, P = 0.0067). MATV response was associated with a hazard ratio of 0.246 (P = 0.0113) for PSA progression, which remained significant when adjusted for treatment type. Significant changes in whole-body tumor burden can be measured on (18)F-fluorocholine PET/CT over the course of contemporary treatments for CRPC. In this study, these changes were found to be predictive of PSA progression as a potential surrogate marker of treatment outcome. Because (18)F-fluorocholine PET/CT can also be used for localizing resistant tumors, this modality can potentially complement other measures of response in the precision management of advanced prostate cancer. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  4. CHADS2 Scores in the Prediction of Major Adverse Cardiovascular Events in Patients with Cushing's Syndrome

    Science.gov (United States)

    Chuang, Mei-Hua; Chuang, Tzyy-Ling; Huang, Kung-Yung; Lyu, Shaw-Ruey; Huang, Chih-Yuan; Lee, Ching-Chih

    2014-01-01

    Vascular events are one of the major causes of death in case of Cushing's syndrome (CS). However, due to the relative low frequency of CS, it is hard to perform a risk assessment for these events. As represented congestive heart failure (C), hypertension (H), age (A), diabetes (D), and stroke (S), the CHADS2 score is now accepted to classify the risk of major adverse cardiovascular events (MACEs) in patients with atrial fibrillation. In this study, participants were enrolled from the National Health Research Institute Database (NHIRD) of Taiwan, and we reviewed 551 patients with their sequential clinically diagnosed CS data between 2002 and 2009 in relation to MACEs risk using CHADS2 score. Good correlation could be identified between the CS and CHADS2 score (AUC = 0.795). Our results show that patients with CS show significantly higher risk of vascular events and the CHADS2 score could be applied for MACEs evaluation. Adequate lifestyle modifications and aggressive cardiovascular risks treatment are suggested for CS patients with higher CHADS2 score. PMID:25101124

  5. Growth hormone action predicts age-related white adipose tissue dysfunction and senescent cell burden in mice.

    Science.gov (United States)

    Stout, Michael B; Tchkonia, Tamara; Pirtskhalava, Tamar; Palmer, Allyson K; List, Edward O; Berryman, Darlene E; Lubbers, Ellen R; Escande, Carlos; Spong, Adam; Masternak, Michal M; Oberg, Ann L; LeBrasseur, Nathan K; Miller, Richard A; Kopchick, John J; Bartke, Andrzej; Kirkland, James L

    2014-07-01

    The aging process is associated with the development of several chronic diseases. White adipose tissue (WAT) may play a central role in age-related disease onset and progression due to declines in adipogenesis with advancing age. Recent reports indicate that the accumulation of senescent progenitor cells may be involved in age-related WAT dysfunction. Growth hormone (GH) action has profound effects on adiposity and metabolism and is known to influence lifespan. In the present study we tested the hypothesis that GH activity would predict age-related WAT dysfunction and accumulation of senescent cells. We found that long-lived GH-deficient and -resistant mice have reduced age-related lipid redistribution. Primary preadipocytes from GH-resistant mice also were found to have greater differentiation capacity at 20 months of age when compared to controls. GH activity was also found to be positively associated with senescent cell accumulation in WAT. Our results demonstrate an association between GH activity, age-related WAT dysfunction, and WAT senescent cell accumulation in mice. Further studies are needed to determine if GH is directly inducing cellular senescence in WAT or if GH actions on other target organs or alternative downstream alterations in insulin-like growth factor-1, insulin or glucose levels are responsible.

  6. Growth hormone action predicts age-related white adipose tissue dysfunction and senescent cell burden in mice

    Science.gov (United States)

    Pirtskhalava, Tamar; Palmer, Allyson K.; List, Edward O.; Berryman, Darlene E.; Lubbers, Ellen R.; Escande, Carlos; Spong, Adam; Masternak, Michal M.; Oberg, Ann L.; LeBrasseur, Nathan K.; Miller, Richard A.; Kopchick, John J.; Bartke, Andrzej; Kirkland, James L.

    2014-01-01

    The aging process is associated with the development of several chronic diseases. White adipose tissue (WAT) may play a central role in age-related disease onset and progression due to declines in adipogenesis with advancing age. Recent reports indicate that the accumulation of senescent progenitor cells may be involved in age-related WAT dysfunction. Growth hormone (GH) action has profound effects on adiposity and metabolism and is known to influence lifespan. In the present study we tested the hypothesis that GH activity would predict age-related WAT dysfunction and accumulation of senescent cells. We found that long-lived GH-deficient and -resistant mice have reduced age-related lipid redistribution. Primary preadipocytes from GH-resistant mice also were found to have greater differentiation capacity at 20 months of age when compared to controls. GH activity was also found to be positively associated with senescent cell accumulation in WAT. Our results demonstrate an association between GH activity, age-related WAT dysfunction, and WAT senescent cell accumulation in mice. Further studies are needed to determine if GH is directly inducing cellular senescence in WAT or if GH actions on other target organs or alternative downstream alterations in insulin-like growth factor-1, insulin or glucose levels are responsible. PMID:25063774

  7. A risk score to predict type 2 diabetes mellitus in an elderly Spanish Mediterranean population at high cardiovascular risk.

    Directory of Open Access Journals (Sweden)

    Marta Guasch-Ferré

    Full Text Available INTRODUCTION: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. MATERIALS AND METHODS: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample. Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample. The discrimination of Finnish Diabetes Risk Score (FINDRISC, German Diabetes Risk Score (GDRS and our scores was assessed with the area under curve (AUC. RESULTS: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%, and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. DISCUSSION: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

  8. A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

    Science.gov (United States)

    Guasch-Ferré, Marta; Bulló, Mònica; Costa, Bernardo; Martínez-Gonzalez, Miguel Ángel; Ibarrola-Jurado, Núria; Estruch, Ramon; Barrio, Francisco; Salas-Salvadó, Jordi

    2012-01-01

    Introduction To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Materials and Methods A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). Results The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. Discussion We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire. PMID:22442692

  9. Factor XIa and Thrombin Generation Are Elevated in Patients with Acute Coronary Syndrome and Predict Recurrent Cardiovascular Events.

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    Rinske Loeffen

    Full Text Available In acute coronary syndrome (ACS cardiac cell damage is preceded by thrombosis. Therefore, plasma coagulation markers may have additional diagnostic relevance in ACS. By using novel coagulation assays this study aims to gain more insight into the relationship between the coagulation system and ACS.We measured plasma thrombin generation, factor XIa and D-dimer levels in plasma from ACS (n = 104 and non-ACS patients (n = 42. Follow-up measurements (n = 73 were performed at 1 and 6 months. Associations between coagulation markers and recurrent cardiovascular events were calculated by logistic regression analysis.Thrombin generation was significantly enhanced in ACS compared to non-ACS patients: peak height 148±53 vs. 122±42 nM. There was a significantly diminished ETP reduction (32 vs. 41% and increased intrinsic coagulation activation (25 vs. 7% in ACS compared to non-ACS patients. Furthermore, compared to non-ACS patients factor XIa and D-dimer levels were significantly elevated in ACS patients: 1.9±1.1 vs. 1.4±0.7 pM and 495(310-885 vs. 380(235-540 μg/L. Within the ACS spectrum, ST-elevated myocardial infarction patients had the highest prothrombotic profile. During the acute event, thrombin generation was significantly increased compared to 1 and 6 months afterwards: peak height 145±52 vs. 100±44 vs. 98±33 nM. Both peak height and factor XIa levels on admission predicted recurrent cardiovascular events (OR: 4.9 [95%CI 1.2-20.9] and 4.5 [1.1-18.9].ACS patients had an enhanced prothrombotic profile, demonstrated by an increased thrombin generation potential, factor XIa and D-dimer levels. This study is the first to demonstrate the positive association between factor XIa, thrombin generation and recurrent cardiovascular events.

  10. Factor XIa and Thrombin Generation Are Elevated in Patients with Acute Coronary Syndrome and Predict Recurrent Cardiovascular Events

    Science.gov (United States)

    Loeffen, Rinske; van Oerle, René; Leers, Mathie P. G.; Kragten, Johannes A.; Crijns, Harry; Spronk, Henri M. H.; ten Cate, Hugo

    2016-01-01

    Objective In acute coronary syndrome (ACS) cardiac cell damage is preceded by thrombosis. Therefore, plasma coagulation markers may have additional diagnostic relevance in ACS. By using novel coagulation assays this study aims to gain more insight into the relationship between the coagulation system and ACS. Methods We measured plasma thrombin generation, factor XIa and D-dimer levels in plasma from ACS (n = 104) and non-ACS patients (n = 42). Follow-up measurements (n = 73) were performed at 1 and 6 months. Associations between coagulation markers and recurrent cardiovascular events were calculated by logistic regression analysis. Results Thrombin generation was significantly enhanced in ACS compared to non-ACS patients: peak height 148±53 vs. 122±42 nM. There was a significantly diminished ETP reduction (32 vs. 41%) and increased intrinsic coagulation activation (25 vs. 7%) in ACS compared to non-ACS patients. Furthermore, compared to non-ACS patients factor XIa and D-dimer levels were significantly elevated in ACS patients: 1.9±1.1 vs. 1.4±0.7 pM and 495(310–885) vs. 380(235–540) μg/L. Within the ACS spectrum, ST-elevated myocardial infarction patients had the highest prothrombotic profile. During the acute event, thrombin generation was significantly increased compared to 1 and 6 months afterwards: peak height 145±52 vs. 100±44 vs. 98±33 nM. Both peak height and factor XIa levels on admission predicted recurrent cardiovascular events (OR: 4.9 [95%CI 1.2–20.9] and 4.5 [1.1–18.9]). Conclusion ACS patients had an enhanced prothrombotic profile, demonstrated by an increased thrombin generation potential, factor XIa and D-dimer levels. This study is the first to demonstrate the positive association between factor XIa, thrombin generation and recurrent cardiovascular events. PMID:27419389

  11. Prediction of cardiovascular risk by electrocardiographic changes in women with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Biberoglu, Ebru Hacer; Kirbas, Ayse; Kirbas, Ozgur; Iskender, Cantekin; Daglar, Halil Korkut; Koseoglu, Cemal; Uygur, Dilek; Danisman, Nuri

    2015-01-01

    We aimed to investigate P wave characteristics in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP). In this case-control study, including 59 pregnant women with intrahepatic cholestasis and 28 with healthy uncomplicated pregnancies, electrocardiographic maximum (Pmax) and minimum (Pmin) P-wave durations and P-wave dispersion (Pd) parameters were investigated. While Pmin and Pd values were significantly lower in women both with mild and severe ICP when compared to healthy pregnant women (p Intrahepatic cholestasis predisposes to cardiovascular complications. P-wave durations and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that these parameters were significantly altered in pregnant women with ICP when compared to the normal ones. This important association can be used to screen for women with an increased risk to better target counseling on lifestyle modifications and to closer follow-up and management of women with a history of ICP.

  12. Real-time prediction of acute cardiovascular events using hardware-implemented Bayesian networks.

    Science.gov (United States)

    Tylman, Wojciech; Waszyrowski, Tomasz; Napieralski, Andrzej; Kamiński, Marek; Trafidło, Tamara; Kulesza, Zbigniew; Kotas, Rafał; Marciniak, Paweł; Tomala, Radosław; Wenerski, Maciej

    2016-02-01

    This paper presents a decision support system that aims to estimate a patient׳s general condition and detect situations which pose an immediate danger to the patient׳s health or life. The use of this system might be especially important in places such as accident and emergency departments or admission wards, where a small medical team has to take care of many patients in various general conditions. Particular stress is laid on cardiovascular and pulmonary conditions, including those leading to sudden cardiac arrest. The proposed system is a stand-alone microprocessor-based device that works in conjunction with a standard vital signs monitor, which provides input signals such as temperature, blood pressure, pulseoxymetry, ECG, and ICG. The signals are preprocessed and analysed by a set of artificial intelligence algorithms, the core of which is based on Bayesian networks. The paper focuses on the construction and evaluation of the Bayesian network, both its structure and numerical specification.

  13. Neither perceived job stress nor individual cardiovascular reactivity predict high blood pressure.

    Science.gov (United States)

    Fauvel, Jean Pierre; M'Pio, Ignasse; Quelin, Pierre; Rigaud, Jean-Pierre; Laville, Maurice; Ducher, Michel

    2003-12-01

    We have reported that high job strain was associated with a significantly higher diastolic blood pressure (DBP) of 4.5 mm Hg during the working hours, irrespective of BP reactivity to a stress test. We report the final results of the first 5-year follow-up study, which aimed to assess the respective influences of perception of professional strain and cardiovascular reactivity to a mental stress test on BP. A cohort of 292 healthy subjects (mean+/-SEM age, 38+/-1 years) was followed up for progression to hypertension outcome, which was defined as an increase in systolic blood pressure (SBP) or DBP >7 mm Hg or a DBP >95 mm Hg during follow-up. None of the subjects was lost to follow-up, and 209 subjects completed the study. The high-strain (HS) group, representing 20.9% of the subjects, was compared with the remaining subjects (non-high-strain [NHS]). Similarly, the subjects with the highest BP stress reactivity (HR; 20.9% of subjects) were compared with the remaining subjects (NHR). Progression to hypertension was reached by 93 subjects (31.8%). Kaplan-Meier survival estimates revealed that neither HS nor HR increased the incidence of progression to hypertension. End-of-follow-up 24-hour ambulatory BPs that were similar in HS and NHS (120+/-2 vs 120+/-1 mm Hg, respectively) and in HR and NHR (122+/-2 vs 120+/-1 mm Hg, respectively) confirmed our findings. Age, alcohol, salt diet, body mass index, and occupation did not interfere with our results. In conclusion, cardiovascular HR and HS do not appear to be major risk markers for future high BP in healthy, young adults.

  14. Hypertriglyceridemia and waist circumference predict cardiovascular risk among HIV patients: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Peter M Janiszewski

    Full Text Available BACKGROUND: Although half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC combined with triglyceride (TG levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women. METHODS: 1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT and abdominal subcutaneous AT (SAT were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast. RESULTS: The high TG/high WC men had the most VAT (208.0 ± 94.4 cm(2, as well as the highest prevalence of metabolic syndrome (42.2% and type-2 diabetes (16.2%, and the highest Framingham risk score (10.3 ± 6.5 in comparison to other groups (p<0.05 for all. High TG/high WC women also had elevated VAT (150.0 ± 97.9 cm(2 and a higher prevalence of metabolic syndrome (53.3%, hypertension (30.5% and type-2 diabetes (12.0%, and Framingham risk score(2.9 ± 2.8 by comparison to low TG/low WC women (p<0.05 for all. CONCLUSIONS: A simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients.

  15. Cardiovascular risk prediction by N-terminal pro brain natriuretic peptide and high sensitivity C-reactive protein is affected by age and sex

    DEFF Research Database (Denmark)

    Olsen, M.H.; Hansen, T.W.; Christensen, M.K.

    2008-01-01

    BACKGROUND: Previous studies have shown that the urine albumin/creatinine ratio (UACR), high sensitivity C-reactive protein (hsCRP) and N-terminal pro brain natriuretic peptide (Nt-proBNP) predict cardiovascular events in a general population aged 41, 51, 61 or 71 years. This study investigated...... factors, UACR, hsCRP and Nt-proBNP. The composite cardiovascular endpoint (CEP) of cardiovascular death and non-fatal stroke or myocardial infarction was assessed after 9.5 years. RESULTS: In Cox regression analyses predicting CEP, the effects of log(hsCRP) and log(Nt-proBNP) were modulated by sex (P ....3-2.2; P proBNP)/SD predicted CEP in 61 plus 71-year-old women (HR 1.74; 1.2-2.5; P pro...

  16. Quality of diabetes care predicts the development of cardiovascular events: results of the AMD-QUASAR study.

    Science.gov (United States)

    Rossi, Maria C E; Lucisano, Giuseppe; Comaschi, Marco; Coscelli, Carlo; Cucinotta, Domenico; Di Blasi, Patrizia; Bader, Giovanni; Pellegrini, Fabio; Valentini, Umberto; Vespasiani, Giacomo; Nicolucci, Antonio

    2011-02-01

    The QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian Diabetes Patients) study aimed to assess whether a quality-of-care summary score predicted the development of cardiovascular (CV) events in patients with type 2 diabetes. In 67 diabetes clinics, data on randomly selected patients were extracted from electronic medical records. The score was calculated using process and outcome indicators based on monitoring, targets, and treatment of A1C, blood pressure, LDL cholesterol, and microalbuminuria. The score ranged from 0 to 40. Overall, 5,181 patients were analyzed; 477 (9.2%) patients developed a CV event after a median follow-up of 28 months. The incidence rate (per 1,000 person-years) of CV events was 62.4 in patients with a score of 25. Multilevel analysis, adjusted for clustering and case-mix, showed that the risk to develop a new CV event was 84% higher in patients with a score of 25. Mean quality score varied across centers from 16.5 ± 7.5 to 29.1 ± 6.3. When the score was tested as the dependent variable, it emerged that 18% of the variance in the score could be attributed to setting characteristics. Our study documented a close relationship between quality of diabetes care and long-term outcomes. A simple score can be used to monitor quality of care and compare the performance of different centers/physicians.

  17. 2-h postchallenge plasma glucose predicts cardiovascular events in patients with myocardial infarction without known diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Henareh Loghman

    2012-08-01

    Full Text Available Abstract Background and purpose The incidence of cardiovascular events remains high in patients with myocardial infarction (MI despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular (CV events are needed. This study aimed to analyze the predictive value of an oral glucose tolerance test (OGTT in patients with acute myocardial infarction without known diabetes mellitus (DM. Methods The prospective cohort study consisted of 123 men and women aged between 31–80 years who had suffered a previous MI 3–12 months before the examinations. The exclusion criteria were known diabetes mellitus. Patients were followed up over 6.03 ± 1.36 years for CV death, recurrent MI, stroke and unstable angina pectoris. A standard OGTT was performed at baseline. Results 2-h plasma glucose (HR, 1.27, 95% CI, 1.00 to 1.62; P  Conclusions In this study population, with previous MI and without known DM, 2-h PG and smoking were significant predictors of CV death, recurrent MI, stroke and unstable angina pectoris, independent of baseline characteristics and medical treatment.

  18. Intraplaque Expression of C-Reactive Protein Predicts Cardiovascular Events in Patients with Severe Atherosclerotic Carotid Artery Stenosis.

    Science.gov (United States)

    Bonaventura, Aldo; Mach, François; Roth, Aline; Lenglet, Sébastien; Burger, Fabienne; Brandt, Karim J; Pende, Aldo; Bertolotto, Maria; Spinella, Giovanni; Pane, Bianca; Palombo, Domenico; Dallegri, Franco; Cea, Michele; Vuilleumier, Nicolas; Montecucco, Fabrizio; Carbone, Federico

    2016-01-01

    Serum c-reactive protein (CRP) was suggested for the assessment of intermediate cardiovascular (CV) risk. Here, systemic or intraplaque CRP levels were investigated as predictors of major adverse cardiovascular events (MACEs) in patients with severe carotid stenosis. CRP levels were assessed in the serum and within different portions (upstream and downstream) of carotid plaques of 217 patients undergoing endarterectomy. The association between CRP and intraplaque lipids, collagen, neutrophils, smooth muscle cells (SMC), and macrophage subsets was determined. No correlation between serum CRP and intraplaque biomarkers was observed. In upstream portions, CRP content was directly correlated with intraplaque neutrophils, total macrophages, and M1 macrophages and inversely correlated with SMC content. In downstream portions, intraplaque CRP correlated with M1 and M2 macrophages. According to the cut-off point (CRP > 2.9%) identified by ROC analysis in upstream portions, Kaplan-Meier analysis showed that patients with high CRP levels had a greater rate of MACEs. This risk of MACEs increased independently of age, male gender, serum CRP, and statin use. In conclusion, in patients with severe carotid artery stenosis, high CRP levels within upstream portions of carotid plaques directly and positively correlate with intraplaque inflammatory cells and predict MACEs at an 18-month follow-up period.

  19. Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome.

    Science.gov (United States)

    Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Kalender, Erol; Aydin, Selahattin; Topaloglu, Serkan; Kisacik, Halil Lutfi; Temizhan, Ahmet

    2016-11-01

    We aimed to investigate the usefulness of monocyte to HDL cholesterol ratio (MHR) in predicting coronary artery disease severity and future major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). 2661 patient with ACS were enrolled and followed up during median 31.6 months. MHR were significantly positively correlated with neutrophil to lymphocyte ratio (r=0.438), CRP (r=0.394), Gensini (r=0.407), and SYNTAX score (r=0.333). During in-hospital and long-term follow-up, MACE, stent thrombosis, non-fatal MI, and mortality occurred more frequently in the third tertile group. Kaplan-Meier analysis revealed the higher occurrence of MACE in the third tertile group compared with other tertiles. Adjusting for other factors, a MHR value in the third tertile group was determined as an independent predictor of in-hospital and long-term MACE. MHR as a novel inflammation-based marker seemed to be an independent predictor of severity of coronary artery disease and future cardiovascular events in patients with ACS. MHR may utilise the identification of patients who are at higher risk for MACE and individualisation of targeted therapy. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  20. Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia

    NARCIS (Netherlands)

    Weeke, Lauren C.; Boylan, Geraldine B.; Pressler, Ronit M.; Hallberg, Boubou; Blennow, Mats; Toet, Mona C.; Groenendaal, Floris; de Vries, Linda S.

    2016-01-01

    Objective: To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia. Methods: Twenty-six full-term infants with HIE (September 2011-

  1. Metabolic syndrome vs.its components for prediction of cardiovascular mortality: A cohort study in Chinese elderly adults

    Institute of Scientific and Technical Information of China (English)

    Dong-Ling Sun; Jian-Hua Wang; Bin Jiang; Liang-Shou Li; Lan-Sun Li; Lei Wu; Hai-Yun Wu; Yao He

    2012-01-01

    Objective The predictive value of the metabolic syndrome (MetS) for mortality from all-cause and cardiovascular disease (CVD) in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults. Methods A cohort of 1,535 subjects (994 men and 541 women) aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios (HRs) predicted by MetS according to the harmonized definition and by its individual components. Results The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 (95% confidence interval (CI): components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality. Conclusions The number of positive MetS components seems no more informative than classifying (dichotomous) MetS for CVD risks assessment in this Chinese cohort.

  2. Skin advanced glycation end products in HIV infection are increased and predictive of development of cardiovascular events.

    Science.gov (United States)

    Sprenger, Herman G; Bierman, Wouter F; Martes, Melanie I; Graaff, Reindert; van der Werf, Tjip S; Smit, Andries J

    2017-01-14

    HIV-1 infection is associated with an increased cardiovascular disease (CVD) risk. Advanced glycation end products are formed as stable markers of glycaemic and oxidative stress. Skin autofluorescence (SAF) as marker of accumulated advanced glycation end products is increased and predictive of CVD events in diabetes mellitus, chronic kidney disease (CKD), and preexisting CVD. We determined SAF levels in HIV-1 infected patients, testing the hypothesis that SAF predicts CVD events in HIV infection. Single-centre prospective cohort study. In 2010-2011, SAF was measured in 91 patients. Development of CVD events was monitored during a median follow-up of 4.8 years. SAF values of the patients were expressed as a ratio (rSAF) to expected SAF levels in age-matched healthy volunteers. Seventy-nine men and 12 women were included, mean age 47 years; 81 patients were on combination antiretroviral therapy. With a mean rSAF of 1.155, SAF levels in patients were 15.5% higher than predicted for their age (95% confidence interval, 10.0-20.0; P WMO) CKD (P = 0.03) remained as independent predictors of CVD events. SAF is increased in HIV-infected patients, and related with smoking, low nadir CD4 cell count, and MSM. Larger studies are needed to confirm whether SAF is an independent predictor of CVD events.

  3. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease.

    Science.gov (United States)

    Sonmez, Alper; Yilmaz, Mahmut Ilker; Saglam, Mutlu; Unal, Hilmi Umut; Gok, Mahmut; Cetinkaya, Hakki; Karaman, Murat; Haymana, Cem; Eyileten, Tayfun; Oguz, Yusuf; Vural, Abdulgaffar; Rizzo, Manfredi; Toth, Peter P

    2015-04-16

    Cardiovascular disease (CVD) risk is substantially increased in subjects with chronic kidney disease (CKD). The Triglycerides (TG) to High-Density Lipoprotein Cholesterol (HDL-C) ratio is an indirect measure of insulin resistance and an independent predictor of cardiovascular risk. No study to date has been performed to evaluate whether the TG/HDL-C ratio predicts CVD risk in patients with CKD. A total of 197 patients (age 53±12 years) with CKD Stages 1 to 5, were enrolled in this longitudinal, observational, retrospective study. TG/HDL-C ratio, HOMA-IR indexes, serum asymmetric dimethyl arginine (ADMA), high sensitivity C-reactive protein (CRP), parathyroid hormone (PTH), calcium, phosphorous, estimated glomerular filtration rate (eGFR), and albumin levels were measured. Flow mediated vasodilatation (FMD) of the brachial artery was assessed by using high-resolution ultrasonography. A total of 11 cardiovascular (CV) deaths and 43 nonfatal CV events were registered in a mean follow-up period of 30 (range 9 to 35) months. Subjects with TG/HDL-C ratios above the median values (>3.29) had significantly higher plasma ADMA, PTH, and phosphorous levels (p=0.04, p=0.02, p=0.01 respectively) and lower eGFR and FMD values (p=0.03, pcardiovascular outcomes [HR: 1.36 (1.11-1.67) (p=0.003)] along with plasma ADMA levels [HR: 1.31 (1.13-1.52) (p<0.001)] and a history of diabetes mellitus [HR: 4.82 (2.80-8.37) (p<0.001)]. This study demonstrates that the elevated TG/HDL-C ratio predicts poor CVD outcome in subjects with CKD. Being a simple, inexpensive, and reproducible marker of CVD risk, the TG/HDL-C ratio may emerge as a novel and reliable indicator among the many well-established markers of CVD risk in CKD. Clinical trial registration number and date: NCT02113462 / 10-04-2014.

  4. Can Pediatric Hypertension Criteria Be Simplified? A Prediction Analysis of Subclinical Cardiovascular Outcomes From the Bogalusa Heart Study.

    Science.gov (United States)

    Xi, Bo; Zhang, Tao; Li, Shengxu; Harville, Emily; Bazzano, Lydia; He, Jiang; Chen, Wei

    2017-04-01

    Prehypertension and hypertension in childhood are defined by sex-, age-, and height-specific 90th (or ≥120/80 mm Hg) and 95th percentiles of blood pressure, respectively, by the 2004 Fourth Report. However, these cutoffs are complex and cumbersome for use. This study assessed the performance of a simplified blood pressure definition to predict adult hypertension and subclinical cardiovascular disease. The cohort consisted of 1225 adults (530 men; aged 26.3-47.7 years) from the Bogalusa Heart Study with 27.1-year follow-up since childhood. We used 110/70 and 120/80 mm Hg for children (age, 6-11 years), and 120/80 and 130/85 mm Hg for adolescents (age, 12-17 years) as the simplified definition of childhood prehypertension and hypertension, respectively, to compare with the 2004 Fourth Report (the complex definition). Adult carotid intima-media thickness, pulse wave velocity, and left ventricular mass were measured using digital ultrasound instruments. Compared with normal blood pressure, childhood hypertensives diagnosed by the simplified definition and the complex definition were both at higher risk of adult hypertension with hazard ratio of 3.1 (95% confidence interval, 1.8-5.3) by the simplified definition and 3.2 (2.0-5.0) by the complex definition, high pulse wave velocity with 3.5 (1.7-7.1) and 2.2 (1.2-4.1), high carotid intima-media thickness with 3.1 (1.7-5.6) and 2.0 (1.2-3.6), and left ventricular hypertrophy with 3.4 (1.7-6.8) and 3.0 (1.6-5.6). The results were confirmed by reclassification or receiver operating curve analyses. The simplified childhood blood pressure definition predicts the risk of adult hypertension and subclinical cardiovascular disease equally as the complex definition does, which could be useful for screening hypertensive children to reduce risk of adult cardiovascular disease. © 2017 American Heart Association, Inc.

  5. Does our gut microbiome predict cardiovascular risk? A review of the evidence from metabolomics.

    Science.gov (United States)

    Griffin, Julian L; Wang, Xinzhu; Stanley, Elizabeth

    2015-02-01

    Millions of microbes are found in the human gut, and are collectively referred as the gut microbiota. Recent studies have estimated that the microbiota genome contains 100-fold more genes than the host genome. These microbiota contribute to digestion by processing energy substrates unutilized by the host, with about half of the total genome of the gut microbiota being related to central carbon and amino acid metabolism as well as the biosynthesis of secondary metabolites. Therefore, the gut microbiome and its interaction with the host influences many aspects of health and disease, including the composition of biofluids such as urine and blood plasma. Metabolomics is uniquely suited to capture these functional host-microbe interactions. This review aims at providing an overview of recent metabolomics evidence of gut microbiota-host metabolic interactions with a specific focus on cardiovascular disease and related aspects of the metabolic syndrome. Furthermore, the emphasis is given on the complexities of translating these metabolite signatures as potential clinical biomarkers, as the composition and activity of gut microbiome change with many factors, particularly with diet, with special reference to trimethylamine-oxide.

  6. Cardiac autonomic neuropathy predicts cardiovascular morbidity and mortality in type 1 diabetic patients with diabetic nephropathy

    DEFF Research Database (Denmark)

    Astrup, Anne Sofie; Tarnow, Lise; Rossing, Peter

    2006-01-01

    Cardiac autonomic neuropathy (CAN) has been associated with a poor prognosis in patients with diabetes. Because CAN is common in patients with diabetic nephropathy, we evaluated the predictive value of CAN in type 1 diabetic patients with and without diabetic nephropathy....

  7. Risk alleles of USF1 gene predict cardiovascular disease of women in two prospective studies.

    Directory of Open Access Journals (Sweden)

    2006-05-01

    Full Text Available Upstream transcription factor 1 (USF1 is a ubiquitously expressed transcription factor controlling several critical genes in lipid and glucose metabolism. Of some 40 genes regulated by USF1, several are involved in the molecular pathogenesis of cardiovascular disease (CVD. Although the USF1 gene has been shown to have a critical role in the etiology of familial combined hyperlipidemia, which predisposes to early CVD, the gene's potential role as a risk factor for CVD events at the population level has not been established. Here we report the results from a prospective genetic-epidemiological study of the association between the USF1 variants, CVD, and mortality in two large Finnish cohorts. Haplotype-tagging single nucleotide polymorphisms exposing all common allelic variants of USF1 were genotyped in a prospective case-cohort design with two distinct cohorts followed up during 1992-2001 and 1997-2003. The total number of follow-up years was 112,435 in 14,140 individuals, of which 2,225 were selected for genotyping based on the case-cohort study strategy. After adjustment for conventional risk factors, we observed an association of USF1 with CVD and mortality among females. In combined analysis of the two cohorts, female carriers of a USF1 risk haplotype had a 2-fold risk of a CVD event (hazard ratio [HR] 2.02; 95% confidence interval [CI] 1.16-3.53; p = 0.01 and an increased risk of all-cause mortality (HR 2.52; 95% CI 1.46-4.35; p = 0.0009. A putative protective haplotype of USF1 was also identified. Our study shows how a gene identified in exceptional families proves to be important also at the population level, implying that allelic variants of USF1 significantly influence the prospective risk of CVD and even all-cause mortality in females.

  8. Comparison of the Combined Obesity Indices to Predict Cardiovascular Diseases Risk Factors and Metabolic Syndrome in Northeast China.

