The association between leisure-time physical activity, low HDL-cholesterol and mortality in a pooled analysis of nine population-based cohorts

Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024

Background

This joint expert review by the Obesity Medicine Association (OMA) and National Lipid Association (NLA) provides clinicians an overview of the pathophysiologic and clinical considerations regarding obesity, dyslipidemia, and cardiovascular disease (CVD) risk.

Methods

This joint expert review is based upon scientific evidence, clinical perspectives of the authors, and peer review by the OMA and NLA leadership.

Results

Among individuals with obesity, adipose tissue may store over 50% of the total body free cholesterol. Triglycerides may represent up to 99% of lipid species in adipose tissue. The potential for adipose tissue expansion accounts for the greatest weight variance among most individuals, with percent body fat ranging from less than 5% to over 60%. While population studies suggest a modest increase in blood low-density lipoprotein cholesterol (LDL-C) levels with excess adiposity, the adiposopathic dyslipidemia pattern most often described with an increase in adiposity includes elevated triglycerides, reduced high density lipoprotein cholesterol (HDL-C), increased non-HDL-C, elevated apolipoprotein B, increased LDL particle concentration, and increased small, dense LDL particles.

Conclusions

Obesity increases CVD risk, at least partially due to promotion of an adiposopathic, atherogenic lipid profile. Obesity also worsens other cardiometabolic risk factors. Among patients with obesity, interventions that reduce body weight and improve CVD outcomes are generally associated with improved lipid levels. Given the modest improvement in blood LDL-C with weight reduction in patients with overweight or obesity, early interventions to treat both excess adiposity and elevated atherogenic cholesterol (LDL-C and/or non-HDL-C) levels represent priorities in reducing the risk of CVD.

Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024

BACKGROUND

This joint expert review by the Obesity Medicine Association (OMA) and National Lipid Association (NLA) provides clinicians an overview of the pathophysiologic and clinical considerations regarding obesity, dyslipidemia, and cardiovascular disease (CVD) risk.

METHODS

This joint expert review is based upon scientific evidence, clinical perspectives of the authors, and peer review by the OMA and NLA leadership.

RESULTS

Among individuals with obesity, adipose tissue may store over 50% of the total body free cholesterol. Triglycerides may represent up to 99% of lipid species in adipose tissue. The potential for adipose tissue expansion accounts for the greatest weight variance among most individuals, with percent body fat ranging from less than 5% to over 60%. While population studies suggest a modest increase in blood low-density lipoprotein cholesterol (LDL-C) levels with excess adiposity, the adiposopathic dyslipidemia pattern most often described with an increase in adiposity includes elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-C), increased non-HDL-C, elevated apolipoprotein B, increased LDL particle concentration, and increased small, dense LDL particles.

CONCLUSIONS

Obesity increases CVD risk, at least partially due to promotion of an adiposopathic, atherogenic lipid profile. Obesity also worsens other cardiometabolic risk factors. Among patients with obesity, interventions that reduce body weight and improve CVD outcomes are generally associated with improved lipid levels. Given the modest improvement in blood LDL-C with weight reduction in patients with overweight or obesity, early interventions to treat both excess adiposity and elevated atherogenic cholesterol (LDL-C and/or non-HDL-C) levels represent priorities in reducing the risk of CVD.

Non-high-density lipoprotein cholesterol and treatment targets in vascular surgery patients

INTRODUCTION

Low-density lipoprotein cholesterol (LDL) is a known contributing factor to atherosclerotic cardiovascular disease (ASCVD) and a primary therapeutic target for medical management of ASCVD. Non-high-density lipoprotein cholesterol (non-HDL) has recently been identified as a secondary therapeutic target but is not yet widely used in vascular surgery patients. We sought to assess if vascular surgery patients were undertreated per non-HDL therapeutic guidelines.

METHODS

This was an observational study that used a single-center database to identify a cohort of adult patients who received care from a vascular surgery provider from 01/2001 to 07/2021. ICD-9/10-CM codes were used to identify patients with a medical history of hyperlipidemia (HLD), coronary artery disease (CAD), cerebrovascular occlusive disease (CVOD), peripheral artery disease (PAD), hypertension (HTN), or diabetes mellitus (DM). Patient smoking status and medications were also identified. Lab values were obtained from the first and last patient encounter within our system. Primary outcomes were serum concentrations of LDL and non-HDL, with therapeutic thresholds defined as 70 mg/dL and 100 mg/dL, respectively.

