Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association

Psychosis in Neurocognitive Disorder Among Ethnoculturally Diverse Older Persons

Background and Objectives

There is longstanding evidence that the presence of psychosis in neurocognitive disorders (NCDs) is associated with faster cognitive and functional decline. The goal of this study was to examine how clinician-diagnosed psychosis differs among ethnoracial groups with NCDs (including early onset) and to explore whether these differences exist even for those without advanced dementia.

Method

This is an IRB-approved retrospective analysis. Data are from the National Alzheimer's Coordinating Center Uniform Dataset from 42 Alzheimer's Disease Research Centers. Participants aged 40-95 years as of June 2023 with mild cognitive impairment (MCI) or dementia on baseline evaluation were included. Psychosis was defined as clinician-diagnosed visual or auditory hallucinations or delusions manifesting at the time of baseline evaluation. Ethnoracial groups were self-reported. Associations between ethnoracial groups and psychosis in NCDs were estimated using adjusted multivariable logistic regression with dichotomous measures of outcomes. Covariates included age, sex, years of education, severity of cognitive impairment (Clinical Dementia Rating scale), and presence or absence of any self-reported preexisting psychiatric illness. An analysis by age younger than 65 years was also conducted. Exploratory multivariable logistic regression analyses were performed for participants with milder stages of dementia (Clinical Dementia Rating 0.5 or 1) and for the subset of participants diagnosed with MCI.

Results

A total of 22,854 participants were included. The mean age was 73 + 9.7 years, and 50% were women. A total of 8,352 (37%) had MCI and 14,502 (63%) had dementia. In adjusted analysis, American Indian/Alaska Native (AI/AN) (OR 2.70, 1.75-4.17, p < 0.0001), Black-Latino (OR 2.33, 1.25-4.35, p = 0.0076), Other-Latino (OR 1.82, 1.42-2.33, p < 0.0001), Black, non-Latino (NL) (OR 1.66,1.47-1.87, p < 0.0001), and White-Latino (OR 1.42, 1.21-1.67, p < 0.0001) participants had greater odds of any psychotic symptom than White-NL participants. For age groups 40 to younger than 65 years, only Black-NL participants (OR 1.56, 1.13-2.14, p = 0.0064) were more likely to be diagnosed with any psychotic symptoms. For milder stages of dementia, Black-Latino (OR 3.44, 1.58-7.48, p = 0.0018), AI/AN (OR 2.73, 1.66-4.48, p < 0.0001), Other-Latino (OR 2.38, 1.72-3.30, p < 0.0001), Black-NL (OR 2.08,1.77-2.45, p < 0.0001), and White-Latino (OR 1.55, 1.23-1.95, p = 0.0002) participants had greater odds of psychosis in NCDs when compared with White-NL participants. For MCI alone, there were no significant differences.

Discussion

Black-NL, Latino, and AI/AN individuals were more likely to be diagnosed with psychosis in NCDs when compared with White-NL participants. More research is needed to explore sociocultural, psychosocial, and neuropathologic factors involved.

Chondroitin sulfate and Cys-Ala-Gly peptides coated ZE21B magnesium alloy for enhanced corrosion resistance and vascular compatibility

Coronary stents are widely used in the interventional treatment of cardiovascular disease. Biodegradable magnesium alloy stents are ideal candidates to replace traditional non-biodegradable stents due to their excellent mechanical properties and biodegradation. However, too fast degradation and poor biocompatibility limit the further clinical application of magnesium alloy stents. Herein, a composite coating consisting of an MgF2 layer, PDA layer, ChS, and CAG peptide was constructed on the Mg-Zn-Y-Nd (ZE21B) alloy to enhance its corrosion resistance, hemocompatibility, and cytocompatibility. The MgF2 and PDA layers in the composite coating could collectively enhance the corrosion resistance of ZE21B alloy, and the ChS and CAG peptides in the composite coating could improve the anticoagulant and pro-endothelialization capacity of ZE21B alloy. The corrosion current density of the modified ZE21B alloy was much lower than that of bare ZE21B alloy, proving the better corrosion resistance. Moreover, the excellent hemocompatibility of modified ZE21B alloy was verified by the lower levels of hemolysis rate, fibrinogen adsorption and denaturation, and platelet adhesion and activation. Furthermore, the composite coating could selectively promote the adhesion, proliferation, migration, and competitive growth of endothelial cells rather than smooth muscle cells on the ZE21B alloy owing to the synergistic biological effects of ChS and CAG peptides. The ChS/CAG modified samples also exhibited excellent biosafety and histocompatibility in vivo implantation experiments. The composite coating significantly improved the corrosion resistance and biocompatibility of ZE21B alloy, and provided a simple and effective strategy for developing degradable vascular stents.

Prenatal Psychosocial Stressors and Blood Pressure Across 4 Years Postpartum

BACKGROUND

Psychosocial stress is a cardiovascular risk factor; however, little is known about whether prenatal psychosocial stressors influence postpartum cardiovascular health. We aimed to examine the associations of multiple measures of prenatal psychosocial stress on maternal blood pressure (BP) in the first 4 years after birth.

METHODS

Among 225 MADRES cohort (Maternal and Developmental Risks From Environmental and Social Stressors) participants, we examined associations of average prenatal Perceived Stress Scale (PSS), Center for Epidemiological Studies Depression (CES-D) scores, and second-trimester neighborhood social cohesion scores on systolic and diastolic BP collected at annual postpartum study visits (1-4 years) using linear mixed-effects models, adjusted for covariates.

RESULTS

Higher prenatal PSS and CES-D scores were associated with greater diastolic BP at 1 year postpartum (0.24 [95% CI, 0.01-0.46] and 0.24 [95% CI, 0.08-0.40] mm Hg per 1-unit higher PSS and CES-D, respectively) and greater systolic BP (0.25 [95% CI, 0.02-0.48] mm Hg per 1-unit higher CES-D). Overall associations of PSS and CES-D with BP were attenuated over the 4-year postpartum period (P<0.05). Stratified analyses suggested larger associations of PSS and CES-D among US-born participants and participants with normotensive pregnancies. While neighborhood social cohesion was not associated with postpartum BP overall, higher neighborhood social cohesion scores were associated with lower BP at 1 year postpartum among participants with normotensive pregnancies and lower systolic BP among foreign-born Hispanic participants.

CONCLUSIONS

Higher prenatal perceived stress and depressive symptoms were associated with greater 1-year postpartum BP, whereas neighborhood cohesion was associated with lower 1-year postpartum BP. These results suggest prenatal psychosocial factors may impact cardiovascular health within the first year after birth.

Hypertensive disorders of pregnancy and gestational diabetes mellitus and predicted risk of maternal cardiovascular disease 10-14 years after delivery: A prospective cohort

AIMS

Studies evaluating the relationship between adverse pregnancy outcomes (APOs), namely hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with the estimated risk of atherosclerotic cardiovascular disease (ASCVD) remains limited and could inform patient-centred decision-making in the postpartum period. We examined whether HDP or GDM were associated with a higher 10- and 30-year predicted risk of ASCVD measured 10-14 years after delivery.

