[Show abstract][Hide abstract] ABSTRACT: Objectives:
Examine associations of favorable levels of all cardiovascular disease (CVD) risk factors (RFs) [i.e., low risk (LR)] at younger ages with high sensitivity C-reactive protein (hs-CRP) at older ages.
There were 1,324 participants ages 65-84 years with hs-CRP ≤ 10mg/l from the Chicago Healthy Aging Study (2007-2010), CVD RFs assessed at baseline (1967-73) and 39 years later. LR was defined as untreated blood pressure (BP) ≤120/≤80 mmHg, untreated serum total cholesterol <200 mg/dL, body mass index (BMI) <25 kg/m(2), not smoking, no diabetes. Hs-CRP was natural log-transformed or dichotomized as elevated (≥3 mg/l or ≥2 mg/l) vs. otherwise.
With multivariable adjustment, the odds ratios (95% confidence intervals) for follow-up hs-CRP ≥3 mg/ in participants with baseline 0RF, 1RF and 2+RFs compared to those with baseline LR were 1.35 (0.89-2.03), 1.61(1.08-2.40) and 1.69(1.04-2.75), respectively. There was also a graded, direct association across four categories of RF groups with follow-up hs-CRP levels (β coefficient/P-trend = 0.18/0.014). Associations were mainly due to baseline smoking and BMI, independent of 39-year change in BMI levels. Similar trends were observed in gender-specific analyses.
Favorable levels of all CVD RFs in younger age are associated with lower hs-CRP level in older age.
[Show abstract][Hide abstract] ABSTRACT: Background:
Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk.
Methods and results:
We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up.
Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines.
Clinical trial registration:
URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
[Show abstract][Hide abstract] ABSTRACT: Background:
Greater public awareness of venous thromboembolism may be an important next step for optimizing venous thromboembolism prevention and treatment. "Lifetime risk" is an easily interpretable way of presenting risk information. Therefore, we sought to calculate the lifetime risk of venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) using data from two large, prospective cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study.
We followed participants aged 45-64 years in ARIC (n=14,185) and ≥65 in CHS (n=5,414) at baseline visits (1987-89 in ARIC, 1989-90 and 1992-93 in CHS) for incident venous thromboembolism (n=728 in ARIC through 2011 and n=172 in CHS through 2001). We estimated lifetime risks and 95% confidence intervals of incident venous thromboembolism using a modified Kaplan-Meier method, accounting for the competing risk of death from other causes.
At age 45, the remaining lifetime risk of venous thromboembolism in ARIC was 8.1% (95% confidence interval: 7.1-8.7). High-risk groups were African Americans (11.5% lifetime risk), those with obesity (10.9%), heterozygous for the factor V Leiden (17.1%), or with sickle cell trait or disease (18.2%). Lifetime risk estimates differed by cohort; these differences were explained by differences in time period of venous thromboembolism ascertainment.
At least 1 in 12 middle-aged adults will develop venous thromboembolism in their remaining lifetime. This estimate of lifetime risk may be useful to promote awareness of venous thromboembolism and guide decisions at both clinical and policy levels.
The American journal of medicine 11/2015; DOI:10.1016/j.amjmed.2015.10.014 · 5.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Atherosclerotic cardiovascular disease (ASCVD) events, including coronary heart disease and stroke, are the most frequent cause of death and major disability in the world. Current American College of Cardiology/American Heart Association primary prevention guidelines are mainly on the basis of randomized controlled trials of statin-based low-density lipoprotein cholesterol (LDL-C)-lowering therapy for primary prevention of ASCVD events. Despite the clear demonstration of statin-based LDL-C lowering, substantial 10-year and lifetime risks of incident ASCVD continue. Although the 10-year risk is low in young and middle-aged adults who would not be treated according to current guidelines, they ultimately account for most incident ASCVD. If statin-based LDL-C lowering were initiated in them at an age before complex coronary plaques are common in the population, a substantial reduction in lifetime risk of incident coronary heart disease might be achieved. We examine this hypothesis and introduce the design of a currently recruiting trial to address it. (Eliminate Coronary Artery Disease [ECAD]; NCT02245087)
Journal of the American College of Cardiology 10/2015; 66(16):1828-1836. DOI:10.1016/j.jacc.2015.08.857 · 16.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
This study was conducted to examine the association between ideal cardiovascular health (CVH) and health-related quality of life and health status indicators.
This cross-sectional study included adult NHANES participants from 2001 to 2010 without CVD (N = 7115). CVH was defined according to AHA definitions with poor, intermediate and ideal levels of the seven factors (diet, BMI, physical activity, smoking, blood pressure, glucose, and cholesterol) assigned scores of 0, 1, and 2, respectively. A CVH score (CVHS) was calculated as the sum of the scores from each individual health factor (range 0-14; higher score indicating greater CVH). CVHS was categorized as poor (0-7), intermediate (8-10), and ideal (11-14). Linear regression models examined the association between CVHS category with health status and number of unhealthy days per month, adjusted for socio-demographic characteristics and disability.
Among US adults 20-79 years, 14, 46 and 40 % had ideal, intermediate and poor CVHS, respectively. Compared to those with poor CVH, individuals in intermediate and ideal CVH were 44 and 71 % less likely to report being in fair/poor health. Participants with ideal CVH scores reported a mean of 2.4 fewer unhealthy days over the past month, including one less day in which their physical health was not good and two fewer days in which their mental health was not good.
Ideal CVH is associated with greater overall health status and fewer physically and mentally unhealthy days.
Health and Quality of Life Outcomes 09/2015; 13(1):152. DOI:10.1186/s12955-015-0352-z · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the cross-sectional association between optimism and cardiovascular health (CVH).
We used data collected from adults aged 52-84 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA) (n=5,134) during the first follow-up visit (2002-2004). Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (with reference being poor CVH), after adjusting for socio-demographic factors and psychological ill-being.
Participants in the highest quartile of optimism were more likely to have intermediate [OR=1.51:95%CI=1.25,1.82] and ideal [OR=1.92:95%CI=1.30,2.85] CVH when compared to the least optimistic group. Individual CVH metrics of diet, physical activity, BMI, smoking, blood sugar and total cholesterol contributed to the overall association.
We offer evidence for a cross-sectional association between optimism and CVH.
[Show abstract][Hide abstract] ABSTRACT: Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant.
Using the Organ Procurement and Transplantation Network database we examined associations between NASH and post liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction, or stroke. A physician panel reviewed cause of death.
Of 48,360 liver transplants (2/2002-12/2011), 5,057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic, and have history of renal failure or prior CVD versus non-NASH (p<0.001 for all). Although there was no difference in overall all-cause mortality (log-rank p=0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio=1.30, 95% Confidence interval (CI): 1.02-1.66; Hazard ratio=1.42, 95% CI: 1.07-1.41, respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥ 55, male sex, diabetes and renal impairment was developed for prediction of post liver transplant CVD mortality (c-statistic 0.60).
NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of co-morbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Liver international: official journal of the International Association for the Study of the Liver 05/2015; DOI:10.1111/liv.12872 · 4.85 Impact Factor