RESULTS

The cohort included 2465 patients. At first encounter, average age was 59.3 years old, 21.4% were on statins, 8.4% were on a high-intensity statin, 25.7% were diagnosed with HLD, 5.2% with CAD, 15.3% with PAD, 26.3% with DM, 18.6% with HTN, and 2.1% with CVOD. At final encounter, mean age was 64.8 years, 23.5% were on statins with 10.1% on high-intensity statin. Diagnoses frequency did not change at final encounter. At first encounter, nearly two-thirds of patients were not at an LDL <70 mg/dL (62.3%) or non-HDL <100 mg/dL (66.0%) with improvement at final encounter to 45.2 and 40.5% of patients not at these LDL or non-HDL treatment thresholds, respectively. Patients on statins exhibited similar trends with 51.1 and 50.1% of patients not at LDL or non-HDL treatment thresholds at first encounter and 39.9 and 35.4% not at LDL or non-HDL treatment thresholds at last encounter. Importantly, 6.9% of patients were at LDL but not non-HDL treatment thresholds.

DISCUSSION

Among vascular surgery patients, over half did not meet non-HDL targets. These results suggest that we may be vastly under-performing adequate medical optimization with only about one-fourth of patients on a statin at their final encounter and approximately one-tenth of patients being treated with a high-intensity statin. With recent evidence supporting non-HDL as a valuable measurement for atherosclerotic risk, there is potential to optimize medical management beyond current high-intensity statin therapy. Further investigation is needed regarding the risk of adverse events between patients treated with these varied therapeutic targets.

The Influence of Lifestyle on High-Density Lipoprotein Concentration among Mexican Emerging Adults

Previous studies have highlighted the role of lifestyle on HDL-C concentrations in adults. To our knowledge, the health and nutritional status of emerging adults have been understudied. The present study aimed to explore the most important lifestyle factors, including micronutrient intake adequacy and the percentage of energy from food processing, according to HDL-C concentrations in emerging adults. In this context, a cross-sectional analysis was conducted on 261 Mexican emerging adults who were apparently healthy. Lifestyle factors were collected through a structured survey and the prevalence of micronutrient intake inadequacy was estimated using the estimated average requirement cut-point method. The percentage of energy from ultra-processed foods was assessed using the NOVA system. HDL-C was determined using the enzymatic colorimetric method. Statistical analyses were conducted in SPSS. The results revealed that lifestyle factors do not differ according to HDL-C status. The participants showed a poor nutritional diet that was energy-dense and micronutrient-inadequate. Nearly half of their energy came from processed and ultra-processed foods. Most participants did not meet the recommendations for key nutrients (ϖ3 fatty acids and phytosterols) that promote a healthy lipid status. In conclusion, regardless of their HDL-C levels, emerging adults exhibited lifestyle-related risk factors. The persistence of these findings over time could contribute to the development of metabolic disorders in the future. It is crucial to increase understanding and to develop effective nutritional interventions during this critical phase of life.

Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity

Introduction

Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues.

Methods

The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism.

Results

The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR

Conclusion

Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.

Collapse

Key Words

• TMAO
• arterial stiffness
• atherosclerosis
• cardiovascular risk
• carotid intima-media thickness
• childhood obesity
• high blood pressure
• pulse wave velocity

Collapse

MESH Headings

• Adult
• Female
• Humans
• Child
• Pediatric Obesity/complications
• Carotid Intima-Media Thickness
• Vascular Stiffness/physiology
• Pulse Wave Analysis
• Acanthosis Nigricans
• Atherosclerosis/diagnosis
• Atherosclerosis/etiology
• Biomarkers

Collapse

Grants Collapse

Affiliation(s)

Monica Simina Mihuta Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Corina Paul Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Andreea Borlea Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Cristina Mihaela Roi Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Denisa Pescari Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Oana-Alexandra Velea-Barta 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Ioana Mozos Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Dana Stoian Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

