Prevention of cardiovascular disease in young adults: Focus on gender differences. A collaborative review from the EAS Young Fellows

Comparison of triglyceride-glucose related indices in prediction of cardiometabolic disease incidence among US midlife women

The effects of triglyceride-glucose (TyG) related indices on cardiometabolic disease (CMD) are still unclear. Our study aimed to investigate the relationship between the TyG-related indices and CMD risk among midlife women. This retrospective observational cohort study utilized data from the 2020 SWAN participants. The TyG index was computed as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Modified TyG indices were created by integrating TyG with body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression and receiver operating characteristic (ROC) analyses were conducted to assess the associations and predictive capacities of TyG and its related indices with CMD incidences. The mean age of participants was 45.7 years, comprising 420 (20.8%) Black, 184 (9.1%) Chinese, 225 (11.1%) Japanese, and 1191 (58.9%) Caucasian or Hispanic women. Over a 10-year follow-up, 837 women (41.4%) developed CMD. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident CMD in the highest quartile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.78 (1.41-2.25), 3.26 (2.51-4.24), 3.13 (2.41-4.06), and 3.19 (2.47-4.12), respectively. The area under the ROC curve for modified TyG indices was significantly higher than that for the TyG index alone. Both the TyG and modified TyG indices were significantly associated with new-onset CMD, with modified TyG indices showing superior performance in identifying individuals at risk for CMD.

Secular trends in physical fitness and cardiovascular risks among Chinese college students: an analysis of five successive national surveys between 2000 and 2019

Background

With increasing concerns about early-onset cardiovascular diseases, it is essential to understand the distribution of cardiovascular health among young adults. This study aimed to characterize trends in physical fitness and the prevalence of overweight/obesity (OWOB), elevated blood pressure (EBP), and their comorbidity among Chinese college students from 2000 to 2019 and to analyze the changes in their associations and subgroup differences.

Methods

Data were extracted from five cycles of the Chinese National Survey on Students' Constitution and Health (2000-2019), including 241,710 college students aged 19-22. Physical fitness indicator (PFI) was computed using standardized z-scores of forced vital capacity, sit-and-reach, 50-m dash, standing long jump, muscle strength, and endurance running. OWOB was defined as a body mass index ≥25 kg/m2, and EBP as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Comorbidity was defined as the co-occurrence of OWOB and EBP. Mixed-effects logistic regression was used to analyze associations, and generalized linear mixed-effects models were applied to examine dose-response relationships.

Findings

The median of college students' PFI deteriorated continuously from -0.16 in 2000 to -1.99 in 2019, with boys experiencing a faster decline than girls. The prevalence of OWOB, EBP, and comorbidity increased significantly from 3.7%, 2.2%, and 0.3% in 2000 to 14.0%, 5.2%, and 1.8% in 2019, respectively, with boys exhibiting higher prevalence than girls. Decreasing PFI levels were significantly associated with the increasing prevalence of OWOB, EBP, and comorbidity, and such associations were strongest in 2019. L-shaped curves were observed for the relationships between PFI and the prevalence of OWOB, EBP, and comorbidity, with stronger associations in boys. Provincial population attributable fraction showed that when improving the PFI levels from low to middle-low or above, college students in Guizhou, Sichuan, and Yunnan provinces exhibited the most reductions in OWOB, EBP, and comorbidity.

Interpretation

Physical fitness among Chinese college students has significantly declined over the past two decades, accompanied by marked increases in the burden of cardiovascular risks. There is an urgent need to increase the focus on college students' health and establish a college-based physical examination system to assess their long-term cardiovascular function.

Funding

The present study was funded by National Key R&D Program of China (Grant No. 2024YFC2707901 to Yi Song), National Natural Science Foundation of China (Grant No. 82273654 to Yi Song), and Beijing Office for Education Sciences Planning (Grant No. BBAA22027 to Yi Song).

Analysis of Personalized Cardiovascular Drug Therapy: From Monitoring Technologies to Data Integration and Future Perspectives

Cardiovascular diseases have long been a major challenge to human health, and the treatment differences caused by individual variability remain unresolved. In recent years, personalized cardiovascular drug therapy has attracted widespread attention. This paper reviews the strategies for achieving personalized cardiovascular drug therapy through traditional dynamic monitoring and multidimensional data integration and analysis. It focuses on key technologies for dynamic monitoring, dynamic monitoring based on individual differences, and multidimensional data integration and analysis. By systematically reviewing the relevant literature, the main challenges in current research and the proposed potential directions for future studies were summarized.

