Search

Introduction: An association between postawakening blood pressure (BP) values assessed by ambulatory BP monitoring (ABPM) and cardiovascular events has been reported. However, whether preawakening or postawakening BP have better correlation with hypertensive organ damage has not been established. Hypothesis: We assessed the hypothesis that preawakening BP assessed by ABPM is associated with target organ damage in Japanese patients with cardiovascular risk factors. Methods: The subjects were 1,465 patients enrolled in the Japan Morning Surge Home Blood Pressure (J-HOP) Study who had one or more cardiovascular risk factors (hypertension, dyslipidemia, diabetes, and smoking) and underwent ABPM. We measured ABPM every 30 minutes over a 24-hr period, and the BP was calculated as 3rd, 2nd, 1st hour before awakening, BP at awakening time, 1st, 2nd and 3rd hour after awakening. We also assessed the subjects' left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), N terminal pro b-type natriuretic peptide (NT-proBNP), urinary albumin/creatinine ratio (UACR), and carotid intima media thickness (IMT). Results: SBP values measured from 3rd hour before awakening to 3rd hour after awakening were 120±18, 122±18, 124±18, 133±21, 137±19, 139±19 and 140±21 mmHg. IMT, baPWV and UACR were most strongly associated with 2nd hour before awakening SBP (IMT: r=0.204, p <0.001; baPWV: r=0.174, p <0.001; UACR: r=0.103, p <0.001). NT-proBNP was most strongly associated with 1st hour before awakening SBP (r=0.125, p <0.001). LVMI had strongest correlation with 1st hour after awakening SBP (r=0.164, p <0.001) Conclusions: Preawakening SBP was a stronger risk factor for chronic hypertensive TOD than postawakening SBP. [ABSTRACT FROM AUTHOR]

Introduction: Nighttime blood pressure (BP) measured by ambulatory BP monitoring (ABPM) is correlated with hypertensive target organ damage (TOD). Several recent studies had described an association between nighttime BP measured by home BP monitoring (HBPM), but there were few data comparing the association between TOD and nighttime BP measured by ABPM or HBPM. Hypothesis: We assessed the hypothesis that individuals who have ≥120 mmHg nighttime systolic BP (SBP) assessed HBPM and ABPM would be more likely to have TOD. Methods: We analyzed the data of 1,005 J-HOP study participants whose nighttime BP was measured by HBPM and ABPM. Nighttime home BP was automatically measured at 2, 3 and 4 a.m. by timer equipped device (HEM-5001, Omron Healthcare). Nighttime home BP was measured as many night as possible in 2 week study duration and mean of all values was used for the analysis. ABPM was measured every 30 min for 24 hour. Nighttime ambulatory SBP was calculated according to patient's diary. We classified the participants into four groups according to their nighttime SBP (mmHg): group 1, HBPM and ABPM <120; group 2, HBPM <120 and ABPM ≥120; group 3, HBPM ≥120 and ABPM <120; group 4, HBPM and ABPM ≥120. TOD as indicated by brachial ankle pulse wave velocity (baPWV), left ventricular mass index (LVMI) and carotid intima media thickness (IMT) were compared among 4 groups. Results: Mean age was 63±11 years; 49.9% were male. Nighttime home BP was measured 8.9±4.3 nights. For groups 1, 2, 3 and 4, respectively, baPWV were 1529±293, 1536±265, 1616±255 and 1710±322 cm/sec, LVMI were 91±23, 94±22, 101±26 and 101±28 g/m2, and IMT were 0.73±0.14, 0.72±0.18, 0.79±0.15 and 0.80±0.19 mm. After age, gender and clinic SBP were adjusted, baPWV, LVMI and IMT of groups 3 and 4 were significant higher than of group 1. In multivariate analyses, nighttime home SBP was an independent predictor of all TOD but nighttime ambulatory SBP was an independent predictor of only baPWV. Conclusions: Nighttime home SBP was more closely associated with TOD than nighttime ambulatory SBP. [ABSTRACT FROM AUTHOR]

Introduction: The HDL particle (HDL-P) number might bea better cardiovascular risk predictor than HDL-C. Also, since HDL comprises a group of heterogeneous subfractions, different size HDL-Ps might have different effects on atherosclerosis. Hypothesis: Total HDL-P and its subfractions, as well as mean HDL size, have different associations with carotid intima-media thickness (cIMT). Methods: We evaluated 4,032 individuals between 35 and 74 years (45.4% men) without previous cardiovascular disease not taking lipid-lowering drugs. HDL size (in nm diameter), HDL-P, and its subfractions were measured (in μmol/l) by nuclear magnetic resonance spectroscopy. The relationships between HDL-P, as well as each subfraction, and cIMT were analyzed by multiple linear regression models. We also constructed logistic regression models to test associations between HDL-P (and its subfractions) and the presence of cIMT>75thpercentile or cIMT≥0.9 mm. Results: The mean cIMT was 0.798±0.195 mm and the mean total HDL-P was 22 μmol/l. The medium and large HDL-P subfractions, as well as HDL size, were negatively associated with cIMT after adjustment for