Cardiovascular risk of smoking and benefits of smoking cessation

Influence of smoking on glycaemic control in individuals with type 1 diabetes using flash glucose monitoring and its mediating role in the relationship between socioeconomic status and glycaemic control

Objective

This study examined the influence of smoking on glycaemic control in individuals with type 1 diabetes (T1D) using flash continuous glucose monitoring (F-CGM) systems, as well as its potential mediating role in the relationship between socioeconomic status (SES) and glycaemic control.

Methods

This study included 378 subjects with T1D (18% smokers). Glucose metrics cloud downloads were obtained over a period of 14 days. Mean annual net income per person based on census tract data was used as a proxy for SES. Mediation analysis was performed using four-way effect decomposition procedures.

Results

Smokers exhibited significantly lower net income than non-smokers (p < 0.001). Compared to smokers, non-smokers showed better glycaemic control characterized as higher time in range (TIR) 70-180 mg/dL (p = 0.002) and lower glycosylated haemoglobin levels (p = 0.008). Mediation analysis revealed a significant mediating role of smoking in the relationship between SES and glycaemic control (TIR).

Conclusions

Our data suggest that smoking exerts a detrimental effect on glycaemic control in individuals with T1D using F-CGM systems. In addition, tobacco use partially mediates the relationship between SES and glycaemic control. Thus, adopting smoking cessation measures could lead to improved glycaemic control and help mitigate the impact of social inequalities on T1D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01535-y.

Exposure to Bupropion-SR vs. Placebo is associated with reductions in smoking among persons receiving methadone with no stated interest in smoking cessation

Smoking is prevalent among individuals receiving methadone treatment. Reducing smoking among this population is needed as smoking is a leading cause of morbidity and preventable death. Smoking cessation interventions for persons receiving medication for opioid use disorder have yielded small changes in abstinence. Bupropion-SR was developed as an anti-depressant medication and is a first-line medication for smoking cessation. There is limited research on the effectiveness of bupropion-SR on smoking cessation among individuals receiving medication for opioid use disorder. This study is a secondary analysis of N = 72 adults enrolled in methadone treatment who endorsed smoking cigarettes. Participants were randomized to receive bupropion-SR 150 mg twice-daily (n = 35) or placebo (n = 37) in the primary study that examined bupropion-SR on cocaine use outcomes over a 30-weeks. Mixed model analyses examined secondary changes in self-reported cigarettes smoked, a self-reported measure of nicotine dependence, and quantitative urinary cotinine values. The longitudinal analysis of self-reported daily cigarettes identified no main effects of group and week however a significant interaction between group and week revealed that persons receiving bupropion-SR group reported less smoking early in the intervention. Longitudinal evaluation of changes in urinary cotinine revealed a significant main effect of week but no main effect of group or group x week interaction. Data suggest that bupropion-SR significantly decreased the number of self-reported cigarettes smoked relative to placebo and reduced nicotine dependence severity by the end of the study. Follow-up studies are needed as these decreases were not identified throughout the full study period or at termination.

Housing hardship and health: Longitudinal evidence of the mediating role of health behaviors

Housing instability is widely recognized as a major environmental factor that significantly shapes both health and overall well-being. This study added to the existing literature by examining the longitudinal relationship between housing-related hardship and self-rated health. Moreover, this study explored health behaviors-specifically substance use and lifestyle behaviors-as potential mediators that link housing hardship to health. Using data from Waves I, III, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study estimated regression models with lagged dependent variables (LDVs) and conducted Sobel tests to formally assess mediation. In the LDV model, housing hardship in Wave III is longitudinally associated with lower self-rated health in Wave V. This relationship remained significant (p = 0.012), though it was substantially attenuated after adjusting for a comprehensive set of confounders, including personal earnings and educational attainment. Smoking emerged as the most significant mediator, accounting for approximately 26% (p < 0.001) of the association, while unhealthy eating behaviors and marijuana use explained 13% (p < 0.001) and 8% (p = 0.008), respectively. Binge drinking and physical activity did not significantly mediate the association. Collectively, the proposed mediating variables explained 34% (p < 0.001) of the association between housing hardship and self-rated health. These findings highlight the importance of tackling both the material aspects of housing hardship and the unhealthy coping mechanisms it fosters to more effectively improve the well-being of individuals experiencing housing instability.

Associations Between Frailty and Risk of All-Cause and Cardiovascular Mortality in Patients with Prediabetes: A Population-Based Study

Objective

Diabetes is a well-known risk factor for frailty that has been associated with adverse prognosis. However, the association of frailty with all-cause and cardiovascular disease (CVD) mortality in patients with prediabetes has not been thoroughly explored.

Methods

Participants with prediabetes were derived from the 1999-2018 National Health and Nutrition Examination Survey and followed up for all-cause and CVD mortality until December 31, 2019. A frailty index calculated using a 49-item deficit accumulation model > 0.21 was used to indicate the presence of frailty. Kaplan-Meier curves and weighted Cox proportional hazards regression were used to assess the association between frailty and mortality.

Results

The weighted prevalence of frailty was 28.21% in this cohort of 7845 prediabetic participants with a mean age of 62.89 years. During a median follow-up time of 90 months, a total of 1983 all-cause (636 CVD-related) deaths occurred. Each 0.01 score increase in the frailty index was associated with a 5% and 6% increased risk of all-cause and CVD-related mortality, respectively. The hazard ratio and 95% confidence interval for all-cause and CVD mortality in the frailty group were 2.28 (1.89-2.76) and 2.84 (2.01-4.02), respectively, compared with those without frailty. Restricted cubic spline analysis showed a linear association between frailty index and all-cause or CVD mortality. Similar results were observed in the sensitivity analyses.

Conclusion

The frailty index was positively associated with all-cause and CVD mortality in participants with prediabetes, highlighting that appropriate screening and management of frailty may help reduce mortality in patients with prediabetes.

Sex-specific associations of cigarettes and e-cigarettes use with self-reported premature atherosclerotic cardiovascular disease among adults aged 18-54 in the United States

BACKGROUND

Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences.

METHODS

Using pooled data from 480,317 adults (ages 18-54; ∼50 % female) from the 2020-2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex.

RESULTS

After controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47-1.94]) and current dual (2.03 [1.69-2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females.

CONCLUSION

Both sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD.

Potential preservative mechanisms of cardiac rehabilitation pathways on endothelial function in coronary heart disease

Cardiac rehabilitation, a comprehensive exercise-based lifestyle and medical management, is effective in decreasing morbidity and improving life quality in patients with coronary heart disease. Endothelial function, an irreplaceable indicator in coronary heart disease progression, is measured by various methods in traditional cardiac rehabilitation pathways, including medicinal treatment, aerobic training, and smoking cessation. Nevertheless, studies on the effect of some emerging cardiac rehabilitation programs on endothelial function are limited. This article briefly reviewed the endothelium-beneficial effects of different cardiac rehabilitation pathways, including exercise training, lifestyle modification and psychological intervention in patients with coronary heart disease, and related experimental models, and summarized both uncovered and potential cellular and molecular mechanisms of the beneficial roles of various cardiac rehabilitation pathways on endothelial function. In exercise training and some lifestyle interventions, the enhanced bioavailability of nitric oxide, increased circulating endothelial progenitor cells (EPCs), and decreased oxidative stress are major contributors to preventing endothelial dysfunction in coronary heart disease. Moreover, the preservation of endothelial-dependent hyperpolarizing factors and inflammatory suppression play roles. On the one hand, to develop more endothelium-protective rehabilitation methods in coronary heart disease, adequately designed and sized randomized multicenter clinical trials should be advanced using standardized cardiac rehabilitation programs and existing assessment methods. On the other hand, additional studies using suitable experimental models are warranted to elucidate the relationship between some new interventions and endothelial protection in both macro- and microvasculature.

Current status of modifiable risk factors for cardiovascular disease in Korean women

Hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking are the primary modifiable risk factors contributing to the increasing morbidity and mortality rates from cardiovascular disease (CVD) among Korean women. Significant sex-related differences exist in the prevalence, awareness, treatment, and control of these risk factors, highlighting the importance of age- and sex-specific approaches to the management and prevention of CVD. Notably, the prevalence of hypertension and diabetes mellitus increases with age, with a higher prevalence in elderly women compared to men. Dyslipidemia and obesity are also trending upward, particularly in postmenopausal women, highlighting the impact of menopause on cardiovascular risk. The present review advocates for improved diagnostic, therapeutic, and educational efforts to mitigate the risk of CVD among Korean women, with the goals of reducing the overall burden of the disease and promoting better cardiovascular health outcomes.