METHODS

A secondary analysis from the international prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (2013-2016) cohort. The exposures were HDP or GDM (untreated according to the International Association of the Diabetes and Pregnancy Study Groups criteria). Outcomes were 10- and 30-year predicted risk of ASCVD (composite of fatal and non-fatal coronary heart disease and stroke) as quantified by the validated Framingham Risk Score as a continuous measure, and secondarily, at thresholds used for clinical decision-making of ≥7.5% for 10-year predicted risk and ≥20% for 30-year predicted risk.

RESULTS

Of 4432 individuals at a median age of 30.5 years and a median gestational age of 27.9 weeks at pregnancy enrollment, 10.7% developed HDP and 13.7% developed GDM. At 10-14 years after delivery, individuals with HDP had a higher 10-year predicted risk of ASCVD (least squares mean: 2.9% vs. 2.2%; adj. β: 0.59; 95% CI: 0.41-0.77) and a higher 30-year predicted risk of ASCVD (7.7% vs. 6.1%; adj. β: 1.27; 95% CI: 0.81-1.72) compared with those without HDP. Similarly, individuals with GDM had a higher predicted risk of ASCVD (10-year: 3.2% vs. 2.1%; adj. β: 0.51; 95% CI: 0.34-0.67 and 30-year: 8.8% vs. 5.8%; adj. β: 1.56; 95% CI: 1.11-2.01) compared with those without GDM. These results were similar when predicted ASCVD risk was assessed at thresholds of ≥7.5% at 10 years and ≥20% at 30 years.

CONCLUSION

Individuals who experienced HDP or GDM had a higher predicted 10- and 30-year risk of ASCVD measured 10-14 years after delivery compared with individuals who did not experience these APOs.

Healthier lifestyles can modify the air pollutants effect on cardiovascular disease among the middle-aged and elderly

There is increasing evidence that air pollutants significantly increase the risk of cardiovascular disease (CVD). Nevertheless, less research has been conducted to date to reveal protective factors. Therefore, this study aims to indicate whether a healthy lifestyle can modify the effects of environmental pollution on CVD. This study screened 3010 participants from the China Health and Retirement Longitudinal Study (CHARLS) Wave 3 (2015). The study aimed to systematically demonstrate the impact of environmental pollution on CVD and elucidate the role of a healthy lifestyle. Air pollutant data were obtained from the China High Air Pollutant (CHAP) datasets. We analyzed the relationship between these pollutants and cardiovascular disease risk using generalized linear mixed models. In addition, healthy lifestyles were categorized as low, medium, and high; stratified analyses were conducted to estimate the effect of healthy lifestyles on the risk of CVD due to air pollutants. 607 had CVD among 3010 participants, and the three-year mean concentrations of the pollutants chloride ion (Cl-), nitrate ion (NO3-), particulate matter with a diameter of 10 micrometers or less (PM10), particulate matter with a diameter of 10 micrometers or less (PM1), particulate matter with a diameter of 10 micrometers or less (PM2.5) were each linked 1.37 (95%CI:1.22,1.54), 1.03 (95%CI:1.00,1.06), 1.02 (95%CI:1.01,1.03), 1.01 (95%CI:1.00,1.01), and 1.01 (95%CI:1.00,1.01) fold risk of CVD, respectively. For the subgroups of low, medium, and high according to the healthy lifestyle score in model 2, the average concentration of Cl- pollutant was each associated with 1.34 (1.12,1.62), 1.34 (1.12,1.61), and 1.32 (1.03,1.71) times risk with CVD, respectively. The NO3 - was each associated with 1.06 (1.02,1.11), 1.01 (0.97,1.05), and 0.98 (0.93,1.04) times risk with CVD, respectively. The PM1 was each associated with 1.03 (1.01,1.05), 1.01 (0.99,1.02), and 1.00 (0.97,1.02) times risk with CVD, respectively. The PM10 was each associated with 1.01 (1.00,1.01), 1.01 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. PM2.5 was each associated with 1.02 (1.01,1.03), 1.00 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. Exposure to these pollutants(Cl-, NO3-, PM10, PM1, PM2.5)is associated with higher risk of CVD, and healthier lifestyles can reduce the risk of CVD due to overall air pollutants.

The Role of Psychological Health in Cardiovascular Health: A Racial Comparison

Purpose: Modifiable health factors influence racial disparities in cardiovascular health (CVH), yet the role of psychological health in these disparities remains understudied. This study examines (1) the association between negative and positive psychological health measures and CVH and (2) the racial differences in these associations among US adults. Methods: Aim 1 included adults aged 34-84 from the MIDUS biomarker substudy (n = 1255). Aim 2 included adults aged 28-84 from the MIDUS parent study (N = 4702). Our outcome was CVH, operationalized as the AHA's Life's Essential 8 (LE8) total score, behavior, and health factor subscores. Negative psychological health was operationalized as depressive symptoms (CES-D), stress reactivity (from the Multidimensional Personality Questionnaire [MPS]), aggression (from the MPS), pessimism (Life Orientation Test), perceived stress (Perceived Stress Scale), and trait anxiety (Spielberger Trait Anxiety Inventory); positive psychological health was operationalized as psychological well-being ("PWB"; Ryff Well-Being Scale [WBS] and MPS), purpose in life (from the WBS), mindfulness (developed by MIDUS), gratitude (developed by MIDUS), and optimism (Life Orientation Test). Results: In covariate-adjusted models, most negative psychological health factors were negatively associated with LE8 total scores and health behavior subscores. Of those, pessimism was the only factor to demonstrate Black-White differences (Black > White, p < 0.001). Positive psychological health factors were less consistently associated with the LE8 total, health behavior, and health factor subscores in covariate-adjusted models. Of these, PWB (Black > White, p < 0.001), gratitude (Black > White, p < 0.001), and optimism (Black > White, p < 0.001) demonstrated significant differences by race. Conclusions: Black-White differences in LE8 are not largely explained by differences in psychological health.

Are the Cardiovascular Benefits and Potential Risks of Physical Activity and Exercise Dependent on Race, Ethnicity, or Sex?

Physical activity (PA) is established as a cornerstone of cardiovascular health, however, disparities in participation exist across sociocultural groups, which in turn affect cardiovascular outcomes. Evidence suggests that although the positive cardiovascular effects of exercise are consistent across populations, notable differences in the magnitude of these benefits exist for racial and ethnic minorities and the female sex. Women derive greater protection from PA compared with men, with reduced rates of sudden cardiac death. In this review we examine the complex interplay of race and/or ethnicity and sex on the cardiovascular benefits associated with PA and exercise, cardiovascular adaptations to exercise, risks of sudden cardiac death, and "excessive" volume of exercise. Understanding these factors is crucial for developing targeted interventions to promote cardiovascular health and offset disparities.

Association between polysocial risk score and CVH among women of reproductive age in the SAFE HEART study: An American Heart Association Research Goes Red Initiative

BACKGROUND

To assess the association between polysocial risk factors and cardiovascular health (CVH) among women of reproductive age.