race/ethnicity, age, and genderand further for smoking status, alcohol use, physical activity (all p<0.001), while small HDL-P showed a direct association with cIMT in these models. However, when adjusted for LDL particle number, systolic blood pressure, waist circumference, fasting plasma glucose, anti-hypertensive drug use, log-transformed triglycerides and estimated glomerular filtration rate, none of the subfractions showed any association. Interestingly, we observe no association between total HDL-P and cIMT in all models studied. Further, when stratified by 0.9 nm and by 75thpercentile, none of the variables showed a statistically significant OR in any of the models tested. Conclusions: Neither total HDL-P number and its subfractions nor HDL size are associated with cIMT after adjustment for confounding covariables. The results were consistent with multiple analytical strategies. [ABSTRACT FROM AUTHOR]

Introduction: Watching television is a major component of sedentary lifestyle, along with reading books or office activities. Few data exist regarding the interrelationship between sedentary behavior patterns and cardiovascular disease burden. Hypothesis: To examine the impact of different components of sedentary lifestyle on carotid atherosclerotic burden. Methods: Corinthia study is a cross sectional epidemiological study based on 2043 inhabitants of Corinthia region, Greece. Ultrasonography was used to measure IMT in carotid arteries, carotid bulb and internal carotid artery. The average of the measurements (meanIMT) and the maximum thickness (maxIMT) were determined as representative values of carotid atherosclerosis burden. We evaluated PA using the self-reported International Physical Activity Questionnaire (IPAQ) and we calculated totals METS/week for each participant. Sedentary activities were recorded based on hours/week spent on reading or office activities (ReadHours) and on hours spent watching TV (TVhours). Results: The mean age of the participants was 63±12years. The median ReadHours was [3 95%CI (0-14) hours/week]. The median TVhours was [7 95%CI(7-28)hours/week] and the median METS/week 631 (0-2190). There was no significant difference according to gender for ReadHours (p=0.11), for TVhours (p=0.37) and for total METS/week (p=0.86). Interestingly, there was no significant association of METS/week with meanIMT (rho=-0.12, p=0.68) and maxIMT (rho=-0.04, p=0.88). However, there was a positive association between TVhours and meanIMT (rho=0.141, p<0.001) and with maxIMT (rho=0.13, p<0.001). On the contrary, Readhours were inversely correlated with meanIMT (rho=-0.107, p=0.002) and maxIMT (rho=-0.099, p=0.005). We found a positive association between maxIMT or meanIMT and TVhours (p=0.002) and a negative one between ReadHours and maxIMT (p=0.05), independently of several confounders habits. (Figure 1). Conclusion: Watching television is associated to more extensive carotid atherosclerotic burden while reading books or office activities may have a favorable result. These data may be important to understand the complicated interplay between sedentary lifestyle and atherosclerosis progression. [ABSTRACT FROM AUTHOR]

Rationale: Neointima refers to proliferation and migration of vascular smooth muscle cells primarily in the tunica intima, resulting in the thickening of arterial walls and decreased arterial lumen space. One key regulator of migration and proliferation is the cytoskeleton stability; this can be enhanced by acetylation of α-tubulin. GCN5 is a histone acetyl transferase that can induce genes transcription via increasing of histone acetylation. ULK1 (Unc-51 Like-Autophagy Activating Kinase) is one of the proteins involved in the degradative pathway called autophagy. However, whether and how ULK1 regulates neointima formation remain unknown. Here we studied whether deletion ULK1 leads to reduction of neointima formation. Methods and results: Human aortic smooth muscle cell (HASMCs) transfected with ULK1 siRNA (siULK1), primary culture of vascular smooth muscle cells (VSMCs) from wild-type and smooth muscle cell -specific ULK1 KO (ULK1smc cre) mice, and WT and ULK1smc cre mice subjected to carotid artery ligation were used to evaluate autophagy activity, GCN5 expression, α-tubulin acetylation, cell migration and neointima formation. Carotid artery ligation (CAL) induced neointima formation and increased the expression autophagy related proteins in WT mice. To mimic this environment in vitro, we treated HAMSCs with platelet-derived growth factor (PDGF)-BB (20 ng/ml) and we found increasing in expression of autophagy related proteins (ATG7, ULK1 and LC3B) and autophagosome formation. Additionally, we observed that the migration induced by PDGF-BB in HAMSC was attenuated by ULK1 knockdown. CAL in ULK1smc cre mice showed a reduction in neointima formation vs CAL in WT. Moreover, GCN5 protein level, but not mRNA expression, was increased in HASMCS transfected with siULK1 and in the ULK1-deficient MVSMCs. Also, we found that deletion of ULK1 increased GCN5 expression in carotid artery and the increase was aggravated by CAL. Consistently, the acetylation of α-tubulin was increased in siULK1-transfected HASMCs, ULK1-deficient MVSMCs, and ULK1smc cre mouse carotid artery. Conclusion: Our data suggest that deletion of ULK1 inhibits neointima formation by reducing autophagic degradation of GCN5 and increasing α-tubulin acetylation in VSMCs. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome has been associated with increased intima-media thickness (IMT) of common carotid artery and cardiovascular disease in adults. The contributions of metabolic syndrome and obesity to carotid IMT in children remain unclear. To clarify this, we examined the relationships between numbers of cardiovascular risk factors and carotid IMT in obese children. Methods: Echocardiography was performed in 386 aged from 6 to 13 years. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery, and carotid stiffness (ß) was calculated. Stroke volume (SV) was measured using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance was estimated by end-systolic pressure/SVI and total arterial compliance by the ratio of pulse pressure/SVI. Lipids, fasting glucose, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were also assessed. Subjects were divided into 4 groups: A group, waist circumference (WC) within normal range; B group, increased WC; C group, increased WC plus any one of the following individual factors of hypertension, dyslipidemia (low high-density lipoprotein-cholesterol and/or high triglyceride), and raised fasting glucose; D group, metabolic syndrome. Results: With increasing number of metabolic syndrome disorders, carotid IMT increased significantly. Carotid ß index was constant from the group A to group C, however, carotid ß was significantly greater in the group D than in the group A,B, and C as shown in Figure. There were significant relationships between HOMA-IR and carotid IMT, arterial elastance, and total arterial compliance (r = 0.22, 0.26, and 0.17, respectively, p < 0.01). Carotid IMT correlated significantly with systolic blood pressure, effective arterial elastance, and total arterial compliance (r = 0.25, 0.20, and 0.24, respectively, p < 0.01). Conclusions: Carotid vascular structural and functional changes become apparent with increasing number of metabolic syndrome disorders. These vascular changes associated with insulin resistance may contribute to the increased prevalence of later cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous measurements of central and peripheral blood pressure (BP) throughout 24 hours (24-h) has become possible due to technological advances. We investigated the association between circadian hemodynamic characteristics and the presence and degree of target organ damage (TOD) in essential hypertension. Methods: Circadian hemodynamics, including 24-h brachial and central systolic BP (SBP), cardiac index (CI), and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 272 hypertensive patients (67.8±16.0 years, 54% women). TOD, namely carotid wall thickening, left ventricular (LV) hypertrophy, and albuminuria, was assessed in all patients. Results: The prevalence of having carotid wall thickening, LV hypertrophy, and albuminuria were 21.5, 26.8, and 46.5%, respectively. All SBP estimates [office, 24-h brachial (TOD 0: 123±13, TOD 1: 129±14, TOD ≥2: 136±14 mmHg) and central], and the difference between 24-h brachial and central SBP (TOD 0: 9±3, TOD 1: 12±5, TOD ≥2: 15±7 mmHg), an index of pressure amplification, increased significantly with increasing the number of having TOD (all p <0.01 for trend). Multivariate logistic regression analysis showed that, 24-h brachial (p <0.05) and central SBP [odds ratio (OR) 1.03 for 1 mmHg increase, p <0.05), and the difference between 24-h brachial and central SBP (OR 1.16 for 1 mmHg increase, p <0.01), but not office, were associated with the presence of at least one sign of TOD. In all subgroups, CI decreased from daytime to nighttime (all p <0.05), but this decrease did not different among subgroups. Both in daytime and nighttime period, TVR increased significantly with increasing the number of having TOD (all p <0.01 for trend). In patients without TOD, TVR did not change significantly from daytime to nighttime; however, a significant increase in TVR was found in those with TOD (TOD 1: 1358±167 to 1415±191, TOD ≥2: 1427±188 to 1492±210 dyn*s/cm5, p <0.05, respectively). Conclusions: These results showed that, in essential hypertension, the 24-h peripheral and central SBP could be a marker of subclinical TOD, and further, circadian hemodynamics in patients with TOD are characterized by increased pressure amplification and disturbed circadian hemodynamic variation. [ABSTRACT FROM AUTHOR]