Evaluations of metabolic and innate immunity profiles in subjects with familial hypercholesterolemia with or without subclinical atherosclerosis

BACKGROUND

Familial hypercholesterolemia (FH) is a genetic condition characterized by high low-density lipoprotein cholesterol (LDL-C). The presence of risk modifiers could promote the atherosclerotic injury beyond LDL-C. Our aim was to evaluate metabolic and innate immunity profiles in FH subjects with or without subclinical atherosclerosis.

METHODS

In this cross-sectional observational study, we evaluated 211 genetically confirmed FH subjects on LDL-C target and without cardiovascular diseases. Biochemical analyses, LDL-C burden (LCB) calculation and vascular profile evaluation were obtained from all subjects. Study population was divided into two groups according to subclinical atherosclerosis: the subclinical atherosclerosis (SA) group and non-subclinical atherosclerosis (NSA) group.

RESULTS

SA group had higher LDL-C at diagnosis (288.35 ± 24.52 vs 267.92 ± 23.86, p < 0.05) and LCB (13,465.84 ± 3617.46 vs 10,872.63 ± 3594.7, p < 0.001) than NSA group. SA group had higher white blood cell count (WBCC, 6.9 ± 1.66 vs 6.1 ± 1.16), neutrophil count (NC, 4.2 ± 1.3 vs 3.6 ± 1.11), monocyte count (MC, 0.8 ± 0.2 vs 0.4 ± 0.1), triglyceride to high-density lipoprotein ratio (TG/HDL, 1.73 ± 0.72 vs 1.45 ± 0.69), triglyceride-glucose index (TyG, 8.29 ± 0.35 vs 8.01 ± 0.33) than NSA group (p value for all < 0.01). Multivariate logistic regression analysis showed that LCB (p < 0.01), WBCC (p < 0.01), NC (p < 0.05), MC (p < 0.05) were associated with subclinical atherosclerosis. Simple linear regression analyses showed that LCB was associated with WBCC, NC, MC (p value for all < 0.01).

CONCLUSION

An increased LCB and an impaired innate immunity profile were found in FH subjects with subclinical atherosclerosis and they were independently associated with atherosclerotic injury. LCB could modulate the innate immunity profile.

Global burden of heart failure in children and adolescents from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019

BACKGROUND

Heart failure (HF) significantly impacts the cardiovascular health of children and adolescents. This study aims to assess epidemiologic trends in HF across sex, age, region, and time period.

METHODS

The number and age-standardized rate (ASR) of prevalence and years lived with disability (YLDs) were derived from the Global Burden of Disease Study 2019. We applied descriptive estimates, correlation analysis, and joinpoint linear regression to determine the trends in HF burden and its etiologies across different dimensions.

RESULTS

Globally, the number of children and adolescent HF patients exceeded 640,000 in 2019. A positive association was found between sociodemographic index (SDI) levels and HF burden, with higher SDI regions showing the greatest impact, especially in the 15-19-year-old group. The prevalence declined from 57.86 per 100,000 in 1990 to 56.17 in 2019, and YLDs decreased from 5.35 to 5.20 per 100,000 over the same period. Temporal burden trends varied among different SDI regions in the first two decades. Overall, children under 10 years old suffered a heavier burden and presented a more evident increasing trend compared to those aged 10-19 years. Males had a more severe HF burden than females across most regions, age groups, and underlying diseases. When exploring HF-related causes, congenital birth defects, cardiomyopathy and myocarditis were the most common etiologies of cardiac dysfunction.

CONCLUSION

Prompt and effective implementation of preventive and management policies worldwide among children and adolescents aged 0-19 years is a top priority to help curb the increasing burden of HF.