Correlation of serum cotinine with fatty liver index in adults: data from the NHANES March 2017 and 2018

BACKGROUND

The correlation between serum cotinine and fatty liver index (FLI) needs further investigation for the early identification, prevention, and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

Data from the NHANES database spanning from March 2017 to 2018 was used to perform the population-based study to assess the relationship between serum cotinine and FLI. A variance estimation strategy was applied to address the data volatility. To examine the correlation between serum cotinine and FLI, a weighted multivariate logistic regression model was used. Initial normality assessment through the Kolmogorov-Smirnov test indicated non-normal distribution. Median and interquartile range were employed for description of non-normally distributed measurement data, and group comparisons were made using the Kruskal-Wallis H test. Proportions were used for ordinal data description and comparisons, with the chi-square test used for categorical data. Smooth curve fittings and generalized additive models were used to explore the non-linear relationship between serum cotinine and FLI.

RESULTS

Finally, 2350 subjects (mean age: 49.83 ± 18.30, 1135 males and 1215 females) were selected for analysis. After adjusting for confounders, serum cotinine showed positive correlation with FLI in adults (β = 0.009, 95% CI: 0.003 to 0.014, P = 0.001). Additionally, individuals in the unexposed and passively exposed groups had lower FLI compared to those in the actively exposed group (β = -3.041, 95% CI: -4.728 to -1.353, P < 0.001; β = -2.159, 95% CI: -4.231 to -0.087, P = 0.041; respectively). Subgroup analyses by gender revealed positive associations between serum cotinine and FLI in both males (β = 0.007, 95% CI: 0.000 to 0.014, P = 0.048) and females (β = 0.012, 95% CI: 0.003 to 0.021, P = 0.007). Additionally, a positive correlation was found in "other races" subgroup (β = 0.017, 95% CI: 0.004 to 0.029, P = 0.008) rather than the subgroups of "Mexican American, Other Hispanic, Non-Hispanic White, and Non-Hispanic Black". The relationship between serum cotinine and FLI exhibited an inverted U-shaped curve with the turning point occurring at 521 ng/mL.

CONCLUSION

This study of a nationally representative sample demonstrates a positive association between serum cotinine and FLI, characterized by an inverted U-shaped curve. Both active and passive smoking emerge as a risk factor for the development and progression of MASLD. Smoking cessation is recommended to manage MASLD and support liver and cardiovascular health.

The Role of Behavioral Factors on Chronic Diseases-Practice and Knowledge Gaps

Background: Behavioral factors, such as smoking, alcohol consumption, stress, poor diet, and physical inactivity, but also sleep deprivation and negative social connections, play a critical role in the development and progression of major chronic diseases. These include cardiovascular diseases, diabetes, chronic respiratory conditions, and cancers. Methods: The objective of this review is to explore the influence of these modifiable risk factors on the global burden of chronic diseases and assess the potential impact of public health interventions and policy changes. Results: The evidence highlights a significant association between behavioral risk factors and increased morbidity and mortality from chronic diseases. Public health interventions and policy changes targeting these modifiable behaviors have shown substantial potential in reducing the prevalence and impact of chronic conditions. Strategies such as smoking cessation programs, dietary improvements, physical activity promotion, and stress reduction are critical in mitigating these risks. Conclusions: Addressing modifiable behavioral factors is essential for the prevention and control of chronic diseases. Bridging the gap between current knowledge and effective implementation of interventions is crucial for improving population health outcomes. Public health strategies focused on modifying key behavioral risks can significantly reduce the burden of chronic diseases, thereby improving overall health and reducing healthcare costs.

Smoking-Associated Changes in Gene Expression in Coronary Artery Disease Patients Using Matched Samples

Smoking is a well known risk factor for coronary artery disease (CAD). However, the effects of smoking on gene expression in the blood of CAD subjects in Hungary have not been extensively studied. This study aimed to identify differentially expressed genes (DEGs) associated with smoking in CAD subjects. Eleven matched samples based on age and gender were selected for analysis in this study. All subjects were non-obese, non-alcoholic, non-diabetic, and non-hypertensive and had moderate to severe stenosis of one or more coronary arteries, confirmed by coronary angiography. Whole blood samples were collected using PAXgene tubes. Next-generation sequencing was employed using the NextSeq 500 system to generate high-throughput sequencing data for transcriptome profiling. The differentially expressed genes were analyzed using the R programming language. Results: The study revealed that smokers exhibited non-significant higher levels of total cholesterol, low-density lipoprotein-cholesterol, and triglycerides compared to non-smokers (p > 0.05), although high-density lipoprotein-cholesterol was also elevated. Despite this, the overall lipid profile of smokers remained less favorable. Non-smokers had a higher BMI (p = 0.02). Differential gene expression analysis identified 58 DEGs, with 38 upregulated in smokers. The key upregulated genes included LILRB5 (log2FC = 2.88, p = 1.05 × 10-5) and RELN (log2FC = 3.31, p = 0.024), while RNF5_2 (log2FC = -5.29, p = 0.028) and IGHV7-4-1_1 (log2FC = -2.86, p = 0.020) were notably downregulated. Heatmap analysis showed a distinct clustering of gene expression profiles between smokers and non-smokers. However, GO analysis did not identify significant biological pathways associated with the DEGs. Conclusions: This research illuminates smoking's biological effects, aiding personalized medicine for predicting and treating smoking-related diseases.

Relationship Between Blood Groups and Cardiovascular Diseases: Insights From an Algerian Inpatient Study

INTRODUCTION

 Research on the association between blood groups and cardiovascular diseases (CVDs) in Africa, including Algeria, is notably limited, with a primary focus on blood donors. This narrow scope hinders a comprehensive understanding of the genetic diversity of blood groups and their potential links to CVD risk within the African context. To bridge this knowledge gap, this study proposes to investigate the distribution of blood group genotypes and their association with CVD prevalence, aiming to enhance knowledge within the African context and contribute to global insights into the relationship between blood groups and CVD.

METHODS

 This retrospective study was conducted within the Cardiology A2 Department of Mustapha Bacha University Hospital (CHU) in Algiers, Algeria. The inclusion criteria comprised patients aged 18 years or older with confirmed diagnoses of CVDs. Conversely, patients without confirmed diagnoses or documented blood groups were excluded from the study. Data collection encompassed key cardiovascular risk factors, and blood groups were determined using standard serological testing methods. Statistical analyses were performed utilizing R and Jamovi software, with a predefined significance threshold of p < 0.05.

RESULTS

 Our analysis of a 2,780-patient cohort (61.7% male, mean age: 62.53 ± 13.06 years) revealed a predominance of blood type O (42.84%), followed by A (32.27%), B (16.19%), and AB (8.71%), with 93.42% of the cohort being Rhesus (Rh)-positive. The calculated ABO allele frequencies were 0.2315 (A), 0.1319 (B), and 0.6532 (O), indicating a significant deviation from Hardy-Weinberg equilibrium (HWE) (χ² = 47.88, p < 0.05), whereas the Rh distribution remained in equilibrium. Hypertension (94.50%), dyslipidemia (94.03%), and diabetes (79.57%) were the most prevalent cardiovascular risk factors. Acute coronary syndrome (ACS) was the leading diagnosis (39.75%), and notably, no significant associations were observed between blood groups and cardiovascular conditions or risk factors, except for a marginally higher prevalence of arrhythmia among Rh-negative (Rh-) individuals (9.29% vs. 5.81%).

CONCLUSION

 This study provides novel insights into the distribution of ABO and Rh blood types among Algerian patients with CVD, highlighting a prevalence of Group O and Rh-positive (Rh+) individuals, though without significant associations between blood groups and major cardiovascular risk factors. Contrary to previous findings suggesting elevated cardiovascular risk in non-O blood groups, our results did not establish significant associations between blood groups and cardiovascular conditions or risk factors. The high prevalence of ACS, hypertension (particularly among older males), dyslipidemia, and smoking underscore the urgent need for targeted preventive strategies and further research to elucidate the complex interplay between blood types, genetic factors, and CVD in this population. These findings emphasize the necessity for addressing modifiable risk factors through education and preventive measures to improve cardiovascular outcomes.

Causes of death and trends in mortality from the year 2000 to 2017 in patients with acute myocardial infarction

OBJECTIVE

To investigate the most common causes of death and trends in cause-specific long-term mortality in patients hospitalized for acute myocardial infarction (AMI).

METHODS

This analysis was based on 10,718 patients, aged 25-74 years, recorded by the population-based Myocardial Infarction Registry Augsburg between 2000 and 2017. All hospitalized cases of AMI occurring in the study region during this period were included. If a patient died during follow-up (median: 6.6 years, IQR: 2.8-11.2) the death certificate was obtained and coded using the ICD-10 to determine the main cause of death. Cause-specific mortality was calculated for three 6-year periods. Multivariable adjusted Cox regression models stratified by time interval were calculated.