METHODS

Our cross-sectional analysis included women of reproductive age (18-44 years) from community settings and the American Heart Association's Research Goes Red (RGR) registry. Polysocial risk scores (0-14) reflected social disadvantage across domains including socioeconomic stability (education, employment, income, insurance, financial strain), living situation (housing stability, housing quality, marital status, home ownership), food security, transportation, utilities, and interpersonal safety. Suboptimal CVH was defined as having ≥2 risk factors from Life's Essential 8 metrics: physical activity, diet, body mass index, sleep, smoking, blood pressure, blood sugar, and cholesterol. Associations between polysocial risk and suboptimal CVH were analyzed using linear regression models RESULTS: Suboptimal CVH increased with higher polysocial risk, from 77.0 % in the lowest quartile to 95.2 % in the highest. Participants in quartile 3 had the highest odds of suboptimal CVH (aOR 9.52, 95 % CI 2.63-34.46), while quartile 4 showed decreased but significant odds (aOR 3.86, 95 % CI 1.03-14.40) compared to quartile 1. Hypertension (aOR 10.23, 95 % CI 3.61-29.01), diabetes (aOR 8.87, 95 % CI 3.12-25.24), hyperlipidemia (aOR 7.48, 95 % CI 2.72-20.55), and smoking (aOR 9.46, 95 % CI 3.25-27.56) were strongly associated with higher polysocial risk in community-enrolled participants, whereas trends were less consistent in RGR-enrolled participants.

CONCLUSIONS

Women with higher social risks face greater odds of suboptimal CVH. Screening for social determinants and tailored public health interventions are essential for mitigating CVH risks in this population.

Exercise and cardiovascular health among breast cancer survivors: a scoping review of current observational evidence

BACKGROUND

Breast cancer survivors are at increased risk of cardiovascular events due to the cardiotoxic effects of cancer treatment. Exercise participation can lower the risk of various adverse cardiovascular health outcomes. However, most breast cancer survivors do not meet exercise guidelines.

OBJECTIVES

To map and critically evaluate the observational literature describing the direction and strength of the relationship between post-diagnosis leisure-time exercise (aerobic and muscle-strengthening) and cardiovascular health (cardiovascular disease, cardiac function, and related physiological risk factors) among diverse breast cancer survivors; and identify variations in this relationship based on race, ethnicity, and/or socioeconomic status.

METHODS

Our scoping review was conducted in accordance with established guidelines and frameworks. Seven databases were searched. Participant characteristics, findings regarding the relationship between exercise and cardiovascular health, and any variations in this relationship were extracted. Article quality was appraised using the Mixed Methods Appraisal Tool.

RESULTS

Fourteen sources were identified, and study quality varied. Two adjusted analyses found aerobic exercise may lower the risk of cardiovascular disease. There was limited data found on the direction and strength of an adjusted relationship between exercise (aerobic or muscle-strengthening) and other cardiovascular outcomes or possible variations in the relationship across racial, ethnic, or socioeconomic groups.

CONCLUSION

Findings highlight a considerable gap in knowledge regarding the relationship between exercise and cardiovascular health among diverse breast cancer survivors. Further longitudinal observational research is needed to better establish the direction and strength of this relationship, and how it differs based on race, ethnicity, or socioeconomic status.

Mind-body therapy for cardiometabolic risk in U.S. middle-aged Black adults: a scoping review

Background

In the U.S., Black adults do not achieve the same life expectancy as their White counterparts, and this is attributable in large part to the development of cardiovascular disease (CVD). Mind-body therapy (MBT) interventions demonstrate improvements in cardiometabolic risk (CMR) factors that promote CVD, with increased feasibility and acceptability in the general population. Less known is the feasibility, acceptability, and evidence of reduction in CMR factors in the U.S. Black population with MBT.

Purpose

This study aimed to synthesize the current state of research regarding MBT on CMR factors in middle-aged U.S. Black adults and identify gaps in the literature. Research Question 1: What types of studies have been conducted (study design, theoretical framework, and cultural relevance)? and Research Question 2: What is the feasibility and acceptability and effectiveness of MBT in Black adults for CMR reduction?

Methods

Following PRISMA-ScR guidelines, a review of three databases was conducted. Our inclusion criteria were articles that (1) describe empirical research; (2) assessed a MBT intervention in middle-aged (35-64) adults with a minimum of 60% Black adult participants for CMR reduction; and (3) written in English. Independent reviewers selected articles for inclusion and data extraction, with a third reviewer providing consensus.

Results

Fourteen articles met the eligibility criteria (n = 14). Characteristics included randomized controlled trials (8, 57.1%); single-arm (3, 21.0%); mixed methods (3, 21.0%); sample size (17-375); mean age range 43-64; female (6, 42.8%); theoretical framework (4, 28.6%); culturally adapted (7, 50.0%); and studies demonstrating feasibility and/or acceptability (7, 50.0%). Of the seven articles assessing CMR physiologic factors, five studies observed significant improvement. For the 11 studies assessing CMR psychological factors, 6 studies had statistically significant results and 3 studies identified trends toward positive statistical outcomes.

Implication

A growing body of literature across research stages demonstrating acceptability, and feasibility, and evidence of effectiveness for selected outcomes of MBT in middle-aged Black adults with CMR factors shows promise. Future research recommendations include greater recruitment of Black men for MBT studies, larger sample sizes, and utilizing culturally adapted interventions for engaging Black adults in MBT for reduced CMR factors.

Getting to the Heart of the Matter: Exploring the Intersection of Cardiovascular Disease, Sex and Race and How Exercise, and Gut Microbiota Influence these Relationships

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. CVD incidence, however, is not uniform with recognized sex differences as well and racial and ethnic differences. Furthermore, gut microbiota have been associated with CVD, sex, and race/ethnicity. Researchers have begun to examine the interplay of these complicated yet interrelated topics. This review will present evidence that CVD (risk and development), and gut microbiota are distinct between the sexes and racial/ethnic groups, which appear to be influenced by acculturation, discrimination, stress, and lifestyle factors like exercise. Furthermore, this review will address the beneficial impacts of exercise on the cardiovascular system and will provide recommendations for future research in the field.

Socioeconomic disadvantage in pregnancy and postpartum risk of cardiovascular disease

BACKGROUND

Pregnancy is an educable and actionable life stage to address social determinants of health (SDOH) and lifelong cardiovascular disease (CVD) prevention. However, the link between a risk score that combines multiple neighborhood-level social determinants in pregnancy and the risk of long-term CVD remains to be evaluated.

OBJECTIVE

To examine whether neighborhood-level socioeconomic disadvantage measured by the Area Deprivation Index (ADI) in early pregnancy is associated with a higher 30-year predicted risk of CVD postpartum, as measured by the Framingham Risk Score.

STUDY DESIGN

An analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. Participant home addresses during early pregnancy were geocoded at the Census-block level. The exposure was neighborhood-level socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]) measured in the first trimester. Outcomes were the predicted 30-year risks of atherosclerotic cardiovascular disease (ASCVD, composite of fatal and nonfatal coronary heart disease and stroke) and total CVD (composite of ASCVD plus coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication, and heart failure) using the Framingham Risk Score measured 2 to 7 years after delivery. These outcomes were assessed as continuous measures of absolute estimated risk in increments of 1%, and, secondarily, as categorical measures with high-risk defined as an estimated probability of CVD ≥10%. Multivariable linear regression and modified Poisson regression models adjusted for baseline age and individual-level social determinants, including health insurance, educational attainment, and household poverty.

