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1.
Int J Mol Sci ; 25(5)2024 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-38473958

RESUMEN

Cardiovascular disease (CVD) encompasses a range of disorders affecting the heart and blood vessels, including coronary heart disease and cerebrovascular disease [...].


Asunto(s)
Enfermedades Cardiovasculares , Trastornos Cerebrovasculares , Enfermedad Coronaria , Diabetes Mellitus , Hipertensión , Humanos , Factores de Riesgo
2.
Blood Press ; 33(1): 2323987, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38465629

RESUMEN

PURPOSE: Socioeconomic status has been related to resting blood pressure (BP) levels at different stages of life. However, the association of childhood socioeconomic status (SES) and adulthood exercise BP is largely unknown. Therefore, we studied the association of childhood SES with adulthood maximal exercise BP. MATERIALS AND METHODS: This investigation consisted of 373 individuals (53% women) participating in the Cardiovascular Risk in Young Finns Study who had data concerning family SES in childhood (baseline in 1980, at age of 6-18 years) and exercise BP response data in adulthood (follow-up in adulthood in 27-29 years since baseline). A maximal cardiopulmonary exercise test with BP measurements was performed by participants, and peak exercise BP was measured. RESULTS: In stepwise multivariable analysis including childhood risk factors and lifestyle factors (body mass index, systolic BP, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, insulin, fruit consumption, vegetable consumption, and physical activity), lower family SES in childhood was associated with higher maximal exercise BP in adulthood (ß value ± SE, 1.63 ± 0.77, p = 0.035). The association remained significant after further adjustment with participants SES in adulthood (ß value ± SE, 1.68 ± 0.65, p = 0.011) and after further adjustment with adulthood body-mass index, systolic BP, maximal exercise capacity, and peak heart rate in exercise (ß value ± SE, 1.25 ± 0.56, p = 0.027). CONCLUSIONS: These findings suggest that lower childhood family SES is associated with higher maximal exercise BP in adulthood.


Limited data are available about the association of childhood socioeconomic status and adulthood exercise blood pressure.We prospectively examined whether childhood socioeconomic status is associated with adulthood exercise blood pressure in 373 participants aged 6­18 years at baseline (1980) from the longitudinal Cardiovascular Risk in Young Finns cohort study.In multivariable analysis, including childhood cardiovascular risk factors and lifestyle factors, lower family socioeconomic status in childhood was associated with higher maximal exercise blood pressure in adulthood.The association remained significant after further adjustment with participants socioeconomic status in adulthood and also after further adjustment with adulthood body mass index, systolic blood pressure, maximal exercise capacity and peak heart rate in exercise.Low childhood socioeconomic status predicted also higher risk of exaggerated exercise blood pressure response in adulthood, although this finding was diluted to non-significant after adjustment with adulthood body mass index and systolic blood pressure.These findings suggest that lower childhood family socioeconomic status is associated with higher maximal exercise blood pressure in adulthood.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Humanos , Femenino , Niño , Adolescente , Masculino , Factores de Riesgo , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Presión Sanguínea , Finlandia , Clase Social , Factores de Riesgo de Enfermedad Cardiaca , Ejercicio Físico , Colesterol
3.
J Hypertens ; 42(4): 610-619, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38441184

RESUMEN

OBJECTIVE: We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. METHODS: In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. RESULTS: During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. CONCLUSION: The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Hiperglucemia , Hipertensión , Estado Prediabético , Anciano , Persona de Mediana Edad , Humanos , Presión Sanguínea , Estado Prediabético/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Estudios Retrospectivos , Hipertensión/complicaciones
4.
BMC Med Genomics ; 17(1): 66, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38438909