The association of sexual frequency with cardiovascular diseases incidence and all-cause mortality

Sexual activity exists in a complex relationship with human health. This study aims to elucidate the correlation between the sexual frequency and the incidence of cardiovascular diseases (CVD) and all-cause mortality among young and middle-aged adults of the United States. We analyzed 17,243 participants from the National Health and Nutrition Examination Survey(NHANES)(2005-2016), comparing CVD incidence and all-cause mortality risks across sexual frequencies using multivariable Logistic and Cox regression models. Kaplan-Meier curves assessed survival probability stratified by sexual frequency, and a restricted cubic spline regression examined the nonlinear relationship between sexual frequency, CVD and survival status. We also established a nomogram and validated it by ROC and calibration curves. Over a median follow-up period of 106 months, 443 patients (2.57%) died. After adjusting for confounders, sexual frequency was found to be associated with CVD incidence and all-cause mortality among young and middle-aged individuals. Those with sexual acts less than 12 times/year faced the highest risks of CVD incidence and all-cause mortality, as frequency increased, the risks gradually decreased, reaching a nadir at approximately 52-103 times/year, but then a negative correlation began to emerge. A nomogram predicting survival rates based on sexual frequency achieved ROC areas of 0.782, 0.807, and 0.803 for 3, 5, and 10 years, with a calibration curve matching the ideal generally. Sexual frequency was associated with the incidence of CVD and all-cause mortality among young and middle-aged adults. Both excessive and infrequent sexual frequency may be detrimental to health.

Statin therapy in primary and secondary cardiovascular disease prevention

PURPOSE OF REVIEW

Atherosclerotic cardiovascular disease (ASCVD) is one of the most common causes of death globally and the leading one in the US. Elevated low-density lipoprotein (LDL) cholesterol is one of the main modifiable disease risk factors and statin therapies have been extensively studied in that regard. The present work presents the clinical trials derived evidence supporting the use of statins in primary and secondary cardiovascular disease prevention.

RECENT FINDINGS

Statins are a major moderator of hepatic LDL cholesterol output, effectively reducing serum LDL cholesterol concentrations, in a dose-dependent manner. Their use as a single agent or in combination with other treatment modalities (ezetimibe, PCSK9 inhibitors etc.) has been proven to prevent ASCVD events and reduce cardiovascular disease incidence and mortality substantially. Their use is warranted as a first line agent in all secondary prevention patients, as well as those in primary prevention at high or very high risk for ASCVD events and based on the presence of specific modifiers, even in selected cases at moderate ASCVD risk. Their potency and dose should be tailored to the individual's cardiovascular risk and the tolerance to their potential adverse effects in order to achieve the guidelines-directed LDL goals. Statin therapies are the mainstay of therapy for ASCVD risk reduction and should be initiated in all patients at high enough of a risk, to reduce event rates, morbidity and mortality.

Food insecurity and the consumption of plant-centered meals and high sodium foods among students at three large state universities

Objective: To examine the associations between food insecurity and plant-centered meal consumption and other sodium-related dietary behaviors among university students. Methods: A web-based survey of students at three California state universities was conducted between August 2018 to May 2019. Multivariable logistic regressions examined the associations between food insecurity and four sodium-related dietary behaviors. Interaction terms were introduced to assess if race/ethnicity moderated these associations. Results: High food insecurity was associated with increased odds of reporting 'likely to order' plant-centered meals (AOR = 1.55, 95% CI = 1.16-2.05). Moderate food insecurity was associated with increased odds of frequently eating processed foods (AOR = 1.40, 95% CI = 1.13-1.74). No moderation effects were found for race/ethnicity. Conclusions: University students with high food insecurity appeared receptive to ordering plant-centered meals, whereas those with moderate food insecurity consumed more processed foods. State universities should encourage and offer more low-sodium, plant-centered meal options in their food venues, on- and off-campus, to promote student health.

Trends in statin use for the primary prevention of atherosclerotic cardiovascular disease among US adults by demographic characteristics, 1999-2020

PURPOSE

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide. Statins, which are effective in preventing ASCVD, are underused, particularly for primary prevention. This study examined trends in statin use for primary ASCVD prevention from 1999 to 2020, focusing on demographic variations.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey, the present study includes individuals aged 18 years and older who had a greater than 10% risk of ASCVD over 10 years, and excluded patients with existing ASCVD. Subgroup analyses by demographic categories were performed. We calculated the changes in statin usage and used linear and quadratic tests to assess the linear and nonlinear trends in those changes.

RESULTS

A total of 10,037 participants were included. Statin usage increased from 16.16% in 1999 to 36.24% in 2010, and 41.74% in 2020 (quadratic P-value < 0.001). In the 18-44 years age group, statin usage increased from 2.52% in 1999 to 8.14% in 2020 (linear P-value = 0.322), showing no significant linear trend. In the "never-married" group, statin usage increased from 19.16% in 1999 to 30.05% in 2020 (linear P-value = 0.256).

