Heart rate (HR) at rest is associated with adverse cardiovascular events; however, the biologic mechanism for the relation is unclear. We hypothesized a strong association between HR at rest and ...subclinical inflammation, given their common interrelation with the autonomic nervous system. HR at rest was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis, a cohort of 4 racial or ethnic groups without cardiovascular disease at baseline and then divided into quintiles. Subclinical inflammation was measured using high-sensitivity C-reactive protein, interleukin-6, and fibrinogen. We used progressively adjusted regression models with terms for physical activity and atrioventricular nodal blocking agents in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables using the clinical cut point of ≥3 mg/L for high-sensitivity C-reactive protein and the upper quartiles of fibrinogen (≥389 mg/dl) and interleukin-6 (≥1.89 pg/ml). Participants had a mean age of 62 years (SD 9.7), mean resting heart rate of 63 beats/min (SD 9.6) and were 47% men. Increased HR at rest was significantly associated with higher levels of all 3 inflammatory markers in both continuous (p for trend <0.001) and categorical (p for trend <0.001) models. Results were similar among all 3 inflammatory markers, and there was no significant difference in the association among the 4 racial or ethnic groups. In conclusion, an increased HR at rest was associated with a higher level of inflammation among an ethnically diverse group of subjects without known cardiovascular disease.
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Effects of Physical Activity on Cardiovascular Disease Ahmed, Haitham M., MD, MPH; Blaha, Michael J., MD, MPH; Nasir, Khurram, MD, MPH ...
The American journal of cardiology,
01/2012, Volume:
109, Issue:
2
Journal Article
Peer reviewed
Much attention has been directed toward lifestyle modifications as effective means of reducing cardiovascular disease risk. In particular, physical activity has been heavily studied because of its ...well-known effects on metabolic syndrome, insulin sensitivity, cardiovascular disease risk, and all-cause mortality. However, data regarding the effects of exercise on various stages of the atherosclerosis pathway remain conflicting. The investigators review previously published reports for recent observational and interventional trials investigating the effects of physical activity on markers of (or causal factors for) atherosclerotic burden and vascular disease, including serum lipoproteins, systemic inflammation, thrombosis, coronary artery calcium, and carotid intima-media thickness. In conclusion, the data show a correlation between physical activity and triglyceride reduction, apolipoprotein B reduction, high-density lipoprotein increase, change in low-density lipoprotein particle size, increase in tissue plasminogen activator activity, and decrease in coronary artery calcium. Further research is needed to elucidate the effect of physical activity on inflammatory markers and intima-media thickness.
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Preterm birth (PTB) is associated with future cardiovascular disease (CVD) risk and disproportionally affects non-Hispanic Black (NHB) women. Limited data exist on the influence of length of US ...residence on nativity-related disparities in PTB. We examined PTB by maternal nativity (US born vs foreign born) and length of US residence among NHB women.
We analyzed data from 2699 NHB women (1607 US born; 1092 foreign born) in the Boston Birth Cohort, originally designed as a case-control study. Using multivariable logistic regression, we investigated the association of PTB with maternal nativity and length of US residence.
In the total sample, 29.1% of women delivered preterm (31.4% and 25.6% among US born and foreign born, respectively). Compared with foreign born, US-born women were younger (25.8 vs 29.5 years), had higher prevalence of obesity (27.6% vs 19.6%), smoking (20.5% vs 4.9%), alcohol use (13.2% vs 7.4%), and moderate to severe stress (73.5% vs 59.4%) (all P < 0.001). Compared with US-born women, foreign-born women had lower odds of PTB after adjusting for sociodemographic characteristics, alcohol use, stress, parity, smoking, body mass index, chronic hypertension, and diabetes (adjusted odds ratio aOR, 0.79; 95% confidence interval CI, 0.65-0.97). Foreign-born NHB women with < 10 years of US residence had 43% lower odds of PTB compared with US-born (aOR, 0.57; 95% CI, 0.43-0.75), whereas those with ≥ 10 years of US residence did not differ significantly from US-born women in their odds of PTB (aOR, 0.76; 95% CI, 0.54-1.07).