RESUMEN

BACKGROUND: Coronary heart disease (CHD) has become a worldwide public health problem. Genetic factors are considered important risk factors for CHD. The aim of this study was to explore the correlation between CYP4A22 gene polymorphism and CHD susceptibility in the Chinese Han population. METHODS: We used SNPStats online software to complete the association analysis among 962 volunteers. False-positive report probability analysis was used to confirm whether a positive result is noteworthy. Haploview software and SNPStats were used for haplotype analysis and linkage disequilibrium. Multi-factor dimensionality reduction was applied to evaluate the interaction between candidate SNPs. RESULTS: In overall and some stratified analyses (male, age ≤ 60 years or CHD patients complicated with hypertension), CYP4A22-rs12564525 (overall, OR = 0.83, p-value is 0.042) and CYP4A22-rs2056900 (overall, OR = 1.22, p-value is 0.032) were associated with the risk of CHD. CYP4A22-4926581 was associated with increased CHD risk only in some stratified analyses. FPRP indicated that all positive results in our study are noteworthy findings. In addition, MDR showed that the single-locus model composed of rs2056900 is the best model for predicting susceptibility to CHD. CONCLUSION: There are significant associations between susceptibility to CHD and CYP4A22 rs12564525, and rs2056900.


Asunto(s)
Enfermedad Coronaria , Hipertensión , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Coronaria/genética , Polimorfismo de Nucleótido Simple , Pueblo Asiatico/genética , Sistema Enzimático del Citocromo P-450/genética , Factores de Riesgo , Citocromo P-450 CYP4A/genética
5.
BMC Geriatr ; 24(1): 225, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38439007

RESUMEN

OBJECTIVE: The aim of present study was to evaluate the combined effect of hypertension and activities of daily living (ADL)/instrumental activities of daily living (IADL) with the risk of CVD, stroke and cardiac events. METHODS: A total of 14,083 participants aged 45 years or older from the China Health and Retirement longitudinal study were included in current study. Participants were divided into 4 groups according to hypertension and ADL/IADL status. Cox proportional hazards regression model was used to explore the associations between hypertension, ADL/IADL and new-onset CVD, stroke and cardiac events. RESULTS: During the 7-year follow-up, a total of 2,324 respondents experienced CVD (including 783 stroke and 1,740 cardiac events). Individuals with limitations in ADL alone, or with hypertension alone, or with both limitations in ADL and hypertension were associated with increased risk of CVD, with the adjusted hazard ratios (95% confidence intervals) were 1.17(1.00-1.35), 1.36(1.24-1.49) and 1.44(1.23-1.68), respectively. Those with limitations in ADL and hypertension also had higher risk of stroke (hazard ratios = 1.64; 1.26-2.14) and cardiac events (hazard ratios = 1.37; 1.14-1.64). Similarly, individuals with both limitations in IADL and hypertension were associated with increased risk of CVD (hazard ratios = 1.34; 1.15-1.57), stroke (hazard ratios = 1.50; 1.17-1.95) and cardiac events (hazard ratios = 1.27; 1.06-1.53). CONCLUSION: Hypertension and limitations in ADL/IADL jointly increased the risk of CVD, stroke and cardiac events.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Accidente Cerebrovascular , Humanos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Actividades Cotidianas , Estudios Longitudinales , Hipertensión/diagnóstico , Hipertensión/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología
6.
Blood Press Monit ; 2024 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-38465651

RESUMEN

OBJECTIVE: The purpose of our study was to analyze the association of blood pressure and blood pressure progression with heart disease and stroke among Chinese population. METHOD: We included a total of 10 122 adults aged 45 years and above free of heart disease or stroke at baseline from the China Health and Retirement Longitudinal Study cohort. We used Cox proportional hazards models to analyze the relationship between cardiovascular risk and prehypertension in subjects with or without progression to hypertension. RESULT: During a mean follow-up of 6.5 years, 1972 subjects were either diagnosed with heart disease or had a stroke (composite outcome). Compared with individuals with normotension at baseline, the fully adjusted hazard ratio (HR) [95% confidence interval (CI)] was 1.25 (1.10-1.42) and 1.52 (1.34-1.74) for composite outcome in individuals with prehypertension and hypertension at baseline, respectively. The subjects who progressed to hypertension had higher risk of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. The subjects who progressed from prehypertension to hypertension had 1.72 times higher risk [HR (95% CI): 1.72 (1.37-2.16)] of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. CONCLUSION: The cardiovascular risk of subjects with prehypertension is higher than that of subjects with normal blood pressure. After a diagnosis of hypertension, subjects who progressed from normal blood pressure to hypertension had an increased risk of heart disease and stroke.

