Early Life Famine Exposure, Ideal Cardiovascular Health Metrics and Risk of Incident Diabetes: Findings from the 4C Study

10.2337/figshare.12185469.v1 ◽

2020 ◽

Author(s):

Jieli Lu ◽

Mian Li ◽

Yu Xu ◽

Yufang Bi ◽

Yingfen Qin ◽

...

Keyword(s):

Cardiovascular Health ◽

Dietary Habits ◽

Ideal Cardiovascular Health ◽

Adjusted Risk ◽

Increased Risk ◽

Famine Exposure ◽

Design And Methods ◽

The Impact ◽

Risk Ratios

OBJECTIVE We aim to investigate the impact of ideal cardiovascular heath metrics (ICVHMs) on the association between famine exposure and adulthood diabetes risk. RESEARCH DESIGN AND METHODS This study included 77 925 participants from the China Cardiometabolic Disease and Cancer Cohort (4C) Study, who were born around the time of the Chinese Great Famine and free of diabetes at baseline. They were divided into 3 famine exposure groups according to the birth year, including non-exposed (1963-1974), fetal-exposed (1959-1962) and childhood exposed (1949-1958). Relative risk regression was used to examine the associations between famine exposure and ICVHMs on diabetes. RESULTS During a mean follow-up of 3.6 years, the cumulative incidence of diabetes was 4.2%, 6.0% and 7.5% in non-exposed, fetal-exposed and childhood-exposed participants, respectively. Compared with non-exposed participants, fetal-exposed but not childhood-exposed participants had increased risks of diabetes with multivariable-adjusted risk ratios (RRs) (95% confidence intervals) (CIs) of 1.17 (1.05-1.31) and 1.12 (0.96-1.30), respectively. Increased diabetes risks were observed in fetal-exposed individuals with non-ideal dietary habits, non-ideal physical activity, BMI ≥24.0 kg/m2, or blood pressure ≥120/80 mmHg, whereas significant interaction was detected only in BMI strata (P for interaction=0.0018). Significant interactions have been detected between number of ICVHMs and famine exposure on the risk of diabetes (P for interaction=0.0005). The increased risk was observed in fetal-exposed participants with 1 or less ICVHMs (RR, 1.59; 95% CI, 1.24-2.04), but not in those with 2 or more ICVHMs. CONCLUSIONS The increased risk of diabetes associated with famine exposure appears to be modified by the presence of ICVHMs.

Download Full-text

Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Circulation ◽

10.1161/circ.141.suppl_1.p100 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Holly C Gooding ◽

Kimberlee Gauvreau ◽

Jennifer Bachman ◽

Annette Baker ◽

Skylar Griggs ◽

...

Keyword(s):

Cardiovascular Health ◽

Dietary Habits ◽

Smoking Status ◽

Clinical Care ◽

Pediatric Care ◽

Initial Assessment ◽

Ideal Cardiovascular Health ◽

Preventive Cardiology ◽

Cardiology Clinic

Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions. Hypothesis: We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling. Methods: We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal). Results: Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p < 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p<0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy. Conclusion: Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.

Download Full-text

Abstract P047: Ideal Cardiovascular Health Score and Oxidative Stress

Circulation ◽

10.1161/circ.137.suppl_1.p047 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Heval Mohamed Kelli ◽

Chang Liu ◽

Ayman Samman-Tahhan ◽

Talal Alghamdi ◽

Yi-An Ko ◽

...

Keyword(s):