CONCLUSION

Statin usage has shown a positive trend among populations requiring primary prevention for ASCVD. Currently, health policies are proving effective. However, the overall statin usage rate remains less than 50%. Additionally, young and never-married individuals should also receive special attention regarding statin usage as primary treatment for ASCVD.

Cardiovascular Risk Estimation and Stratification Among Individuals with Hypercholesterolemia

PURPOSE OF THE REVIEW

This review aims to assess the variability in considering hypercholesterolemia for cardiovascular risk stratification in the general population. Recent literature on the integration of hypercholesterolemia into clinical risk scores and its interaction with other risk factors will be explored.

RECENT FINDINGS

The impact of hypercholesterolemia on risk estimation varies among different cardiovascular risk calculators. Elevated lipid levels during early life stages contribute to atherosclerotic plaque development, influencing disease severity despite later treatment initiation. The interplay between low-density lipoprotein cholesterol (LDLc), inflammatory markers and non-LDL lipid parameters enhances cardiovascular risk stratification. Studies have also examined the role of coronary artery calcium (CAC) score as a negative risk marker in populations with severe hypercholesterolemia. Furthermore, polygenic risk scores (PRS) may aid in diagnosing non-monogenic hypercholesterolemia, refining cardiovascular risk stratification and guiding lipid-lowering therapy strategies. Understanding the heterogeneity in risk estimation and the role of emerging biomarkers and imaging techniques is crucial for optimizing cardiovascular risk prediction and guiding personalized treatment strategies in individuals with hypercholesterolemia.

Comparison of autonomic nervous system dysfunction, arterial stiffness, and heart rate recovery according to spinal cord injury level

OBJECTIVE

To investigate the differences in autonomic nervous system (ANS) dysfunction, arterial stiffness, and the degree of delay in post-exercise heart rate recovery (HRR) according to the level of spinal cord injury (SCI), and propose preventive measures against cardiovascular diseases after SCI.

METHODS

This retrospective study included 51 patients with SCI. Based on the neurological level of injury (NLI), patients were divided into two groups: Group A (NLI at and above T6) and Group B (NLI below T6). To assess ANS dysfunction, the head-up tilt test and 24-hour ambulatory blood pressure monitoring were conducted. Arterial stiffness was measured using the pulse wave velocity test. The exercise tolerance test was conducted to measure post-exercise HRR.

RESULTS

Group A had significantly higher values in the head-up tilt test and 24-hour ambulatory blood pressure monitoring. In the pulse wave velocity test, both sides (left and right) had significantly higher values in Group B. One minute after the exercise tolerance test, Group A had significantly slower HRR (18.8 ± 11.1 beats/minute) than Group B.

CONCLUSION

Understanding the impact of ANS dysfunction and arterial stiffness on HRR in SCI according to NLI may provide insights for clinical management and preventative strategies for cardiovascular diseases.

Sex and age significantly modulate cardiovascular disease presentation in type 2 diabetes: a large population-based cohort study

Aims

We aimed to describe and compare the incidence of the first cardiovascular event and its major subtypes, coronary heart disease (CHD), cerebrovascular disease, heart failure (HF), or peripheral artery disease (PAD), according to age and sex in a population-based cohort of individuals with type 2 diabetes (T2D) from a Mediterranean region.

Material and methods

We used linked primary care electronic medical reports, pharmacy-invoicing data, and hospital admission disease registry records from the SIDIAP database, which contains linked data for 74% of the Catalonian population. We selected individuals with T2D aged 30 to 89 years free of cardiovascular disease (CVD). The primary outcome was the first presentation of CVD.

Results

The study cohort included 247,751 individuals (48.6% women, 66.8 ± 11.9 years). During a 6.99-year follow-up, the cumulative incidence of the first cardiovascular event was 23.4%. Men were at higher risk for CVD (hazard ratio [HR]: 1.47 95%CI: 1.45-1.50), CHD (HR: 1.52 95%CI: 1.47-1.57), cerebrovascular disease (HR:1.07 95%CI: 1.03-1.10) and PAD (HR: 2.30 95%CI: 2.21-2.39) than women but at a lower risk for HF (HR:0.70 95%CI: 0.68-0.73). CHD and PAD were the most frequent CVD presentations among men (28.1% and 27.5%) and HF (40.1%) in women. CHD predominated among young participants of both sexes, while HF predominated among women older than 65 and men older than 75.