RESULTS

Among 4309 nulliparous individuals at baseline, the median age was 27 years (interquartile range [IQR]: 23-31) and the median ADI was 43 (IQR: 22-74). At 2 to 7 years postpartum (median: 3.1 years, IQR: 2.5, 3.7), the median 30-year risk of ASCVD was 2.3% (IQR: 1.5, 3.5) and of total CVD was 5.5% (IQR: 3.7, 7.9); 2.2% and 14.3% of individuals had predicted 30-year risk ≥10%, respectively. Individuals living in the highest ADI tertile had a higher predicted risk of 30-year ASCVD % (adjusted ß: 0.41; 95% confidence interval [CI]: 0.19, 0.63) compared with those in the lowest tertile; and those living in the top 2 ADI tertiles had higher absolute risks of 30-year total CVD % (T2: adj. ß: 0.37; 95% CI: 0.03, 0.72; T3: adj. ß: 0.74; 95% CI: 0.36, 1.13). Similarly, individuals living in neighborhoods in the highest ADI tertile were more likely to have a high 30-year predicted risk of ASCVD (adjusted risk ratio [aRR]: 2.21; 95% CI: 1.21, 4.02) and total CVD ≥10% (aRR: 1.35; 95% CI: 1.08, 1.69).

CONCLUSION

Neighborhood-level socioeconomic disadvantage in early pregnancy was associated with a higher estimated long-term risk of CVD postpartum. Incorporating aggregated SDOH into existing clinical workflows and future research in pregnancy could reduce disparities in maternal cardiovascular health across the lifespan, and requires further study.

Quality of Oral Anticoagulation Control with Warfarin According to Sex: A Cross-Sectional Study

Evidence indicates a difference between men and women in oral anticoagulation control, but the results were discrepant. This study investigated the association of sex with oral anticoagulation control in patients on warfarin assisted by anticoagulation clinics (ACs) in Brazil. The cross-sectional study included patients on warfarin recruited at three public ACs in southeast Brazil (2014-2015). The quality of oral anticoagulation was estimated by the time in therapeutic range (TTR). Univariable and multivariable linear regression models were built to examine the association of sociodemographic, behavior, clinical, and drug therapy variables with TTR. Overall, 801 participants were studied (455; 56.8% women), with a mean age of 65.0 (13.4) years. The female sex was associated with lower TTR than the male sex (Beta (95% CI) = -17.01 (-30.25; -3.76), p = 0.012), however, this difference decreased with increasing age, becoming null after age 60. Smoking patients had a lower TTR than non-smokers (-5.18 (-10.02; -0.34), p = 0.036). The results showed that the association of sex with oral anticoagulation control is dependent on age. Women have lower TTR than men, but this difference is null in older patients. Knowledge of these factors may be useful for developing strategies to improve care for these patients.

Demographic diversity in platelet function and response to antiplatelet therapy

Recent studies have highlighted the complexity of platelet biology, revealing their diverse roles beyond hemostasis. Pathological platelet activation is now recognized as a key contributor to thrombosis and inflammation that are both central to cardiovascular disease (CVD). Emerging research emphasizes the significant impact of demographic factors - such as age, sex, race, and ethnicity - on CVD risk and responses to antiplatelet therapies. These population-based differences, shaped by genetic and non-genetic factors, highlight the need for reevaluation of antiplatelet strategies. We address current knowledge and emphasize the pressing need for further research into platelet biology and cardiovascular outcomes across diverse populations. In this review we advocate for tailored therapeutic approaches in CVD based on the recent demographic-focused findings.

Epigenetic modifications and emerging therapeutic targets in cardiovascular aging and diseases

The complex mechanisms underlying the development of cardiovascular diseases remain not fully elucidated. Epigenetics, which modulates gene expression without DNA sequence changes, is shedding light on these mechanisms and their heritable effects. This review focus on epigenetic regulation in cardiovascular aging and diseases, detailing specific epigenetic enzymes such as DNA methyltransferases (DNMTs), histone acetyltransferases (HATs), and histone deacetylases (HDACs), which serve as writers or erasers that modify the epigenetic landscape. We also discuss the readers of these modifications, such as the 5-methylcytosine binding domain proteins, and the erasers ten-eleven translocation (TET) proteins. The emerging role of RNA methylation, particularly N6-methyladenosine (m6A), in cardiovascular pathogenesis is also discussed. We summarize potential therapeutic targets, such as key enzymes and their inhibitors, including DNMT inhibitors like 5-azacytidine and decitabine, HDAC inhibitors like belinostat and givinotide, some of which have been approved by the FDA for various malignancies, suggesting their potential in treating cardiovascular diseases. Furthermore, we highlight the role of novel histone modifications and their associated enzymes, which are emerging as potential therapeutic targets in cardiovascular diseases. Thus, by incorporating the recent studies involving patients with cardiovascular aging and diseases, we aim to provide a more detailed and updated review that reflects the advancements in the field of epigenetic modification in cardiovascular diseases.

Current status of modifiable risk factors for cardiovascular disease in Korean women

Hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking are the primary modifiable risk factors contributing to the increasing morbidity and mortality rates from cardiovascular disease (CVD) among Korean women. Significant sex-related differences exist in the prevalence, awareness, treatment, and control of these risk factors, highlighting the importance of age- and sex-specific approaches to the management and prevention of CVD. Notably, the prevalence of hypertension and diabetes mellitus increases with age, with a higher prevalence in elderly women compared to men. Dyslipidemia and obesity are also trending upward, particularly in postmenopausal women, highlighting the impact of menopause on cardiovascular risk. The present review advocates for improved diagnostic, therapeutic, and educational efforts to mitigate the risk of CVD among Korean women, with the goals of reducing the overall burden of the disease and promoting better cardiovascular health outcomes.

Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative

BACKGROUND

Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women.

METHODS AND RESULTS

A total of 121 286 study-eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which 16 108 major CVD events were documented. Using generalized structural equations modeling coupled with survival analysis techniques, we estimated the effects of SES on major CVD events through smoking, body mass index, comorbidities, cardiometabolic risk factors, and self-rated health, controlling for WHI component, region, age, race, ethnicity, marital status, and health care provider access. Among veterans, SES characteristics were indirectly related to major CVD events through body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Among nonveterans, lower education (β= 0.2, P<0.0001), household income (β=+0.4, P<0.0001), and neighborhood SES (β=+0.2, P<0.0001) were positively related to major CVD events, and these relationships were partly mediated by body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Smoking played a mediating role only among nonveterans.

CONCLUSIONS

Nonveteran postmenopausal women exhibit more complex pathways between SES and major CVD events than their veteran counterparts, informing the design, conduct, and evaluation of preventive strategies targeting CVD by veteran status.

2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association

AIM

The "2024 Guideline for the Primary Prevention of Stroke" replaces the 2014 "Guidelines for the Primary Prevention of Stroke." This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals with no history of stroke.

METHODS

A comprehensive search for literature published since the 2014 guideline; derived from research involving human participants published in English; and indexed in MEDLINE, PubMed, Cochrane Library, and other selected and relevant databases was conducted between May and November 2023. Other documents on related subject matter previously published by the American Heart Association were also reviewed.