Oxidative Stress ◽

Lifestyle Intervention ◽

High Performance ◽

Cardiovascular Health ◽

Entire Cohort ◽

Ideal Cardiovascular Health ◽

Stress Ratios ◽

The Impact ◽

And Oxidative Stress

Introduction: Ideal cardiovascular health (CVH) promotion is effective for cardiovascular disease prevention. Whether increased CVH score improves oxidative stress is less clear. Our study examined the correlation between changes in ideal CVH status and oxidative stress. Hypothesis: Improvement in CVH score is correlated with changes in oxidative stress. Methods: A total of 569 actively working adult employees (51±11 years, 64% women, 21% Black) underwent a health partner-mediated lifestyle intervention. Serial counseling was delivered by a trained HP focused on promoting clinical self-knowledge and adoption of a healthier lifestyle, based on the subject’s personal schedule. Anthropometric, dietary and laboratory measurements were obtained at baseline and 1- and 2-year follow-up visits. Plasma levels of reduced (glutathione) and oxidized (cystine) aminothiols were measured by high performance liquid chromatography at baseline and follow-up to assess oxidative stress. Ratios of oxidized to reduced aminothiols (cystine/glutathione) were calculated. Linear mixed-effects model was used to examine the correlation between the changes in CVH score and changes in oxidative stress metrics overall 2 years follow-up. Results: Over 2-years, cystine (p=0.01) improved while cystine/glutathione (p=0.03) and glutathione (p<0.001) decreased in the entire cohort. At baseline, CVH score was significantly associated with improvement in cystine by -0.39 μM (95% CI, -0.45, -0.32), glutathione by 0.22 μM (95% CI, 0.14, 0.29) and cystine/glutathione by -0.40 (95% CI, -0.46, -0.33). Overall, one unit increase in the CVH score was associated with a decrease of -0.33 μM (95% CI, -0.42, -0.24) in cystine and -0.38 (95% CI, -0.46, -0.29) in the cystine/glutathione ratio over 2 years. Similarly, an improvement in CVH score by one unit at 2 years was associated with improvement in glutathione by 0.30 μM (95% CI, 0.21, 0.39). Furthermore, reduction in BMI, systolic blood pressure and fasting glucose level was significantly associated with improvement in cystine (all p<0.01), glutathione (all p<0.01) and cystine/glutathione (all p<0.01) over 2 years. Conclusion: Improvement in CVH with a lifestyle intervention was associated with early and sustained improvement in oxidative stress. Whether the impact of changes in CVH metrics on oxidative stress improves long-term morbidity and mortality needs further investigation in a controlled design.

Download Full-text

Ideal Cardiovascular Health Metrics Modify the Association Between Exposure to Chinese Famine in Fetal and Cardiovascular Disease: A Prospective Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.751910 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiong Ding ◽

Jinfeng Li ◽

Ying Wu ◽

Peng Yang ◽

Dandan Zhao ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Prospective Cohort ◽

Cardiovascular Health ◽

Cox Regression ◽

Cvd Risk ◽

Fetal Period ◽

Ideal Cardiovascular Health ◽

Famine Exposure

Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood.Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk.Results: After a median of 13.0 (12.7–13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07–1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11–1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031).Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.

Download Full-text

Applications of intraoperative Duplex ultrasound in vascular surgery: a systematic review

The Ultrasound Journal ◽

10.1186/s13089-021-00208-8 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Pasha Normahani ◽

Bilal Khan ◽

Viknesh Sounderajah ◽

Sepideh Poushpas ◽

Muzaffar Anwar ◽

...

Keyword(s):

Bypass Surgery ◽

Duplex Ultrasound ◽

Residual Flow ◽

Scanning Strategy ◽

Adjusted Risk ◽

Conflicting Evidence ◽

Carotid Artery Endarterectomy ◽

The Impact ◽

Modest Reduction

Abstract Objective This review aims to summarise the contemporary uses of intraoperative completion Duplex ultrasound (IODUS) for the assessment of lower extremity bypass surgery (LEB) and carotid artery endarterectomy (CEA). Methods We performed a systematic literature search using the databases of MEDLINE. Eligible studies evaluated the use of IODUS during LEB or CEA. Results We found 22 eligible studies; 16 considered the use of IODUS in CEA and 6 in LEB. There was considerable heterogeneity between studies in terms of intervention, outcome measures and follow-up. In the assessment of CEA, there is conflicting evidence regarding the benefits of completion imaging. However, analysis from the largest study suggests a modest reduction in adjusted risk of stroke/mortality when using IODUS selectively (RR 0.74, CI 0.63–0.88, p = 0.001). Evidence also suggests that uncorrected residual flow abnormalities detected on IODUS are associated with higher rates of restenosis (range 2.1% to 20%). In the assessment of LEB, we found a paucity of evidence when considering the benefit of IODUS on patency rates or when considering its utility as compared to other imaging modalities. However, the available evidence suggests higher rates of thrombosis or secondary intervention in grafts with uncorrected residual flow abnormalities (up to 36% at 3 months). Conclusions IODUS can be used to detect defects in both CEA and LEB procedures. However, there is a need for more robust prospective studies to determine the best scanning strategy, criteria for intervention and the impact on clinical outcomes.

