Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events

Importance

There is consistent evidence of the association between ideal cardiovascular health and lower incident cardiovascular disease (CVD); however, most studies used a single measure of cardiovascular health.

Objective

To examine how cardiovascular health changes over time and whether these changes are associated with incident CVD.

Design, Setting, and Participants

Prospective cohort study in a UK general community (Whitehall II), with examinations of cardiovascular health from 1985/1988 (baseline) and every 5 years thereafter until 2015/2016 and follow-up for incident CVD until March 2017.

Exposures

Using the 7 metrics of the American Heart Association (nonsmoking; and ideal levels of body mass index, physical activity, diet, blood pressure, fasting blood glucose, and total cholesterol), participants with 0 to 2, 3 to 4, and 5 to 7 ideal metrics were categorized as having low, moderate, and high cardiovascular health. Change in cardiovascular health over 10 years between 1985/1988 and 1997/1999 was considered.

Main Outcome and Measure

Incident CVD (coronary heart disease and stroke).

Results

The study population included 9256 participants without prior CVD (mean [SD] age at baseline, 44.8 [6.0] years; 2941 [32%] women), of whom 6326 had data about cardiovascular health change. Over a median follow-up of 18.9 years after 1997/1999, 1114 incident CVD events occurred. In multivariable analysis and compared with individuals with persistently low cardiovascular health (consistently low group, 13.5% of participants; CVD incident rate per 1000 person-years, 9.6 [95% CI, 8.4-10.9]), there was no significant association with CVD risk in the low to moderate group (6.8% of participants; absolute rate difference per 1000 person-years, -1.9 [95% CI, -3.9 to 0.1]; HR, 0.84 [95% CI, 0.66-1.08]), the low to high group, (0.3% of participants; absolute rate difference per 1000 person-years, -7.7 [95% CI, -11.5 to -3.9]; HR, 0.19 [95% CI, 0.03-1.35]), and the moderate to low group (18.0% of participants; absolute rate difference per 1000 person-years, -1.3 [95% CI, -3.0 to 0.3]; HR, 0.96 [95% CI, 0.80-1.15]). A lower CVD risk was observed in the consistently moderate group (38.9% of participants; absolute rate difference per 1000 person-years, -4.2 [95% CI, -5.5 to -2.8]; HR, 0.62 [95% CI, 0.53-0.74]), the moderate to high group (5.8% of participants; absolute rate difference per 1000 person-years, -6.4 [95% CI, -8.0 to -4.7]; HR, 0.39 [95% CI, 0.27-0.56]), the high to low group (1.9% of participants; absolute rate difference per 1000 person-years, -5.3 [95% CI, -7.8 to -2.8]; HR, 0.49 [95% CI, 0.29-0.83]), the high to moderate group (9.3% of participants; absolute rate difference per 1000 person-years, -4.5 [95% CI, -6.2 to -2.9]; HR, 0.66 [95% CI, 0.51-0.85]), and the consistently high group (5.5% of participants; absolute rate difference per 1000 person-years, -5.6 [95% CI, -7.4 to -3.9]; HR, 0.57 [95% CI, 0.40-0.80]).

Conclusions and Relevance

Among a group of participants without CVD who received follow-up over a median 18.9 years, there was no consistent relationship between direction of change in category of a composite metric of cardiovascular health and risk of CVD.

Incidence of cardiovascular diseases and type-2-diabetes mellitus in patients with psychiatric disorders

OBJECTIVE

To assess the incidence of cardiovascular diseases (CVD) and type-2-diabetes in patients with psychiatric disorders.

METHODS

A population-based study was conducted using the Swedish national health registries. Patients were identified from the Electronic Medical Records (EMR) in 20 primary care centers and were categorized in four diagnosis cohorts according to their first psychiatric diagnosis: bipolar disorder, schizophrenia, major depressive disorder, or other mood disorder. A control cohort of patients with no psychiatric disorders followed in the same primary care centers was also identified. Incident CVD and type-2-diabetes were defined as the presence of a diagnosis of CVD or diabetes during the follow-up period in patients without prior event.