Introduction: Sitosterolemia is an atherogenic sterol storage disorder with <100 cases reported worldwide. Due to lack of genetic and lifestyle variability, we hypothesized that in a nuclear family with homozygous sitosterolemia, (i) sitosterol levels and clinical features would be similar and that (ii) atherosclerosis burden would be associated with serum sitosterol levels. Methods: We studied an Old Order Amish nuclear family homozygous for mutations in ABCG8. Clinical features were assessed by a physician. Sitosterol and campesterol testing were performed by Mayo Medical Laboratories using ion-monitoring electron impact gas chromatography-mass spectrometry. High-resolution B-mode ultrasound of each carotid artery was performed to determine far wall intima-media thickness (IMT) and plaque score (S2000, Siemens Medical Solutions, Malvern, PA). Associations between age, sterol levels, carotid IMT, and plaque score were performed using Spearman's ρ. Results: There were 7 participants: 4 females, median age 20 years (range 11-50 years; see Table). Their sitosterol and campesterol levels at presentation were very high: 150.0 (141.4-226.8) mg/dL (reference 0-5 mg/dL) and 77.2 (44.4-110.2) mg/dL (reference 0-7 mg/dL), respectively. Three had clinical symptoms of easy fatigability or exertional dyspnea and had tendon xanthomata and carotid plaques. Neither sitosterol (ρ=-0.36, p=0.39) nor campesterol levels (ρ=-0.39, p=0.34) were associated with carotid IMT or carotid plaque score (p>0.12). Conclusions: In an Old-Order Amish family, individuals with homozygous sitosterolemia had marked phenotypic variability. Sitosterol and campesterol levels were not associated with carotid IMT or carotid plaque burden, suggesting that heterogeneity in genetic modifiers or environmental exposure may modify risk of arterial disease. [ABSTRACT FROM AUTHOR]

Introduction: In general, women have lower prevalence of subclinical arterial damage and a more favorable cardiovascular risk than men. Whether these sex-specific differences are maintained in subjects with increased body mass index (BMI) is less explored. Hypothesis: Sex differences in the prevalence of subclinical arterial damage are maintained among subjects with increased BMI. Methods: In 580 healthy subjects (mean age 48±9 years, 61% women) with BMI >27 kg/m2 participating in the Fat Associated Cardiovascular Dysfunction (FATCOR) project, carotid and femoral intima-media thickness (IMT) was assessed by ultrasound and carotid-femoral pulse wave velocity (PWV) by applanation tonometry. Subclinical arterial damage was defined as maximum carotid or femoral IMT >0.9 mm and/or PWV >10 m/s. Results: Women had higher BMI and fat mass, and lower fat free mass, muscle mass and blood pressure (all p<0.05). There was no differences in age, renal function, prevalence of hypertension, diabetes, obesity (BMI≥30 kg/m2) or smoking among sexes. Prevalence of subclinical arterial damage was lower in women compared to men (38% vs. 52%, p=0.002) with both lower carotid femoral IMT and lower PWV (1.2±0.8 vs. 1.5±1.0 mm, p=0.002) and (7.3±1.6 vs. 7.8±1.7 m/s, p=0.001), respectively (Figure). In multivariable logistic regression analysis, female sex was associated with lower prevalence of subclinical arterial damage (OR 0.29 [95% CI 0.11-0.78], p=0.014), independent of age, body composition, hypertension and diabetes. Conclusions: In healthy subjects with increased BMI, prevalence of subclinical arterial damage was lower in women, suggesting presence of sex-specific arterial protective mechanisms. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The relationship between intake of saturated fats and subclinical atherosclerosis is unclear and poorly investigated. We aimed to investigate this association and to explore whether genetics may affect the relation. Subclinical atherosclerosis was assessed by carotid intima-media thickness (C-IMT), measured at baseline and after 30 months, in a European cohort including middle-aged men and women at high risk of cardiovascular disease. Methods: Men (n=1,643) and women (n=1,764) aged 54-79 were recruited from seven centres - in Italy, France, Netherland, Sweden and Finland. Intake of saturated fat was classified as high or low. Logistic regression models (OR; 95% CI) were employed to assess the associations between high intake of saturated fat and the mean and the maximum values of C-IMT in the whole carotid artery (C-IMTmean, C-IMTmax), in the common (CC-), bifurcation (Bif-) and internal (ICA-) carotid arteries, at baseline (cut–off>=75th) and at the progression (cut–off>zero). For the gene–diet interaction we considered 207,586 genetic variants (minor allele frequency >5%) from Illumina 200K Cardio-Metabo and Immuno Chips and performed measures of interactions on the additive scale. Results: After adjustment for age and sex, high intake of saturated fats was associated with increased risk of increased C-IMTmean (OR: 1.27; 1.09–1.49), C-IMTmax (OR: 1.17; 1.01–1.36), CC-IMTmean (OR: 1.23; 1.05–1.43) and ICA-IMTmean (OR: 1.26; 1.09–1.48). However, after further adjustment for smoking status, physical activity, education, alcohol consumption and latitude, results were no longer significant. No clear associations were observed between high intake of saturated fats and risk of atherosclerotic progression. There was no evidence of interaction between high intake of saturated fats and any of the genetic variants considered, after corrections for multiple testing. Conclusions: High intake of saturated fats was not independently associated with subclinical atherosclerosis. Moreover, we did not identify any significant gene-dietary fat interactions in relation to risk of subclinical atherosclerosis. [ABSTRACT FROM AUTHOR]