7.
Artículo en Inglés | MEDLINE | ID: mdl-38450952

RESUMEN

Nocturnal blood pressure and nighttime dipping patterns are associated with the occurrence of cardiovascular events. However, there is few research on whether riser pattern is associated with the poor prognosis of patients with coronary heart disease (CHD) and hypertension independent of nighttime systolic blood pressure (SBP). This prospective and observational clinical study included 568 hospitalized patients with CHD and hypertension. All patients underwent 24-h ambulatory blood pressure (BP) monitoring during their hospitalization. Multivariate adjusted Cox proportional hazard models were utilized to examine the associations of nocturnal blood pressure and dipping status with primary endpoint events. Additionally, Harrell's C-statistics were employed to compare the discriminative ability of each model. During the 1-year follow-up period, 64 (11.3%) primary endpoint events were recorded, including 55 (9.7%) atherosclerotic cardiovascular disease (ASCVD) events. After adjusting for demographic and clinical risk variables, nighttime SBP was significantly related to the risk of incident primary endpoint events [per 20 mm Hg increase: hazard ratio (HR) = 1.775, 95% confidence interval (CI) 1.256-2.507]. The riser pattern group exhibited a significantly higher risk for primary endpoint events compared to the dipper pattern group, even after adjusting for office SBP (HR: 2.687, 95% CI: 1.015-7.110, p = .047). Furthermore, the addition of nighttime SBP or dipping status to the base model yielded statistically significant increments in C-statistic values (p = .036 and p = .007). However, adding both nighttime SBP and dipping status did not significantly enhance the model's performance in predicting the risk of primary endpoint events and ASCVD events according to the C-index (p = .053 and p = .054), which meant that the riser pattern group did not exhibit a significantly higher risk for primary endpoint events compared to the dipper pattern group after adjusting for nighttime SBP. In conclusion, nocturnal SBP and riser pattern demonstrated an association with adverse prognosis in patients with CHD and hypertension. Notably, nocturnal SBP proved to be a more reliable predictor than dipping status.

8.
Nutr J ; 23(1): 33, 2024 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-38459491

RESUMEN

BACKGROUND: The relationship between vitamin D status and mortality among adults with hypertension remains unclear. METHODS: This prospective cohort study involved a sample of 19,500 adults with hypertension who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. We utilized a weighted COX proportional hazard model to assess the association between vitamin D status and mortality. This statistical model calculates hazard ratios (HR) and their corresponding 95% confidence intervals (95% CI). RESULTS: The study indicated that lower serum 25(OH)D concentration was associated with an increased risk of all-cause mortality among individuals with hypertension. Specially. Those with concentrations between 25.0 and 49.9 nmol/L (HR = 1.71, 95%CI = 1.22-2.40) and less than 25.0 nmol/L (HR = 1.97, 95%CI = 1.15-3.39) had higher hazard ratios for all-cause mortality. Individuals with hypertension who took vitamin D supplements had a lower risk of all-cause mortality, but not the risk of CVD mortality (HR 0.75, 95%CI 0.54-1.03), compared to those who did not supplement (HR = 0.76, 95%CI = 0.61-0.94). Subgroup analysis further revealed that vitamin D supplementation was associated with a reduced risk of all-cause mortality among individuals without diabetes (HR = 0.65, 95%CI = 0.52-0.81) and individuals without CVD (HR = 0.75, 95%CI = 0.58-0.97), and a decreased risk of CVD mortality among individuals without diabetes (HR = 0.63, 95%CI = 0.45-0.88) and without CVD (HR = 0.61, 95%CI = 0.40-0.92). Furthermore, higher-dose vitamin D supplementation was also associated with a greater reduction in all-cause mortality among hypertensive individuals, and there was the potential synergistic effect of combining normal-dose calcium and vitamin D supplementation, showing a superior effect on mortality compared to low-dose supplementation in adults with hypertension. CONCLUSIONS: This prospective cohort study demonstrated a significant association between lower serum 25 (OH)D concentration and increased all-cause mortality among adults with hypertension. Furthermore, the study found that vitamin D supplementation had a strong and significantly positive correlation with reduced all-cause and CVD mortality among hypertensive individuals without diabetes or CVD. This positive correlation suggests that vitamin D supplementation could potentially be an effective strategy to reduce the risk of mortality in this specific group of people.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Hipertensión , Deficiencia de Vitamina D , Vitamina D/análogos & derivados , Adulto , Humanos , Encuestas Nutricionales , Estudios Prospectivos , Vitaminas , Suplementos Dietéticos
9.
Methodist Debakey Cardiovasc J ; 20(2): 94-106, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38495667