RESULTS

The age and sex standardized incidence rate of CVD was 13.5 per 1000 patient-year in the patients with any psychiatric disorder versus 6.3 per 1000 patient-year in the controls. A similar trend was observed for incident diabetes (5.7 versus 3.4 per 1000 patient-year, respectively). The bipolar disorder and the schizophrenia cohorts showed the highest standardized incidence rates.

CONCLUSION

Incidence of CVD and to a lesser extent type-2-diabetes was particularly high in patients with psychiatric disorders. This carries strong clinical implications for the prevention of CVD and type-2-diabetes in these patients.

Influence of centre expertise on the diagnosis and management of hypertrophic cardiomyopathy: A study from the French register of hypertrophic cardiomyopathy (REMY)

BACKGROUND

Our knowledge of hypertrophic cardiomyopathy (HCM) mainly originates from quarternary centres. The objective is to assess the current management of HCM patients in a large multicentre French register according to the level of expertise.

METHODS AND RESULTS

A total of 1431 HCM patients were recruited across 26 (11 expert and 15 non-expert) centres in REMY, a prospective hospital-based register of adult HCM patients. A sarcomeric origin was suspected in 1284 (89.7%) patients [261 (20.3%) with a reported gene mutation, 242 (18.8%) genotype-negative], while 107 (7.5%) had a diagnosis of non-sarcomeric HCM. Patients managed in non-expert centres were older (P < 0.01) and presented more often with NYHA III/IV class dyspnoea (P < 0.01), congestive heart failure (P < 0.01), low LEVF (P < 0.01), less often with a syncope history (P < 0.01) and lower LV obstruction (P < 0.01) than patients in expert centres. Genotype positive sarcomeric aetiologies were less frequent in non-expert centres (P < 0.01). The use of diagnostic and prognostic tests as cardiac MRI (P < 0.001), genetic (P < 0.001) and alpha-galactosidase A enzyme level testing (P < 0.001), Holter ECG (P < 0.001), and exercise test (P < 0.001), was lower in non-expert centres. Septal ablation procedures using alcohol (P < 0.001) or myectomy (P < 0.001) were more frequent in expert centres.

CONCLUSION

In real life practice, only a minority of HCM patients are identified as sarcomere positive as per genetic testing. The management of HCM patients varies according to the centre's level of expertise, with less access to diagnostic and prognostic tests in non-expert centres. Non-sarcomeric HCM may therefore be overlooked despite specific treatment in some aetiologies.

Abstract P194: Body Silhouette Trajectories Across the Lifespan and Vascular Aging: The Paris Prospective Study 3

Background: Vascular aging, i.e. accumulation of functional and structural changes of vessels throughout life, is a major contributor to cardiovascular disease. It can be quantified by higher carotid stiffness, intima-media thickness and diameter, and hypertension. Weight gain across the lifetime may be an important, modifiable determinant of vascular aging.

Aim: To assess lifetime body silhouette trajectories (a marker of weight change across the lifespan) in relation to vascular aging in late adulthood.

Methods: We used cross-sectional data from a community-based study (n=8,083; age 59.4; 38.6% women). A linear mixed model was used to assess trajectories of recalled body silhouettes from age 8 to 45. We assessed carotid stiffness, IMT and diameter (ultrasonography), resting hypertension (blood pressure ≥140/90 mmHg or use of antihypertensives), and exaggerated exercise blood pressure, a marker of masked hypertension (systolic blood pressure ≥150 mmHg during submaximal exercise).

Results: We identified 5 trajectories: lean-stable (32%), lean-increase (11%), moderate-stable (33%), lean-marked increase (16%) and heavy-stable (8%). Compared to those in the lean-stable trajectory, individuals in the moderate-stable, lean-marked increase and heavy-stable trajectories had more evidence of vascular aging (Figure).

Conclusions: Vascular aging was most prominent among individuals who were lean in early life but gained weight during young adulthood, and among those who were heavy in early life and maintained weight. This suggests that prevention of weight gain across the life course, especially during young adulthood, is important to promote healthy vascular aging.