Collapse

Physical activity: associations with health and summary of guidelines

The understanding of how physical activity and insufficient physical activity are associated with health outcomes has increased considerably over the past decades. Along with physical activity, the evidence on the associations between sedentary behavior and health has increased, which has resulted in the introduction of recommendations of sedentary behavior. In this article, we 1) present terminology for physical activity and sedentary behavior epidemiology, 2) show the relevant scientific evidence on associations of physical activity and sedentary behavior with selected health-related outcomes and 3) introduce the global guidelines for physical activity and sedentary behavior by the World Health Organization (WHO). Health-related outcomes include cardiovascular morbidity and mortality, total mortality, glucose regulation and type 2 diabetes, adiposity, overweight, obesity, cancer, musculoskeletal and bone health, brain health, and quality of life. These health-related outcomes are reflected across age groups and some population groups, such as pregnant and postpartum women. Furthermore, we discuss physical activity levels across Nordic countries and over time. For the Nordic Nutrition Recommendations, shared common physical activity guidelines were not developed. Instead, each country has created their own guidelines that are being referenced in the article, along with the global WHO guidelines.

Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study

BACKGROUND

Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery.

METHODS

This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated.

RESULTS

In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUC_baseline 0.74 [0.71-0.77], ROC AUC_{baseline+4METs} 0.74 [0.71-0.77], ROC AUC_{baseline+floors climbed} 0.75 [0.71-0.78], AUC_{baseline+fitnessvspeers} 0.74 [0.71-0.77], and AUC_{baseline+physical activity} 0.75 [0.72-0.78]).

CONCLUSIONS

Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery.

CLINICAL TRIAL REGISTRATION

NCT03016936.

Longitudinal Association between Physical Activity, Blood Lipids, and Risk of Dyslipidemia among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2009 and 2015

Physical activity is needed in today’s highly sedentary society. Research into Chinese trends with respect to the longitudinal association between changes in physical activity (PA) and dyslipidemia (DL) is limited. The present study assessed PA and PA-related changes associated with the level of serum lipids, and the risk of dyslipidemia stratified by gender, via a population-based longitudinal observational study among adults (>18 years old) residing in nine provinces in China. Data of 3380 adult participants, gleaned from two surveys in 2009 and 2015 used by the China Health and Nutrition Survey (CHNS), were analyzed. Three-level random intercept growth models were used to calculate the associations between total physical activity (TPA), the four activity subtypes, and changes in the level of blood lipids. Three-level logistic regression models were utilized to assess the association between TPA and the risk of DL. The highest level of TPA was observed to correlate with the lowest prevalence of DL. Compared with the lowest level of TPA, the highest level of TPA increases the concentration of HDL-C (β = 0.050, 95% CI = 0.005, 0.096) in males, and also reduces the risk in males of having low HDL-C by 31% (OR = 0.69, 95% CI = 0.52, 0.91). Occupational PA was positively associated with higher HDL-C levels in both genders (males: β = 0.004, 95% CI = 0.002, 0.007; females: β = 0.002, 95% CI = 0.000, 0.004), and leisure-time physical activity (LTPA) was negatively associated with TG levels in males. Increasing TPA benefited HDL-C levels in males, irrespective of the level of basic TPA of individuals. Physical activity (especially occupational PA) was superior in positively influencing HDL-C in males, but not in females. Leisure-time physical activity needs to be increased substantially in order to increase TPA to levels that would be beneficial to blood lipid levels and DL, irrespective of baseline TPA levels.

Physical activity and individual plasma phospholipid SFAs in pregnancy: a longitudinal study in a multiracial/multiethnic cohort in the United States

BACKGROUND

Circulating individual SFAs in pregnant females are critical for maternal and fetal health. However, research on identifying their modifiable factors is limited.

OBJECTIVES

We aimed to examine the associations of total physical activity (PA) and types of PA with circulating individual SFAs during pregnancy in a multiracial/multiethnic cohort of pregnant females in the United States.

METHODS

The study included participants in a nested case-control study (n = 321) from the Eunice Kennedy Shriver NICHD Fetal Growth Studies-Singleton Cohort. Sampling weights were applied, so the results represented the entire Fetal Growth Cohort. Plasma phospholipid SFAs were measured at 4 visits [10-14 (visit 1), 15-26 (visit 2), 23-31 (visit 3), and 33-39 (visit 4) weeks of gestation] throughout pregnancy. PA of the previous year at visit 1 and since the previous visit at the subsequent visits was assessed using the validated Pregnancy PA Questionnaire. Time-specific and longitudinal associations were examined using multivariable linear and generalized estimating equation models.