RESUMEN

Cardiovascular disease (CVD) remains a leading cause of mortality in women, necessitating innovative primary prevention strategies. Contemporary guidelines on primary prevention of CVD highlight the increasing prevalence of CVD risk factors and emphasize the significance of female-specific risk enhancers that substantially augment the future risk of CVD. These risk factors occur throughout a woman's life cycle, such as hormonal contraception, hypertensive disorders of pregnancy, and menopause, all of which confer an added layer of risk in women beyond the conventional risk factors. Despite this, current methods may not fully capture the nuanced vulnerabilities in women that increase their risk of CVD. In this review, we highlight gender-specific risk enhancers and subsequent prevention as well as strategies to improve primary prevention of CVD in women.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Embarazo , Femenino , Humanos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Menopausia , Factores de Riesgo , Prevención Primaria
10.
Int J Cardiol Cardiovasc Risk Prev ; 21: 200253, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38496330

RESUMEN

Background: The clinical characteristics and risk factors of all-cause mortality in young hospitalized patients with comorbid coronary heart disease and hypertension (CAD + HT) are not well-characterized. Method: A total of 2288 hospitalized CAD patients (age<45 years) with or without hypertension in the Chinese PLA General Hospital from August 5, 2008 to June 22, 2018 were conducted. The risk factors of all-cause mortality were estimated in young CAD + HT patients by COX models. Results: The overall prevalence of hypertension in young CAD patients was 50.83% (n = 1163). CAD + HT patients had older age, higher heart rate, BMI, uric acid, triglyceride and lower level of eGFR and HDL-C than CAD patients (P < 0.05). The proportion of cardiovascular-related comorbidities (including obesity, diabetes mellitus, hyperuricemia and chronic kidney disease [CKD]) in the CAD + HT group was significantly higher than that in CAD group (P < 0.0001). The risk of all-cause mortality was higher in CAD + HT patients, although after adjusting for all covariates, there was no significant difference between the two groups. Furthermore, CKD (HR, 3.662; 95% CI, 1.545-8.682) and heart failure (HF) (HR, 3.136; 95%CI, 1.276-7.703) were associated with an increased risk of all-cause mortality and RAASi (HR, 0.378; 95%CI, 0.174-0.819) had a beneficial impact in CAD + HT patients. Conclusions: Hypertension was highly prevalent in young CAD patients. Young CAD + HT patients had more cardiovascular metabolic risk factors, more cardiovascular-related comorbidities and higher risk of all-cause mortality. CKD and HF were the risk factors, while RAASi was a protective factor, of all-cause mortality in CAD + HT patients.