Abstract 112: Carotid Artery Stiffness Increases the Risk of Incident Depressive Symptoms: The Paris Prospective Study 3

Introduction: Late-life depression is related to poor quality of life, functional impairment, and increased risk of mortality and cardiovascular disease. Effective interventions for prevention and treatment of late-life depression need to be developed, which requires a better understanding of late-life depression risk factors. Arterial stiffness, an important cardiovascular disease risk factor, may contribute to late-life depression via cerebrovascular damage, but evidence is scarce.

Aim: We investigated the association between carotid artery stiffness and incident depressive symptoms in a large community-based cohort study.

Methods: This longitudinal study included 7,013 participants (60 (SD 6) years; 36% women) free of depressive symptoms at baseline. Carotid stiffness (high-resolution echotracking) was determined at baseline. Presence of depressive symptoms was determined at baseline and at 4 and 6 years of follow-up, and was defined as a score ≥7 on a validated 13-item questionnaire (Q2DA) and/or new use of antidepressants. Cox regression and generalized estimating equations (GEE) were used.

Results: In total, 6.9% (n=484) of the participants had incident depressive symptoms at 4 or 6 years of follow-up. Greater carotid stiffness was associated with a higher incidence of depressive symptoms (Figure). Results were qualitatively similar when GEE was used instead of Cox regression.

Conclusions: Greater carotid stiffness is associated with a higher incidence of depressive symptoms. This study supports the hypothesis that carotid stiffness contributes to the development of late-life depression.

Abstract P171: Occupational, Sport and Leisure Physical Activity Have Contrasting Effects on Neural Baroreflex Sensitivity. The Paris Prospective Study III

Background: Physical activity (PA) is beneficial for baroreflex sensitivity (BRS), but it is unclear whether the type of PA has similar effects on the neural (nBRS) or vascular (carotid stiffness) components of BRS. We sought to determine this in healthy adults from a community- based study via assessment of occupational (OPA), sport (SPA), leisure (LPA) and total PA (TPA).

Methods: In 8649 adults aged 50 to 75 years, resting nBRS (estimated by low frequency gain, from carotid distension rate and heart rate) and carotid stiffness were measured by high-precision carotid echotracking. PA was self-reported using the Baecke questionnaire, which distinguishes OPA, SPA, LPA and TPA. The associations between PA and nBRS and carotid stiffness were quantified using multivariate linear regression analysis. Analyses were conducted separately in the working and non- working population.

Results: In working adults (n=5039), OPA was associated with lower nBRS function (p=0.026) and borderline higher carotid stiffness (p=0.08). The associations between OPA and nBRS remained independent after additionally adjusting for SPA (p=0.03) and exaggerated exercise blood pressure (p=0.005), a predictor of future hypertension and cardiovascular events. When examining the type of OPA separately (i.e. lifting heavy loads, standing or walking at work) lifting heavy loads only was associated with impaired nBRS (p=0.048). When stratified by education, this association remained only in those with less than tertiary education. SPA was associated with higher nBRS (p=0.0005) and borderline lower carotid stiffness (p=0.052). Neither LPA nor TPA was associated with nBRS or carotid stiffness. In non-working adults (n=3610), SPA and TPA were both associated with lower carotid stiffness (p=0.012 and p=0.020), but not nBRS. LPA was not associated with either parameter.

Conclusion: Occupation-related PA, in particular lifting heavy loads, is associated with lower nBRS function, especially in those with lower education. Higher amounts of sport-related PA are associated with higher nBRS and lower carotid stiffness.

Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia

IMPORTANCE

Evidence is limited regarding the relation between cardiovascular health level and dementia risk.

OBJECTIVE

To investigate the association between cardiovascular health level, defined using the 7-item tool from the American Heart Association (AHA), and risk of dementia and cognitive decline in older persons.

DESIGN, SETTING, AND PARTICIPANTS

Population-based cohort study of persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who underwent repeated in-person neuropsychological testing (January 1999-July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016).

