Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice.

PURPOSE OF REVIEW: Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. RECENT FINDINGS: A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.

Trends in food consumption by degree of processing and diet quality over 17 years: results from the Framingham Offspring Study.

Ultraprocessed foods provide the majority of energy content in the American diet, yet little is known regarding consumption trends over time. We determined trends in diet processing level and diet quality from 1991 to 2008 within the prospective Framingham Offspring Cohort. Dietary intakes were collected by FFQ quadrennially 1991-2008 (total of four examinations). The analytical sample included 2893 adults with valid dietary data for ≥3 examinations (baseline mean age = 54 years). Based on the NOVA framework, we classified foods as: unprocessed/minimally processed foods; processed culinary ingredients (salt/sugar/fats/oils); and processed foods and ultraprocessed foods. We evaluated diet quality using the Dietary Guidelines for Americans Adherence Index (DGAI) 2010. Trends in consumption of foods within each processing level (servings/d) and diet quality over the four examinations were evaluated using mixed effects models with subject-specific random intercepts. Analyses were stratified by sex, BMI (<25 kg/m2, 25-29·9 kg/m2, ≥30 kg/m2) and smoking status. Over 17 years of follow-up, ultraprocessed food consumption decreased from 7·5 to 6·0 servings/d and minimally processed food consumption decreased from 11·9 to 11·3 servings/d (Ptrend < 0·001). Changes in intakes of processed foods, culinary ingredients and culinary preparations were minimal. Trends were similar by sex, BMI and smoking status. DGAI-2010 score increased from 60·1 to 61·5, P < 0·001. The current study uniquely describes trends in diet processing level in an ageing US population, highlighting the longstanding presence of ultraprocessed foods in the American diet. Given the poor nutritional quality of ultraprocessed foods, public health efforts should be designed to limit their consumption.

Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease.

BACKGROUND: While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. OBJECTIVE: We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). METHODS: A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. RESULTS: Young to middle-aged patients compared to older ones were more likely to be male (p < 0.01), smokers (21 vs. 9%, p < 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p < 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p < 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. CONCLUSION: Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population.

Intravenous diltiazem infusions for rapid atrial fibrillation or flutter in the emergency department: A retrospective, exploratory analysis.

BACKGROUND: Emergency physicians commonly treat patients with atrial fibrillation (AF) or atrial flutter (AFL) with rapid ventricular response, and intravenous (IV) diltiazem is the most commonly used medication for rate control of such patients. We sought to compare rate control success and safety outcomes for emergency department (ED) patients with AF or AFL who, after a diltiazem bolus, received a diltiazem drip compared to those who did not receive a drip. METHODS: We performed a retrospective cohort study comparing outcomes of ED patients from a single hospital system with AF and AFL and a heart rate (HR) > 100 beats/min who received a diltiazem drip after an IV diltiazem bolus to those who received no drip. The primary outcome was a HR < 100 beats/min at the time of ED disposition. Secondary outcomes were hospital length of stay and safety (hypotension, electrical cardioversion, vasopressor use, and death). We compared groups using propensity score matching. RESULTS: Between January 1, 2020, and November 8, 2022, there were 746 AF or AFL patients eligible for analysis. Of those, 382 (51.2%) received a diltiazem drip and 364 (48.8%) did not. In the unadjusted analysis, the last recorded ED HR was <100 beats/min in 55.2% of patients in the drip group compared to 65.9% in the no-drip group (difference 10.7%, 95% confidence interval [CI] 3.7 to 17.7). After propensity matching, diltiazem drip use was associated with lower likelihood of rate control in the ED (OR 0.69, 95% CI 0.48-0.99) and 22.5 h (95% CI 12.2-36.8) longer hospital stay. CONCLUSIONS: For patients with AF or AFL, the use of a diltiazem drip after an IV diltiazem bolus was associated with less rate control in the ED.

Racial and ethnic disparities in prostate cancer screening following the 2018 US Preventive Services Task Force recommendation statement.