Introduction: South Asians are the second fastest growing ethnic group in the United States and have high rates of cardiovascular disease (CVD) that is not explained by widely known risk factors. Moderate alcohol consumption has been associated with lower risk of CVD in some race/ethnic groups, but the association of alcohol consumption and atherosclerosis in South Asians has not been investigated. Methods: We used data from 906 South Asian participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort. Alcohol consumption was ascertained via questionnaire, coronary artery calcium (CAC) was measured with computed tomography and expressed as Agatston units, and common carotid artery intima-media thickness (cIMT) was measured using B-mode ultrasonography. We used logistic regression models to examine cross-sectional associations of alcohol consumption with CAC prevalence (CAC>0) and used linear regression model for cIMT. Models were adjusted for age, sex, income, and cardiovascular risk factors. Results: The mean age of MASALA participants was 55.3 (±9.4) years, and 46% of participants were women. Family history of MI, mean LDL and HDL concentrations, BMI and use of lipid-lowering medications did not differ by alcohol consumption. Compared with non-drinkers, participants consuming 4-6 drinks/week had statistically significant 48% decreased odds of any CAC prevalence. After adjusting for potential confounders and mediators, participants consuming 4-6 drinks/week showed 58% and 63% decreased CAC prevalence. Alcohol consumption of >7 drinks/week was associated with 0.09 mm (95% CI, 0.02-0.16) increase in common-cIMT compared to no alcohol intake. Conclusion: The association between alcohol intake and subclinical atherosclerosis varied by the amount of intake among South Asians. Long-term follow-up of the MASALA cohort will examine prospective associations of alcohol intake with incident CVD events. [ABSTRACT FROM AUTHOR]

Introduction: Both acute and agent specific chronic infections have been associated with increased cardiovascular risk, however data on the burden of common recurrent infections and cardiovascular disease (CVD) is limited. Hypothesis: Women with greater exposure to uncomplicated common infectious events have an increased risk of subclinical CVD (sCVD) compared to women with no events. Methods: In a cross-sectional study we assessed the relationship of recurrent infections and carotid artery intima-media thickness (IMT) in 1,945 disease-free women from the Mexican Teachers' Cohort. Through 2012-2016, participants answered questions on respiratory, urinary tract and vaginal infections during the previous year and IMT was measured using ultrasound by standardized neurologists and log-transformed. Total infectious episodes were categorized as "0", "1 or 2" and "3 or more". We defined sCVD as mean right and left IMT≥0.8mm or plaque. Multivariable linear and logistic regression analyses were used to evaluate the association of infectious events with IMT and sCVD adjusting for age, sociodemographic, and cardiovascular risk factors. Results: Among participants (50 ±5 years of age) 14% (278 of 1945) reported no infections, 41% (800 of 1945) 1 or 2 infections, and 45% (867 of 1945) 3 or more. Overall prevalence of sCVD was 12% (242 of 1945). Adjusted models for logistic regression showed that women with 3 or more infections had 80% higher odds of subclinical CVD (95% CI 1.1, 2.9) compared to women without infections (p-trend: 0.019). Sub-analyses by type of infection were not significantly associated with sCVD (Image 1). Linear regression analysis did not show a significant association between mean IMT and recurrent infections. Conclusion: Recurrent infectious events in women are associated with greater sCVD, which supports the hypothesis of low grade chronic inflammation in CVD. [ABSTRACT FROM AUTHOR]