EXPOSURES

The number of the AHA's Life's Simple 7 metrics at recommended optimal level (nonsmoking, body mass index <25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol <200 mg/dL [untreated], fasting glucose <100 mg/dL [untreated], and blood pressure <120/80 mm Hg [untreated]; score range, 0-7) and a global cardiovascular health score (range, 0-14; poor, intermediate, and optimal levels of each metric assigned a value of 0, 1, and 2, respectively).

MAIN OUTCOMES AND MEASURES

Incident dementia validated by an expert committee and change in a composite score of global cognition (in standard units, with values indicating distance from population means, 0 equal to the mean, and +1 and -1 equal to 1 SD above and below the mean).

RESULTS

Among 6626 participants (mean age, 73.7 years; 4200 women [63.4%]), 2412 (36.5%), 3781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively, at baseline. Over a mean follow-up duration of 8.5 (range, 0.6-16.6) years, 745 participants had incident adjudicated dementia. Compared with the incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years among those with 0 or 1 health metrics at optimal levels, the absolute differences in incident dementia rates for 2, 3, 4, 5, and 6 to 7 metrics were, respectively, -0.26 (95% CI, -0.48 to -0.04), -0.59 (95% CI, -0.80 to -0.38), -0.43 (95% CI, -0.65 to -0.21), -0.93 (95% CI, -1.18 to -0.68), and -0.96 (95% CI, -1.37 to -0.56) per 100 person-years. In multivariable models, the hazard ratios for dementia were 0.90 (95% CI, 0.84-0.97) per additional optimal metric and 0.92 (95% CI, 0.89-0.96) per additional point on the global score. Furthermore, the gain in global cognition associated with each additional optimal metric at baseline was 0.031 (95% CI, 0.009-0.053) standard units at inclusion, 0.068 (95% CI, 0.045-0.092) units at year 6, and 0.072 (95% CI, 0.042-0.102) units at year 12.

CONCLUSIONS AND RELEVANCE

In this cohort of older adults, increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were associated with a lower risk of dementia and lower rates of cognitive decline. These findings may support the promotion of cardiovascular health to prevent risk factors associated with cognitive decline and dementia.

Self-reported body silhouette trajectories across the lifespan and excessive daytime sleepiness in adulthood: a retrospective analysis. The Paris Prospective Study III

OBJECTIVES

Excessive daytime sleepiness (EDS) is a common sleep complaint in the population and is increasingly recognised as deleterious for health. Simple and sensitive tools allowing identifying individuals at greater risk of EDS would be of public health importance. Hence, we determined trajectories of body silhouette from early childhood to adulthood and evaluated their association with EDS in adulthood.

DESIGN

A retrospective analysis in a prospective community-based study.

PARTICIPANTS

6820 men and women self-reported their silhouette at ages 8, 15, 25, 35 and 45 using the body silhouettes proposed by Stunkard et al. EDS was defined by an Epworth Sleepiness Scale score ≥11.

MAIN OUTCOME MEASURE

Presence of EDS in adulthood.

RESULTS

The study population comprised 6820 participants (mean age 59.8 years, 61.1% men). Five distinct body silhouettes trajectories over the lifespan were identified: 31.9% 'lean stable', 11.1% 'lean increase', 16.1% 'lean-marked increase', 32.5% 'moderate stable' and 8.4% 'heavy stable'. Subjects with a 'heavy-stable' trajectory (OR 1.24, 95% CI 0.94 to 1.62) and those with a 'lean-marked increase' trajectory (OR 1.46, 95% CI 1.18 to 1.81) were more likely to have EDS when compared with the 'lean-stable' group after adjusting for confounding. Further adjustment for birth weight strengthened the magnitude of the ORs.

CONCLUSION

Increasing body silhouette and to a lesser extent constantly high body silhouette trajectory from childhood to adulthood are associated with increased likelihood of EDS, independently of major confounding variables.

TRIAL REGISTRATION NUMBER

NCT00741728; Pre-results.

Determinants of occurrence and survival after sudden cardiac arrest-A European perspective: The ESCAPE-NET project

AIMS

The ESCAPE-NET project ("European Sudden Cardiac Arrest network- towards Prevention, Education and New Effective Treatments") aims to study: (1) risk factors and mechanisms for the occurrence of sudden cardiac arrest (SCA) in the population, and (2) risk factors and treatment strategies for survival after SCA on a European scale.