RESULTS

The most common cause of death was cardiovascular disease (CVD), more precisely ischemic-heart disease (IHD), followed by cancer. The proportions of CVD deaths and IHD deaths were stable over time. An increasing trend was observed in cancer mortality in post-AMI patients. In male patients, the hazard ratio for cancer mortality was 44.4% higher in 2012-2017 compared to 2000-2005, in female patients, it was more than twice as high in 2006-2012 compared to 2000-2005.

CONCLUSION

This study revealed consistent CVD and IHD long-term mortality and increasing trends in long-term cancer mortality in patients post-AMI. Thus, post-AMI patients should emphasize tertiary prevention of CVD by minimizing risk factors. Furthermore, patients should regularly undergo cancer screening programs. The reasons for the unfavorable development in terms of increasing cancer mortality should be investigated in further studies.

COPD is associated with increased cardiovascular disease risk independent of phenotype

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide that frequently presents with concomitant cardiovascular diseases. Despite the pathological distinction between individual COPD phenotypes such as emphysema and chronic bronchitis, there is a lack of knowledge about the impact of COPD phenotype on cardiovascular disease risk. Thus, this study aimed to utilize a nationally representative sample to investigate cardiovascular disease prevalence in patients with COPD with emphysema and chronic bronchitis phenotypes.

METHODS

Data from 31,560 adults including 2504 individuals with COPD, collected as part of the National Health and Nutrition Examination Survey (1999-2018), were examined.

RESULTS

A significantly increased cardiovascular disease risk, including coronary heart disease, heart failure, myocardial infarction and stroke, was identified in patients with COPD among all disease phenotypes. Particularly, compared to those without COPD, individuals with chronic bronchitis presented with 1.76 (95% CI: 1.41-2.20) times greater odds, individuals with emphysema with 2.31 (95% CI: 1.80-2.96) times greater odds, while those with a concurrent phenotype (combined chronic bronchitis and emphysema) exhibited 2.98 (95% CI: 2.11-4.21) times greater odds of reporting cardiovascular diseases.

CONCLUSION

Our data confirms that patients with COPD present an elevated risk of developing cardiovascular disease among all phenotypes, with the most marked increase being in those with concurrent chronic bronchitis and emphysema phenotypes. These findings emphasize the need for awareness and appropriate cardiovascular screening in COPD.

Prevalence of Elevated Blood Triglycerides and Associated Risk Factors: Findings from a Nationwide Health Screening in Mongolia

BACKGROUND

This study aims to assess the demographic, lifestyle, and clinical characteristics associated with varying levels of triglycerides (TGs) in a large population sample.

METHODS

This cross-sectional study utilized data from a nationwide health screening program in Mongolia. A total of 125,330 participants (mean age: 43.8 ± 15.3 years) were included. TG levels were categorized into normal, borderline high, high, and very high. Due to the small number of participants in the very high TG group, they were combined with the high TG category for analysis. Multivariate logistic regression was performed to identify independent predictors of elevated TG levels.

RESULTS

The majority of participants (80.3%) had normal TG levels, while 10.3% had borderline high, 8.7% had high, and 0.7% had very high TG levels. Significant predictors of elevated TG levels included age (OR 1.013, 95% CI 1.012-1.014), male (OR 2.328, 95% CI 2.251-2.408), obesity (OR 1.920, 95% CI 1.855-1.987), central obesity (OR 1.866, 95% CI 1.801-1.933), smoking (OR 1.399, 95% CI 1.347-1.453), alcohol use (OR 1.233, 95% CI 1.176-1.292), and non-regular exercise (OR 1.144, 95% CI 1.118-1.171). Sex-specific analysis revealed that elevated TG levels were more prevalent among males, regardless of other risk factors such as obesity and smoking.

CONCLUSIONS

Male sex, obesity, and smoking were the strongest predictors of elevated TG levels.

Qualitative exploration of awareness about risk factors and transformative behaviours among Pakistani patients with coronary artery disease

OBJECTIVES

To explore patients' awareness of risk factors for coronary artery disease (CAD) and experiences of the behavioural modifications, they made during their recovery through in-depth semistructured interviews.

DESIGN

Qualitative exploration was undertaken as part of a larger project to answer the study questions.

SETTING

Participants were recruited from a public-sector tertiary care hospital in Lahore Pakistan.

PARTICIPANTS

A total of 20 participants, men and women, who had more than 6 months of experience living with CAD, were recruited using a purposive sampling technique.

RESULTS

The data were organised and analysed using NVIVO software. An inductive coding approach was used to generate codes, categories and themes. Three themes emerged from participants' data: lifestyle choices and behavioural factors, reflective awareness and lifestyle changes, holistic perspectives and health management.

CONCLUSIONS

The present study's findings align with recent literature, emphasising the complex nature of risk factors contributing to heart disease. The participants' understanding and behavioural changes show the importance of health awareness and preventive measures in reducing cardiovascular risks.

Effect of fruit and mint flavored Rogue® oral nicotine product use on smoking reduction and quitting in a 6-Month prospective cohort of adults who smoke cigarettes

BACKGROUND

Quitting cigarette smoking can substantially reduce or eliminate the risk of developing numerous chronic diseases. Use of flavored tobacco or nicotine products is commonly cited by adults who smoke cigarettes to be important in helping them reduce or quit smoking. The purpose of this analysis was to understand the association between the levels of use of flavored oral nicotine products and smoking reduction and quitting and how reduction or quitting may differ between predominant users of fruit/other versus mint flavored oral nicotine products after six months of use.

METHODS

Participants were provided with their choice of a variety of forms and flavors of Rogue® nicotine products (Study Products) over a 6-month actual use period and completed online surveys assessing tobacco, nicotine and Study Product use at Baseline and Months 1, 2, 4, and 6 thereafter.

RESULTS

Among the 1393 participants at Month 6, 41.4% and 52.5% used predominantly fruit/other or mint Study Product flavors, respectively. Compared to predominant mint users, predominant fruit/other users had greater cigarette reduction (mean reduction: 50.0% vs. 48.4%) and a higher proportion had quit smoking (proportion quit: 15.4% vs. 11.6%) at Month 6. Additionally, 38.8% of predominant fruit/other users and 39.3% of predominant mint users reduced their cigarette consumption by ≥ 50% from Baseline. Increased use of fruit/other flavors was independently associated with smoking reduction (8.6% greater reduction per 10 pieces/day; p < 0.001) and odds of quitting smoking (OR = 1.29 [95% CI: 1.04-1.59] per 10 pieces/day; p = 0.017). Increased use of mint flavors was independently associated with smoking reduction (7.5% greater reduction per 10 mint pieces/day; p < 0.001) but not with odds of quitting smoking.

CONCLUSIONS

Increased use of either fruit/other or mint flavored Study Products at Month 6 was associated with significantly increased smoking reduction, whereas only increased use of fruit/other flavors was associated with greater odds of quitting smoking among participants in the study.

TRIAL REGISTRATION

This study was observational. Participants were not prospectively assigned to one or more health-related interventions and could choose to use or not use the commercially available study products provided during the study. Thus, the study was not registered in a trial database by the Sponsor.

Resistin concentrations in perivascular adipose tissue as a highly sensitive marker of smoking status in patients with advanced coronary artery disease requiring coronary artery bypass grafting

Background

Smoking is a significant risk factor for numerous diseases, including coronary artery disease (CAD). Chronic inflammation from smoking affects endothelial function and may alter adipokine secretion, particularly resistin, in perivascular adipose tissue (PVAT). This study investigated the association between resistin concentrations in PVAT and smoking status in CAD patients undergoing coronary artery bypass grafting (CABG).

Methods

The study included 110 patients with advanced CAD scheduled for CABG. Patients were categorized into never-smokers and ever-smokers, with the latter further divided into current and past smokers. Resistin concentrations in PVAT and plasma, along with plasma interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) concentrations, were measured using ELISA.

Result

Significant differences in PVAT resistin concentrations were observed between never-smokers and ever-smokers (p < 0.0001), as well as between never-smokers and both current (p < 0.0001) and past smokers (p < 0.0001). PVAT resistin concentrations correlated positively with the number of pack-years (p < 0.0001) and plasma resistin (p < 0.0001) and IL-6 concentrations (p < 0.0001). Plasma resistin, IL-6, and hs-CRP concentrations were higher in ever-smokers compared with never-smokers. Multiple regression analysis indicated that smoking is significantly correlated with higher PVAT resistin concentrations, with increased pack-years (p = 0.0002), higher plasma resistin concentrations (p < 0.0001), and IL-6 concentrations (p < 0.0001), all contributing to elevated PVAT resistin.

Conclusion

Smoking status in advanced CAD patients requiring CABG is positively associated with PVAT resistin concentrations, with a clear demonstration of dose-dependency.

