Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population

Exploring the presence of oral bacteria in non-oral sites of patients with cardiovascular diseases using whole metagenomic data

Cardiovascular diseases (CVDs) encompass various conditions affecting the heart and its blood vessels and are often linked with oral microbes. Our data analysis aimed to identify oral bacteria from other non-oral sites (i.e., gut, arterial plaque and cultured blood) that could be linked with CVDs. Taxonomic profiling identified bacteria to the species level and compared with the Human Oral Microbiome Database (HOMD). The oral bacteria in the gut, cultured blood and arterial plaque samples were catalogued, with their average frequency calculated for each sample. Additionally, data were filtered by comparison with the Human Microbiome Project (HMP) database. We identified 17,243 microbial species, of which 410 were present in the HOMD database and further denominated as "oral", and were found in at least one gut sample, but only 221 and 169 species were identified in the cultured blood and plaque samples, respectively. Of the 410 species, 153 were present solely in oral-associated environments after comparison with the HMP database, irrespective of their presence in other body sites. Our results suggest a potential connection between the presence of specific species of oral bacterial and occurrence of CVDs. Detecting these oral bacterial species in non-oral sites of patients with CVDs could help uncover the link between oral health and general health, including cardiovascular conditions via bacterial translocation.

Risk factors associated with the incidence and prevalence of hypertension in Ghana: an integrated review (2016-2021)

This study synthesized the risk factors associated with hypertension among adolescents and adults in Ghana. A systematic search in four databases between 2016 and 2021 retrieved 119 Ghanaian studies, and through screening, 16 were selected. Thematic analysis was used to synthesize extracted data. Prevalence of hypertension ranged from 13.0% to 28.4% and prehypertension 22.0% to 51.4%. The non-modifiable hypertension risk factors were age, marital status, gender, and residence. The modifiable risk factors were consuming additional table salt, salted meat, alcohol, canned meats, smoking, and psychological factors, including stress and anxiety. Also, higher education and socio-economic status, employment, access to medical insurance, overweight, and higher BMI were risk factors. Targeted, sustained, systematic, and effective intervention programs should target high-risk people.

Hypertension literacy: Concept analysis

AIM

Analysis of the concept of hypertension literacy to ensure clarity, reduce ambiguities and promote consistency in usage.

DESIGN

Walker and Avant's concept analysis method was adopted.

METHODS

Searched four electronic databases using keywords combined with the appropriate Boolean operators. After removing duplicates, thirty titles were identified, and ten articles met the basic criteria for inclusion. The analysis was done using a convergent synthesis design to integrate results and transform them into qualitative descriptions.

RESULTS

Hypertension literacy's defining attributes were hypertension information search skills, comprehension of numeracy associated with blood pressure and medication and utilization of hypertension prevention information. The identified antecedents were formal education and improved cognitive, social, economic and health-related experiences. Consequences of hypertension literacy included improved self-reported and increased health awareness. Hypertension literacy allows nurses to assess and accurately improve knowledge and facilitate people to adopt prevention behaviours.

The association between arterial hypertension and menarcheal age

OBJECTIVE

Menarche, as a milestone of puberty, may have a long-term effect on health. The present study investigated the association of age at menarche with the incidence of arterial hypertension.

STUDY DESIGN

A total of 4747 post-menarcheal participants of the Tehran Lipid and Glucose Study who met the eligibility criteria were selected. Demographic, lifestyle, reproductive, and anthropometric data, as well as risk factors for cardiovascular diseases, were collected. Participants were classified according to their age at menarche: group I: ≤11 years, group II: 12-15 years, and group III: ≥16 years.

MAIN OUTCOME MEASURES

A Cox proportional hazards regression model was used to estimate the associations between age at menarche and arterial hypertension outcomes. The generalized estimating equation models were used to compare the trend of changes in systolic and diastolic blood pressure between the three groups.

RESULTS

The mean age of participants at baseline was 33.9 (13.0). At the end of the study, 1261 (26.6 %) participants had arterial hypertension. Women in group III had a 2.04-fold higher risk of arterial hypertension than those in group II. The mean changes in systolic and diastolic blood pressure were 29 % (95 % CI: 0.02-0.57) and 16 % (95 % CI: 0.00-0.38) higher for women in group III compared with group II.