METHODS

This is an Horizon2020 funded program of the European Union, performed by a European public-private consortium of 16 partners across 10 EU countries. There are 11 deep-phenotyped SCA cohorts for the study of risk factors and treatment strategies for survival after SCA, and 5 deep-phenotyped observational prospective population cohorts for the study of risk factors for occurrence of SCA. Personalized risk scores for predicting SCA onset and for predicting survival after SCA will be derived and validated.

RESULTS

The 11 clinical studies with SCA cases comprise 85,790 SCA cases; the 5 observational prospective population cohorts include 53,060 subjects. A total of 15,000 SCA samples will be genotyped for common and rare variants at the Helmholtz Zentrum München (Germany) using the Illumina Global Screening Array which contains > 770,000 SNPs, and after imputation, a database of an estimated > 9 million variants will be available for genome wide association studies. Standardization of risk factors definition and outcomes is ongoing. An Executive Committee has been created along with a Collaboration Policy document.

CONCLUSION

ESCAPE-NET will complement ongoing efforts on SCA outside Europe and within Europe including the EuReCa project.

Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating Effect of Blood Biomarkers: The PRIME Study

Background

The aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers.

Methods and Results

The association of ideal CVH with outcomes was derived in 9312 middle‐aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case–control study nested within the cohort after 10 years of follow‐up. After a median follow‐up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high‐sensitivity C‐reactive protein, IL‐6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high‐sensitivity C‐reactive protein (16.69%), IL‐6 (8.52%), and fibrinogen (7.30%)

Conclusions

Our study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.

Complement-Activating Anti-HLA Antibodies in Kidney Transplantation: Allograft Gene Expression Profiling and Response to Treatment

Complement-activating anti-HLA donor-specific antibodies (DSAs) are associated with impaired kidney transplant outcome; however, whether these antibodies induce a specific rejection phenotype and influence response to therapy remains undetermined. We prospectively screened 931 kidney recipients for complement-activating DSAs and used histopathology, immunostaining, and allograft gene expression to assess rejection phenotypes. Effector cells were evaluated using in vitro human cell cultures. Additionally, we assessed the effect of complement inhibition on kidney allograft rejection phenotype and the clinical response to complement inhibition in 116 independent kidney recipients with DSAs at transplant receiving rejection prophylaxis with eculizumab or standard of care (plasma exchange and intravenous Ig) at ten international centers. The histomolecular rejection phenotype associated with complement-activating DSA was characterized by complement deposition and accumulation of natural killer cells and monocytes/macrophages in capillaries and increased expression of five biologically relevant genes (CXCL11, CCL4, MS4A7, MS4A6A, and FCGR3A) indicative of endothelial activation, IFNγ response, CD16-mediated natural killer cell activation, and monocyte/macrophage activation. Compared with standard of care, eculizumab specifically abrogated this histomolecular rejection phenotype and associated with a decreased 3-month rejection incidence rate in patients with complement-activating DSAs (56%; 95% confidence interval [95% CI], 38% to 74% versus 19%; 95% CI, 8% to 35%; P=0.001) but not in those with noncomplement-activating DSAs (9%; 95% CI, 2% to 25% versus 13%; 95% CI, 2% to 40%; P=0.65). In conclusion, circulating complement-activating anti-HLA DSAs are associated with a specific histomolecular kidney allograft rejection phenotype that can be abrogated by complement inhibition.

Sex disparities in ideal cardiovascular health

OBJECTIVE

To quantify the gap in the distribution of ideal cardiovascular health (CVH) between men and women accounting for comorbidities, socioeconomic and psychological confounding factors.

METHODS

A cross-sectional analysis was conducted among 9012 French men and women aged 50-75 years who were participants of the Paris Prospective Study 3. Each of the seven metrics was defined according to the American Heart Association criteria, and the CVH was considered as poor (0 or 1 ideal health metric), intermediate (2, 3 or 4 ideal health metrics) and ideal (5-7 ideal health metrics). The odds of intermediate and ideal CVH in women compared with men were estimated by multivariate polytomous logistic regression analysis using poor CVH as the reference category.

