Novel risk factors of cardiovascular disease and their associations between obesity, physical activity and physical fitness

The Etiology of the Thrombotic Phenomena Involved in the Process of Coronary Artery Disease-What Is the Role of Thrombophilic Genes in the Development of This Pathology?

Cardiovascular diseases, among which includes coronary artery disease, represent one of the most important causes of mortality and morbidity worldwide. Research aimed at determining the risk factors involved recognizes a group of "traditional" risk factors, but also more recent studies identified over 100 "novel" ones which may have a role in the disease. Among the latter is the thrombophilia profile of a patient, a pathology well-established for its involvement in venous thromboembolism, but with less studied implications in arterial thrombosis. This paper reviews the literature, explaining the pathophysiology of the thrombophilia causes associated most with coronary thrombosis events. Results of several studies on the subject, including a meta-analysis with over 60,000 subjects, determined the significant involvement of factor V Leiden, prothrombin G20210A mutation, plasminogen activator inhibitor-1 and antiphospholipid syndrome in the development of coronary artery disease. The mechanisms involved are currently at different stages of research, with some already established and used as therapeutic targets.

Re-evaluating the mythical divide between traditional and novel cardiovascular risk factors in rheumatoid arthritis

Cardiovascular (CV) risk factors for rheumatoid arthritis (RA) are conventionally classified as 'traditional' and 'novel'. We argue that this classification is obsolete and potentially counterproductive. Further, we discuss problems with the common practice of adjusting for traditional CV risk factors in statistical analyses. These analyses do not target well-defined effects of RA on CV risk. Ultimately, we propose a future direction for cardiorheumatology research that prioritises optimising current treatments and identifying novel therapeutic targets over further categorisation of well-known risk factors.

Higher vegetable consumption is related to a lower risk of cardiometabolic risk cluster among children and adolescents: A national cross-sectional study in China

BACKGROUND AND AIMS

Evidence about the association between vegetable consumption and cardiometabolic risk factors (CMRFs) cluster among children and adolescents was inconsistent. We aimed to investigate the prevalence of CMRFs and CMRFs cluster, and to evaluate their associations with vegetable consumption.

METHODS AND RESULTS

A total of 14,061 participants aged 6-19 years were recruited from 7 provinces of China. A standard physical examination, including height, weight and blood pressure, was conducted. Information regarding CMRFs was obtained through anthropometric measurements and blood sample testing, while weekly frequency and daily servings of vegetable consumption data collected by questionnaires. Logistic regression models were used to analyze the odds ratios (OR) for associations between CMRFs, CMRFs cluster and vegetable consumption. The prevalence of no CMRFs cluster among children and adolescents was 26.4%. Participants whose daily vegetable consumption was 0.75-1.5 and ≥1.5 servings showed a lower risk of high blood pressure (HBP), high total cholesterol (TC), high triglyceride (TG), and high low-density lipoprotein cholesterol (LDL-C) compared to those with daily vegetable consumption of <0.75 servings. Besides, higher average daily vegetable consumption was strongly associated with lower risks of CMRFs cluster. Stratified analyses showed that the protective effects of more vegetable intake on CMRFs cluster were profounder in boys and young adolescents.

CONCLUSION

More vegetable intake was associated with lower risks of CMRFs cluster in Chinese children and adolescents aged 6-19 years, which further highlighted the significance of vegetable consumption to improve the cardiometabolic risk status.

Can Anthropometry and Body Composition Explain Physical Fitness Levels in School-Aged Children?

Physical fitness (PF) is closely related to various health outcomes and quality of life among children. However, the associations between anthropometry, body composition (BC), and PF are not fully elucidated. This cross-sectional study aimed to investigate the associations between demographic metrics (age, sex), anthropometric measures (body mass index z-score (BMI z-score) waist/height ratio (WHtR)), BC parameters (body-fat percentage (BF%), muscle weight), and PF levels (800-m run, sit-and-reach, 1-min sit-ups, standing long jump) in school-aged children. Continuous variables were dichotomized by median splits. The results of 180 girls and 180 boys (mean age: 10.0 ± 0.7 years; mean BMI z-score: 0.366 ± 1.216) were analyzed. Multivariable linear regressions revealed that BF% (regression coefficient (B) = 3.4, 95% confidence interval (CI) = 2.5-4.3) was independently correlated with the 800-m run. Sex (B = 4.6, 95% CI = 3.0-6.3), age (B = 3.1, 95% CI = 1.9-4.3), and BMI z-score (B = -0.7, 95% CI = -1.4--0.1) were independently related to sit-and-reach. Age (B = 3.3, 95% CI = 2.0-4.7), BF% (B = -0.3, 95% CI = -0.4--0.2), and muscle weight (B = 0.7, 95% CI = 0.2-1.2) were independently associated with 1-min sit-ups. In addition to demography, anthropometry and BC provided additional information concerning some PF levels in school-aged children. Weight management and PF promotion should be addressed simultaneously in terms of preventive medicine and health promotion for children.