CONCLUSIONS

Late menarche could be a risk factor for arterial hypertension, so it is necessary to pay more attention to age at menarche in cardiovascular risk assessment programs.

Cardiovascular complications in a diabetes prediction model using machine learning: a systematic review

Prediction model has been the focus of studies since the last century in the diagnosis and prognosis of various diseases. With the advancement in computational technology, machine learning (ML) has become the widely used tool to develop a prediction model. This review is to investigate the current development of prediction model for the risk of cardiovascular disease (CVD) among type 2 diabetes (T2DM) patients using machine learning. A systematic search on Scopus and Web of Science (WoS) was conducted to look for relevant articles based on the research question. The risk of bias (ROB) for all articles were assessed based on the Prediction model Risk of Bias Assessment Tool (PROBAST) statement. Neural network with 76.6% precision, 88.06% sensitivity, and area under the curve (AUC) of 0.91 was found to be the most reliable algorithm in developing prediction model for cardiovascular disease among type 2 diabetes patients. The overall concern of applicability of all included studies is low. While two out of 10 studies were shown to have high ROB, another studies ROB are unknown due to the lack of information. The adherence to reporting standards was conducted based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) standard where the overall score is 53.75%. It is highly recommended that future model development should adhere to the PROBAST and TRIPOD assessment to reduce the risk of bias and ensure its applicability in clinical settings. Potential lipid peroxidation marker is also recommended in future cardiovascular disease prediction model to improve overall model applicability.

A Unified Model of Age-Related Cardiovascular Disease

Despite progress in biomedical technologies, cardiovascular disease remains the main cause of mortality. This is at least in part because current clinical interventions do not adequately take into account aging as a driver and are hence aimed at suboptimal targets. To achieve progress, consideration needs to be given to the role of cell aging in disease pathogenesis. We propose a model unifying the fundamental processes underlying most age-associated cardiovascular pathologies. According to this model, cell aging, leading to cell senescence, is responsible for tissue changes leading to age-related cardiovascular disease. This process, occurring due to telomerase inactivation and telomere attrition, affects all components of the cardiovascular system, including cardiomyocytes, vascular endothelial cells, smooth muscle cells, cardiac fibroblasts, and immune cells. The unified model offers insights into the relationship between upstream risk factors and downstream clinical outcomes and explains why interventions aimed at either of these components have limited success. Potential therapeutic approaches are considered based on this model. Because telomerase activity can prevent and reverse cell senescence, telomerase gene therapy is discussed as a promising intervention. Telomerase gene therapy and similar systems interventions based on the unified model are expected to be transformational in cardiovascular medicine.

Association of metabolic comorbidity with myocardial infarction in individuals with a family history of cardiovascular disease: a prospective cohort study

Background

The association between metabolic comorbidity and myocardial infarction (MI) among individuals with a family history of cardiovascular disease (CVD) is yet to be elucidated. We aimed to examine the combined effects of metabolic comorbidities, including diabetes mellitus, hypertension, and dyslipidemia, with a family history of CVD in first-degree on the risk of incident MI.

Methods

This cohort study consisted of 81,803 participants aged 40–89 years without a previous history of MI at baseline from the Korean Genome and Epidemiology Study. We performed Cox proportional hazard regression analysis to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for MI and early-onset MI risk associated with metabolic comorbidity in individuals with a family history of CVD.

Results

During a median follow-up of 5 years, 1,075 and 479 cases of total and early-onset MI were reported, respectively. According to the disease score, among individuals who had a positive family history of CVD, the HRs for MI were 1.92 (95% CI: 1.47–2.51) in individuals with one disease, 2.75 (95% CI: 2.09–3.61) in those with two diseases, and 3.74 (95% CI: 2.45–5.71) in those with three diseases at baseline compared to individuals without a family history of CVD and metabolic diseases. Similarly, an increase of the disease score among individuals with a positive family history of CVD was associated with an increase in early-onset MI risk.

Conclusion

Metabolic comorbidity was significantly associated with an increased risk of MI among individuals with a family history of CVD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14330-2.

