Contributions of increasing obesity and diabetes to slowing decline in subclinical coronary artery disease

Obesity and Coronary Heart Disease: Epidemiology, Pathology, and Coronary Artery Imaging

Overweight and obesity contribute to the development of cardiovascular disease (CVD) in general and coronary heart disease (CHD) in particular in part by their association with traditional and nontraditional CVD risk factors. Obesity is also considered to be an independent risk factor for CVD. The metabolic syndrome, of which central obesity is an important component, is strongly associated with CVD including CHD. There is abundant epidemiologic evidence of an association between both overweight and obesity and CHD. Evidence from postmortem studies and studies involving coronary artery imaging is less persuasive. Recent studies suggest the presence of an obesity paradox with respect to mortality in persons with established CHD. Physical activity and preserved cardiorespiratory fitness attenuate the adverse effects of obesity on CVD events. Information concerning the effect of intentional weight loss on CVD outcomes in overweight and obese persons is limited.

BMI modified the association of current smoking with the incidence of hypertension in Chinese population: a 22-year cohort study

Background

There was little known on how the interaction effect between obesity and current smoking affected the incidence of hypertension. The aim of this study was to investigate how body mass index (BMI) modified the effect of current smoking on the incidence of hypertension.

Methods

Data were obtained from the China Health and Nutrition Survey (CHNS). According to the WHO recommendations for Chinese people, the normal weight, overweight, and obesity were defined using the BMI cutoff values 18.5 kg/m², 23.0 kg/m², and 27.5 kg/m, respectively. Current smokers were defined as having smoked at least 100 cigarettes or electronic cigarettes, 20 cigars, or 20 tobacco pipes and other type of tobacco in the last 30 days preceding the survey. Hypertension was defined as systolic blood pressure (SBP)/ diastolic blood pressure (DBP) ≥ 140/90 mmHg, use of anti-hypertensive medications, or a self-reported diagnosis.

Results

This study included 12,900 subjects. There were interaction effects between obesity and current smoking in females (P = 0.030) and the 50–59 years group (P = 0.049). Current smoking was a significant predictor of incident hypertension only in the total and female populations with normal weight (HR: 1.119 and 1.274; HR 95% CI: 1.013–1.236 and 1.143–1.415; and P = 0.027 and 0.040, respectively). Stratified by age, current smoking affected the development of hypertension only in the 50–59 years subjects with the normal weight (HR: 1.356; HR 95% CI: 1.084–1.697; and P = 0.008).

Conclusions

Current smoking was a significant predictor of incident hypertension only in the female and middle-age populations with normal weight but not in the overweight and obesity as well as the younger and elder populations.

The CXCL12 SNPs and their haplotypes are associated with serum lipid traits

The relationship among the single nucleotide polymorphisms (SNPs) of the C-X-C motif chemokine ligand 12 gene (CXCL12) and the serum lipid profiles in the Chinese population has rarely been described, especially in somewhat old-fashioned and isolated Maonan minority. The goal of the current study was to elucidate the connection among the CXCL12 rs501120 and rs1746048 SNPs, haplotypes, several environmental factors and serum lipid traits in the Maonan as well as Han populations. Genotyping of the two SNPs, gel electrophoresis and direct sequencing were accomplished in 1,494 distinct subjects (Maonan, 750 and Han, 744) using polymerase chain reaction and restriction fragment length polymorphism. The frequencies of genotypes as well as alleles of the two SNPs were not similar between the two ethnic groups. The rs501120 SNP was related with serum total cholesterol levels, while the rs1746048 SNP was related with serum apolipoprotein (Apo) B levels. Four haplotypes were identified, of which the rs501120A-rs1746048C haplotype was the most common. The haplotypes of rs501120A-rs1746048T increased and rs501120G-rs1746048C decreased the risk of hyperlipidemia (P < 0.001 for each), showing consistent association with the levels of serum triglyceride, ApoA1 and ApoB. These outcomes specify that the CXCL12 SNPs as well as their haplotypes are related to serum lipid levels. Different serum lipid levels between both populations may partially be related to the CXCL12 SNPs, their haplotypes along with several environmental factors.

Association between the PPP1R3B polymorphisms and serum lipid traits, the risk of coronary artery disease and ischemic stroke in a southern Chinese Han population

Background

Little is known about the association of the protein phosphatase 1 regulatory subunit 3B gene (PPP1R3B) single nucleotide polymorphisms (SNPs) and serum lipid levels, the risk of coronary artery disease (CAD) and ischemic stroke (IS) in the Chinese populations. This study detected such association in a Southern Chinese Han population.