RESULTS

Total PA (metabolic equivalent of task-h/wk) was positively associated with circulating heptadecanoic acid (17:0) at visit 1 (β × 103: 0.07; 95% CI: 0.02, 0.11) and pentadecanoic acid (15:0) at visit 3 (β × 103: 0.09; 95% CI: 0.03, 0.14) independent of sociodemographic, reproductive, pregnancy, and dietary factors. Across the 4 visits, the positive associations with total PA were consistent for pentadecanoic acid (β × 103: 0.06; 95% CI: 0.02, 0.10) and heptadecanoic acid (β × 103: 0.10; 95% CI: 0.06, 0.14). Out of the 4 PA types (i.e., sports/exercise, household/caregiving, transportation, and occupational PA) considered, the magnitude of positive associations was the largest for sports/exercise PA.

CONCLUSIONS

Our findings suggest that maternal PA is positively associated with circulating pentadecanoic and heptadecanoic acids. The findings warrant confirmation by future studies.This trial was registered at clinicaltrials.gov as NCT00912132.

Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study : Physical inactivity level in the Legal Amazon

BACKGROUND

The practice of regular physical activity can alter the lipid profile in populations according to diverse demographic characteristics.

OBJECTIVE

To evaluate the association of physical inactivity with the lipid profile among vulnerable populations.

METHODS

A cross-sectional study was conducted among 349 vulnerable individuals from Tocantins state, northern Brazil. The International Physical Activity Questionnaire 7 Day short form was used to measure self-reported physical activity levels. Venous blood samples were drawn to evaluate lipid profile. Logistic regression adjusted by the socioeconomic variables was used to analyse the effects of physical inactivity on the lipidic profile. The level of significance was 5% and Stata® (StataCorp, LC) version 11 was used.

RESULTS

We observe an inverse relationship between physical inactivity and HDL-C-that is, those who were sedentary or below the WHO Recommendations for physical activity were at 2.6 greater odds (IC95% 1.21, 5.67; p = 0.015) of having a lower HDL compared with those meeting or exceeding WHO physical activity recommendations.

CONCLUSION

On the vulnerable populations studied, the insufficiently active or sedentary individuals (called the physical inactivity individuals) have more risk of the altered HDL-C.

Frequency of daily tooth brushing and subsequent cardiovascular events

OBJECTIVE

Although previous studies have shown an inverse association between the frequency of daily tooth brushing and cardiovascular risk factors, research on cardiovascular events is limited. This study aimed to evaluate the association between the frequency of daily tooth brushing and subsequent cardiovascular events.

METHODS AND RESULTS

A retrospective longitudinal study was conducted at a hospital in Tokyo, Japan. We included all participants who underwent health check-ups from 2005 to 2011 and followed up to 2018. Our outcomes were the development of cardiovascular events. Outcomes were compared by the frequency of daily tooth brushing with a generalized estimating equation, adjusting for potential confounders. A total of 71 221 participants were included. The mean age was 45.6 years and 50.3% were male. During a median follow-up of 2061 (interquartile range: 933-3311) days, 1905 participants developed cardiovascular events. The adjusted odds ratios (ORs) of cardiovascular events increased in a dose-dependent manner as the frequency of tooth brushing decreased. Even those who brushed their teeth once in a day had a higher adjusted OR of stroke (1.22; 95% confidence interval, 1.01-1.48) than did those who brushed after every meal.

CONCLUSIONS

Frequent tooth brushing was inversely associated with subsequent cardiovascular events in a dose-dependent manner. Even brushing one's teeth once a day may be related to an increased likelihood of stroke than brushing one's teeth after every meal. Less frequent tooth brushing may be considered to be a marker for subsequent cardiovascular disease and coronary heart disease, rather than a risk factor.

A cohort study on risk factors of high-density lipoprotein cholesterol hypolipidemia among urban Chinese adults

Background

High-density lipoprotein cholesterol (HDL-C) hypolipidemia, a major type of dyslipidemia, has been associated with many kinds of diseases, such as stroke, coronary heart disease, obesity and diabetes, and has displayed an increasing prevalence in China. This study explores the risk factors of HDL-C hypolipidemia and makes recommendations for controlling and preventing HDL-C hypolipidemia and the diseases caused by it.

