Distribution of lifestyle and emerging risk factors by 10-year risk for coronary heart disease

The Effects of Job Instability and Financial Strain on C-Reactive Protein in a Sample of Mexican Immigrants

OBJECTIVE

Mexican immigrants have lower cardiovascular disease risk than US citizens, but risk increases with level of acculturation. Our study investigated whether job stress and financial strain would be related to inflammation (C-reactive protein), lipids, and blood pressure, and if they would play a role in the acculturation process in Mexican immigrants.

METHODS

A sample of 310 Mexican immigrants living in the United States were studied on measures of job stress, financial strain, acculturation, and cardiovascular disease risk factors (C-reactive protein, lipids, and blood pressure).

RESULTS

Job instability, financial strain, and acculturation, were related to inflammation, but psychological demands and decision latitude were not related. Lipids and blood pressure were not related to the variables of interest. Body mass index (BMI) was related to both increased acculturation and inflammation, and when controlling for BMI, acculturation was no longer a significant predictor of inflammation. Job instability and financial strain remained significant predictors of inflammation after controlling for BMI, sex, and age. Job instability and financial strain were not related to acculturation, suggesting that these factors are significant stressors for both newly arrived and more established immigrants.

CONCLUSIONS

Job instability and financial strain predict increased inflammation in Mexican immigrants but they do not play a role in the relationship between acculturation and C-reactive protein. The effects of acculturation on inflammation in this study were mediated by BMI.

Menopausal hormone treatment cardiovascular disease: another look at an unresolved conundrum

Cardiovascular disease (CVD) is the most common cause of death in women. Before the Women's Health Initiative (WHI) hormone trials, evidence favored the concept that menopausal hormone treatment (MHT) protects against CVD. WHI studies failed to demonstrate CVD benefit, with worse net outcomes for MHT versus placebo in the population studied. We review evidence regarding the relationship between MHT and CVD with consideration of mechanisms and risk factors for atherogenesis and cardiac events, results of observational case-control and cohort studies, and outcomes of randomized trials. Estrogen effects on CVD risk factors favor delay or amelioration of atherosclerotic plaque development but may increase risk of acute events when at-risk plaque is present. Long-term observational studies have shown ∼40% reductions in risk of myocardial infarction and all-cause mortality. Analyses of data from randomized control trials other than the WHI show a ∼30% cardioprotective effect in recently menopausal women. Review of the literature as well as WHI data suggests that younger and/or more recently menopausal women may have a better risk-benefit ratio than older or remotely menopausal women and that CVD protection may only occur after >5 years; WHI women averaged 63 years of age (12 years postmenopausal) and few were studied for >6 years. Thus, a beneficial effect of long-term MHT on CVD and mortality is still an open question and is likely to remain controversial for the foreseeable future.

Impact of gender on clinical outcomes after mTOR-inhibitor drug-eluting stent implantation in patients with first manifestation of ischaemic heart disease

BACKGROUND

Women have a worse outcome than men after percutaneous coronary intervention (PCI). However, in the drug-eluting stent (DES) era, limited data are available about the impact of gender-related differences on clinical outcome. Furthermore, many series have also included patients previously treated by coronary-artery bypass grafts or PCI, which may bias the evaluation of DES-related clinical events at follow up. We aimed to assess the impact of gender on clinical outcomes in a consecutive series of patients at first manifestation of coronary artery disease (CAD) undergoing PCI with mTOR-inhibitor DES.

METHODS AND RESULTS

A total of 138 consecutive patients (age 64 ± 13 years, female gender 29%) undergoing successful mTOR-inhibitor DES implantation [sirolimus-eluting stent (SES); zotarolimus-eluting stent (ZES); and everolimus-eluting stent (EES)] for the treatment of stable chronic angina or an acute coronary syndrome, as their first clinical manifestation of CAD, were prospectively enrolled between February 2008 and May 2009. Major adverse cardiac events (MACE), defined as a combination of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TVR) at 12-month follow up, constituted the endpoint of the study. Fifty-one (37%) patients received SES; 46 (33%) patients received ZES; and 41 (30%) patients received EES. At follow up, 21 (15%) patients experienced a MACE. Three (2%) patients had cardiac death, five (4%) had MI, while 13 (9%) patients underwent clinically driven TVR. MACE occurred more frequently in females than males [10 (25%) vs. 11 (11%), p = 0.05]. At Cox regression analysis, the only independent predictors of MACE were female gender and implantation of more than one stent [hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.46-9.36, p = 0.006; HR 1.26, 95% CI 0.99-2.74, p = 0.01, respectively].