The prevalence of CVD risk factors and proportion of women delivering preterm were lower in foreign-born than US-born NHB women. The “foreign-born advantage” was not observed with ≥ 10 years of US residence. Our study highlights the need to intensify public health efforts in exploring and addressing nativity-related disparities in PTB.
L’accouchement avant terme (AAT) est associé à un risque futur de maladie cardiovasculaire (MCV) et touche disproportionnellement les femmes noires non hispaniques (NNH). Les données sur l’influence de la durée de résidence aux É.-U. sur les disparités de l’AAT liées au lieu de naissance sont limitées. Nous avons examiné l’AAT en fonction du lieu de naissance de la mère (née aux É.-U. vs née à l’étranger) et la durée de résidence aux É.-U. chez les femmes NNH.
Nous avons analysé les données de 2 699 femmes NNH (1 607 nées aux É.-U.; 1 092 nées à l’étranger) de la Boston Birth Cohort, conçue à l’origine comme une étude cas-témoins. À l’aide de la régression logistique multivariée, nous avons examiné l’association de l’AAT au lieu de naissance de la mère et à la durée de résidence aux É.-U.
Dans l’échantillon total, 29,1 % des femmes qui avaient accouché avant terme (soit 31,4 % des femmes nées aux É.-U. et 25,6 % des femmes nées à l’étranger). Comparativement aux femmes nées à l’étranger, les femmes nées aux É.-U. étaient plus jeunes (25,8 vs 29,5 ans), montraient une prévalence plus élevée d’obésité (27,6 % vs 19,6 %), du tabagisme (20,5 % vs 4,9 %), de la consommation d’alcool (13,2 % vs 7,4 %) et de stress modéré à important (73,5 % vs 59,4 %) (toutes les valeurs P < 0,001). Comparativement aux femmes nées aux É.-U., les femmes nées à l’étranger avaient un risque inférieur d’AAT après l’ajustement des caractéristiques sociodémographiques, de la consommation d’alcool, du stress, de la parité, du tabagisme, de l’indice de masse corporelle, de l’hypertension chronique et du diabète (ratio d’incidence approché ajusté RIAa, 0,79; intervalle de confiance IC à 95 %, 0,65-0,97). Les femmes NNH nées à l’étranger de < 10 ans de résidence aux É.-U. avaient une probabilité 43 % plus faible d’AAT que les femmes nées aux É.-U. (RIAa, 0,57; IC à 95 %, 0,43-0,75), tandis que les femmes de ≥ 10 ans de résidence aux É.-U. ne montraient pas de différence significative dans leur probabilité d’AAT par rapport aux femmes nées aux É.-U. (RIAa, 0,76; IC à 95 %, 0,54-1,07).
La prévalence des facteurs de risque de MCV et la proportion de femmes qui accouchent avant terme étaient plus faibles chez les femmes NNH nées à l’étranger que chez les femmes NNH nées aux É.-U. L’« avantage d’être nées à l’étranger » n’était pas observé lors de ≥ 10 ans de résidence aux É.-U. Notre étude illustre la nécessité d’intensifier les efforts de santé publique pour explorer et remédier aux disparités liées au lieu de naissance dans l’AAT.
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Abstract Background Cardiovascular calcification outside of the coronary tree, known as extracoronary calcification (ECC), is highly prevalent, often occurs concurrently in multiple sites, and yet ...its prognostic value is unclear. Objective To determine whether multisite ECC is associated with coronary heart disease (CHD) events, CHD mortality, and all-cause mortality. Methods We evaluated 5903 participants from the Multi-Ethnic Study of Atherosclerosis without diabetes who underwent CT imaging for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta. Participants were followed for 10.3 years. Multivariable adjusted hazard ratios estimated risk of outcomes for increasing numbers of ECC sites (0, 1, 2, 3, and 4), and receiver operator characteristic analysis assessed model discrimination. Results Prevalence of any ECC was 45%; median age was 62 years. Compared with those without ECC, those with ECC in 4 sites had increased hazards of 4.5, 7.1 and 2.3 for CHD events, CHD mortality, and all-cause mortality, respectively, independent of traditional risk factors (TRF; all P ≤ .05), and had ≥2-fold increased hazards for outcomes independent of coronary artery calcification (CAC). Each additional site of ECC was positively associated with each outcome in a graded fashion. When added to TRF, ECC significantly increased the area under the receiver operator characteristic curve for all outcomes and modestly increased the area under the curve for mortality beyond TRF + CAC (0.799 to 0.802; P = .03). Conclusion Increasing multisite ECC has a graded association with higher CHD and mortality risk, contributing information beyond TRF. Multisite ECC incidentally identified on imaging can be used to improve individualized risk prediction.