STRUCTURE

Ischemic and hemorrhagic strokes lead to significant disability but, most important, are preventable. The 2024 primary prevention of stroke guideline provides recommendations based on current evidence for strategies to prevent stroke throughout the life span. These recommendations align with the American Heart Association's Life's Essential 8 for optimizing cardiovascular and brain health, in addition to preventing incident stroke. We also have added sex-specific recommendations for screening and prevention of stroke, which are new compared with the 2014 guideline. Many recommendations for similar risk factor prevention were updated, new topics were reviewed, and recommendations were created when supported by sufficient-quality published data.

The Relationship of Pain Intensity, Perceived Injustice, and Pain Catastrophizing to Heart Rate Variability In Naturally Occurring Acute Pain

OBJECTIVES

Behavioral factors of pain catastrophizing and perceived injustice are associated with pain intensity in chronic pain. Diminished heart rate variability (HRV) is also strongly associated with chronic pain. These factors have been less explored earlier in the pain experience and it is unclear whether they play a role in the transition from acute to chronic pain. The aim of this study was to determine the relationship between pain catastrophizing, perceived injustice, pain intensity, and HRV in naturally occurring acute pain.

MATERIALS AND METHODS

Ninety-seven patients were recruited from local outpatient physical therapy clinics. Seated HRV was captured on 94 patients via Polar chest strap while patients were taking a survey via iPad. In addition to sociodemographic data, the survey included the Pain Catastrophizing Scale (PCS), Injustice Experience Questionnaire (IEQ), and Numeric Pain Rating Scale (NPRS). The natural log of high-frequency power (lnHFP) HRV was used in the statistical analysis.

RESULTS

Multiple linear regression modeling revealed that lower pain catastrophizing, higher perceived injustice, and lower pain intensity were associated with lower HRV, and accounted for 11.4% of the variance in HRV.

DISCUSSION

While greater chronic pain intensity is associated with lower HRV, the relationship is reversed in the setting of acute pain. These findings highlight the need to better understand the unique factors that contribute to lower HRV in the acute phase.

Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies' consensus document

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide. Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women's cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD. Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)'s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women. This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex- and gender-based research through collaboration across different affiliated societies within the BCS.

The complexity of cardiovascular risk in women. Descriptive review

OBJECTIVES

Cardiovascular diseases (CVD) are the greatest threat to the health of women and is the leading cause of death amongst women globally; however, cardiovascular disease in women remains understudied, under-recognized, underdiagnosed, and undertreated. The aim of this descriptive review is to summarize the existing problem and to identify the knowledge gaps in cardiovascular disease research, prevention, treatment, and access to care for women.

MATERIAL AND METHODS

This is a descriptive review of the literature based on numerous articles published in peer-reviewed journals since the beginning of this century related to the spectrum of cardiovascular disease in women.

RESULTS

There are several obstacles to improve cardiovascular disease outcomes in women. One of them is the lack of reliable, effective screening modalities since her participation in clinical trial is quite low. Other concern is the complexity of the female organism with several hormonal changes during her life and the hemodynamics stress during pregnancy. Moreover, in the last stage of their life several cardiometabolic risk factor may appear, most of them not recognized by the health team in primary care attention.

DISCUSSION

Effective strategies are required to address inequalities in the diagnosis, treatment and prevention of heart disease in women; to advance innovative solutions for early detection and oriented management; to clarify the underlying biological mechanisms that contribute to sex-specific differences in outcomes; and finally, reduce the global burden of cardiovascular disease in women.

Impact of Digital Health Interventions on Birth Equity: A Review

The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.

Home environment and cigarette quitting behaviors among rural Black/African American women caregivers

OBJECTIVE

This cross-sectional study described the home tobacco environment and its association with quitting behaviors among Black/African American women caregivers who smoke cigarettes and live in rural, low-resourced areas.

METHOD

A baseline survey was administered to caregivers enrolled in a randomized trial from 2020 to 2022 (n = 147). Logistic regressions identified the associations between the independent variables (home cigarette smoking bans, caregiver restrictions on child cigarette access, number of people in the home who smoked around the caregiver during the past week, and who smoked in the caregiver's home) and three outcome variables: lifetime quit attempt, past-year quit attempt and use of evidence-based cessation strategies during a last quit attempt.

RESULTS

Caregivers have multiple generations of family smoking in their homes, including caregivers' children/nieces/nephews (21%) and their parents (36%). Young family members smoking in the home was related to the caregiver's parents (p = .046) and grandparents (p = .03) smoking in the home. The number of people smoking around the caregiver was associated with lower odds of a lifetime quit attempt (odds ratio, OR = 0.63, confidence interval, CI [0.47, 0.85]; adjusted OR = 0.61, CI [0.45, 0.84]). No independent variables were significantly related to past-year quit attempts in unadjusted or adjusted models. Caregivers with young family members smoking in the home were more likely to have used evidence-based cessation strategies versus those without young family smoking (OR = 16.96, CI [1.01, 283.68]).

CONCLUSIONS

Black/African women caregivers who smoke and live in rural, low-resourced areas are exposed to numerous family members smoking in their homes which may affect quitting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence of Cardiometabolic Risk Factors in Women: Insights From the Houston HeartReach Study

BACKGROUND

Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening.

METHODS

Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test.

RESULTS

Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (<$25,000) were more likely to have diabetes (P = .001) and overweight or obesity (P = .004) than participants in the highest income bracket (≥$50,000). Unemployed participants had a higher prevalence of diabetes (P < .001), overweight or obesity (P = .004), and dyslipidemia (P < .001) than employed participants. Comorbidity analysis revealed clustering of multiple cardiometabolic risk factors. Moreover, risk factor hot spots were identified by zip code, which could help select future sites for targeted screening.

CONCLUSION

The analysis found that cardiometabolic risk factor prevalence varies with demographic and socioeconomic status. Geographic areas where cardiometabolic risk factor prevalence was highest were also identified. Further participant recruitment and analysis are required to create predictive models of cardiovascular disease risk in women.

Central Hemodynamics in African American Women: Examining the Role of Superwoman Schema Endorsement

BACKGROUND

African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women.

METHODS AND RESULTS

Using cross-sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0-105) and SWS-Obligation to Help Others (range, 0-3). Multiple linear regression modeled associations between Overall SWS (10-unit increments) and SWS-Obligation to Help Others (1-unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19-1.47]) and SWS-Obligation to Help Others (β=2.03 [95% CI, 0.39-3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02-1.30]) and SWS-Obligation to Help Others (β=2.21 [95% CI, 0.58-3.84]). Significant associations were not observed between pulse wave velocity and SWS.

CONCLUSIONS

Greater endorsement of the Superwoman role and prioritizing caregiving over self-care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.

Improving diversity in cardiac surgery clinical trials with ROMA:Women as an exemplar

PURPOSE OF REVIEW

To describe methods to improve representation of women in cardiac surgery clinical trials.

