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Kartiosuo N, Raitakari OT, Juonala M, Viikari JSA, Sinaiko AR, Venn AJ, Jacobs DR, Urbina EM, Woo JG, Steinberger J, Bazzano LA, Daniels SR, Magnussen CG, Rahimi K, Dwyer T. Cardiovascular Risk Factors in Childhood and Adulthood and Cardiovascular Disease in Middle Age. JAMA Netw Open 2024; 7:e2418148. [PMID: 38913374 PMCID: PMC11197443 DOI: 10.1001/jamanetworkopen.2024.18148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/18/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Recent evidence suggests that childhood levels of serum lipids, blood pressure, body mass index (BMI), and smoking contribute to adult risk of cardiovascular disease (CVD). Evidence is lacking on whether this is independent of adult risk levels. Objective To quantify direct and indirect effects of childhood risk factors on adult CVD via adulthood risk factors using mediation analysis, and to quantify their relative importance during different life-course stages using a life-course approach. Design, Setting, and Participants This prospective cohort study followed participants from the US, Finland, and Australia from childhood (1970s-1990s) until 2019, with data on CVD risk factors in childhood and adulthood. Longitudinal childhood and adulthood risk factors were summarized to describe BMI, lipids, and blood pressure cumulatively. Childhood and adulthood smoking were assessed with questionnaires. Data analysis was performed May 2022 to August 2023. Main Outcomes and Measures The primary outcomes were fatal and nonfatal cardiovascular events in adulthood. Mediation analysis was used to estimate the direct and indirect effects of the childhood risk factors with CVD events, reported as incidence rate ratios (RRs) and 95% CIs. Results A total of 10 634 participants (4506 male participants [42.4%]; mean [SD] age at childhood visit, 13.3 [3.0] years; mean [SD] age at adulthood visit, 32.3 [6.0] years) were included in the cohort. The mean (SD) age at CVD event or censoring was 49.2 (7.0) years. The median (IQR) follow-up time was 23.6 (18.7-30.2) years. Childhood risk factors, (low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], triglycerides, systolic blood pressure [SBP], smoking, BMI, and a combined score of these) were associated with CVD. BMI (direct effect for incidence RR per 1 SD unit, 1.18; 95% CI, 1.05-1.34) and LDL-C (direct effect incidence RR, 1.16; 95% CI, 1.01-1.34) in particular were found to play an important role via direct pathways, whereas the indirect effects were larger for TC, triglycerides, SBP, and the combined score. Childhood smoking only affected CVD via adulthood smoking. Life-course models confirmed that for the risk of CVD, childhood BMI plays nearly as important role as adulthood BMI, whereas for the other risk factors and the combined score, adulthood was the more important period. Conclusions and Relevance In this cohort study of 10 634 participants, childhood risk factors were found to be associated both directly and indirectly to adult CVD, with the largest direct effect seen for BMI and LDL-C. These findings suggest that intervention for childhood risk factors, in particular BMI, is warranted to reduce incidence of adult CVD as it cannot be fully mitigated by risk factor management in adulthood.
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Affiliation(s)
- Noora Kartiosuo
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Internal Medicine, University of Turku, Turku, Finland
| | - Jorma S. A. Viikari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Department of Internal Medicine, University of Turku, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis
| | - Alison J. Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Elaine M. Urbina
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jessica G. Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Stephen R. Daniels
- University of Colorado School of Medicine, and Anschutz Medical Campus, Children’s Hospital Colorado, Aurora
| | - Costan G. Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Kazem Rahimi
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Terence Dwyer
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Mszar R, Katz ME, Grandhi GR, Osei AD, Gallo A, Blaha MJ. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep 2024; 26:217-230. [PMID: 38662272 DOI: 10.1007/s11883-024-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography. RECENT FINDINGS Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk. Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miriam E Katz
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Gowtham R Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Albert D Osei
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Antonio Gallo
- Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, APHP, INSERM UMR1166, Hôpital Pitié-Salpètriêre, Sorbonne Université, Paris, France