    Science.gov (United States)

    Tao, Yuchun; Yu, Jianxing; Tao, Yuhui; Pang, Hui; Yu, Yang; Yu, Yaqin; Jin, Lina

    2016-08-09

    Obesity is associated with cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia and diabetes) and metabolic syndrome (MetS), and it may be flawed that most studies only use one obesity index to predict these risk factors. Therefore, our study aims to compare the various combined obesity indices systematically, and to find the optimal combined obesity indices to predict CVD risk factors and MetS. A total of 16,766 participants aged 18-79 years old were recruited in Jilin Province in 2012. Receiver operating characteristic curve (ROC) curves and multiple logistic regressions were used to evaluate the predictive capacity of the combined obesity indices for CVD risk factors and MetS. The adjusted area under receiver operating characteristic (AUROC) with two combined obesity indices had been improved up to 19.45%, compared with one single obesity index. In addition, body mass index (BMI) and waist circumference (WC) were the optimal combinations, where the AUROC (95% confidence interval (CI)) for hypertension, dyslipidemia, diabetes and MetS in males were 0.730 (0.718, 0.740), 0.694 (0.682, 0.706), 0.725 (0.709, 0.742) and 0.820 (0.810, 0.830), and in females were 0.790 (0.780, 0.799), 0.727 (0.717, 0.738), 0.746 (0.731, 0.761) and 0.828 (0.820, 0.837), respectively. The more abnormal obesity indices that one has the higher the risk for CVD risk factors and MetS, especially in males. In addition, the combined obesity indices have better predictions than one obesity index, where BMI and WC are the optimal combinations.

  9. Prediction of First Cardiovascular Disease Event in Type 1 Diabetes Mellitus: The Steno Type 1 Risk Engine.

    Science.gov (United States)

    Vistisen, Dorte; Andersen, Gregers Stig; Hansen, Christian Stevns; Hulman, Adam; Henriksen, Jan Erik; Bech-Nielsen, Henning; Jørgensen, Marit Eika

    2016-03-15

    Patients with type 1 diabetes mellitus are at increased risk of developing cardiovascular disease (CVD), but they are currently undertreated. There are no risk scores used on a regular basis in clinical practice for assessing the risk of CVD in type 1 diabetes mellitus. From 4306 clinically diagnosed adult patients with type 1 diabetes mellitus, we developed a prediction model for estimating the risk of first fatal or nonfatal CVD event (ischemic heart disease, ischemic stroke, heart failure, and peripheral artery disease). Detailed clinical data including lifestyle factors were linked to event data from validated national registers. The risk prediction model was developed by using a 2-stage approach. First, a nonparametric, data-driven approach was used to identify potentially informative risk factors and interactions (random forest and survival tree analysis). Second, based on results from the first step, Poisson regression analysis was used to derive the final model. The final CVD prediction model was externally validated in a different population of 2119 patients with type 1 diabetes mellitus. During a median follow-up of 6.8 years (interquartile range, 2.9-10.9) a total of 793 (18.4%) patients developed CVD. The final prediction model included age, sex, diabetes duration, systolic blood pressure, low-density lipoprotein cholesterol, hemoglobin A1c, albuminuria, glomerular filtration rate, smoking, and exercise. Discrimination was excellent for a 5-year CVD event with a C-statistic of 0.826 (95% confidence interval, 0.807-0.845) in the derivation data and a C-statistic of 0.803 (95% confidence interval, 0.767-0.839) in the validation data. The Hosmer-Lemeshow test showed good calibration (P>0.05) in both cohorts. This high-performing CVD risk model allows for the implementation of decision rules in a clinical setting. © 2016 American Heart Association, Inc.

  10. Electrocardiographic changes improve risk prediction in asymptomatic persons age 65 years or above without cardiovascular disease

    DEFF Research Database (Denmark)

    Jørgensen, Peter Godsk; Jensen, Jan S; Marott, Jacob L;

    2014-01-01

    : In all, 6,991 participants from the Copenhagen Heart Study attending an examination at age ≥65 years were included. ECG changes were defined as Q waves, ST-segment depression, T-wave changes, ventricular conduction defects, and left ventricular hypertrophy based on the Minnesota code. The primary...... with conventional risk factors. All ECG changes except 1 univariably predicted both endpoints. Event rates of ECG changes versus no ECG changes were respectively 41.4% versus 27.8% and 64.6% versus 50.8%. When added to existing risk scores, ECG changes independently increased the risk of both endpoints. Fatal CVD......BACKGROUND: Risk prediction in elderly patients is increasingly relevant due to longer life expectancy. OBJECTIVES: This study sought to examine whether electrocardiographic (ECG) changes provide prognostic information incremental to current risk models and to the conventional risk factors. METHODS...

  11. Performance of different adiposity measures for predicting cardiovascular risk in adolescents

    Science.gov (United States)

    Zhao, Min; Bovet, Pascal; Ma, Chuanwei; Xi, Bo

    2017-01-01

    This study aims to compare the performance of body mass index (BMI), waist circumference (WC), and waist-to-height-ratio (WHtR) to predict the presence of at least 3 main CV risk factors in US adolescents. A total of 3621 adolescents (boys: 49.9%) aged 12–17 years from the US National Health and Nutrition Examination Survey (1999–2012) were included in this study. Measured CV risk factors included systolic/diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting plasma glucose. The AUC of BMI-z score, WC-z score and WHtR-z score to predict at least three CV risk factors were similar (~0.85), irrespective of criteria used to define abnormal levels of CV risk factors. A 1-SD increase in any of three indices to predict CV risk was also similar for the three adiposity scores. For instance, a 1-SD increase risk in BMI-z score, WC-z score and WHtR-z score was 3.32 (95%CI 2.53–4.36), 3.43 (95%CI 2.64–4.46), and 3.45 (95%CI 2.64–4.52), respectively, in the total population using the International Diabetes Federation definition. In addition, the most efficient WHtR cut-off for screening CV risk was ~0.50 in US adolescents. In summary, BMI, WC and WHtR performed similarly well to predict the presence of at least 3 main CV risk factors among US adolescents. PMID:28262726

  12. Anger suppression predicts pain, emotional, and cardiovascular responses to the cold pressor.

    Science.gov (United States)

    Quartana, Phillip J; Bounds, Sara; Yoon, K Lira; Goodin, Burel R; Burns, John W

    2010-06-01

    Manipulated anger suppression has been shown to heighten pain and anger responses to pain. We examined whether individual differences in self-reported anger suppression predicted pain, anger, and blood pressure responses to acute pain. Healthy participants (N = 47) underwent an anger-provoking speech task followed by a cold pressor pain task. Participants reported their degree of suppression of thoughts and feelings related to the speech. Pain intensity ratings were obtained throughout the cold pressor. Self-reported anger, anxiety and positive emotion, as well as ratings of sensory, general distress, and anger-specific elements of pain were obtained following the cold pressor. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded throughout. Self-reported suppression predicted greater pain intensity ratings, perception of sensory and anger-specific elements of pain, and self-reported anger in response to the cold pressor. Associations between self-reported suppression and pain intensity and ratings of anger-specific elements of pain were statistically mediated by pain-induced changes in self-reported anger, whereas the effect of suppression on sensory pain ratings was not. Self-reported suppression was also correlated inversely with SBP responses to the cold pressor. Consistent with an ironic process model and prior studies involving experimental manipulation of suppression, self-reported suppression of anger predicted greater pain intensity and perception of the anger-specific element of pain. Findings also suggest that suppression might attenuate homeostatic pressor responses to acute pain.

  13. Moving beyond regression techniques in cardiovascular risk prediction: applying machine learning to address analytic challenges.

    Science.gov (United States)

    Goldstein, Benjamin A; Navar, Ann Marie; Carter, Rickey E

    2016-07-19

    Risk prediction plays an important role in clinical cardiology research. Traditionally, most risk models have been based on regression models. While useful and robust, these statistical methods are limited to using a small number of predictors which operate in the same way on everyone, and uniformly throughout their range. The purpose of this review is to illustrate the use of machine-learning methods for development of risk prediction models. Typically presented as black box approaches, most machine-learning methods are aimed at solving particular challenges that arise in data analysis that are not well addressed by typical regression approaches. To illustrate these challenges, as well as how different methods can address them, we consider trying to predicting mortality after diagnosis of acute myocardial infarction. We use data derived from our institution's electronic health record and abstract data on 13 regularly measured laboratory markers. We walk through different challenges that arise in modelling these data and then introduce different machine-learning approaches. Finally, we discuss general issues in the application of machine-learning methods including tuning parameters, loss functions, variable importance, and missing data. Overall, this review serves as an introduction for those working on risk modelling to approach the diffuse field of machine learning.

  14. Plasma osteoprotegerin levels predict cardiovascular and all-cause mortality and deterioration of kidney function in type 1 diabetic patients with nephropathy

    DEFF Research Database (Denmark)

    Jorsal, A.; Tarnow, L.; Flyvbjerg, A.

    2008-01-01

    AIMS/HYPOTHESIS: The bone-related peptide osteoprotegerin is produced by vascular cells and is involved in the process of vascular calcification. The aim of this study was to investigate the predictive value of plasma levels of osteoprotegerin in relation to mortality, cardiovascular events and d...

  15. Candy consumption in childhood is not predictive of weight, adiposity measures or cardiovascular risk factors in young adults: the Bogalusa Heart Study

    Science.gov (United States)

    There are limited data available on the longitudinal relationship between candy consumption by children on weight and other cardiovascular risk factors (CVRF) in young adults. The present study investigated whether candy consumption in children was predictive of weight and CVRF in young adults. A lo...

  16. [Comparison of the cardiovascular predictive value of MDRD and CKD-EPI in estimating chronic kidney disease].

    Science.gov (United States)

    Cinza-Sanjurjo, S; Calvo-Gómez, C; Hermida-Ameijeiras, A; López-Paz, J E; González-Juanatey, J R

    2016-01-01

    To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9±2.6 mL/min/1.73m(2) and 76.9±2.2 mL/min/1.73m(2), respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95%CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10-year prospective cohort study.

    Science.gov (United States)

    Lim, Tae-Seok; Yun, Jae-Seung; Cha, Seon-Ah; Song, Ki-Ho; Yoo, Ki-Dong; Ahn, Yu-Bae; Park, Yong-Moon; Ko, Seung-Hyun

    2016-11-01

    Elevated lipoprotein(a) (Lp[a]) level is known to be a risk factor for cardiovascular disease (CVD). However, the data that has been reported on the association between the Lp(a) level and CVD in type 2 diabetes has been limited and incoherent. The aim of this study was to investigate the relationship between the Lp(a) concentration and new onset CVD in type 2 diabetes. From March 2003 to December 2004, patients with type 2 diabetes without a prior history of CVD were consecutively enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. Cox proportional hazards models were used to identify the associations between the Lp(a) and CVD after adjusting for confounding variables. Of the 1,183 patients who were enrolled, 833 participants were evaluated with a median follow-up time of 11.1 years. A total of 202 participants were diagnosed with CVD (24.2%). The median Lp(a) level for 1st and 4th quartile group was 5.4 (3.5 to 7.1) and 55.7 mg/dL (43.1 to 75.3). Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin and angiotensin converting enzyme inhibitors/angiotensin receptor blockers at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with serum Lp(a) level (hazard ratio, 1.92; 95% confidence interval [CI], 1.26 to 2.92; p level was an independent predictable risk factor for CVD in type 2 diabetes. Other cardiovascular risk factors should be treated more intensively in type 2 diabetic patients with high Lp(a) levels.

  18. The predictive value of chronic kidney disease for assessing cardiovascular events under consideration of pretest probability for coronary artery disease in patients who underwent stress myocardial perfusion imaging.

    Science.gov (United States)

    Furuhashi, Tatsuhiko; Moroi, Masao; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Fukuda, Hiroshi; Sugi, Kaoru

    2013-02-01

    Pretest probability of coronary artery disease (CAD) facilitates diagnosis and risk stratification of CAD. Stress myocardial perfusion imaging (MPI) and chronic kidney disease (CKD) are established major predictors of cardiovascular events. However, the role of CKD to assess pretest probability of CAD has been unclear. This study evaluates the role of CKD to assess the predictive value of cardiovascular events under consideration of pretest probability in patients who underwent stress MPI. Patients with no history of CAD underwent stress MPI (n = 310; male = 166; age = 70; CKD = 111; low/intermediate/high pretest probability = 17/194/99) and were followed for 24 months. Cardiovascular events included cardiac death and nonfatal acute coronary syndrome. Cardiovascular events occurred in 15 of the 310 patients (4.8 %), but not in those with low pretest probability which included 2 CKD patients. In patients with intermediate to high pretest probability (n = 293), multivariate Cox regression analysis identified only CKD [hazard ratio (HR) = 4.88; P = 0.022) and summed stress score of stress MPI (HR = 1.50; P probability. In patients with intermediate to high pretest probability, CKD and stress MPI are independent predictors of cardiovascular events considering the pretest probability of CAD in patients with no history of CAD. In assessing pretest probability of CAD, CKD might be an important factor for assessing future cardiovascular prognosis.

  19. Retinopathy Signs Improved Prediction and Reclassification of Cardiovascular Disease Risk in Diabetes: A prospective cohort study

    Science.gov (United States)

    Ho, Henrietta; Cheung, Carol Y.; Sabanayagam, Charumathi; Yip, Wanfen; Ikram, Mohammad Kamran; Ong, Peng Guan; Mitchell, Paul; Chow, Khuan Yew; Cheng, Ching Yu; Tai, E. Shyong; Wong, Tien Yin

    2017-01-01

    CVD risk prediction in diabetics is imperfect, as risk models are derived mainly from the general population. We investigate whether the addition of retinopathy and retinal vascular caliber improve CVD prediction beyond established risk factors in persons with diabetes. We recruited participants from the Singapore Malay Eye Study (SiMES, 2004–2006) and Singapore Prospective Study Program (SP2, 2004–2007), diagnosed with diabetes but no known history of CVD at baseline. Retinopathy and retinal vascular (arteriolar and venular) caliber measurements were added to risk prediction models derived from Cox regression model that included established CVD risk factors and serum biomarkers in SiMES, and validated this internally and externally in SP2. We found that the addition of retinal parameters improved discrimination compared to the addition of biochemical markers of estimated glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hsCRP). This was even better when the retinal parameters and biomarkers were used in combination (C statistic 0.721 to 0.774, p = 0.013), showing improved discrimination, and overall reclassification (NRI = 17.0%, p = 0.004). External validation was consistent (C-statistics from 0.763 to 0.813, p = 0.045; NRI = 19.11%, p = 0.036). Our findings show that in persons with diabetes, retinopathy and retinal microvascular parameters add significant incremental value in reclassifying CVD risk, beyond established risk factors. PMID:28148953

  20. External model validation of binary clinical risk prediction models in cardiovascular and thoracic surgery.

    Science.gov (United States)

    Hickey, Graeme L; Blackstone, Eugene H

    2016-08-01

    Clinical risk-prediction models serve an important role in healthcare. They are used for clinical decision-making and measuring the performance of healthcare providers. To establish confidence in a model, external model validation is imperative. When designing such an external model validation study, thought must be given to patient selection, risk factor and outcome definitions, missing data, and the transparent reporting of the analysis. In addition, there are a number of statistical methods available for external model validation. Execution of a rigorous external validation study rests in proper study design, application of suitable statistical methods, and transparent reporting.

  1. Lifetime cumulative risk factors predict cardiovascular disease mortality in a 50-year follow-up study in Finland.

    Science.gov (United States)

    Reinikainen, Jaakko; Laatikainen, Tiina; Karvanen, Juha; Tolonen, Hanna

    2015-02-01

    Systolic blood pressure, total cholesterol and smoking are known predictors of cardiovascular disease (CVD) mortality. Less is known about the effect of lifetime accumulation and changes of risk factors over time as predictors of CVD mortality, especially in very long follow-up studies. Data from the Finnish cohorts of the Seven Countries Study were used. The baseline examination was in 1959 and seven re-examinations were carried out at approximately 5-year intervals. Cohorts were followed up for mortality until the end of 2011. Time-dependent Cox models with regular time-updated risk factors, time-dependent averages of risk factors and latest changes in risk factors, using smoothing splines to discover nonlinear effects, were used to analyse the predictive effect of risk factors for CVD mortality. A model using cumulative risk factors, modelled as the individual-level averages of several risk factor measurements over time, predicted CVD mortality better than a model using the most recent measurement information. This difference seemed to be most prominent for systolic blood pressure. U-shaped effects of the original predictors can be explained by partitioning a risk factor effect between the recent level and the change trajectory. The change in body mass index predicted the risk although body mass index itself did not. The lifetime accumulation of risk factors and the observed changes in risk factor levels over time are strong predictors of CVD mortality. It is important to investigate different ways of using the longitudinal risk factor measurements to take full advantage of them. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  2. Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries

    DEFF Research Database (Denmark)

    Ueda, Peter; Woodward, Mark; Lu, Yuan

    2017-01-01

    BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and ......BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores...... for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central...... and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13...

  3. Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Chuang Yuan

    Full Text Available The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC for cardiovascular (CV diseases and all-cause mortality.Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear.A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed.Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs of CV events, CV mortality and all-cause mortality were 1.19 (1.06-1.35, 95%CI, 9 studies with 18993 subjects, 1.09 (1.01-1.18, 95%CI, 2 studies with 2550 subjects and 1.65 (1.15-2.37, 95%CI, 6 studies with 3619 subjects, respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively.Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases.

  4. Adding pharmacists to primary care teams reduces predicted long-term risk of cardiovascular events in type 2 diabetic patients without established cardiovascular disease: results from a randomized trial.

    Science.gov (United States)

    Ladhani, N N; Majumdar, S R; Johnson, J A; Tsuyuki, R T; Lewanczuk, R Z; Spooner, R; Simpson, S H

    2012-11-01

    To determine the impact of adding pharmacists to primary care teams on predicted 10-year risk of cardiovascular events in patients with Type 2 diabetes without established cardiovascular disease. This was a pre-specified secondary analysis of randomized trial data. The main study found that, compared with usual care, addition of a pharmacist resulted in improvements in blood pressure, dyslipidaemia, and hyperglycaemia for primary care patients with Type 2 diabetes. In this sub-study, predicted 10-year risk of cardiovascular events at baseline and 1 year were calculated for patients free of cardiovascular disease at enrolment. The primary outcome was change in UK Prospective Diabetes Study (UKPDS) risk score; change in Framingham risk score was a secondary outcome. Baseline characteristics were similar between the 102 intervention patients and 93 control subjects: 59% women, median (interquartile range) age 57 (50-64) years, diabetes duration 3 (1-6.5) years, systolic blood pressure 128 (120-140) mmHg, total cholesterol 4.34 (3.75-5.04) mmol/l and HbA(1c) 54 mmol/mol (48-64 mmol/mol) [7.1% (6.5-8.0%)]. Median baseline UKPDS risk score was 10.2% (6.0-16.7%) for intervention patients and 9.5% (5.8-15.1%) for control subjects (P = 0.80). One-year post-randomization, the median absolute reduction in UKPDS risk score was 1.0% greater for intervention patients compared with control subjects (P = 0.032). Similar changes were seen with the Framingham risk score (median reduction 1.2% greater for intervention patients compared with control subjects, P = 0.048). The two risk scores were highly correlated (rho = 0.83; P primary care teams for 1 year significantly reduced the predicted 10-year risk of cardiovascular events for patients with Type 2 diabetes without established cardiovascular disease. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  5. Music therapy-induced changes in salivary cortisol level are predictive of cardiovascular mortality in patients under maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Hou YC

    2017-02-01

    Full Text Available Yi-Chou Hou,1 Yen-Ju Lin,2 Kuo-Cheng Lu,1 Han-Sun Chiang,3 Chia-Chi Chang,4 Li-King Yang1 1Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 2Department of Nursing, Taipei Medical University, 3Graduate Institute of Basic Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, 4School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China Background: Music therapy has been applied in hemodialysis (HD patients for relieving mental stress. Whether the stress-relieving effect by music therapy is predictive of clinical outcome in HD patients is still unclear.Methods: We recruited a convenience sample of 99 patients on maintenance HD and randomly assigned them to the experimental (n=49 or control (n=50 group. The experimental group received relaxing music therapy for 1 week, whereas the control group received no music therapy. In the experimental group, we compared cardiovascular mortality in the patients with and without cortisol changes.Results: The salivary cortisol level was lowered after 1 week of music therapy in the experimental group (−2.41±3.08 vs 1.66±2.11 pg/mL, P<0.05, as well as the frequency of the adverse reaction score (−3.35±5.76 vs −0.81±4.59, P<0.05, the severity of adverse reactions score (−1.93±2.73 vs 0.33±2.71, P<0.05, and hemodialysis stressor scale (HSS score (−6.00±4.68 vs −0.877±7.08, P<0.05. The difference in salivary cortisol correlated positively with HD stress score scales (r=0.231, P<0.05, systolic blood pressure (r=0.264, P<0.05, and respiratory rates (r=0.369, P<0.05 and negatively with finger temperature (r=−0.235, P<0.05 in the total study population. The 5-year cardiovascular survival in the experimental group was higher in patients whose salivary cortisol lowered by <0.6 pg/mL than that in patients whose salivary cortisol lowered by >0.6 pg/mL (83.8% vs

  6. Evaluation of Burden Descent Model for Burden Distribution in Blast Furnace

    Institute of Scientific and Technical Information of China (English)

    Ping ZHOU; Peng-yu SHI; Yan-po SONG; Kai-le TANG; Dong FU; Chenn QZHOU

    2016-01-01

    Mathematical models for burden descending process have been applied to obtain whole burden structures in blast furnace,whereas the accuracy of those burden descent models has not been sufficiently investigated.Special evaluation method based on timeline burden profiles was established to quantitatively evaluate the error between ex-perimental and modeled burden structures.Four existing burden descent models were utilized to describe the burden structure of a 1/20 scaled warm blast furnace.Input modeling conditions including initial burden profile,descending volumes in each time interval,and normalized descending velocity distribution were determined via special image pro-cessing technology.Modeled burden structures were evaluated combined with the published experimental data.It is found that all the models caught the main profile of the burden structure.Furthermore,the improved nonuniform de-scent model (Model IV)shows the highest level of precision especially when burden descends with unstable velocity distribution tendency.Meanwhile,the traditional nonuniform descent model (Model III)may also be desirable to model the burden descending process when the burden descending velocity presents a linear tendency.Finally,the uni-form descent model (Model I)might be the first option for roughly predicting burden structure.

  7. Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events.

    Science.gov (United States)

    Hirono, Akira; Kusunose, Kenya; Kageyama, Norihito; Sumitomo, Masayuki; Abe, Masahiro; Fujinaga, Hiroyuki; Sata, Masataka

    2017-08-19

    An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  8. Integration of Attributes from Non-Linear Characterization of Cardiovascular Time-Series for Prediction of Defibrillation Outcomes.

    Directory of Open Access Journals (Sweden)

    Sharad Shandilya

    Full Text Available The timing of defibrillation is mostly at arbitrary intervals during cardio-pulmonary resuscitation (CPR, rather than during intervals when the out-of-hospital cardiac arrest (OOH-CA patient is physiologically primed for successful countershock. Interruptions to CPR may negatively impact defibrillation success. Multiple defibrillations can be associated with decreased post-resuscitation myocardial function. We hypothesize that a more complete picture of the cardiovascular system can be gained through non-linear dynamics and integration of multiple physiologic measures from biomedical signals.Retrospective analysis of 153 anonymized OOH-CA patients who received at least one defibrillation for ventricular fibrillation (VF was undertaken. A machine learning model, termed Multiple Domain Integrative (MDI model, was developed to predict defibrillation success. We explore the rationale for non-linear dynamics and statistically validate heuristics involved in feature extraction for model development. Performance of MDI is then compared to the amplitude spectrum area (AMSA technique.358 defibrillations were evaluated (218 unsuccessful and 140 successful. Non-linear properties (Lyapunov exponent > 0 of the ECG signals indicate a chaotic nature and validate the use of novel non-linear dynamic methods for feature extraction. Classification using MDI yielded ROC-AUC of 83.2% and accuracy of 78.8%, for the model built with ECG data only. Utilizing 10-fold cross-validation, at 80% specificity level, MDI (74% sensitivity outperformed AMSA (53.6% sensitivity. At 90% specificity level, MDI had 68.4% sensitivity while AMSA had 43.3% sensitivity. Integrating available end-tidal carbon dioxide features into MDI, for the available 48 defibrillations, boosted ROC-AUC to 93.8% and accuracy to 83.3% at 80% sensitivity.At clinically relevant sensitivity thresholds, the MDI provides improved performance as compared to AMSA, yielding fewer unsuccessful defibrillations

  9. Application of cardiovascular disease risk prediction models and the relevance of novel biomarkers to risk stratification in Asian Indians

    Directory of Open Access Journals (Sweden)

    S Kanjilal

    2008-02-01

    Full Text Available S Kanjilal1, VS Rao1, M Mukherjee1, BK Natesha1, KS Renuka1, K Sibi1, SS Iyengar1, Vijay V Kakkar1,21Tata Proteomics and Coagulation Department, Thrombosis Research Institute, Bangalore, Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India; 2Thrombosis Research Institute, London, UKAbstract: The increasing pressure on health resources has led to the emergence of risk assessment as an essential tool in the management of cardiovascular disease (CVD. Concern exists regarding the validity of their generalization to all populations. Existing risk scoring models do not incorporate emerging ‘novel’ risk factors. In this context, the aim of the study was to examine the relevance of British, European, and Framingham predictive CVD risk scores to the asymptomatic high risk Indian population. Blood samples drawn from the participants were analyzed for various ‘traditional’ and ‘novel’ biomarkers, and their CVD risk factor profiling was also done. The Framingham model defined only 5% of the study cohort to be at high risk, which appears to be an underestimation of CVD risk in this genetically predisposed population. These subjects at high risk had significantly elevated levels of lipid, pro-inflammatory, pro-thrombotic, and serological markers. It is more relevant to develop risk predictive scores for application to the Indian population. This study substantiates the argument that alternative approaches to risk stratification are required in order to make them more adaptable and applicable to different populations with varying risk factor and disease patterns.Keywords: atherosclerosis, risk factors, risk score, Framingham, plasma biomarkers

  10. Excess pressure integral predicts cardiovascular events independent of other risk factors in the conduit artery functional evaluation substudy of Anglo-Scandinavian Cardiac Outcomes Trial.

    Science.gov (United States)

    Davies, Justin E; Lacy, Peter; Tillin, Therese; Collier, David; Cruickshank, J Kennedy; Francis, Darrel P; Malaweera, Anura; Mayet, Jamil; Stanton, Alice; Williams, Bryan; Parker, Kim H; McG Thom, Simon A; Hughes, Alun D

    2014-07-01

    Excess pressure integral (XSPI), a new index of surplus work performed by the left ventricle, can be calculated from blood pressure waveforms and may indicate circulatory dysfunction. We investigated whether XSPI predicted future cardiovascular events and target organ damage in treated hypertensive individuals. Radial blood pressure waveforms were acquired by tonometry in 2069 individuals (aged, 63±8 years) in the Conduit Artery Functional Evaluation (CAFE) substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Measurements of left ventricular mass index (n=862) and common carotid artery intima media thickness (n=923) were also performed. XSPI and the integral of reservoir pressure were lower in people treated with amlodipine±perindopril than in those treated with atenolol±bendroflumethiazide, although brachial systolic blood pressure was similar. A total of 134 cardiovascular events accrued during a median 3.4 years of follow-up; XSPI was a significant predictor of cardiovascular events after adjustment for age and sex, and this relationship was unaffected by adjustment for conventional cardiovascular risk factors or Framingham risk score. XSPI, central systolic blood pressure, central augmentation pressure, central pulse pressure, and integral of reservoir pressure were correlated with left ventricular mass index, but only XSPI, augmentation pressure, and central pulse pressure were associated positively with carotid artery intima media thickness. Associations between left ventricular mass index, XSPI, and integral of reservoir pressure and carotid artery intima media thickness and XSPI were unaffected by multivariable adjustment for other covariates. XSPI is a novel indicator of cardiovascular dysfunction and independently predicts cardiovascular events and targets organ damage in a prospective clinical trial.

  11. Enneagram Personality System as an Effective Model in Prediction of Risk of Cardiovascular Diseases: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Saeid Komasi

    2016-09-01

    Full Text Available Introduction: Studies on behavioral patterns and personality traits play a critical role in the prediction of healthy or unhealthy behaviors and identification of high-risk individuals for cardiovascular diseases (CVDs in order to implement preventive strategies. This study aimed to compare personality types in individuals with and without CVD based on the enneagram of personality. Materials and Methods: This case-control study was conducted on 96 gender-matched participants (48 CVD patients and 48 healthy subjects.Data were collected using the Riso-Hudson Enneagram Type Indicator (RHETI. Data analysis was performed in SPSS V.20 using MANOVA, Chi-square, and T-test. Results: After adjustment for age and gender there is a significant difference between two groups (and male in term of personality types one and five. In CVD patients, score of personality type one (F(1,94=9.476 (P=0.003 was significantly higher, while score of personality type five was significantly lower (F(1,94=6.231 (P=0.014, compared to healthy subjects. However, this significant difference was only observed in the score of personality type one in female patients (F(1,66=4.382 (P=0.04. Conclusion: Identifying healthy personality type one individuals before CVD development, providing necessary training on the potential risk factors of CVDs, and implementation of preventive strategies (e.g., anger management skills could lead to positive outcomes for the society and healthcare system. It is recommended that further investigation be conducted in this regard.

  12. Preventing Heart Attacks and Strokes: Increasing Awareness of the Adverse Cardiovascular Health Impacts of Air Pollution

    Science.gov (United States)

    Summary: Chronic cardiovascular disease imposes a significant health and economic burden on individuals and communities. Despite decades of improvement in cardiovascular mortality, cardiovascular disease and stroke remain the leading cause of death in the U.S. and disparities i...

  13. High plasma cholesteryl ester transfer but not CETP mass predicts incident cardiovascular disease : A nested case control study

    NARCIS (Netherlands)

    Kappelle, Paul J.W.H.; Perton, Frank; Hillege, Hans L.; Dallinga-Thie, Geesje M.; Dullaart, Robin P. F.

    Objective: The relationship of cardiovascular disease (CVD) with plasma cholesteryl ester transfer protein (CETP) levels is controversial. We determined whether plasma cholesteryl ester transfer (CET), reflecting CETP-mediated transfer of cholesteryl esters from endogenous HDL towards apolipoprotein

  14. Joint audits - benefit or burden?

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    In this paper we examine whether there are perceived and observed benefits or burdens from using two audit firms instead of one. In 2005 the mandatory joint audit requirement was abolished in Denmark. This provides a unique setting for studying the consequences and implications of going from...... a joint audit regime to a single auditor/voluntary joint audit regime. The dataset used in this paper has been collected for the full population of non-financial Danish companies listed on the Copenhagen Stock Exchange (CSE) in the years 2004 and 2005. We find that a majority of firms perceive joint...... audits to be a net burden. Furthermore, based on DeAngelo's (1981) initial audit pricing model and legislators' claim that joint audits are an unnecessary economic burden to the companies we predict and find discounts (of around 25%) in audit fees in companies that change to single audits. The primary...

  15. Role of γ-glutamyl transferase levels in prediction of high cardiovascular risk among patients with non-alcoholic fatty liver disease

    Directory of Open Access Journals (Sweden)

    Benan Kasapoglu

    2016-01-01

    among patients with fatty liver disease should be regarded as a sign of increased cardiovascular disease risk. Larger studies are warranted to elucidate the role of GGT in prediction of cardiovascular risk.

  16. Epicardial Adipose Tissue Is Associated with Plaque Burden and Composition and Provides Incremental Value for the Prediction of Cardiac Outcome. A Clinical Cardiac Computed Tomography Angiography Study.

    Directory of Open Access Journals (Sweden)

    Gitsios Gitsioudis

    Full Text Available We sought to investigate the association of epicardial adipose tissue (eCAT volume with plaque burden, circulating biomarkers and cardiac outcomes in patients with intermediate risk for coronary artery disease (CAD.177 consecutive outpatients at intermediate risk for CAD and completed biomarker analysis including high-sensitive Troponin T (hs-TnT and hs-CRP underwent 256-slice cardiac computed tomography angiography (CCTA between June 2008 and October 2011. Patients with lumen narrowing ≥50% exhibited significantly higher eCAT volume than patients without any CAD or lumen narrowing 3 risk factors, presence of CAD, hs-CRP and hs-TnT.Epicardial adipose tissue volume is independently associated with plaque burden and maximum luminal narrowing by CCTA and may serve as an independent predictor for cardiac outcomes in patients at intermediate risk for CAD.

  17. Strategic integration of in vivo cardiovascular models during lead optimization: predictive value of 4 models independent of species, route of administration, and influence of anesthesia.