RESULTS

The mean age was 59.49 year (SD 6.25) and there were 38.54% of women. Though women were slightly older, less educated, more deprived, more often depressed, they were twice more often in ideal CVH than men (14.77% vs 6.84%, p<0.0001). After adjustment for age, deprivation score, education and depression, women were four times more often in ideal CVH (OR 4.01, 95% CI 3.42 to 4.69) and two times more often in intermediate CVH (OR 2.07, 95% CI 1.88 to 2.28) than men.

CONCLUSION

The sex disparities in the prevalence of ideal CVH have the potential to guide sex-specific strategies for improving CVH status in the general population.

CLINICAL TRIAL REGISTRATION

NCT00741728;Pre-results.

[Silhouettes at different age of life: Retrospective appreciation of corpulence and his impact on prevalence of hypertension at 60years]

PURPOSE OF THE STUDY

In epidemiological studies, recall of weight and height are not readily available at different ages of life. In order to improve the knowledge of the weight history, Sörensen et al. in 1983, developed a tool from silhouettes allowing an individual to evaluate his corpulence at different ages of life. Validity studies showed that measured weight and size were correlated to 80% in the reported silhouette. Studies have also shown that silhouettes are a good way to trace the weight history in an individual's life. Very few epidemiological studies have used this tool. A French study revealed a decrease of the risk of breast cancer in obese girls between the age of 8 and adolescence. Another study showed that a low birth weight or a thin silhouette before adulthood was associated with an increased risk of diabetes. On the basis of these findings, it was interesting to evaluate the relationship between the silhouette at 20years and the risk of hypertension at the age of 60years.

RESULTS

It was shown that the prevalence of hypertension at age 60 was higher among obese subjects at 20years than among thin subjects (45.3% vs 36.7% (P<0.05).

CONCLUSION

The classification between slimness and obesity is relevant using this tool. The history of corpulence is an important element to consider in the determinants of pathology, especially in hypertension.

Abstract 560: Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function the Paris Prospective Study III

Objective: We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA).

Approach and Results: Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.55 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima–media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young’s elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41).

Conclusions: In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.

Abstract 381: Ideal Cardiovascular Health and Cardiovascular Disease: Heterogeneity Across Event Phenotype and Contribution of Multiple Biomarkers

Aims: To investigate whether or not the association between baseline cardiovascular health (CVH) and incident cardiovascular disease (CVD) differs by event phenotypes and to address the mediating effect of inflammatory and haemostatic blood biomarkers.

Methods: The association of ideal CVH with outcomes was computed in 9312 middle-aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline blood biomarkers was evaluated in a case control study nested within the cohort after 10 years of follow-up.

Results: After a median follow-up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared to those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (HR=0.28; 95% CI: 0.17; 0.46) and a 76% lower risk of stroke (HR=0.24; 95% CI: 0.06; 0.98). No heterogeneity was detected across main CHD and main stroke phenotypes. While significantly lower mean concentrations of hs-CRP, IL-6 (inflammatory markers), and fibrinogen, von Willbrandt factor (haemostatic factors) were noted in the controls with higher CVH status, the association of CVH with incident CHD was not attenuated upon adjustment for these biomarkers.

Conclusion: these results support the universal promotion of ideal CVH for CVD in general and suggest that the lower risk of CHD associated with ideal CVH is independent from inflammatory and haemostatic biomarkers.

Exome-wide association study reveals novel susceptibility genes to sporadic dilated cardiomyopathy

Aims

Dilated cardiomyopathy (DCM) is an important cause of heart failure with a strong familial component. We performed an exome-wide array-based association study (EWAS) to assess the contribution of missense variants to sporadic DCM.

