Update on Preventive Cardiology

Re-evaluating cardiovascular risk in systolic-dominant, diastolic-dominant and parallelly-elevated hypertension: insights from northeast rural cardiovascular health study

BACKGROUND

Hypertension is a major risk factor for cardiovascular disease (CVD), with a high prevalence in rural northeastern China. This study assesses the cardiovascular risk associated with different blood pressure patterns: systolic dominant, diastolic dominant, and parallel elevation.

METHODS

We analyzed data from the Northeast Rural Cardiovascular Health Study (NCRCHS), which included 8,189 participants aged 35 and above. Baseline surveys from 2012 to 2013 and follow-ups in 2015 and 2018 provided a median follow-up of 4.66 years. Participants were categorized into ten subgroups based on systolic and diastolic blood pressure elevations. Kaplan-Meier curves and Cox regression models were used to examine CVD incidence and cardiovascular risk across these groups.

RESULTS

The incidence of CVD varied significantly among hypertension categories. Patients with grade 1 hypertension had no significant increase in cardiovascular risk at nearly 5 years. Notably, parallel elevations in systolic and diastolic pressures posed the highest cardiovascular risk, while a predominant rise in diastolic pressure alone did not significantly increase risk. This highlights the importance of analyzing blood pressure comprehensively for cardiovascular risk stratification and suggests rethinking treatment strategies for diastolic dominant hypertension.

CONCLUSIONS

Our findings call for a nuanced approach to cardiovascular risk assessment in hypertension, taking into account distinct patterns of systolic and diastolic blood pressure. The study supports personalized treatment interventions and reinforces current hypertension treatment guidelines. We advocate for prioritizing non-pharmacological management in grade 1 hypertension and further clinical evaluation of treatment thresholds for diastolic dominant hypertension.

Use of the Vascular Overload Index to Predict Cardiovascular Disease in a Rural Population of China

Objective

To explore the relationship between vascular overload index (VOI) and cardiovascular disease (CVD) in rural population and find effective ways to prevent cardiovascular disease in rural low-income populations.

Methods

The data for this study was obtained from a large cohort study called the Northeast China Rural Cardiovascular Health Study (NCRCHS) conducted in 2013 and followed up during 2015-2018. 10,174 subjects completed at least one follow-up visit. Cox regression equation was used to explore whether VOI and cardiovascular disease were independently related. The Kaplan-Meier curves were used to calculate the cumulative incidence of any adverse outcome, and the log-rank test and restrict mean survival analysis were used to compare group differences. Reclassification and discrimination statistics were used to determine whether VOI could strengthen the ability of the model to predict CVD events.

Results

The prevalence of CVD in the VOI quartiles was 1.92%, 3.96%, 5.42%, and 11.34% for Q1-Q4, respectively (P for trend <0.001). After adjusting for multiple confounders, there was a 2.466-fold increased risk of CVD when comparing the highest and lowest groups. Besides, this study found that for every standard deviation increase, the results still exist. The risk of cardiovascular disease increased by 1.358-fold in this model. The restrict mean survival analysis results show that with the increase of VOI, the restrict mean survival time (RMST) within 5 years gradually became shorter. Reclassification and discrimination statistics indicated that VOI significantly enhanced the ability to estimate CVD events within 4 years.

Conclusion

Analyses showed that VOI was significantly associated with CVD. VOI is a simple and accurate prognostic marker of CVD risk, which has the potential ability to improve the risk stratification of CVD.

Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Cardiovascular Disease among Middle-Aged Population

PURPOSE

To explore the predictive value of ACEF scores for identifying the risk of cardiovascular disease (CVD) in the general population.

METHODS

A total of 8613 participants without a history of CVD were enrolled in the follow-up. The endpoint was CVD incidence, defined as stroke or coronary heart disease (CHD) diagnosed during the follow-up period. Cox regression analyses were used to calculate hazard ratios (HRs) with respect to the age, creatinine, and ejection fraction (ACEF) scores and CVD. A Kaplan-Meier curve was used to analyze the probability of CVD in different quartiles of ACEF. Restricted cubic spline was used to further explore whether the relationship between ACEF and CVD was linear. Finally, we assessed the discriminatory ability of ACEF for CVD using C-statistics, net reclassification index, and integrated discrimination improvement (IDI).