Methods

Using a retrospective cohort study design, 26,863 urban adults without dyslipidemia, diabetes, cardiovascular and cerebrovascular diseases, hepatosis, renal insufficiency and thyroid diseases were enrolled in the study between 2010 and 2015. Data on each individual were collected at the 2010 baseline year and at a follow-up medical check. A Cox regression model was constructed to evaluate the influence of potential risk factors on the outcome event- HDL-C hypolipidemia.

Results

The incidence of HDL-C hypolipidemia was 5.7% (1531/26863). Sex, age, body mass index (BMI), HDL-C, triglyceride (TG) and urea nitrogen (UN) were significant risk factors of HDL-C hypolipidemia. Men were more likely to develop HDL-C hypolipidemia than women during follow-up medical checks (HR = 1.258, P = 0.014). The incidence of HDL-C hypolipidemia in the over 65 years old group was higher than that of the ≤65 age group (HR = 1.276, P = 0.009). The incidence of HDL-C hypolipidemia increased with increasing BMI (HR = 1.030, P = 0.002), TG (HR = 1.321, P = 0.001) and UN (HR = 1.054, P = 0.019), while falling with increasing HDL-C in the baseline year (HR = 0.002, P < 0.001).

Conclusions

Men, aged over 65, with high BMI were at the highest risk of developing HDL-C hypolipidemia. Measures should be taken to prevent HDL-C hypolipidemia even for healthy urban adults whose blood biochemical indicators were in the normal range when their level of TG, UN and HDL-C are closed to the border of the normal value range.

Physical Activity-Related Metabolites Are Associated with Mortality: Findings from the Atherosclerosis Risk in Communities (ARIC) Study

Habitual physical activity can diminish the risk of premature death. Identifying a pattern of metabolites related to physical activity may advance our understanding of disease etiology. We quantified 245 serum metabolites in 3802 participants from the Atherosclerosis Risk in Communities (ARIC) study using chromatography-mass spectrometry. We regressed self-reported moderate-to-vigorous intensity leisure-time physical activity (LTPA) against each metabolite, adjusting for traditional risk factors. A standardized metabolite risk score (MRS) was constructed to examine its association with all-cause mortality using the Cox proportional hazard model. We identified 10 metabolites associated with LTPA (p < 2.04 × 10^-4) and established that an increase of one unit of the metabolic equivalent of task-hours per week (MET·hr·wk^-1) in LTPA was associated with a 0.012 SD increase in MRS. During a median of 27.5 years of follow-up, we observed 1928 deaths. One SD increase of MRS was associated with a 10% lower risk of death (HR = 0.90, 95% CI: 0.85-0.95). The highest vs. the lowest MRS quintile rank was associated with a 22% reduced risk of death (HR = 0.78, 95% CI: 0.62-0.94). The effects were consistent across race and sex groups. In summary, we identified a set of metabolites associated with LTPA and an MRS associated with a lower risk of death. Our study provides novel insights into the potential mechanisms underlying the health impacts of physical activity.

Lower or higher HDL-C levels are associated with cardiovascular events in the general population in rural China

BACKGROUND

The present study aims to estimate whether high-density lipoprotein cholesterol (HDL-C) is correlated with cardiovascular events (CVEs) and cardiovascular mortality (CVM) in a large sample of the general population in rural areas of China.

METHODS

Adult participants (n = 10,266, age = 53.79 ± 10.49 years; 46.5% men) were enrolled from the Northeast China Rural Cardiovascular Health Study (NCRCHS). Laboratory testing, blood pressure, weight, height, and questionnaires about socioeconomic status were collected.

RESULTS

In all, 585 nonfatal or fatal CVEs and 212 cardiovascular deaths were documented during a 4.66-year follow-up. Compared to the reference groups (HDL-C between 1.5 and 1.99 mmol/L), either lower or higher levels of HDL-C were correlated with an increased incidence of CVEs but not CVM [hazard ratio (HR) _{the lowest} = 1.369, 95% confidence interval, 1.007-1.861; HR _{the highest} = 1.044, 0.509-2.231]. Elevated CVM was seen in the lowest HDL-C category (1.840; 1.121-3.021).

CONCLUSIONS

Lower or higher HDL-C was associated with a higher incidence of CVEs but not CVM in the general population of rural China. Perhaps if an appropriate level of HDL-C is maintained, CVEs can be effectively prevented.

Estimated cardiorespiratory fitness in childhood and cardiometabolic health in adulthood: 1970 British Cohort Study

Background

Associations of cardiorespiratory fitness in childhood and adulthood with adult cardiometabolic risk factors are poorly understood, not least because of the paucity of studies.