RECENT FINDINGS

Cardiovascular disease risk among women is high. Historically, women have been excluded from cardiac surgery trials, in part due to restrictive inclusion criteria. Surgical outcomes, specifically after coronary artery bypass grafting, are consistently worse among female patients, and these outcomes have not improved over the last decade. Addressing treatment effects and clinical benefit among women requires accurate representation in cardiovascular surgery trials. ROMA:Women, is the first cardiac surgery trial to focus solely on women, with the goal of addressing underrepresentation. Through utilizing specific strategies, ROMA:Women is a promising first step in advancing health equity.

SUMMARY

Strategies to ensure effective recruitment and representation among women in cardiac surgery clinical trials, such as tailored eligibility criteria and comprehensive strategies to improve communication and increase trust, are two of many potential approaches to address the structural barriers to female representation in cardiac surgery clinical trials. To date, ROMA:Women is an example of a trial that has shown extraordinary preliminary success enrolling women. Designing trials exclusively for women is one strategy to improve the diversity of clinical trial participation.

Design and rationale of the social determinants of the risk of hypertension in women of reproductive age (SAFE HEART) study: An American Heart Association research goes red initiative

BACKGROUND

Cardiovascular health literacy (CVHL) and social determinants of health (SDoH) play interconnected and critical roles in shaping cardiovascular health (CVH) outcomes. However, awareness of CVH risk has declined markedly, from 65% of women being aware that cardiovascular disease (CVD) is the leading cause of death for women in 2009 to just 44% being aware in 2019. The American Heart Association Research Goes Red (RGR) initiative seeks to develop an open-source, longitudinal, dynamic registry that will help women to be aware of and participate in research studies, and to learn about CVD prevention. We proposed to leverage this platform, particularly among Black and Hispanic women of reproductive age, to address CVHL gaps and advance health equity.

METHODS

The primary objective of the study is to evaluate the cross-sectional association of CVHL, SDoH using a polysocial score, and CVH in women of reproductive age at increased risk of developing hypertension (HTN). To achieve this we will use a cross-sectional study design, that engages women already enrolled in the RGR registry (registry-enrolled). To enhance the racial and ethnic/social economic diversity of the cohort, we will additionally enroll 300 women from the Baltimore and Washington D.C. community into the Social Determinants of the Risk of Hypertension in Women of Reproductive Age (SAFE HEART) Study. Community-enrolled and registry-enrolled women will undergo baseline social phenotyping including detailed SDoH questionnaire, CVH metrics assessment, and CVHL assessment. The secondary objective is to assess whether a 4-month active health education intervention will result in a change in CVHL in the 300 community-enrolled women.

DISCUSSION

The SAFE HEART study examines the association between CVHL, SDoH, and CVH, with a focus on racial and ethnic minority groups and socioeconomically disadvantaged women of reproductive age, and the ability to improve these parameters by an educational intervention. These findings will inform the future development of community-engaged strategies that address CVHL and SDoH among women of reproductive age.

Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies

Background

Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.

Methods

UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade.

Findings

The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.

Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.

Funding

National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

A quantitative study to assess cardiovascular risks among older African American women living in rural black belt areas of Alabama

Limited information is available regarding the knowledge of Cardiovascular Disease (CVD) risk factors and the actual risk behaviors among African American (AA) older women living in rural areas of Alabama. A pilot study of needs assessment for CVD prevention behaviors was conducted to collect such data from rural AA women. This paper reports the quantitative part of the needs assessment of this pilot study. We recruited participants (N = 30) using convenience sampling. Data collection measures included: i) American Heart Association's CVD-related knowledge questionnaire, ii) Five Times Sit to Stand Test to measure dynamic balance and iii) Six minute walk test (6MWT) to assess exercise endurance iv) standard weighing scale to measure body weight and v) standard measurements scale to measure height.  Descriptive and inferential statistics were used to analyze the data. The majority (76%) of participants had hypertension (70%), diabetes (60%), poor balance (70%), and low exercise endurance (100%). Most of the participants had low knowledge related to CVD risk factors. This study demonstrated the need to conduct a large-scale study to assess knowledge related to heart health and the actual needs and preferences of these individuals. Conducting such a study would lay the foundation for developing a need-based program for these underserved individuals while incorporating their preferences and the strategies that would help engage them in a heart health intervention.

Emerging Pathway to a Precision Medicine Approach for Angina With Nonobstructive Coronary Arteries in Women

Women are disproportionately affected by symptoms of angina with nonobstructive coronary arteries (ANOCA) which is associated with significant mortality and economic impact. Although distinct endotypes of ANOCA have been defined, it is underdiagnosed and is often incompletely characterized when identified. Patients are often unresponsive to traditional therapeutic options, which are typically antianginal, and the current ability to guide treatment modification by specific pathways is limited. Studies have associated specific genetic loci, transcriptomic features, and biomarkers with ANOCA. Such panomic data, in combination with known imaging and invasive diagnostic techniques, should be utilized to define more precise pathophysiologic subtypes of ANOCA in women, which will in turn help to identify targeted, effective therapies. A precision medicine-based approach to managing ANOCA incorporating these techniques in women has the potential to significantly improve their clinical care.

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.

Coexistence of Standard Modifiable, Other Classical, and Novel and Classical Atherosclerotic Cardiovascular Disease Risk Factors in Middle Eastern Young Women

Background

The coexistence of multiple standard modifiable risk factors (SMuRFs),classical and novel risk factors (RFs) for atherosclerotic cardiovascular disease (ASCVD) is common in the Middle East (ME). There is a paucity of data on the coexistence of these RFs in ME young women.

Aim

Comparing the prevalence and the statistical patterns of the SMuRFs, classical and novel RFs in target population.

Methods

In this case-control (1:2) study, consecutive young women aged 18-50 years were enrolled in 12 centers (July 2021 to October 2023). Prevalence and coexistence of 19 RFs were compared between cases with ASCVD and their controls. The RFs included SMuRFs (hypertension, type 2 diabetes, dyslipidemia, and cigarette smoking), other classical RF (obesity, family history of premature ASCVD, and physical inactivity), novel RFs and social determinants of health (health insurance, place of residence, depression, and level of education).

Results

The study included 627 subjects; 209 had ASCVD (median age 46 years, IQR 49-42 years) and 418 controls (median age 45 years, IQR 48-41 years). The presence of 1-2 RFs; (ASCVD: 63.2%, Control: 54.1%, p=0.037) and 3-4 RFs; (ASCVD: 27.8%, Control: 3.3%, p < 0.001) SMuRFs was more prevalent in women with ASCVD. Similarly, the presence of 4-5 RFs; (ASCVD: 40.7%, Control: 14.6%, p<0.001), and 6-7 (ASCVD: 10.5%, Control: 1%, p < 0.001). The classical RF were also significantly common in these women. The distribution of multiple novel RF was not statistically significant across both groups. Finally, regarding the socioeconomic RFs in women with ASCVDs, the presence of 1-2 RFs (ASCVD: 59.8%, Control: 76.1%, p < 0.001) was significantly less common while the presence of 3-4 RFs (ASCVD: 39.2%, Control: 21.8%, p < 0.001) was vastly more common.

Conclusion

An elevated rate of coexistence of classical RF in the case group, mainly socioeconomic and SMuRFs. By managing them primary and secondary ASCVDs prevention attained.