Methods

Genotypes of 4 novel PPP1R3B SNPs (rs12785, rs330910, rs330915 and rs9949) in 1704 Han Chinese (CAD, 556; IS, 531 and control, 617) were determined by the Snapshot technology.

Results

The rs12785A and rs9949A allele frequency was higher in both CAD/IS patients than in controls. The rs330910T and rs330915T allele frequency was also higher in CAD patients than in controls. The rs330910T allele carriers in controls had lower serum low-density lipoprotein cholesterol (LDL-C) levels than the rs330910T allele non-carriers (P < 0.0014). The rs12785A, rs9949A and rs330910T allele carriers were associated with an increased risk of CAD (P = 0.008–0.004). There was strong linkage disequilibrium among the 4 SNPs in the controls and CAD/IS patients. The T-A-A-G haplotype was associated with a decreased risk of CAD and IS, whereas the A-A-T-A haplotype was associated with an increased risk for IS. Haplotype-environment interactions on the risk of CAD and IS were also observed.

Conclusions

Several PPP1R3B polymorphisms were associated with serum LDL-C levels, the risk of CAD and IS in the Southern Chinese Han population. But these findings still need to be confirmed in the other populations with larger sample sizes.

Electronic supplementary material

The online version of this article (10.1186/s12986-018-0266-y) contains supplementary material, which is available to authorized users.

DOCK7-ANGPTL3 SNPs and their haplotypes with serum lipid levels and the risk of coronary artery disease and ischemic stroke

BACKGROUND

Little is known about the association of the dedicator of cytokinesis 7 (DOCK7 rs1748195) and angiopoietin like 3 (ANGPTL3 rs12563308) single nucleotide polymorphisms (SNPs) and their haplotypes with serum lipid levels and the risk of coronary artery disease (CAD) and ischemic stroke (IS) in the Chinese populations. This study aimed to detect such association in a Southern Chinese Han population.

METHODS

This study included 1728 subjects (CAD, 568; IS, 539; and controls, 621). Genotypes of the two SNPs were determined by the Snapshot technology.

RESULTS

The genotypic and allelic frequencies of the rs1748195 SNP were different between CAD patients and controls (P < 0.05 for each), the rs1748195G allele frequency was higher in CAD patients than in controls (27.6% vs. 23.6%, P = 0.024). The genotypic frequencies of the rs12563308 SNP were also different between CAD patients and controls (P = 0.021). The rs1748195 SNP was associated with an increased risk of CAD after controlling for potential confounders and Bonferroni correction (P < 0.025 considered statistically significant; Recessive: OR = 1.79, 95% CI = 1.04-3.06, P = 0.017; Log-additive: OR = 1.27, 95% CI = 1.02-1.57, P = 0.014), whereas the rs12563308 SNP was associated with a decreased risk of CAD (Dominant: OR = 0.69, 95% CI = 0.45-0.94, P = 0.011; Log-additive: OR = 0.73, 95% CI = 0.49-0.89, P = 0.009). The rs1748195 SNP was also associated with an increased risk of severity to coronary artery atherosclerosis (Dominant: OR = 1.45, 95% CI = 1.07-2.11, P = 0.017; Log-additive: OR = 1.35, 95% CI = 1.09-1.82, P = 0.013). The interactions of SNP-environment on serum lipid levels and the risk of severity to coronary artery atherosclerosis, CAD and IS were noted. The rs1748195G-rs12563308T haplotype was associated with an increased angiographic severity to coronary artery atherosclerosis (OR = 1.46, 95% CI = 1.05-2.03), and the risk of CAD (OR = 1.37, 95% CI = 1.08-1.74). The interactions of haplotype-hypertension on the risk of CAD and haplotype-drinking on the risk of CAD/IS were observed.

CONCLUSIONS

These results suggest that the DOCK-ANGPTL3 SNPs and their haplotypes were associated with the angiographic severity to coronary artery atherosclerosis and the risk of CAD and IS in the Southern Chinese Han population.