OBJECTIVE: In 2018, the United States Preventive Services Task Force promoted shared decision making between healthcare provider and patient for men aged 55 to 69. This study aimed to analyze rates of prostate-specific antigen (PSA) testing across racial and ethnic groups following this new recommendation. METHODS: A secondary analysis was conducted of the 2020-2021 Behavioral Risk Factor Surveillance System database to assess men aged 55 or older without a history of prostate cancer. We defined four race-ethnicity groups: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), Hispanics, and Other. The primary outcome was the most recent PSA test (MRT), defined as the respondent's most recent PSA test occurring pre-2018 or post-2018 guidelines. Logistic regression adjusted for covariates including age, socioeconomic status factors, marital status, smoking history, and healthcare access factors. RESULTS: In the age 55 to 69 study sample, NHW men had the greatest proportion of MRT post-2018 guidelines (n = 15,864, 72.5%). NHB men had the lowest percentage of MRT post-2018 guidelines (n = 965, 66.6%). With NHW as referent, the crude odds of the MRT post-2018 guidelines was 0.68 (95% confidence interval (CI) = 0.53-0.90) for NHB. The maximally adjusted odds ratio was 0.78 (0.59-1.02). CONCLUSIONS: We found that NHB aged 55 to 69 reported decreased rates of PSA testing after 2018 when compared to NHW. This was demonstrated on crude analysis but not after adjustment. Such findings suggest the influence of social determinants of health on preventative screening for at-risk populations.

Clinical, Sociodemographic, and Neighborhood Characteristics Associated with Adverse Pregnancy Outcomes.

Background: Cardiovascular risk is increased by a history of adverse pregnancy outcomes (APOs). Efforts to understand and prevent these adverse outcomes may improve both fetal and birthing persons' outcomes in the peripartum period, and over the patient's lifetime. This study aims to assess the association of clinical, sociodemographic, and economic neighbor-hood factors with preterm birth (PTB) and APOs (the composite of stillbirth, small for gestation age, and low birthweight). Materials and Methods: This is a cross-sectional study using the electronic medical records of deliveries from seven Northwell Health hospitals between January 1, 2018 and July 31, 2020. There were 62,787 deliveries reviewed in this study. Deliveries that were not the first for the patient during the study period and multiple gestational pregnancies were excluded. Patients with incomplete data on outcome were also excluded. Main outcomes were PTB and composite APOs. Measures included history of PTB, hypertension, diabetes, body mass index, race/ethnicity, age, preferred language, marital status, parity, health insurance, and median income, percent unemployment, and mean household size by zip code. Results: Of the 62,787 deliveries, 43.3% were from white, Non-Hispanic, and Non-Latino patients. There were 4,552 (7.2%) PTBs and 8,634 (13.8%) APOs. Patients enrolled in public insurance had higher odds of PTB (odds ratio [OR] 1.15, 95% CI 1.06-1.24) and APOs (OR 1.19, 95% CI 1.12-1.25). There was a statistically significant association of both PTB (p = 0.037) and APOs (p = 0.005) when comparing patients that live in a zip code with a median income over 100k to those with an income <100k. In addition, living in a zip code within the second quintile of unemployment was associated with lower odds of APOs (OR 0.92, 95% CI 0.84-0.99). Conclusions: Numerous sociodemographic and clinical factors are associated with both PTB and APOs. Tailored programs addressing these disparities may improve outcomes in pregnant persons.

Traditional and non-traditional cardiovascular risk factor profiles in young patients with coronary artery disease.