Effects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes: A Systematic Review

BACKGROUND

Growing evidence suggests maternal stress contributes to the development of adverse pregnancy outcomes that are associated with cardiovascular and cardiometabolic risk in birthing persons. Mindfulness-based interventions may positively affect psychological stress in pregnancy and, in turn, reduce stress. However, few study authors have examined the effects of mindfulness-based interventions on adverse pregnancy outcomes that heighten cardiovascular risk.

OBJECTIVE

The aim of this study was to appraise available literature examining the effects of mindfulness-based interventions delivered during pregnancy on adverse pregnancy outcomes associated with future cardiovascular and cardiometabolic disease risk.

METHODS

In this systematic review, multiple electronic databases were searched using major keywords, including "mindfulness-based intervention," "pregnancy," "preterm delivery," "gestational diabetes," "small for gestational age," "preeclampsia," and "hypertension in pregnancy" during February 2023.

RESULTS

Six studies using mindfulness-based interventions during pregnancy were included. The review indicated that these interventions were largely effective at reducing prenatal stress; however, the overall effects of interventions were mixed concerning their impact on pregnancy complications. Study authors examining the effects on gestational diabetes-related outcomes reported significant improvements in blood glucose levels, hemoglobin A 1c , and oral glucose tolerance. Outcomes were mixed or inconclusive related to the effects of interventions on the incidence of preterm birth, birth of a small-for-gestational-age newborn, and preeclampsia.

CONCLUSIONS

Mitigating cardiovascular and cardiometabolic risk-associated adverse pregnancy outcomes through mindfulness-based approaches may represent an emerging field of study. The few studies and limited, mixed findings synthesized in this review indicate that high-validity studies are warranted to examine the effects of mindfulness-based interventions on pregnancy complications that contribute to cardiovascular-related maternal morbidity and suboptimal life course health for diverse birthing persons.

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study

Background and Aims

Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran.

Methods

This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used.

Results

The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications.

Conclusion

Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Mental and Physical Health Comorbidities in Traumatic Brain Injury: A Non-TBI Controls Comparison

OBJECTIVE

To examine whether aging with a TBI was associated with a greater burden of health-related comorbidities compared with a non-TBI control cohort and examine the associations between comorbidity burden, emotional outcomes, and health-related quality of life (HRQoL) after TBI across ages.

DESIGN

Cross-sectional.

SETTING

Research center or telephone.

PARTICIPANTS

The study included 559 participants (NTBI=291, NControls=268). Participants with TBI were recruited during inpatient rehabilitation and had sustained a moderate-severe TBI 1-33 years previously. Non-TBI controls were a convenience sample recruited through advertisements in the community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The number of cardiovascular, general physical health, and mental health comorbidities was compared between cohorts and age strata using Poisson regression. The relationships between comorbidities, age, emotional outcomes (Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-9), and HRQoL (PROMIS Global Health Measure) were examined with linear regression. Distinct subgroups of comorbidities were identified using latent class analysis. Associations between comorbidity classes with demographic and outcome variables were evaluated using multinomial logistic and linear regressions, respectively.

RESULTS

TBI participants had a significantly higher comorbidity burden than controls, primarily driven by elevated rates of mental health disorders (RR=2.71, 95% confidence interval [1.37, 5.35]). Cardiovascular and physical health comorbidities were not elevated in the TBI group compared with controls. Both cohorts had 3 similar comorbidity subgroups, suggesting consistent patterns of co-occurring health conditions regardless of TBI exposure. Physical and mental health comorbidities were associated with elevated depression and anxiety symptoms and diminished HRQoL after TBI compared with controls.

CONCLUSION

TBI was associated with greater mental, but not physical, health comorbidities in the decades after injury. However, physical and mental health comorbidities significantly affected emotional and HRQoL status after TBI, underscoring a greater need for long-term support for individuals with TBI coping with both physical and mental health comorbidities.

Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood

Polycystic ovary syndrome (PCOS) is a lifelong chronic condition that affects one in ten females and can be diagnosed in adolescence. As adolescents with PCOS transition to adulthood, counselling for lifestyle management and mental health concerns often transition from involving the family unit to increasingly individual-focused approaches. PCOS is associated with a large range of comorbidities affecting reproductive, metabolic, dermatological, and psychological health. The diagnosis and comorbidities of PCOS are influenced by pubertal hormones and need to be reassessed continuously to ensure that treatment remains appropriate for age and development. As young patients grow up, personal concerns often change, especially in relation to reproductive management. In this Review, we present prevalence rates, screening tools, and treatment recommendations for PCOS-related conditions, and we consider the diagnostic and clinical elements of optimal transition of care models that ensure continuity of comprehensive care for adolescents moving from the paediatric health-care system to the adult health-care system.

Cardiovascular disease in Arab Americans: A literature review of prevalence, risk factors, and directions for future research

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Recent evidence suggests Arab Americans, individuals with ancestry from Arabic-speaking countries, have an elevated risk for CVD compared to other ethnicities in the US. However, research focusing specifically on CVD in this population is limited. This literature review synthesizes studies investigating CVD prevalence, risk factors, and outcomes in Arab Americans. Multiple studies found higher rates of coronary heart disease, cerebrovascular disease, and hypertension compared to non-Hispanic White participants. The prevalence of type 2 diabetes, a major CVD risk factor, was also markedly higher, ranging from 16 % to 41 % in Arab Americans based on objective measures. Possible explanations include high rates of vitamin D deficiency, genetic factors, and poor diabetes control. Other metabolic factors like dyslipidemia and obesity did not consistently differ from general population estimates. Psychosocial factors may further increase CVD risk, including acculturative stress, discrimination, low health literacy, and barriers to healthcare access. Smoking, especially waterpipe use, was more prevalent in Arab American men. Though heterogenous, Arab Americans overall appear to have elevated CVD risk, warranting tailored screening and management. Culturally appropriate educational initiatives on CVD prevention are greatly needed. Future directions include better characterizing CVD prevalence across Arab American subgroups, delineating genetic and environmental factors underlying increased diabetes susceptibility, and testing culturally tailored interventions to mitigate CVD risks. In summary, this review highlights concerning CVD disparities in Arab Americans and underscores the need for group-specific research and preventive strategies.

Understanding the spectrum of cardiovascular risk in women - A primer for prevention

Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.

Perfluoroalkyl/Polyfluoroalkyl Substances: Links to Cardiovascular Disease Risk

Conservative estimates by the World Health Organization suggest that at least a quarter of global cardiovascular diseases are attributable to environmental exposures. Associations between air pollution and cardiovascular risk have garnered the most headlines and are strong, but less attention has been paid to other omnipresent toxicants in our ecosystem. Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are man-made chemicals that are extensively used in industrial and consumer products worldwide and in aqueous film-forming foam utilized in firefighting. As such, our exposure to PFAS is essentially ubiquitous. Given the long half-lives of these degradation-resistant chemicals, virtually, all people are carrying a body burden of PFAS. Health concerns related to PFAS are growing such that the National Academies of Sciences, Engineering and Medicine has recommended standards for clinical follow-up of individuals with high PFAS blood levels, including prioritizing screening for dyslipidemia. The link between PFAS and dyslipidemia has been extensively investigated, and evidence for associations is compelling. However, dyslipidemia is not the only cardiovascular risk factor with which PFAS is associated. Here, we review the epidemiological evidence for links between PFAS of concern identified by the National Academies of Sciences, Engineering and Medicine and risk factors for cardiovascular disease, including overweight/obesity, glucose intolerance, hypertension, dyslipidemia, and hyperuricemia. Moreover, we review the potential connections of PFAS with vascular disease and atherosclerosis. While observational data support associations between the National Academies of Sciences, Engineering and Medicine PFAS and selected cardiac risk factors, additional research is needed to establish causation and better understand how exposure to PFAS leads to the development of these conditions.