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•The prevalence of suboptimal cardiovascular risk profiles increased from 2015 to 2019.•This increase was mainly driven by overweight/obesity.•Social determinants of health have a role to ...play.•Non-Hispanic Blacks had the highest prevalence of suboptimal cardiovascular risk profile.
Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women.
With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015–2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18–44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile.
The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%–73.3%) in 2015 to 75.9% (75.0%–76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%–58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%–72.6%; p<0.001) and Hispanic (75.1%–80.3%; p<0.001) women but not among non-Hispanic Black (82.7%–83.7%; p=0.48) or Asian (68.1%–73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile.
There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.
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Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and ...duration of US residence are not well studied.
We analyzed data from 6088 women (mean age: 27.5 years standard deviation: 6.3 years) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group.
Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts.
The “healthy immigrant effect” and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed.
Le diabète sucré gestationnel (DSG) est associé à l’augmentation du risque de maladies cardiovasculaires (MCV). Les différences raciales/ethniques dans la prévalence du DSG ont été décrites, mais les disparités selon le lieu de naissance et la durée de résidence aux É.-U font l’objet de peu d’études.
Nous avons analysé les données de 6 088 femmes (âge moyen : 27,5 ans écart type : 6,3 ans) de la Boston Birth Cohort qui ont déclaré être noires non hispaniques (NNH; n = 2 697), hispaniques (n = 2 395) ou blanches non hispaniques (BNH; n = 996). À l’aide de la régression logistique multivariée, nous avons examiné l’association transversale entre le lieu de naissance et la durée de résidence aux É.-U. (< 10 vs ≥ 10 ans), et le DSG dans chaque groupe racial/ethnique
Les femmes NNH, BNH et hispaniques nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans avaient une prévalence plus faible des facteurs de risque de MCV que celles qui avaient une résidence aux É.-U. de ≥ 10 ans, et ce, de façon respective comme suit : le tabagisme (NNH : 1,7 % vs 3,1 %; BNH : 5,7 % vs 8,1 %; hispaniques : 0,4 % vs 2,6 %); l’obésité (NNH : 17,1 % vs 23,4 %; BNH : 3,8 % vs 15,6 %; hispaniques : 10,9 % vs 22,7 %); le stress important (NNH : 8,7 % vs 11,9 %; BNH : 5,7 % vs 28,1 %; hispaniques : 3,8 % vs 7,3 %). Lors de l’ajustement des caractéristiques sociodémographiques et des facteurs de risque de MCV, les femmes NNH nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans montraient une plus grande probabilité d’avoir le DSG (rapport de cotes ajusté : 1,60, intervalle de confiance à 95 % : 0,99-2,60) que leurs homologues nées aux É.-U., alors que les femmes hispaniques nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans montraient une plus faible probabilité d’avoir le DSG (rapport de cotes ajusté : 0,54, intervalle de confiance à 95 % : 0,32-0,91). La probabilité que les femmes hispaniques et NNH qui avaient une durée de résidence aux É.-U. de ≥ 10 ans aient le DSG n’était pas significativement différente de celles de leurs homologues nées aux É.-U.
L’« effet de l’immigrant en bonne santé » et son déclin associé à la plus longue durée de résidence aux É.-U. s’appliquent à la prévalence du DSG chez les femmes hispaniques, mais non chez les femmes NNH. D’autres recherches sur l’intersectionnalité entre la race et les disparités selon le lieu de naissance sont nécessaires.
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Abstract Background The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association ...cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation PCE) is untested. Objectives This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle–brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis). Methods The PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell’s C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease–related death, or fatal or nonfatal stroke. Results Of 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell’s C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell’s C statistic when added to the cPCE. Conclusions CAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers.