Sprint Interval Training and the School Curriculum: Benefits Upon Cardiorespiratory Fitness, Physical Activity Profiles, and Cardiometabolic Risk Profiles of Healthy Adolescents

BACKGROUND

This study examined the impact of a 4-week school-based sprint interval training program on cardiorespiratory fitness (CRF), daily physical activity (PA) behavior, and cardiometabolic risk (CMR) outcomes in adolescents.

METHODS

A total of 56 adolescents (22 females) were allocated to either an intervention (n = 22; 17.0 [0.3] y) or control group (n = 30; 16.8 [0.5] y). Intervention group performed 5 to 6, 30 second "all out" running sprints, interspersed with 30-second rest intervals, 3 times per week, for 4 consecutive weeks, whereas control group performed their normal physical education lessons. CRF was estimated from the 20-m multistage fitness test and PA behavior was determined using accelerometry. Fasting blood samples were obtained to measure biochemical markers of CMR.

RESULTS

Significant group × time interactions were observed for CRF (5.03 [1.66 to 8.40]; P < .001; d = 0.95), sedentary time (136.15 [91.91 to 180.39]; P = .004; d = 1.8), moderate PA (57.20 [32.17 to 82.23]; P < .001; d = 1.5), vigorous PA (5.40 [4.22 to 6.57]; P < .001; d = 1.2), fasting insulin (0.37 [-0.48 to 1.21]; P = .01; d = 1.0), homeostasis model of assessment-insulin resistance (0.26 [0.15 to 0.42]; P < .001; d = 0.9), and clustered CMR score (0.22 [-0.05 to 0.68]; P < .001; d = 10.63).

CONCLUSION

Findings of this study indicate that 4 weeks of school-based sprint interval training improves CRF, improves PA profiles, and maintains CMR in adolescents during the school term.

Effects of early- and mid-life stress on DNA methylation of genes associated with subclinical cardiovascular disease and cognitive impairment: a systematic review

Background

Traditional and novel risk factors cannot sufficiently explain the differential susceptibility to cardiovascular disease (CVD). Epigenetics may serve to partially explain this residual disparity, with life course stressors shown to modify methylation of genes implicated in various diseases. Subclinical CVD is often comorbid with cognitive impairment (CI), which warrants research into the identification of common genes for both conditions.

Methods

We conducted a systematic review of the existing literature to identify studies depicting the relationship between life course stressors, DNA methylation, subclinical CVD, and cognition.

Results

A total of 16 articles (8 human and 8 animal) were identified, with the earliest published in 2008. Four genes (COMT, NOS3, Igfl1, and Sod2) were analyzed by more than one study, but not in association with both CVD and CI. One gene (NR3C1) was associated with both outcomes, albeit not within the same study. There was some consistency among studies with markers used for subclinical CVD and cognition, but considerable variability in stress exposure (especially in human studies), cell type/tissue of interest, method for detection of DNA methylation, and risk factors. Racial and ethnic differences were not considered, but analysis of sex in one human study found statistically significant differentially methylated X-linked loci associated with attention and intelligence.

Conclusions

This review suggests the need for additional studies to implement more comprehensive and methodologically rigorous study designs that can better identify epigenetic biomarkers to differentiate individuals vulnerable to both subclinical CVD and associated CI.

Electronic supplementary material

The online version of this article (10.1186/s12881-019-0764-4) contains supplementary material, which is available to authorized users.