Conclusions

In individuals with T2D, the overall risk and the type of first CVD manifestation largely varied by sex and age. This epidemiological evidence should be considered in clinical practice.

The impact of SLCO1B1 rs4149056 on LDL-C target achievement after lipid lowering therapy optimization in men and women with familial hypercholesterolemia

Background and aims

FH women are less likely to receive intensive statin treatment and to obtain a 50% reduction of LDL-C from baseline compared to men with FH. SLCO1B1 rs4149056 might influence statin therapy compliance and thus LDL-C target achievement. Our aim was to evaluate the impact of SLCO1B1 rs4149056 on LDL-C target achievement after lipid lowering therapy (LLT) optimization in men and women with FH.

Methods

This was a retrospective observational study involving 412 FH subjects with a probable or defined clinical diagnosis of FH who had had genetic analysis from June 2016 to September 2022. Biochemical analysis was obtained from all subjects at baseline and at the last follow-up after LLT optimization.

Results

After LLT optimization the percentage of FH subjects on high-intensity statins decreased from the M/SLCO1B1- group to the W/SLCO1B1+ group and the same was found in LDL-C target distribution (for both p for trend < 0.01). The prevalence of SASE fear increased from the M/SLCO1B1- group to the W/SLCO1B1+ group and the same was observed in reported myalgia distribution (for both p for trend < 0.01). Logistic regression analysis showed that the W/SCLO1B1-, M/SCLO1B1+ and W/SCLO1B1+ groups were inversely associated with LDL-C target achievement (p for trend < 0.001) and the W/SCLO1B1+ group exhibited the strongest association.

Conclusion

A low prevalence of FH women with SLCO1B1 rs4149056 were on high intensity statins and they rarely achieved LDL-C target. The genotype effect of SLCO1B1 rs4149056 could be more pronounced in FH women than men.

Sex differences in diagnostic modalities of coronary artery disease: Evidence from coronary microcirculation

Although atherosclerosis is usually considered a disease of the large arteries, risk factors for atherosclerosis also trigger structural and functional abnormalities at a microvascular level. In cardiac disease, microvascular dysfunction is especially relevant in women, among whom the manifestation of ischemic disease due to impaired coronary microcirculation is more common than in men. This sex-specific clinical phenotype has important clinical implications and, given the higher pre-test probability of coronary microvascular dysfunction in females, different diagnostic modalities should be used in women compared to men. In this review, we summarize invasive and non-invasive diagnostic modalities to assess coronary microvascular function, ranging from catheter-based evaluation of endothelial function to Doppler echocardiography and positron emission tomography. Moreover, we discuss different clinical settings in which microvascular disease plays an important role, underlining the importance of choosing the right diagnostic modality depending on the sex of the patients.

Cardiovascular disease in transgender individuals

The population of people identifying as transgender has grown rapidly in recent years, resulting in a substantive increase in individuals obtaining gender-affirming medical care to align their secondary sex characteristics with their gender identity. This has established benefits for patients including improvements in gender dysphoria and psychosocial functioning, while reducing adverse mental health outcomes. Despite these potential advantages, recent evidence has suggested that gender-affirming hormone therapy (GAHT) may increase the risk of cardiovascular disease. However, owing to a paucity of research, the mechanisms underpinning these increased risks are poorly understood. Moreover, previous research has been limited by heterogenous methodologies, being underpowered, and lacking appropriate control populations. Consequently, the need for evidence regarding cardiovascular health in LGBTQ + individuals has been recognised as a critical area for future research to facilitate better healthcare and guidance. Recent research investigating the effect of transmasculine (testosterone) GAHT on cardiovascular disease risk points to testosterone effecting the nitric oxide pathway, triggering inflammation, and promoting endothelial dysfunction. Equivalent studies focussing on transfeminine (oestrogen) GAHT are required, representing a crucial area of future research. Furthermore, when examining the effects of GAHT on the vasculature, it cannot be ignored that there are multiple factors that may increase the burden of cardiovascular disease in the transgender population. Such stressors include major psychological stress; increased adverse health behaviours, such as smoking; discrimination; and lowered socioeconomic status; all of which undoubtedly impact upon cardiovascular disease risk and offers the opportunity for intervention.