Smoking and outcomes in candidates for liver transplantation: Analysis of the Pulmonary Vascular Complications of Liver Disease 2 (PVCLD2)

Patients with chronic liver disease commonly have abnormal lung function; however, the impact of smoking on outcomes in these patients is unknown. We hypothesized current or past smoking would be associated with worse survival in patients with advanced liver disease. The Pulmonary Vascular Complications in Liver Disease Study 2 (PVCLD2) was a prospective cohort of patients with advanced liver disease undergoing evaluation for liver transplantation (LT). Patients were classified by self-report as a "non-smoker," "past smoker," or "current smoker." We used Cox proportional hazards models and Fine-Gray models with LT as a competing risk. Models were adjusted for age, sex, body mass index, race, family income, liver disease etiology, and Model for End-Stage Liver Disease-Sodium score. Of the 410 patients included, most (65%) were male and the mean age at enrollment was 56.5 years. One hundred sixty (39%) patients were nonsmokers, 183 (45%) were past smokers, and 67 (16%) were current smokers. In total, 151 (37%) patients received an LT, and 88 (20%) patients died. When compared to nonsmokers, current smokers had a 2.17-fold increase in risk of death overall (95% CI: 1.12-4.18, p = 0.02). There was a 7% increase in overall risk of death for every 5 pack-years increase (95% CI: 1.01-1.13, p = 0.02). With LT as a competing risk, the subdistributional HR of current smokers versus nonsmokers for death was 2.45 (95% CI: 1.31-4.60, p = 0.005). In this model, past smokers displayed a nonsignificant increase in the risk of death compared to nonsmokers (subdistributional HR: 1.58, 95% CI: 0.91-2.72, p = 0.10). Patients with advanced liver disease undergoing evaluation for LT who smoke have an increased risk of death. Smoking cessation could lead to improved overall survival with or without LT.

Disparities in Exposure to Pro-Tobacco and anti-Tobacco Advertisements in the United States

OBJECTIVES

This study investigates the prevalence of exposure to pro- and anti-tobacco advertisements across different sociodemographic groups and sources of exposure in the United States.

METHODS

The study included 6252 participants from the Health Information National Trends Survey. Binary logistic regression was used to examine associations between exposure to pro and anti-tobacco advertisements, the sources of exposure, and demographic factors.

RESULTS

10% of our sample were current smokers. A rate of 48.14% reported exposure to pro-tobacco ads, and 61.28% reported exposure to anti-tobacco ads. Findings reveal notable disparities in exposure to both pro and anti-tobacco advertisements. Exposure to pro-tobacco ads was more common among current smokers (OR = 0.53 (95% CI 0.44-0.64), p < 0.001), male participants (female: OR = 0.85 (95% CI 0.77-0.95), p = 0.003), and younger adults. Reported exposure to anti-tobacco ads was more common among younger adults, individuals with lower levels of education and income, and current smokers. Radio, TV, and billboards were among the most common sources of ad exposure for both types. Stores were among the most common sources of exposure to pro-tobacco ads (stores: 35.58% (18-34), 39.58% (35-49), and online sources (21.71%) were among the sources where people encountered anti-tobacco messages most frequently.

CONCLUSIONS

The findings underscore the importance of understanding the changing media consumption patterns and advertising awareness across various demographic groups. They also highlight the urgent need for targeted tobacco prevention interventions, especially via Radio, TV, billboards, and stores, particularly among younger adults, racial minorities, and current smokers who show higher exposure to pro-tobacco ads.

Differential effects of cigarette smoking on cardiovascular disease in females: A narrative review and call to action

OBJECTIVE

Cigarette smoking continues to be a major driver in the incidence and progression of cardiovascular disease (CVD). As females become an increasingly larger fraction of those who smoke it is imperative that the sex-specific effects of smoking be further explored and acted upon.

METHODS

This narrative review describes current evidence on the differential effects of smoking on CVD in females and the need to improve treatment.

RESULTS

Evidence to date suggests that smoking has disproportionately negative effects on the cardiovascular (CV) system in females, especially in those who are younger. Usually, the onset of CVD is later in females than males, but smoking decreases or eliminates this gap. Females are also more likely to develop types of CVD closely tied to smoking, such as ST-elevated myocardial infarctions, with even higher rates among those who are younger. Possible mechanisms for these worse outcomes in females include a complex interplay between nicotine, other products of combusted cigarettes, and hormones. Sex differences also exist in treatment for smoking. In females, Varenicline appears more effective than either Bupropion or nicotine replacement therapy while in males, all three therapies show similar efficacy. Disparities in smoking are also apparent in secondary prevention settings. Females and males are entering secondary prevention with equal rates of smoking, with potentially higher levels of exposure to the byproducts of smoking in females.

CONCLUSIONS

These disproportionately negative outcomes for females who smoke require additional research and these persisting rates of smoking suggest a need for female-specific approaches for treating smoking.

Pre-pregnancy substance use and first trimester cardiovascular health among nulliparous pregnant people: The nuMoM2b Study

BACKGROUND

Suboptimal pre-pregnancy health, including substance use and cardiovascular risk factors, is associated with higher risks of maternal-foetal morbidity and mortality.

OBJECTIVE

To determine if pre-pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). It is hypothesised that pre-pregnancy use of substances is associated with worse CVH in the first trimester of pregnancy.

METHODS

This is a secondary analysis from the 2010-2015 United States nuMoM2b cohort (n = 9895). Pre-pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through questionnaires. Latent class analysis categorised participants based on their 3-month pre-pregnancy or ever(*) substance use: (1) Illicit substances*, marijuana*, and alcohol use (n = 1234); (2) marijuana* and alcohol use (n = 2066); (3) tobacco and alcohol use (n = 636); and (4) alcohol only use (n = 3194). The referent group reported no pre-pregnancy substance use (n = 2765). First trimester CVH score from 0 (least healthy) to 100 (most healthy) was calculated using a modified American Heart Association Life's Essential 8 framework and included body mass index (BMI), blood pressure, blood glucose, non-HDL cholesterol, diet, sleep, and physical activity. Multiple linear regression evaluated the relationship between pre-pregnancy substance use classes and CVH scores.

RESULTS

CVH score varied by class: No substance use (mean: 65, SD: ±1.3), illicit substances*, marijuana*, and alcohol use (68 ± 1.3), marijuana* and alcohol use (67 ± 1.3), tobacco and alcohol use (62 ± 1.4), and alcohol only use (67 ± 1.3). In adjusted models, those who used tobacco and alcohol compared to the no substance use class had a lower CVH score (-2.82); other classes had scores ranging from 1.81 to 2.44 points higher than the no substance use class. Individual CVH component scores followed similar patterns.

CONCLUSIONS

All groups, but most markedly those who used tobacco and alcohol prior to pregnancy, began pregnancy with only moderate CVH and may benefit from CVH promotion efforts along with substance use treatment.

Risk management of patients with multiple CVDs: what are the best practices?

INTRODUCTION

Managing patients with multiple risk factors for CVDs can present distinct challenges for healthcare providers, therefore addressing them can be paramount to optimize patient care.

AREAS COVERED

This narrative review explores the burden that CVDs place on healthcare systems as well as how we can best optimize the risk management of these patients. Through a comprehensive review of literature, guidelines and clinical studies, this paper explores various approaches to risk management, lifestyle modifications and pharmacological interventions utilized in the management of CVDs. Furthermore, emerging technologies such as machine learning (ML) are discussed, highlighting potential opportunities for future research. By reviewing existing recommendations and evidence, this paper aims to provide insight into optimizing strategies and improving the outcomes for patients with multiple CVDs.

EXPERT OPINION

Optimizing risk factors can have a significant impact on patient outcomes, as such each patient should have a clear plan on how to manage these risk factors to minimize adverse healthcare results.

The Impact of Maternal Passive Tobacco Smoke on Neonatal Myocardiopathy in Mice

BACKGROUND

Tobacco smoke has a global impact, particularly on pregnant women and their newborns. An emerging body of research suggests that passive tobacco smoking is a significant contributor to congenital cardiovascular disorders (CVDs).

AIM OF THE STUDY

This study aimed to mimic the effects of passive tobacco smoke (PTS) on neonates exposed throughout the gestational period.

METHODS

Female mice (DPC = 0) were exposed to PTS; 24 cigarettes/day with an interval of 10 min between each cigarette in a specialized smoke chamber from conception to birth. Histopathological analysis was employed to evaluate PTS-induced cardiac damage in neonates.

RESULTS

The results revealed significant alterations in cell structure, namely, widened interstitial spaces, hemorrhage, pyknotic nuclei, inflammatory cell infiltration, collagen deposition, and fibrosis.

CONCLUSION

Maternal exposure to PTS during pregnancy may lead to neonatal myocardiopathy.

