Racial and sex differences in biological and chronological heart age in the Coronary Artery Risk Development in Young Adults study

Cardiovascular magnetic resonance imaging markers of ageing: a multi-centre, cross-sectional cohort study

Aims

Cardiac ageing involves a series of anatomical and physiological changes contributing to a decline in overall performance. Cardiac magnetic resonance (CMR) provides comprehensive structural and functional assessment for detecting age-related cardiovascular remodelling. We aimed to develop a fully automated CMR model to predict functional heart age.

Methods and results

This international, multi-centre, retrospective observational study enrolled 191 healthy individuals with normal body mass index (BMI), free of metabolic, cardiovascular, and respiratory disease as the derivation cohort. Left atrial (LA) end-systolic volume and LA ejection fraction were selected for the final model. The model was validated on 366 patients with BMI >25 kg/m2 and one or more comorbidities [hypertension, diabetes mellitus (DM), atrial fibrillation (AF), and obesity]. In healthy individuals [median age: 34 years, 105 (55%) female], CMR-derived functional heart age was similar to the chronological age [bias: 0.05%, 95% confidence interval (CI): 9.56-9.67%, P = 0.993]. In the validation cohort [median age: 53 years, 157 (43%) female], CMR-derived functional heart age was 4.6 years higher than chronological age (95% CI: 1.6-7.6 years, P = 0.003). Cardiac magnetic resonance-derived functional heart age was significantly higher in patients with hypertension (P < 0.001), DM (P < 0.001), and AF (P < 0.001) than age-matched healthy controls. Moreover, CMR-derived functional heart age was higher than the chronological age in obesity Class I (P = 0.07), obesity Class II (P = 0.11), and obesity Class III (P < 0.001).

Conclusion

This study highlights the time course of structural and physiological changes in the heart during healthy and unhealthy ageing. We propose simple equations that should help communicate subtle changes in heart assessment with ageing.

Registration

ClinicalTrials.gov: NCT05114785.

Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score

INTRODUCTION

Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health.

AIM

This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults.

METHODS

Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator.

RESULTS

We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups.

CONCLUSIONS

These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.

Folate, Vitamin B6, and Vitamin B12 Status in Association With Metabolic Syndrome Incidence

IMPORTANCE

The associations of B vitamin status with metabolic syndrome (MetS) incidence among the US population remain unclear.

OBJECTIVE

To investigate intakes and serum concentrations of folate, vitamin B6, and vitamin B12 in association with MetS risk in a large US cohort.

DESIGN, SETTING, AND PARTICIPANTS

This prospective study included Black and White young adults in the US who were enrolled from 1985 to 1986 and studied until 2015 to 2016. Diet was assessed using a validated diet history at examination years 0, 7, and 20. Serum concentrations of folate, vitamin B6, and vitamin B12 were assayed at examination years 0, 7, and 15 in a subset of 1430 participants. MetS was ascertained by clinic and laboratory measurements and self-reported medication use. Data were analyzed between January and July 2021.

EXPOSURES

Intakes and serum levels of folate, vitamin B6, and vitamin B12.

MAIN OUTCOMES AND MEASURES

Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs for the associations of energy-adjusted B vitamin intakes or serum B vitamin levels with incident MetS.

RESULTS

The study included 4414 participants, with 2225 Black individuals (50.4%) and 2331 women (52.8%). The mean (SD) age at baseline was 24.9 (3.6) years. A total of 1240 incident MetS cases occurred during the 30 years (mean [SD], 22.1 [9.5] years) of follow-up. Compared with the lowest quintile of each energy-adjusted B vitamin intake, the HRs for incident MetS in the highest quintile were 0.39 (95% CI, 0.31-0.49) for folate (P for trend < .001), 0.61 (95% CI, 0.46-0.81) for vitamin B6 (P for trend = .002), and 0.74 (95% CI, 0.58-0.95) for vitamin B12 (P for trend = .008) after adjustment for potential confounders. Similarly, significant inverse associations were observed in the subset with serum data on these B vitamins (folate: HR, 0.23; 95% CI, 0.17-0.33; P for trend < .001; vitamin B6: HR, 0.48; 95% CI, 0.34-0.67; P for trend < .001; and vitamin B12: HR, 0.70; 95% CI, 0.51-0.96; P for trend = .01).

CONCLUSIONS AND RELEVANCE

This prospective cohort study found that intakes and serum concentrations of folate, vitamin B6, and vitamin B12 were inversely associated with incident MetS among Black and White young adults in the US.

Predicted heart age profile across 41 countries: A cross-sectional study of nationally representative surveys in six world regions

BACKGROUND

Predicted heart age (PHA) can simplify communicating the absolute cardiovascular disease (CVD) risk. Few studies have characterized PHA across multiple populations, and none has described whether people with excess PHA are eligible for preventive treatment for CVD.

METHODS

Pooled analysis of 41 World Health Organization (WHO) STEPS surveys conducted in 41 countries in six world regions between 2013 and 2019. PHA was calculated as per the non-laboratory Framingham risk score in adults without history of CVD. We described the differences between chronological age and PHA, the distribution of PHA, and the proportion of people with excess PHA that were eligible for antihypertensive and lipid-lowering treatment following the WHO guidelines. Logistic regression models were fitted to assess sociodemographic and health-related variables associated with PHA excess.

FINDINGS

94,655 individuals aged 30-74 years were included. 36% of those aged 30-34 years had a PHA of 30-34 years; 9% of those aged 60-64 years had a PHA of 60-64 years. Countries in Africa had the lowest prevalence of very high PHA (i.e., PHA exceeding chronological age in ≥5 years) and countries in Western Pacific had the highest. ≥50% of the population with PHA excess (i.e., PHA exceeding chronological age in ≥1 year) was not eligible for antihypertensive nor lipid-lowering treatment. Abdominal obesity, high total cholesterol, smoking and having diabetes were associated with higher odds of having PHA excess, whereas higher education and employment were inversely associated with excess PHA.

INTERPRETATION

PHA is generally higher than chronological age in LMICs and there are regional disparities. Most people with excess PHA would not be eligible to receive preventive medication.

FUNDING

RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).

Stress and aging: A neurovisceral integration perspective

Darwin emphasized the intimate relationship between the brain and the heart over 150 years ago. Healthy aging is associated with significant changes in both the brain and the heart. The changes between these, the two most important organs of the body, are linked via the vagus nerve. In this review, we examine the normative changes with aging and the effect that stress may have on how the brain-heart connection changes with age. We provide a framework based on the concept of neurovisceral integration and propose that stress regulation is emotion regulation. As such, studies that have investigated emotion regulation may yield insights into successful stress regulation that helps protect people from age-related decline. In addition, interventions that improve brain health also improve heart health and vice versa. We conclude by noting that significant sex and ethnic differences exist but that future studies are needed to more fully explicate how they may moderate the associations between stress and aging.