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Gaye B, Tafflet M, Arveiler D, Montaye M, Wagner A, Ruidavets JB, Kee F, Evans A, Amouyel P, Ferrieres J, Empana JP. Ideal Cardiovascular Health and Incident Cardiovascular Disease: Heterogeneity Across Event Subtypes and Mediating Effect of Blood Biomarkers: The PRIME Study. J Am Heart Assoc 2017; 6:JAHA.117.006389. [PMID: 29042430 PMCID: PMC5721848 DOI: 10.1161/jaha.117.006389] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to investigate whether the association between baseline cardiovascular health (CVH) and incident cardiovascular disease differs according to coronary heart disease (CHD) and stroke subtypes, and to assess the mediating effect of inflammatory and hemostatic blood biomarkers. Methods and Results The association of ideal CVH with outcomes was derived in 9312 middle‐aged men from Northern Ireland and France (whole cohort) in multivariable Cox proportional hazards regression analysis. The mediating effect of baseline inflammatory and hemostatic blood biomarkers was evaluated in a case–control study nested within the cohort after 10 years of follow‐up. After a median follow‐up of 10 years, 614 first CHD events and 117 first stroke events were adjudicated. Compared with those with poor CVH, those with an ideal CVH profile at baseline had a 72% lower risk of CHD (hazard ratio=0.28; 95% confidence interval, 0.17; 0.46) and a 76% lower risk of stroke (hazard ratio =0.24; 95% confidence interval, 0.06; 0.98). The magnitude of the risk reductions was similar for incident angina and myocardial infarction, but was lower for ischemic stroke. In the controls, the mean concentrations of high‐sensitivity C‐reactive protein, IL‐6, and fibrinogen decreased with higher CVH status. Furthermore, the association of behavioral CVH with incident CHD was partly mediated by high‐sensitivity C‐reactive protein (16.69%), IL‐6 (8.52%), and fibrinogen (7.30%) Conclusions Our study shows no clear heterogeneity in the association of baseline CVH with the main subtypes of cardiovascular disease. This supports a universal promotion of ideal CVH for all cardiovascular disease subtypes. Furthermore, our mediation analysis suggests that the lower risk of CHD associated with ideal CVH is partly mediated by lower inflammatory and hemostatic blood biomarkers.
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Affiliation(s)
- Bamba Gaye
- INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Muriel Tafflet
- INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique Arveiler
- The Strasbourg MONICA Project, Laboratoire d'épidémiologie et de santé publique, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France
| | - Michèle Montaye
- The Lille MONICA Project, INSERM, U1167, Institut Pasteur de Lille, Université Nord de France, Lille, France
| | - Aline Wagner
- The Strasbourg MONICA Project, Laboratoire d'épidémiologie et de santé publique, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France
| | | | - Frank Kee
- The UKCRC Centre of Excellence for Public Health (NI), The Queen's University, Belfast, Northern Ireland
| | - Alun Evans
- The UKCRC Centre of Excellence for Public Health (NI), The Queen's University, Belfast, Northern Ireland
| | - Philippe Amouyel
- The Lille MONICA Project, INSERM, U1167, Institut Pasteur de Lille, Université Nord de France, Lille, France
| | - Jean Ferrieres
- The Toulouse MONICA Project, Toulouse University School of Medicine, Toulouse, France
| | - Jean-Philippe Empana
- INSERM, U970, Paris Cardiovascular Research Center, University Paris Descartes, Sorbonne Paris Cité, Paris, France
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Antihypertensive treatment is not a risk factor for major cardiovascular events in the Gubbio residential cohort study. J Hypertens 2016; 33:736-44; discussion 744. [PMID: 25915878 DOI: 10.1097/hjh.0000000000000490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Demonstration of antihypertensive beneficial role in population settings is difficult. Relationships of antihypertensive treatment, blood pressure control, risk factors and cardiovascular outcomes were investigated in the Gubbio study. MATERIAL AND METHODS Among 2248 cardiovascular disease-free men and women aged 35-74 years, individuals were classified as nonhypertensive, controlled hypertensive, uncontrolled hypertensive and untreated hypertensive based on cut-off limits of 140/90 mmHg for SBP/DBP and/or the use of antihypertensive drugs. End-point was the first major coronary, cerebrovascular or peripheral hard event [cardiovascular disease (CVD)] during a 15-year average. Univariate and multivariate analyses were run. RESULTS Nonhypertensive individuals were about 10 years younger and had lower risk factor levels than the other categories. The relative risk (and 95% confidence interval) for CVD versus nonhypertension was 1.78 (1.02-3.10) for controlled hypertension, 3.76 (2.79-5.06) for uncontrolled hypertension and 3.30 (2.59-4.21) for untreated hypertension (UTH). After adjusting for covariates, such as sex, age, achieved blood pressure and other risk factors, the CVD risk of controlled hypertension was practically equal to that of nonhypertension, and remained unchanged even when blood pressure was excluded from the model (1.03, 0.58-1.82). The higher cardiovascular risk of uncontrolled hypertension and UTH was reduced after adjusting for covariates, but remained significantly higher than in nonhypertension, with no significant differences between uncontrolled hypertension and UTH. CONCLUSIONS A higher level of baseline risk is not due to treatment per se, the risk being similar in uncontrolled hypertension and UTH. Adjustment for risk factors reduces the risk only in controlled hypertension, suggesting that there may be structural alterations scarcely reversible by antihypertensive treatment.
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George J, Rapsomaniki E, Pujades-Rodriguez M, Shah AD, Denaxas S, Herrett E, Smeeth L, Timmis A, Hemingway H. How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People. Circulation 2015; 132:1320-8. [PMID: 26330414 PMCID: PMC4590518 DOI: 10.1161/circulationaha.114.013797] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Given the recent declines in heart attack and stroke incidence, it is unclear how women and men differ in first lifetime presentations of cardiovascular diseases (CVDs). We compared the incidence of 12 cardiac, cerebrovascular, and peripheral vascular diseases in women and men at different ages. METHODS AND RESULTS We studied 1 937 360 people, aged ≥ 30 years and free from diagnosed CVD at baseline (51% women), using linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry, and mortality (Cardiovascular Research Using LInked Bespoke Studies and Electronic Records [CALIBER] research platform). During 6 years median follow-up between 1997 and 2010, 114 859 people experienced an incident cardiovascular diagnosis, the majority (66%) of which were neither myocardial infarction nor ischemic stroke. Associations of male sex with initial diagnoses of CVD, however, varied from strong (age-adjusted hazard ratios, 3.6-5.0) for abdominal aortic aneurysm, myocardial infarction, and unheralded coronary death (particularly >60 years), through modest (hazard ratio, 1.5-2.0) for stable angina, ischemic stroke, peripheral arterial disease, heart failure, and cardiac arrest, to weak (hazard ratio <1.5) for transient ischemic attack, intracerebral hemorrhage, and unstable angina, and inverse (0.69) for subarachnoid hemorrhage (all P<0.001). CONCLUSIONS The majority of initial presentations of CVD are neither myocardial infarction nor ischemic stroke, yet most primary prevention studies focus on these presentations. Sex has differing associations with different CVDs, with implications for risk prediction and management strategies. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164371.
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Affiliation(s)
- Julie George
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
| | - Eleni Rapsomaniki
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Mar Pujades-Rodriguez
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Anoop Dinesh Shah
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Spiros Denaxas
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Emily Herrett
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Liam Smeeth
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Adam Timmis
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
| | - Harry Hemingway
- From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.)
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