11.
Pediatr Nephrol ; 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38503990

RESUMEN

BACKGROUND: Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care. METHODS: Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months. RESULTS: Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12). CONCLUSIONS: Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

12.
J Am Heart Assoc ; 13(6): e032186, 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38471824

RESUMEN

BACKGROUND: Recently, the target systolic blood pressure (BP) <120 mm Hg was suggested in the population with chronic kidney disease. We aimed to determine the applicability of intensified BP and to assess the incidence of cardiovascular disease (CVD) in the population with chronic kidney disease. METHODS AND RESULTS: Participants who were >20 years old and had estimated glomerular filtration rate 15 to 60 mL/min per 1.73 m2 during 2009 to 2011 were included from the database of Korean National Health Insurance Service and were followed up to 2018. Participants were categorized by BP as <120/80 mm Hg; 120 to 129/<80 mm Hg; 130 to 139/80 to 89 mm Hg; ≥140/90 mm Hg. The primary outcome was CVD risk and the secondary outcomes were all-cause mortality and progression to end-stage renal disease followed by subgroup analysis. Among the 45 263 adults with chronic kidney disease, 5196 CVD events were noted. In Cox regression analysis, higher BP was associated with a higher risk for CVD (hazard ratio [HR], 1.15 [95% CI, 1.12-1.19]; P for trend <0.001), end-stage renal disease (HR, 1.29 [95% CI, 1.22-1.37]; P for trend <0.001), and all-cause mortality (HR, 1.09 [95% CI, 1.06-1.13]; P for trend <0.001) than BP <120/80 mm Hg. In subgroup analysis, the association between BP and CVD showed a different trend in participants taking antihypertensives compared with those not using antihypertensive drugs. When comparing BP-treated individuals to untreated individuals, a significant interaction in the association between BP categories and end-stage renal disease was observed. CONCLUSIONS: The new intensive BP target proposed by 2021 Kidney Disease: Improving Global Outcomes should be applied to patients with chronic kidney disease in a personalized and advisory manner.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Fallo Renal Crónico , Insuficiencia Renal Crónica , Adulto , Humanos , Adulto Joven , Presión Sanguínea/fisiología , Estudios Retrospectivos , Factores de Riesgo , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/complicaciones , Antihipertensivos/uso terapéutico , Antihipertensivos/farmacología , Insuficiencia Renal Crónica/complicaciones , Fallo Renal Crónico/complicaciones , República de Corea/epidemiología
13.
J Am Heart Assoc ; 13(6): e032493, 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38497469

RESUMEN

BACKGROUND: Among individuals with hypertension and low diastolic blood pressure (DBP), the optimal BP target remains controversial due to concerns that BP lowering may reduce coronary perfusion. We determined the impact of intensive BP control among individuals with elevated systolic BP who have low DBP and elevated hs-cTnT (high-sensitivity cardiac troponin T) levels. METHODS AND RESULTS: A total of 8828 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were stratified by baseline DBP. Those with low DBP (<70 mm Hg) were further stratified by elevated hs-cTnT (≥14 ng/L) at baseline. The effects of intensive versus standard BP lowering on a cardiovascular disease composite end point, all-cause death, and 1-year change in hs-cTnT were determined. The combination of low DBP/high hs-cTnT was independently associated with a higher risk for cardiovascular disease and all-cause death, as well as greater 1-year increases in hs-cTnT, compared with DBP ≥70 mm Hg. However, randomization to intensive versus standard BP lowering led to similar reductions in cardiovascular disease risk among individuals with low DBP/high hs-cTnT (hazard ratio [HR], 0.82 [95% CI, 0.57-1.19]), low DBP/low hs-cTnT (HR, 0.48 [95% CI, 0.29-0.79]), and DBP ≥70 mm Hg (HR, 0.73 [95% CI, 0.60-0.89]; P for interaction=0.20). Intensive BP lowering also led to a reduction in all-cause death that was similar across groups (P for interaction=0.57). CONCLUSIONS: In this nonprespecified subgroup analysis of SPRINT, individuals with low DBP and elevated hs-cTnT, low DBP and nonelevated hs-cTnT, and DBP ≥70 mm Hg derived similar cardiovascular disease and mortality benefits from intensive BP lowering. These findings warrant confirmation in other studies.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Hipotensión , Humanos , Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Troponina , Factores de Riesgo , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Troponina T , Biomarcadores
14.
Sci Rep ; 14(1): 6191, 2024 03 14.
Artículo en Inglés | MEDLINE | ID: mdl-38485964