Heterogeneity in the Prevalence of Cardiovascular Risk Factors by Ethnicity and Birthplace Among Asian Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey

BACKGROUND

Asian people in the United States have different sociodemographic and health-related characteristics that might affect cardiovascular disease (CVD) risk by ethnicity and birthplace. However, they are often studied as a monolithic group in health care research. This study aimed to examine heterogeneity in CVD risk factors on the basis of birthplace among the 3 largest Asian subgroups (Chinese, Asian Indian, and Filipino) compared with US-born non-Hispanic White (NHW) adults.

METHODS AND RESULTS

A cross-sectional analysis was conducted using the 2010 to 2018 National Health Interview Survey data from 125 008 US-born and foreign-born Chinese, Asian Indian, Filipino, and US-born NHW adults. Generalized linear models with Poisson distribution were used to examine the prevalence and prevalence ratios of self-reported hypertension, diabetes, high cholesterol, physical inactivity, smoking, and overweight/obesity among Asian subgroups compared with US-born NHW adults. The study included 118 979 US-born NHW and 6029 Asian adults who self-identified as Chinese (29%), Asian Indian (33%), and Filipino (38%). Participants' mean (±SD) age was 49±0.1 years, and 53% were females. In an adjusted analysis, foreign-born Asian Indians had significantly higher prevalence of diabetes, physical inactivity, and overweight/obesity; foreign-born Chinese had higher prevalence of physical inactivity, and foreign-born Filipinos had higher prevalence of all 5 CVD risk factors except smoking compared with NHW adults.

CONCLUSIONS

This study revealed significant heterogeneity in the prevalence of CVD risk factors among Asian subgroups by ethnicity and birthplace, stressing the necessity of disaggregating Asian subgroup data. Providers should consider this heterogeneity in CVD risk factors and establish tailored CVD prevention plans for Asian subgroups.

Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.

Physical activity can reduce the risk of blood cadmium and blood lead on stroke: Evidence from NHANES

The detrimental impact of heavy metals on cardiovascular well-being is a global concern, and engaging in suitable physical activity has been shown to confer cardiovascular advantage. Nevertheless, the potential of exercise to mitigate the deleterious effects of heavy metals on stroke remains uncertain. We conducted a cross-sectional survey to assess the influence of blood cadmium and blood lead on stroke occurrence, while also examining the role of physical activity. Weighted multivariate regression analysis was employed to examine the potential correlation, while subgroup and interaction analyses were used to investigate the sensitivity and robustness of the results. After controlling risk factors, it revealed a positive correlation between blood cadmium and lead levels and the occurrence of stroke. Specifically, a 50% increase in blood cadmium was associated with a 28% increase in stroke incidence, while a 50% increase in blood lead was associated with a 47% increase in stroke incidence. To estimate the non-linear relationship, we employed restricted cubic models. The results demonstrate a gradual decrease in the slope of the model curve as the intensity of physical activity increases, implying that engaging in physical activity may contribute to a reduction in the occurrence of stroke caused by blood cadmium and lead. Our findings suggest that blood cadmium and lead could be considered an autonomous risk factor for stroke within the general population of the United States. Moreover, engaging in physical activity has the potential to mitigate the potential detrimental consequences associated with exposure to heavy metals.

Sex-Related Differences in Ventricular Tachyarrhythmia Events in Patients With Implantable Cardioverter-Defibrillator and Prior Ventricular Tachyarrhythmias

BACKGROUND

Data on the risk of ventricular tachycardia (VT), ventricular fibrillation (VF), and death by sex in patients with prior VT/VF are limited.

OBJECTIVES

This study aimed to assess sex-related differences in implantable cardioverter-defibrillator (ICD)-treated VT/VF events and death in patients implanted for secondary prevention or primary prevention ICD indications who experienced VT/VF before enrollment in the RAID (Ranolazine Implantable Cardioverter-Defibrillator) trial.

METHODS

Sex-related differences in the first and recurrent VT/VF requiring antitachycardia pacing or ICD shock and death were evaluated in 714 patients.

RESULTS

There were 124 women (17%) and 590 men observed during a mean follow-up of 26.81 ± 14.52 months. Compared to men, women were at a significantly lower risk of VT/VF/death (HR: 0.67; P = 0.029), VT/VF (HR: 0.68; P = 0.049), VT/VF treated with antitachycardia pacing (HR: 0.59; P = 0.019), and VT/VF treated with ICD shock (HR: 0.54; P = 0.035). The risk of recurrent VT/VF was also significantly lower in women (HR: 0.35; P < 0.001). HR for death was similar to the other endpoints (HR: 0.61; P = 0.162). In comparison to men, women presented with faster VT rates (196 ± 32 beats/min vs 177 ± 30 beats/min, respectively; P = 0.002), and faster shock-requiring VT/VF rates (258 ± 56 beats/min vs 227 ± 57 beats/min, respectively; P = 0.30). There was a significant interaction for the risk of VT/VF by race (P = 0.013) with White women having significantly lower risk than White men (HR: 0.36; P < 0.001), whereas Black women had a similar risk to Black men (HR: 1.06; P = 0.851).

CONCLUSIONS

Women with a history of prior VT/VF experienced a lower risk recurrent VT/VF requiring ICD therapy when compared to men. Black Women had a risk similar to men, whereas the lower risk for VT/VF in women was observed primarily in White women. (Ranolazine Implantable Cardioverter-Defibrillator Trial; NCT01215253).

Reproductive milestones across the lifespan and cardiovascular disease risk in women

Cardiovascular disease (CVD) is the leading cause of death for women across the developed and developing world. Beyond traditional cardiovascular risk factors, a number of reproductive milestones have been recognized. The goal of this White Paper, issued by the International Menopause Society in conjunction with World Menopause Day 2023, is to highlight female reproductive milestones in terms of potential cardiovascular risk and to review recommendations for minimizing that risk. The primary milestones discussed relate to menstrual cyclicity, adverse pregnancy outcomes, breast cancer treatments and menopause. Each of these categories has a number of permutations that have been shown in observational studies to be associated with increased cardiovascular risks. In current clinical care, recognition of these reproductive milestones has been encouraged so patients can be informed and motivated to engage in primary prevention of CVD early in their life course rather than retrospectively later in life. Options for specifically targeted care with specialist teams are designed to enhance success with risk identification, screening and possible detection of CVD and, optimally, primary or secondary prevention of CVD. Promoting cardiovascular health of women has far-reaching effects for themselves, their families and their progeny. It is time to make women's cardiovascular health a priority.