    Science.gov (United States)

    Fryer, Ryan M; Harrison, Paul C; Muthukumarana, Akalushi; Nodop Mazurek, Suzanne G; Ng, Khing Jow; Chen, Rong Rhonda; Harrington, Kyle E; Dinallo, Roger M; Chi, Liguo; Reinhart, Glenn A

    2012-04-01

    The strategic integration of in vivo cardiovascular models is important during lead optimization to enable a wide therapeutic index for cardiovascular safety. However, under what conditions (eg, species, route of administration, anesthesia) studies should be performed to drive go/no-go is open to interpretation. Two compounds, torcetrapib and a novel steroid hormone mimetic (SHM-1121X), both with off-target cardiovascular liabilities, were profiled in 4 in vivo cardiovascular models. Overlapping plasma concentrations of torcetrapib were achieved in all models tested; values ranged from therapeutic to supratherapeutic. In anesthetized rats, intravenous torcetrapib elicited dose-dependent increases in mean arterial pressure (MAP; 2-18 mm Hg above vehicle during the low- and high-dose infusion), and in anesthetized dogs, torcetrapib increased MAP from 4 to 22 mm Hg. In conscious rats, a single oral dose of torcetrapib increased MAP from 10 to 18 mm Hg in the low-dose and high-dose groups, respectively, whereas in conscious dogs, MAP increased from 3 to 12 mm Hg. SHM-1121X produced marked hypotension in the same models. Pharmacokinetic-pharmacodynamic analysis demonstrated strong correlation across the models tested for both compounds. Results suggest that equivalency across models allows for flexibility to address key issues and enable go/no-go during lead optimization without concern for discordant results. The predictive value of each model was validated with torcetrapib and, when put into practice, led to a decisive no-go for SHM-1121X.

  18. Using the Job Burden-Capital Model of Occupational Stress to Predict Depression and Well-Being among Electronic Manufacturing Service Employees in China

    Science.gov (United States)

    Wang, Chao; Li, Shuang; Li, Tao; Yu, Shanfa; Dai, Junming; Liu, Xiaoman; Zhu, Xiaojun; Ji, Yuqing; Wang, Jin

    2016-01-01

    Background: This study aimed to identify the association between occupational stress and depression-well-being by proposing a comprehensive and flexible job burden-capital model with its corresponding hypotheses. Methods: For this research, 1618 valid samples were gathered from the electronic manufacturing service industry in Hunan Province, China; self-rated questionnaires were administered to participants for data collection after obtaining their written consent. The proposed model was fitted and tested through structural equation model analysis. Results: Single-factor correlation analysis results indicated that coefficients between all items and dimensions had statistical significance. The final model demonstrated satisfactory global goodness of fit (CMIN/DF = 5.37, AGFI = 0.915, NNFI = 0.945, IFI = 0.952, RMSEA = 0.052). Both the measurement and structural models showed acceptable path loadings. Job burden and capital were directly associated with depression and well-being or indirectly related to them through personality. Multi-group structural equation model analyses indicated general applicability of the proposed model to basic features of such a population. Gender, marriage and education led to differences in the relation between occupational stress and health outcomes. Conclusions: The job burden-capital model of occupational stress-depression and well-being was found to be more systematic and comprehensive than previous models. PMID:27529267

  19. Using the Job Burden-Capital Model of Occupational Stress to Predict Depression and Well-Being among Electronic Manufacturing Service Employees in China

    Directory of Open Access Journals (Sweden)

    Chao Wang

    2016-08-01

    Full Text Available Background: This study aimed to identify the association between occupational stress and depression-well-being by proposing a comprehensive and flexible job burden-capital model with its corresponding hypotheses. Methods: For this research, 1618 valid samples were gathered from the electronic manufacturing service industry in Hunan Province, China; self-rated questionnaires were administered to participants for data collection after obtaining their written consent. The proposed model was fitted and tested through structural equation model analysis. Results: Single-factor correlation analysis results indicated that coefficients between all items and dimensions had statistical significance. The final model demonstrated satisfactory global goodness of fit (CMIN/DF = 5.37, AGFI = 0.915, NNFI = 0.945, IFI = 0.952, RMSEA = 0.052. Both the measurement and structural models showed acceptable path loadings. Job burden and capital were directly associated with depression and well-being or indirectly related to them through personality. Multi-group structural equation model analyses indicated general applicability of the proposed model to basic features of such a population. Gender, marriage and education led to differences in the relation between occupational stress and health outcomes. Conclusions: The job burden-capital model of occupational stress-depression and well-being was found to be more systematic and comprehensive than previous models.

  20. Scintigraphic calf perfusion symmetry after exercise and prediction of cardiovascular events: One stone to kill two birds?

    Energy Technology Data Exchange (ETDEWEB)

    Tellier, Philippe [Centre de Medecine Nucleaire de l' Artois, Clinique Sainte Catherine, 62 223 Sainte Catherine Les Arras (France)]. E-mail: phtellier2@wanadoo.fr; Lecouffe, Pascal [Centre de Medecine Nucleaire de l' Artois, Clinique Sainte Catherine, 62 223 Sainte Catherine Les Arras (France); Zureik, Mahmoud [National Institute of Health and Medical Research (INSERM), Unit 508, Institut Pasteur de Lille (France)

    2007-02-01

    Background: Peripheral arterial disease (PAD) is commonly associated with a high cardiovascular mortality and morbidity as a marker of plurifocal atherosclerosis. Whether exercise thallium perfusion muscular asymmetry in the legs associated with PAD has prognostic value is unknown. Such a hypothesis was evaluated in a prospective study which remains the gold standard in clinical research. Methods and results: Scintigraphic calf perfusion symmetry after exercise (SCPSE) was measured at the end of a maximal or symptom-limited treadmill exercise test in 358 patients with known or suspected coronary artery disease (CAD). During the follow-up period (mean 85.3{+-}32.8 months), 93 cardiovascular events and deaths (incident cases) occurred. Among those incident cases, the percentage of subjects with higher SCPSE values (third tertile) was 45.2%, versus 29.1% in controls (lower tertiles) (p=0.005). In stepwise multivariate analysis performed with the Cox proportional hazards model, previous CAD and SCPSE were the only significant independent predictors of prognosis. The multivariate relative risk of cardiovascular death or event in subjects with higher values of SCPSE was 1.94 (95% CI: 1.15-3.21; p<0.01). Conclusions: Scintigraphic calf perfusion asymmetry after exercise was independently associated with incident cardiovascular events in high-risk subjects. This index, which is easily and quickly calculated, could be used for evaluation of cardiovascular risk.

  1. Prediction of 10-year Atherosclerotic Cardiovascular Disease Risk among Adults Aged 40-79 Years in China: a Nationally Representative Survey.

    Science.gov (United States)

    Zhang, Mei; Jiang, Yong; Wang, Li Min; Li, Yi Chong; Huang, Zheng Jing; Li, Jian Hong; Zhou, Mai Geng; Zhao, Wen Hua

    2017-04-01

    To establish the distribution of 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Chinese adults. We estimated the 10-year ASCVD risk by applying the 2013 American College of Cardiology/ American Heart Association pooled cohort equations (PCEs) to the data obtained from the 2010 China Chronic Disease and Risk Factor Surveillance that involved 61,541 participants (representing 520,158,652 Chinese adults) aged 40-79 years. We also compared the ASCVD risk with the 10-year ischemic cardiovascular disease (ICVD) risk, which was calculated using the simplified scoring tables recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases (Chinese model). Based on the PCEs, the average 10-year ASCVD risk among adults without self-reported stroke or myocardial infraction was 12.5%. Approximately 247 million (47.4%) and 107 million (20.6%) adults had ⋝ 7.5% and > 20% 10-year ASCVD risks, respectively. The 10-year ASCVD risk > 20% was higher among men, less educated individuals, smokers, drinkers, and physically inactive individuals than among their counterparts. Overall, 29.0% of adults categorized using the Chinese model were overclassified with the PCEs. Our results define the distribution of 10-year ASCVD risk among Chinese adults. The 10-year ASCVD risk predicted by the PCEs was higher than the ICVD risk predicted by the Chinese model. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  2. Reduced brachial flow-mediated vasodilation in young adult ex extremely low birth weight preterm: a condition predictive of increased cardiovascular risk?

    Science.gov (United States)

    Bassareo, P P; Fanos, V; Puddu, M; Demuru, P; Cadeddu, F; Balzarini, M; Mercuro, G

    2010-10-01

    Sporadic data present in literature report how preterm birth and low birth weight constitute the risk factors for the development of cardiovascular diseases in later life. To assess the presence of potential alterations to endothelial function in young adults born preterm at extremely low birth weight (Cesarea, Israel). Endothelial function was significantly reduced in ex-ELBW subjects compared to C (1.94 +/- 0.37 vs. 2.68 +/- 0.41, p < 0.0001). Moreover, this function correlated significantly with gestational age (r = 0.56, p < 0.0009) and birth weight (r = 0.63, p < 0.0001). The results obtained reveal a significant decrease in endothelial function of ex-ELBW subjects compared to controls, underlining a probable correlation with preterm birth and low birth weight. Taken together, these results suggest that an ELBW may underlie the onset of early circulatory dysfunction predictive of increased cardiovascular risk.

  3. First month prednisone dose predicts prednisone burden during the following 11 months: an observational study from the RELES cohort

    OpenAIRE

    2016-01-01

    Aim To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2–12). Methods 223 patients from the Registro Español de Lupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2–12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium do...

  4. A neurodegenerative vascular burden index and the impact on cognition

    Directory of Open Access Journals (Sweden)

    Sebastian eHeinzel

    2014-07-01

    Full Text Available A wide range of vascular burden factors have been identified to impact vascular function and structure as indicated by carotid intima-media thickness (IMT. On the basis of their impact on IMT, vascular factors may be selected and clustered in a vascular burden index (VBI. Since many vascular factors increase the risk of Alzheimer's disease (AD, a multifactorial neurodegenerative VBI may be related to early pathological processes in AD and cognitive decline in its preclinical stages.We investigated an elderly cohort at risk for neurodegeneration (TREND study, n = 1102 for the multifactorial influence of vascular burden factors on IMT measured by ultrasound. To create a VBI for this cohort, vascular factors and their definitions (considering medical history, medication and/or blood marker data were selected based on their statistical effects on IMT in multiple regressions including age and sex. The impact of the VBI on cognitive performance was assessed using the Trail-Making Test (TMT and the CERAD neuropsychological battery.IMT was significantly predicted by age (standardized β = .26, sex (.09; males > females and the factors included in the VBI: obesity (.18, hypertension (.14, smoking (.08, diabetes (.07, and atherosclerosis (.05, whereas other cardiovascular diseases or hypercholesterolemia were not significant. Individuals with 2 or more VBI factors compared to individuals without had an odds ratio of 3.17 regarding overly increased IMT (≥1.0 mm. The VBI showed an impact on executive control (log(TMT B-A, p = .047 and a trend towards decreased global cognitive function (CERAD total score, p = .057 independent of age, sex and education.A VBI established on the basis of IMT may help to identify individuals with overly increased vascular burden linked to decreased cognitive function indicating neurodegenerative processes. The longitudinal study of this risk cohort will reveal the value of the VBI as prodromal marker for cognitive decline and

  5. Prevalence of cardiovascular risks factors and 10 year predictions of coronary heart disease in seafarers of Pertamina shipping (Indonesia)

    DEFF Research Database (Denmark)

    Purnawarma, Irwin GNI; Jensen, Olaf Chresten; Canals, ML

    2011-01-01

    Background Cardiovascular disease is (CVD) is becoming a major health problem in the world and they have to be taken into account in shipping companies. Employees and Company management should be aware of the dangers and implications, CVD can bring. Objectives To obtain the prevalence of cardiova...

  6. Eosinophilia and positive skin tests predict cardiovascular mortality in a general population sample followed for 30 years

    NARCIS (Netherlands)

    Hospers, JJ; Rijcken, P; Schouten, JP; Postma, DS; Weiss, ST

    1999-01-01

    The authors investigated whether two objective allergy markers, peripheral blood eosinophilia and skin tests for common aeroallergens, were associated with cardiovascular death. Of 5,382 subjects in the Vlagtwedde-Vlaardingen Study (the Netherlands) with data on allergy markers in 1965-1972, 507

  7. Coronary artery calcification score by multislice computed tomography predicts the outcome of dobutamine cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    Janssen, CHC; Kuijpers, D; Vliegenthart, R; Overbosch, J; van Dijkman, PRM; Zijlstra, F; Oudkerk, M

    The aim of this study was to determine whether a coronary artery calcium (CAC) score of less than 11 can reliably rule out myocardial ischemia detected by dobutamine cardiovascular magnetic resonance imaging (CMR) in patients suspected of having myocardial ischemia. In 114 of 136 consecutive

  8. An exploratory analysis of criteria for the metabolic syndrome and its prediction of long-term cardiovascular outcomes

    NARCIS (Netherlands)

    Girman, C.J.; Dekker, J.M.; Rhodes, T.; Nijpels, M.G.A.A.M.; Stehouwer, C.D.A.; Bouter, L.M.; Heine, R.J.

    2005-01-01

    /=2 components in women. Exploratory analyses of alternative metabolic syndrome criteria suggest cardiovascular risk estimates comparable to those derived by using NCEP, but criteria evaluating risk on more of a continuum would potentially allow consideration of alternative definitions by gender or

  9. Non-linear Equation using Plasma Brain Natriuretic Peptide Levels to Predict Cardiovascular Outcomes in Patients with Heart Failure

    Science.gov (United States)

    Fukuda, Hiroki; Suwa, Hideaki; Nakano, Atsushi; Sakamoto, Mari; Imazu, Miki; Hasegawa, Takuya; Takahama, Hiroyuki; Amaki, Makoto; Kanzaki, Hideaki; Anzai, Toshihisa; Mochizuki, Naoki; Ishii, Akira; Asanuma, Hiroshi; Asakura, Masanori; Washio, Takashi; Kitakaze, Masafumi

    2016-11-01

    Brain natriuretic peptide (BNP) is the most effective predictor of outcomes in chronic heart failure (CHF). This study sought to determine the qualitative relationship between the BNP levels at discharge and on the day of cardiovascular events in CHF patients. We devised a mathematical probabilistic model between the BNP levels at discharge (y) and on the day (t) of cardiovascular events after discharge for 113 CHF patients (Protocol I). We then prospectively evaluated this model on another set of 60 CHF patients who were readmitted (Protocol II). P(t|y) was the probability of cardiovascular events occurring after >t, the probability on t was given as p(t|y) = -dP(t|y)/dt, and p(t|y) = pP(t|y) = αyβP(t|y), along with p = αyβ (α and β were constant); the solution was p(t|y) = αyβ exp(-αyβt). We fitted this equation to the data set of Protocol I using the maximum likelihood principle, and we obtained the model p(t|y) = 0.000485y0.24788 exp(-0.000485y0.24788t). The cardiovascular event-free rate was computed as P(t) = 1/60Σi=1,…,60 exp(-0.000485yi0.24788t), based on this model and the BNP levels yi in a data set of Protocol II. We confirmed no difference between this model-based result and the actual event-free rate. In conclusion, the BNP levels showed a non-linear relationship with the day of occurrence of cardiovascular events in CHF patients.

  10. The increasing burden of depression

    Directory of Open Access Journals (Sweden)

    Lépine J-P

    2011-05-01

    Full Text Available Jean-Pierre Lépine1, Mike Briley21Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris Unité INSERM 705 CNRS UMR 8206, Université Paris Diderot, Paris, France; 2NeuroBiz Consulting and Communication, Castres, FranceAbstract: Recent epidemiological surveys conducted in general populations have found that the lifetime prevalence of depression is in the range of 10% to 15%. Mood disorders, as defined by the World Mental Health and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, have a 12-month prevalence which varies from 3% in Japan to over 9% in the US. A recent American survey found the prevalence of current depression to be 9% and the rate of current major depression to be 3.4%. All studies of depressive disorders have stressed the importance of the mortality and morbidity associated with depression. The mortality risk for suicide in depressed patients is more than 20-fold greater than in the general population. Recent studies have also shown the importance of depression as a risk factor for cardiovascular death. The risk of cardiac mortality after an initial myocardial infarction is greater in patients with depression and related to the severity of the depressive episode. Greater severity of depressive symptoms has been found to be associated with significantly higher risk of all-cause mortality including cardiovascular death and stroke. In addition to mortality, functional impairment and disability associated with depression have been consistently reported. Depression increases the risk of decreased workplace productivity and absenteeism resulting in lowered income or unemployment. Absenteeism and presenteeism (being physically present at work but functioning suboptimally have been estimated to result in a loss of $36.6 billion per year in the US. Worldwide projections by the World Health Organization for the year 2030 identify unipolar major depression as the leading cause of disease burden

  11. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography.

    Science.gov (United States)

    Zhang, Yan; Li, Sha; Guo, Yuan-Lin; Wu, Na-Qiong; Zhu, Cheng-Gang; Gao, Ying; Xu, Rui-Xia; Dong, Qian; Liu, Geng; Sun, Jing; Li, Jian-Jun

    2016-08-01

    Recently, monocyte-to-high density lipoprotein ratio (MHR) has been proposed as a novel prognostic indicator of cardiovascular diseases. However, no study is currently available regarding the comparison between MHR and monocyte count (MC) in predicting the outcomes among patients undergoing coronary angiography. A total of 3798 patients scheduled for selective coronary angiography were enrolled and followed up to capture major adverse cardiovascular events (MACEs, death, acute myocardial infarction, unstable angina, stroke, heart failure, and unexpected coronary revascularization). Cox proportional hazards models were used to evaluate the risk of MHR or MC on MACEs. During a median of 24.6 months follow-up, 347 (9.1%) MACEs occurred. The upper tertiles of MC and MHR have a significant lower event-free survival (p = 0.011; p = 0.014, respectively). Significantly, both MC and MHR were associated with increased MACEs risk after adjusting for potential confounders [adjusted HR (95% CI): 2.734 (1.547-4.832); 2.031 (1.268-3.254), respectively]. Additionally, the area under the receiver-operating characteristic curves of MC or MHR in predicting MACEs were 0.574 (0.542-0.606) and 0.562 (0.530-0.594) (p MHR was an independent predictor of MACEs whereas the prognostic impact was not superior to MC in patients who underwent coronary angiography. Key Messages MHR has been suggested as a novel prognostic indicator of several cardiovascular diseases. No study is currently available regarding the comparison of MHR to MC in predicting the outcomes in a large cohort of patients undergoing coronary angiography. Our data firstly indicate that MHR is independently associated with MACEs in patients undergoing coronary angiography whereas the prognostic impact is similar to MC.

  12. Effects of nutrition and exercise health behaviors on predicted risk of cardiovascular disease among workers with different body mass index levels.

    Science.gov (United States)

    Huang, Jui-Hua; Huang, Shu-Ling; Li, Ren-Hau; Wang, Ling-Hui; Chen, Yu-Ling; Tang, Feng-Cheng

    2014-04-29

    Workplace health promotion programs should be tailored according to individual needs and efficient intervention. This study aimed to determine the effects of nutrition and exercise health behaviors on predicted risk for cardiovascular disease (CVD) when body mass index (BMI) is considered. In total, 3350 Taiwanese workers were included in this cross-sectional study. A self-reported questionnaire was used to measure their nutrition and exercise behaviors. Data on anthropometric values, biochemical blood determinations, and predicted CVD risk (using the Framingham risk score) were collected. In multiple regression analyses, the nutrition behavior score was independently and negatively associated with CVD risk. Exercise was not significantly associated with the risk. However, the interactive effect of exercise and BMI on CVD risk was evident. When stratified by BMI levels, associations between exercise and CVD risk were statistically significant for ideal weight and overweight subgroups. In conclusion, nutrition behavior plays an important role in predicting the CVD risk. Exercise behavior is also a significant predictor for ideal weight and overweight workers. Notably, for underweight or obese workers, maintaining health-promoting exercise seems insufficient to prevent the CVD. In order to improve workers' cardiovascular health, more specific health-promoting strategies should be developed to suit the different BMI levels.

  13. Effects of Nutrition and Exercise Health Behaviors on Predicted Risk of Cardiovascular Disease among Workers with Different Body Mass Index Levels

    Directory of Open Access Journals (Sweden)

    Jui-Hua Huang

    2014-04-01

    Full Text Available Workplace health promotion programs should be tailored according to individual needs and efficient intervention. This study aimed to determine the effects of nutrition and exercise health behaviors on predicted risk for cardiovascular disease (CVD when body mass index (BMI is considered. In total, 3350 Taiwanese workers were included in this cross-sectional study. A self-reported questionnaire was used to measure their nutrition and exercise behaviors. Data on anthropometric values, biochemical blood determinations, and predicted CVD risk (using the Framingham risk score were collected. In multiple regression analyses, the nutrition behavior score was independently and negatively associated with CVD risk. Exercise was not significantly associated with the risk. However, the interactive effect of exercise and BMI on CVD risk was evident. When stratified by BMI levels, associations between exercise and CVD risk were statistically significant for ideal weight and overweight subgroups. In conclusion, nutrition behavior plays an important role in predicting the CVD risk. Exercise behavior is also a significant predictor for ideal weight and overweight workers. Notably, for underweight or obese workers, maintaining health-promoting exercise seems insufficient to prevent the CVD. In order to improve workers’ cardiovascular health, more specific health-promoting strategies should be developed to suit the different BMI levels.

  14. Improving long-term prediction of first cardiovascular event: the contribution of family history of coronary heart disease and social status.

    Science.gov (United States)

    Veronesi, G; Gianfagna, F; Giampaoli, S; Chambless, L E; Mancia, G; Cesana, G; Ferrario, M M

    2014-07-01

    The aim of this study is to assess whether family history of coronary heart disease (CHD) and education as proxy of social status improve long-term cardiovascular disease risk prediction in a low-incidence European population. The 20-year risk of first coronary or ischemic stroke events was estimated using sex-specific Cox models in 3956 participants of three population-based surveys in northern Italy, aged 35-69 years and free of cardiovascular disease at enrollment. The additional contribution of education and positive family history of CHD was defined as change in discrimination and Net Reclassification Improvement (NRI) over the model including 7 traditional risk factors. Kaplan-Meier 20-year risk was 16.8% in men (254 events) and 6.4% in women (102 events). Low education (hazard ratio=1.35, 95%CI 0.98-1.85) and family history of CHD (1.55; 1.19-2.03) were associated with the endpoint in men, but not in women. In men, the addition of education and family history significantly improved discrimination by 1%; NRI was 6% (95%CI: 0.2%-15.2%), raising to 20% (0.5%-44%) in those at intermediate risk. NRI in women at intermediate risk was 7%. In low-incidence populations, family history of CHD and education, easily assessed in clinical practice, should be included in long-term cardiovascular disease risk scores, at least in men. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. miRNA-197 and miRNA-223 Predict Cardiovascular Death in a Cohort of Patients with Symptomatic Coronary Artery Disease.

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    Christian Schulte

    Full Text Available Circulating microRNAs (miRNAs have been described as potential diagnostic biomarkers in cardiovascular disease and in particular, coronary artery disease (CAD. Few studies were undertaken to perform analyses with regard to risk stratification of future cardiovascular events. miR-126, miR-197 and miR-223 are involved in endovascular inflammation and platelet activation and have been described as biomarkers in the diagnosis of CAD. They were identified in a prospective study in relation to future myocardial infarction.The aim of our study was to further evaluate the prognostic value of these miRNAs in a large prospective cohort of patients with documented CAD.Levels of miR-126, miR-197 and miR-223 were evaluated in serum samples of 873 CAD patients with respect to the endpoint cardiovascular death. miRNA quantification was performed using real time polymerase chain reaction (RT-qPCR.The median follow-up period was 4 years (IQR 2.78-5.04. The median age of all patients was 64 years (IQR 57-69 with 80.2% males. 38.9% of the patients presented with acute coronary syndrome (ACS, 61.1% were diagnosed with stable angina pectoris (SAP. Elevated levels of miRNA-197 and miRNA-223 reliably predicted future cardiovascular death in the overall group (miRNA-197: hazard ratio (HR 1.77 per one standard deviation (SD increase (95% confidence interval (CI 1.20; 2.60, p = 0.004, C-index 0.78; miRNA-223: HR 2.23 per one SD increase (1.20; 4.14, p = 0.011, C-index 0.80. In ACS patients the prognostic power of both miRNAs was even higher (miRNA-197: HR 2.24 per one SD increase (1.25; 4.01, p = 0.006, C-index 0.89; miRA-223: HR 4.94 per one SD increase (1.42; 17.20, p = 0.012, C-index 0.89.Serum-derived circulating miRNA-197 and miRNA-223 were identified as predictors for cardiovascular death in a large patient cohort with CAD. These results reinforce the assumption that circulating miRNAs are promising biomarkers with prognostic value with respect to future

  16. Nonfasting hyperlipidemia and cardiovascular disease

    DEFF Research Database (Denmark)

    Nordestgaard, B G; Langsted, A; Freiberg, J J

    2009-01-01

    , total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A1 all associate with increased risk of cardiovascular disease. These new data open the possibility that nonfasting rather than fasting lipid profiles can be used for cardiovascular risk prediction. If implemented, this would...... of cardiovascular disease and early death....

  17. Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors

    DEFF Research Database (Denmark)

    Schoormans, Dounya; van de Poll-Franse, Lonneke; Vissers, Pauline

    2017-01-01

    .05-1.08] after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk [HR = 0.89; 95% CI 0.52-1.53]. Older age [HR = 1.06; 95% CI 1.05-1.08], hypertension [HR = 1.80; 95% CI 1.32-2.46], and hypercholesterolemia [HR = 1......PURPOSE: To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics...... in a population-based observational study. METHODS: Adult 1-year breast cancer survivors (n = 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD...

  18. The Global Cancer Burden

    Centers for Disease Control (CDC) Podcasts

    2012-02-02

    This podcast describes the global burden of cancer and efforts by CDC and others to reduce that burden.  Created: 2/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 2/2/2012.

  19. Predicting cardiovascular disease morbidity and mortality in chronic kidney disease in Spain. The rationale and design of NEFRONA: a prospective, multicenter, observational cohort study

    Directory of Open Access Journals (Sweden)

    Roig Jordi

    2010-07-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD. Cardiovascular risk assessment in this population is hampered by the failure of traditional risk factors to fully account for the elevated CVD risk (reverse epidemiology effect and the presence of emerging risk factors specifically related to kidney failure. Therefore, diagnostic tools capable of improving cardiovascular risk assessment beyond traditional risk factors are currently warranted. We present the protocol of a 4-year prospective study aimed to assess the predictive value of non-invasive imaging techniques and biomarkers for CVD events and mortality in patients with CKD. Methods From November 2009 to October 2010, 4137 asymptomatic adult patients with stages 2 to 5 CKD will be recruited from nephrology services and dialysis units throughout Spain. During the same period, 843 participants without CKD (control group will be recruited from lists of primary care physicians, only at baseline. During the follow-up, CVD events and mortality will be recorded from all CKD patients. Clinical and laboratory characteristics will be collected in a medical documentation sheet. Three trained itinerant teams will carry out a carotid ultrasound to assess intima-media thickness and presence of plaques. A composite atherosclerosis score will be constructed based on carotid ultrasound data and measurement of ankle-brachial index. In CKD patients, presence and type of calcifications will be assessed in the wall of carotid, femoral and brachial arteries, and in cardiac valves, by ultrasound. From all participants, blood samples will be collected and stored in a biobank to study novel biomarkers. Conclusions The NEFRONA study is the first large, prospective study to examine the predictive value of several non-invasive imaging techniques and novel biomarkers in CKD patients throughout Spain. Hereby, we present the

  20. Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic

    Directory of Open Access Journals (Sweden)

    Duggirala Sivaram Prasad

    2011-01-01

    Full Text Available Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.

  1. Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa

    Science.gov (United States)

    Hemphill, Linda C.; Palai, Tommy; Nkele, Isaac; Bennett, Kara; Lockman, Shahin; Triant, Virginia A.

    2017-01-01

    Objectives HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA). Methods HIV-infected adults from 30–50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III–NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden’s J index. Results Among 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar’s exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar’s exact test p = 0.34). Youden’s J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66–0.99). Conclusion While the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with

  2. Caregiver Burden: Looking Beyond the Unidimensional Total Score.

    Science.gov (United States)

    Lau, Sabrina; Chong, Mei Sian; Ali, Noorhazlina; Chan, Mark; Chua, Kia Chong; Lim, Wee Shiong

    2015-01-01

    The Zarit Burden Interview allows caregiver burden to be interpreted from a total score. However, recent studies propose a multidimensional Zarit Burden Interview model. This study aims to determine the agreement between unidimensional (UD) and multidimensional (MD) classification of burden, and differences in predictors among identified groups. We studied 165 dyads of dementia patients and primary caregivers. Caregivers were dichotomized into low-burden and high-burden groups based upon: (1) UD score using quartile cutoffs; and (2) MD model via exploratory cluster analysis. We compared UD versus MD 2×2 classification of burden using κ statistics. Caregivers not showing agreement by either definition were classified as "intermediate" burden. We performed binary logistic regression to ascertain differences in predictive factors. The 2 models showed moderate agreement (κ=0.72, P<0.01), yielding 104 low, 20 intermediate (UD "low burden"/MD "high burden"), and 41 high-burden caregivers. Neuropsychiatric symptoms [odds ratio (OR)=1.27, P=0.003], coresidence (OR=6.32, P=0.040), and decreased caregiving hours (OR=0.99, P=0.018) were associated with intermediate burden, whereas neuropsychiatric symptoms (OR=1.21, P=0.001) and adult children caregivers (OR=2.80, P=0.055) were associated with high burden. Our results highlight the differences between UD and MD classification of caregiver burden. Future studies should explore the significance of the noncongruent intermediate group and its predictors.

  3. High aortic augmentation index predicts mortality and cardiovascular events in men from a general population, but not in women

    DEFF Research Database (Denmark)

    Janner, Julie Hjortsø; Godtfredsen, Nina Skavlan; Ladelund, Steen

    2012-01-01

    Background: A recent meta-analysis concluded that augmentation index (AIx), a measure of pulse wave reflections influencing the central blood pressure, is related to mortality and cardiovascular disease (CVD) events and is likely to be clinically useful. However, prospective data based on non high...... relates to CVD in men but question the value in women. This gender differences may relate to different development in AIx with increasing age in men and women. Further studies are needed before AIx can be considered in CVD risk stratification or clinical practice....

  4. Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction

    DEFF Research Database (Denmark)

    Langsted, A.; Freiberg, J.J.; Nordestgaard, Børge

    2008-01-01

    years of age from the Copenhagen General Population Study. We also studied 9319 individuals 20 to 93 years of age from the Copenhagen City Heart Study, 1166 of whom developed cardiovascular events during 14 years of follow-up. Compared with fasting levels, total cholesterol, low-density lipoprotein...... to HDL cholesterol, and ratio of apolipoprotein B to apolipoprotein A1 did not change in response to normal food intake. The maximum changes after normal food and fluid intake from fasting levels were -0.2 mmol/L for total cholesterol, -0.2 mmol/L for low-density lipoprotein cholesterol, -0.1 mmol...

  5. Is the 90th Percentile Adequate? The Optimal Waist Circumference Cutoff Points for Predicting Cardiovascular Risks in 124,643 15-Year-Old Taiwanese Adolescents.

    Directory of Open Access Journals (Sweden)

    Jason Jiunshiou Lee

    Full Text Available Adolescent obesity has increased to alarming proportions globally. However, few studies have investigated the optimal waist circumference (WC of Asian adolescents. This study sought to establish the optimal WC cutoff points that identify a cluster of cardiovascular risk factors (CVRFs among 15-year-old ethnically Chinese adolescents. This study was a regional population-based study on the CVRFs among adolescents who enrolled in all the senior high schools in Taipei City, Taiwan, between 2011 and 2014. Four cross-sectional health examinations of first-year senior high school (grade 10 students were conducted from September to December of each year. A total of 124,643 adolescents aged 15 (boys: 63,654; girls: 60,989 were recruited. Participants who had at least three of five CVRFs were classified as the high-risk group. We used receiver-operating characteristic curves and the area under the curve (AUC to determine the optimal WC cutoff points and the accuracy of WC in predicting high cardiovascular risk. WC was a good predictor for high cardiovascular risk for both boys (AUC: 0.845, 95% confidence interval [CI]: 0.833-0.857 and girls (AUC: 0.763, 95% CI: 0.731-0.795. The optimal WC cutoff points were ≥78.9 cm for boys (77th percentile and ≥70.7 cm for girls (77th percentile. Adolescents with normal weight and an abnormal WC were more likely to be in the high cardiovascular risk group (odds ratio: 3.70, 95% CI: 2.65-5.17 compared to their peers with normal weight and normal WC. The optimal WC cutoff point of 15-year-old Taiwanese adolescents for identifying CVRFs should be the 77th percentile; the 90th percentile of the WC might be inadequate. The high WC criteria can help health professionals identify higher proportion of the adolescents with cardiovascular risks and refer them for further evaluations and interventions. Adolescents' height, weight and WC should be measured as a standard practice in routine health checkups.