Study objective: There is an increasing trend in myocardial infarction (MI) hospitalizations in young individuals. The prevalence of modifiable cardiovascular risk factors is high in this population. This study aims to assess the prevalence of traditional and non-traditional cardiovascular risk factors among young patients with coronary artery disease (CAD) including novel lipid and dietary biomarkers with a focus on potential gender differences. Design: The Young Heart study is a prospective, single-center pilot cohort study. Baseline data included medical history, medications, and lifestyle factors. We also collected blood samples for lipid profile, lipoprotein (a), high-sensitivity C-reactive protein (hsCRP), and trimethylamine N-oxide (TMAO). Participants: A total of 60 patients aged <60 years with CAD (on coronary CT or invasive angiogram) were included in the study. Results: The median age was 51 years and predominantly male (70 %). Baseline assessment revealed a high prevalence of hypertension (76.7 %), hyperlipidemia (91.7 %), and obstructive CAD (88.3 %). 36.7 % had diabetes, 28.3 % had prediabetes, and 38.3 % had prior MI. Uncontrolled risk factors were prevalent, including increased waist circumference (54.6 %), metabolic syndrome (60.0 %), and LDL ≥70 mg/dL (47.5 %), Lp(a) ≥75 nmol/L (47.5 %). Furthermore, 41.7 % had hsCRP ≥2 mg/L, and 28.3 % had suboptimal TMAO levels. 70.0 % of patients were on guideline-directed doses of statins. Conclusion: Young patients with CAD demonstrated a substantial burden of traditional and non-traditional cardiovascular risk factors. The study findings highlight the need for targeted interventions to improve risk factor control and optimize lifestyle behaviors. Further investigation is warranted to assess the impact of these interventions on cardiovascular outcomes.

Prevalence and outcomes of atrial fibrillation in patients hospitalized with COVID-19.

OBJECTIVE: Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID-19 infection. METHODS: We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders. RESULTS: This analysis included 94,114 COVID-19 hospitalizations, of which 9391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% vs. 9.6%, p < .001), prolonged length of stay (40.0% vs. 27.1%, p < .001), vasopressor use (4.4% vs. 1.9%, p < .001), mechanical ventilation (19.0% vs. 9.1%, p < .001), and ICU admission (18.4% vs. 8.8%, p < .001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality adjusted odds ratio [OR], 2.04, 95% CI: 1.92-2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31-1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88-2.15). CONCLUSION: COVID-19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF.

Atrial fibrillation (AF) is a common heart rhythm disorder, especially in patients with high cardiovascular risk. This study aimed to investigate the hospital outcomes for patients admitted with both AF and COVID-19. We used data from the California State Inpatient Database for the year 2020, focusing on COVID-19 hospitalizations of adults aged 18 and older. The main outcomes studied were in-hospital death, extended hospital stays, use of vasopressor medications that raise blood pressure, need for mechanical ventilation, and admission to the intensive care unit (ICU). Our results showed that patients with both COVID-19 and AF had significantly worse outcomes compared to those without AF. Specifically, these patients had higher rates of death, extended hospital stays, vasopressor medication use, mechanical ventilation, and ICU admission, even after accounting for other health conditions. The study concludes that hospitalized COVID-19 patients with underlying AF are at a greater risk for severe complications and death. This highlights the need for increased attention and care for COVID-19 patients with AF to improve their hospital outcomes.

A case-control study of stroke risk factors and outcomes in African American stroke patients with and without crack-cocaine abuse.

BACKGROUND: Stroke in crack-cocaine abusers is increasingly recognized. We aimed to identify significant differences in stroke risk factors, characteristics, and outcomes between hospitalized stroke patients with and without crack-cocaine abuse. METHODS: This was a retrospective study that compared stroke patients with crack-cocaine abuse (cases) to stroke patients without crack-cocaine (controls). RESULTS: We identified 93 crack-cocaine cases and 93 controls admitted between January 2004 and May 2006 to one teaching hospital. There were significant differences between crack-cocaine cases and controls in age (48.7 years vs. 55 years) (P = 0.0001), male gender (65.6% vs. 40.9%) (odds ratios, OR = 1.64, 95% CI 1.22-2.21), arterial hypertension (61.1% vs. 83.9%) (OR = 0.30, 95% CI 0.15-0.60), hypercholesterolemia (18.7% vs. 68.5%) (OR = 0.10, 95% CI 0.05-0.21), diabetes (20.9% vs. 41.9%) (OR = 0.36, 95% CI 0.19-0.70), cigarette smoking (70.6% vs. 29%) (OR = 5.86, 95% CI 3.07-11.20), ischemic stroke (61.3% vs. 79.6%) (OR = 0.40, 95% CI 0.21-0.78), and intracerebral hemorrhage (33.3% vs. 17.2%) (OR = 3.03, 95% CI 1.53-6.00). Also, there were significant differences in National Institutes of Health Stroke Scale scores (3.3 vs. 7) (P < 0.0001), and MRS scores (1.8 vs. 2.5) (P = 0.0022) at hospital discharge. Using univariable and multivariable logistic regression, we found that crack-cocaine abusers had 2.28 higher odds of having a favorable functional outcome (MRS score ≤ 2) at hospital discharge, after adjusting for stroke risk factors and characteristics. CONCLUSIONS: Our study suggests that crack-cocaine abusers with stroke had fewer traditional risk factors, and more favorable functional outcome as compared to non-crack-cocaine abusers.