CONCLUSIONS

In conclusion, our finding suggests that women may have a worse outcome as compared with men after mTOR-inhibitor DES implantation.

Relationships among Obesity, Bone Mineral Density, and Cardiovascular Risks in Post-menopausal Women

PURPOSE

This study explored the relationships among obesity, bone mineral density, and cardiovascular risks in post-menopausal women.

METHODS

One hundred post-menopausal women were recruited via convenience sampling from osteoporosis prevention program participants who were living in a metropolitan city in September 2006. Obesity was evaluated by body mass index, bone mineral density measured by DEXA scan, and cardiovascular risk factors assessed by a guideline of American Heart Association.

RESULTS

Seventy-two percent of women were either in the osteopenia or osteoporosis group, while 28% were in normal range in lumbar vertebrae. Obese women had greater bone mineral density in lumbar (F=3.31, p=.040) and femur (F=4.72, p=.011). Variables for cardiovascular risks were significantly different for high density lipoprotein (F=7.51, p=.001), systolic blood pressure (F=5.21, p=.007), and in percent of 10-year cardiovascular disease risk according to obesity.

CONCLUSION

Post-menopausal women are at risk for obesity, osteoporosis, and cardiovascular disease. In order to prevent these conditions, nursing interventions such as resistance and aerobic exercise that reduces body weight and bone loss, increases high density lipoprotein, and reduces systolic blood pressure, should be proposed continually through health promotion programs for postmenopausal women.

Temporal changes in trying to lose weight and recommended weight-loss strategies among overweight and obese Americans, 1996-2003

OBJECTIVES

We examined whether the reported prevalence of trying to lose weight among overweight and obese individuals has changed over time, and whether those trying to lose weight report using recommended weight-loss strategies.

METHODS

We used Behavioral Risk Factor Surveillance System data from 50 states and the District of Columbia during 1996, 1998, 2000, and 2003. The sample included participants with a self-reported Body Mass Index (BMI) of > or =25.0 kg/m(2) (N=333,378). The prevalence of trying to lose weight and eating fewer calories, using physical activity, or both, were examined for endpoint change and linear trends.

RESULTS

Between 1996 and 2003, the prevalence of trying to lose weight among obese individuals increased significantly, while it remained stable among overweight individuals. The prevalence of eating fewer calories, using physical activity and using a combination of both increased significantly over time among the overweight and obese individuals trying to lose weight.

CONCLUSION

Despite a rise in the number of overweight and obese people, there was little change among overweight adults in trying to lose weight over time, and a modest-but significant-change among obese adults in trying to lose weight over time. Among those who reported trying to lose weight, there were significant increases in their efforts to use recommended strategies.

Kidney function and estimated vascular risk in patients with primary dyslipidemia

Background:

Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation.

Aim:

To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia.

Methods:

Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation.

Results:

In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined.

Conclusions:

Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.

Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002

BACKGROUND

Epidemiological studies have shown positive findings associated with legume consumption and measures of cardiovascular disease and obesity. However, few observational trials have examined beans as a separate food variable when determining associations with health parameters.

OBJECTIVE

To determine the association of consuming beans on nutrient intakes and physiological parameters using the National Health and Examination Survey (NHANES) 1999-2002.

METHODS

Using data from NHANES 1999-2002, a secondary analysis was completed with a reliable 24-hour dietary recall where three groups of bean consumers were identified (N = 1,475). We determined mean nutrient intakes and physiological values between bean consumers and non-consumers. Least square means, standard errors and ANOVA were calculated using appropriate sample weights following adjustment for age, gender, ethnicity and energy.

RESULTS

Relative to non-consumers, bean consumers had higher intakes of dietary fiber, potassium, magnesium, iron, and copper (p's < 0.05). Those consuming beans had a lower body weight (p = 0.008) and a smaller waist size (p = 0.043) relative to non-consumers. Additionally, consumers of beans had a 23% reduced risk of increased waist size (p = 0.018) and a 22% reduced risk of being obese (p = 0.026). Also, baked bean consumption was associated with a lower systolic blood pressure.

CONCLUSIONS

Bean consumers had better overall nutrient intake levels, better body weights and waist circumferences, and lower systolic blood pressure in comparison to non-consumers. These data support the benefits of bean consumption on improving nutrient intake and health parameters.