  6. Soluble CD40 ligand is elevated in type 1 diabetic nephropathy but not predictive of mortality, cardiovascular events or kidney function.

    Science.gov (United States)

    Lajer, Maria; Tarnow, Inge; Michelson, Alan D; Jorsal, Anders; Frelinger, Andrew L; Parving, Hans-Henrik; Rossing, Peter; Tarnow, Lise

    2010-01-01

    Soluble CD40 ligand (sCD40L) derived from platelets mediates atherothrombosis, leading to proinflammatory and proatherosclerotic responses. We investigated the predictive value of plasma sCD40L for all-cause mortality, cardiovascular mortality and morbidity, progression towards end-stage renal disease (ESRD) and rate of decline in glomerular filtration rate (GFR) in patients with type 1 diabetes (T1DM) and nephropathy. The study was a prospective, observational follow-up study of 443 T1DM patients with diabetic nephropathy (274 men; age 42.1 ± 10.5 years [mean ± SD], duration of diabetes 28.3 ± 8.9 years, GFR 76 ± 33 ml/min/1.73 m2) and a control group of 421 patients with longstanding type 1 diabetes and persistent normoalbuminuria (232 men; age 45.4 ± 11.5 years, duration of diabetes 27.7 ± 10.1 years) at baseline. sCD40L was measured by ELISA. Plasma sCD40L levels were higher in patients with diabetic nephropathy compared to normoalbuminuric patients (median (range) 1.54 (0.02-13.38) vs. 1.30 (0.04-20.65) µg/L, respectively p = 0.004). The patients were followed for 8.1 (0.0-12.9) years (median (range)). Among normoalbuminuric patients, sCD40L levels did not predict all-cause mortality (p = 0.33) or combined fatal and non-fatal cardiovascular disease (CVD) (p = 0.27). Similarly, among patients with diabetic nephropathy, the covariate adjusted sCD40L levels did not predict all-cause mortality (p = 0.86) or risk of fatal and non-fatal CVD (p = 0.08). Furthermore, high levels of sCD40L did not predict development of ESRD (p = 0.85) nor rate of decline in GFR (p = 0.69). Plasma sCD40L is elevated in T1DM nephropathy but is not a predictor of all-cause mortality, cardiovascular mortality and morbidity or deterioration of kidney function

  7. CHADS2 Scores in the Prediction of Major Adverse Cardiovascular Events in Patients with Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Yuh-Feng Wang

    2014-01-01

    Full Text Available Vascular events are one of the major causes of death in case of Cushing’s syndrome (CS. However, due to the relative low frequency of CS, it is hard to perform a risk assessment for these events. As represented congestive heart failure (C, hypertension (H, age (A, diabetes (D, and stroke (S, the CHADS2 score is now accepted to classify the risk of major adverse cardiovascular events (MACEs in patients with atrial fibrillation. In this study, participants were enrolled from the National Health Research Institute Database (NHIRD of Taiwan, and we reviewed 551 patients with their sequential clinically diagnosed CS data between 2002 and 2009 in relation to MACEs risk using CHADS2 score. Good correlation could be identified between the CS and CHADS2 score (AUC=0.795. Our results show that patients with CS show significantly higher risk of vascular events and the CHADS2 score could be applied for MACEs evaluation. Adequate lifestyle modifications and aggressive cardiovascular risks treatment are suggested for CS patients with higher CHADS2 score.

  8. Using Support Vector Machine to Predict Eco-environment Burden:A Case Study of Wuhan,Hubei Province,China1

    Institute of Scientific and Technical Information of China (English)

    XIANG-MEI LI; JING-XUAN ZHOU; SONG-HU YUAN; XIN-PING ZHOU; QIANG FU

    2008-01-01

    Objective The human socio-economic development depends on the planet's natural capital.Humans have had a considerable impact on the earth,such as resources depression and environment deterioration.The objective of this study was to assess the impact of socio-eeonomic development on the ecological environment of Wuhan,Hubei Province,China,during the general planning period 2006-2020. Methods Support vector machine(SVM) model was constructed to simulate the process of eco-economic system of Wuhan.Socio-economic factors of urban total ecological footprint(TEF)were selected by partial least squares(PLS)and leave-one-out cross validation(LOOCV).Historical data of socio-economic factors as inputs,and corresponding historical data of TEF as target outputs.were presented to identify and validate the SVM model.When simulated as output in succession. Results Up to 2020,the district would have suffered an accumulative TEF of 28.374 million gha,which was over 1.5 times that of 2004 and healrly 3 times that of 1988.The per capita EF would be up to 3.019 gha in 2020. Conclusions The simulation indicated that although the increase rate of GDP would be restricted in a lower level during the general planning period,urban ecological environment burden could not respond to the socio-economic circumstances promptly.SVM provides tools for dynamic assessment of regional eco-environment.However,there still exist limitations and disadvantages in the model.We believe that the next logical step in deriving better dynamic models of ecosystem is to integrate SVM and other algorithms or technologies.

  9. A platelet P-selectin test predicts adverse cardiovascular events in patients with acute coronary syndromes treated with aspirin and clopidogrel.

    Science.gov (United States)

    Thomas, Mark R; Wijeyeratne, Yanushi D; May, Jane A; Johnson, Andrew; Heptinstall, Stan; Fox, Susan C

    2014-01-01

    There is wide variation in response to antiplatelet therapy and high on-treatment platelet reactivity is associated with adverse cardiovascular events. The objective here was to determine whether the results of a novel strategy for assessing platelet reactivity (based on P-selectin measurement) are associated with clinical outcomes in patients with acute coronary syndromes (ACS). This was a prospective cohort study of 100 ACS patients taking aspirin and clopidogrel. P-selectin tests designed to assess response to P2Y12 antagonists or aspirin were performed alongside light transmission aggregometry. For the P2Y12 P-selectin test, an optimal cutoff for high platelet reactivity was determined by receiver operating characteristic (ROC) curve analysis. Patients were divided into two cohorts based on this value: patients with (n = 42) or without (n = 58) high platelet reactivity. The primary endpoint was defined as the composite of cardiovascular death, myocardial infarction and stent thrombosis. After 12 months, the primary endpoint occurred in 12 patients. ROC curve analysis determined that the P2Y12 P-selectin test results were predictive of the primary endpoint (area under curve = 0.69, p = 0.046). The primary endpoint occurred more frequently in patients with high on-treatment platelet reactivity compared to those without (21.4% vs. 5.2%; hazard ratio (HR) 4.14; p = 0.026). The P2Y12 P-selectin test results correlated with light transmission aggregometry (Spearman p P-selectin test, only two patients demonstrated high on-treatment platelet reactivity. This study suggests that a P2Y12 P-selectin test is capable of detecting high on-treatment platelet reactivity, which is associated with subsequent cardiovascular events.

  10. ANGPTL4 variants E40K and T266M are associated with lower fasting triglyceride levels and predicts cardiovascular disease risk in Type 2 diabetic Tunisian population.

    Science.gov (United States)

    Abid, Kaouthar; Trimeche, Thouraya; Mili, Donia; Msolli, Mohamed Amine; Trabelsi, Imen; Nouira, Semir; Kenani, Abderraouf

    2016-03-23

    Angiopoietin-like protein 4 (ANGPTL4) is a metabolic factor that increases plasma triglyceride levels by inhibiting lipoprotein lipase (LPL). The objective of this study was to investigate the association of ANGPTL4 variants (E40K and T266M) with triglyceride levels and with cardiovascular risk factors, such as metabolic syndrome (MetS) and obesity in type 2 diabetic Tunisian population. We investigated the effect of the tagging single nucleotide polymorphisms (SNPs) rs1044250 (T266M) and rs116843064 (E40K) with triglyceride (TG) levels and CAD risk factors in a cohort of 220 patients undergoing coronary angiography for the evaluation of stable CAD, all of whom had (type 2 diabetes) T2D and were at least overweight. Multivariate logistic regressions were performed on association studies. TT genotype of rs1044250 (T266M variant) showed a protective effect on CVD risk in CAD group patients (OR 1.92, 95% CI 0.601.42, p =0.05) compared with control Group patients (OR 1.17, 95% CI 0.70-1.66, p = 0.72). Likewise, GA genotype of rs116843064 (E40K variant): (OR 0.74, 95% CI 0.54-1.65, p =0.01) for the CAD group compared with control Group patients (OR 1.12, 95% CI 0.68-1.74, p = 0.074). ANGPTL4 variants are associated with, not only lower fasting triglyceride levels, but also a decreased cardiovascular risk in T2D Tunisian patients. So, T266M and E40K polymorphism predicts cardiovascular disease risk in Type 2 diabetic Tunisian population.

  11. Observed and predicted reduction of ischemic cardiovascular events in the Simvastatin and Ezetimibe in Aortic Stenosis trial

    DEFF Research Database (Denmark)

    Holme, Ingar; Boman, Kurt; Brudi, Philippe

    2010-01-01

    In the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial, combined ezetimibe (10 mg) and simvastatin (40 mg) decreased low-density lipoprotein cholesterol levels by 50% and ischemic cardiovascular event (ICE) risk by 22% compared to placebo. A larger decrease in ICE risk might have been...... expected for the degree of lipid-lowering observed. This analysis investigated relations between changes in lipoprotein components (LCs), and ICE risk decrease in the SEAS trial in all patients, by severity of aortic stenosis (AS), and compared to results of other clinical trials. A total of 1,570 patients...... with baseline aortic jet velocity (JV) data, baseline and 1-year low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and apolipoprotein B, and no ICEs during the first year were included in the analysis. Relations between on-treatment measurements of 1-year LCs and time-to-ICE occurrence...

  12. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals.

    Science.gov (United States)

    Chandran, S; Parker, F; Lontos, S; Vaughan, R; Efthymiou, M

    2015-12-01

    Polyps identified at colonoscopy are predominantly diminutive (1%) of high-grade dysplasia or carcinoma; however, the cost of histological assessment is substantial. The aim of this study was to determine whether prediction of colonoscopy surveillance intervals based on real-time endoscopic assessment of polyp histology is accurate and cost effective. A prospective cohort study was conducted across a tertiary care and private community hospital. Ninety-four patients underwent colonoscopy and polypectomy of diminutive (≤5 mm) polyps from October 2012 to July 2013, yielding a total of 159 polyps. Polyps were examined and classified according to the Sano-Emura classification system. The endoscopic assessment (optical diagnosis) of polyp histology was used to predict appropriate colonoscopy surveillance intervals. The main outcome measure was the accuracy of optical diagnosis of diminutive colonic polyps against the gold standard of histological assessment. Optical diagnosis was correct in 105/108 (97.2%) adenomas. This yielded a sensitivity, specificity and positive and negative predictive values (with 95%CI) of 97.2% (92.1-99.4%), 78.4% (64.7-88.7%), 90.5% (83.7-95.2%) and 93% (80.9-98.5%) respectively. Ninety-two (98%) patients were correctly triaged to their repeat surveillance colonoscopy. Based on these findings, a cut and discard approach would have resulted in a saving of $319.77 per patient. Endoscopists within a tertiary care setting can accurately predict diminutive polyp histology and confer an appropriate surveillance interval with an associated financial benefit to the healthcare system. However, limitations to its application in the community setting exist, which may improve with further training and high-definition colonoscopes. © 2015 Royal Australasian College of Physicians.

  13. Similar support for three different life course socioeconomic models on predicting premature cardiovascular mortality and all-cause mortality

    Directory of Open Access Journals (Sweden)

    Lynch John

    2006-08-01

    Full Text Available Abstract Background There are at least three broad conceptual models for the impact of the social environment on adult disease: the critical period, social mobility, and cumulative life course models. Several studies have shown an association between each of these models and mortality. However, few studies have investigated the importance of the different models within the same setting and none has been performed in samples of the whole population. The purpose of the present study was to study the relation between socioeconomic position (SEP and mortality using different conceptual models in the whole population of Scania. Methods In the present investigation we use socioeconomic information on all men (N = 48,909 and women (N = 47,688 born between 1945 and 1950, alive on January, 1st,1990, and living in the Region of Scania, in Sweden. Focusing on three specific life periods (i.e., ages 10–15, 30–35 and 40–45, we examined the association between SEP and the 12-year risk of premature cardiovascular mortality and all-cause mortality. Results There was a strong relation between SEP and mortality among those inside the workforce, irrespective of the conceptual model used. There was a clear upward trend in the mortality hazard rate ratios (HRR with accumulated exposure to manual SEP in both men (p for trend Conclusion There was a strong relation between SEP and cardiovascular and all-cause mortality, irrespective of the conceptual model used. The critical period, social mobility, and cumulative life course models, showed the same fit to the data. That is, one model could not be pointed out as "the best" model and even in this large unselected sample it was not possible to adjudicate which theories best describe the links between life course SEP and mortality risk.

  14. Feature Selection Using Particle Swarm Optimization for Predicting the Risk of Cardiovascular Disease in Type-II Diabetic Patients

    Directory of Open Access Journals (Sweden)

    P. Radha

    2014-11-01

    Full Text Available Diabetes is the most common disease nowadays in all populations and in all age groups. A wide range of computational methods and tools for data analysis are available to predict the T2D patients with CVD risk factors. Efficient predictive modelling is required for medical researchers and practitioners to improve the prediction accuracy of the classification methods .The aim of this research was to identify significant factors influencing type 2 diabetes control with CVD risk factors, by applying particle swarm optimization feature selection system to improve prediction accuracy and knowledge discovery. Proposed system consists of four major steps such as preprocessing and dimensionality reduction of type 2 diabetes with CVD factors, Attribute Value Measurement, Feature Selection, and Hybrid Prediction Model. In proposed methods the pre-processing and dimensionality reduction of the patients records is performed by using Kullback Leiber Divergence(KLD Principal component analysis (PCA, then attribute values measurement is performed using Fast Correlation-Based Filter Solution(FCBFS, feature selection is performed by using Particle Swarm Optimization (PSO, finally hybrid prediction model which uses Improved Fuzzy C Means (IFCM clustering algorithm aimed at validating chosen class label of given data and subsequently applying Extreme Learning Machine(ELM classification algorithm to the result set.

  15. Predictive Validity of the American College of Cardiology/American Heart Association Pooled Cohort Equations in Predicting All-Cause and Cardiovascular Disease-Specific Mortality in a National Prospective Cohort Study of Adults in the United States.

    Science.gov (United States)

    Loprinzi, Paul D; Addoh, Ovuokerie

    2016-06-01

    The predictive validity of the Pooled Cohort risk (PCR) equations for cardiovascular disease (CVD)-specific and all-cause mortality among a national sample of US adults has yet to be evaluated, which was this study's purpose. Data from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed up through December 31, 2011, to ascertain mortality status via the National Death Index probabilistic algorithm. The analyzed sample included 11,171 CVD-free adults (40-79 years of age). The 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined from the PCR equations. For the entire sample encompassing 849,202 person-months, we found an incidence rate of 1.00 (95% CI, 0.93-1.07) all-cause deaths per 1000 person-months and an incidence rate of 0.15 (95% CI, 0.12-0.17) CVD-specific deaths per 1000 person-months. The unweighted median follow-up duration was 72 months. For nearly all analyses (unadjusted and adjusted models with ASCVD expressed as a continuous variable as well as dichotomized at 7.5% and 20%), the ASCVD risk score was significantly associated with all-cause and CVD-specific mortality (Pequations was associated with all-cause and CVD-specific mortality among those free of CVD at baseline. In this American adult sample, the PCR equations provide evidence of predictive validity.

  16. Prediction of intermittent claudication, ischemic stroke, and other cardiovascular disease by detection of abdominal aortic calcific deposits by plain lumbar radiographs.

    Science.gov (United States)

    Levitzky, Yamini S; Cupples, L Adrienne; Murabito, Joanne M; Kannel, William B; Kiel, Douglas P; Wilson, Peter W F; Wolf, Philip A; O'Donnell, Christopher J

    2008-02-01

    There has been little attention to vascular calcium testing for generalized assessment of cardiovascular disease (CVD) outcomes, such as intermittent claudication (IC) and ischemic stroke (IS). We hypothesize that aortic calcium is an important predictor of CVD outcomes. Lumbar x-rays were obtained in 848 men and 1,301 women (mean ages 59.7 and 60.1 years, respectively) from the original cohort of the Framingham Heart Study. Abdominal aortic calcium (AAC) deposits were graded using a previously validated scale. Participants were categorized according to a 10-year Framingham coronary heart disease (CHD) risk score. Multivariable Cox proportional hazards analyses were performed to relate AAC to CVD outcomes. There were 199 IC events, 201 IS events, 702 CHD events, and 1,121 CVD events during 32 years of follow-up. Multivariable adjusted hazard ratios for the third versus first AAC tertile in the combined cohort were 1.68 (95% confidence interval [CI] 1.12 to 2.50) for IC, 1.73 (95% CI 1.12 to 2.65) for IS, 1.59 (95% CI 1.26 to 2.00) for CHD, and 1.64 (95% CI 1.37 to 1.97) for CVD. Hazard ratios for IC and IS were similar in magnitude to those for CHD and CVD. A high AAC score was associated with significantly higher incidence of events in subjects at intermediate Framingham CHD risk for all end points. Risk prediction based on cardiovascular risk factors improved for most outcomes when AAC was added. In conclusion, there was a graded, increasing, and independent association of AAC with incident IC and IS, similar in magnitude to risks predicted for CHD and CVD. AAC appears to be useful for risk stratification in patients at intermediate CHD risk.

  17. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study.

    Directory of Open Access Journals (Sweden)

    Giustino Parruti

    Full Text Available BACKGROUND: Psychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients. METHODOLOGY/PRINCIPAL FINDINGS: HIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure and Carotid Plaques (CPs, focal thickening ≥1.5 mm were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II, Type D personality (Distressed Personality or Type D by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20. Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5% attended IMT measurements; 201 (86.6% attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4% had CPs at baseline. Nineteen patients (9.5% had ≥1 vascular event; 12 (6.0% died due to such events (n = 4 or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression and CPs (logistic regression. At follow-up analysis, log-rank tests and Cox's regression revealed that only older age (p = 0.001, current smoking (p = 0.019 and alexithymia score≥50 (p = 0.013 were independently associated with vascular events. CONCLUSIONS/SIGNIFICANCE: In HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs

  18. Validation of the Ability of SYNTAX and Clinical SYNTAX Scores to Predict Adverse Cardiovascular Events After Stent Implantation: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Chen, JiaYuan; Tang, Buzhou; Lin, YongQing; Ru, Ying; Wu, MaoXiong; Wang, Xiaolong; Chen, Qingcai; Chen, YangXin; Wang, JingFeng

    2016-10-01

    To compare the predicative ability of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and clinical SYNTAX scores for major adverse cardiac events (MACEs) after stent implantation in patients with coronary artery disease (CAD). Studies were identified by electronic and manual searches. Twenty-six studies were included in the meta-analysis. The pooled C-statistics of SYNTAX score for 1- and 5-year all-cause mortality (ACM) were 0.65 (95% confidence interval [CI]: 0.61-0.68) and 0.62 (95% CI: 0.59-0.65), respectively, with weak heterogeneity. The 1- and 5-year ACM pooled C-statistics for clinical SYNTAX scores were significantly higher at 0.77 and 0.71, respectively (Ps SYNTAX score for predicting 1-year ACM per unit was 1.04 (95% CI: 1.03-1.05). Calibration analysis indicated SYNTAX scores overestimated the risk of major adverse cardiac and cerebrovascular events in each risk stratum. The SYNTAX score demonstrated minimal discrimination in predicting 1- or 5-year adverse cardiovascular events after percutaneous coronary intervention in patients with CAD. The clinical SYNTAX score could further improve the predictive capability for ACM but not MACE.

  19. Maternal short stature does not predict their children's fatness indicators in a nutritional dual-burden sample of urban Mexican Maya.

    Science.gov (United States)

    Wilson, Hannah J; Dickinson, Federico; Griffiths, Paula L; Bogin, Barry; Hobbs, Matthew; Varela-Silva, M Inês

    2014-04-01

    The co-existence of very short stature due to poor chronic environment in early life and obesity is becoming a public health concern in rapidly transitioning populations with high levels of poverty. Individuals who have very short stature seem to be at an increased risk of obesity in times of relative caloric abundance. Increasing evidence shows that an individual is influenced by exposures in previous generations. This study assesses whether maternal poor early life environment predicts her child's adiposity using cross sectional design on Maya schoolchildren aged 7-9 and their mothers (n = 57 pairs). We compared maternal chronic early life environment (stature) with her child's adiposity (body mass index [BMI] z-score, waist circumference z-score, and percentage body fat) using multiple linear regression, controlling for the child's own environmental exposures (household sanitation and maternal parity). The research was performed in the south of Merida, Yucatan, Mexico, a low socioeconomic urban area in an upper middle income country. The Maya mothers were very short, with a mean stature of 147 cm. The children had fairly high adiposity levels, with BMI and waist circumference z-scores above the reference median. Maternal stature did not significantly predict any child adiposity indicator. There does not appear to be an intergenerational component of maternal early life chronic under-nutrition on her child's obesity risk within this free living population living in poverty. These results suggest that the co-existence of very short stature and obesity appears to be primarily due to exposures and experiences within a generation rather than across generations. Copyright © 2013 Wiley Periodicals, Inc.

  20. Multifactorial Prevention of Cardiovascular Disease in Patients with Hypertension : the Cardiovascular Polypill

    NARCIS (Netherlands)

    Lafeber, M; Spiering, W; Visseren, F L J; Grobbee, D E

    2016-01-01

    Hypertension is a major, if not the most important, contributor to the disease burden and premature death globally which is largely related to cardiovascular disease. In both the primary and the secondary preventions of cardiovascular disease, blood pressure (BP) targets are often not achieved which

  1. Index of central obesity as a parameter to replace waist circumference for the definition of metabolic syndrome in predicting cardiovascular disease.

    Science.gov (United States)

    Luo, Wenshu; Guo, Zhirong; Wu, Ming; Hao, Chao; Zhou, Zhengyuan; Yao, Xingjuan

    2014-10-01

    To compare the suitability of metabolic syndrome definitions in predicting cardiovascular disease (CVD) risk. We analyzed data from a population-based prospective cohort of 3598 participants from Jiangsu, China. Waist circumference was replaced with central obesity [index of central obesity (ICO), a ratio of waist circumference and height] in Cholesterol Education Program Adult Treatment Panel III (ICO-replaced ATPIII) and International Diabetes Federation (ICO-replaced IDF), respectively. Cox proportional-hazards regression model and the receiver operating characteristic curve (ROC curve) was used to evaluate the suitability of ATPIII, IDF, ICO-replaced IDF and ICO-replaced ATPIII in predicting CVD risk. ICO was a better parameter in predicting CVD risk by ROC curve analysis. The ROC curve analysis also showed that although ICO-replaced IDF and IDF had the higher degree of specificity, lower sensitivity, longer ROC curve distance, less area under the curve to identify CVD than ATPIII and ICO-replaced ATPIII, therefore ICO-replaced IDF and IDF seemed to be undesirable. However, there was no significant difference in area under the curve between ATPIII and ICO-replaced ATPIII in predicting CVD risk. But it seems that odds ratios for abnormal triglyceride and high-density lipoprotein levels increase slightly when using ICO, but decrease for hyperglycemia and hypertension when using ICO. ICO was a better predictor of abnormal triglyceride and high-density lipoprotein levels than waist circumference, but waist circumference was a better predictor of hyperglycemia and hypertension than ICO. However, we failed to support ICO as a better parameter for metabolic syndrome definition in predicting CVD risk compared with waist circumference.

  2. Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes.

    Science.gov (United States)

    Zafrir, Barak; Azencot, Mali; Dobrecky-Mery, Idit; Lewis, Basil S; Flugelman, Moshe Y; Halon, David A

    2016-08-01

    Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes. We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (heart rate reserve), abnormal heart rate recovery at 1 minute 100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke. Resting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease. © The European Society of Cardiology 2015.

  3. Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts

    Science.gov (United States)

    Rücker, Viktoria; Keil, Ulrich; Fitzgerald, Anthony P; Malzahn, Uwe; Prugger, Christof; Ertl, Georg; Heuschmann, Peter U; Neuhauser, Hannelore

    2016-01-01

    Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk. PMID:27612145

  4. Predicted impact of various clinical practice strategies on cardiovascular risk for the treatment of hypertension: a clinical trial simulation study.

    Science.gov (United States)

    Jin, Yuyan; Bies, Robert; Gastonguay, Marc R; Wang, Yaning; Stockbridge, Norman; Gobburu, Jogarao; Madabushi, Rajanikanth

    2014-12-01

    Hypertension control rate in the US is low with the current clinical practice (JNC 7) and cardiovascular disease (CVD) remain is the leading cause of morbidity and mortality. A 6-month clinical trial simulation case study testing different virtual clinical practice strategies was performed in an attempt to increase the control rate. The CVD risk was calculated using the Framingham CVD risk model at baseline and 6 months post-treatment. The estimated CVD events for the baseline patient sample without any treatment was 998 (95% CI: 967-1,026) over 6 months in 100,000 patients. Treating these patients for 6 months with current clinical practice, high dose strategy, high dose with low target BP strategy resulted in a reduction in CVD events of 191(95% CI: 169-205), 284 (95% CI: 261-305), and 353 (95% CI: 331-375), respectively. Hence the two alternative strategies resulted in an increase in treatment effect by 49% (95%CI: 44-59%) and 85% (95%CI: 79-99%), respectively. The increased safety with the current low dose strategy may potentially be offset by increased CVD risk in the time necessary to control hypertension.

  5. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

    Science.gov (United States)

    Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2010-07-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

  6. Lipid and Some Other Cardiovascular Risk Factors Assessment in a ...

    African Journals Online (AJOL)

    Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural ... of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in ... and risk predictive index were higher in females while triglyceride (TG), high density ...

  7. The FTO gene rs9939609 polymorphism predicts risk of cardiovascular disease: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chibo Liu

    Full Text Available OBJECTIVE: Genome-wide association studies have shown that variance in the fat mass- and obesity- associated gene (FTO is associated with risk of obesity in Europeans and Asians. Since obesity is associated with an increased risk of cardiovascular disease (CVD, several studies have investigated the association between variant in the FTO gene and CVD risk, with inconsistent results. In this study, we performed a meta-analysis to clarify the association of rs9939609 variant (or its proxies [r (2>0.90] in the FTO gene with CVD risk. METHODS: Published literature from PubMed and Embase was retrieved. Pooled odds ratios with 95% confidence intervals were calculated using the fixed- or random- effects model. RESULTS: A total of 10 studies (comprising 19,153 CVD cases and 103,720 controls were included in the meta-analysis. The results indicated that the rs9939609 variant was significantly associated with CVD risk (odds ratio = 1.18, 95% confidence interval = 1.07-1.30, p = 0.001 [Z test], I (2 = 80.6%, p<0.001 [heterogeneity], and there was an insignificant change after adjustment for body mass index (BMI and other conventional CVD risk factors (odds ratio = 1.16, 95% confidence interval = 1.05-1.27, p = 0.003 [Z test], I (2 = 75.4%, p<0.001 [heterogeneity]. CONCLUSIONS: The present meta-analysis confirmed the significant association of the rs9939609 variant in the FTO gene with CVD risk, which was independent of BMI and other conventional CVD risk factors.

  8. Rising Burden of Obesity in Asia

    Directory of Open Access Journals (Sweden)

    Ambady Ramachandran

    2010-01-01

    Full Text Available Overweight and obesity have reached epidemic proportions in many Asian countries. These countries also face a grave burden of obesity-related disorders such as diabetes, hypertension, and cardiovascular diseases, which develop at a younger age than in Western populations. These disorders are also manifested in childhood. The major causative factors are related to the lifestyle changes occurring due to rapid socioeconomic transition. Asian populations show several differences in genetic factors when compared with the white population, and they also have lower cut points for environmental risk factors. National programmes targeting public awareness, education and improved structural facilities to facilitate healthy lifestyle are the keys to alleviate the economic and health care burden of the obesity-related disorders.

  9. Carotid plaque burden as a measure of subclinical atherosclerosis

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Muntendam, Pieter; Adourian, Aram

    2012-01-01

    The purpose of this study was to compare carotid plaque burden, carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and abdominal aortic diameter (AAD) to coronary artery calcium score (CACS) in people without known cardiovascular disease....

  10. Predicted changes in fatty acid intakes, plasma lipids, and cardiovascular disease risk following replacement of trans fatty acid-containing soybean oil with application-appropriate alternatives.

    Science.gov (United States)

    Lefevre, Michael; Mensink, Ronald P; Kris-Etherton, Penny M; Petersen, Barbara; Smith, Kim; Flickinger, Brent D

    2012-10-01

    The varied functional requirements satisfied by trans fatty acid (TFA)--containing oils constrains the selection of alternative fats and oils for use as potential replacements in specific food applications. We aimed to model the effects of replacing TFA-containing partially hydrogenated soybean oil (PHSBO) with application-appropriate alternatives on population fatty acid intakes, plasma lipids, and cardiovascular disease (CVD) risk. Using the National Health and Nutrition Examination Survey 24-hour dietary recalls for 1999-2002, we selected 25 food categories, accounting for 86 % of soybean oil (SBO) and 79 % of TFA intake for replacement modeling. Before modeling, those in the middle quintile had a mean PHSBO TFA intake of 1.2 % of energy. PHSBO replacement in applications requiring thermal stability by either low-linolenic acid SBO or mid-oleic, low-linolenic acid SBO decreased TFA intake by 0.3 % of energy and predicted CVD risk by 0.7-0.8 %. PHSBO replacement in applications requiring functional properties with palm-based oils reduced TFA intake by 0.8 % of energy, increased palmitic acid intake by 1.0 % of energy, and reduced predicted CVD risk by 0.4 %, whereas replacement with fully hydrogenated interesterified SBO reduced TFA intake by 0.7 % of energy, increased stearic acid intake by 1.0 % of energy, and decreased predicted CVD risk by 1.2 %. PHSBO replacement in both thermal and functional applications reduced TFA intake by 1.0 % of energy and predicted CVD risk by 1.5 %. Based solely on changes in plasma lipids and lipoproteins, all PHSBO replacement models reduced estimated CVD risk, albeit less than previously reported using simpler replacement models.

  11. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

    Science.gov (United States)

    Lassale, Camille; Gunter, Marc J; Romaguera, Dora; Peelen, Linda M; Van der Schouw, Yvonne T; Beulens, Joline W J; Freisling, Heinz; Muller, David C; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K; Katzke, Verena A; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Boer, Jolanda M A; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G M; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.

  12. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

    Science.gov (United States)

    Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  13. Simulation analysis of economic burden in hypertension and myocardial infarction treatment with beta blockers

    Directory of Open Access Journals (Sweden)

    Maja Atanasijevič Kunc

    2012-02-01

    Full Text Available Background: Hypertension has become a veryfrequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicatingthat treatment costs in patients with hypertension and cardiovascular diseases representan important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become evenworse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projectionsindicating the expected trends of mentioned problems in the forthcoming decades would also be of interest.Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groupsof patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations

  14. Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Udompunturak Suthipol

    2008-09-01

    Full Text Available Abstract Background The objective was to compare the value of late gadolinium enhancement (LGE and end-diastolic wall thickness (EDWT assessed by cardiovascular magnetic resonance (CMR in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG. Methods We enrolled patients with coronary artery disease and left ventricular ejection fraction Results We studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 ± 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6% and 1,196 segments (59.2% respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2% that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC curves demonstrated that the LGE area was the most important predictor (p Conclusion LGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.

  15. Apolipoprotein B/A-I and total cholesterol/high-density lipoprotein cholesterol ratios both predict cardiovascular events in the general population independently of nonlipid risk factors, albuminuria and C-reactive protein

    NARCIS (Netherlands)

    Kappelle, P.J.W.H.; Gansevoort, R. T.; Hillege, J. L.; Wolffenbuttel, B. H. R.; Dullaart, R. P. F.