What Do We Know about Diet and Markers of Cardiovascular Health in Children: A Review

Chronic diseases such as cancer, diabetes, and cardiovascular diseases (CVD) are the main health concerns in the 21st century, with CVD as the number one cause of mortality worldwide. Although CVD hard endpoints such as stroke or heart attack do not usually occur in children, evidence shows that the manifestation of CVD risk factors begins in childhood, preceding clinical complications of CVD in adulthood. Dietary intake is a modifiable risk factor that has been shown to make a substantial contribution to the risk of CVD in adulthood. However, less is known about the association between dietary intake and markers of cardiovascular health in children. This review summarises the current evidence on the relationship between dietary intake and markers of cardiovascular health including traditional CVD risk factors, physical fitness, and indices of arterial stiffness and wave reflection in children. Original research published in English, between January 2008 and December 2018 fulfilling the objective of this review were screened and included. Findings show that adaptation of a healthy lifestyle early in life can be beneficial for reducing the risk of CVD later in life. Furthermore, keeping arterial stiffness low from a young age could be a potential CVD prevention strategy. However, limited studies are available on diet-arterial stiffness relationship in children, and future research is required to better understand this association to aid the development and implementation of evidence-based strategies for preventing CVD-related complications later in life.

Effect of Low- Versus High-Intensity Exercise Training on Biomarkers of Inflammation and Endothelial Dysfunction in Adolescents With Obesity: A 6-Month Randomized Exercise Intervention Study

PURPOSE

To investigate the effects of a low- versus high-intensity aerobic training on biomarkers of inflammation and endothelial dysfunction in adolescents with obesity.

METHODS

Sixty-two adolescents with obesity [age = 15 (14) y, body mass index = 34.87 (4.22) kg·m^-2] were randomized to receive either a high-intensity training (HIT, n = 31) or a low-intensity training (LIT, n = 31) for 24 weeks. All participants also received nutritional, psychological, and clinical counseling. Leptin, total and subtype leukocyte counts, tumor necrosis factor-alpha, interleukin-6, myeloperoxidase, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1 were obtained at baseline and after 24 weeks.

RESULTS

HIT reduced neutrophils [from 4.4 (1.9) to 3.6 (1.3) µL^-1 × 10³; P = .01] and monocytes [from 7.2 (2.5) to 5.2 (1.8) µL^-1 × 10²; P < .01], but LIT increased neutrophils [from 4.5 (1.7) to 5.2 (3.3) µL^-1 × 10³; P = .01]. Although tumor necrosis factor-alpha increased in LIT [from 13.3 (7.5) to 17.7 (10.8) pg·mL^-1; P = .01], it decreased in HIT [from 12.4 (7.5) to 11.3 (6.2) pg·mL^-1; P = .01]. No changes in leukocyte counts, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and homeostasis assessment model for insulin resistance were observed.

CONCLUSIONS

Both HIT and LIT improved the inflammatory profile. The study, however, indicated that the number of biomarkers and the magnitude of changes were higher in the HIT compared with LIT.

Noninvasive positive pressure ventilation enhances the effects of aerobic training on cardiopulmonary function

Purpose

The purpose of this study was to determine the effect of aerobic training under noninvasive positive pressure ventilation (NPPV) on maximal oxygen uptake (V˙O2max).

Methods

Ten healthy young male volunteers participated in the study. Before the training, stroke volume (SV) and cardiac output (CO) were measured in all subjects under 0, 4, 8, and 12 cmH₂O NPPV at rest. Then, the subjects exercised on a cycle ergometer at 60% of pre-training V˙O2max for 30 min daily for 5 consecutive days with/without NPPV. The 5-day exercise protocol was repeated after a three-week washout period without/with NPPV. The primary endpoint was changes in V˙O2max. The secondary endpoints were changes in SV, CO, maximum heart rate (HR_max), maximum respiratory rate (RR_max), maximum expiratory minute volume (VE_max) and the percent change in plasma volume (PV).

Results

NPPV at 12 cmH₂O significantly reduced SV and CO at rest. V˙O2max significantly increased after 5 days training with and without NPPV, but the magnitude of increase in V˙O2max after training under 12 cmH₂O NPPV was significantly higher than after training without NPPV. VE_max significantly increased after training under NPPV, but not after training without NPPV. HR_max and RR_max did not change during training irrespective of NPPV. The percent change in PV was similar between training with and without NPPV. The 5-day training program with NPPV resulted in greater improvement in V˙O2max than without NPPV.

Conclusions

Aerobic training under NPPV has add-on effects on V˙O2max and exercise-related health benefits in healthy young men.

BIDIRECTIONAL PROSPECTIVE ASSOCIATIONS OF METABOLIC SYNDROME COMPONENTS WITH DEPRESSION, ANXIETY, AND ANTIDEPRESSANT USE

BACKGROUND

Metabolic syndrome components-waist circumference, high-density lipoprotein cholesterol (HDL-C), triglycerides, systolic blood pressure and fasting glucose-are cross-sectionally associated with depression and anxiety with differing strength. Few studies examine the relationships over time or whether antidepressants have independent effects.