RESUMEN

Observational studies have suggested that insulin resistance (IR) is associated with hypertension and various cardiovascular diseases. However, the presence of a causal relationship between IR and cardiovascular disease remains unclear. Here, we applied Mendelian randomization (MR) approaches to address the causal association between genetically determined IR and the risk of cardiovascular diseases. Our primary genetic instruments comprised 53 SNPs associated with IR phenotype from a GWAS of up to 188,577 participants. Genetic association estimates for hypertension and venous thromboembolism (VTE) were extracted from UK Biobank, estimates for atrial fibrillation (AF) were extracted from the hitherto largest GWAS meta-analysis on AF, estimates for heart failure were extracted from HERMES Consortium, estimates for peripheral artery disease (PAD) and aortic aneurysm were extracted from the FinnGen Study. The main analyses were performed using the random-effects inverse-variance weighted approach, and complemented by sensitivity analyses and multivariable MR analyses. Corresponding to 55% higher fasting insulin adjusted for body mass index, 0.46 mmol/L lower high-density lipoprotein cholesterol and 0.89 mmol/L higher triglyceride, one standard deviation change in genetically predicted IR was associated with increased risk of hypertension (odds ratio (OR) 1.06, 95% CI 1.04-1.08; P = 1.91 × 10-11) and PAD (OR 1.90, 95% CI 1.43-2.54; P = 1.19 × 10-5). Suggestive evidence was obtained for an association between IR and heart failure (OR per SD change in IR: 1.19, 95% CI 1.01-1.41, P = 0.041). There was no MR evidence for an association between genetically predicted IR and atrial fibrillation, VTE, and aortic aneurysm. Results were widely consistent across all sensitivity analyses. In multivariable MR, the association between IR and PAD was attenuated after adjustment for lipids (P = 0.347) or BMI (P = 0.163). Our findings support that genetically determined IR increases the risk of hypertension and PAD.


Asunto(s)
Aneurisma de la Aorta , Fibrilación Atrial , Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Hiperinsulinismo , Hipertensión , Resistencia a la Insulina , Enfermedad Arterial Periférica , Tromboembolia Venosa , Humanos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/genética , Resistencia a la Insulina/genética , Fibrilación Atrial/genética , Análisis de la Aleatorización Mendeliana , Hipertensión/genética , Insuficiencia Cardíaca/genética , Estudio de Asociación del Genoma Completo , Polimorfismo de Nucleótido Simple
15.
Lupus Sci Med ; 11(1)2024 Mar 21.
Artículo en Inglés | MEDLINE | ID: mdl-38519060

RESUMEN

INTRODUCTION: It remains unclear how the presence of renal involvement will affect the cardiovascular (CV) risk factors and complications in patients with SLE. METHODS: We conducted a systematic review and meta-analysis using PubMed, EMBASE, MEDLINE and Scopus to identify studies published between 1947 and 2022 that evaluate the CV risk factors and complications in patients with SLE with or without lupus nephritis (LN). RESULTS: 58 studies were evaluated, with 22 two-arm studies (n=8675) included in two-arm meta-analysis and 45 studies (n=385 315) included in proportional meta-analysis. Patients with SLE with LN showed significantly higher risk of hypertension (HT) (OR=4.93, 95% CI=3.17 to 7.65, p<0.00001, I2=56%), hyperlipidaemia (OR=11.03, 95% CI=4.20 to 28.95, p<0.00001, I2=0%) and diabetes mellitus (DM) (OR=1.88, 95% CI=1.09 to 3.25, p=0.02, I2=32%) compared with those without LN. Patients with LN showed numerically higher prevalence of myocardial infarction (OR=1.35, 95% CI=0.53 to 3.45, p=0.52, I2=78%) and cerebrovascular accident (OR=1.64, 95% CI=0.79 to 3.39, p=0.27, I2=23%) than general patients with SLE. The incidence rates of CV mortality are also increased in patients with SLE with LN compared with those without LN (11.7/1000 patient-years vs 3.6/1000 patient-years). CONCLUSION: Patients with SLE with LN show increased risk of CV risk factors including DM, HT and hyperlipidaemia. Early identification and optimal control of these CV risk factors may reduce the risk of CV disease and other non-CV complications. PROSPERO REGISTRATION NUMBER: CRD42022314682.