Cardiovascular Disease Risk Profiles in Indonesian Athletes

BACKGROUND: Notwithstanding how physical exercise lessens cardiovascular and all-cause mortality, young and active athletes might have cardiovascular risk factors or fundamental cardiovascular diseases (CVDs), putting them at increased risk for sudden cardiac death during times of strenuous exercise. AIM: The study aimed to assess the cardiovascular risk profile possessed by Indonesian athletes. METHODS: This research was a quantitative study using a cross-sectional design, involving 234 Indonesian athletes (163 men and 71 women) from three sports, including football, basketball, and swimming. Data were collected between December 2020 to March 2021 using the Jakarta Cardiovascular Risk Score instrument adapted from the Framingham risk score. Descriptive statistics were utilized to dissect data information for frequency distribution, percentage, mean, and standard deviation. RESULTS: Most of the participants in this study had excessive weekly exercise duration (more than 255 minutes/week) (n=177 athletes, 75.64%). Twenty-one participants (8.97%) had a higher MAP more than normal, and 51 participants (21.79%) had overweight BMI. In addition, 142 participants (60.68%) had a cardiovascular genetic disease from their parents (family history) and most of the participants also were active smokers (n=150, 64.10%). Based on the Jakarta Cardiovascular Risk Score, the Indonesian athletes who participated in this study had a mean cardiovascular risk of -1.5 (SD= 3.088, min-max= (-7) – 6). Most of the participants had low cardiovascular risk (n= 193, 82.48%). However, some participants had moderate and high cardiovascular risk, 32 (13.67%) and 9 (3.85%), respectively. CONCLUSION:  Most of the participants had low cardiovascular risk, however some of the participants had moderate and high cardiovascular risk.

Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12

BACKGROUND

Hypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans.

METHODS

Data were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group.

RESULTS

Increasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension.

CONCLUSION

There was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.

Cardiovascular disease risk factors among undergraduate medical students in a tertiary care centre of eastern India: a pilot study

BACKGROUND

Handful studies report the prevalence of cardiovascular disease (CVD) risk factors among medical students from India and none from the eastern part of the country.

AIM

To estimate the prevalence of risk factors of CVD and their correlation with CVD risk ratio among the MBBS students from eastern India.

METHODS

433 students were studied. International Physical Activity Questionnaire-long form was used for assessment of physical activity and Perceived Stress Scale (PSS) to elicit psychological stress levels. Waist-to-height ratio (WHtR) was calculated. Total cholesterol to high-density lipoprotein ratio was calculated as the CVD risk ratio.

RESULTS

39.3% were women and 68.6% of the subjects were in junior classes. 22.4% subjects had high PSS while 30% performed low physical activity. Tobacco and alcohol intake was prevalent in 29.3% and 21.0% respectively. High CVD risk ratio was found in 14.3%. Most risk factors were more prevalent among juniors except diabetes. Among the non-overweight and non-obese subjects there was a significant positive correlation between WHtR and CVD risk score (R = 0.33, p < 0.001). 82.7% of the variance in CVD risk ratio could be explained by WHtR, Body mass index, Triglycerides and Low-density lipoprotein (F(7, 425) = 296.085), of which LDL (β = 0.755) contributed the most.

CONCLUSIONS

High prevalence of different modifiable CVD risk factors revealed among the subjects in this study is concerning. WHtR appears promising as an independent early predictor of CVD risk in Indian population. A dedicated CVD risk assessment tool for the young population is necessary.

Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

BACKGROUND

The involvement of traditional risk factors and combined genetic markers of recurrent arterial ischemic stroke (AIS) in adults remains unclear.

OBJECTIVE

This study aims to determine significant clinical and genetic factors of AIS recurrence, and to investigate the combined effect of genotypes on the occurrence of a second cerebral ischemic attack.

METHODS

We investigated a cohort study of AIS patients (18-50 years old) followed in the neurology department over 5 years. Traditional and genetic risk factors were carried through a multivariable logistic regression model. We used a Cox proportional hazard model for identifying predictors of recurrence.