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Liu Q, Xiang H, Chen S, Ouyang J, Liu H, Zhang J, Chai Y, Gao P, Zhang X, Fan J, Zheng X, Lu H. Associations between Life's Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study. BMC Public Health 2024; 24:1090. [PMID: 38641579 PMCID: PMC11031939 DOI: 10.1186/s12889-024-18622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/16/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life's Essential 8 (LE8) and AAC remains unexplored. METHODS The study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cohort, which included adults aged 40 or above. The research used the LE8 algorithm to evaluate CVH. Semi-quantitative AAC-24 scoring techniques were employed to assess AAC, categorized into no calcification, mild to moderate calcification, and severe calcification. RESULTS The primary analysis involved 2,478 participants. Following adjustments for multiple factors, the LE8 score exhibited a significant association with ACC risk (Mild-moderate ACC: 0.87, 95% CI: 0.81,0.93; Severe ACC: 0.77, 95% CI: 0.69,0.87, all P < 0.001), indicating an almost linear dose-response relationship. Compared to the low CVH group, the moderate CVH group showed lower odds ratios (OR) for mild-moderate and severe calcification (OR = 0.78, 95% CI: 0.61-0.99, P = 0.041; OR = 0.68, 95% CI: 0.46-0.99, P = 0.047, respectively). Moreover, the high CVH group demonstrated even lower ORs for mild-moderate and severe calcification (OR = 0.46, 95% CI: 0.31, 0.69, P < 0.001; OR = 0.29, 95% CI: 0.14, 0.59, P = 0.001, respectively). Interactions were found between chronic kidney disease (CKD) condition, history of CVD, marital status and CVH metrics to ACC. Participants without CKD exhibited a more pronounced negative association between the CVH metric and both mild-moderate and severe ACC. Those lacking a history of CVD, and never married/widowed/divorced/separated showed a stronger negative association between the CVH metric and severe ACC. CONCLUSIONS The novel CVH metrics demonstrated an inverse correlation with the risk of AAC. These findings suggest that embracing improved CVH levels may assist in alleviating the burden of ACC.
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Affiliation(s)
- Quanjun Liu
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Hong Xiang
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Shuhua Chen
- Department of Biochemistry, School of Life Sciences of Central, South University, Changsha, China
| | - Jie Ouyang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Huiqin Liu
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Jing Zhang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Yanfei Chai
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Peng Gao
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Xiao Zhang
- Department of Biochemistry, School of Life Sciences of Central, South University, Changsha, China
| | - Jianing Fan
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Xinru Zheng
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China
| | - Hongwei Lu
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China.
- Department of Cardiology, The Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Yuelu District, Changsha, China.
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Stanesby O, Zhou Z, Fonseca R, Kidokoro T, Otahal P, Fraser BJ, Wu F, Juonala M, Viikari JSA, Raitakari OT, Tomkinson GR, Magnussen CG. Tracking of apolipoprotein B levels measured in childhood and adolescence: systematic review and meta-analysis. Eur J Pediatr 2024; 183:569-580. [PMID: 38051379 PMCID: PMC10912277 DOI: 10.1007/s00431-023-05350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
To quantify the tracking of apolipoprotein B (apoB) levels from childhood and adolescence and compare the tracking of apoB with low-density lipoprotein (LDL) cholesterol, a systematic search of MEDLINE, Embase, Web of Science, and Google Scholar was performed in October 2023 (PROSPERO protocol: CRD42022298663). Cohort studies that measured tracking of apoB from childhood/adolescence (< 19 years) with a minimum follow-up of 1 year, using tracking estimates such as correlation coefficients or tracking coefficients, were eligible. Pooled correlations were estimated using random-effects meta-analysis. Risk of bias was assessed with a review-specific tool. Ten studies of eight unique cohorts involving 4677 participants met the inclusion criteria. Tracking of apoB was observed (pooled r = 0.63; 95% confidence interval [CI] = 0.53-0.71; I2 = 96%) with no significant sources of heterogeneity identified. Data from five cohorts with tracking data for both lipids showed the degree of tracking was similar for apoB (pooled r = 0.59; 95% CI = 0.55-0.63) and LDL cholesterol (pooled r = 0.58; 95% CI = 0.47-0.68). Study risk of bias was moderate, mostly due to attrition and insufficient reporting. CONCLUSION ApoB levels track strongly from childhood, but do not surpass LDL cholesterol in this regard. While there is strong evidence that apoB is more effective at predicting ASCVD risk than LDL cholesterol in adults, there is currently insufficient evidence to support its increased utility in pediatric settings. This also applies to tracking data, where more comprehensive data are required. WHAT IS KNOWN • Apolipoprotein B is a known cause of atherosclerotic cardiovascular disease. • Apolipoprotein B levels are not typically measured in pediatric settings, where low-density lipoprotein cholesterol remains the primary lipid screening measure. WHAT IS NEW • This meta-analysis of 10 studies showed apolipoprotein B levels tracked strongly from childhood but did not exceed low-density lipoprotein cholesterol in this regard. • More comprehensive tracking data are needed to provide sufficient evidence for increased utility of apolipoprotein B in pediatric settings.