Temporal Associations Between Smoking and Cardiovascular Disease, 1971 to 2006 (from the Framingham Heart Study)

Smoking has consistently been related to cardiovascular risk. Public health efforts have yielded reduced smoking prevalence and gains in cardiovascular disease (CVD) prevention. We hypothesized that the contribution of tobacco to CVD risk would be attenuated over prospective decades (1971 to 2006) in a community-based cohort. We evaluated 5,041 Framingham Heart Study Offspring Cohort participants (mean age 36.1 years, 52% women) without prevalent CVD. We collected prospective data on smoking status, relevant CVD risk factors, and incident CVD events across prospective decades. We used multivariable-adjusted, Cox proportional hazard models to measure the effect of smoking on incident CVD over 3 prospective 12-year follow-up periods. Our results demonstrated a consistent twofold increased risk of CVD in men who smoke compared with nonsmokers for each 12-year time period spanning from 1971 to 2006. Women who smoked had a 1.5-fold increased CVD risk. Smoking remains an important risk factor despite substantial improvements in the prevention and treatment of CVD. Significant, contemporary improvements in CVD prevention-such as gains in hypertension and cholesterol treatment-have not attenuated the strong and persistent associations between smoking and CVD observed here. In conclusion, our results highlight the importance of continued public health efforts to address smoking as a modifiable exposure that strongly contributes toward CVD risk.

Trends in mortality rates by subtypes of heart disease in Mississippi, 1980-2013

BACKGROUND

Heart disease (HD) is the leading cause of death among Mississippians. However, trends in mortality rates for HD subtypes in Mississippi have not been adequately described. This study examined trends in mortality rates for HD subtypes among adults in Mississippi from 1980 through 2013.

METHODS

We used Mississippi Vital Statistics data to calculate age-specific mortality rates for HD subtypes for Mississippians age 35 and older. Cases were identified via underlying cause of death codes from the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). We used Joinpoint software to calculate the average annual percent change (AAPC) in mortality rates for HD subtypes by race, sex, and age group.

RESULTS

Overall, the age-adjusted coronary heart disease (CHD) mortality rate among Mississippi adults decreased by 62.7% between 1980 and 2013, with an AAPC of -3.0% (95% CI -3.7 to -2.3), while the age-adjusted heart failure mortality rate increased by 66.7%, with an AAPC of 1.4% (95% CI 0.5 to 2.3). Trends varied across HD subtypes: Annual rates of hypertensive HD mortality increased significantly for men, for individuals age 35 to 54, and for individuals age 75 and older. CHD mortality experienced a significant annual decrease among all race, sex, and age subgroups, while heart failure increased significantly among women, whites, and individuals age 75 and older.

CONCLUSIONS

From 1980 to 2013, CHD mortality decreased significantly while heart failure mortality increased significantly among adult Mississippians. However, HD subtype trends differed by race, sex, and age group.

Trends in Coronary Atherosclerosis: A Tale of Two Population Subgroups

BACKGROUND

We previously investigated trends in subclinical coronary artery disease and associated risk factors among autopsied non-elderly adults who died from nonnatural causes. Although grade of atherosclerosis declined from 1981 through 2009, the trend was nonlinear, ending in 1995, concurrent with increasing obesity/diabetes in this population. The previous study used linear regression and examined trends for all 4 major epicardial coronary arteries combined. The present investigation of coronary artery disease trends for the period 1995 through 2012 was prompted by a desire for more detailed examination of more recent coronary artery disease trends in light of reports that the epidemics of obesity and diabetes have slowed and are perhaps ending.

METHODS

This population-based series of cross-sectional investigations identified all Olmsted County, Minnesota residents aged 16-64 years who died 1995 through 2012 (N = 2931). For decedents with nonnatural manner of death, pathology reports were reviewed for grade of atherosclerosis assigned each major epicardial coronary artery. Using logistic regression, we estimated calendar-year trends in grade (unadjusted and age- and sex-adjusted) for each artery, initially as an ordinal measure (range, 0-4); then, based on evidence of nonproportional odds, as a dichotomous variable (any atherosclerosis, yes/no) and as an ordinal measure for persons with atherosclerosis (range, 1-4).

RESULTS

Of 474 nonnatural deaths, 453 (96%) were autopsied; 426 (90%) had coronary stenosis graded. In the ordinal-logistic model for trends in coronary artery disease grade (range, 0-4), the proportional odds assumption did not hold. In subsequent analysis as a dichotomous outcome (grades 0 vs 1-4), each artery exhibited a significant temporal decline in the proportion with any atherosclerosis. Conversely, for subjects with coronary artery disease grade 1-4, age- and sex-adjusted ordinal regression revealed no change over time in 2 arteries and statistically significant temporal increases in severity in 2 arteries.

CONCLUSIONS

Findings suggest that efforts to prevent coronary artery disease onset have been relatively successful. However, statistically significant increases in the grade of atherosclerosis in 2 arteries among persons with coronary artery disease may be indicative of a major public health challenge.