Preventive Cardiovascular Care in Patients With HIV Infection in an Outpatient Clinic.

BACKGROUND: People/patients living with human immunodeficiency virus (PLWH) are at an increased risk for atherosclerotic cardiovascular disease due to normal disease processes, antiretroviral medication adverse effects, and age-related comorbid conditions. Preventive cardiovascular (CV) screenings such as the need for statin, low-dose aspirin, or smoking cessation counseling are not well studied in PLWH. OBJECTIVES: To investigate whether there are differences in preventive CV care offered to patients with and without human immunodeficiency virus (HIV) infection in 1 outpatient clinic. METHODS: This retrospective study enrolled 150 consecutive patients if they had at least 4 appointments in 2 years and they did not have a history and they do not have a history of CV events. A randomly selected sample of patients without HIV infection receiving primary care services in the same clinic were used as the control group and were enrolled using the same inclusion criteria. RESULTS: More patients met statin criteria and were prescribed it in the HIV-negative arm [(70% vs. 24.67%; p < 0.0001); (89.52% vs. 54.05%; p < 0.0001)]. More patients in the HIV-negative arm met aspirin criteria and were prescribed it [(10.67% vs. 8.16%; p = 0.46); (50% vs. 33.3%; p = 0.33)]. There were more current smokers in the HIV-positive arm and a slightly greater number that received smoking cessation counseling [(38% vs. 11.33%; p < 0.0001); (82.46% vs. 76.47%; p = 0.58)]. CONCLUSION: Our results found that PLWH receive less preventive CV care compared to non-HIV-infected patients in the same outpatient clinic. Increased efforts are needed to ensure PLWH are receiving primary preventive CV care they need.

Comparison of a single shot T1-weighted in- and out-of-phase magnetization prepared gradient recalled echo with a standard two-dimensional gradient recalled echo: preliminary findings.

PURPOSE: To compare in-phase (IP)/out-of-phase (OP) single shot magnetization-prepared gradient-recalled-echo (MP-GRE) with a standard two-dimensional gradient-recalled-echo (2D-GRE), and to compare image quality of MP-GRE in cooperative and noncooperative subjects. MATERIALS AND METHODS: Ninety-six consecutive subjects (52 males, 44 females; mean age, 53.2 ± 16.7 years), both cooperative (n = 73) and noncooperative (n = 23) subjects who had MRI examinations including precontrast T1-weighted IP/OP MP-GRE with or without IP/OP 2D-GRE were included in the study. The sequences were independently qualitatively evaluated by two radiologists. Quantitative analysis of liver fat index, signal-to-noise ratio (SNR) and liver-lesion contrast-to-noise ratio (CNR) was also performed. Data were subjected to statistical analysis. RESULTS: The visual detection of the presence or absence of liver steatosis showed no differences between 2D-GRE and MP-GRE imaging (k = 1). Minor differences were observed on image quality between MP-GRE and 2D-GRE in cooperative subjects, and between MP-GRE sequences performed in cooperative and noncooperative subjects. Liver fat index results were strongly positively correlated (r = .98; 95% confidence interval [CI] 0.97 to 0.98; P < .0001). Intercept (.14; 95% CI .13 to .15; P < .0001) and slope (.83; 95% CI .79 to .86; P < .0001) were statistically significant. CONCLUSION: IP/OP MP-GRE and 2D-GRE comparably demonstrate the presence or absence of hepatic steatosis. Image quality of MP-GRE was also comparable to 2D-GRE, and was not substantially adversely affected if subjects were unable to cooperate with breathholding instructions.

Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action.

Ultra-processed foods are industrially manufactured ready-to-eat or ready-to-heat formulations containing food additives and little or no whole foods, in contrast to processed foods, which are whole foods preserved by traditional techniques such as canning or pickling. Recent epidemiological studies suggest that higher consumption of ultra-processed food is associated with increased risk of cardiovascular disease (CVD). However, epidemiological evidence needs to be corroborated with criteria of biological plausibility. This review summarizes the current evidence on the putative biological mechanisms underlying the associations between ultra-processed foods and CVD. Research ranging from laboratory-based to prospective epidemiological studies and experimental evidence suggest that ultra-processed foods may affect cardiometabolic health through a myriad of mechanisms, beyond the traditionally recognized individual nutrients. Processing induces significant changes to the food matrix, for which ultra-processed foods may affect health outcomes differently than unrefined whole foods with similar nutritional composition. Notably, the highly degraded physical structure of ultra-processed foods may affect cardiometabolic health by influencing absorption kinetics, satiety, glycemic response, and the gut microbiota composition and function. Food additives and neo-formed contaminants produced during processing may also play a role in CVD risk. Key biological pathways include altered serum lipid concentrations, modified gut microbiota and host-microbiota interactions, obesity, inflammation, oxidative stress, dysglycemia, insulin resistance, and hypertension. Further research is warranted to clarify the proportional harm associated with the nutritional composition, food additives, physical structure, and other attributes of ultra-processed foods. Understanding how ultra-processing changes whole foods and through which pathways these foods affect health is a prerequisite for eliminating harmful processing techniques and ingredients.

Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study.

BACKGROUND: Ultra-processed foods provide 58% of total energy in the U.S. diet, yet their association with cardiovascular disease (CVD) remains understudied. OBJECTIVES: The authors investigated the associations between ultra-processed foods and CVD incidence and mortality in the prospective Framingham Offspring Cohort. METHODS: The analytical sample included 3,003 adults free from CVD with valid dietary data at baseline. Data on diet, measured by food frequency questionnaire, anthropometric measures, and sociodemographic and lifestyle factors were collected quadrennially from 1991 to 2008. Data regarding CVD incidence and mortality were available until 2014 and 2017, respectively. Ultra-processed foods were defined according to the NOVA framework. The authors used Cox proportional hazards models to determine the multivariable association between ultra-processed food intake (energy-adjusted servings per day) and incident hard CVD, hard coronary heart disease (CHD), overall CVD, and CVD mortality. Multivariable models were adjusted for age, sex, education, alcohol consumption, smoking, and physical activity. RESULTS: During follow-up (1991 to 2014/2017), the authors identified 251, 163, and 648 cases of incident hard CVD, hard CHD, and overall CVD, respectively. On average, participants consumed 7.5 servings per day of ultra-processed foods at baseline. Each additional daily serving of ultra-processed foods was associated with a 7% (95% confidence interval [CI]: 1.03 to 1.12), 9% (95% CI: 1.04 to 1.15), 5% (95% CI: 1.02 to 1.08), and 9% (95% CI: 1.02 to 1.16) increase in the risk of hard CVD, hard CHD, overall CVD, and CVD mortality, respectively. CONCLUSIONS: The current findings support that higher consumption of ultra-processed foods is associated with increased risk of CVD incidence and mortality. Although additional research in ethnically diverse populations is warranted, these findings suggest cardiovascular benefits of limiting ultra-processed foods.

Falls following discharge after an in-hospital fall.

BACKGROUND: Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. METHODS: We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks). Time spent rehospitalized or institutionalized was censored in rate calculations. RESULTS: Of 95 hospitalized patients who fell during recruitment, 65 (68%) met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days). Seventy-five percent were African-American and 43% were women. Sixteen patients (25%) had multiple falls during hospitalization and 23 patients (35%) suffered a fall-related injury during hospitalization. Nineteen patients (29%) experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4). Twenty-three patients (35%) were readmitted and 3(5%) died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008). CONCLUSION: Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population.