    2011-01-01

    Background. The total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and apolipoprotein (apo) B/A-I ratios predict major adverse cardiovascular events (MACEs). The extent to which these associations are modified by high-sensitivity C-reactive protein (hs-CRP) and albuminuria is largely

  16. Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers.

    NARCIS (Netherlands)

    Jacobs, P.C.; Prokop, M.; Graaf, Y. van der; Gondrie, M.J.; Janssen, K.J.; Koning, H.J. de; Isgum, I.; Klaveren, R.J.J. van; Oudkerk, M.; Ginneken, B. van; Mali, W.P.Th.

    2010-01-01

    BACKGROUND: Coronary artery calcium (CAC) and thoracic aorta calcium (TAC) can be detected simultaneously on low-dose, non-gated computed tomography (CT) scans. CAC has been shown to predict cardiovascular (CVD) and coronary (CHD) events. A comparable association between TAC and CVD events has yet t

  17. Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers

    NARCIS (Netherlands)

    Jacobs, Peter C.; Prokop, Mathias; van der Graaf, Yolanda; Gondrie, Martijn J.; Janssen, Kristel J.; de Koning, Harry J.; Isgum, Ivana; van Klaveren, Rob J.; Oudkerk, Matthijs; van Ginneken, Bram; Mali, Willem P.

    2010-01-01

    Background: Coronary artery calcium (CAC) and thoracic aorta calcium (TAC) can be detected simultaneously on low-dose, non-gated computed tomography (CT) scans. CAC has been shown to predict cardiovascular (CVD) and coronary (CHD) events. A comparable association between TAC and CVD events has yet t

  18. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil;

    2015-01-01

    BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship......%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups. CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1...

  19. Cardiovascular Deconditioning

    Science.gov (United States)

    Charles, John B.; Fritsch-Yelle, Janice M.; Whitson, Peggy A.; Wood, Margie L.; Brown, Troy E.; Fortner, G. William

    1999-01-01

    Spaceflight causes adaptive changes in cardiovascular function that may deleteriously affect crew health and safety. Over the last three decades, symptoms of cardiovascular changes have ranged from postflight orthostatic tachycardia and decreased exercise capacity to serious cardiac rhythm disturbances during extravehicular activities (EVA). The most documented symptom of cardiovascular dysfunction, postflight orthostatic intolerance, has affected a significant percentage of U.S. Space Shuttle astronauts. Problems of cardiovascular dysfunction associated with spaceflight are a concern to NASA. This has been particularly true during Shuttle flights where the primary concern is the crew's physical health, including the pilot's ability to land the Orbiter, and the crew's ability to quickly egress and move to safety should a dangerous condition arise. The study of astronauts during Shuttle activities is inherently more difficult than most human research. Consequently, sample sizes have been small and results have lacked consistency. Before the Extended Duration Orbiter Medical Project (EDOMP), there was a lack of normative data on changes in cardiovascular parameters during and after spaceflight. The EDOMP for the first time allowed studies on a large enough number of subjects to overcome some of these problems. There were three primary goals of the Cardiovascular EDOMP studies. The first was to establish, through descriptive studies, a normative data base of cardiovascular changes attributable to spaceflight. The second goal was to determine mechanisms of cardiovascular changes resulting from spaceflight (particularly orthostatic hypotension and cardiac rhythm disturbances). The third was to evaluate possible countermeasures. The Cardiovascular EDOMP studies involved parallel descriptive, mechanistic, and countermeasure evaluations.

  20. Combining psychosocial data to improve prediction of cardiovascular disease risk factors and events:: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study

    Science.gov (United States)

    Whittaker, Kerry S.; Krantz, David S.; Rutledge, Thomas; Johnson, B. Delia; Wawrzyniak, Andrew J.; Bittner, Vera; Eastwood, Jo-Ann; Eteiba, Wafia; Cornell, Carol E.; Pepine, Carl J.; Vido, Diane A.; Handberg, Eileen; Merz, C. Noel Bairey

    2012-01-01

    Background There is overlap among psychosocial variables associated with cardiovascular disease (CVD), and utility of combining psychosocial variables as risk markers for understanding CVD is largely unknown. Methods Women (n=493) in the NHLBI Women's Ischemia Syndrome Evaluation (WISE) Study were evaluated. The predictive value for CVD events was determined for multivariate combination of Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Social Network Index (SNI), and Cook-Medley hostility (Ho) scales. Principal components analysis of psychosocial scales revealed composite psychosocial risk markers, and their relationships to CVD events and risk factors were assessed. Results In a multivariate model, the block of SNI, Hostile Affect, STAI and BDI predicted CVD events (χ2[6]=27.8, p<0.001). Scale-wise factor analysis revealed two factors: Negative Affectivity (NA) and Hostility(explained variance 45.6% and 17.1%, respectively). SNI didn't load on either factor. NA was associated with BMI (β [SE] = 0.18[0.09], p=0.04), Hostility with metabolic syndrome (Exp(β)= 0.60[0.28], p=0.04), both factors with blood pressure (BP). NA with SBP β=2.53[1.04], p=0.02, DBP β=1.66[0.60], p=0.02; Hostility with SBP β=2.72[1.13], p=0.02, DBP β =1.83[0.65], p=0.005). Neither factor predicted CVD events. In multivariable analyses, original scales were associated with CVD events (lower SNI HR=0.74, CI=0.57–0.96), low Hostile Affect (HR=0.80, CI=0.56–1.03), and higher BDI(HR=1.33, CI=1.08–1.74). Conclusion In women with suspected ischemia, there is shared variance among psychosocial variables. Multivariate combination of psychosocial risk markers predicts CVD events; derived psychosocial factors were associated with CVD risk factors but not events. Measuring common and unique variance among psychosocial variables may be useful for understanding and predicting CVD. PMID:22434916

  1. Predicting cardiovascular disease morbidity and mortality in chronic kidney disease in Spain. The rationale and design of NEFRONA: a prospective, multicenter, observational cohort study

    OpenAIRE

    Roig Jordi; Sarró Felipe; Vidal Teresa; Valdivielso Jose; Coll Blai; Borràs Mercè; Martínez Montserrat; Junyent Mireia; Craver Lourdes; Fernández Elvira

    2010-01-01

    Abstract Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Cardiovascular risk assessment in this population is hampered by the failure of traditional risk factors to fully account for the elevated CVD risk (reverse epidemiology effect) and the presence of emerging risk factors specifically related to kidney failure. Therefore, diagnostic tools capable of improving cardiovascular risk assessment beyond tradit...

  2. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis.

    Science.gov (United States)

    Ataklte, Feven; Erqou, Sebhat; Kaptoge, Stephen; Taye, Betiglu; Echouffo-Tcheugui, Justin B; Kengne, Andre P

    2015-02-01

    The burden of hypertension in Sub-Saharan Africa has been increasing over the past few decades. However, a large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease in the region. We conducted a systematic review and meta-analysis to assess the recent burden of hypertension in Sub-Saharan Africa, based on studies published between 2000 and 2013. We pooled data from 33 surveys involving over 110 414 participants of mean age 40 years. Hypertension prevalence varied widely across the studies (range 15%-70%), partly because of differences in participant mean ages (31-76 years). The predicted prevalence of hypertension at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%-34%). Of those with hypertension, only between 7% and 56% (pooled prevalence: 27%; 95% confidence interval, 23%-31%) were aware of their hypertensive status before the surveys. Overall, 18% (95% confidence interval, 14%-22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%-8%) had controlled blood pressure. This review found a high prevalence of hypertension, as well as low percentage of hypertension awareness, treatment, and control in Sub-Saharan Africa, highlighting the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention.

  3. The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sillanpaa, Niko; Hakomaki, Jari; Lahteela, Arto; Dastidar, Prasun; Soimakallio, Seppo [Tampere University Hospital, Medical Imaging Center, Tampere (Finland); Saarinen, Jukka T.; Numminen, Heikki; Elovaara, Irina [Tampere University Hospital, Department of Neurology, Tampere (Finland); Rusanen, Harri [Oulu University Hospital, Department of Neurology, Oulu (Finland)

    2012-07-15

    Recently two classification methods based on the location and the extent of thrombosis detected with CT angiography have been introduced: the Boston Acute Stroke Imaging Scale (BASIS) and the clot burden score (CBS). We studied the performance of BASIS and CBS in predicting good clinical outcome (mRS {<=}2 at 90 days) in an acute (<3 h) stroke cohort treated with intravenous thrombolytic therapy. Eighty-three consecutive patients who underwent multimodal CT were analyzed. Binary logistic regression model was used to assess how BASIS, CBS, and cerebral blood volume (CBV) ASPECTS predict favorable clinical outcome. Diagnostic sensitivities and specificities were calculated and compared. Patients with low CBS and CBV ASPECTS scores and major strokes according to BASIS had significantly higher admission NIHSS scores, larger perfusion defects, and more often poor clinical outcome. In logistic regression analysis, CBV ASPECTS, CBS and BASIS were significantly associated with the clinical outcome. The performance of BASIS improved when patients with thrombosis of the M2 segment of the middle cerebral artery were classified as having minor stroke (M1-BASIS). In the anterior circulation, the sum of CBS and CBV ASPECTS (CBSV) proved to be the most robust predictor of favorable outcome. CBV ASPECTS and CBS had high sensitivity but moderate to poor specificity while BASIS was only moderately sensitive and specific. CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. (orig.)

  4. Asbestos Burden Predicts Survival in Pleural Mesothelioma

    OpenAIRE

    Christensen, Brock C; Roelofs, Cora R.; Longacker, Jennifer L.; Marsit, Carmen J; Nelson, Heather H.; Kelsey, Karl T.; Godleski, John Joseph; Bueno, Raphael; Sugarbaker, David John

    2008-01-01

    Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of < 1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. Objective: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods: We studied incident cases of MPM...

  5. The Supply and Demand of the Cardiovascular Workforce

    Science.gov (United States)

    Narang, Akhil; Sinha, Shashank S.; Rajagopalan, Bharath; Ijioma, Nkechinyere N.; Jayaram, Natalie; Kithcart, Aaron P.; Tanguturi, Varsha K.; Cullen, Michael W.

    2017-01-01

    As the burden of cardiovascular disease in the United States continues to increase, uncertainty remains on how well-equipped the cardiovascular workforce is to meet the challenges that lie ahead. In a time when health care is rapidly shifting, numerous factors affect the supply and demand of the cardiovascular workforce. This Council Commentary critically examines several factors that influence the cardiovascular workforce. These include current workforce demographics and projections, evolving health care and practice environments, and the increasing burden of cardiovascular disease. Finally, we propose 3 strategies to optimize the workforce. These focus on cardiovascular disease prevention, the effective utilization of the cardiovascular care team, and alterations to the training pathway for cardiologists. PMID:27712782

  6. Cardiovascular System

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    2011189 Vulnerable plaque burden post pharmaco-logical and interventional treatments in patients with acute coronary syndrome and borderline lesion: intravascular ultrasound follow up results. YU Danqing (余丹青)

  7. The innate immune response to coxsackievirus B3 predicts progression to cardiovascular disease and heart failure in male mice

    Directory of Open Access Journals (Sweden)

    Onyimba Jennifer A

    2011-02-01

    Full Text Available Abstract Background Men are at an increased risk of dying from heart failure caused by inflammatory heart diseases such as atherosclerosis, myocarditis and dilated cardiomyopathy (DCM. We previously showed that macrophages in the spleen are phenotypically distinct in male compared to female mice at 12 h after infection. This innate immune profile mirrors and predicts the cardiac immune response during acute myocarditis. Methods In order to study sex differences in the innate immune response, five male and female BALB/c mice were infected intraperitoneally with coxsackievirus B3 (CVB3 or phosphate buffered saline and their spleens were harvested 12 h later for microarray analysis. Gene expression was determined using an Affymetrix Mouse Gene 1.0 ST Array. Significant gene changes were verified by quantitative real-time polymerase chain reaction or ELISA. Results During the innate immune response to CVB3 infection, infected males had higher splenic expression of genes which are important in regulating the influx of cholesterol into macrophages, such as phospholipase A2 (PLA2 and the macrophage scavenger receptor compared to the infected females. We also observed a higher expression in infected males compared to infected females of squalene synthase, an enzyme used to generate cholesterol within cells, and Cyp2e1, an enzyme important in metabolizing cholesterol and steroids. Infected males also had decreased levels of the translocator protein 18 kDa (TSPO, which binds PLA2 and is the rate-limiting step for steroidogenesis, as well as decreased expression of the androgen receptor (AR, which indicates receptor activation. Gene differences were not due to increased viral replication, which was unaltered between sexes. Conclusions We found that, compared to females, male mice had a greater splenic expression of genes which are important for cholesterol metabolism and activation of the AR at 12 h after infection. Activation of the AR has been linked to

  8. Does IQ predict total and cardiovascular disease mortality as strongly as other risk factors? Comparison of effect estimates using the Vietnam Experience Study

    DEFF Research Database (Denmark)

    Batty, G D; Shipley, M J; Gale, C R

    2008-01-01

    To compare the strength of the relation of two measurements of IQ and 11 established risk factors with total and cardiovascular disease (CVD) mortality.......To compare the strength of the relation of two measurements of IQ and 11 established risk factors with total and cardiovascular disease (CVD) mortality....

  9. Prediction of cardiovascular disease mortality by proteinuria and reduced kidney function: pooled analysis of 39,000 individuals from 7 cohort studies in Japan.

    Science.gov (United States)

    Nagata, Masaharu; Ninomiya, Toshiharu; Kiyohara, Yutaka; Murakami, Yoshitaka; Irie, Fujiko; Sairenchi, Toshimi; Miura, Katsuyuki; Okamura, Tomonori; Ueshima, Hirotsugu

    2013-07-01

    There are limited studies addressing whether proteinuria and estimated glomerular filtration rate (eGFR) are independently associated with cardiovascular disease in Asia. Using data from 7 prospective cohorts recruited between 1980 and 1994 in Japan, we assessed the influence of proteinuria (≥1+ on dipstick) and reduced eGFR on the risk of cardiovascular disease mortality in 39,405 participants (40-89 years) without kidney failure. During a 10.1-year follow-up, 1,927 subjects died from cardiovascular disease. Proteinuria was associated with a 1.75-fold (95% confidence interval (CI): 1.44, 2.11) increased risk of cardiovascular disease mortality after adjustment for potential confounding factors. Additionally, the multivariate-adjusted hazard ratio of cardiovascular disease mortality increased linearly with lower eGFR levels (P(trend) cardiovascular disease mortality than those with eGFR of ≥90 mL/minute/1.73 m². Subjects with both proteinuria and eGFR of cardiovascular disease mortality compared with those with neither of these risk factors. There was no evidence of interaction in the relationship between proteinuria and lower eGFR (P(interaction) = 0.77). The present results suggest that proteinuria and lower eGFR are independent risk factors for cardiovascular disease mortality in the Japanese population.

  10. Worldwide burden of diabetes

    Directory of Open Access Journals (Sweden)

    Jaikrit Bhutani

    2014-01-01

    Full Text Available Diabetes is a pandemic of major public health importance cannot be disputed. While the IDF data does emphasis the importance of diabetes as a global public health problem, it does not place in perspective the ranking of diabetes as compared to other diseases and illnesses. The GBD data highlight this fact in multiple ways. The disease and its complications or comorbid conditions rank high in the list of risk factors, and causes of death. This communication describes the global burden of diabetes especially south-east Asia and the statistical sequelae of the disease.

  11. Availability, price and affordability of cardiovascular medicines : A comparison across 36 countries using WHO/HAI data

    NARCIS (Netherlands)

    van Mourik, Maaike S. M.; Cameron, Alexandra; Ewen, Marg; Laing, Richard O.

    2010-01-01

    Background: The global burden of cardiovascular disease (CVD) continues to rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data

  12. Cardiovascular burden of diabetes mellitus: a review | Dodiyi ...

    African Journals Online (AJOL)

    Results: Diabetes mellitus affects the heart in four main ways; autonomic neuropathy, more severe ... In type 2 diabetes autonomic dysfunction impairs exercise tolerance, reduces response in heart rate and blood pressure thus blunting the ... on the increase in Africa even as the continent adopts a more westernised lifestyle.

  13. mHealth in Cardiovascular Health Care.

    Science.gov (United States)

    Chow, Clara K; Ariyarathna, Nilshan; Islam, Sheikh Mohammed Shariful; Thiagalingam, Aravinda; Redfern, Julie

    2016-08-01

    Mobile health (mHealth) has been defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices and personal digital assistants. Cardiovascular mHealth is, arguably, leading the mHealth space, through innovation, research and implementation, and especially in the areas of prevention, cardiac rehabilitation and education. mHealth includes simple strategies, such as the use of short message service (SMS) or text messages in successful short-term smoking-cessation, weight loss and diabetes management programs. The recent Australian Tobacco, Exercise and Diet Messages (TEXT ME) randomised clinical trial addressed multiple cardiovascular risk factors. mHealth can also involve more complex strategies, such as smart phone applications (apps), global positioning systems (GPS) and Bluetooth technologies. Although many apps could be considered suitable for primary prevention, they are largely unregulated and most are not evidence-based. Some have been well-developed, such as the Food Switch app and an iPhone electrocardiogram (ECG) system. The "explosion" of apps has driven initiatives such as the Mobile Applications Rating Scale (MARS). More recently, the use of sensors to monitor and provide feedback to patients and healthcare providers is being explored. With almost two billion people currently owning a Smartphone, and 50% of adults (globally) predicted to own one by 2018, mHealth provides the prospect of delivering efficient, affordable healthcare services to widespread populations both locally and globally. In particular, it has the potential to reduce socioeconomic disparity and alleviate the burden of cardiovascular disease. There is now a need to rethink traditional health service structures and bioengineering capacity, to ensure mHealth systems are also safe, secure and robust. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of

  14. Global burden of COPD.

    Science.gov (United States)

    López-Campos, José Luis; Tan, Wan; Soriano, Joan B

    2016-01-01

    It is estimated that the world population will reach a record 7.3 billion in 2015, and the high burden of chronic conditions associated with ageing and smoking will increase further. Respiratory diseases in general receive little attention and funding in comparison with other major causes of global morbidity and mortality. In particular, chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the 21st century. Worldwide, COPD is in the spotlight, since its high prevalence, morbidity and mortality create formidable challenges for health-care systems. This review emphasizes the magnitude of the COPD problem from a clinician's standpoint by drawing extensively from the new findings of the Global Burden of Disease study. Updated, distilled information on the population distribution of COPD is useful for the clinician to help provide an appreciation of the relative impact of COPD in daily practice compared with other chronic conditions, and to allocate minimum resources in anticipation of future needs in care. Despite recent trends in reduction of COPD standardized mortality rates and some recent successes in anti-smoking efforts in a number of Western countries, the overarching demographic impact of ageing in an ever-expanding world population, joined with other factors such as high rates of smoking and air pollution in Asia, will ensure that COPD will continue to pose an ever-increasing problem well into the 21st century.

  15. Salmonella burden in Lebanon.

    Science.gov (United States)

    Malaeb, M; Bizri, A R; Ghosn, N; Berry, A; Musharrafieh, U

    2016-06-01

    Salmonellosis is a disease that represents a major public health concern in both developing and developed countries. The aim of this article is to evaluate the public health burden of Salmonella illness in Lebanon. The current scope of the Salmonella infection problem was assessed in relation to disease incidence and distribution with respect to age, gender and district. Factors that provide a better understanding of the magnitude of the problem were explored and highlighted. Data reported to the Epidemiologic Surveillance Department at the Lebanese Ministry of Public Health between 2001 and 2013 was reviewed. Information obtained was compared to information reported regionally and globally. The estimated true incidence was derived using multipliers from the CDC and Jordan. A literature review of all published data from Lebanon about Salmonella susceptibility/resistance patterns and its serious clinical complications was conducted. The estimated incidence was 13·34 cases/100 000 individuals, most cases occurred in the 20-39 years age group with no significant gender variation. Poor and less developed districts of Lebanon had the highest number of cases and the peak incidence was in summer. Reflecting on the projected incidence derived from the use of multipliers indicates a major discrepancy between what is reported and what is estimated. We conclude that data about Salmonella infection in Lebanon and many Middle Eastern and developing countries lack crucial information and are not necessarily representative of the true incidence, prevalence and burden of illness.

  16. Cardiovascular Risk in Malaysia: causes, consequences and prevention

    NARCIS (Netherlands)

    Selvarajah, S.|info:eu-repo/dai/nl/352274786

    2012-01-01

    Cardiovascular disease forms the highest morbidity and mortality worldwide and disproportionately affects low and middle-income developing countries. In developing countries, cardiovascular morbidity and mortality tend to affect the (younger) working adults. This poses a significant burden to the ec

  17. Diet, nutrition and the prevention of hypertension and cardiovascular diseases

    NARCIS (Netherlands)

    Reddy, K.S.; Katan, M.B.

    2004-01-01

    Cardiovascular diseases (CVD) are growing contributors to global disease burdens, with epidemics of CVD advancing across many regions of the world which are experiencing a rapid health transition. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases

  18. Cardiovascular Risk in Malaysia: causes, consequences and prevention

    NARCIS (Netherlands)

    Selvarajah, S.

    2012-01-01

    Cardiovascular disease forms the highest morbidity and mortality worldwide and disproportionately affects low and middle-income developing countries. In developing countries, cardiovascular morbidity and mortality tend to affect the (younger) working adults. This poses a significant burden to the ec

  19. Diet, nutrition and the prevention of hypertension and cardiovascular diseases

    NARCIS (Netherlands)

    Reddy, K.S.; Katan, M.B.

    2004-01-01

    Cardiovascular diseases (CVD) are growing contributors to global disease burdens, with epidemics of CVD advancing across many regions of the world which are experiencing a rapid health transition. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases

  20. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Biering-Sørensen, Sofie Reumert; Olsen, Flemming Javier

    2017-01-01

    BACKGROUND: Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. METHODS AND RESULTS: A total of 1296...... participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were...... diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; Page...

  1. In-treatment midwall and endocardial fractional shortening predict cardiovascular outcome in hypertensive patients with preserved baseline systolic ventricular function: the Losartan Intervention For Endpoint reduction study

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Gerdts, Eva; Palmieri, Vittorio;

    2010-01-01

    Endocardial fractional shortening (EFS) and midwall shortening (MWS) are impaired in patients with left ventricular hypertrophy. However, it remains unknown whether improvement of left ventricular systolic function during treatment reduces cardiovascular morbidity and mortality in hypertensive pa...

  2. Do experiences of racial discrimination predict cardiovascular disease among African American Men? The moderating role of internalized negative racial group attitudes

    OpenAIRE

    Chae, David H.; Lincoln, Karen D.; Adler, Nancy E.; Syme, S. Leonard

    2010-01-01

    Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group ...

  3. Prediction of cardiovascular events in statin-treated stable coronary patients of the treating to new targets randomized controlled trial by lipid and non-lipid biomarkers.

    Directory of Open Access Journals (Sweden)

    Benoit J Arsenault

    Full Text Available Several plasma non-lipid biomarkers have been shown to predict major cardiovascular events (MCVEs in population studies. Our objective was to investigate the relationship between lipid and non-lipid biomarkers levels achieved during statin therapy and the incidence of MCVEs in patients with stable coronary heart disease (CHD. We conducted a substudy of the TNT (Treating to New Targets study, which was a randomized trial that compared the efficacy of high (80 mg versus low (10 mg dose atorvastatin for the secondary prevention of CHD. Fasting plasma levels of standard lipids and of 18 non-lipid biomarkers were obtained after an 8-week run-in period on atorvastatin 10 mg in 157 patients who experienced MCVEs during the 4.9 years of study follow-up and in 1349 controls. MCVE was defined as CHD death, nonfatal, non-procedure-related myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke. After adjusting for age, sex and treatment arm, plasma levels of high-density lipoprotein (HDL cholesterol, triglycerides, high-sensitivity C-reactive protein (hsCRP, insulin, neopterin, N-terminal pro-brain natriuretic peptide (BNP, lipoprotein(a [Lp(a], and the soluble receptor for advanced glycation end products (sRAGE were predictive of recurrent MCVEs (P ≤ 0.02 for each doubling of plasma concentration. However, no significant association was observed between the risk of recurrent MCVEs and plasma levels of low-density lipoprotein cholesterol, adiponectin, cystatin C, lipoprotein-associated phospholipase A2, monocyte chemotactic protein-1, matrix metalloproteinase-9, myeloperoxidase, osteopontin, soluble CD40 ligand, soluble intercellular adhesion molecule-1, or soluble vascular cell adhesion molecule-1. After further adjustment for diabetes, hypertension, smoking, and BMI, the relationship between hsCRP, insulin and MCVE were no longer significant, while the relationship between Lp(a, neopterin, NT-proBNP and sRAGE and MCVE remained

  4. Erythropoietin in cardiovascular diseases : exploring new avenues

    NARCIS (Netherlands)

    Van der Meer, Peter; Veldhuisen, Dirk J. N.; Januzzi, James L.

    2008-01-01

    Cardiovascular disease is an important burden in the Western world, with a prevalence that is increasing exponentially. Indeed, the lifetime risk of coronary artery disease at 40 years of age is I in 2 for men and I in 3 for women, and it is estimated that one-third of the population worldwide will

  5. Cardiovascular pharmacogenetics.

    Science.gov (United States)

    Myburgh, Renier; Hochfeld, Warren E; Dodgen, Tyren M; Ker, James; Pepper, Michael S

    2012-03-01

    Human genetic variation in the form of single nucleotide polymorphisms as well as more complex structural variations such as insertions, deletions and copy number variants, is partially responsible for the clinical variation seen in response to pharmacotherapeutic drugs. This affects the likelihood of experiencing adverse drug reactions and also of achieving therapeutic success. In this paper, we review key studies in cardiovascular pharmacogenetics that reveal genetic variations underlying the outcomes of drug treatment in cardiovascular disease. Examples of genetic associations with drug efficacy and toxicity are described, including the roles of genetic variability in pharmacokinetics (e.g. drug metabolizing enzymes) and pharmacodynamics (e.g. drug targets). These findings have functional implications that could lead to the development of genetic tests aimed at minimizing drug toxicity and optimizing drug efficacy in cardiovascular medicine.

  6. Estimating the true global burden of mental illness.

    Science.gov (United States)

    Vigo, Daniel; Thornicroft, Graham; Atun, Rifat

    2016-02-01

    We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes. Using published data, we estimate the disease burden for mental illness to show that the global burden of mental illness accounts for 32·4% of years lived with disability (YLDs) and 13·0% of disability-adjusted life-years (DALYs), instead of the earlier estimates suggesting 21·2% of YLDs and 7·1% of DALYs. Currently used approaches underestimate the burden of mental illness by more than a third. Our estimates place mental illness a distant first in global burden of disease in terms of YLDs, and level with cardiovascular and circulatory diseases in terms of DALYs. The unacceptable apathy of governments and funders of global health must be overcome to mitigate the human, social, and economic costs of mental illness.

  7. Prediction of Cardiovascular Disease Risk by Cardiac Biomarkers in 2 United Kingdom Cohort Studies: Does Utility Depend on Risk Thresholds For Treatment?

    Science.gov (United States)

    Welsh, Paul; Hart, Carole; Papacosta, Olia; Preiss, David; McConnachie, Alex; Murray, Heather; Ramsay, Sheena; Upton, Mark; Watt, Graham; Whincup, Peter; Wannamethee, Goya; Sattar, Naveed

    2016-02-01

    We tested the predictive ability of cardiac biomarkers N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T, and midregional pro adrenomedullin for cardiovascular disease (CVD) events using the British Regional Heart Study (BRHS) of men aged 60 to 79 years, and the MIDSPAN Family Study (MFS) of men and women aged 30 to 59 years. They included 3757 and 2226 participants, respectively, and during median 13.0 and 17.3 years follow-up the primary CVD event rates were 16.6 and 5.3 per 1000 patient-years, respectively. In Cox models adjusted for basic classical risk factors, 1 SD increases in log-transformed NT-proBNP, high-sensitivity troponin T, and midregional pro adrenomedullin were generally associated with increased primary CVD risk in both the studies (P<0.006) except midregional pro adrenomedullin in MFS (P=0.10). In BRHS, QRISK2 risk factors yielded a C-index of 0.657, which was improved by 0.017 (P=0.005) by NT-proBNP, but not by other biomarkers. Using 28% 14-year risk as a proxy for 20% 10-year risk, NT-proBNP improved risk classification for primary CVD cases (case net reclassification index, 5.9%; 95% confidence interval, 2.8%-9.2%), but only improved classification of noncases at a 14% 14-year risk threshold (4.6%; 2.9%-6.3%). In MFS, ASSIGN risk factors yielded a C-index of 0.752 for primary CVD; none of the cardiac biomarkers improved the C-index. Improvements in risk classification were only seen using NT-proBNP and high-sensitivity troponin T among cases using the 28% 14-year risk threshold (4.7%; 1.0%-9.2% and 2.6%; 0.0%-5.8%, respectively). In conclusion, the improvement in treatment allocation gained by adding cardiac biomarkers to risk scores seems to depend on the risk threshold chosen for commencing preventative treatments. © 2015 The Authors.

  8. Predictive role of the Mediterranean diet on mortality in individuals at low cardiovascular risk: a 12-year follow-up population-based cohort study.

    Science.gov (United States)

    Bo, Simona; Ponzo, Valentina; Goitre, Ilaria; Fadda, Maurizio; Pezzana, Andrea; Beccuti, Guglielmo; Gambino, Roberto; Cassader, Maurizio; Soldati, Laura; Broglio, Fabio

    2016-04-12

    Adherence to the Mediterranean diet reduces the risk of all-cause and cardiovascular (CV) mortality and the incidence of CV events. However, most previous studies were performed in high-risk individuals. Our objective was to assess whether the adherence to the Mediterranean diet, evaluated by the MED score, was associated with all-cause and CV mortality and incidence of CV events in individuals at low CV risk from a population-based cohort, after a 12-year mean follow-up. A cohort of 1658 individuals completed a validated food-frequency questionnaire in 2001-2003. The MED score was calculated by a 0-9 scale. Anthropometric, laboratory measurements, and the vital status were collected at baseline and during 2014. The baseline CV risk was estimated by the Framingham risk score. Participants were divided into two groups: individuals at low risk (CV risk ≥ 10. During a 12-year mean follow-up, 220 deaths, 84 due to CV diseases, and 125 incident CV events occurred. The adherence to the Mediterranean diet was low in 768 (score 0-2), medium in 685 (score 4-5) and high in 205 (score > 6) individuals. Values of BMI, waist circumference, fasting glucose and insulin significantly decreased from low to high diet adherence only in participants with CV risk ≥ 10. In a Cox-regression model, the hazard ratios (HRs) in low-risk individuals per unit of MED score were: HR = 0.83 (95 % CI 0.72-0.96) for all-cause mortality, HR = 0.75 (95 % CI 0.58-0.96) for CV mortality, and HR = 0.79 (95 % CI 0.65-0.97) for CV events, after multiple adjustments. In individuals with CV risk ≥ 10, the MED score predicted incident CV events (HR = 0.85; 95 % CI 0.72-0.99), while the associations with all-cause (HR = 1.02; 95 % CI 0.90-1.15) and CV mortality (0.94; 95 % CI 0.76-1.15) were not significant. Greater adherence to the Mediterranean diet was associated with reduced fatal and non fatal CV events, especially in individuals at low CV risk, thus suggesting the usefulness of promoting this

  9. Waist circumference values equivalent to body mass index points for predicting absolute cardiovascular disease risks among adults in an Aboriginal community: a prospective cohort study.