Download Full-text

Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting

Open Heart ◽

10.1136/openhrt-2020-001425 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001425

Author(s):

Marc Meller Søndergaard ◽

Johannes Riis ◽

Karoline Willum Bodker ◽

Steen Møller Hansen ◽

Jesper Nielsen ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Heart Rate ◽

Left Bundle Branch Block ◽

Bundle Branch Block ◽

Increased Risk ◽

Pr Interval ◽

Qrs Duration ◽

The Impact

AimLeft bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data.Methods and resultsUsing ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment.ConclusionProlonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.

Download Full-text

A prospective study of eating away-from-home meals and weight gain in a Mediterranean population: the SUN (Seguimiento Universidad de Navarra) cohort

Public Health Nutrition ◽

10.1017/s1368980009992783 ◽

2009 ◽

Vol 13 (9) ◽

pp. 1356-1363 ◽

Cited By ~ 59

Author(s):

Maira Bes-Rastrollo ◽

Francisco Javier Basterra-Gortari ◽

Almudena Sánchez-Villegas ◽

Amelia Marti ◽

José Alfredo Martínez ◽

...

Keyword(s):

Weight Gain ◽

Dietary Habits ◽

Mediterranean Area ◽

Mediterranean Population ◽

University Graduates ◽

The Sun ◽

Adjusted Risk ◽

Mediterranean Countries ◽

Eating Out

AbstractObjectiveThe traditional Mediterranean food pattern is more easily preserved when meals are eaten at home; however, as a result of recent socio-economic changes, away-from-home meal consumption has increased rapidly in Mediterranean countries. Little research has been conducted so far to investigate the long-term health effects of these changes in the Mediterranean area.DesignIn a prospective Spanish dynamic cohort of 9182 university graduates (the SUN Study; Seguimiento Universidad de Navarra, University of Navarra Follow-up) with a mean age of 37 years, followed up for an average of 4·4 years, we assessed the association between the frequency of eating out of home and weight gain or incident overweight/obesity. Dietary habits were assessed with an FFQ previously validated in Spain.ResultsDuring follow-up, eating-out consumers (two times or more per week) had higher average adjusted weight gain (+129 g/year, P < 0·001) and higher adjusted risk of gaining 2 kg or more per year (OR = 1·36; 95 % CI 1·13, 1·63) than non-eating-out consumers. Among participants with baseline BMI < 25 kg/m2, we observed 855 new cases of overweight/obesity. Eating away-from-home meals was significantly associated with a higher risk of becoming overweight/obese (hazard ratio = 1·33; 95 % CI 1·13, 1·57).ConclusionsA higher frequency of meals eaten out of home may play a role in the current obesity epidemic observed in some Mediterranean countries.

Download Full-text

Abstract 13315: Long-term Risk of Cardiovascular Events Following Hospitalization for Sepsis: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.13315 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Leah B Kosyakovsky ◽

Federico Angriman ◽

Emma Katz ◽

Neill Adhikari ◽

Lucas C Godoy ◽

...

Keyword(s):