Asunto(s)
Enfermedades Cardiovasculares , Hiperlipidemias , Hipertensión , Lupus Eritematoso Sistémico , Nefritis Lúpica , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/complicaciones , Factores de Riesgo , Nefritis Lúpica/complicaciones , Nefritis Lúpica/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Hipertensión/complicaciones , Hipertensión/epidemiología , Hiperlipidemias/complicaciones , Hiperlipidemias/epidemiología
16.
Nat Med ; 30(3): 818-828, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38459180

RESUMEN

The genetic and genomic basis of sex differences in blood pressure (BP) traits remain unstudied at scale. Here, we conducted sex-stratified and combined-sex genome-wide association studies of BP traits using the UK Biobank resource, identifying 1,346 previously reported and 29 new BP trait-associated loci. Among associated loci, 412 were female-specific (Pfemale ≤ 5 × 10-8; Pmale > 5 × 10-8) and 142 were male-specific (Pmale ≤ 5 × 10-8; Pfemale > 5 × 10-8); these sex-specific loci were enriched for hormone-related transcription factors, in particular, estrogen receptor 1. Analyses of gene-by-sex interactions and sexually dimorphic effects identified four genomic regions, showing female-specific associations with diastolic BP or pulse pressure, including the chromosome 13q34-COL4A1/COL4A2 locus. Notably, female-specific pulse pressure-associated loci exhibited enriched acetylated histone H3 Lys27 modifications in arterial tissues and a female-specific association with fibromuscular dysplasia, a female-biased vascular disease; colocalization signals included Chr13q34: COL4A1/COL4A2, Chr9p21: CDKN2B-AS1 and Chr4q32.1: MAP9 regions. Sex-specific and sex-biased polygenic associations of BP traits were associated with multiple cardiovascular traits. These findings suggest potentially clinically significant and BP sex-specific pleiotropic effects on cardiovascular diseases.


Asunto(s)
Enfermedades Cardiovasculares , Estudio de Asociación del Genoma Completo , Masculino , Humanos , Femenino , Presión Sanguínea/genética , Enfermedades Cardiovasculares/genética , Fenotipo , Genoma , Polimorfismo de Nucleótido Simple , Predisposición Genética a la Enfermedad/genética , Proteínas Asociadas a Microtúbulos
17.
P R Health Sci J ; 43(1): 18-24, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38512757

RESUMEN

BACKGROUND & OBJECTIVES: Patients with non-alcoholic fatty liver disease (NAFLD) have high prevalences of hypertension (HTN), type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD), and vice versa. The mechanism of this development is unknown but appears to be related to an underlying metabolic derangement that affects multiple organs. This study aimed to determine the prevalences of these conditions in patients with diagnosed NAFLD. METHODS: Our cohort study aimed to determine the prevalences of HTN, T2DM, and CVD in NAFLD patients registered in the liver database of the University of Puerto Rico School of Medicine; this information is recorded in their medical records. Patients whose liver disease had a different etiology were excluded. The study was approved by the UPR Medical Sciences Campus Institutional Review Board. RESULTS: Our final sample consisted of 141 NAFLD patients; 64.5% (n = 91) of them were females. The average age was 69 (±10.2 years). The prevalences of HTN, T2DM, and CVD were 53.9%, 57.5%, and 7.8%, respectively. In patients with NAFLD, there was a significant association between T2DM and being 65 years old or older (P < 0.001). CONCLUSION: Our data indicate that HTN and T2DM are highly prevalent in NAFLD patients in PR; however, CVD prevalence was lower than expected. Additional, studies are required to further define the associations. We recommend metabolic condition screening for all NAFLD patients.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipertensión , Enfermedad del Hígado Graso no Alcohólico , Femenino , Humanos , Anciano , Masculino , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Prevalencia , Factores de Riesgo , Estudios de Cohortes , Hipertensión/epidemiología , Hispánicos o Latinos
18.
BMC Public Health ; 24(1): 849, 2024 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-38504228