    Science.gov (United States)

    Adegbija, Odewumi; Hoy, Wendy E; Wang, Zhiqiang

    2015-11-13

    There have been suggestions that currently recommended waist circumference (WC) cut-off points for Australians of European origin may not be applicable to Aboriginal people who have different body habitus profiles. We aimed to generate equivalent WC values that correspond to body mass index (BMI) points for identifying absolute cardiovascular disease (CVD) risks. Prospective cohort study. An Aboriginal community in Australia's Northern Territory. From 1992 to 1998, 920 adults without CVD, with age, WC and BMI measurements were followed-up for up to 20 years. Incident CVD, coronary artery disease (CAD) and heart failure (HF) events during the follow-up period ascertained from hospitalisation data. We generated WC values with 10-year absolute risks equivalent for the development of CVD as BMI values (20-34 kg/m(2)) using the Weibull accelerated time-failure model. There were 211 incident cases of CVD over 13,669 person-years of follow-up. At the average age of 35 years, WC values with absolute CVD, CAD and HF risks equivalent to BMI of 25 kg/m(2) were 91.5, 91.8 and 91.7 cm, respectively, for males, and corresponding WC values were 92.5, 92.7 and 93 cm for females. WC values with equal absolute CVD, CAD and HF risks to BMI of 30 kg/m(2) were 101.7, 103.1 and 102.6 cm, respectively, for males, and corresponding values were 99.2, 101.6 and 101.5 cm for females. Association between WC and CVD did not depend on gender (p=0.54). WC ranging from 91 to 93 cm was equivalent to BMI 25 kg/m(2) for overweight, and 99 to 103 cm was equivalent to BMI of 30 kg/m(2) for obesity in terms of predicting 10-year absolute CVD risk. Replicating the absolute risk method in other Aboriginal communities will further validate the WC values generated for future development of WC cut-off points for Aboriginal people. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Nonfasting hyperlipidemia and cardiovascular disease

    DEFF Research Database (Denmark)

    Nordestgaard, B G; Langsted, A; Freiberg, J J

    2009-01-01

    , total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A1 all associate with increased risk of cardiovascular disease. These new data open the possibility that nonfasting rather than fasting lipid profiles can be used for cardiovascular risk prediction. If implemented, this would...... of cardiovascular disease and early death....... that are clinically unimportant. Also, elevated levels of nonfasting triglycerides as a marker of elevated remnant lipoprotein cholesterol associate strongly with increased risk of myocardial infarction, ischemic stroke, and early death. The mechanism behind these findings likely involves entrance of remnant...

  11. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study

    DEFF Research Database (Denmark)

    Friis-Møller, Nina; Thiébaut, Rodolphe; Reiss, Peter;

    2010-01-01

    aimed to develop cardiovascular risk-assessment models tailored to HIV-infected patients. METHODS AND RESULTS: Prospective multinational cohort study. The data set included 22 625 HIV-infected patients from 20 countries in Europe and Australia who were free of CVD at entry into the Data collection.......670-0.818) for coronary heart disease and 0.769 (0.695-0.824) for CVD. The models estimated more accurately the outcomes in the subgroups than the Framingham score. CONCLUSION: Risk equations developed from a population of HIV-infected patients, incorporating routinely collected cardiovascular risk parameters...

  12. Depression and caregiver burden among rural elder caregivers.

    Science.gov (United States)

    Butler, Sandra S; Turner, Winston; Kaye, Lenard W; Ruffin, Leah; Downey, Roberta

    2005-01-01

    Family caregivers of older adults frequently experience feelings of burden and depression though they may not come to the attention to health and service providers until they are at a point of crisis. Through a simple screening tool, the Maine Primary Partners in Caring (MPPC) project identified individuals providing care to older adults through rural primary care practices, in order to provide upstream interventions before caregivers were in crisis. This paper describes a sample (n=62) of rural family caregivers identified through their physicians' offices. High levels of caregiver burden and depression were reported. Family support and knowledge of caregiver tasks predicted decreased caregiver burden and depression, while isolation predicted increased caregiver burden. Implications of these results for gerontological social workers are outlined.

  13. Family burden, family health and personal mental health.

    Science.gov (United States)

    Ennis, Edel; Bunting, Brendan P

    2013-03-21

    The economic and moral implications of family burden are well recognised. What is less understood is whether or how family health and family burden relate to personal mental health. This study examines family health and perceived family burden as predictors of personal mental health, taking personal and sociodemographic factors into consideration. Data used was from the National Comorbidity Study Replication (NCS-R), namely the random 30% of participants (N = 3192) to whom the family burden interview was administered. Measures of family burden and mental health were considered for analysis. Binary logistic regressions were used as means of analyses. Perception of family burden was associated with an increased vulnerability to personal mental health problems, as was the presence of mental health difficulties within the family health profile. Which member of the family (kinship) was ill bore no relation to prediction of personal mental health. Personal and socio-demographic factors of sex, age, marital status, education and household income were all predictive of increased vulnerability to mental health problems over the last 12 months. Certain elements of family health profile and its perceived burden on the individuals themselves appears related to risk of personal incidence of mental health problems within the individuals themselves. For moral and economic reasons, further research to understand the dynamics of these relationships is essential to aid developing initiatives to protect and support the mental health and wellbeing of relatives of ill individuals.

  14. Urgent need for human resources to promote global cardiovascular health.

    Science.gov (United States)

    Vedanthan, Rajesh; Fuster, Valentin

    2011-02-01

    The World Health Organization estimates the existence of a global shortage of over 4 million health-care workers. Given the growing global burden of cardiovascular disease (CVD), the shortfall in global human resources for health (HRH) is probably even greater than predicted. A critical challenge going forward is to determine how to integrate CVD-related human resource needs into the overall global HRH agenda. We describe the CVD implications of core HRH objectives, including coverage, motivation, and competence, in addition to issues such as health-care worker migration and the need for input from multiple stakeholders to successfully address the current problems. We emphasize gaps in knowledge regarding HRH for global CVD-related care and research opportunities. In light of the current global epidemiologic transition from communicable to noncommunicable diseases, now is the time for the global health community to focus on CVD-related human resource needs.

  15. ASSESSMENT OF MAXIMUM ALLOWABLE FISCAL BURDEN ON UKRAINE NATIONAL ECONOMY

    Directory of Open Access Journals (Sweden)

    M. Aleksandrova

    2014-03-01

    Full Text Available The article was reviewed reproductive aspect of the relationship between fiscal burden and a penchant for economic development under certain assumptions about the relationship of these variables. The analysis was based on a fairly simple dynamic model in which the share of income that goes to the development of production, relying constant. Computed optimal fiscal burden for the economic development of the country is 19.29% of GDP. The estimation and comparison of the calculations of the tax burden followed its dynamics, by comparative assessment with those of developed countries. The prospects of the proposed approach for predicting the development of national economy were analyzed.

  16. Morphological Atherosclerosis Calcification Distribution (MACD) Index is a Strong Predictor of Cardio-Vascular Death and Include Predictive Power of BMD

    DEFF Research Database (Denmark)

    Christiansen, Claus; Karsdal, Morten; Ganz, Melanie

    Aortic calcification is a major risk factor for cardiovascular disease (CVD) related deaths. We investigated the relation between mortality and aspects of number, size, morphology and distribution of calcified plaques in the lumbar aorta and BMD of postmenopausal women. 308 women aged 48 to 76 were...

  17. Myocardial infarct heterogeneity assessment by late gadolinium enhancement cardiovascular magnetic resonance imaging shows predictive value for ventricular arrhythmia development after acute myocardial infarction

    NARCIS (Netherlands)

    Robbers, Lourens F. H. J.; Delewi, Ronak; Nijveldt, Robin; Hirsch, Alexander; Beek, Aernout M.; Kemme, Michiel J. B.; van Beurden, Yvette; van der Laan, Anja M.; van der Vleuten, Pieter A.; Tio, Rene A.; Zijlstra, Felix; Piek, Jan J.; van Rossum, Albert C.

    2013-01-01

    The aim of this study was to assess the association between the proportions of penumbrauvisualized by late gadolinium enhanced cardiovascular magnetic resonance imaging (LGE-CMR)uafter acute myocardial infarction (AMI) and the prevalence of ventricular tachycardia (VT). One-hundred and sixty-two AMI

  18. Independent effects of age-related changes in waist circumference and BMI z scores in predicting cardiovascular disease risk factors in a prospective cohort of adolescent females

    Science.gov (United States)

    BACKGROUND: Cross-sectional data indicate that central adiposity is associated with cardiovascular disease risk, independent of total adiposity. The use of longitudinal data to investigate the relation between changes in fat distribution and the emergence of risk factors is limited. OBJECTIVE: We ...

  19. Prediction of Cardiovascular Events in Patients with Ankylosing Spondylitis and Psoriatic Arthritis : Role of Lipoproteins in a High-risk Population

    NARCIS (Netherlands)

    Semb, Anne Grete; Kvien, Tore K.; DeMicco, David A.; Fayyad, Rana; Wun, Chuan-Chuan; LaRosa, John; Betteridge, John; Pedersen, Terje R.; Holme, Ingar

    2012-01-01

    Objective. To evaluate lipids and apolipoproteins as predictors of cardiovascular mortality and morbidity (CVD) in patients with spondyloarthritis (SpA). Methods. In the pooled cohort of participants in the IDEAL, TNT, and CARDS trials, 50 had ankylosing spondylitis (AS), 36 had psoriatic arthritis

  20. Myocardial infarct heterogeneity assessment by late gadolinium enhancement cardiovascular magnetic resonance imaging shows predictive value for ventricular arrhythmia development after acute myocardial infarction

    NARCIS (Netherlands)

    Robbers, Lourens F. H. J.; Delewi, Ronak; Nijveldt, Robin; Hirsch, Alexander; Beek, Aernout M.; Kemme, Michiel J. B.; van Beurden, Yvette; van der Laan, Anja M.; van der Vleuten, Pieter A.; Tio, Rene A.; Zijlstra, Felix; Piek, Jan J.; van Rossum, Albert C.

    2013-01-01

    The aim of this study was to assess the association between the proportions of penumbrauvisualized by late gadolinium enhanced cardiovascular magnetic resonance imaging (LGE-CMR)uafter acute myocardial infarction (AMI) and the prevalence of ventricular tachycardia (VT). One-hundred and sixty-two AMI

  1. Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients

    DEFF Research Database (Denmark)

    Mogensen, Ulrik Madvig; Jensen, Tonny; Køber, Lars

    2012-01-01

    Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty......-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (-) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using...... with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease....

  2. Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: a meta-analysis.

    Science.gov (United States)

    Li, Wei-Jie; Chen, Xu-Miao; Nie, Xiao-Ying; Zhang, Jing; Cheng, Yun-Jiu; Lin, Xiao-Xiong; Wu, Su-Hua

    2015-04-01

    Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients.

  3. Caregiver burden in dependent elderly.

    Directory of Open Access Journals (Sweden)

    José Mauricio Ocampo

    2009-11-01

    Full Text Available Objectives: To determine the frequency and the associated factors with the presence of care burden imposed by dependent elderly of Buenaventura, Valle; Colombia. Design: A pilot cross-sectional study. Patients and methods: Between March and May of 2006, data were collected on 35 over 60 years old patients who live in the community of Buenaventura, with a score in the Barthel index Results: The mean age and the standard deviation of the patient group was 78.9±10 years. There was a larger proportion of women (68.5%. In the care givers, the regular age and the standard deviation was 49.4±18.8 years, where 91% were women. It was found that for 54.2% of the caregivers there was no burden at all, 40% of them had a minimum burden and the others a greater burden. Bivariate analysis between the care giver’s burden and the number of chronic disease, the score on the minimental test, elderly depression and the family APGAR, resulted in statistic association (p Conclusions: There is an association between aged people, dependent in basic common day activities related with physical aspects, and care giver’s burden. Being the caregivers mostly family members, further studies must be focused on identifying and realizing interventions to prevent or limit the decrease of declining mental health and loss of life quality and the consequent increase of the care giver’s burden.

  4. Burden in the main caregiver

    Directory of Open Access Journals (Sweden)

    Fabiola Yonte Huete

    2010-09-01

    Full Text Available Objectives: The main objective is to determine the degree of burden in the main caregivers of dependent patients, to analyse the profile of informal caregivers and dependent patients. Their claims and help received with caring, the influence of mental deteriorate and duration of care giving regarding the burden of caregivers.Methods: Descriptive cross-sectional observational study amongst 50 caregivers and dependents. We used descriptive statistics and correlational studies. Results: 86 % of caregivers were women, middle aged, son/daughter of the dependent, married, with basic studies, no work outside the home, the average time in the role of caregiver was 16,96 hours a day and 2,1 free hours a day. 64 % of them received family support and 68 % wish to receive economic aid. It was found that for 38 % of the caregivers there was no burden at all, 34 % of them had a minimum burden and 28 % a greater burden.Conclusion: There are some caregivers with moderate or great burden. Our caregiver wishes to receive economic help. Our research shows that the decrease of mental health and the years of evolution do not have a significant statistically influence on caregivers. It is necessary prioritize the interventions and its recipients, provide solutions for caregivers with a greater burden, trying to keep away “caregiver syndrome”.

  5. Unmet needs for cardiovascular care in Indonesia.

    Directory of Open Access Journals (Sweden)

    Asri Maharani

    Full Text Available In the past twenty years the heaviest burden of cardiovascular diseases has begun to shift from developed to developing countries. However, little is known about the real needs for cardiovascular care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for cardiovascular care based on objective assessment.Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4 survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high cardiovascular risk failed to receive cardiovascular care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for cardiovascular care, while health facility density and physician density show no association with them.The prevalence of unmet needs for cardiovascular care is considerable in Indonesia. Inequality persists as a factor in meeting needs for cardiovascular care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and improvement in the quality of healthcare providers are recommended in order to meet this ever-increasing need.

  6. Predictive Value of Beat-to-Beat QT Variability Index across the Continuum of Left Ventricular Dysfunction: Competing Risks of Non-cardiac or Cardiovascular Death, and Sudden or Non-Sudden Cardiac Death

    Science.gov (United States)

    Tereshchenko, Larisa G.; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D.; de Luna, Antoni Bayes; Zareba, Wojciech

    2012-01-01

    Background The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Methods and Results Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Conclusions Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk. PMID:22730411

  7. Predictive value of beat-to-beat QT variability index across the continuum of left ventricular dysfunction: competing risks of noncardiac or cardiovascular death and sudden or nonsudden cardiac death.

    Science.gov (United States)

    Tereshchenko, Larisa G; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D; de Luna, Antoni Bayes; Zareba, Wojciech

    2012-08-01

    The goal of the present study was to determine the predictive value of beat-to-beat QT variability in heart failure patients across the continuum of left ventricular dysfunction. Beat-to-beat QT variability index (QTVI), log-transformed heart rate variance, normalized QT variance, and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca heart failure study (mean age, 63.1±11.7; men, 70.6%; left ventricular ejection fraction >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death (subhazard ratio, 1.67 [95% CI, 1.14-2.47]; P=0.009) and, in particular, with non-SCD (subhazard ratio, 2.91 [1.69-5.01]; P<0.001). Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular (subhazard ratio, 1.57 [1.04-2.35]; P=0.031) and non-SCD in multivariate competing risk model (subhazard ratio, 2.58 [1.13-3.78]; P=0.001). No interaction between QTVI and left ventricular ejection fraction was found. QTVI predicted neither noncardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability rather than increased QT variability was the reason for increased QTVI in the present study. Increased QTVI because of depressed heart rate variability predicts cardiovascular mortality and non-SCD but neither SCD nor extracardiac mortality in heart failure across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from heart failure patients at risk.

  8. [Cardiovascular risk factors in women].

    Science.gov (United States)

    Cengel, Atiye

    2010-03-01

    It is estimated that at least 80% of patients with cardiovascular disease (CVD) have conventional risk factors and optimization of these risk factors can reduce morbidity and mortality due to this disease considerably. Contemporary women have increased burden of some of these risk factors such as obesity, metabolic syndrome and smoking. Turkish women have a worse CV risk profile than Turkish men in some aspects. Risk stratification systems such as Framingham have a tendency of underestimating the risk in women. Coronary artery disease remains in vessel wall for a longer period of time in women; therefore obstructive disease appear later in their lifespan necessitating risk stratification systems for estimating their lifetime risk.

  9. HIV / AIDS: An Unequal Burden

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: An Unequal Burden Past Issues / Summer 2009 ... high-risk category, emphasizes Dr. Cargill. Photo: iStock HIV and Pregnancy Are there ways to help HIV- ...

  10. Catechins as Potential Mediators of Cardiovascular Health.

    Science.gov (United States)

    Mangels, Daniel R; Mohler, Emile R

    2017-05-01

    The impact of diet on cardiovascular disease has become an increasingly relevant topic as ongoing epidemiological evidence continues to demonstrate clear associations with disease burden and mortality. Certain diets, such as those high in sodium and saturated fat, are associated with cardiovascular disease states, while other diets can be cardioprotective. However, there is limited knowledge on how the micro- and macronutrients within such cardioprotective diets afford their benefits. One such micronutrient is the catechin class, which are naturally occurring compounds in plant foods, such as teas, cocoa, wine, pears, and apples. Recent evidence reveals that catechins may be a key mediator in cardiovascular health via mechanisms of blood pressure reduction, flow-mediated vasodilation, and atherosclerosis attenuation. This review evaluates the current literature on the interplay between catechins and cardiovascular disease, which may have important implications for nutrition counseling and pharmaceutical drug development. © 2017 American Heart Association, Inc.

  11. Socioeconomic burden of hereditary angioedema

    DEFF Research Database (Denmark)

    Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen

    2014-01-01

    who were working or in school (n = 120), 72 provided work/school absenteeism data, resulting in an estimated 20 days missing from work/school on average per year; 51% (n = 84) indicated that HAE has hindered their career/educational advancement. CONCLUSION: HAE poses a considerable burden on patients...... and their families in terms of direct medical costs and indirect costs related to lost productivity. This burden is substantial at the time of attacks and in between attacks....

  12. The burden of Alzheimer's disease.

    Science.gov (United States)

    Burns, Alistair

    2000-07-01

    Alzheimer's disease (AD) imposes a severe burden upon patients and their carers. In particular, family carers of AD patients face extreme hardship and distress that represents a major but often hidden burden on healthcare systems. Carers often experience clinically significant alterations in physical and mental health, particularly depression. A number of individual features of the dementia syndrome that are known to be particularly burdensome to carers include the degree of cognitive impairment, amount of help required with activities of daily living, personality changes and the presence of psychiatric symptoms and behavioural disturbances. The neuropsychiatric features of AD patients can adversely impact the relationship between the patient and caregiver generating feelings of strain, burden and social isolation. Individual characteristics of the caregiver including personality, gender, degree of formal and informal support and physical and mental health, as well as attributional style ('coping style') and expressed emotion (critical or hostile attitudes), also dictate carer burden. As informal caregivers play such a crucial role in the care of AD patients, appropriate management strategies that incorporate interventions which address the specific burdens of the individual caregiver are essential. Reducing the burden of care can be achieved by the combination of a number of individual and general measures, including education, respite and emotion-focused interventions. These measures, accompanied by non-pharmacological strategies, are extremely important in the total care of the AD patient, with the emphasis on maintaining people in the community as long as possible.

  13. Predicting depression from illness severity in cardiovascular disease patients: self-efficacy beliefs, illness perception, and perceived social support as mediators.

    Science.gov (United States)

    Greco, A; Steca, P; Pozzi, R; Monzani, D; D'Addario, M; Villani, A; Rella, V; Giglio, A; Malfatto, G; Parati, G

    2014-04-01

    Many studies have investigated the relationships between cardiovascular diseases and patients' depression; nevertheless, few is still known as regard the impact of illness severity on depression and whether psychosocial variables mediate this association. The aim of this study is to investigate the putative mediating role of illness representations, self-efficacy beliefs, and perceived social support on the relationship between illness severity and depression. A total of 75 consecutive patients with cardiovascular disease (80 % men; mean age = 65.44, SD = 10.20) were enrolled in an Italian hospital. Illness severity was measured in terms of left ventricular ejection fraction, whereas psychological factors were assessed using self-report questionnaires. The relationship between left ventricular ejection fraction and depression was mediated by identity illness perception, self-efficacy beliefs in managing cardiac risk factors, and perceived social support. The treatment of depression in cardiovascular disease patients may therefore benefit from a psychological intervention focused on patients' illness representations, self-efficacy beliefs, and their perceived social support.

  14. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Directory of Open Access Journals (Sweden)

    Na Zhao

    Full Text Available Global Registry of Acute Coronary Events (GRACE risk score and red blood cell distribution width (RDW content can both independently predict major adverse cardiac events (MACEs in patients with acute coronary syndrome (ACS. We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58% patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40. GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p < 0.001; 1.699; 1.294-2.232; p < 0.001; respectively. Furthermore, Kaplan-Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001. For GRACE score alone, the area under the receiver operating characteristic (ROC curve for MACEs was 0.749 (95% CI: 0.707-0.787. The area under the ROC curve for MACEs increased to 0.805 (0.766-0.839, p = 0.034 after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001 and integrated discrimination improvement (IDI = 0.023, p = 0.002. Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

  15. Riesgo cardiovascular, una herramienta útil para la prevención de las enfermedades cardiovasculares Cardiovascular risk, a useful tool for prevention of cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Jorge Vega Abascal

    2011-03-01

    Full Text Available El riesgo cardiovascular se define como la probabilidad de padecer un evento cardiovascular en un determinado período. Mejorar la exactitud en la predicción del riesgo requiere la evaluación y el tratamiento de múltiples factores de riesgo cardiovascular, los que tienen un efecto sinérgico, más que aditivo, sobre el riesgo cardiovascular total. El cálculo utilizando métodos cuantitativos es más preciso que el obtenido con métodos cualitativos. La predicción del riesgo cardiovascular ha constituido, en los últimos años, la piedra angular en las guías clínicas de prevención cardiovascular, y deviene una herramienta útil del Médico de Familia para establecer prioridades en la atención primaria, mejorando la atención a los pacientes y eligiendo más eficazmente la terapéutica a seguir, con el objetivo de acercarnos más a la realidad multifactorial de las enfermedades cardiovasculares y a su prevención.The cardiovascular risk is defined like a probability of suffering a cardiovascular event in a determined period. To improve the accuracy in risk prediction requires the assessment and treatment of different cardiovascular risk factors, which have a synergistic effect more than additive on the total cardiovascular risk. The calculus using quantitative methods is more accurate than that obtained with qualitative methods. The prediction of cardiovascular risk has been in past years the cornerstone in clinical guidances of cardiovascular prevention and becomes an useful tool for Family Physician to establish priorities in the primary care, improving the patients care and selecting in a more effective way the therapy to be followed to bring closer more to multifactor reality of cardiovascular diseases and its prevention.

  16. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation.

    Science.gov (United States)

    Chan, Yap-Hang; Yiu, Kai-Hang; Lau, Kui-Kai; Yiu, Yuen-Fung; Li, Sheung-Wai; Lam, Tai-Hing; Lau, Chu-Pak; Siu, Chung-Wah; Tse, Hung-Fat

    2014-12-01

    To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. Baseline CHADS2 score was associated with lower FMD (Pearson r = -0.16, P PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P PR prolongation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Biomarkers of cardiovascular disease risk in women.

    Science.gov (United States)

    Manson, JoAnn E; Bassuk, Shari S

    2015-03-01

    Cardiovascular disease (CVD), including coronary heart disease and stroke, is the leading cause of death among U.S. women and men. Established cardiovascular risk factors such as smoking, diabetes, hypertension, and elevated total cholesterol, and risk prediction models based on such factors, perform well but do not perfectly predict future risk of CVD. Thus, there has been much recent interest among cardiovascular researchers in identifying novel biomarkers to aid in risk prediction. Such markers include alternative lipids, B-type natriuretic peptides, high-sensitivity troponin, coronary artery calcium, and genetic markers. This article reviews the role of traditional cardiovascular risk factors, risk prediction tools, and selected novel biomarkers and other exposures in predicting risk of developing CVD in women. The predictive role of novel cardiovascular biomarkers for women in primary prevention settings requires additional study, as does the diagnostic and prognostic utility of cardiac troponins for acute coronary syndromes in clinical settings. Sex differences in the clinical expression and physiology of metabolic syndrome may have implications for cardiovascular outcomes. Consideration of exposures that are unique to, or more prevalent in, women may also help to refine cardiovascular risk estimates in this group.

  18. Thallium stress testing does not predict cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Holley, J.L.; Fenton, R.A.; Arthur, R.S. (Univ. of Pittsburgh, PA (USA))

    1991-05-01

    This study assessed the usefulness of thallium stress testing as a predictor of perioperative cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation. Demographic factors influencing the exercise performance in these patients were also examined. The medical records of 189 consecutive patients with diabetic nephropathy who were evaluated for cadaveric renal transplantation were reviewed. Thallium stress testing was the initial examination of cardiovascular status in 141 patients. An adequate examination was one in which at least 70% of maximum heart rate was achieved. A thallium stress test was normal if there were no ST segment depressions on the electrocardiogram and no perfusion abnormalities on the thallium scan. Forty-four patients underwent cardiac catheterization as the initial evaluation (Group C) and four patients underwent transplantation without a formal cardiovascular evaluation (Group D). Sixty-four of the 141 patients undergoing thallium stress testing had an adequate and normal examination (Group A). The incidence of perioperative cardiac events in this group was 2%. Seventy-seven patients (Group B) had an abnormal (n = 41) or an inadequate (n = 36) thallium stress test and most (n = 61) then underwent coronary angiography. The use of beta-blockers was the only predictor of an abnormal or inadequate thallium stress test. Forty-three percent of patients with inadequate or abnormal thallium stress tests had significant coronary artery disease on cardiac catheterization. The perioperative risk of cardiac events was not different in Group A versus Groups B, C, and D combined. Survival of Group A and B patients was not different but was significantly longer than that of Group C patients.

  19. Genetics of cardiovascular and renal complications in diabetes.

    Science.gov (United States)

    Ma, Ronald C W

    2016-03-01

    The development of debilitating complications represents a major healthcare burden associated with the treatment of diabetes. Despite advances in new therapies for controlling hyperglycemia, the burden associated with diabetic complications remains high, especially in relation to cardiovascular and renal complications. Furthermore, an increasing proportion of patients develop type 2 diabetes at a younger age, putting them at higher risk of developing complications as a result of the increased exposure to hyperglycemia. Diabetes has become the main contributing cause to end-stage renal disease in most countries. Although there has been important breakthroughs in our understanding of the genetics of type 1 and type 2 diabetes, bringing important insights towards the pathogenesis of diabetes, there has been comparatively less progress in our understanding of the genetic basis of diabetic complications. Genome-wide association studies are beginning to expand our understanding of the genetic architecture relating to diabetic complications. Improved understanding of the genetic basis of diabetic cardiorenal complications might provide an opportunity for improved risk prediction, as well as the development of new therapies.

  20. Renal function estimation and Cockroft-Gault formulas for predicting cardiovascular mortality in population-based, cardiovascular risk, heart failure and post-myocardial infarction cohorts: The Heart 'OMics' in AGEing (HOMAGE) and the high-risk myocardial infarction database initiatives.

    Science.gov (United States)

    Ferreira, João Pedro; Girerd, Nicolas; Pellicori, Pierpaolo; Duarte, Kevin; Girerd, Sophie; Pfeffer, Marc A; McMurray, John J V; Pitt, Bertram; Dickstein, Kenneth; Jacobs, Lotte; Staessen, Jan A; Butler, Javed; Latini, Roberto; Masson, Serge; Mebazaa, Alexandre; Rocca, Hans Peter Brunner-La; Delles, Christian; Heymans, Stephane; Sattar, Naveed; Jukema, J Wouter; Cleland, John G; Zannad, Faiez; Rossignol, Patrick

    2016-11-10

    Renal impairment is a major risk factor for mortality in various populations. Three formulas are frequently used to assess both glomerular filtration rate (eGFR) or creatinine clearance (CrCl) and mortality prediction: body surface area adjusted-Cockcroft-Gault (CG-BSA), Modification of Diet in Renal Disease Study (MDRD4), and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The CKD-EPI is the most accurate eGFR estimator as compared to a "gold-standard"; however, which of the latter is the best formula to assess prognosis remains to be clarified. This study aimed to compare the prognostic value of these formulas in predicting the risk of cardiovascular mortality (CVM) in population-based, cardiovascular risk, heart failure (HF) and post-myocardial infarction (MI) cohorts. Two previously published cohorts of pooled patient data derived from the partners involved in the HOMAGE-consortium and from four clinical trials - CAPRICORN, EPHESUS, OPTIMAAL and VALIANT - the high risk MI initiative, were used. A total of 54,111 patients were included in the present analysis: 2644 from population-based cohorts; 20,895 from cardiovascular risk cohorts; 1801 from heart failure cohorts; and 28,771 from post-myocardial infarction cohorts. Participants were patients enrolled in the respective cohorts and trials. The primary outcome was CVM. All formulas were strongly and independently associated with CVM. Lower eGFR/CrCl was associated with increasing CVM rates for values below 60 mL/min/m(2). Categorical renal function stages diverged in a more pronounced manner with the CG-BSA formula in all populations (higher χ(2) values), with lower stages showing stronger associations. The discriminative improvement driven by the CG-BSA formula was superior to that of MDRD4 and CKD-EPI, but remained low overall (increase in C-index ranging from 0.5 to 2 %) while not statistically significant in population-based cohorts. The integrated discrimination improvement and

  1. Burden of Proof in Bioethics.

    Science.gov (United States)

    Koplin, Julian J; Selgelid, Michael J

    2015-11-01

    A common strategy in bioethics is to posit a prima facie case in favour of one policy, and to then claim that the burden of proof (that this policy should be rejected) falls on those with opposing views. If the burden of proof is not met, it is claimed, then the policy in question should be accepted. This article illustrates, and critically evaluates, examples of this strategy in debates about the sale of organs by living donors, human enhancement, and the precautionary principle. We highlight general problems with this style of argument, and particular problems with its use in specific cases. We conclude that the burden ultimately falls on decision-makers (i.e. policy-makers) to choose the policy supported by the best reasons.

  2. Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease

    OpenAIRE

    Magnussen, Costan G.; Smith, Kylie J.

    2016-01-01

    A high blood pressure level in adults is considered the single most important modifiable risk factor for global disease burden, especially those of cardiovascular (CV) origin such as stroke and ischemic heart disease. Because blood pressure levels have been shown to persist from childhood to adulthood, elevations in pediatric levels have been hypothesized to lead to increased CV burden in adulthood and, as such, might provide a window in the life course where primordial and primary prevention...

  3. Cardiovascular diseases in Ghana within the context of globalization.

    Science.gov (United States)

    Ofori-Asenso, Richard; Garcia, Daireen

    2016-02-01

    This paper discusses how globalization and its elements are influencing health dynamics and in particular Cardiovascular diseases (CVDs) in Ghana. It assesses the growing burden of CVDs and its relationship with globalization. It further describes the conceptual framework on which to view the impact of globalization on CVDs in Ghana. It also set out the dimensions of the relationship between CVD risk factors and globalization. The paper concludes with a discussion on strategies for tackling the growing burden of CVDs in Ghana.

  4. Genetics of cardiovascular and renal complications in diabetes

    OpenAIRE

    Ma, Ronald CW

    2015-01-01

    Abstract The development of debilitating complications represents a major heathcare burden associated with the treatment of diabetes. Despite advances in new therapies for controlling hyperglycemia, the burden associated with diabetic complications remains high, especially in relation to cardiovascular and renal complications. Furthermore, an increasing proportion of patients develop type 2 diabetes at a younger age, putting them at higher risk of developing complications as a result of the i...

  5. A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children1234

    Science.gov (United States)

    Horlick, Mary; Berenson, Gerald S

    2013-01-01

    Background: Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBFSlaughter) is widely used, the accuracy of this method has not been well studied. Objective: The objective was to determine the accuracy of the Slaughter skinfold-thickness equations. Design: We compared agreement between PBFSlaughter and estimations derived from dual-energy X-ray absorptiometry (PBFDXA) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study. Results: PBFSlaughter was highly correlated (r = 0.90) with PBFDXA, but it markedly overestimated levels of PBFDXA in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥50 mm, PBFSlaughter overestimated PBFDXA by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points. We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBFSlaughter. Conclusions: These results indicate that PBFSlaughter, which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimates the body fatness of children who have thick skinfold thicknesses. Furthermore, PBFSlaughter has no advantage over sex- and age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values. PMID:24153344

  6. Gene polymorphisms as risk factors for predicting the cardiovascular manifestations in Marfan syndrome. Role of folic acid metabolism enzyme gene polymorphisms in Marfan syndrome.