METHODS

Participants were from the Netherlands Study of Depression and Anxiety (NESDA; N = 2,776; 18-65 years; 66% female). At baseline, 2- and 6-year follow-up, participants completed diagnostic interviews, depression and anxiety symptom inventories, antidepressant use assessment, and measurements of the five metabolic syndrome components. Data were analyzed for the consistency of associations between psychopathology indicators and metabolic syndrome components across the three assessment waves, and whether psychopathology or antidepressant use at one assessment predicts metabolic dysregulation at the next and vice versa.

RESULTS

Consistently across waves, psychopathology was associated with generally poorer values of metabolic syndrome components, particularly waist circumference and triglycerides. Stronger associations were observed for psychopathology symptom severity than diagnosis. Antidepressant use was independently associated with higher waist circumference, triglycerides and number of metabolic syndrome abnormalities, and lower HDL-C. Symptom severity and antidepressant use were associated with subsequently increased number of abnormalities, waist circumference, and glucose after 2 but not 4 years. Conversely, there was little evidence that metabolic syndrome components were associated with subsequent psychopathology outcomes.

CONCLUSIONS

Symptom severity and antidepressant use were independently associated with metabolic dysregulation consistently over time and also had negative consequences for short-term metabolic health. This is of concern given the chronicity of depression and anxiety and prevalence of antidepressant treatment.

Prenatal and childhood growth and physical performance in old age--findings from the Helsinki Birth Cohort Study 1934-1944

Health in adulthood is in part a consequence of development and growth taking place during sensitive periods in early life. It has not been explored previously whether early growth is associated with physical performance in old age from a life course perspective taking into account health-related behavior, biological risk factors, and early life experiences. At a mean age of 71 years, physical performance was assessed using the Senior Fitness Test (SFT) in 1078 individuals belonging to the Helsinki Birth Cohort Study. We used multiple linear regression analysis to assess the association between the SFT physical fitness scores and individual life course measurements. Several adult characteristics were associated with physical performance including socioeconomic status, lifestyle factors, and adult anthropometry. Higher birth weight and length were associated with better physical performance, even after adjusting for potential confounders (all p values <0.05). The strongest individual association between life course measurements and physical performance in old age was found for adult body fat percentage. However, prenatal growth was independently associated with physical performance seven decades later. These findings suggest that physical performance in old age is at least partly programmed in early life.

Microvascular dysfunction in schizophrenia: a case-control study

Background:

Schizophrenia is a mental illness associated with cardiovascular disease at a younger age than in the general population. Endothelial dysfunction has predictive value for future cardiovascular events; however, the impact of a diagnosis of schizophrenia on this marker is unknown.

Aims:

We tested the hypothesis that subjects with schizophrenia have impaired endothelial function.

Methods:

A total of 102 subjects (34.5±7.5 years) participated in this study. This sample consisted of 51 subjects with a diagnosis of schizophrenia and 51 healthy subjects, who were matched for age (P=0.442), sex (P>0.999), and smoking status (P=0.842). Peripheral artery microvascular and conduit vessel endothelial function was measured using hyperemic velocity time integral (VTI), pulse arterial tonometry (PAT), and flow-mediated dilation (FMD).

Results:

Significantly lower values of VTI were noted in subjects with schizophrenia (104.9±33.0 vs. 129.1±33.8 cm, P<0.001), whereas FMD (P=0.933) and PAT (P=0.862) did not differ between the two groups. A multivariable-linear-regression analysis, built on data from univariate and partial correlations, showed that only schizophrenia, sex, lipid-lowering medications, antihypertensive medications, and low-density lipoprotein (LDL)-cholesterol were predictive of attenuated VTI, whereas age, ethnicity, family history of cardiovascular disease, smoking status, systolic blood pressure, waist circumference, HDL-cholesterol, triglycerides, C-reactive protein, and homeostatic model assessment-insulin resistance (HOMA-IR), antidiabetic medications, antidepressant medications, mood stabilizers, benzodiazepines, and anticholinergic medications did not predict VTI in this model (adjusted R²=0.248).

Conclusions:

Our findings suggest that a diagnosis of schizophrenia is associated with impaired microvascular function as indicated by lower values of VTI, irrespective of many other clinical characteristics. It might be an early indicator of cardiovascular risk in schizophrenia, and might help to identify high-risk individuals.