RESULTS

Two hundred and seventy patients were enrolled in our study. The risk of AIS recurrence was 36.2% within 5 years. The potential risk of recurrence of AIS increased with traditional and genetic risk factors such as hypertension, diabetes mellitus, heart failure, and family history of cerebrovascular diseases. This risk increased with increasing number of genetic factors. The hazard ratio (HR) was 0.66 (95% confidence interval [CI] 0.97-2.67) for the subject with one genetic factor, 1.61 (95% CI 0.97-2.25) for combined methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and 2.57 (95% CI 1.32-4.99) for combined factor V Leiden (FVL) and MTHFR polymorphisms (677 or 1298). The HR for the three polymorphisms combined was 6.04 (95% CI 2.40-15.16).

CONCLUSIONS

Our findings suggest that cumulative effect of both traditional and common genetic risk factors was associated with recurrence of ischemic stroke. We demonstrated for the first time that a combined genotype FVL/MTHFR profile increase the risk of a second cerebral ischemic attack.

Impact of a family history of cardiovascular disease on prevalence, awareness, treatment, control of dyslipidemia, and healthy behaviors: Findings from the Korea National Health and Nutrition Examination Survey

BACKGROUND

Family history (FH) is one of important risk factors for cardiovascular disease (CVD). However, little is known about its impact on dyslipidemia prevalence and management status. Thus, we aimed to investigate the impact of FH of CVD on dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors in Korean adults.

METHODS

We conducted a cross-sectional study using representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018. A total of 22,024 participants aged ≥ 19 years without histories of CVDs were classified into two groups according to the presence of FH of CVD (with FH, n = 3,778; without FH, n = 18,246). FH of CVD was defined as having a first-degree relative with ischemic heart disease or stroke. Multivariate logistic regression analyses were performed to evaluate the association between FH of CVD and dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors (weight control, non-smoking, non-risky drinking, sufficient physical activity, and undergoing health screening).

RESULTS

FH of CVD was significantly associated with a higher dyslipidemia prevalence (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.18-1.51), better awareness (aOR 1.54, 95%CI 1.19-2.00), and treatment rates (aOR 1.34, 95%CI 1.12-1.60), but not control. Having an FH of CVD was not predictive of any healthy behaviors in dyslipidemia patients. For non-dyslipidemia patients, FH of CVD even showed significant association with smoking (aOR 1.18, 95%CI 1.02-1.36), and risky drinking (aOR 1.20, 95%CI 1.03-1.40) while it was predictive of receiving health screening (aOR 1.14, 95% CI 1.02-1.27).

CONCLUSIONS

Having an FH of CVD might positively trigger dyslipidemia patients to start pharmacological intervention, but not non-pharmacological interventions. Therefore, physicians should make more efforts to educate and promote the importance of non-pharmacological behavioral modification in dyslipidemia patients with an FH of CVD.

Recent Advances of Cell Membrane Coated Nanoparticles in Treating Cardiovascular Disorders

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, causing approximately 17.9 million deaths annually, an estimated 31% of all deaths, according to the WHO. CVDs are essentially rooted in atherosclerosis and are clinically classified into coronary heart disease, stroke and peripheral vascular disorders. Current clinical interventions include early diagnosis, the insertion of stents, and long-term preventive therapy. However, clinical diagnostic and therapeutic tools are subject to a number of limitations including, but not limited to, potential toxicity induced by contrast agents and unexpected bleeding caused by anti-platelet drugs. Nanomedicine has achieved great advancements in biomedical area. Among them, cell membrane coated nanoparticles, denoted as CMCNPs, have acquired enormous expectations due to their biomimetic properties. Such membrane coating technology not only helps avoid immune clearance, but also endows nanoparticles with diverse cellular and functional mimicry. In this review, we will describe the superiorities of CMCNPs in treating cardiovascular diseases and their potentials in optimizing current clinical managements.

Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with cardiometabolic disease, but recent systematic reviews and meta-analyses of longitudinal studies that quantify these associations are lacking.

OBJECTIVE AND RATIONALE

Is PCOS a risk factor for cardiometabolic disease?

SEARCH METHODS

We searched from inception to September 2019 in MEDLINE and EMBASE using controlled terms (e.g. MESH) and text words for PCOS and cardiometabolic outcomes, including cardiovascular disease (CVD), stroke, myocardial infarction, hypertension (HT), type 2 diabetes (T2D), metabolic syndrome and dyslipidaemia. Cohort studies and case–control studies comparing the prevalence of T2D, HT, fatal or non-fatal CVD and/or lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) between women with and without PCOS of ≥18 years of age were eligible for this systematic review and meta-analysis. Studies were eligible regardless of the degree to which they adjusted for confounders including obesity. Articles had to be written in English, German or Dutch. Intervention studies, animal studies, conference abstracts, studies with a follow-up duration less than 3 years and studies with less than 10 PCOS cases were excluded. Study selection, quality assessment (Newcastle–Ottawa Scale) and data extraction were performed by two independent researchers.