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Affiliation(s)
- Oliver Stanesby
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tetsuhiro Kidokoro
- Research Institute for Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turkuand, Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
- Centre for Population Health Research, University of Turkuand, Turku University Hospital, Turku, Finland.
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Meng Y, Sharman JE, Koskinen JS, Juonala M, Viikari JSA, Buscot MJ, Wu F, Fraser BJ, Rovio SP, Kähönen M, Rönnemaa T, Jula A, Niinikoski H, Raitakari OT, Pahkala K, Magnussen CG. Blood Pressure at Different Life Stages Over the Early Life Course and Intima-Media Thickness. JAMA Pediatr 2024; 178:133-141. [PMID: 38048127 PMCID: PMC10696511 DOI: 10.1001/jamapediatrics.2023.5351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/17/2023] [Indexed: 12/05/2023]
Abstract
Importance Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear. Objective To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT). Design, setting, and participants The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years. Exposures BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years). Main outcomes and measures Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage. Results Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years). Conclusion and relevance In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.
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Affiliation(s)
- Yaxing Meng
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Juhani S. Koskinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, Satakunta Central Hospital, Pori, Finland
| | - Markus Juonala
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Jorma S. A. Viikari
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Brooklyn J. Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Suvi P. Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tapani Rönnemaa
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Harri Niinikoski
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Unit of Health and Physical Activity, University of Turku, Turku, Finland
| | - Costan G. Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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7
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Meng Y, Niinikoski H, Rovio SP, Fraser BJ, Wu F, Jula A, Rönnemaa T, Viikari JSA, Raitakari OT, Pahkala K, Magnussen CG. The Influence of Dietary Counseling Over 20 Years on Tracking of Non-High-Density Lipoprotein Cholesterol from Infancy to Young Adulthood. J Pediatr 2024; 264:113776. [PMID: 37839509 DOI: 10.1016/j.jpeds.2023.113776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/13/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
This 26-year study found that non-high-density lipoprotein cholesterol (non-HDL-C) levels tracked from infancy to young adulthood suggesting early-life non-HDL-C could predict future levels. However, infancy-onset dietary counseling reduced the odds of maintaining at-risk non-HDL-C, highlighting the potential importance of early interventions in preventing cardiovascular risk associated with high pediatric non-HDL-C.
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Affiliation(s)
- Yaxing Meng
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia
| | - Harri Niinikoski
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Suvi P Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Tapani Rönnemaa
- Division of Medicine, Turku University Hospital, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland
| | - Jorma S A Viikari
- Division of Medicine, Turku University Hospital, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Paavo Nurmi Centre, Unit of Health and Physical Activity, University of Turku, Turku, Finland
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
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8
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Abstract
Cardiometabolic diseases, including cardiovascular disease and diabetes, are major causes of morbidity and mortality worldwide. Despite progress in prevention and treatment, recent trends show a stalling in the reduction of cardiovascular disease morbidity and mortality, paralleled by increasing rates of cardiometabolic disease risk factors in young adults, underscoring the importance of risk assessments in this population. This review highlights the evidence for molecular biomarkers for early risk assessment in young individuals. We examine the utility of traditional biomarkers in young individuals and discuss novel, nontraditional biomarkers specific to pathways contributing to early cardiometabolic disease risk. Additionally, we explore emerging omic technologies and analytical approaches that could enhance risk assessment for cardiometabolic disease.
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Affiliation(s)
- Usman A Tahir
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
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9
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Neels JG, Leftheriotis G, Chinetti G. Atherosclerosis Calcification: Focus on Lipoproteins. Metabolites 2023; 13:metabo13030457. [PMID: 36984897 PMCID: PMC10056669 DOI: 10.3390/metabo13030457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease characterized by the accumulation of lipids in the vessel wall, leading to the formation of an atheroma and eventually to the development of vascular calcification (VC). Lipoproteins play a central role in the development of atherosclerosis and VC. Both low- and very low-density lipoproteins (LDL and VLDL) and lipoprotein (a) (Lp(a)) stimulate, while high-density lipoproteins (HDL) reduce VC. Apolipoproteins, the protein component of lipoproteins, influence the development of VC in multiple ways. Apolipoprotein AI (apoAI), the main protein component of HDL, has anti-calcific properties, while apoB and apoCIII, the main protein components of LDL and VLDL, respectively, promote VC. The role of lipoproteins in VC is also related to their metabolism and modifications. Oxidized LDL (OxLDL) are more pro-calcific than native LDL. Oxidation also converts HDL from anti- to pro-calcific. Additionally, enzymes such as autotaxin (ATX) and proprotein convertase subtilisin/kexin type 9 (PCSK9), involved in lipoprotein metabolism, have a stimulatory role in VC. In summary, a better understanding of the mechanisms by which lipoproteins and apolipoproteins contribute to VC will be crucial in the development of effective preventive and therapeutic strategies for VC and its associated cardiovascular disease.