The Role of Global Longitudinal Strain in Predicting Left Ventricular Reverse Remodeling After Mitral Valve Replacement Surgery in Patients With Primary Mitral Regurgitation

OBJECTIVES

This study aimed to identify the utility of global longitudinal strain (GLS) as a reliable parameter that can accurately forecast left ventricle reverse remodeling (LVRR) in patients undergoing valve replacement surgery for severe chronic primary mitral regurgitation (MR), thereby aiding in assessing mortality and morbidity risk.

METHODS

This retrospective observational study involved severe primary MR patients who underwent valve replacement surgery between 2018 and 2023. Pre- and postsurgery echocardiography data were collected, with GLS measurements utilized to assess left ventricular function. Various echocardiography parameters, including MR severity and LV dimensions, were analyzed. Bivariate and multivariate analyses were performed to explore relationships between GLS and LVRR.

RESULTS

This study enrolled 103 patients (54.4% male; mean age 45.4 ± 13.6 years). Statistical analyses revealed GLS to be an independent predictor of LVRR, with a threshold of -16.25% showing 89% sensitivity and 50% specificity. Each 1% increase in GLS corresponded to a 1.14-fold (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.01-1.31; p < 0.05) increased likelihood of LVRR.

CONCLUSION

These findings highlight GLS's potential as a prognostic marker for postsurgical outcomes in severe MR patients.

The Relationship Between Periodontitis, Gingivitis, Smoking, Missing Teeth, Endodontic Infections, Aortic Aneurysm, and Coronary Artery Disease: The 10-Year Results of 25 Patients

Background Emerging research suggests a correlation between poor oral health and cardiovascular diseases (CVDs), with inflammation being a central mechanism. Periodontitis and gingivitis are chronic inflammatory diseases that can lead to systemic health issues if untreated. It has been indicated previously that endodontic infections and missing teeth may contribute to elevated cardiovascular risk, and smoking exacerbates both periodontal and cardiovascular conditions. This study expands upon existing research by examining both periodontal and endodontic health factors together and investigating smoking as a potentially amplifying factor. Poor periodontal health may contribute to systemic inflammation, which is a recognized risk factor for atherosclerosis and cardiovascular events. This study aims to evaluate these relationships over a decade, providing insights into the potential preventive impact of periodontal care on cardiovascular health. Materials and methods This 10-year retrospective study examines the complex relationships among periodontal health factors (including periodontitis, gingivitis, and missing teeth), endodontic infections, smoking, and cardiovascular conditions, specifically coronary artery disease (CAD) and aortic aneurysm. By analyzing data from 25 patients aged 45-75, the study aims to assess whether these oral health indicators correlate with increased cardiovascular risks. The study's methodology included comprehensive dental and cardiovascular evaluations for each patient, with baseline data collected at the study's inception and follow-ups over the next decade. Oral health assessments documented the severity of periodontal diseases and recorded the presence of endodontic infections. Cardiovascular evaluations were conducted to establish the incidence and progression of CAD and aortic aneurysm, while lifestyle factors, particularly smoking, were noted as significant contributors. This approach allowed for an in-depth exploration of the possible causal pathways linking oral health to cardiovascular outcomes.  Results Results demonstrated that severe periodontitis, high numbers of missing teeth, and the presence of endodontic infections were significantly associated with higher incidences of CAD and aortic aneurysm. Smoking, as expected, acted as a compounding factor, intensifying the risk of cardiovascular outcomes in patients with poor oral health. Interaction terms further highlighted how smoking combined with advanced periodontitis notably increased CAD risk. The findings align with the hypothesis that severe periodontal disease and endodontic infections contribute to cardiovascular risk, especially among smokers. These results indicate that periodontal disease may serve as a marker for systemic inflammation, which has far-reaching effects beyond oral health alone. Conclusion The 10-year study showed a strong association between periodontal disease, smoking, hypertension, periodontitis and CVDs. This study underscores the importance of maintaining good oral health and cessation of smoking to mitigate cardiovascular risk. The results advocate for a multidisciplinary approach to patient care, integrating dental health with broader cardiovascular risk management. Future research is recommended to confirm these findings in larger, more diverse cohorts and to explore further the underlying mechanisms connecting oral infections and systemic inflammation with cardiovascular health.

Hepatitis C Infection Is Not a Cardiovascular Risk Factor in Young Adults

Background: Cardiovascular diseases are one of the leading causes of hospitalization and death in Poland and around the world and are still an ongoing problem for modern medicine. Despite advances in diagnosis and treatment, both conservative and invasive, the prevention of cardiovascular disease directed at reducing risk factors remains a problem. The main classical risk factors for the development of cardiovascular disease in Poland include hypertension, lipid disorders, obesity, diabetes and smoking. A new non-classical risk factor is HCV infection. Most of the studies on the impact of HCV infection on cardiovascular disease involve elderly populations with long-term infections and advanced liver fibrosis. Methods: Hence, we set out to analyze the prevalence of risk factors and cardiovascular disease in a population of young adults under 45 years of age infected with HCV, according to gender, HCV genotype and the duration of infection. The study group consisted of 217 patients of both sexes aged 21 to 45 years (mean age 36 years). Results: No cardiovascular disease was found among the young adults infected with HCV in the study group. The most common risk factor was cigarette smoking, which affected 20.7% of the subjects, followed by hypertension (12%) and diabetes mellitus (5.5%); the prevalence was lower than in the general population. Most of the patients were characterized as overweight, with a mean BMI of 26.39 kg/m2. The mean values of other metabolic parameters-total cholesterol, LDL, HDL, uric acid and glucose-were within the population norm. The mean value of CRP was 1.43, which may indicate a moderate cardiovascular risk. Conclusions: Based on the conducted research, it was found that HCV infection in young individuals was not a risk factor for cardiovascular diseases, and the prevalence of risk factors was similar to that in the general population. The effect of HCV on the increase in C-reactive protein requires further study. The early detection of HCV infection and treatment can be considered as a prevention of cardiovascular disease.

Population-Level Distribution, Risk Factors, and Burden of Mortality and Disability-Adjusted Life Years Attributable to Major Noncommunicable Diseases in Western Europe (1990-2021): Ecological Analysis

Background

Cardiovascular diseases (CVDs) and neoplasms are leading causes of mortality worldwide.

Objective

This study aims to provide a comprehensive analysis of the mortality burden and disability-adjusted life years (DALYs) attributable to CVDs and neoplasms in Western Europe, investigate associated risk factors, and identify regional disparities. Additionally, the study evaluates the effectiveness of the Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) in promoting healthier lives in the region.

Methods

The study collected data on mortality and DALYs due to CVDs and cancers from 24 Western European countries using the Global Burden of Disease Study 2021. The analysis explored age, sex, and country-specific patterns, as well as risk factors contributing to these deaths. Additionally, the study examined time trends by calculating the annual percent change in mortality rates from 1990 to 2021 by region and cause.

Results

In 2021, CVDs and neoplasms accounted for 27.8% and 27.1% of total deaths in Western Europe, with age-standardized death rates of 106.8 and 125.8 per 100,000, respectively. The top two CVDs in this region were ischemic heart disease and stroke, with age-standardized death rates of 47.27 (95% uncertainty interval [UI] 50.42-41.45) and 27.06 (95% UI 29.17-23.00), respectively. Similarly, the top two neoplasms were lung cancer and colorectal cancer, with age-standardized death rates of 26.4 (95% UI 27.69-24.47) and 15.1 (95% UI 16.25-13.53), respectively. Between 1990 and 2021, CVD mortality rates decreased by 61.9%, while cancer rates decreased by 28.27%. Finland had the highest CVD burden (39.5%), and Monaco had the highest rate of cancer-related deaths (34.8%). Gender differences were observed, with males experiencing a higher burden of both CVDs and cancer. Older individuals were also more at risk. Smoking had a stronger impact on CVD mortality and DALYs in males, while a higher Human Development Index was associated with increased cancer deaths and DALYs in females.

Conclusions

The study findings highlight the substantial burden of NCDs, particularly CVDs and cancer, in Western Europe. This underscores the critical need for targeted interventions and effective implementation of the Action Plan for the Prevention and Control of NCDs to achieve the goal of ensuring healthy lives for all.

Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications

BACKGROUND

The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD).

AIM

To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVDA); (b) The rates of patient admission with subsequent development of CVD (CVDS) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVDA and CVDS on mortality rates relative to those seen in patients without overt CVD (CVD-) and (d) The time course of mortality in CVD- versus CVDS patients.

METHODS

Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined.

RESULTS

Of the total 17,389 patients, there were 2,159 with CVDA. Over a median follow-up time of 4.6 years, CVDS admissions (n = 8,529) occurred more commonly in the presence of CVDA (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVDS cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVDA, 64.7% for CVDS, and 40.8% for CVD- (p < 0.001). Development of CVDS was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001).

CONCLUSIONS

Approximately 50% of patients assigned to cancer chemotherapy developed CVDS, heralding a particularly high risk of mortality over the next 12 months. Both CVDA and CVDS are associated with substantial increases in mortality rates relative to those in CVD- patients. This increased risk merits close individual monitoring.