Introduction: Intrauterine and early life factors such as low birth weight, not being breastfed, smoking parents, and other socioeconomic conditions have been associated with later predisposition to chronic diseases. Although there still exists controversy in which is the best marker for environmental exposition during early lifetime, leg length has been one of the most accepted. Hypothesis: There is an inverse relationship between leg length and subclinical cardiovascular disease (sCVD). Methods: We conducted a cross-sectional analysis of a sub sample of 2,038 women from the Mexican Teacher's Cohort. Participants underwent anthropometry during clinical assessments. Trunk length was calculated as the height measured in seated position minus the height of the stool participants were sitting on. Leg length was defined as height minus trunk length. Carotid intima media thickness(CIMT) was measured by trained neurologists through standardized ultrasound and log-transformed. We defined sCVD as CIMT ≥0.8 mm or the presence of plaque. We used multivariable linear and logistic regression models to estimate the association between leg length quartiles with CIMT and sCVD respectively. Results: Mean height was 153.8 cm and mean leg length was 72 cm. The prevalence of sCVD was 23%(469 of 2038). Participants with shorter legs were likely to report low birthweight, indigenous origin, rural residence, and low socioeconomic environment. We observed an inverse relationship between leg length and mean IMT when we compared the lowest(median 67cm) to the highest quartile(median 77.1 cm) (multivariable-adjusted mean % difference= -2.93; 95% CI-5.53,-0.32). In contrast to the lowest quartile, the multiple-adjusted odds ratio for sCVD in the highest quartile was 0.58(95% CI 0.34, 0.98). Additional analysis controlling for mediators such as weight, diabetes, hypertension and hypercholesterolemia weakened the association but remained significant. Conclusion: We found a significant association between leg length, CIMT and sCVD in a population of middle-aged Mexican women. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have analyzed the association between carotid intima-media thickness (CIMT) and insulin resistance, glucose levels or glycated hemoglobin with mixed results. Objective: To evaluate the association between CIMT and homeostasis model assessment - insulin resistance (HOMA-IR), fasting and post-load plasma glucose and glycated hemoglobin in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. Methods: We included 8,028 participants (aged 35-74 years) without diabetes or overt cardiovascular disease who had complete CIMT data at baseline. We built crude and adjusted linear and binary logistic models to evaluate the association between CIMT and (a) HOMA-IR; (b) fasting plasma glucose; (c) post-load plasma glucose; and (d) glycated hemoglobin. We also built post-hoc models, stratified by sex. Results: In the fully-adjusted linear models, only the association between CIMT (in mm) and HOMA-IR remained significant (table). Consistent with these results, only the association between the highest age- sex- and race-specific CIMT quartile and HOMA-IR was significant in the adjusted model (odds ratio [OR]: 1.10; 95% CI: 1.04 - 1.17). The association between HOMA-IR and the highest CIMT quartile remained significant in sex-specific analyses (OR: 1.10; 95% CI: 1.02 - 1.20 for men and OR: 1.10; 95% CI: 1.02 - 1.20 for women). We did not find an independent association between CIMT and glucose or glycated hemoglobin levels. Conclusion: We found a direct, independent association between HOMA-IR and CIMT in a large sample of non-diabetic men and women. Mechanisms unrelated to glucose homeostasis, as a direct effect of insulin on atherosclerosis or medial hypertrophy, may be involved in this association. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease (CVD) in women often develops in the absence of conventional risk factors. Prenatal loss, a common pregnancy outcome, may result in physiologic changes that could affect future risk of myocardial infarction. Little is known about the impact of pregnancy loss on early markers of CVD risk. Hypothesis: Pregnancy loss affects carotid artery intima-media thickness (CIMT). Methods: We conducted a cross-sectional analysis among 1,769 disease-free women from the Mexican Teachers' Cohort who had been pregnant to evaluate the relation between pregnancy loss and CIMT. In 2008 participants answered a baseline questionnaire on reproductive history, risk factors for chronic disease and medical conditions that was updated in 2011. We defined pregnancy loss as abortion and/or stillbirth. Between 2012 and 2016, CIMT was measured by trained neurologists using ultrasound in three clinical sites. We log-transformed CIMT and defined carotid atherosclerosis as CIMT ≥0.8mm or plaque. We used multivariable linear and logistic regression models to assess the relation between pregnancy loss, CIMT and carotid atherosclerosis. Results: Mean age of participants was 49.8 (SD ± 5.1) years. The prevalence of pregnancy loss was 22% (394 of 1769), while we observed carotid atherosclerosis in 23% (405 of 1769) of participants. Comparing participants who reported a pregnancy loss to those who did not, the multivariable-adjusted odds ratio for carotid atherosclerosis was 1.52 (95% CI 1.12, 2.06). Women who experienced a stillbirth had 2.32 higher odds (95% CI 1.03, 5.21) of carotid atherosclerosis than those who did not. Mean CIMT appeared to be higher in women who reported a pregnancy loss relative to those who did not, however, in multivariable analyses, pregnancy loss and stillbirth were not significantly associated with CIMT. Conclusions: Abortion and stillbirth may be associated with a higher risk of CVD. Additional investigation on potential underlying mechanisms for this association is required. [ABSTRACT FROM AUTHOR]