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Affiliation(s)
- Jaap G Neels
- Université Côte d'Azur, INSERM, C3M, 06200 Nice, France
| | | | - Giulia Chinetti
- Université Côte d'Azur, CHU, INSERM, C3M, 06200 Nice, France
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10
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1156] [Impact Index Per Article: 1156.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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11
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Agbaje AO, Lloyd-Jones DM, Magnussen CG, Tuomainen TP. Cumulative dyslipidemia with arterial stiffness and carotid IMT progression in asymptomatic adolescents: A simulated intervention longitudinal study using temporal inverse allocation model. Atherosclerosis 2023; 364:39-48. [PMID: 36462968 DOI: 10.1016/j.atherosclerosis.2022.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIMS We aimed to examine the longitudinal associations of total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, and low-density lipoprotein cholesterol (LDL-C) with carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) progression. METHODS We studied 1779, 15-year-old participants from the Avon Longitudinal Study of Parents and Children, UK birth cohort, followed up for 9 years. Fasting TC, non-HDL-C, HDL-C, triglyceride, and LDL-C were measured at 15, 17, and 24 years and age-categorized as normal, elevated, and dyslipidemia based on National Heart, Lung, and Blood Institute lipid guidelines. cfPWV and cIMT were measured at 17 and 24 years. Associations were examined using linear mixed-effect models. To simulate the treatment of dyslipidemia we conducted temporal inverse allocation model analyses. RESULTS Among 1779 [49.9% female] participants, mean lipid levels and proportions at elevated or dyslipidemia categories increased from ages 15 through 24 years. Persistently elevated TC: effect estimate 0.026 mm; [95% CI 0.004 to 0.049; p = 0.024], elevated non-HDL-C, and elevated LDL-C were cumulatively associated with cIMT progression. Persistent borderline-low HDL-C: -0.027 mm; [-0.050 to -0.005; p = 0.019] and very-low HDL-C -0.035 mm; [-0.057 to -0.013; p = 0.002] levels were associated with cIMT progression. A temporal inverse allocation of elevated and dyslipidemic levels with normal lipid levels at age 17 years attenuated the associations of cumulative elevated TC, non-HDL-C, LDL-C, and low HDL-C with cIMT progression. Cumulative elevated lipids or dyslipidemia were not associated with cfPWV progression. CONCLUSIONS Late adolescence is key to preventing, halting, and reversing dyslipidemic-related preclinical atherosclerosis progression, warranting universal lipid screening in the general pediatric population.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Costan G Magnussen
- Baker Heart and Diabetes Research Institute, Melbourne, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
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12
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Sena C, Ohene-Adjei M, Deng S, Patibandla N, May B, de Ferranti SD, Starc TJ, Thaker VV. Lack of Age-Appropriate Reference Intervals Causing Potentially Missed Alerts in Clinical Reports of Dyslipidemia. J Pediatr 2023; 252:208-212.e3. [PMID: 36115623 PMCID: PMC10230545 DOI: 10.1016/j.jpeds.2022.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
This study shows that only 12.5% of laboratory reports (2/16) included age-appropriate pediatric reference ranges for all lipid and lipoproteins. The use of erroneous reference range(s) could lead to missed alerts of dyslipidemia in up to 97.3% (total cholesterol), 93.6% (high-density lipoprotein cholesterol), 94.8% (low-density lipoprotein cholesterol), and 87.8% (triglycerides) of youth in the population-based National Health and Nutrition Examination Survey cohort. These findings highlight the potential missed opportunities for reinforcing lifestyle counseling for dyslipidemia in addition to obesity in youth.
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Affiliation(s)
- Cecilia Sena
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Michael Ohene-Adjei
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Shuliang Deng
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Benjamin May
- Herbert Irving Cancer Center, Columbia University Medical Center, New York, NY
| | | | - Thomas J Starc
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Vidhu V Thaker
- Department of Pediatrics, Columbia University Medical Center, New York, NY.