OUTCOMES

Of the 5971 identified records, 23 cohort studies were included in the current systematic review. Women with PCOS had increased risks of HT (risk ratio (RR): 1.75, 95% CI 1.42 to 2.15), T2D (RR: 3.00, 95% CI 2.56 to 3.51), a higher serum concentration of TC (mean difference (MD): 7.14 95% CI 1.58 to 12.70 mg/dl), a lower serum concentration of HDL-C (MD: −2.45 95% CI −4.51 to −0.38 mg/dl) and increased risks of non-fatal cerebrovascular disease events (RR: 1.41, 95% CI 1.02 to 1.94) compared to women without PCOS. No differences were found for LDL-C (MD: 3.32 95% CI −4.11 to 10.75 mg/dl), TG (MD 18.53 95% CI −0.58 to 37.64 mg/dl) or coronary disease events (RR: 1.78, 95% CI 0.99 to 3.23). No meta-analyses could be performed for fatal CVD events due to the paucity of mortality data.

WIDER IMPLICATIONS

Women with PCOS are at increased risk of cardiometabolic disease. This review quantifies this risk, which is important for clinicians to inform patients and to take into account in the cardiovascular risk assessment of women with PCOS. Future clinical trials are needed to assess the ability of cardiometabolic screening and management in women with PCOS to reduce future CVD morbidity.

Assessment of Cardiovascular Risk Factors in Young Adults through the Nursing Diagnosis: A Cross-Sectional Study among International University Students

Four out of five deaths from cardiovascular disease are due to heart attacks and strokes in low- and middle-income countries. Early identification of risk factors in exposed individuals will help to develop interventions that may eliminate and/or reduce these risks and prevent the development of cardiovascular diseases. So, it is necessary to investigate the risk of impaired cardiovascular function in university students due to the increase in some risk factors and cardiovascular events in young adults, and to describe its epidemiology among international university students. For this, an observational cross-sectional study through interviews is designed. The clinical validity was addressed following the Fehring model. In addition, anthropometric data and results of laboratory tests were collected. The nursing diagnosis “Risk of impaired cardiovascular function” showed clinical validity, high sensitivity and specificity, as well as predictive values. Fehring ratio values were above 0.79 and Kappa Index above 0.72. The study showed a high frequency of this nursing diagnosis among university students, especially in students of Brazilian nationality. The main risks of impaired cardiovascular function found in 86.8% of students were: family history of cardiovascular disease, sedentary lifestyle, pharmacological agent, dyslipidemia, and insufficient knowledge. The most prevalent risk factors of the nursing diagnosis in the studied population were related to insufficient knowledge of modifiable health habits, such as sedentary lifestyle. The information provided is expected to serve as the basis for the planning and implementation of health actions aimed at reducing modifiable risk factors for cardiovascular disease.

Cardiometabolic and Thrombotic Risk Profile in Women Undergoing Oocyte Donation for Assisted Reproduction