Smoking Status and Premature Death Among Japanese Rural Community-Dwelling Persons

Background: Smoking status is known to be an independent and significant predictor of health outcomes related to aging and plays a crucial role in overall mortality rates. This cohort study investigated the relationship between smoking status and survival outcomes over follow-up periods of 9 and 21 years. Methods: The sample consisted of 3526 participants with a mean age of 64 ± 12 years, 44.1% of whom were male. The median follow-up duration was 6315 days, with an interquartile range of 3441 to 7727 days. Smoking status [i.e., Brinkmann index (BI)] was calculated by multiplying the number of years smoked by the number of cigarettes smoked daily. Based on this, participants were categorized into non-smokers, former smokers, and current smokers. The data were analyzed using Cox regression, employing age as the time variable and accounting for various risk factors. Results: A total of 1111 participants (49.2%) were confirmed to have died. Among these, 564 were male (36.2% of all male participants), and 547 were female (27.8% of all female participants). The multivariate-adjusted odds ratio (95% confidence interval) for all-cause mortality compared with never-smokers was 1.51 (1.17-1.96) for former smokers with BI > 800, 1.61 (1.20-2.17) for current smokers with BI of 400-799 and 1.62 (95% CI, 1.24-2.10) with BI of ≥800 (P for trend <0.001). Participants who died within three years of follow-up were excluded to avoid the possibility of reverse causation, but the results were essentially unchanged. Conclusion: We found that the BI is a valid predictor of future mortality risk and that BI 800 for former smokers and BI 400 for current smokers were useful cutoff values. Efforts to control smoking should focus not only on current smokers but also on former smokers to reduce the risk of premature death associated with smoking.

The potential protective role of vitamin D and calcium supplements in reducing cardiovascular disease risk among elderly patients with osteopenia

BACKGROUND

Cardiovascular disease and low bone mineral density are major health problems in the elderly. These two conditions are considered independent of each other and age-related diseases. The aim of this study is to investigate the association between low bone mineral density (BMD) and cardiovascular disease (CVD) incidents, and the effect of vitamin D and calcium supplement on the incidence of CVD in patients with low BMD.

METHODS

A total of 1047 patients (597 females/450 males) with the age of 65 years and more were diagnosed with osteopenia for 13 years or more. The study also included 220 patients (107 females/113 males) with osteopenia who already took calcium and vitamin D continually since their diagnosis. BMD was measured by dual-energy X-ray absorptiometry. The incidence of any cardiovascular diseases in the study patients and the presence of corresponding risk factors were collected and analyzed.

RESULTS

In both elderly Arab females and males, there was an association between total hip and femoral neck BMD and the possibility to have CVD. On the other hand, the results showed that patients who use calcium and vitamin D supplements showed a significant reduction in the incidence of CVD comparing to the non-treated patients.

CONCLUSION

Low total hip and femoral neck BMD were associated with a higher chance to have CVD incidents in both elderly Arab males and females; moreover, calcium and vitamin D supplements have a possible protective role in reducing cardiovascular disease in elderly patients with osteopenia.

Going from Primary to Primordial Prevention: Is the Juice Worth the Squeeze?

PURPOSE OF REVIEW

While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events.

RECENT FINDINGS

Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies.

Early thoracic surgery consultation and location of therapy impact time to esophagectomy

Background

Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients.

Methods

We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days.

Results

In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% vs. 3.65%, P=0.05) and required CRT dose reduction (16.67% vs. 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% vs. 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% vs. 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy.

Conclusions

Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy.

The Impact of Smoking on Arterial Stiffness in Young Adults: A Prospective Analysis

BACKGROUND

Arterial stiffness is a crucial factor in the pathogenesis of cardiovascular disease, often associated with aging. However, the impact of smoking on arterial stiffness is frequently underestimated. This study aims to investigate the intricate relationship between smoking and arterial stiffness to advance our understanding of and therapeutic approaches to cardiovascular health.

METHODS

A prospective analysis was conducted from January to July 2024, focusing on arterial stiffness parameters in a cohort of students from the Carol Davila University of Medicine and Pharmacy. Participants were categorized as smokers or non-smokers based on self-reported smoking status. The study endpoints included correlations between high pulse wave velocity, elevated peripheral and central systolic blood pressure, increased peripheral and central pulse pressure, and smoking status. These markers were assessed using an arteriograph device measuring the time difference between the initial forward pulse wave and the reflected pulse wave in the brachial artery to indirectly estimate the PWV using oscillometric pulsations.

RESULTS

Our investigation, involving 102 young individuals aged 20 to 26 (69 females, 33 males), revealed that smokers exhibited significantly higher average values of arterial stiffness indicators compared to non-smokers. Current smokers had higher mean systolic blood pressure (130.65 vs. 123.05 mmHg), higher mean peripheral pulse pressure (53.19 vs. 45.64 mmHg), higher mean central pulse pressure (33.66 vs. 29.69 mmHg), and higher mean pulse wave velocity (5.27 vs. 5.03 m/s).

CONCLUSIONS

The utilization of arterial stiffness markers as predictive tools offers opportunities for personalized treatment strategies, potentially enhancing cardiovascular health outcomes.

e-Cigarettes, Smoking Cessation, and Weight Change: Retrospective Secondary Analysis of the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation Trial

BACKGROUND

While smoking cessation has been linked to substantial weight gain, the potential influence of e-cigarettes on weight changes among individuals who use these devices to quit smoking is not fully understood.

OBJECTIVE

This study aims to reanalyze data from the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation (E3) trial to assess the causal effects of e-cigarette use on change in body weight.

METHODS

This is a secondary analysis of the E3 trial in which participants were randomized into 3 groups: nicotine e-cigarettes plus counseling, nonnicotine e-cigarettes plus counseling, and counseling alone. With adjustment for baseline variables and the follow-up smoking abstinence status, weight changes were compared between the groups from baseline to 12 weeks' follow-up. Intention-to-treat and as-treated analyses were conducted using doubly robust estimation. Further causal analysis used 2 different propensity scoring methods to estimate causal regression curves for 4 smoking-related continuous variables. We evaluated 5 different subsets of data for each method. Selection bias was addressed, and missing data were imputed by the machine learning method extreme gradient boosting (XGBoost).

RESULTS

A total of 257 individuals with measured weight at week 12 (mean age: 52, SD 12 y; women: n=122, 47.5%) were included. Across the 3 treatment groups, of the 257 participants, 204 (79.4%) who continued to smoke had, on average, largely unchanged weight at 12 weeks, with comparable mean weight gain ranging from -0.24 kg to 0.33 kg, while 53 (20.6%) smoking-abstinent participants gained weight, with a mean weight gain ranging from 2.05 kg to 2.70 kg. After adjustment, our analyses showed that the 2 e-cigarette arms exhibited a mean gain of 0.56 kg versus the counseling alone arm. The causal regression curves analysis also showed no strong evidence supporting a causal relationship between weight gain and the 3 e-cigarette-related variables. e-Cigarettes have small and variable causal effects on weight gain associated with smoking cessation.

CONCLUSIONS

In the E3 trial, e-cigarettes seemed to have minimal effects on mitigating the weight gain observed in individuals who smoke and subsequently quit at 3 months. However, given the modest sample size and the potential underuse of e-cigarettes among those randomized to the e-cigarette treatment arms, these results need to be replicated in large, adequately powered trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02417467; https://www.clinicaltrials.gov/study/NCT02417467.

Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations

Background

Cardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups.

Methods

We identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression.

Results

Of the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status.

Conclusions

There is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.

Risk of smoking cessation treatment dropout: a cohort to help (re)think care

OBJECTIVES

to evaluate the relative risk of smoking cessation treatment dropout during its intensive phase.

METHODS

a retrospective and quantitative cohort study was developed from the electronic medical records of individuals who started smoking cessation treatment between 2015 and 2019 at a specialty clinic in a city in the interior of São Paulo, Brazil. The relative risk of dropping out of treatment was calculated using the Poisson regression model.

RESULTS

it was observed that out of the 396 (100.0%) individuals who started the treatment, 109 (27.5%) abandoned it before the end of the intensive phase. For each one-year increase in age, the risk of dropping out of smoking cessation treatment decreased by an average of 2%.

CONCLUSIONS

the risk of dropping out of smoking cessation treatment is higher among younger individuals. It is necessary to rethink the care offered to younger adults to promote the continuity of treatment.