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13
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Gaggini M, Gorini F, Vassalle C. Lipids in Atherosclerosis: Pathophysiology and the Role of Calculated Lipid Indices in Assessing Cardiovascular Risk in Patients with Hyperlipidemia. Int J Mol Sci 2022; 24:ijms24010075. [PMID: 36613514 PMCID: PMC9820080 DOI: 10.3390/ijms24010075] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
The role of lipids is essential in any phase of the atherosclerotic process, which is considered a chronic lipid-related and inflammatory condition. The traditional lipid profile (including the evaluation of total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) is a well-established tool to assess the risk of atherosclerosis and as such has been widely used as a pillar of cardiovascular disease prevention and as a target of pharmacological treatments in clinical practice over the last decades. However, other non-traditional lipids have emerged as possible alternative predictors of cardiometabolic risk in addition to traditional single or panel lipids, as they better reflect the overall interaction between lipid/lipoprotein fractions. Therefore, this review deals with the lipid involvement characterizing the pathophysiology of atherosclerosis, discussing some recently proposed non-traditional lipid indices and, in the light of available knowledge, their actual potential as new additive tools to better stratify cardiovascular risk in patients with hyperlipidemia as well as possible therapeutic targets in the clinical practice.
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Affiliation(s)
- Melania Gaggini
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Francesca Gorini
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Cristina Vassalle
- Fondazione CNR—Regione Toscana G Monasterio, Via Moruzzi 1, 56124 Pisa, Italy
- Correspondence:
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14
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Xu Y, Han Y, Wang Y, Gong J, Li H, Wang T, Chen X, Chen W, Fan Y, Qiu X, Wang J, Xue T, Li W, Zhu T. Ambient Air Pollution and Atherosclerosis: A Potential Mediating Role of Sphingolipids. Arterioscler Thromb Vasc Biol 2022; 42:906-918. [PMID: 35652334 DOI: 10.1161/atvbaha.122.317753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pathophysiological mechanisms of air pollution-induced atherosclerosis are incompletely understood. Sphingolipids serve as biological intermediates during atherosclerosis development by facilitating production of proatherogenic apoB (apolipoprotein B)-containing lipoproteins. We explored whether sphingolipids mediate the proatherogenic effects of air pollution. METHODS This was a prospective panel study of 110 participants (mean age 56.5 years) followed from 2013 to 2015 in Beijing, China. Targeted lipidomic analyses were used to quantify 24 sphingolipids in 579 plasma samples. The mass concentrations of ambient particulate matter ≤2.5 μm in diameter (PM2.5) were continuously monitored by a fixed station. We evaluated the associations between sphingolipid levels and average PM2.5 concentrations 1-30 days before clinic visits using linear mixed-effects models and explored whether sphingolipids mediate PM2.5-associated changes in the levels of proatherogenic apoB-containing lipoproteins (LDL-C [low-density lipoprotein cholesterol] and non-HDL-C [nonhigh-density lipoprotein cholesterol]) using mediation analyses. RESULTS We observed significant increases in the levels of non-HDL-C and fourteen sphingolipids associated with PM2.5 exposure, from short- (14 days) to medium-term (30 days) exposure time windows. The associations exhibited near-monotonic increases and peaked in 30-day time window. Increased levels of the sphingolipids, namely, sphinganine, ceramide C24:0, sphingomyelins C16:0/C18:0/C18:1/C20:0/C22:0/C24:0, and hexosylceramides C16:0/C18:0/C20:0/C22:0/C24:0/C24:1 significantly mediated 32%, 58%, 35% to 93%, and 23% to 86%, respectively, of the positive association between 14-day PM2.5 average and the non-HDL-C level, but not the LDL-C level. Similar mediation effects (19%-91%) of the sphingolipids were also observed in 30-day time window. CONCLUSIONS Our results suggest that sphingolipids may mediate the proatherogenic effects of short- and medium-term PM2.5 exposure.
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Affiliation(s)
- Yifan Xu
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Yiqun Han
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Yanwen Wang
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China.,Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, United Kingdom (Y.H.)