Background: The last two decades have seen a growing number of pregnancies in women who needed the donation of oocytes. With oocyte donation pregnancies, studies on obstetric outcomes among these women revealed an increased incidence of pre-eclampsia and pregnancy-induced hypertension. Furthermore, several studies have found a higher incidence of low birth weight, preterm birth, and delivery by cesarean section in oocyte donation rather than in women subjected to assisted reproduction techniques (ART) with autologous oocytes. Numerous studies have also shown a deep connection between cardiovascular and thrombotic risk factors and adverse pregnancy outcomes. In this setting, to strictly assess the preconceptional risk for women who undergo egg donation to achieve pregnancy, the aim of our study is to draw a detailed assessment of the vascular risk profile of patients with gamete donation ART indications through the evaluation of comorbidities and cardiometabolic and thrombophilic markers Materials and Methods: Patients undergoing ART with oocyte or sperm donation or double donation of gametes underwent a careful clinical assessment through a detailed personal and family anamnesis and they were evaluated for cardiometabolic and thrombophilic profile. Clinical and demographic characteristics, comorbidities, and biohumoral parameters were collected. The study was approved by the Regional Ethical Committee(Em 2018-017 CINECA 10189). Results: We evaluated 525 women. Around 73.1% were >40 years and 35% of them were older than 45 years. There was a high prevalence of dyslipidemias (58.1%), smoking habit (24.6%), a body mass index >25 in 28.6% of patients, a high abdominal circumference in 58.1% of cases, a prevalence of acquired thrombophilia in about 7% and hereditary of 19.2%. Around 39.2% of patients had total cholesterol >200 mg/dL, 19.5% had high-density lipoprotein <48 mg/dL and 43.6% had low-density lipoprotein >115 mg/dL, and 6.9% had triglyceride values >150 mg/dL. Conclusions: A careful assessment of the preconceptional status of patients undergoing ART programs with oocyte donation can be highly recommended.

Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports on 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 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. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals.

RESULTS

Each of the 26 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, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Does Information on Blood Heavy Metals Improve Cardiovascular Mortality Prediction?

Background

To evaluate whether blood markers of lead, cadmium, and mercury can improve prediction for cardiovascular disease (CVD) mortality when added individually, jointly, or as an integrative index/Environmental Risk Score (ERS), in a model with established risk factors.

Methods and Results

Our study sample comprised 16 028 adults aged ≥40 years who were enrolled in the National Health and Nutrition Examination Survey 1999–2012 and followed up through December 31, 2015. The study sample was randomly split into training for the ERS construction (n=8043) and testing for the evaluation of prediction performance (n=7985). ERS was computed using elastic‐net penalized Cox's model based on the selected metal predictors predicting CVD mortality. During median follow‐up of 7.2 years, 517 died from CVD. In the training set, linear terms of cadmium and mercury, squared terms of lead and mercury, and all 3 pairwise interactions were selected by elastic‐net for ERS construction. In the testing set, the C‐statistic increased from 0.845 when only established CVD risk factors were in the model to 0.854 when the ERS was additionally added to the model. Addition of all linear, squared, and pairwise interaction terms of blood metals to the Cox's models improved C‐statistic from 0.845 to 0.857. The improvement remained significant when it was assessed by net reclassification improvement and integrated discrimination improvement.

Conclusions

Our findings suggest that blood markers of toxic metals can improve CVD risk prediction over the established risk factors and highlight their potential utility for CVD risk assessment, prevention, and precision health.

Eligibility for cardiovascular risk screening among different ethnic groups: The HELIUS study

BACKGROUND

Ethnic differences in the age-of-onset of cardiovascular risk factors may necessitate ethnic-specific age thresholds to initiate cardiovascular risk screening. Recent European recommendations to modify cardiovascular risk estimates among certain ethnic groups may further increase this necessity.

AIMS

To determine ethnic differences in the age to initiate cardiovascular risk screening, with and without implementation of ethnic-specific modification of estimated cardiovascular risk.

METHODS

We included 18,031 participants of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan background from the HELIUS study (Amsterdam). Eligibility for cardiovascular risk screening was defined as being eligible for blood pressure-lowering treatment, based on a combination of systolic blood pressure, estimated cardiovascular risk, and ethnic-specific conversion of estimated cardiovascular risk as recommended by European cardiovascular disease prevention guidelines. Age-specific proportions of eligibility were determined and compared between ethnic groups via logistic regression analyses.

RESULTS

Dutch men reached the specified threshold to initiate cardiovascular risk screening (according to Dutch guidelines) at an average age of 51.5 years. Among ethnic minority men, this age ranged from 39.8 to 52.4. Among Dutch women, the average age threshold was 53.4. Among ethnic minority women, this age ranged from 36.8 to 49.1. Age-adjusted odds of eligibility were significantly higher than in the Dutch among all subgroups, except among Moroccan men. Applying ethnic-specific conversion factors had minimal effect on the age to initiate screening in all subgroups.

CONCLUSIONS

Most ethnic minority groups become eligible for blood pressure-lowering treatment at a lower age and may therefore benefit from lower age-thresholds to initiate cardiovascular risk screening.