CV RISK - A new relative cardiovascular risk score.

BACKGROUND AND AIMS: Nowadays it is recommended to use risk scores to evaluate the magnitude of cardiovascular risk in healthy people, most popular being SCORE (Europe) and Framingham and ASCVD (US). Unfortunately, they are not enough motivating in young and old population, don't consider protective factors and cannot be used in cardiovascular patients always included in very high risk category. To improve the evaluation everytime of individual cardiovascular risk we described a new score - CVRISK (cardiovascular relative individual risk). METHODS: It uses 15 items and can be used also in cardiovascular patients. The first seven items are clinical - age and gender, heredity, smoking, hypertension, obesity, psychosocial stress, previous cardiovascular disease. For items refer to laboratory data - LDL-C, HDL-C, TG, fasting plasma glucose (diabetes mellitus). The last two are protective factors - physical activity and healthy diet. RESULTS: Every item has a number of risk points and protective factors decrease with 25% and 15% the calculated risk. The risk can be automatically calculated after the introduction of the required data through an algorithm available at www.cvrisk.ro. Here, the calculated risk is compared with optimal and maximal risk. Thus the user is motivated to initiate or to continue preventive measures also suggested at www.cvrisk.ro, to improve cardiovascular health. CONCLUSION: CVRISK is not a substitute of current risk scores, but a complimentary tool to appreciate and modulate the individual cardiovascular risk. It can be useful to prevent CV disease or to improve its evolution. Individuals themselves can calculate it in order to maintain or improve their health.

Sex differences in the prevalence of vascular disease and risk factors in young hospitalized patients with psoriasis.

BACKGROUND: Psoriasis is an inflammatory skin disease associated with atherosclerotic cardiovascular disease (ASCVD) risk factors and vascular disease. The relative impact of psoriasis on vascular disease is the strongest in young patients with psoriasis, yet data are lacking on how sex differences influence cardiovascular risk factors and vascular disease in these patients. OBJECTIVE: This observational study aimed to identify the burden of cardiovascular risk factors and vascular disease in patients with psoriasis and to explore whether this burden is different between men and women age < 35 years. METHODS: Young (age ≥ 20 and < 35 years) hospitalized patients with psoriasis from the United States National Inpatient Sample were compared with those matched patients without psoriasis. Vascular disease was defined as ASCVD and/or venous thromboembolic disease. Multivariable logistic regression was used to determine the associations between psoriasis, sex, ASCVD risk factors, and vascular disease. RESULTS: Overall, patients with psoriasis (n = 18,353) were more often obese (16% vs. 6%); smokers (31% vs. 17%); and diagnosed with diabetes mellitus (10% vs. 6%), hypertension (16% vs. 8%), hyperlipidemia (6% vs. 2%), ASCVD (2.2% vs. 1.6%), and deep vein thrombosis (6% vs. 4%; all p < .001) compared with patients without psoriasis (n = 55,059; matched by age, sex, and race). When stratified by sex, women with psoriasis were more likely to have multiple cardiovascular risk factors and ASCVD (odds ratio: 2.6; 95% confidence interval [2.1-3.1]) compared with men with psoriasis (odds ratio: 1.2; 95% confidence interval [0.9-1.4]; interaction p < .01). The association between psoriasis and ASCVD in women remained unchanged after multivariable adjustment for traditional cardiovascular risk factors. CONCLUSION: Psoriasis was associated with cardiovascular disease and risk factors in young hospitalized patients, with stronger associations among women than among men.

Relationship of ankle blood pressures to cardiovascular events in older adults.