| | - Jicheng Gong
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Haonan Li
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Teng Wang
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Xi Chen
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Wu Chen
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Yunfei Fan
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Xinghua Qiu
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Junxia Wang
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
| | - Tao Xue
- School of Public Health (T.X.), Peking University, Beijing, China
| | - Weiju Li
- Peking University Hospital (W.L.), Peking University, Beijing, China
| | - Tong Zhu
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering, Center for Environment and Health (Y.X., Y.H., Y.W., J.G., H.L., T.W., X.C., W.C., Y.F., X.Q., J.W., T.Z.), Peking University, Beijing, China
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15
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Meng Y, Buscot MJ, Juonala M, Wu F, Armstrong MK, Fraser BJ, Pahkala K, Hutri-Kähönen N, Kähönen M, Laitinen T, Viikari JSA, Raitakari OT, Magnussen CG, Sharman JE. Relative Contribution of Blood Pressure in Childhood, Young- and Mid-Adulthood to Large Artery Stiffness in Mid-Adulthood. J Am Heart Assoc 2022; 11:e024394. [PMID: 35699171 PMCID: PMC9238667 DOI: 10.1161/jaha.121.024394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Blood pressure associates with arterial stiffness, but the contribution of blood pressure at different life stages is unclear. We examined the relative contribution of childhood, young‐ and mid‐adulthood blood pressure to mid‐adulthood large artery stiffness. Methods and Results The sample comprised 1869 participants from the Cardiovascular Risk in Young Finns Study who had blood pressure measured in childhood (6–18 years), young‐adulthood (21–30 years), and mid‐adulthood (33–45 years). Markers of large artery stiffness were pulse wave velocity and carotid distensibility recorded in mid‐adulthood. Bayesian relevant life course exposure models were used. For each 10‐mm Hg higher cumulative systolic blood pressure across the life stages, pulse wave velocity was 0.56 m/s higher (95% credible interval: 0.49 to 0.63) and carotid distensibility was 0.13%/10 mm Hg lower (95% credible interval: −0.16 to −0.10). Of these total contributions, the highest contribution was attributed to mid‐adulthood systolic blood pressure (relative weights: pulse wave velocity, childhood: 2.6%, young‐adulthood: 5.4%, mid‐adulthood: 92.0%; carotid distensibility, childhood: 5.6%; young‐adulthood: 10.1%; mid‐adulthood: 84.3%), with the greatest individual contribution coming from systolic blood pressure at the time point when pulse wave velocity and carotid distensibility were measured. The results were consistent for diastolic blood pressure, mean arterial pressure, and pulse pressure. Conclusions Although mid‐adulthood blood pressure contributed most to mid‐adulthood large artery stiffness, we observed small contributions from childhood and young‐adulthood blood pressure. These findings suggest that the burden posed by arterial stiffness might be reduced by maintaining normal blood pressure levels at each life stage, with mid‐adulthood a critical period for controlling blood pressure.
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Affiliation(s)
- Yaxing Meng
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Markus Juonala
- Department of Medicine University of Turku Turku Finland.,Division of Medicine Turku University Hospital Turku Finland
| | - Feitong Wu
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Matthew K Armstrong
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Physical Activity and Health University of Turku Turku Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation Tampere University Tampere Finland
| | - Mika Kähönen
- Department of Clinical Physiology Tampere University HospitalFaculty of Medicine and Health TechnologyTampere University Tampere Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Jorma S A Viikari
- Department of Medicine University of Turku Turku Finland.,Division of Medicine Turku University Hospital Turku Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Costan G Magnussen
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - James E Sharman
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
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16
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Abstract
Cardiovascular diseases caused by atherosclerosis do not typically manifest before middle age; however, the disease process begins early in life. Preclinical atherosclerosis can be quantified with imaging methods in healthy populations long before clinical manifestations present. Cohort studies have shown that childhood exposure to risk factors, such as dyslipidaemia, elevated blood pressure and tobacco smoking, are associated with adult preclinical atherosclerotic phenotypes. Importantly, these long-term effects are substantially reduced if the individual becomes free from the risk factor by adulthood. As participants in the cohorts continue to age and clinical end points accrue, the strongest evidence linking exposure to risk factors in early life with cardiovascular outcomes has begun to emerge. Although science has deciphered the natural course of atherosclerosis, discovered its causal risk factors and developed effective means to intervene, we are still faced with an ongoing global pandemic of atherosclerotic diseases. In general, atherosclerosis goes undetected for too long, and preventive measures, if initiated at all, are inadequate and/or come too late. In this Review, we give an overview of the available literature suggesting the importance of initiating the prevention of atherosclerosis in early life and provide a summary of the major paediatric programmes for the prevention of atherosclerotic disease. We also highlight the limitations of current knowledge and indicate areas for future research.