Methods and results

116,855 single nucleotide variants (SNVs) were analyzed in 2796 DCM patients and 6877 control subjects from 6 populations of European ancestry. We confirmed two previously identified associations with SNVs in BAG3 and ZBTB17 and discovered six novel DCM-associated loci (Q-value<0.01). The lead-SNVs at novel loci are common and located in TTN, SLC39A8, MLIP, FLNC, ALPK3 and FHOD3. In silico fine mapping identified HSPB7 as the most likely candidate at the ZBTB17 locus. Rare variant analysis (MAF<0.01) demonstrated significant association for TTN variants only (P = 0.0085). All candidate genes but one (SLC39A8) exhibit preferential expression in striated muscle tissues and mutations in TTN, BAG3, FLNC and FHOD3 are known to cause familial cardiomyopathy. We also investigated a panel of 48 known cardiomyopathy genes. Collectively, rare (n = 228, P = 0.0033) or common (n = 36, P = 0.019) variants with elevated in silico severity scores were associated with DCM, indicating that the spectrum of genes contributing to sporadic DCM extends beyond those identified here.

Conclusion

We identified eight loci independently associated with sporadic DCM. The functions of the best candidate genes at these loci suggest that proteostasis regulation might play a role in DCM pathophysiology.

When Blue-Collars Feel Blue

Background—

The association of psychological variables with cardiovascular health might depend on socioeconomic status. We examined the moderating effect of occupational grade on the association between depression and incident cardiac events among middle-aged workers from the GAZEL cohort.

Methods and Results—

A total of 10 541 participants (7855 men, mean age: 47.8±3.5 years) free of cardiovascular diseases completed the Center of Epidemiologic Studies Depression scale in 1993. Age, sex, and occupational grade (low, medium, and high) were obtained from company records. Classical cardiovascular risk factors were self-reported. All participants were followed-up for medically certified cardiac events from January 1994 to December 2014. Associations between baseline variables and incident cardiac events were estimated with hazard ratios and 95% confidence intervals computed in Cox regressions. After a median follow-up of 21 years, 592 (5.6%) participants had a cardiac event. There was a significant interaction between depression and occupational grade in both age- and sex-adjusted ( P =0.008) and multiadjusted ( P =0.009) models. This interaction was mainly explained by an association between depression and incident cardiac events that prevailed among participants of low occupational grade (3.71 versus 1.96 events per 1000 person-years among those depressed versus nondepressed, multiadjusted hazard ratios [95% confidence intervals], 1.99 [1.12–3.48]).

Conclusions—

From a research perspective, these results may account for previous conflicting results and constitute an impetus for reanalyzing previous data sets, taking into account the moderating role of socioeconomic status. From a clinical perspective, they urge clinicians and policy makers to consider depressive symptoms and low socioeconomic status as synergistic cardiovascular risk factors.

Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction

Background:

In-hospital mortality of ST-segment–elevation myocardial infarction (STEMI) has decreased drastically. In contrast, prehospital mortality from sudden cardiac arrest (SCA) remains high and difficult to reduce. Identification of the patients with STEMI at higher risk for prehospital SCA could facilitate rapid triage and intervention in the field.

Methods:

Using a prospective, population-based study evaluating all patients with STEMI managed by emergency medical services in the greater Paris area (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of prehospital SCA and used these variables to build an SCA prediction score, which we validated internally and externally.

Results:

In the overall STEMI population (n=8112; median age, 60 years; 78% male), SCA occurred in 452 patients (5.6%). In multivariate analysis, younger age, absence of obesity, absence of diabetes mellitus, shortness of breath, and a short delay between pain onset and call to emergency medical services were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold in those with a score between 20 and 29, and >18-fold in patients with a score ≥30 compared with those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared with 1.6% in patients with a score ≤9 ( P for trend <0.001). The area under the curve values were 0.7033 in the internal validation sample and 0.6031 in the external validation sample. Sensitivity and specificity varied between 96.9% and 10.5% for scores ≥10 and between 18.0% and 97.6% for scores ≥30, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively).

Conclusions:

At the early phase of STEMI, the risk of prehospital SCA can be determined through a simple score of 5 routinely assessed predictors. This score might help optimize the dispatching and management of patients with STEMI by emergency medical services.