Objectives

We investigated associations between nonexercise testing cardiorespiratory fitness (NETCRF) in childhood/adulthood and cardiometabolic risk factors in adulthood.

Methods

Based on an established algorithm comprising gender, age, body mass index, resting heart rate, and self‐reported physical activity at age 10, we computed NETCRF. Risk factors were assessed at age 46 in 5009 participants when NETCRF was again calculated. Linear regression was used to summarize associations between NETCRF in childhood and risk factors in adulthood and, additionally, the relationship between NETCRF in adulthood and risk factors in adulthood after adjusting for childhood NETCRF.

Results

Inconsistent associations were observed between childhood NETCRF and adult risk factors. NETCRF in adulthood was associated with blood pressure [−5.8 (−6.7, −4.9)], glycated hemoglobin [−3.41 (−4.06, −2.76)], total cholesterol [−0.16 (−0.24, −0.08)], HDL cholesterol [0.19 (0.16, 0.22)], triglycerides [−0.68 (−0.85, −0.50)], and C‐reactive protein [−0.29 (−0.35, −0.22)] in adult males. Similar associations were observed in adult females. Compared to those with low estimated fitness in both childhood and adulthood, participants with low fitness in childhood and high fitness in adulthood had a lower risk of two or more cardiometabolic risk factors (odds ratio: 0.25; 95% confidence interval: 0.19, 0.31).

Conclusion

Associations between estimated fitness and risk factors are stronger in adulthood than from childhood to adulthood. Adults with previously sedentary childhoods may still gain benefits from improving their fitness.

Dietary Intakes Are Associated with HDL-Cholesterol in Survivors of Childhood Acute Lymphoblastic Leukaemia

Survivors of childhood acute lymphoblastic leukemia (cALL) are at high risk of developing dyslipidemia, including low HDL-cholesterol (HDL-C). This study aimed to examine the associations between food/nutrient intake and the levels of HDL-C in a cohort of children and young adult survivors of cALL. Eligible participants (n = 241) were survivors of cALL (49.4% boys; median age: 21.7 years old) recruited as part of the PETALE study. Nutritional data were collected using a validated food frequency questionnaire. Fasting blood was used to determine participants' lipid profile. Multivariable logistic regression models were fitted to evaluate the associations between intakes of macro- and micronutrients and food groups and plasma lipids. We found that 41.3% of cALL survivors had at least one abnormal lipid value. Specifically, 12.2% had high triglycerides, 17.4% high LDL-cholesterol, and 23.1% low HDL-C. Low HDL-C was inversely associated with high intake (third vs. first tertile) of several nutrients: proteins (OR: 0.27, 95% CI: 0.08-0.92), zinc (OR: 0.26, 95% CI: 0.08-0.84), copper (OR: 0.34, 95% CI: 0.12-0.99), selenium (OR: 0.17, 95% CI: 0.05-0.59), niacin (OR: 0.25, 95% CI: 0.08-0.84), riboflavin (OR: 0.31, 95% CI: 0.12-0.76) and vitamin B12 (OR: 0.35, 95% CI: 0.13-0.90). High meat consumption was also inversely associated (OR: 0.28, 95% CI: 0.09-0.83) with low HDL-C while fast food was positively associated (OR: 2.41, 95% CI: 1.03-5.63) with low HDL-C. The role of nutrition in the development of dyslipidemia after cancer treatment needs further investigation.

Everything in Moderation: Investigating the U-Shaped Link Between HDL Cholesterol and Adverse Outcomes

Despite historical evidence suggesting an inverse association between HDL cholesterol (HDL-C) and adverse cardiovascular events, pharmacological efforts to increase HDL-C and improve outcomes have not been successful. Recently, a U-shaped association between HDL-C and adverse events has been demonstrated in several population cohorts, further complicating our understanding of the clinical significance of HDL. Potential explanations for this finding include genetic mutations linked to very high HDL-C, impaired HDL function at high HDL-C levels, and residual confounding. However, our understanding of this association remains premature and needs further investigation.

Prevalence and predictors of physical inactivity levels among Kenyan adults (18-69 years): an analysis of STEPS survey 2015

BACKGROUND

Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.

METHODS

This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.

RESULTS

A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9-41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30-49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).

CONCLUSION

A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.