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17
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Simons R, Maire R, Van Drongelen A, Valk P. Grounding of Pilots: Medical Reasons and Recommendations for Prevention. Aerosp Med Hum Perform 2021; 92:950-955. [PMID: 34986933 DOI: 10.3357/amhp.5985.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: This article presents the results of an EASA-commissioned study aimed at analyzing the medical causes of grounding of a broad European pilot population and recommending measures to reduce the risk of in-flight incapacitation in commercial air transport pilots.METHOD: European National Aviation Authorities (NAAs) were requested to provide data concerning the total number of pilots that were examined, their age and license category, number of unfit pilots, and the medical causes of each case of grounding. Diagnoses were classified according to the format and definitions laid down in Commission Regulation (EU) No. 1178/2011 Part Med.RESULTS: Analyzed were 82,435 cases assessed by 6 NAAs. Of these cases, 2.1% were assessed as unfit to fly. Frequent causes for grounding a pilot were cardiovascular (19%), psychiatric (11%), neurological (10%), and psychological (9%). Cardiovascular conditions were the most frequent cause for grounding in the older age groups, with 21% in the age 51-60 cohort, 28% in the age 61-65 cohort, and 48% in those beyond 65 yr. Psychiatric and psychological diagnoses were most frequent in the age 20-40 cohort.DISCUSSION: Cardiovascular conditions were the most frequent cause for grounding. Cardiovascular diseases (CVD) are associated with modifiable risk factors. Tackling these risk factors gives aeromedical examiners the opportunity to improve the health of pilots and reduce CVD-related flight safety risks by reducing the number of pilots at risk of in-flight incapacitation. The mandatory periodical medical examination of pilots provides an excellent framework for risk prevention and follow-up of preventive measures.Simons R, Maire R, Van Drongelen A, Valk P. Grounding of pilots: medical reasons and recommendations for prevention. Aerosp Med Hum Perform. 2021; 92(12):950-955.
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18
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Ji X, Zhang Z, Lin D, Dai M, Zhao X, Guo X, Du J, Zhou M, Wang Y. A Novel Clinical Five-Risk Factor Panel for Individualized Recurrence Risk Assessment of Patients With Acute Anterior Uveitis. Transl Vis Sci Technol 2021; 10:29. [PMID: 34817576 PMCID: PMC8626851 DOI: 10.1167/tvst.10.13.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Detecting and managing relapses of acute anterior uveitis (AAU) is necessary for improving follow-up planning to minimize recurrences and further complications. However, reliable clinical and laboratory risk factors are lacking, as is a predictive model for use in clinical practice that is capable of identifying patients at high risk for recurrence after remission. Methods We analyzed 38 laboratory parameters and clinical data from a large longitudinal retrospective cohort of 233 patients with AAU. Association of laboratory parameters with recurrence-free survival (RFS) was evaluated using univariate Cox proportional hazards regression. A clinically applicable predictive model was developed using a logistic regression model. Results Of the 38 laboratory parameters studied, we identified 5 parameters (HDL, ankylosing spondylitis, HLA-B27, MO, and LDL) to be associated with RFS. We developed a clinical five-risk factor panel (5RF-panel), which was capable of effectively distinguishing recurrent patients from nonrelapsed patients (area under the curve [AUC] = 0.837), as well as between patients with high and low risks of AAU recurrence (hazard ratio [HR] = 45.874, 95% confidence interval [CI] = 5.232-402.2, P < 0.001). The robust performance of the 5RF-panel was further validated in the testing cohort (AUC = 0.725, and HR = 51.982, 95% CI = 4.438-608.9, P = 0.024). Furthermore, the 5RF-panel demonstrated superior performance in stratifying recurrence risk based on known risk factors. Conclusions We identified and validated a novel clinical 5RF-panel to predict individualized risk of AAU recurrence and improved patient classification for clinical management. Translational Relevance The present study identified and validated a 5RF-panel that is a promising individualized predictive tool to monitor recurrence risk and guide personalized management of patients with AAU.