Potential roles of IL-38, among other inflammation-related biomarkers, in predicting post-percutaneous coronary intervention cardiovascular events

Percutaneous coronary intervention (PCI), as a relatively rapid and effective minimally invasive treatment for coronary heart disease (CHD), can effectively relieve coronary artery stenosis and restore myocardial perfusion. However, the occurrence of major adverse cardiovascular events (MACE) is a significant challenge for post PCI care. To better understand risk/benefit indicators and provide post PCI MACE prediction, 408 patients with CHD who had undergone PCI treatment from 2018 to 2021 in Tianjin Chest hospital were retrospectively studied for their clinical characteristics in relation with the MACE occurrence during a 12-month follow-up. In the study, 194 patients had MACE and 214 patients remained MACE-free. Using uni- and multivariate regression analyses, we have shown that smoking history, elevated serum C-reactive protein levels (hs-CRP), and high haemoglobin levels A1c (HbA1c) are all independent risk factors for MACE after PCI. Furthermore, we have discovered that the serum level of IL-38, one of the latest members identified in the IL-1 cytokine family, is another predictive factor and is reversely related to the occurrence of MACE. The serum level of IL-38 alone is capable of predicting non-MACE occurrence in subcategorized patients with abnormal levels of hs-CRP and/or HbA1c.

Optimizing Cardiovascular Health: A Comprehensive Review of Risk Assessment Strategies for Primary Prevention

Cardiovascular disease (CVD) is a leading global health concern, and effective primary prevention strategies are essential to mitigate its impact. This comprehensive review examines current risk assessment strategies for primary prevention of CVD, emphasizing the importance of early identification and intervention to reduce disease incidence. Traditional risk factors such as hypertension, hyperlipidemia, smoking, and lifestyle choices are discussed alongside emerging factors, including genetic predispositions and biomarkers. The review evaluates various risk assessment tools and models, such as the Framingham risk score, atherosclerotic CVD risk calculator, QRISK, and Reynolds risk score, highlighting their methodologies, strengths, and limitations. Additionally, the review explores lifestyle modifications, including dietary changes, physical activity, weight management, smoking cessation, and pharmacological interventions like statins and antihypertensives. Special considerations for different populations, including the elderly, women, and those with a family history of CVD, are addressed. Future directions in cardiovascular risk assessment are also discussed, focusing on technological advancements and personalized medicine. This review aims to enhance the implementation of effective primary prevention measures and improve cardiovascular health outcomes by providing a thorough analysis of risk assessment strategies.

Strategies for Cardiovascular Disease Prevention in Type 1 Diabetes: A Comprehensive Review

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D), necessitating effective prevention strategies. This comprehensive review consolidates current knowledge and evidence on preventing CVD in T1D patients. It begins by exploring the pathophysiological mechanisms that link T1D to an increased risk of CVD, highlighting factors such as chronic hyperglycemia, hypertension, dyslipidemia, and inflammation. The review also examines the epidemiology and specific risk factors for CVD in this population, emphasizing the need for rigorous risk assessment and screening. Lifestyle modifications, including dietary interventions, regular physical activity, and smoking cessation, are evaluated for their effectiveness in reducing CVD risk. Additionally, the review discusses pharmacological interventions, such as insulin therapy for glycemic control, antihypertensive medications, lipid-lowering agents, and antiplatelet therapy, underscoring their critical role in CVD prevention. Emerging therapies and future research directions are explored, focusing on novel pharmacological agents, advances in insulin delivery systems, and personalized medicine approaches. The importance of integrated care models involving multidisciplinary teams and the use of technology is highlighted as essential for comprehensive management. Challenges and barriers to implementing these strategies, including healthcare system limitations, patient adherence, and socioeconomic factors, are also addressed. This review provides a detailed synthesis of current strategies and future directions for preventing CVD in individuals with T1D, serving as a valuable resource for clinicians, researchers, and policymakers dedicated to improving cardiovascular outcomes in this high-risk population.

Joint Associations of Diet and Device-Measured Physical Activity with Mortality and Incident CVD and Cancer: A Prospective Analysis of the UK Biobank Study

BACKGROUND

We examined the joint associations of diet and device-measured intensity-specific physical activity (PA) with all-cause mortality (ACM), cardiovascular disease (CVD), and cancer incidence.

METHODS

We used data from 79,988 participants from the UK Biobank, a population-based prospective cohort study. Light PA (LPA), moderate-to-vigorous PA (MVPA), vigorous PA (VPA), and total PA (TPA) were measured using a wrist-worn accelerometer. Diet quality score (DQS) was based on 10 foods and ranged from 0 (unhealthiest) to 100 (healthiest) points. We derived joint PA and diet variables. Outcomes were ACM, CVD, and cancer incidence including PA, diet and adiposity-related (PDAR) cancer.

RESULTS

During a median follow-up of 8 years, 2,863 deaths occurred, 11,053 participants developed CVD, 7,005 developed cancer, and 3,400 developed PDAR cancer. Compared with the least favorable referent group (bottom PA tertile/low DQS), participants with middle and high (total and intensity specific) PA, except for LPA, had lower ACM risk and incident CVD risk, regardless of DQS. For example, among middle and high VPA and high DQS groups, CVD HR were 0.79 (95% CI, 0.74-0.86) and 0.75 (95% CI, 0.69-0.82), respectively. The pattern of cancer results was less pronounced but in agreement with the ACM and CVD incidence findings (e.g., HR, 0.90, 95% CI, 0.81-0.99; 0.88, 0.79-0.98; and 0.82, 0.74-0.92 among high VPA for low, moderate, and high DQS groups, respectively).

CONCLUSIONS

Device-measured PA reveals novel joint associations with diet on health outcomes.

IMPACT

Our results emphasize the crucial role of PA in addition to a healthy diet for reducing chronic diseases and mortality risk.

The role of adolescents' mental health and well-being in predicting their smoking status

OBJECTIVES

This study aims to examine the relationship between adolescent's mental health, well-being and their tobacco use.

METHODS

The study employed a relational survey model. The sample consisted of 691 adolescents aged between 12 and 15. This study deployed "Decisional Balance Scale" to predict and define the adolescents' tobacco use, and the "Me and My Feelings Scale" to evaluate mental health and well-being. Multiple linear regression analysis was used during data analysis.

RESULT

The results revealed that the emotional difficulties dimension of Me and My Feelings Scale had a statistically significant effect on the Decisional Balance Scale. However, the behavioral difficulties dimension did not have a statistically significant impact on the Decisional Balance Scale.

CONCLUSIONS

Adolescents' mental health affects their tobacco use at the level of 2.3 %. A significant relationship was noted across the adolescents' mental health and their perceptions towards smoking.

Global burden of cardiovascular disease attributable to smoking, 1990-2019: an analysis of the 2019 Global Burden of Disease Study

AIMS

This study aims to investigate the trends in the global cardiovascular disease (CVD) burden attributable to smoking from 1990 to 2019.

METHODS AND RESULTS

Global Burden of Disease Study 2019 was used to analyse the burden of CVD attributable to smoking (i.e. ischaemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, and aortic aneurysm). Age-standardized mortality rates (ASMRs) per 100 000 and age-standardized disability-adjusted life year rates (ASDRs) per 100 000, as well as an estimated annual percentage change (EAPC) in ASMR and ASDR, were determined by age, sex, year, socio-demographic index (SDI), regions, and countries or territories. The global ASMR of smoking-attributed CVD decreased from 57.16/100 000 [95% uncertainty interval (UI) 54.46-59.97] in 1990 to 33.03/100 000 (95% UI 30.43-35.51) in 2019 [EAPC -0.42 (95% UI -0.47 to -0.38)]. Similarly, the ASDR of smoking-attributed CVD decreased between 1990 and 2019. All CVD subcategories showed a decline in death burden between 1990 and 2019. The burden of smoking-attributed CVD was higher in men than in women. Significant geographic and regional variations existed such that Eastern Europe had the highest ASMR and Andean Latin America had the lowest ASMR in 2019. In 2019, the ASMR of smoking-attributed CVD was lowest in high SDI regions.

CONCLUSION

Smoking-attributed CVD morbidity and mortality are declining globally, but significant variation persists, indicating a need for targeted interventions to reduce smoking-related CVD burden.

An overview of traditional smoking cessation interventions and E-cigarettes

Many people still struggle with quitting smoking despite available treatment options, making it one of the most significant public health challenges that our society faces. The use of electronic cigarettes (E-cigarettes) has become increasingly popular among people who are seeking to quit smoking. The objective of this review paper is to present a comprehensive analysis of the mechanisms, several types, and impact of E-cigarettes, along with supporting evidence indicating their efficacy in aiding smokers to quit tobacco usage. Additionally, the review discusses recent developments in the treatment of smoking cessation, which include conventional smoking cessation methods. Also, the review discusses the challenges, potential risks, ethical considerations, and controversies surrounding the use of E-cigarettes. The present review presents a comprehensive examination of the existing methods and approaches employed in smoking cessation, including the emerging utilization of E-cigarettes as an effective option in smoking cessation. It explores their efficacy as a valuable instrument in promoting smoking cessation.