Background: The RIESGO (RISK) study was established to investigate associations between lifestyle, risk factors and cerebrovascular diseases in 300 attendees to the annual meeting of the Mexican Academy of Neurology. In these analyses we describe traditional and several new risk factors for Cerebrovascular Disease on the RIESGO participants as well as a novel way to create a cohort. Methods: The RIESGO study employed a sample of the Mexican Congress of neurology attendees and intends to follow them prospectively. All attendees were invited to participate (n=1300). A survey on lifestyle questions, and clinical evaluations were conducted at the congress site, non-parametric descriptive statistics were used. Results: 300 attendees (68.8% physicians) participated in RIESGO, 18-83 years old mean 47.1(DE=13.9) and 59% were men. In the RIESGO study, self-reported Diabetes (DM) was 6.8% compared to 20.1% using Glycated Hemoglobin (HbA1c) for diagnosis (>6.5%) and 40% of those with self-reported DM had elevated HbA1c. Also remarkable is the 20.3% major and minor electrocardiographic abnormalities. Systolic and diastolic hypertension was observed in 14.1% and 4.1% respectively, vs 18.4% for self-reported hypertension. Obesity and overweight was observed 66.2% based on BMI > 25kg/m2. Active and former smoking rates were 14.3% and 24.4% respectively, active exercise (>150min/week) was reported in 48.5% and high alcohol consumption (>25 12Oz Beer or equivalent/30days) was 19.9%. The subclinical outcomes were: intima-media thickness (≥0.8mm) found in 2.3%, carotid plaque in 6% and ventricular hypertrophy (Sokolow) in 1.8%. We also explored other new risk factors associated with stroke, and found a high heart rate at rest (>70 beats per minute) in 35%, ventricular premature beats 1.1%, prolonged QTc 0.6% and 0% in men and women respectively, finally on the perceived stress scale 97% "never" or "almost never" felt stressed and only 2.3% felt "fairly often stressed". We will also discuss the association of traditional vs newer risk factors with subclinical outcomes. Conclusions: These findings indicate a high prevalence and poor awareness and control of major cardiovascular disease risk factors and subclinical outcomes, despite the fact that RIESGO participants have a substantially higher education level and health information than the general Mexican population. These findings reflect the alarming public health problems that diabetes and cardiovascular diseases represent in the Mexican population, even among the most educated individuals. Recurrent attendance at the annual meeting is a novel and convenient way to establish a low cost follow-up study. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular mortality has risen 30 fold in South Asia yet there is little data on how socioeconomic status (SES) contributes to the rising cardiovascular disease (CVD) burden. In Bangladesh, CVD accounts for the majority of non-communicable mortality. The purpose of this study was to determine the role of SES on subclinical atherosclerosis measured as carotid intima media thickness (cIMT) in a rural Bangladesh population. Methods: cIMT was measured in 1022 participants (average age 46, 40% male) randomly selected from the Health Effects of Arsenic Longitudinal Study (HEALS), a population-based prospective cohort study based in rural Bangladesh. SES was measured with survey data as occupation type, land ownership, educational attainment, and television ownership. We assessed the association between each of these SES indicators and cIMT adjusting for potential confounders. Results: Over half of the participants received formal education (53%) and under half owned land (48%) and a television (44%). Women were primarily homemakers (95%) and men worked as factory workers (24%), laborers (18%), or in business (55%). In univariate analysis, those owning greater than one acre of land (p = 0.03), owning a television (p =0.02), or laborers and business owners when compared to factory workers had higher levels of cIMT (p<0.01). Educational attainment was not an independent predictor of cIMT (p = 0.7). In multivariate analysis after adjustment for potential confounders, men employed in the business sector had a 26.7 μm (95% CI 6.7 - 46.9, p < 0.01) significantly greater level of cIMT when compared to factory workers. The association was strongest in older men (50.8 μm, 95% CI 9.0 - 92.6, ≥50 years old compared to younger men (19.4 μm, 95% CI -2.0 - 40.9, <50 years old). Other SES indicators were not predictors of cIMT after multivariate adjustment. Conclusion: Working in the business sector was positively associated with subclinical atherosclerosis after adjustment for confounders. This finding is consistent with evidence from other developing nations suggesting that certain SES factors are independent predictors of CVD. [ABSTRACT FROM AUTHOR]