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Affiliation(s)
- Xiwen Ji
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zicheng Zhang
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Dan Lin
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Mali Dai
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xia Zhao
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xingneng Guo
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jie Du
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China.,Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Meng Zhou
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yuqin Wang
- School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, People's Republic of China
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19
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Dzaye O, Razavi AC, Dardari ZA, Shaw LJ, Berman DS, Budoff MJ, Miedema MD, Nasir K, Rozanski A, Rumberger JA, Orringer CE, Smith SC, Blankstein R, Whelton SP, Mortensen MB, Blaha MJ. Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing Among At-Risk Young Adults. J Am Coll Cardiol 2021; 78:1573-1583. [PMID: 34649694 PMCID: PMC9074911 DOI: 10.1016/j.jacc.2021.08.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are currently no recommendations guiding when best to perform coronary artery calcium (CAC) scanning among young adults to identify those susceptible for developing premature atherosclerosis. OBJECTIVES The purpose of this study was to determine the ideal age at which a first CAC scan has the highest utility according to atherosclerotic cardiovascular disease (ASCVD) risk factor profile. METHODS We included 22,346 CAC Consortium participants aged 30-50 years who underwent noncontrast computed tomography. Sex-specific equations were derived from multivariable logistic modeling to estimate the expected probability of CAC >0 according to age and the presence of ASCVD risk factors. RESULTS Participants were on average 43.5 years of age, 25% were women, and 34% had CAC >0, in whom the median CAC score was 20. Compared with individuals without risk factors, those with diabetes developed CAC 6.4 years earlier on average, whereas smoking, hypertension, dyslipidemia, and a family history of coronary heart disease were individually associated with developing CAC 3.3-4.3 years earlier. Using a testing yield of 25% for detecting CAC >0, the optimal age for a potential first scan would be at 36.8 years (95% CI: 35.5-38.4 years) in men and 50.3 years (95% CI: 48.7-52.1 years) in women with diabetes, and 42.3 years (95% CI: 41.0-43.9 years) in men and 57.6 years (95% CI: 56.0-59.5 years) in women without risk factors. CONCLUSIONS Our derived risk equations among health-seeking young adults enriched in ASCVD risk factors inform the expected prevalence of CAC >0 and can be used to determine an appropriate age to initiate clinical CAC testing to identify individuals most susceptible for early/premature atherosclerosis.
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Affiliation(s)
- Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St Luke's Hospital, New York, New York, USA
| | - John A Rumberger
- Department of Cardiac Imaging, Princeton Longevity Center, Princeton, New Jersey, USA
| | - Carl E Orringer
- Cardiovascular Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin Bødtker Mortensen
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Armstrong MK, Fraser BJ, Magnussen CG. Early-Life Initiation of Primary Prevention Strategies to Reduce Atherosclerosis Risk-Reply. JAMA Cardiol 2021; 6:1467-1468. [PMID: 34613327 DOI: 10.1001/jamacardio.2021.3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew K Armstrong
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Department of Health and Human Physiology, University of Iowa, Iowa City
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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21
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Aguilo G, Vinuela I, Verd S. Early-Life Initiation of Primary Prevention Strategies to Reduce Atherosclerosis Risk. JAMA Cardiol 2021; 6:1466-1467. [PMID: 34613352 DOI: 10.1001/jamacardio.2021.3954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gloria Aguilo
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Isabel Vinuela
- Department of Pediatrics, Hospital Son Espases, Palma de Mallorca, Spain
| | - Sergio Verd
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain.,Baleares Health Sciences Research Institute, IdISBa, Palma de Mallorca, Spain
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22
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Cartier LJ, Robin A, St-Cœur S, Lagacé M, Canales DD, Douville P. Impact of the 2016 Canadian Lipid Guidelines on Daily Practice at a Community Hospital. Can J Diabetes 2021; 46:75-80. [PMID: 34340938 DOI: 10.1016/j.jcjd.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the impact of the 2016 Canadian cardiovascular society guidelines for the management of dyslipidemia. More specifically, we assessed the use of 1) alternate lipid targets when triglyceride (TG) levels are high; and 2) nonfasting lipid testing. METHODS Lipid profiles and pharmacy data were obtained from patients with a history of myocardial infarction and from patients ≥40 years of age with a diagnosis of diabetes. RESULTS As TG increased to >1.5 mmol/L, percent within target for non-high-density lipoprotein cholesterol and apolipoprotein B 18 months after guideline release remained low in both patients with atherosclerotic cardiovascular disease (40%) and patients with diabetes in primary prevention (30%). Approximately 50% of patients were fasting when presenting for lipid testing. Use of high-intensity statin was suboptimal in both groups. CONCLUSIONS The concept of alternate lipid targets may not be well understood by many physicians, leading to undertreatment of patients. Progress was made in the promotion of routine nonfasting lipid testing.
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Affiliation(s)
| | - Alex Robin
- The Moncton Hospital, Horizon Health Network, Moncton, New Brunswick, Canada
| | - Simon St-Cœur
- The Moncton Hospital, Horizon Health Network, Moncton, New Brunswick, Canada
| | - Mathieu Lagacé
- The Moncton Hospital, Horizon Health Network, Moncton, New Brunswick, Canada
| | - Donaldo D Canales
- Office of Research Services, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Pierre Douville
- Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec City, Canada
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