    Science.gov (United States)

    Benke, Kálmán; Ágg, Bence; Mátyás, Gábor; Szokolai, Viola; Harsányi, Gergely; Szilveszter, Bálint; Odler, Balázs; Pólos, Miklós; Maurovich-Horvat, Pál; Radovits, Tamás; Merkely, Béla; Nagy, Zsolt B; Szabolcs, Zoltán

    2015-10-01

    Folic acid metabolism enzyme polymorphisms are believed to be responsible for the elevation of homocysteine (HCY) concentration in the blood plasma, correlating with the pathogenesis of aortic aneurysms and aortic dissection. We studied 71 Marfan patients divided into groups based on the severity of cardiovascular involvement: no intervention required (n=27, Group A); mild involvement requiring intervention (n=17, Group B); severe involvement (n=27, Group C) subdivided into aortic dilatation (n=14, Group C1) and aortic dissection (n=13, Group C2), as well as 117 control subjects. We evaluated HCY, folate, vitamin B12 and the polymorphisms of methylenetetrahydrofolate reductase (MTHFR;c.665C>T and c.1286A>C), methionine synthase (MTR;c.2756A>G) and methionine synthase reductase (MTRR;c.66A>G). Multiple comparisons showed significantly higher levels of HCY in Group C2 compared to Groups A, B, C1 and control group (pMarfan patients, and especially aortic dissection, is associated with higher HCY plasma levels and prevalence of homozygous genotypes of folic acid metabolism enzymes than mild or no cardiovascular involvement. These results suggest that impaired folic acid metabolism has an important role in the development and remodelling of the extracellular matrix of the aorta.

  7. Importance of Android/Gynoid Fat Ratio in Predicting Metabolic and Cardiovascular Disease Risk in Normal Weight as well as Overweight and Obese Children

    Science.gov (United States)

    Regier, Michael

    2014-01-01

    Numerous studies have shown that android or truncal obesity is associated with a risk for metabolic and cardiovascular disease, yet there is evidence that gynoid fat distribution may be protective. However, these studies have focused on adults and obese children. The purpose of our study was to determine if the android/gynoid fat ratio is positively correlated with insulin resistance, HOMA2-IR, and dislipidemia in a child sample of varying body sizes. In 7–13-year-old children with BMI percentiles ranging from 0.1 to 99.6, the android/gynoid ratio was closely associated with insulin resistance and combined LDL + VLDL-cholesterol. When separated by sex, it became clear that these relationships were stronger in boys than in girls. Subjects were stratified into BMI percentile based tertiles. For boys, the android/gynoid ratio was significantly related to insulin resistance regardless of BMI tertile with and LDL + VLDL in tertiles 1 and 3. For girls, only LDL + VLDL showed any significance with android/gynoid ratio and only in tertile 2. We conclude that the android/gynoid fat ratio is closely associated with insulin resistance and LDL + VLDL-, “bad,” cholesterol in normal weight boys and may provide a measurement of metabolic and cardiovascular disease risk in that population. PMID:25302115

  8. Predictable and SuStainable Implementation of National Cardiovascular Registries (PASSION) infrastructure: A think tank report from Medical Device Epidemiological Network Initiative (MDEpiNet).

    Science.gov (United States)

    Zeitler, Emily P; Al-Khatib, Sana M; Drozda, Joseph P; Kessler, Larry G; Kirtane, Ajay J; Kong, David F; Laschinger, John; Marinac-Dabic, Danica; Morice, Marie-Claude; Reed, Terrie; Sedrakyan, Art; Stein, Kenneth M; Tcheng, James; Krucoff, Mitchell W

    2016-01-01

    The MDEpiNet is a public-private partnership between the US Food and Drug Administration's Center for Devices and Radiological Health and participating partners. The PASSION program is an MDEpiNet-sponsored program that aims to demonstrate the goals of MDEpiNet by using cardiovascular medical device registries to bridge evidence gaps across the medical device total product life cycle. To this end, a PASSION Think Tank meeting took place in October 2014 in Silver Spring, MD, to facilitate discussion between stakeholders about the successes, challenges, and future novel applications of medical device registries, with particular emphasis on identifying pilot projects. Participants spanned a broad range of groups including patients, device manufacturers, regulators, physicians/academicians, professional societies, providers, and payers. The meeting focus included 4 areas of cardiovascular medicine intended to cultivate interest in 4 MDEpiNet disease-specific/device-specific working groups: coronary intervention, electrophysiology, valvular disease, and peripheral vascular disease. In addition, more general issues applying to registry-based infrastructure and analytical methodologies for assessing device benefit/risk were considered to provide context for the working groups as PASSION programs going forward. This article summarizes the discussions at the meeting and the future directions of the PASSION program.

  9. Importance of android/gynoid fat ratio in predicting metabolic and cardiovascular disease risk in normal weight as well as overweight and obese children.

    Science.gov (United States)

    Samsell, Lennie; Regier, Michael; Walton, Cheryl; Cottrell, Lesley

    2014-01-01

    Numerous studies have shown that android or truncal obesity is associated with a risk for metabolic and cardiovascular disease, yet there is evidence that gynoid fat distribution may be protective. However, these studies have focused on adults and obese children. The purpose of our study was to determine if the android/gynoid fat ratio is positively correlated with insulin resistance, HOMA2-IR, and dislipidemia in a child sample of varying body sizes. In 7-13-year-old children with BMI percentiles ranging from 0.1 to 99.6, the android/gynoid ratio was closely associated with insulin resistance and combined LDL + VLDL-cholesterol. When separated by sex, it became clear that these relationships were stronger in boys than in girls. Subjects were stratified into BMI percentile based tertiles. For boys, the android/gynoid ratio was significantly related to insulin resistance regardless of BMI tertile with and LDL + VLDL in tertiles 1 and 3. For girls, only LDL + VLDL showed any significance with android/gynoid ratio and only in tertile 2. We conclude that the android/gynoid fat ratio is closely associated with insulin resistance and LDL + VLDL-, "bad," cholesterol in normal weight boys and may provide a measurement of metabolic and cardiovascular disease risk in that population.

  10. Osteoporosis and ischemic cardiovascular disease.

    Science.gov (United States)

    Laroche, Michel; Pécourneau, Virginie; Blain, Hubert; Breuil, Véronique; Chapurlat, Roland; Cortet, Bernard; Sutter, Bruno; Degboe, Yannick

    2016-11-09

    Osteoporosis and cardiovascular disease were long viewed as independent of each other. However, numerous epidemiological studies, which are discussed in the first part of this review, have provided incontrovertible evidence of a link. Thus, the risk of coronary artery disease and stroke is higher in patients with a history of osteoporotic fracture or low bone mineral density than in non-osteoporotic patients. In the other direction, patients with cardiovascular disease are at higher risk for bone loss and osteoporotic fracture. The link between osteoporosis and cardiovascular disease is due in part to shared conventional risk factors such as estrogen deprivation in women, smoking, low physical activity, and diabetes. In addition, atheroma plaque calcification involves cytokines and growth factors that also play a role in bone turnover, including proinflammatory cytokines (IL-6 and TNFα), osteoprotegerin, sclerostin, matrix GLA protein, and FGF-23. Several recent studies have provided support for these pathophysiological hypotheses. Thus, elevation of osteoprotegerin, sclerostin, or FGF-23 levels may explain and predict the occurrence of both osteoporotic fractures and cardiovascular events. The association between osteoporosis and cardiovascular disease found in most epidemiological and pathophysiological studies suggests a need for evaluating potential benefits from routine bone absorptiometry and osteoporotic fracture detection in patients with cardiovascular disease and from exercise testing and arterial Doppler imaging in patients with osteoporosis.

  11. Burden of allergic respiratory disease

    DEFF Research Database (Denmark)

    Linneberg, A; Petersen, Karin Dam; Hahn-Pedersen, J

    2016-01-01

    ; there was little or no evidence of increasing or decreasing cost trends. Increased awareness of the detrimental effects of AR and/or AA on patients' HRQL and its considerable cost burden might encourage early diagnosis and treatment, in order to minimize the disease burden and ensure beneficial and cost-effective...... the disease-specific rhinitis quality of life questionnaire or generic instruments (SF-36 and SF-12). Summary estimates obtained by meta-analysis showed that HRQL in patients with perennial HDM allergy was significantly worse than that of patients with seasonal pollen allergy, when measured by both disease...

  12. Indigenous identity: burden or liberation?

    DEFF Research Database (Denmark)

    Steur, Luisa Johanna

    2010-01-01

    With the rise of ‘adivasi’ (‘indigenous’ or ‘tribal’) movements in different parts of South Asia in the past two decades, the question of how to understand ‘adivasi identity’ has become hotly debated: is it a burden, inviting distorted stereotypical depictions of subaltern people, or is it a prom......With the rise of ‘adivasi’ (‘indigenous’ or ‘tribal’) movements in different parts of South Asia in the past two decades, the question of how to understand ‘adivasi identity’ has become hotly debated: is it a burden, inviting distorted stereotypical depictions of subaltern people...

  13. Associations of dietary fiber intake with long-term predicted cardiovascular disease risk and C-reactive protein levels (from the National Health and Nutrition Examination Survey Data [2005-2010]).

    Science.gov (United States)

    Ning, Hongyan; Van Horn, Linda; Shay, Christina M; Lloyd-Jones, Donald M

    2014-01-15

    Dietary fiber intake might reduce cardiovascular risk factor levels and, in turn, might lower the long-term risk of cardiovascular disease (CVD). A total of 11,113 subjects, aged 20 to 79 years with no history of CVD, from the 2005 to 2010 National Health and Nutrition Examination Survey were included in the present study to examine associations of dietary fiber intake with predicted lifetime CVD risk and C-reactive protein levels. Dietary fiber intake showed a significant gradient association with the likelihood of having a low or an intermediate predicted lifetime CVD risk among young and middle-age adults. In fully adjusted multinomial logistic models, dietary fiber intake was related to a low lifetime CVD risk with an odds ratio of 2.71 (95% confidence interval 2.05 to 3.59) in the young adults and 2.13 (95% confidence interval 1.42 to 3.20) in the middle-age adults and was related to an intermediate lifetime risk of 2.65 (95% confidence interval 1.79 to 3.92) in the young and 1.98 (95% confidence interval 1.32 to 2.98) in the middle-age adults compared with a high lifetime risk. A significant inverse linear association was seen between dietary fiber intake and log-transformed C-reactive protein levels with a regression coefficient ± standard error of -0.18 ± 0.04 in the highest quartile of fiber intake compared with the lowest fiber intake. In conclusion, these data suggest that dietary fiber intake is independently associated with the predicted lifetime CVD risk, especially in young and middle-age adults. A greater amount of dietary fiber intake might be associated with lower C-reactive protein levels.

  14. Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

    Science.gov (United States)

    Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

    2015-06-01

    Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Predicting the consumption of foods low in saturated fats among people diagnosed with Type 2 diabetes and cardiovascular disease. The role of planning in the theory of planned behaviour.

    Science.gov (United States)

    White, Katherine M; Terry, Deborah J; Troup, Carolyn; Rempel, Lynn A; Norman, Paul

    2010-10-01

    The present study tested the utility of an extended version of the theory of planned behaviour that included a measure of planning, in the prediction of eating foods low in saturated fats among adults diagnosed with Type 2 diabetes and/or cardiovascular disease. Participants (N=184) completed questionnaires assessing standard theory of planned behaviour measures (attitude, subjective norm, and perceived behavioural control) and the additional volitional variable of planning in relation to eating foods low in saturated fats. Self-report consumption of foods low insaturated fats was assessed 1 month later. In partial support of the theory of planned behaviour, results indicated that attitude and subjective norm predicted intentions to eat foods low in saturated fats and intentions and perceived behavioural control predicted the consumption of foods low in saturated fats. As an additional variable, planning predicted the consumption of foods low in saturated fats directly and also mediated the intention-behaviour and perceived behavioural control-behaviour relationships, suggesting an important role for planning as a post-intentional construct determining healthy eating choices. Suggestions are offered for interventions designed to improve adherence to healthy eating recommendations for people diagnosed with these chronic conditions with a specific emphasis on the steps and activities that are required to promote a healthier lifestyle.

  16. Dependence and caregiver burden in Alzheimer's disease and mild cognitive impairment.

    LENUS (Irish Health Repository)

    Gallagher, Damien

    2011-03-01

    The dependence scale has been designed to be sensitive to the overall care needs of the patient and is considered distinct from standard measures of functional ability in this regard. Little is known regarding the relationship between patient dependence and caregiver burden. We recruited 100 patients with Alzheimer\\'s disease or mild cognitive impairment and their caregivers through a memory clinic. Patient function, dependence, hours of care, cognition, neuropsychiatric symptoms, and caregiver burden were assessed. Dependence was significantly correlated with caregiver burden. Functional decline and dependence were most predictive of caregiver burden in patients with mild impairment while behavioral symptoms were most predictive in patients with moderate to severe disease. The dependence scale demonstrated good utility as a predictor of caregiver burden. Interventions to reduce caregiver burden should address patient dependence, functional decline, and behavioral symptoms while successful management of the latter becomes more critical with disease progression.

  17. Prediction

    CERN Document Server

    Sornette, Didier

    2010-01-01

    This chapter first presents a rather personal view of some different aspects of predictability, going in crescendo from simple linear systems to high-dimensional nonlinear systems with stochastic forcing, which exhibit emergent properties such as phase transitions and regime shifts. Then, a detailed correspondence between the phenomenology of earthquakes, financial crashes and epileptic seizures is offered. The presented statistical evidence provides the substance of a general phase diagram for understanding the many facets of the spatio-temporal organization of these systems. A key insight is to organize the evidence and mechanisms in terms of two summarizing measures: (i) amplitude of disorder or heterogeneity in the system and (ii) level of coupling or interaction strength among the system's components. On the basis of the recently identified remarkable correspondence between earthquakes and seizures, we present detailed information on a class of stochastic point processes that has been found to be particu...

  18. Final infarct size measured by cardiovascular magnetic resonance in patients with ST elevation myocardial infarction predicts long-term clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Vejlstrup, Niels Grove; Kelbæk, Henning Skov

    2013-01-01

    AIMS: Tailored heart failure treatment and risk assessment in patients following ST-segment elevation myocardial infarction (STEMI) is mainly based on the assessment of the left ventricular (LV) ejection fraction (EF). Assessment of the final infarct size in addition to the LVEF may improve...... the prognostic evaluation. To evaluate the prognostic importance of the final infarct size measured by cardiovascular magnetic resonance (CMR) in patients with STEMI. METHODS AND RESULTS: In an observational study the final infarct size was measured by late gadolinium enhancement CMR 3 months after initial...... admission in 309 patients with STEMI. The clinical endpoint was a composite of all-cause mortality and admission for heart failure. During the follow-up period of median 807 days (IQR: 669-1117) 35 events (5 non-cardiac deaths, 3 cardiac deaths, and 27 admissions for heart failure) were recorded. Patients...

  19. A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children.

    Science.gov (United States)

    Freedman, David S; Horlick, Mary; Berenson, Gerald S

    2013-12-01

    Although estimation of percentage body fat with the Slaughter skinfold-thickness equations (PBF(Slaughter)) is widely used, the accuracy of this method has not been well studied. The objective was to determine the accuracy of the Slaughter skinfold-thickness equations. We compared agreement between PBF(Slaughter) and estimations derived from dual-energy X-ray absorptiometry (PBF(DXA)) in 1169 children in the Pediatric Rosetta Body Composition Project and the relation to cardiovascular disease risk factors, as compared with body mass index (BMI), in 6725 children in the Bogalusa Heart Study. PBF(Slaughter) was highly correlated (r = 0.90) with PBF(DXA), but it markedly overestimated levels of PBF(DXA) in children with large skinfold thicknesses. In the 65 boys with a sum of skinfold thicknesses (subscapular- plus triceps-skinfold thicknesses) ≥ 50 mm, PBF(Slaughter) overestimated PBF(DXA) by 12 percentage points. The comparable overestimation in girls with a high skinfold sum was 6 percentage points. We also found that, after adjustment for sex and age, BMI showed slightly stronger associations with lipid, lipoprotein, insulin, and blood pressure values than did PBF(Slaughter). These results indicate that PBF(Slaughter), which was developed among a group of much thinner children and adolescents, is fairly accurate among nonobese children, but markedly overestimates the body fatness of children who have thick skinfold thicknesses. Furthermore, PBF(Slaughter) has no advantage over sex- and age-adjusted BMIs at identifying children who are at increased risk of cardiovascular disease based on lipid, lipoprotein, insulin, and blood pressure values.

  20. Pulse Pressure Predicts Incident Cardiovascular Disease but Not Diabetic Nephropathy in Patients With Type 1 Diabetes (The FinnDiane Study)

    Science.gov (United States)

    Gordin, Daniel; Wadén, Johan; Forsblom, Carol; Thorn, Lena; Rosengård-Bärlund, Milla; Tolonen, Nina; Saraheimo, Markku; Harjutsalo, Valma; Groop, Per-Henrik

    2011-01-01

    OBJECTIVE Pulse pressure (PP), an estimate of arterial stiffness, has been shown to be associated with incident cardiovascular disease (CVD) in patients with type 1 diabetes (T1D). However, diabetic kidney disease, a strong predictor of CVD, was not previously taken into account. Furthermore, the role of PP as a predictor of diabetic nephropathy is not known. Therefore, we prospectively investigated the associations between PP and these diabetes complications in patients with T1D. RESEARCH DESIGN AND METHODS A total of 4,509 patients from the FinnDiane Study participated. Follow-up data on incident CVD events and renal status (median 5.3 years) were available in 69 and 76% of the patients, respectively. Altogether, 269 patients (8.6%) had an incident CVD event and 370 patients (10.8%) progressed to a higher level of albuminuria or to end-stage renal disease. RESULTS PP was higher at baseline in patients who experienced a CVD event (66 ± 18 vs. 52 ± 14 mmHg; P < 0.001) or progressed in their renal status (58 ± 18 vs. 54 ± 15 mmHg; P < 0.01) during follow-up. In a Cox regression model, PP was independently associated with a first ever CVD event (hazard ratio per 10 mmHg 1.22 [95% CI 1.10–1.34]) but not progression of renal disease (1.00 [0.89–1.12]) after adjustments for traditional risk factors. CONCLUSIONS PP, a marker of arterial stiffness, is a risk factor for cardiovascular complications but not for diabetic nephropathy in patients with T1D. PMID:21330642

  1. Predictive Value of Having Positive Family History of Cardiovascular Disorders, Diabetes Mellitus, Dyslipidemia, and Hypertension in Non-Alcoholic Fatty Liver Disease Patients

    Directory of Open Access Journals (Sweden)

    Hossein Khedmat

    2013-05-01

    Full Text Available In the present study, we examined the relationship between family history of cardiovascular diseases (CVD, dyslipidemia, hypertension, and diabetes with laboratorial abnormalities and syndromes in Iranian patients with non-alcoholic fatty liver disease (NAFLD. A total of 332 NAFLD patients from our outpatient clinic were consecutively entered into analysis. Exclusion criteria were having diabetes mellitus and fasting blood glucose over 126, active hepatitis B virus infection, having HCV positive serology, and to be under corticosteroid therapy. Family history of CVD, diabetes, dyslipidemia, and hypertension were taken from patients and related to the study variables. Family history of cardiovascular diseases (CVD was associated with low HDL levels (P=0.05. Patients with positive family history of diabetes mellitus were significantly more likely to have AST/ALT levels proportion of higher than one (P=0.044. Family history of dyslipidemia was a predictor for hypertriglyceridemia (P=0.02, higher prothrombin time levels (P=0.013, lower albumin (P=0.024 and T4 (P=0.043 levels. Family history of hypertension was associated with dysglycemia/diabetes (P=0.038, high ALT (P=0.008, and low TIBC (P=0.007 and albumin levels (P=0.001. Family history for CVD, diabetes, dyslipidemia, and hypertension were of clinical importance in the Iranian patients with NAFLD. We therefore recommend that physicians should precisely get family history of main disorders in all NAFLD patients; and to pay more attention to those having the mentioned family histories. Further studies with larger patient population and prospective approach are needed for confirming our findings.

  2. Abdominal obesity in Japanese-Brazilians: which measure is best for predicting all-cause and cardiovascular mortality? Obesidade abdominal em nipo-brasileiros: que medida antropométrica tem maior capacidade de predizer a mortalidade geral e por doenças cardiovasculares?

    Directory of Open Access Journals (Sweden)

    Marselle Rodrigues Bevilacqua

    2011-10-01

    Full Text Available This study aimed to verify which anthropometric measure of abdominal obesity was the best predictor of all-cause and cardiovascular mortality in Japanese-Brazilians. The study followed 1,581 subjects for 14 years. Socio-demographic, lifestyle, metabolic, and anthropometric data were collected. The dependent variable was vital status (alive or dead at the end of the study, and the independent variable was presence of abdominal obesity according to different baseline measures. The mortality rate was estimated, and Poisson regression was used to obtain mortality rate ratios with abdominal obesity, adjusted simultaneously for the other variables. The mortality rate was 10.68/thousand person-years. Male gender, age > 60 years, and arterial hypertension were independent risk factors for mortality. The results indicate that prevalence of abdominal obesity was high among Japanese-Brazilians, and that waist/hip ratio was the measure with the greatest capacity to predict mortality (especially cardiovascular mortality in this group.O objetivo foi verificar qual medida antropométrica de obesidade abdominal melhor prediz mortalidade geral e por doenças cardiovasculares entre nipo-brasileiros. Foram seguidos, por 14 anos, 1.581 sujeitos. Coletaram-se dados sociodemográficos, de estilo de vida, metab��licos e antropométricos. Considerou-se vivo ou óbito ao final do estudo como variável dependente e a presença de obesidade abdominal por diferentes medidas na linha de base como variável independente. Estimou-se o coeficiente de mortalidade e se usou o modelo de Poisson para obtenção das razões entre eles e a obesidade abdominal, ajustados simultaneamente às demais variáveis. O coeficiente de mortalidade foi de 10,68/mil pessoas-ano. O gênero masculino, a idade > 60 anos e ter hipertensão arterial foram fatores de risco independentes para mortalidade. Os resultados indicaram que entre nipo-brasileiros a prevalência de obesidade abdominal foi

  3. HMGB1 is associated with atherosclerotic plaque composition and burden in patients with stable coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Martin Andrassy

    Full Text Available OBJECTIVES: The role of inflammation in atherosclerosis is widely appreciated. High mobility group box 1 (HMGB1, an injury-associated molecular pattern molecule acting as a mediator of inflammation, has recently been implicated in the development of atherosclerosis. In this study, we sought to investigate the association of plasma HMGB1 with coronary plaque composition in patients with suspected or known coronary artery disease (CAD. DESIGN: HMGB1, high sensitive troponin T (hsTnT and high sensitive C-reactive protein (hsCRP were determined in 152 consecutive patients with suspected or known stable CAD who underwent clinically indicated 256-slice coronary computed tomography angiography (CCTA. Using CCTA, we assessed 1 coronary calcification, 2 non-calcified plaque burden and 3 the presence of vascular remodeling in areas of non-calcified plaques. RESULTS: Using univariate analysis, hsCRP, hsTnT and HMGB1 as well as age, and atherogenic risk factors were associated with non-calcified plaque burden (r = 0.21, p = 0.009; r = 0.48, p<0.001 and r = 0.34, p<0.001, respectively. By multivariate analysis, hsTnT and HMGB1 remained independent predictors of the non-calcified plaque burden (r = 0.48, p<0.01 and r = 0.34, p<0.001, respectively, whereas a non-significant trend was noticed for hs-CRP (r = 0.21, p = 0.07. By combining hsTnT and HMGB1, a high positive predictive value for the presence of non-calcified and remodeled plaque (96% and 77%, respectively was noted in patients within the upper tertiles for both biomarkers, which surpassed the positive predictive value of each marker separately. CONCLUSIONS: In addition to hs-TnT, a well-established cardiovascular risk marker, HMGB1 is independently associated with non-calcified plaque burden in patients with stable CAD, while the predictive value of hs-CRP is lower. Complementary value was observed for hs-TnT and HMGB1 for the prediction of complex coronary plaque.

  4. GlycA Is a Novel Biomarker of Inflammation and Subclinical Cardiovascular Disease in Psoriasis.

    Science.gov (United States)

    Joshi, Aditya A; Lerman, Joseph B; Aberra, Tsion M; Afshar, Mehdi; Teague, Heather L; Rodante, Justin A; Krishnamoorthy, Parasuram; Ng, Qimin; Aridi, Tarek Z; Salahuddin, Taufiq; Natarajan, Balaji; Lockshin, Benjamin N; Ahlman, Mark A; Chen, Marcus Y; Rader, Daniel J; Reilly, Muredach P; Remaley, Alan T; Bluemke, David A; Playford, Martin P; Gelfand, Joel M; Mehta, Nehal N

    2016-11-11

    GlycA, an emerging inflammatory biomarker, predicted cardiovascular events in population-based studies. Psoriasis, an inflammatory disease associated with increased cardiovascular risk, provides a model to study inflammatory biomarkers in cardiovascular disease (CVD). Whether GlycA associates with psoriasis and how it predicts subclinical CVD beyond high-sensitivity C-reactive protein in psoriasis is unknown. To investigate the relationships between GlycA and psoriasis and between GlycA and subclinical CVD. Patients with psoriasis and controls (n=412) participated in a 2-stage study. We measured GlycA by nuclear magnetic resonance spectroscopy. National Institutes of Health (NIH) participants underwent 18-F Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (18-FDG PET/CT) scans to assess vascular inflammation (VI) and coronary computed tomographic angiography to quantify coronary artery disease burden. Psoriasis cohorts were young (mean age=47.9), with low cardiovascular risk and moderate skin disease. high-sensitivity C-reactive protein and GlycA were increased in psoriasis compared with controls (GlycA: [PENN: 408.8±75.4 versus 289.4±60.2, Ppsoriasis severity. In stage 2, VI (β=0.36, Ppsoriasis. In receiver operating characteristic analysis, GlycA added value in predicting VI (P=0.01) and coronary artery disease (Ppsoriasis severity (Ppsoriasis severity and subclinical CVD beyond traditional CV risk and high-sensitivity C-reactive protein. Moreover, psoriasis treatment reduced GlycA and VI. These findings support the potential use of GlycA in subclinical CVD risk assessment in psoriasis and potentially other inflammatory diseases. © 2016 American Heart Association, Inc.

  5. Review of the Predictive Value of Combined Obesity and Inflammation on Cardiovascular Diseases%肥胖结合炎症反应预测心脑血管疾病的研究进展

    Institute of Scientific and Technical Information of China (English)

    刘星; 吴红梅; 杜焕民; 张卿(综述); 牛凯军(审校)

    2015-01-01

    The prevalence of obesity has become a worldwide public health problem .In recent years, some studies have suggested that many obese individuals are in a healthy state without any related diseases . Individuals with obesity,visceral obesity in particular,have a low-grade but chronic inflammatory state.An unfavorable inflammatory state accompanied by changes of inflammatory cytokines in the body acting directly on the target organ can result in cardiovascular disease.So,taking the combination of obesity and the inflam-mation index together into consideration will be a more accurate approach to cardiovascular disease preven-tion.This view is still in dispute,therefore here elaborates on both the limitations of using obesity alone,and the advantages of combining inflammation markers to predict cardiovascular disease , seeking to prove that combining the obesity index with inflammation markers is a strong predictor of cardiovascular disease .%肥胖的流行在世界范围内已经成为一个重要的全球性公共健康问题。一些研究发现很多肥胖的个体处于健康状态,并没有出现相关疾病。肥胖,特别是内脏肥胖,可产生体内慢性低度炎症反应状态,炎症反应状态伴随着体内多种炎性因子水平的变化,从而直接作用于相应的靶部位最终引起心脑血管疾病。因此,结合肥胖和炎症反应的指标共同对心脑血管疾病进行预测会更加精确。但是,这个观点尚存在争议。该文通过阐述单独用肥胖预测心血管疾病的局限性,以及结合炎症反应和肥胖指标预测的优势来证明肥胖结合炎症反应指标是预测心脑血管疾病强有力的指标。

  6. Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA.

    Directory of Open Access Journals (Sweden)

    Eric T Roberts

    Full Text Available The Multi-Ethnic Study of Atherosclerosis (MESA showed that the addition of coronary artery calcium (CAC to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels <160 mg/dL. However, the cost-effectiveness of incorporating CAC into treatment decision rules has yet to be clearly delineated.To model the cost-effectiveness of CAC for cardiovascular risk stratification in asymptomatic, intermediate risk patients not taking a statin. Treatment based on CAC was compared to (1 treatment of all intermediate-risk patients, and (2 treatment on the basis of United States guidelines.We developed a Markov model of first coronary heart disease (CHD and cardiovascular disease (CVD events. We modeled statin treatment in intermediate risk patients with CAC≥1 and CAC≥100, with different intensities of statins based on the CAC score. We compared these CAC-based treatment strategies to a "treat all" strategy and to treatment according to the Adult Treatment Panel III (ATP III guidelines. Clinical and economic outcomes were modeled over both five- and ten-year time horizons. Outcomes consisted of CHD and CVD events and Quality-Adjusted Life Years (QALYs. Sensitivity analyses considered the effect of higher event rates, different CAC and statin costs, indirect costs, and re-scanning patients with incidentalomas.We project that it is both cost-saving and more effective to scan intermediate-risk patients for CAC and to treat those with CAC≥1, compared to treatment based on established risk-assessment guidelines. Treating patients with CAC≥100 is also preferred to existing guidelines when we account for statin side effects and the disutility of statin use.Compared to the alternatives we assessed, CAC testing is both effective and cost saving as a risk-stratification tool, particularly if there are adverse effects of long-term statin use. CAC may enable providers to better tailor

  7. Do Physical Activity, Body Mass Index, and Sleep Duration Predict Clustered Cardiovascular Disease Risk in Children?- A Part of the OPUS Study

    DEFF Research Database (Denmark)

    Hjorth, Mads F.; Damsgaard, Camilla T.; Dalskov, Stine-Mathilde

    Objective To investigate the single and combined associations of physical activity (PA), body mass index (BMI), and sleep duration with clustering of cardiovascular disease risk markers in healthy children. Methods We did a cross-sectional pilot-study of 74 Danish school children aged 8-11 years....... Risk factors included in a continuous metabolic syndrome score (cMETscore) were mean z-scores of high-density lipoprotein, triglyceride, insulin resistance, and mean arterial blood pressure. Physical activity (counts/min) and sleep duration were assessed for 7 days using an accelerometer. Results Mean...... BMI was 17.1 (range 13.4-25.4) kg/m2, with 10.8% classified as overweight using isoBMI. Controlled for age and sex, P A was negatively associated with cMET-score (Standardised beta coefficients (sBeta)=-0.32); n=74; P=0.016) and BMI was positively associated with cMETscore (sBeta=0.49; n=74; P...

  8. Do Physical Activity, Body Mass Index, and Sleep Duration Predict Clustered Cardiovascular Disease Risk in Children?- A Part of the OPUS Study

    DEFF Research Database (Denmark)

    Hjorth, Mads F.; Damsgaard, Camilla T.; Dalskov, Stine-Mathilde

    Objective To investigate the single and combined associations of physical activity (PA), body mass index (BMI), and sleep duration with clustering of cardiovascular disease risk markers in healthy children. Methods We did a cross-sectional pilot-study of 74 Danish school children aged 8-11 years....... Risk factors included in a continuous metabolic syndrome score (cMETscore) were mean z-scores of high-density lipoprotein, triglyceride, insulin resistance, and mean arterial blood pressure. Physical activity (counts/min) and sleep duration were assessed for 7 days using an accelerometer. Results Mean...... BMI was 17.1 (range 13.4-25.4) kg/m2, with 10.8% classified as overweight using isoBMI. Controlled for age and sex, P A was negatively associated with cMET-score (Standardised beta coefficients (sBeta)=-0.32); n=74; P=0.016) and BMI was positively associated with cMETscore (sBeta=0.49; n=74; P...

  9. The Personality and Psychological Stress Predict Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention for Five Years.