BACKGROUND AND PURPOSE: Low values of ankle-arm systolic blood pressure ratio predict mortality and cardiovascular events. High values, associated with arterial calcification, also carry risk for mortality. We focus on the extent to which low and high ankle-arm index values as well as noncompressible arteries are associated with mortality and cardiovascular events, including stroke in older adults. METHODS: We followed 2886 adults aged 70 to 79 for a mean of 6.7 years for vital status and cardiovascular events (coronary heart disease, stroke, and congestive heart failure). RESULTS: Normal ankle-arm index values of 0.91 to 1.3 were found in 80%, low values of 1.3 were obtained in 5%, and noncompressible arteries were found in 2% of the group. Increased mortality was associated with both low and high ankle-arm index values beginning at levels of <1.0 or >or=1.4. Subjects with low ankle-arm index values or noncompressible arteries had significantly higher event rates than those with normal ankle blood pressures for all end points. For coronary heart disease, hazard ratios associated with a low ankle-arm index, high ankle-arm index, and noncompressible arteries were 1.4, 1.5, and 1.7 (P<0.05 for all) after controlling for age, gender, race, prevalent cardiovascular disease, diabetes, and major cardiovascular risk factors. Noncompressible arteries carried a particularly high risk of stroke and congestive heart failure (hazard ratio=2.1 and 2.4, respectively). CONCLUSIONS: Among older adults, low and high ankle-arm index values carry elevated risk for cardiovascular events. Noncompressible leg arteries carry elevated risk for stroke and congestive heart failure specifically.

The cholesterol-lowering effect of statins is potentiated by whole grains intake. The Polish Norwegian Study (PONS).

BACKGROUND: Hypercholesterolemia treatment guidelines emphasize an adequate whole grains (WG) intake, alone or complementary to pharmacological treatment. We conducted this study to compare the prevalence of adequate WG intake and levels of blood lipids according to the statin/WG intake status. METHODS: This cross-sectional analysis of a community-based study included 12,754 men and women, age 45-64. Statin use over past 30days was recorded by trained nurses. Food intake over past 12months was assessed by a validated food-frequency questionnaire. Adequate WG intake was defined as ≥3oz-equivalents/day, representing ≥3WGservings/day. RESULTS: The prevalence of an adequate WG intake was marginally superior in statin users (26.79%) than non-users (21.51%). This superiority was attenuated after multiple covariates adjustment (PR 1.12, 95%CI 1.02-1.22). Statin users with an adequate WG intake had lower multivariable-adjusted mean blood total cholesterol (185.14mg/dL vs. 190.14mg/dL) and LDL cholesterol (103.30mg/dL vs. 108.19mg/dL) than those with an inadequate WG intake. Statin users with an adequate WG intake had lower odds (OR, 95% CI) of having TC≥240mg/dL (OR 0.67, 95% CI 0.46-0.98) and lower odds of having LDL≥100mg/dL (OR 0.72, 95% CI 0.58-0.89), compared to statin users with inadequate WG intake. A subgroup analysis restricted to those with prevalent CVD yielded similar results. CONCLUSIONS: In this community based sample of middle-aged adults, only one in four statin users had adequate whole grain intake. Statin users with adequate WG intake had statistically and clinically significant lower levels of blood total- and LDL-cholesterol.

Television viewing time among statin users and non-users. The Polish Norwegian Study (PONS).

Sedentary behavior has emerged as an independent cardiovascular disease risk factor. Uncertainty exists about the behaviors of statin users, who may exhibit either a healthy adherer or a false reassurance effect. We conducted this study in order to assess and compare TV viewing among statin users and nonusers. We used data from a cross-sectional study of 12,754 participants, from south-east Poland, age 45 to 64 years in 2010-11. Statin use during last 30 days was recorded by trained nurses. Participants reported time spent viewing TV/week. There were 1728 (13.5%) statin users of which 628 (36.34%) had cardiovascular diseases. The prevalence of viewing TV ≥ 21 h/week was higher among statin users (29.72%) compared to non-users (23.10%) and remained 15% higher after adjusting for age, sex, education, smoking, chronic obstructive pulmonary disease and other chronic diseases (prevalence ratio, PR 1.15, 95% CI 1.06 to 1.25). We found a similar pattern in both those with and without prevalent cardiovascular disease. In conclusion, we found a higher prevalence of prolonged TV-viewing among statin users than non-users. Future studies are needed to explore innovative behavioral interventions and patient counseling strategies to reduce TV viewing among statin users.