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Heart failure with preserved ejection fraction (HFpEF) is a prevalent condition with no established prevention or treatment strategies. Furthermore, the pathophysiology and predisposing risk factors ...for HFpEF are incompletely understood. Therefore, we sought to characterize the incidence and determinants of HFpEF in the Multi-Ethnic Study of Atherosclerosis (MESA). Our study included 6,781 MESA participants (White, Black, Chinese, and Hispanic men and women age 45 to 84 years, free of baseline cardiovascular disease). The primary end point was time to diagnosis of HFpEF (left ventricular ejection fraction ≥45%). Multivariable adjusted hazard ratios (HRs) with 95% confidence intervals were calculated to identify predictors of HFpEF. Over median follow-up of 11.2 years (10.6 to 11.7), 111 subjects developed HFpEF (cumulative incidence 1.7%). Incidence rates were similar across all races/ethnicities. Age (HR 2.3 1.7 to 3.0), hypertension (HR 1.8 1.1 to 2.9), diabetes (HR 2.3 1.5 to 3.7), body mass index (HR 1.4 1.1 to 1.7), left ventricular hypertrophy by electrocardiography (HR 4.3 1.7 to 11.0), interim myocardial infarction (HR 4.8 2.7 to 8.6), elevated N-terminal of the prohormone brain natriuretic peptide (HR 2.4 1.5 to 4.0), detectable troponin T (HR 4.5 1.9 to 10.9), and left ventricular mass index by magnetic resonance imaging (MRI; 1.3 1.0 to 1.6) were significant predictors of incident HFpEF. Worsening renal function, inflammatory markers, and coronary artery calcium were significant univariate but not multivariate predictors of HFpEF. Gender was neither a univariate nor multivariate predictor of HFpEF. In conclusion, we demonstrate several risk factors and biomarkers associated with incident HFpEF that were consistent across different racial/ethnic groups and may represent potential therapeutic targets for the prevention and treatment of HFpEF.
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Abstract This expert consensus statement summarizes the available data regarding the prognostic value of CAC in the asymptomatic population and its ability to refine individual risk prediction, ...addresses the limitations identified in the current traditional risk factor-based treatment strategies recommended by the 2013 ACC/AHA Prevention guidelines including use of the Pooled Cohort Equations (PCE), and the US Preventive Services Task Force (USPSTF) Recommendation Statement for Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. It provides CAC based treatment recommendations both within the context of the shared decision making model espoused by the 2013 ACC/AHA Prevention guidelines and independent of these guidelines.
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Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and insulin resistance and has been linked with increased cardiovascular risk. Although physical activity (PA) and lifestyle ...modification are often recommended in patients at cardiovascular risk, the benefit across the cardiometabolic risk spectrum is unclear. We aimed to evaluate the relation of PA and NAFLD independent of metabolic syndrome (MS) or obesity. We evaluated 5,743 healthy Brazilian subjects (43 ± 10 years, 79% men) without clinical coronary heart disease from December 2008 to December 2010. NAFLD was diagnosed using ultrasounds, and self-reported PA was assessed using the International Physical Activity Questionnaire scale. In a multivariate logistic regression adjusted for cardiometabolic risk factors, we evaluated for an independent association of NAFLD and PA. In the total study population, NAFLD prevalence was 36% (n = 2,075), obesity 23% (1,300), and MS 20% (1,152). NAFLD was more prevalent in subjects with MS (74%) than those without (26%) and in those obese (73%) than in those nonobese (25%). Overall, 1,305 (23%) subjects reported low activity, 1,990 (35%) moderate activity, and 2,448 (42%) high activity. NAFLD prevalence was lower at higher levels of reported PA (low 45%, moderate 38%, and high 30%, p <0.001). After adjusting for risk factors, subjects with high activity had lower odds of having NAFLD. The favorable association was independent of obesity or MS. In conclusion, PA presents a dose-response association with NAFLD independent of the MS or obesity. Our results are compatible with the idea that benefits of PA are relevant to everyone regardless of cardiometabolic risk.
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