    Science.gov (United States)

    Du, Jinling; Zhang, Danyang; Yin, Yue; Zhang, Xiaofei; Li, Jifu; Liu, Dexiang; Pan, Fang; Chen, Wenqiang

    2016-04-01

    To investigate the effects of personality type and psychological stress on the occurrence of major adverse cardiovascular events (MACEs) at 5 years in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Two hundred twenty patients with stable angina (SA) or non-ST segment elevation acute coronary syndrome (NSTE-ACS) treated with PCI completed type A behavioral questionnaire, type D personality questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Trait Coping Style Questionnaire (TCSQ), and Symptom Checklist 90 (SCL-90) at 3 days after PCI operation. Meanwhile, biomedical markers (cTnI, CK-MB, LDH, LDH1) were assayed. MACEs were monitored over a 5-year follow-up. NSTE-ACS group had higher ratio of type A behavior, type A/D behavior, and higher single factor scores of type A personality and type D personality than control group and SAP group. NSTE-ACS patients had more anxiety, depression, lower level of mental health (P Type D patients were at a cumulative increased risk of adverse outcome compared with non-type D patients (P type A and type D personality and this tendency was associated with myocardial injury. They also had obvious anxiety, depression emotion, and lower level of mental health, which were related to personality and coping style. Type D personality was an independent predictor of adverse events.

  10. Using Predicted Cardiovascular Disease Risk in Conjunction With Blood Pressure to Guide Antihypertensive Medication Treatment.

    Science.gov (United States)

    Muntner, Paul; Whelton, Paul K

    2017-05-16

    Using cardiovascular disease (CVD) risk instead of or in addition to blood pressure (BP) to guide antihypertensive treatment is an active area of research. The purpose of this review is to provide an overview of studies that could inform this treatment paradigm. We review data from randomized trials on relative and absolute CVD risk reduction that can occur when antihypertensive treatment is guided by CVD risk. We also review population-level data on using CVD risk in conjunction with BP to guide antihypertensive treatment, the broad distribution in CVD risk for people with similar BP levels, and the use of CVD risk for guiding antihypertensive treatment among subgroups including older adults, young adults, and those with diabetes mellitus or chronic kidney disease. In addition, we review potential challenges in implementing antihypertensive treatment recommendations that incorporate CVD risk. In closing, we provide recommendations for using CVD risk in combination with BP to guide antihypertensive treatment. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Gaede, Peter; Vedel, Pernille; Larsen, Nicolai

    2003-01-01

    Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabe...

  12. Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone: Comparison of Four Analysis Methods.

    Science.gov (United States)

    Jablonowski, Robert; Chaudhry, Uzma; van der Pals, Jesper; Engblom, Henrik; Arheden, Håkan; Heiberg, Einar; Wu, Katherine C; Borgquist, Rasmus; Carlsson, Marcus

    2017-09-01

    Late gadolinium enhancement (LGE) border zone on cardiac magnetic resonance imaging has been proposed as an independent predictor of ventricular arrhythmias. The purpose was to determine whether size and heterogeneity of LGE predict appropriate implantable cardioverter defibrillator (ICD) therapy in ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients and to evaluate 4 LGE border-zone algorithms. ICM and NICM patients who underwent LGE cardiac magnetic resonance imaging prior to ICD implantation were retrospectively included. Two semiautomatic algorithms, expectation maximization, weighted intensity, a priori information and a weighted border zone algorithm, were compared with a modified full-width half-maximum and a 2-3SD threshold-based algorithm (2-3SD). Hazard ratios were calculated per 1% increase in LGE. A total of 74 ICM and 34 NICM were followed for 63 months (1-140) and 52 months (0-133), respectively. ICM patients had 27 appropriate ICD events, and NICM patients had 7 ICD events. In ICM patients with primary prophylactic ICD, LGE border zone predicted ICD therapy in univariable and multivariable analysis measured by the expectation maximization, weighted intensity, a priori information, weighted border zone, and modified full-width half-maximum algorithms (hazard ratios 1.23, 1.22, and 1.05, respectively; P<0.05; negative predictive value 92%). For NICM, total LGE by all 4 methods was the strongest predictor (hazard ratios, 1.03-1.04; P<0.05), though the number of events was small. Appropriate ICD therapy can be predicted in ICM patients with primary prevention ICD by quantifying the LGE border zone. In NICM patients, total LGE but not LGE border zone had predictive value for ICD therapy. However, the algorithms used affects the predictive value of these measures. © 2017 American Heart Association, Inc.

  13. Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Cardiovascular Links

    Directory of Open Access Journals (Sweden)

    Cheryl R. Laratta

    2014-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.

  14. Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update

    Directory of Open Access Journals (Sweden)

    S. Burlina

    2016-01-01

    Full Text Available The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity around the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk of cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify appropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and metabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected.

  15. The Burden of Musculoskeletal Conditions

    OpenAIRE

    Clémence Palazzo; Jean-François Ravaud; Agathe Papelard; Philippe Ravaud; Serge Poiraudeau

    2014-01-01

    OBJECTIVE: Despite the burden of rheumatic and musculoskeletal diseases (RMDs), these conditions probably deserve more attention from public health authorities in several countries including developed ones. We assessed their contribution to disability. METHODS: Data on disabilities associated with RMDs were extracted from the national 2008-2009 Disability-Health Survey of 29,931 subjects representative of the population in France. We used the core set of disability categories for RMDs of the ...

  16. Burden of Osteoporosis in Iran

    Directory of Open Access Journals (Sweden)

    F Abolhassani

    2004-11-01

    Full Text Available Osteoporosis is the most common metabolic bone disease. In addition to morbidity, osteoporotic fractures also increase mortality risk in affected patients. Enough evidence is not available to indicate that, like western countries, osteoporosis is a public health problem in Iran. Therefore EMRC planned to estimate the burden of osteoporotic fractures in year 2001 based on existing sources of data. The EMRC study on bone density, the MOH study on unintentional injuries, and international literature on mortality risk following osteoporotic fractures were the main sources of information used for this study. To estimate burden of osteoporotic fractures, the prevalence of osteoporosis, the incidence of osteoporotic fractures, and the relative risk of mortality following these fractures were approximated. The mean duration of disability following major osteoporotic fractures was estimated through epidemiologic modeling. Assumptions on the disability weights of morbid conditions resulting from osteoporotic fractures were made through comparing these conditions with similar ones in Global Burden of Disease Study. Based on mortality and incidence rates, mean durations of disability, and disability weights; the DALYs indicator was calculated for Spine, Hip, and Forearm fractures. In women hip, spine, and forearm fractures were responsible for 15880, 1269, and 121 mortality- and morbidity-related lost years of life respectively. Similar figures in men were 16495, 2225, and 37 years. Collectively osteoporosis deprived Iranian population from 36026 healthy years of life (18757 in men and 17270 in women in 2001. Higher burden of osteoporosis in men, mainly results from higher risk of mortality following fractures in male sex. The national study on unintentional injuries indicates that the incidence of osteoporotic hip fractures in Iranian population is much less than other populations. Higher bone mineral density and other probable differences between Iranians

  17. Overlooking Informal Dementia Caregivers' Burden.

    Science.gov (United States)

    Riedel, Oliver; Klotsche, Jens; Wittchen, Hans-Ulrich

    2016-07-01

    Patients with Alzheimer's disease (AD) need early caregiver support. Caregivers often have poor health, but usually do not have time to seek medical advice for their own conditions. Patients' physicians, who are frequently the sole medical practitioner caregivers contact regularly, have an important function in recognizing family caregivers' burdens. The current study investigated to what extent medical practitioners recognized family caregivers' problems. In a two-staged survey in neurology outpatient care, caregivers of patients with mild or moderate AD were enrolled and assessed by physicians regarding their physical and mental burden, as well as need for help and advice about AD. Subsequently, caregivers' mental health was evaluated in a comprehensive diagnostic interview by blinded psychologists. Overall, 73.7% of caregivers had at least one somatic condition and 43.7% had clinically relevant depressive symptoms (of these, 37.5% met criteria for major depression). The findings suggest that the burden of a substantial proportion of affected family caregivers is overlooked. [Res Gerontol Nurs. 2016; 9(4):167-174.]. Copyright 2016, SLACK Incorporated.

  18. Predictive value of microalbuminuria on cardiovascular and all-cause mortality%微量白蛋白尿对心血管疾病死亡及全因死亡风险的预测价值

    Institute of Scientific and Technical Information of China (English)

    李妍妍; 陆菊明; 王淑玉; 卢艳慧; 宋瑛; 刘力生; 田慧; 潘长玉

    2011-01-01

    Objective To analyze the effect of microalbuminuria on predicting cardiovascular disease mortality and total mortality risk in 2181 subjects.Methods These subjects came from Beijing epidemiological data in the moderate-elderly population in June 2004.After 4 years follow up, the death of various reasons were observed of death of four-year period for various reasons in May 2008.In according to the albumin creatinine ratio (ACR) value, all subjects were divided into normal albuminuria group (NAU group), microalbuminuria group (MIAU group) and macroalbuminuria group (MAAU in according to the ACR).The various causes of death were analyzed, and the baseline clinical characteristics and metabolic markers were compared between the death group and survival group.In the follow-up, Cox regression model was used.After adjusted for age, DM history, history of hypertension, dyslipidemia and other potential risk factors, the relationship between ACR levels and cardiovascular- or all-cause mortality was analyzed.Results Totally 77 subjects died during the 4 years follow up.The all-cause mortality was 8.7/1000 person-year in total population.The CVD and malignant tumor were the main causes of death.Compared with the survival population,the proportion of MIAU, MAAU, and DM were significantly higher in the death population ( 18.2% vs 8.7% ,9.1% vs 1.6%, 50.6% vs 25.8%, P < 0.01 ).The all-cause mortality was 6.8‰,20.6‰ and 58.8 ‰ in NAU, MIAU, MAAU population respectively.In the NAU population, malignant tumor was the leading cause of death, followed by cardiovascular disease.While in MIAU and MAAU population, cardiovascular disease was the primary cause of death.After age, blood glucose, hypertension,dyslipidemia and other factors were adjusted, compared with the NAU, the risk of death of cardiovascular disease was increased by 1.72 times and the all-cause death increased by 1.01 times in MIAU group, risk of death of cardiovascular disease increased by 3.87 times and of all

  19. A prediction of the renal and cardiovascular efficacy of aliskiren in ALTITUDE using short-term changes in multiple risk markers

    DEFF Research Database (Denmark)

    Smink, P A; Hoekman, J; Grobbee, D E;

    2014-01-01

    INTRODUCTION: We recently developed and validated in existing trials a novel algorithm (PRE score) to predict long-term drug efficacy based on short-term (month-6) drug-induced changes in multiple risk markers. To show the value of the PRE score for ongoing and planned clinical trials, we here re...

  20. Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease: the type D personality construct.

    Science.gov (United States)

    Denollet, Johan; Pedersen, Susanne S; Vrints, Christiaan J; Conraads, Viviane M

    2013-01-01

    Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition (SI), or rather the main effect of either trait alone. In this 5-year follow-up of 541 patients with CAD, the Type D construct (14-item Type D Scale) was tested by examining a) the interaction of continuous NA and SI z scores and b) a four-group classification defined by low/high trait scores. End points were major adverse cardiac events (MACEs; death, myocardial infarction [MI], coronary revascularization) and cardiac death/MI. At follow-up, 113 patients had a MACE, including 47 patients with cardiac death/MI. After adjustment for disease severity, age, sex, and main trait effects, the interaction of NA and SI z scores was associated with MACE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.11-1.67). This continuous measure of Type D was also associated with cardiac death/MI (OR = 1.48, 95% CI = 1.11-1.96) and remained an independent predictor of events after adjustment for depressive symptoms. Using a cutoff of 10 on both NA and SI scales, Type D was associated with an adjusted OR of 1.74 (95% CI = 1.11-2.73) for MACE and an OR of 2.35 (95% CI = 1.26-4.38) for death/MI but was unrelated to noncardiac death. Patients with high NA or SI alone were not at increased risk. Continuous (NA × SI interaction) and dichotomized measures of Type D were associated with cardiovascular events in patients with CAD. Research is needed to explore moderating factors that may alter this association.

  1. Cost-effectiveness of coronary artery calcium testing for coronary heart and cardiovascular disease risk prediction to guide statin allocation: the Multi-Ethnic Study of Atherosclerosis (MESA).

    Science.gov (United States)

    Roberts, Eric T; Horne, Aaron; Martin, Seth S; Blaha, Michael J; Blankstein, Ron; Budoff, Matthew J; Sibley, Christopher; Polak, Joseph F; Frick, Kevin D; Blumenthal, Roger S; Nasir, Khurram

    2015-01-01

    The Multi-Ethnic Study of Atherosclerosis (MESA) showed that the addition of coronary artery calcium (CAC) to traditional risk factors improves risk classification, particularly in intermediate risk asymptomatic patients with LDL cholesterol levels statin. Treatment based on CAC was compared to (1) treatment of all intermediate-risk patients, and (2) treatment on the basis of United States guidelines. We developed a Markov model of first coronary heart disease (CHD) and cardiovascular disease (CVD) events. We modeled statin treatment in intermediate risk patients with CAC≥1 and CAC≥100, with different intensities of statins based on the CAC score. We compared these CAC-based treatment strategies to a "treat all" strategy and to treatment according to the Adult Treatment Panel III (ATP III) guidelines. Clinical and economic outcomes were modeled over both five- and ten-year time horizons. Outcomes consisted of CHD and CVD events and Quality-Adjusted Life Years (QALYs). Sensitivity analyses considered the effect of higher event rates, different CAC and statin costs, indirect costs, and re-scanning patients with incidentalomas. We project that it is both cost-saving and more effective to scan intermediate-risk patients for CAC and to treat those with CAC≥1, compared to treatment based on established risk-assessment guidelines. Treating patients with CAC≥100 is also preferred to existing guidelines when we account for statin side effects and the disutility of statin use. Compared to the alternatives we assessed, CAC testing is both effective and cost saving as a risk-stratification tool, particularly if there are adverse effects of long-term statin use. CAC may enable providers to better tailor preventive therapy to patients' risks of CVD.

  2. Genetic lipid disorders, Familial Dysbetalipoproteinemia and cardiovascular disease

    NARCIS (Netherlands)

    Koopal, C.

    2017-01-01

    Background Cardiovascular disease (CVD) is a large worldwide medical burden, with yearly increasing morbidity and mortality. An important risk factor for CVD are high cholesterol levels, with low-density lipoprotein cholesterol (LDL-C) as the main focus of research up to now. The introduction of

  3. Urine albumin/creatinine ratio, high sensitivity C-reactive protein and N-terminal pro brain natriuretic peptide--three new cardiovascular risk markers--do they improve risk prediction and influence treatment?

    DEFF Research Database (Denmark)

    Olsen, Michael H; Sehestedt, Thomas; Lyngbaek, Stig

    2010-01-01

    In order to prioritize limited health resources in a time of increasing demands optimal cardiovascular risk stratification is essential. We tested the additive prognostic value of 3 relatively new, but established cardiovascular risk markers: N-terminal pro brain natriuretic peptide (Nt-pro...... a larger subgroup of 16% with high cardiovascular risk in which primary prevention may be advised despite low-moderate cardiovascular risk based on HeartScore. Furthermore, combined use of high UACR or high Nt-proBNP in subjects with known cardiovascular disease or diabetes identified a large subgroup...

  4. Investigating the burden of parasitic zoonotic diseases

    OpenAIRE

    2010-01-01

    Although the global burden for most parasitic zoonoses is not yet known, it is clear that collectively parasitic zoonoses have a similar human disease burden to any one of the big three human infectious diseases: malaria, tuberculosis or HIV. In addition many also have a substantial animal health and economic burden.

  5. Morphological Atherosclerosis Calcification Distribution (MACD) Index is a Strong Predictor of Cardio-Vascular Death and Include Predictive Power of BMD

    DEFF Research Database (Denmark)

    Christiansen, Claus; Karsdal, Morten; Ganz, Melanie;

    followed for 8.3±0.3 years and CVD deaths were recorded. BMD and several aortic calcification markers were computed: number, morphology, distribution, from outlines of the calcified plaques in lumbar X-rays. These markers were compared to BMD, SCORE card, Framingham score, and the Aortic Calcification...... Severity score - AC24. AC24 adjusted by age, waist circumference, and triglyceride levels (ATW) predicted mortality in postmenopausal women (CVD p=0.03, All-cause p=0.006). The SCORE card and the Framingham score resulted in mortality odds ratios (MOR) of 5.0 and 5.2 - defining high risk as =6 and =18......, respectively. BMD and BMD adjusted for ATW was lower in the group of deceased than in survivors (pscores based on the calcification geometry provided highly significant predictions. The number of calcified deposits...

  6. Trends for type 2 diabetes and other cardiovascular risk factors in Mexico from 1993-2006.

    Science.gov (United States)

    Villalpando, Salvador; Shamah-Levy, Teresa; Rojas, Rosalba; Aguilar-Salinas, Carlos A

    2010-01-01

    To describe the trends in the prevalence of type 2 diabetes (T2D), and other cardiovascular risk factors in three national health surveys (1993, 2000 and 2006). The databases of three surveys: ENEC 1993, ENSA 2000 and ENSANUT 2006 were gathered. Calculations of published data were reprocessed to do appropriate adjustments to assure comparability among surveys. From 1993 to 2006 the prevalence of type 2 diabetes (6.7-14.4%), metabolic syndrome (26.6-36.8%), hypertension (23.8-30.7%), hypercholesterolemia (27-43.6%), and high LDL-cholesterol (31.6-46%) increased rapidly. The prevalence of low HDL cholesterol was very high (60.5-63%) in all surveys and remained remarkably unchanged among surveys. This increasing trends for the prevalence of T2D and cardiovascular risk factors predicts larger increments in the near future for T2D and cardiovascular morbidity and mortality. Intensification of the preventive and remedy strategies is mandatory in order curve the foreseen dramatic increment in the disease burden.

  7. Can purchasing information be used to predict adherence to cardiovascular medications? An analysis of linked retail pharmacy and insurance claims data.

    Science.gov (United States)

    Krumme, Alexis A; Sanfélix-Gimeno, Gabriel; Franklin, Jessica M; Isaman, Danielle L; Mahesri, Mufaddal; Matlin, Olga S; Shrank, William H; Brennan, Troyen A; Brill, Gregory; Choudhry, Niteesh K

    2016-11-09

    The use of retail purchasing data may improve adherence prediction over approaches using healthcare insurance claims alone. Retrospective. A cohort of patients who received prescription medication benefits through CVS Caremark, used a CVS Pharmacy ExtraCare Health Care (ECHC) loyalty card, and initiated a statin medication in 2011. We evaluated associations between retail purchasing patterns and optimal adherence to statins in the 12 subsequent months. Among 11 010 statin initiators, 43% were optimally adherent at 12 months of follow-up. Greater numbers of store visits per month and dollar amount per visit were positively associated with optimal adherence, as was making a purchase on the same day as filling a prescription (p<0.0001 for all). Models to predict adherence using retail purchase variables had low discriminative ability (C-statistic: 0.563), while models with both clinical and retail purchase variables achieved a C-statistic of 0.617. While the use of retail purchases may improve the discriminative ability of claims-based approaches, these data alone appear inadequate for adherence prediction, even with the addition of more complex analytical approaches. Nevertheless, associations between retail purchasing behaviours and adherence could inform the development of quality improvement interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Expressed emotion and caregiver burden in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    B P Nirmala

    2011-01-01

    Full Text Available Background: Family′s expressed emotion has been shown to be predictive of outcome in mental and physical illnesses in a variety of cultural settings. The relationship between caregiver burden and high level of expressed emotions has demonstrated a high level of relapse among the psychiatric patients in the West. Aim: The current study explores the relationship between caregivers′ burden and level of expressed emotions by the patients with schizophrenia in Indian setting. Materials and Methods : The sample for the study consisted of totally 70 subjects comprising 35 schizophrenic patients and 35 caregivers. The schizophrenic patients who were attending the Day Care Center run by Department of Psychiatric and Neuro Rehabilitation Unit at National Institute of Mental Health and Neuro Sciences (NIMHANS in Bangalore, India (a tertiary care center and their primary caregivers were included. Family emotional involvement and criticism scale and The burden assessment schedule were administered to assess the expressed emotions and caregivers′ burden. Carl Pearson Correlation test used to study the relationship between the variables. Results and Conclusion: The study highlighted the need for addressing expressed emotion in comprehensive psychosocial intervention plan. More attention should be paid to the needs of the caregivers in order to alleviate their burden in managing mentally ill patients.

  9. Primary caregivers of schizophrenia outpatients: burden and predictor variables.

    Science.gov (United States)

    Grandón, Pamela; Jenaro, Cristina; Lemos, Serafín

    2008-04-15

    This article explores family burden in relation to relatives' coping strategies and social networks, as well as in relation to the patients' severity of positive and negative symptoms. Data on the severity of symptoms (Positive and Negative Syndrome Scale for Schizophrenia [PANSS]), social functioning (Social Functioning Scale [SFS]), caregivers burden (Interview on Objective and Subjective Family Burden or Entrevista de Carga Familiar Objetiva y Subjetiva [ECFOS]), coping skills (Family Coping Questionnaire [FCQ]), and social support (Social Network Questionnaire [SNQ]) were gathered from a randomized sample of 101 Chilean outpatients and their primary caregivers, mostly mothers. Low levels of burden were typically found, with the exception of moderate levels on general concerns for the ill relative. A hierarchical regression analysis with four blocks showed that clinical characteristics, such as higher frequency of relapses, more positive symptoms and lower independence-performance, together with lower self-control attributed to the patient, decrease in social interests, and less affective support, predict burden. The results support the relevance of psychoeducational interventions where families' needs are addressed.

  10. Cardiovascular System

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009049 A 10 years review of the characteristics of in-hospital ventricular fibrillation victim in a single center. WANG Jing(王靖), et al. Clin Electrophysiol Lab & Arrhythmia Center, Cardiovasc Instit & Fuwai Hosp, PUMC & CAMS, Beijing 100037. Chin J Intern Med 2009;48(3):201-204. Objective To study the factors influencing the outcome of patients suffering from inhospital ventricular fibrillation (IHVF), as there have been few studies focusing on this topic. Methods Patients with IHVF collected in a single cardiac center were classified into a successful group and a failure group. Data relevant to the predicting factors of the two groups were compared. Results There were 206 events in the analysis.

  11. EXCESS PRESSURE INTEGRAL PREDICTS CARDIOVASCULAR EVENTS INDEPENDENT OF OTHER RISK FACTORS IN THE CONDUIT ARTERY FUNCTIONAL EVALUATION (CAFE) SUB-STUDY OF ANGLO-SCANDINAVIAN CARDIAC OUTCOMES TRIAL (ASCOT)

    Science.gov (United States)

    Davies, Justin E; Lacy, Peter; Tillin, Therese; Collier, David; Cruickshank, J Kennedy; Francis, Darrel P; Malaweera, Anura; Mayet, Jamil; Stanton, Alice; Williams, Bryan; Parker, Kim H; McG Thom, Simon A; Hughes, Alun D

    2014-01-01

    Excess pressure integral (XSPI), a new index of surplus work performed by the left ventricle, can be calculated from blood pressure (BP) waveforms and may indicate circulatory dysfunction. We investigated whether XSPI predicted future cardiovascular (CV) events and target organ damage in treated hypertensive individuals. Radial BP waveforms were acquired by tonometry in 2069 individuals (63±8y) in the Conduit Artery Functional Evaluation sub-study of the Anglo-Scandinavian Cardiac Outcomes trial. Measurements of left ventricular mass index (LVMI; n = 862) and common carotid artery intima media thickness (cIMT; n = 923) were also performed. XSPI and the integral of reservoir pressure (PRI) were lower in people treated with amlodipine ± perindopril than atenolol ± bendroflumethiazide, although brachial systolic BP was similar. A total of 134 CV events accrued over a median 3.4 years of follow-up; XSPI was a significant predictor of CV events after adjustment for age and sex and this relationship was unaffected by adjustment for conventional CV risk factors or Framingham risk score. XSPI, central systolic BP, central augmentation pressure (AP), central pulse pressure (cPP) and PRI were correlated with LVMI, but only XSPI, AP and cPP were positively associated with cIMT. Associations between LVMI and XSPI and PRI, and cIMT and XSPI were unaffected by multivariable adjustment for other covariates. XSPI is a novel indicator of CV dysfunction and independently predicts CV events and target organ damage in a prospective clinical trial. PMID:24821941

  12. Discordance of Low-Density Lipoprotein and High-Density Lipoprotein Cholesterol Particle Versus Cholesterol Concentration for the Prediction of Cardiovascular Disease in Patients With Metabolic Syndrome and Diabetes Mellitus (from the Multi-Ethnic Study of Atherosclerosis [MESA]).

    Science.gov (United States)

    Tehrani, David M; Zhao, Yanglu; Blaha, Michael J; Mora, Samia; Mackey, Rachel H; Michos, Erin D; Budoff, Matthew J; Cromwell, William; Otvos, James D; Rosenblit, Paul D; Wong, Nathan D

    2016-06-15

    A stronger association for low-density lipoprotein particle (LDL-P) and high-density lipoprotein particle (HDL-P) versus cholesterol concentrations (LDL-C and HDL-C) in predicting coronary heart disease (CHD) has been noted. We evaluate the role of these factors and extent of particle-cholesterol discordance in those with diabetes mellitus (DM) and metabolic syndrome (MetS) for event prediction. In the Multi-Ethnic Study of Atherosclerosis, we examined discordance of LDL and HDL (defined as a subject's difference between baseline particle and cholesterol percentiles), LDL-C, LDL-P, HDL-C, and HDL-P in relation to incident CHD and cardiovascular disease (CVD) events in subjects with DM, MetS (without DM), or neither condition using Cox regression. Of the 6,417 subjects with 10-year follow-up, those with MetS (n = 1,596) and DM (n = 838) had significantly greater LDL and HDL discordance compared with those without these conditions. In discordance models, only LDL discordance (per SD) within the MetS group was positively associated with CHD events (adjusted hazard ratio [HR] = 1.22, 95% confidence interval [CI] 1.01 to 1.48, p lipoprotein particles and discordances in those with MetS and DM. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The disease burden across different ethnic groups in Amsterdam, the Netherlands, 2011-2030.

    Science.gov (United States)

    Ikram, Umar Z; Kunst, Anton E; Lamkaddem, Majda; Stronks, Karien

    2014-08-01

    Current disease burden estimates do not provide evidence across different ethnic groups. This study aims to assess the disease burden as measured by the disability-adjusted life years (DALYs) for six ethnic groups in Amsterdam, the Netherlands, for 2011 and 2030. The DALYs were calculated by combining three components: disease-/sex-/age-specific DALYs per person; disease-specific relative risks (RRs) by ethnicity; and sex-/age-specific population sizes by ethnicity in Amsterdam in 2011 and 2030. Disease-specific DALYs were derived from the National Institute of Public Health. The RRs were obtained through a systematic review of studies published in 1997-2008. The population figures were gathered from the Statistics Netherlands and municipality of Amsterdam. The findings suggest that cardiovascular diseases and anxiety and depressive disorders dominate disease burden in all ethnic groups in 2011 and 2030. In most of the non-Western ethnic minorities, diabetes mellitus is the strongest contributor to the disease burden. The total disease burden will increase more strongly in non-Western ethnic minorities than ethnic Dutch. The 2030 disease burden is estimated to be highest among Surinamese and Antilleans. In ethnic minorities, diabetes plays an important role in the disease burden, and the total disease burden will grow stronger than ethnic Dutch, resulting in a higher total disease burden for some ethnic groups in 2030. We encourage researchers to estimate the disease burden by ethnicity so that health priorities can be set in the fields of policy, health care and research. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  14. Distribution of major health risks: findings from the Global Burden of Disease study.

    Directory of Open Access Journals (Sweden)

    Anthony Rodgers

    2004-10-01

    Full Text Available BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to

  15. 45 CFR 672.17 - Burden of presentation; burden of persuasion.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Burden of presentation; burden of persuasion. 672.17 Section 672.17 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION ENFORCEMENT AND HEARING PROCEDURES § 672.17 Burden of presentation; burden of persuasion. The...

  16. 40 CFR 305.33 - Burden of presentation; burden of persuasion.

    Science.gov (United States)

    2010-07-01

    ... persuasion. 305.33 Section 305.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Hearing Procedure § 305.33 Burden of presentation; burden of persuasion. The Requestor has the burden of... justified. Accordingly, the Requestor bears the burdens of presentation and persuasion. Following the...

  17. Joint audits - benefit or burden?

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    In this paper we examine whether there are perceived and observed benefits or burdens from using two audit firms instead of one. In 2005 the mandatory joint audit requirement was abolished in Denmark. This provides a unique setting for studying the consequences and implications of going from...... a joint audit regime to a single auditor/voluntary joint audit regime. The dataset used in this paper has been collected for the full population of non-financial Danish companies listed on the Copenhagen Stock Exchange (CSE) in the years 2004 and 2005. We find that a majority of firms perceive joint...

  18. HIV and risk of cardiovascular disease in sub-Saharan Africa: Rationale and design of the Ndlovu Cohort Study.

    Science.gov (United States)

    Vos, Alinda; Tempelman, Hugo; Devillé, Walter; Barth, Roos; Wensing, Annemarie; Kretzschmar, Mirjam; Klipstein-Grobusch, Kerstin; Hoepelman, Andy; Tesselaar, Kiki; Aitken, Sue; Madzivhandila, Mashudu; Uiterwaal, Cuno; Venter, Francois; Coutinho, Roel; Grobbee, Diederick E

    2017-07-01

    Background The largest proportion of people living with HIV resides in sub-Saharan Africa (SSA). Evidence from developed countries suggests that HIV infection increases the relative risk of cardiovascular disease (CVD) by up to 50%. Differences in lifestyle, gender distribution, routes of HIV transmission and HIV subtype preclude generalisation of data from Western countries to the SSA situation. The Ndlovu Cohort Study aims to provide insight into the burden of cardiovascular risk factors and disease, the mechanisms driving CVD risk and the contribution of HIV infection and its treatment to the development of CVD in a rural area of SSA. Design The Ndlovu Cohort Study is a prospective study in the Moutse area, Limpopo Province, South Africa. Methods A total of 1000 HIV-positive and 1000 HIV-negative participants aged 18 years and older with a male to female ratio of 1:1 will be recruited. Measurements of CVD risk factors and HIV-related characteristics will be performed at baseline, and participants will be followed-up over time at 6-month intervals. The burden of CVD will be assessed with repeated carotid intima-media thickness and pulse wave velocity measurements, as well as by recording clinical cardiovascular events that occur during the follow-up period. Conclusion This project will contribute to the understanding of the epidemiology and pathogenesis of CVD in the context of HIV infection in a rural area of SSA. The ultimate goal is to improve cardiovascular risk prediction and to indicate preventive approaches in the HIV-infected population and, potentially, for non-infected high-risk populations in a low-resource setting.

  19. Optimal cut-off of obesity indices to predict cardiovascular disease risk factors and metabolic syndrome among adults in Northeast China.

    Science.gov (United States)

    Yu, Jianxing; Tao, Yuchun; Tao, Yuhui; Yang, Sen; Yu, Yaqin; Li, Bo; Jin, Lina

    2016-10-13

    CVD risk factors (hypertension, dyslipidemia and diabetes) and MetS are closely related to obesity. The selection of an optimal cut-off for various obesity indices is particularly important to predict CVD risk factors and MetS. Sixteen thousand seven hundred sixty-six participants aged 18-79 were recruited in Jilin Province in 2012. Five obesity indices, including BMI, WC, WHR, WHtR and BAI were investigated. ROC analyses were used to evaluate the predictive ability and determine the optimal cut-off values of the obesity indices for CVD risk factors and MetS. BMI had the highest adjusted ORs, and the adjusted ORs for hypertension, dyslipidemia, diabetes and MetS were 1.19 (95 % CI, 1.17 to 1.20), 1.20 (95 % CI, 1.19 to 1.22), 1.12 (95 % CI, 1.10 to 1.13), and 1.40 (95 % CI, 1.38 to 1.41), respectively. However, BMI did not always have the largest adjusted AUROC. In general, the young age group (18 ~ 44) had higher ORs and AUROCs for CVD risk factors and MetS than those of the other age groups. In addition, the optimal cut-off values for WC and WHR in males were relatively higher than those in females, whereas the BAI in males was comparatively lower than that in females. The appropriate obesity index, with the corresponding optimal cut-off values, should be selected in different research studies and populations. Generally, the obesity indices and their optimal cut-off values are: BMI (24 kg/m(2)), WC (male: 85 cm; female: 80 cm), WHR (male: 0.88; female: 0.85), WHtR (0.50), and BAI (male: 25 cm; female: 30 cm). Moreover, WC is superior to other obesity indices