The incidence of heart attacks among young individuals in Mosul City

BACKGROUND

Rapid socioeconomic progress has greatly affected the world, and the risk of cardiovascular diseases (CVDs) has increased. The growing burden of CVDs has become a major public health issue. The study aimed to identify the main risk factors that lead to the contribution of heart attacks among young people in Mosul City, Iraq.

MATERIALS AND METHODS

The study was dependent on achieving the objectives through a descriptive study design that was performed in the emergency medical wards of three teaching hospitals in Mosul City, Iraq. The sample was the convenience of patients who were admitted to the emergency department and who had signs and symptoms of heart attacks during the period of data collection starting from November 1, 2022, until April 1, 2023. The participants were 247 cases recorded during that period, and their ages ranged between 20 and 45 years. The tool used in this study from the World Health Organization (WHO) is related to risk factors for CVDs and consists of eleven items.

RESULTS

Approximately seventy percent of the study sample was male, 68.4% were less than 39 years, and 35.6% of them were diagnosed with heart diseases (angina and myocardial infarction) that require hospitalization, and there are several risk factors in the study sample, the most prominent of which were physical inactivity (88.6%), following unhealthy diet patterns (87.5%) and hypertension (69.3%).

CONCLUSION

The study concluded that the risky health factors that contribute to the occurrence of heart attacks among young people in this study are hypertension, high blood cholesterol, unhealthy diet, heavy smoking, stress, family history, alcohol drinking, obesity, and diabetes mellitus (DB).

The association between weight loss medications and cardiovascular complications

OBJECTIVE

Obesity and its cardiovascular complications are major causes of morbidity and mortality. Little is known in real-world settings about the effect of newly approved antiobesity medications (AOMs) on cardiovascular complications among patients with obesity.

METHODS

This retrospective cohort study examined the association between newly approved AOM use and cardiovascular events among Medicare patients with obesity using data from 2020 to 2022. Patient age, gender, comorbidity scores, socioeconomic status, and baseline cardiovascular comorbidities were compared descriptively. Subgroup analysis compared variables by medication type. Relative risk and absolute risk of cardiovascular disease (CVD) events were estimated using Cox and Aalen regression models.

RESULTS

The analysis included 5926 patients treated with semaglutide and tirzepatide, including Ozempic (5404 patients), Wegovy (375 patients), or Mounjaro (147 patients). Hypertension, type 2 diabetes, and hyperlipidemia were the most common comorbidities. For patients with AOMs, less incidence of heart failure (4.89% vs. 6.13%, p < 0.0001), atrial fibrillation (3.83% vs. 5.17%, p < 0.0001), arrhythmia (3.59% vs. 4.14%, p < 0.0153), and peripheral vascular disease (3.44% vs. 2.94%, p < 0.0395) was found versus patients without AOMs. Patients receiving AOMs showed an 8% risk reduction in any CVD. Protective effect on CVD was apparent over the first 375 days.

CONCLUSIONS

Results suggest that utilization of AOMs effectively alleviates the high prevalence of CVD.

Effect of tobacco use on Zenker's diverticulotomy outcomes

OBJECTIVE

To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD).

STUDY DESIGN

Single institution retrospective review.

SETTING

Tertiary care academic hospital.

METHODS

A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence.

RESULTS

Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94).

CONCLUSIONS

There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.

Association of lifestyle modification with the development of cardiovascular disease in gastric cancer patients who underwent gastrectomy: A nationwide population-based study

BACKGROUND

While cancer patients are at an increased risk of cardiovascular disease (CVD), the role of modifiable risk factors remains poorly understood. This study investigated whether lifestyle modifications affect CVD development in gastric cancer patients who undergo surgery.

METHODS

Using data from the Korean National Health Insurance Service (NHIS), gastric cancer patients who underwent surgery from 2010 to 2017 were identified. Lifestyle behaviours, surveyed within 2 years before and after surgery were analysed. Incident CVD, defined as a composite of myocardial infarction and stroke, was compared among subgroups of lifestyle behaviour changes.

RESULTS

Among 22,211 gastrectomy patients, 628 (2.8%) developed CVD (5.68/1000 person-years). Persistent smokers (HR: 1.72, 95% CI: 1.33-2.22) and new smokers (HR: 1.85, 95% CI: 1.04-3.30) faced higher CVD risks than non-smokers, with an especially pronounced risk in persistent-smoking females (HR: 3.89, 95% CI: 1.20-12.62). Smoking cessation showed no significant risk difference compared to non-smokers (HR: 1.16, 95% CI: 0.93-1.43). Female new drinkers had a higher CVD risk than non-drinking females (HR: 2.89, 95% CI: 1.06-7.88), while men did not show such association. Changes in physical activity, when compared to physical inactivity, were not associated with CVD risk.

CONCLUSION

Gastric cancer patients who smoked after surgery were more likely to develop CVD irrespective of their prior smoking status, with a notable vulnerability in persistent female smokers. Smoking cessation could potentially mitigate CVD risk to levels observed in non-smokers. Alcohol intake should be avoided following surgery, especially for female gastric cancer patients.

The impact of baseline health factors on second primary cancer risk after radiotherapy for prostate cancer

PURPOSE

In evaluating second primary cancers (SPCs) following External Beam Radiotherapy (EBRT), the role of lifestyle factors is frequently not considered due to data limitations. We investigated the association between smoking, comorbidities, and SPC risks within EBRT-treated patients for localized prostate cancer (PCa).

PATIENTS & METHODS

The study included 1,883 PCa survivors aged 50-79, treated between 2006 and 2013, with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT). Clinical data were combined with SPC and survival data from the Netherlands Cancer Registry with a 12-month latency period. Standardized Incidence Ratios (SIRs) were calculated comparing the EBRT cohort with the general Dutch population. To explore the effect of patient and treatment characteristics on SPCs we conducted a Cox regression analysis. Lastly, we estimated cumulative incidences of developing solid SPC, pelvis SPC, and non-pelvis SPC using a competing risk analysis.

RESULTS

Significantly increased SIRs were observed for all SPC (SIR = 1.21, 95% confidence interval [CI]: 1.08-1.34), pelvis SPC (SIR = 1.46, 95% CI: 1.18-1.78), and non-pelvis SPC (SIR = 1.18, 95% CI [1.04-1.34]). Smoking status was significantly associated with pelvic and non-pelvic SPCs. Charlson comorbidity index (CCI) ≥ 1 (Hazard Ratio [HR] = 1.45, 95% CI: 1.10-1.91), cardiovascular disease (HR = 1.41, 95% CI: 1.05-1.88), and chronic obstructive pulmonary disease (COPD) (HR = 1.91, 95% CI: 1.30-2.79) were significantly associated with non-pelvis SPC. The proportion of active smoking numbers in the cohort was similar to the general population.

INTERPRETATION

We conclude that the presence of comorbidities in the EBRT population might be a relevant factor in observed excess non-pelvis SPC risk, but not for excess pelvis SPC risk.

The characteristics and risk of obesity central and concomitant impaired fasting glucose: Findings from a cross-sectional study

INTRODUCTION

Obesity is associated with concomitant chronic conditions. An early metabolic consequence of obesity is disruption of glucose and insulin homeostasis. One of the consequences is impaired fasting glucose (IFG). Visceral fat is metabolically more harmful than subcutaneous fat, but few information is available regarding the association between the risk of abnormal glucose in increased waist circumference.

METHODS

This study is based on a cross sectional of 1,381 population-based from Palembang, Indonesia. The eligibility requirements subject were to be older than 18 and consent to taking fasting glucose and lipid profile tests as well as physical exams measuring their body weight, height, blood pressure, abdominal circumference, and waist circumference.

RESULTS

The number of subjects consisting of 798 noncentral obesity with normoglycemia, 376 central obesity with normoglycemia, and 207 central obesity with concomitant IFG. The prevalence central obesity with concomitant IFG was 35.51%. In subjects with central obesity, there were significant differences in proportions based on sex, age, marital status, education, and occupation. In multivariate analysis show that the risk factors that contribute to having a significant association with central obesity with concomitant IFG are sex (female), age (>40 years), blood pressure (hypertension), and HDL-C <50 mg/dL (p<0.001). The analysis also founded that there was a significant difference in the dietary pattern of sweet foods (p = 0.018), sweet drinks (p = 0.002), soft drinks (p = 0.001) and smoking habit (p<0.001) between subjects with obesity central and concomitant IFG compared to subjects with noncentral obesity. The majority of subjects with obesity central and concomitant IFG had consuming these risky foods >6 times/week.

CONCLUSION

The prevalence of central obesity with IFG is quite high. There are significant differences in the characteristics, lipid profile, blood pressure, dietary pattern, and smoking habit of central obesity with concomitant IFG was confirmed in this population-based observational study.