RESULTS

During a median follow-up period of 4.66 years, 388 participants were diagnosed with CVD. The Kaplan-Meier curve showed that ACEF was associated with CVD, and participants with high ACEF scores were significantly more likely to be diagnosed with CVD compared to participants with low ACEF scores in the general population. In the multivariate Cox regression analysis, the adjusted HRs for four quartiles of ACEF were as follows: the first quartile was used as a reference; the second quartile: HR = 2.33; the third quartile: HR = 4.81; the fourth quartile: HR = 8.00. Moreover, after adding ACEF to the original risk prediction model, we observed that new models had higher C-statistic values of CVD than the traditional model. Furthermore, the results of both NRI and IDI were positive, indicating that ACEF enhanced the prediction of CVD.

CONCLUSIONS

Our study showed that the ACEF score was associated with CVD in the general population in northeastern China. Furthermore, ACEF could be a new tool for identifying patients at high risk of primary CVD in the general population.

Is waist-to-height ratio the best predictive indicator of cardiovascular disease incidence in hypertensive adults? A cohort study

Background

Cardiovascular disease (CVD) brings high mortality and economic burden to patients, especially in rural areas. Simple, low-cost abdominal adiposity measures may help identify individuals with increased CVD risk. It is unclear that which obesity indices is the best to predict CVD in hypertensive people.

Methods

Northeast China Rural Cardiovascular Health Study (NCRCHS) is a prospective cohort study in a general population in Northeast China. The study examined the cardiovascular health from 2013 to 2015, and follow-up captured the CVD incidence in 2018. Baseline waist-to-height ratio (WHtR), waist circumference (WC), waist-to-hip (WHR)and body mass index (BMI) were calculated and analyzed in relation to the CVD incidence.

Results

A total of 4244 hypertensive adults without pre-existing CVD at baseline were included in this analysis (age 35–92 years; 2108 men). Over a median follow-up of 4.66 years, a total of 290 CVD cases (6.83%) were documented during the follow-up. Baseline WHtR showed a significant positive association with CVD incidence, even after adjusting for age, sex, diabetes, drinking, smoking, SBP, DBP, Triglyceride, HDL-C, LDL-C, and TC (Hazard Ratios per SD of WHtR ranging from 1.03 to 1.31, p = 0.017). Reclassification and discrimination analyses indicated WHtR addition could improve the conventional model for predicting adverse outcomes within 4 years. Moreover, WHtR predicted the CVD incidence better than other obesity indices (BMI, WC, WHR).

Conclusion

These findings support a positive association between WHtR and CVD incidence in CVD-free hypertensive adults. WHtR can be used to predict CVD incidence in hypertensive adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02646-1.

Association of Blood Mercury Levels with the Risks of Overweight and High Waist-to-Height Ratio in Children and Adolescents: Data from the Korean National Health and Nutrition Examination Survey

A previous study in adults demonstrated the substantial role of mercury exposure in the development of overweight and obesity. Although children and adolescents are more susceptible to the toxic effects of mercury than adults, studies on the association of overweight and obesity with mercury exposure is limited. This study aimed to investigate the association of blood mercury levels with the body mass index (BMI) and waist-to-height ratio (WHtR) as obesity indices in Korean children and adolescents. The analyzed cross-sectional data were obtained from 1327 participants (age: 10–18 years; 672 male and 655 female) who completed the Korean National Health and Nutrition Examination Survey 2010–2013. The covariates included sociodemographic factors (age, sex, and household income), dietary factors (fish, shellfish, and seaweed consumption), lifestyle factors (alcohol consumption, smoking status, and exercise), and blood hematocrit levels. The adjusted geometric mean blood mercury level was 2.19 µg/L, and the level of mercury was significantly higher in the overweight (BMI ≥ 85th gender and age-specific percentiles) and high WHtR (cutoff: ≥0.5) groups than in the normal group. In all the participants, the blood mercury levels were significantly positively associated with the BMI and WHtR after adjusting for all covariates (p < 0.05). All the participants in the highest blood mercury level quartile were at a higher risk for overweight and a high WHtR than those in the lowest quartile after adjusting for all covariates (p < 0.05). Our study suggests a significant association between mercury exposure and the risks of overweight and high WHtR in Korean children and adolescents.