Systematic Review ◽

Cumulative Incidence ◽

Meta Analysis ◽

Hazard Ratios ◽

Increased Risk ◽

Significant Difference ◽

Sepsis Survivors ◽

Risk Ratios

Introduction: Sepsis results in dysregulated inflammation, coagulation, and metabolism, which may contribute to increased cardiovascular disease (CVD) risk. We conducted a systematic review and meta-analysis to determine the association between sepsis and subsequent long-term CVD events. Methods: MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception to May 2020 to identify observational studies of adult sepsis survivors (defined by diagnostic codes or consensus definitions) measuring long-term CV outcomes. The primary outcome was a composite of myocardial infarction, CV death, and stroke. Random-effects models estimated the pooled cumulative incidence and adjusted hazard ratios of CV events relative to hospital or population controls. Odds ratios were included as risk ratios assuming <10% incidence in non-septic controls, and risk ratios were taken as hazard ratios (HR) assuming no censoring. Outcomes were analyzed at maximum follow-up (primary analysis) and stratified by time (<1 year, 1-2 years, and >2 years) since sepsis. Results: Of 11,235 abstracts screened, 25 studies (22 cohort studies, 2 case-crossover studies, and 1 case-control) involving 1,949,793 sepsis survivors were included. The pooled cumulative incidence of CVD events was 9% (95% CI; 5-14%). Sepsis was associated with an increased risk (HR 1.59, 95% CI 1.37-1.86) of CVD events at maximum follow-up ( Figure ); between-study heterogeneity was substantial (I 2 =97.3%). There was no significant difference when comparing studies using population and hospital controls. Significantly elevated risk was observed up to 5 years following sepsis. Conclusions: Sepsis survivors experience an approximately 50% increased risk of CVD events, which may persist for years following the index episode. These results highlight a potential unmet need for early cardiac risk stratification and optimization in sepsis survivors.

Download Full-text

Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽

10.1161/circ.137.suppl_1.021 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Joshua J Joseph ◽

Aleena Bennett ◽

Justin B Echouffo Tcheugui ◽

Valery S Effoe ◽

James Odei ◽

...

Keyword(s):

Racial Differences ◽

Impaired Fasting Glucose ◽

Lower Risk ◽

Cardiovascular Health ◽

Fasting Glucose ◽

Glycemic Status ◽

Ideal Cardiovascular Health ◽

Normal Fasting Glucose ◽

Prevention Of Diabetes

Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

Download Full-text

Abstract P186: A Randomized Preschool Trial To Promote Cardiovascular Health In Colombia: 18 Month Follow Up.

Circulation ◽

10.1161/circ.125.suppl_10.ap186 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Jaime Céspedes ◽

German Briceño ◽

Michael Farkouh ◽

Rajesh Vedanthan ◽

Martha Leal ◽

...

Keyword(s):

Educational Intervention ◽

Cardiovascular Health ◽

Controlled Trial ◽

Intervention Group ◽

Educational Programs ◽

Control Group ◽

Active Lifestyle ◽

And Control ◽

The Impact

Introduction: Educational programs for children can increase uptake of healthy lifestyle behaviors. However, the impact of educational programs in preschool-aged children in low- and middle-income countries is not known. We conducted a five month educational intervention in preschool facilities (PF) in Bogota, Colombia, to assess changes in preschooler’s knowledge, attitudes and habits (KAH) towards healthy eating and living an active lifestyle. Methods: We conducted a cluster, randomized, controlled trial, and randomly assigned 14 PF in Bogota to a five-month educational intervention (7 PF) or to usual curriculum (7 PF). The intervention included classroom activities and use of printed material and videos. A total of 1216 pre-school children, 928 parents, and 120 teachers participated. A structured survey was used to evaluate changes in KAH with a weighted total score (WTS). The primary outcome was change in children's WTS, and the secondary outcomes were change in parents’ and teachers' WTS. The control PF were provided the intervention after the initial evaluation. To assess sustainability, we evaluated both intervention and control groups at 18 months. Results: At 6 months, children in the intervention group showed 10.9% increase in WTS vs. 5.3% in controls, p<0.001, after adjustment for cluster, sex, age and teachers' educational level. Among parents, the equivalent results were 8.9% and 3.1%, respectively, p< 0.001, and among teachers 9.4% and 2.5%, p=0.06. At the 18-month extended follow-up, both the intervention and control children showed a significant further increase in WTS, p<0.001 (Figure 1). In parents and teachers in the intervened group, there was no significant increase in WTS, p=0.7417, and p=0.1197. In the control group, there was an increase in WTS in teachers but not in parents, p=0.001, and p=0.4239. Conclusion: A preschool based intervention, aimed at changing KAH related to healthy diet and active lifestyle, is feasible, efficacious and sustainable up to 18 months in very young children in Colombia.

Download Full-text