The correlation between waist circumference and ESC cardiovascular risk score: data from the German metabolic and cardiovascular risk project (GEMCAS)

BACKGROUND

Identification of patients with high cardiovascular risk, an immanent task of primary care physicians, is laborious, cost intensive and thus difficult to perform. Waist circumference (WC), given its association with multiple risk factors, is an easy to use tool for initial assessment of cardiovascular risk, but its predictive validity in primary care has not been assessed.

PATIENTS AND METHODS

In 2005 a nationwide sample of 35,869 unselected patients visiting a primary care physician was screened. The global cardiovascular risk using the SCORE Score of the European Society of Cardiology was assessed in 10,323 men (aged 35-65) and 18,852 women (45-65). Logistic regressions and Spearman correlations were used to evaluate the interdependence of WC and cardiovascular risk factors as well as the estimated cardiovascular risk.

RESULTS

Of these unselected patients 21.9% had an increased WC (women >80-88, men >94-102 cm) and further 36.5% had a high WC (women >88, men >102 cm). The proportion of patients with a low HDL-cholesterol was higher in high WC compared to normal WC (prevalence rate ratio (PRR) 1.88 [95%CI 1.74-2.02] in men and 2.97 [2.75-3.21] in women). The same applied to elevated triglycerides (PRR 1.72 [1.62-1.84] and 2.57 [2.36-2.80], respectively), impaired fasting glucose (PRR 2.30 [2.13-2.49] and 3.66 [3.29-4.06]), and elevated blood pressure (PRR 1.27 [1.23-1.30] and 1.57 [1.52-1.62]), respectively. The estimated risk to die from cardiovascular events within 10 years based on the SCORE scoring scheme increased with increasing WC (age adjusted rho 0.18 in women and 0.19 in men). A SCORE score of more than 5% was observed in 24.12% of men (age adjusted PRR 1.27, 95%CI 1.12; 1.44) and 3.19% of women (age adjusted PRR 1.77, 95%CI 1.26;2.49) with a high WC as compared to 10.88% of men and 0.95% of women with a normal WC. Particularly, in the age groups 50-59 years (men, 11.1%) and 60-65 years (women, 10.2%) a high WC identified more frequently patients with a SCORE result necessitating action (>5% risk) than in lean men (3.52%, P < 0.0001) and women (4.32%, P < 0.0001).

CONCLUSIONS

Routine measurement of waist circumference in primary care attendees is a suitable screening tool to identify patients with high cardiovascular risk in which a further diagnostic workup is necessary. Current cut-off values reflect a higher risk threshold in men than in women. Future research should identify new thresholds based on cardiovascular risk burden.

High-sensitivity C-reactive protein is associated with the risk of coronary heart disease as estimated by the Framingham Risk Score in middle-aged Japanese men

BACKGROUND

High-sensitivity C-reactive protein (hsCRP) has emerged as an independent predictor of coronary heart disease (CHD) in Western countries. However, it is still uncertain regarding whether hsCRP is associated with the risk of CHD in Japan.

METHODS

The serum hsCRP levels were measured in 687 middle-aged Japanese male workers (age range; 40-59 years) during an annual health examination at a company in Kanagawa, Japan, in 2005. All participants were free from any cardiovascular diseases and any medications for hypertension, hyperlipidemia, or diabetes. The Framingham Risk Score (FRS) was calculated as an individual's risk level of future development of CHD. Associations between hsCRP and the FRS were then evaluated.

RESULTS

The distribution of hsCRP was skewed to the left with a median value (interquartile range) of 0.3 (0.2, 0.6) mg/L. Log-transformed hsCRP significantly correlated with all components of the FRS except for age. The FRS gradually and significantly increased (p=0.001 for trend) with an increase in the quartiles of hsCRP after adjusting for multiple potential confounders such as triglycerides, the body mass index, alcohol intake, and a family history of cardiovascular disease. For the highest quartile of hsCRP, crude and above-listed confounders-adjusted odds ratios of the high-risk for CHD (FRS>/=6 point) compared to the lowest quartile were 6.97 (95% CI: 3.20-15.17, p<0.001) and 3.85 (95% CI: 1.69-8.77, p=0.001), respectively.

CONCLUSIONS

These results suggest that hsCRP is associated with the risk of CHD, as estimated by the FRS, in middle-aged Japanese men.