RESUMEN

CONTEXT: Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Using the multiple causes of death method could help understand the magnitude of these relationships and enable better targeting of investments in health. OBJECTIVES: To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. METHODS: Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the causes of death associated with IHD when IHD was defined as the underlying cause of death (UC) and the causes of death listed as the UC when IHD was recorded in any other lines of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these causes of death and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. RESULTS: When IHD was listed as the UC of death, the most frequent associated causes of death were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent cause of death in women were DM as the UC and associated cause of death, AH as the UC, and CIHD and Alzheimer's disease as associated causes of death, while the most frequent causes of death in men were substance dependence as the UC and associated cause of death, and cancer as an associated cause of death. The most frequent causes of death were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. CONCLUSIONS: Several diseases - including AMI, AH, CIHD, HF, and DM - were the most frequent associated causes of death when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated cause of death. The degree of these associations varied between sexes and geographic regions.


Asunto(s)
Enfermedad de Alzheimer , Diabetes Mellitus , Dislipidemias , Insuficiencia Cardíaca , Hipertensión , Infarto del Miocardio , Isquemia Miocárdica , Enfermedad Pulmonar Obstructiva Crónica , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Causas de Muerte , Brasil/epidemiología , Diabetes Mellitus/epidemiología
19.
Intern Emerg Med ; 2024 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-38441863

RESUMEN

The objective of this study was to assess the associations of asthma control with hypertension, cardiovascular disease, and mortality in obese individuals. We used data from the National Health and Nutrition Examination Survey (NHANES), 2001-2018. Weighted logistic regression analyses and Cox proportional hazard models were performed to evaluate the influence of asthma control on hypertension, cardiovascular disease, and mortality. A total of 2744 obese participants were included. Of them, 937 participants had poorly controlled asthma, 873 had well-controlled asthma, and 934 did not have asthma. We found that poorly controlled asthma was associated with an increased risk of angina pectoris, congestive heart failure (CHF), stroke, and all-cause mortality in obese participants, while well-controlled asthma was associated with an increased risk of CHF and all-cause mortality. Compared with patients with poorly controlled asthma, patients with well-controlled asthma were at low risk of angina pectoris (OR [odds ratio], 0.49; 95% CI [confidence interval], 0.29-0.81), heart attack (OR, 0.54; 95% CI 0.34-0.87), CHF (OR, 0.62; 95% CI 0.39-0.99), and stroke (OR, 0.45; 95% CI 0.27-0.73). The present study suggested that obese individuals with poorly controlled asthma were associated with increased risks of angina pectoris, CHF, stroke, and all-cause mortality. Well-controlled asthma had fewer negative health effects than poorly controlled asthma in obese individuals.

20.
JAMA Netw Open ; 7(3): e2356445, 2024 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-38441897

RESUMEN

Importance: Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. Objective: To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). Design, Setting, and Participants: This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. Intervention: The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Main Outcomes and Measures: Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. Results: A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Conclusions and Relevance: Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. Trial Registration: ClinicalTrials.gov Identifier: NCT03643705.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Hipertensión , Recién Nacido , Femenino , Masculino , Humanos , Persona de Mediana Edad , Anciano , Presión Sanguínea , Rol de la Enfermera , Hipertensión/tratamiento farmacológico
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