Introduction: Sleep quantity has been associated with higher risk of cardiovascular disease (CVD), however little is known about the impact of sleep quality on subclinical CVD. Hypothesis: Poor sleep quality is associated with subclinical CVD. Methods: We assessed the relationship between sleep quality and common carotid artery intima media thickness (IMT) through a cross-sectional analysis of a sub sample of 442 disease-free women from the Mexican Teacher's Cohort. Sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in an online questionnaire applied to participants in 2014-2016. We defined poor sleep quality as a PSQI score above 5. Right and left carotid IMT was measured at clinical visits in 2012, 2013 and 2016 through carotid ultrasound performed by trained neurologists; results were log-transformed. Subclinical CVD was defined as the mean of right and left IMT ≥0.8mm or the presence of an atherosclerotic plaque. Multivariable linear and logistic regression models were used to evaluate the association of sleep quality with IMT or subclinical CVD, respectively. Results: In women of 49±5 years, the prevalence of poor sleep quality was 41% (185 of 442) and of subclinical CVD was 12.2% (54 of 442). The multivariable-adjusted percent difference of IMT was 2.4% (95% CI 0.03, 4.9), greater amongst those with poor sleep versus adequate sleep quality. The odds of developing subclinical CVD in women with poor sleep quality were 2.2 (95% CI 1.2, 4.1) times greater than those with adequate sleep quality (figure). Additionally, further adjustments for stress and depressive symptoms attenuated the results and were no longer statistically significant. Conclusion: Poor sleep quality is associated with IMT and subclinical CVD in a population of middle-aged women and this association is potentially mediated by stress and depression. Further analysis is needed regarding this association. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have examined the association between adipose tissue distribution and atherosclerosis. However, the effect of smoking on this association has not been evaluated yet. Hypothesis: We assessed the hypothesis that there is positive association between the ratio of visceral and subcutaneous adipose tissue areas and carotid intima media thickness (CIMT), and the association can be modified according to gender and smoking status in South Korea. Methods: A total of 1,606 middle-aged participants without cardiovascular disease were enrolled in this cross-sectional study from 2013 to 2015 in South Korea (568 men; 1,038 women). The CIMT of study participants was measured using B-mode ultrasonography at distal right common carotid artery, based on a predetermined protocol. We measured the abdominal adipose tissue distribution of study participants using computerized tomography. The area of adipose tissue at L4 vertebrae level was calculated, and the area of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were separated by abdominal wall. Then, we calculated the ratio of VAT and SAT (VAT/SAT) area. Other major cardiovascular risk factors were measured by standardized questionnaire, physical exam and fasting blood analysis. Smoking status of study participants was classified into three groups: current, former and never smokers. For evaluating the association between adipose tissue area and CIMT, we used multiple linear regressions. Separated analyses based on gender and smoking status were also performed. Results: Mean CIMT of study participants was 0.62 mm (SD, 0.12 mm), and mean VAF/SAF ratio of study participants was 0.62 (SD, 0.29). The prevalence of current smoker was 36.8% (209 of 568) for men, and 4.1% (42 of 1038) for women. In our multiple linear regression models, the VAT/SAT ratio showed statistically significant positive β-coefficient for total participants (β =8.62, p=0.008): showing significant for men (β =15.95, p=0.001) and not for women (β =3.15, p=0.377). When considering men only with respect to smoking status, the association between VAT/SAT ratio and CIMT was significant for current smokers (β=30.37, p<0.001), while it was not for never smokers (β=0.62, p=0.958) and former smokers (β=12.84, p=0.119). There was no significant interaction for gender and also for smoking status for men (p for interaction>0.05). Conclusions: In conclusion, the VAT/SAT ratio was positively associated with CIMT, and more preeminent positive association was observed for current men smokers than for never and former men smokers. The results of this study supported the need of smoking cessation to prevent atherosclerosis by adipose tissue distribution, especially for men. [ABSTRACT FROM AUTHOR]