Abstract P127: Racial Disparities in Risk Factor Control in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christina Parrinello ◽  
Ina Rastegar ◽  
Job G Godino ◽  
Michael D Miedema ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Racial Disparities ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Tight Control ◽  
Risk Factor Control ◽  
Atherosclerosis Risk In Communities

Background: Racial disparities in risk factor control have been documented in middle-aged adults, but much less is known about older adults with diabetes. Our findings will inform clinical guidelines on appropriate risk factor control in older adults with diabetes. Methods: In 2011-13, 6,538 ARIC participants attended visit 5, and 4,988 provided data on all key covariates used in these analyses. Of these, 31% had diagnosed diabetes (N=1,561, 72% white, mean age=75 years) and were included in this study. Tight control of risk factors was defined according to American Diabetes Association guidelines: hemoglobin A1c <7%; low-density lipoprotein cholesterol <100 mg/dL; systolic blood pressure (BP) <140 mmHg and diastolic BP <80 mmHg. We evaluated risk factor control overall and by race. We used logistic regression and predictive margins to assess independent associations of race with tight risk factor control. Results: Among older adults with diabetes, 64% used glucose-lowering medication, 70% lipid-lowering medication and 82% BP-lowering medication. Only 5% of participants did not take medication for any of these risk factors. Tight control was observed in 72% for glucose, 64% for lipids and 70% for BP. Only 34% had tight control of all three. A higher proportion of whites than blacks consistently achieved tight control ( Figure ). In multivariable analyses of persons with diabetes who were treated for risk factors, racial disparities in tight control of lipids and BP remained significant: adjusted prevalence ratios and 95% CIs (white vs black) were 1.04 (0.91, 1.17) for glucose, 1.21 (1.08-1.34) for lipids, 1.15 (1.03-1.26) for BP, and 1.33 (0.95, 1.70) for tight control of all three risk factors. Conclusions: Our results highlight racial disparities in risk factor control in older adults with diabetes that were not explained by demographic or clinical characteristics. Further studies are needed to elucidate the determinants of disparities in risk factor control and strategies to address these.

scholarly journals Prevalence of and Racial Disparities in Risk Factor Control in Older Adults With Diabetes: The Atherosclerosis Risk in Communities Study

Diabetes Care ◽  
2015 ◽  
Vol 38 (7) ◽  
pp. 1290-1298 ◽  
Author(s):  
Christina M. Parrinello ◽  
Ina Rastegar ◽  
Job G. Godino ◽  
Michael D. Miedema ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Racial Disparities ◽  
Risk Factor Control ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Abstract TMP16: Morphologic Evolution and Remodelling of Intracranial Atherosclerosis Under Intensive Risk Factor Control

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Thomas Leung ◽  
Yannie Soo ◽  
Vincent Ip ◽  
Ka Sing Wong ◽  
Simon Yu
Keyword(s):  
Risk Factor ◽  
Medical Therapy ◽  
Plaque Rupture ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Risk Factor Control ◽  
Luminal Narrowing ◽  
Atherosclerotic Stenosis ◽  
Before And After ◽  
One Year

Introduction: In SAMMPRIS, the benefit of aggressive medical therapy over stenting persisted throughout the extended follow-up. It is uncertain how modern medical management could diminish stroke relapses. Method: In a prospective academic-initiated study, we recruited 40 patients (mean age 63.4±9.0 years) with acute strokes attributed to high-grade (≥70%) intracranial atherosclerotic stenosis for 3D-rotational angiograms before and after intensive medical therapy for 12 months. Treatment targets included low-density lipoprotein <70 mg/dl; HbA1c <6.5%; and systolic blood pressure <140 mmHg. We analyzed the morphologic and geometric evolution of the symptomatic plaques. Results: Overall, the risk factor control reached the pre-specified intensity. Plaque thickness, and hence luminal narrowing, significantly diminished at one year (from 1.50±0.48 to 1.24±0.42mm; p<0.001). The site of maximal stenosis shifted significantly towards mid-portion of the plaque (p<0.001), leading to a diminished upstream angulation. The ulcers noted at baseline (n=3) had all healed by one year. There was no significant change in terms of plaque length or lesion eccentricity. Conclusion: Intracranial plaques might regress and positively remodel under intensive risk factor control. These morphologic changes might stabilise the plaques, alleviate unfavourable hemodynamics across the steno-occlusion, and hence reduce the risk of plaque rupture or platelet aggregation.

scholarly journals Association between lipoprotein cholesterol and future cardiovascular disease and mortality in older adults: a Korean nationwide longitudinal study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Seung Hee Kim ◽  
Ki Young Son
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Risk Factor ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Incidence Rates ◽  
Brain Disease ◽  
Lipoprotein Cholesterol ◽  
Diabetic Patients ◽  
Ischemic Brain

Abstract Background Dyslipidemia is considered an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults. Despite its importance, there have been few reports on the association between lipoprotein cholesterol and future CVD and cardiovascular (CV) mortality among elderly Asians aged ≥ 65 years. This study investigated the association between lipoprotein cholesterol and future CVD and CV mortality in an elderly Korean population using a large nationwide sample. Methods From the cohort database of the Korean National Health Insurance Service, 62,604 adults aged ≥ 65 years (32,584 men and 30,020 women) were included. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were categorized by quartiles. Cox proportional hazard models and linear regression analyses were used to assess the association between the quartiles of lipoprotein cholesterol and future CV events or mortality. Results The mean follow-up period was 3.3 years. The incidence rates of ischemic heart disease and ischemic brain disease were 0.97 and 0.61 per 1,000 person-years, respectively, and the mortality rates from these diseases were 0.22 and 0.34 per 1,000 person-years, respectively. In a completely adjusted model, high HDL-C and LDL-C levels were not associated with total CV events and CVD mortality. However, high LDL-C levels were significantly associated with a lower incidence of ischemic brain disease. Furthermore, diabetic patients with high LDL-C levels were more likely to have higher CV mortality, whereas non-smokers with high LDL-C levels were less likely to be at risk of CV events. Conclusions Neither high LDL-C nor HDL-C levels were significantly associated with future CV mortality in older adults aged ≥ 65 years. High LDL-C levels do not seem to be a risk factor for CVD in elderly individuals, and further studies are required.

scholarly journals Non-HDL Cholesterol Versus LDL Cholesterol as a CVD Risk Factor in Diabetic Subjects

2014 ◽  
Vol 31 (4) ◽  
pp. 199-203
Author(s):  
M Saiedullah ◽  
S Begum ◽  
S Hayat ◽  
SM Kamahuddin ◽  
MR Rahman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Upward Trend ◽  
Cvd Risk ◽  
Cross Sectional

Objective: Serum low density lipoprotein (LDL) cholesterol is considered as the primary target of lipid lowering therapy and non-high density lipoprotein (HDL) cholesterol is the recommended second target. Recent studies claimed that non-HDL cholesterol is a better predictor of cardiovascular diseases (CVD) than LDL cholesterol. In this study we aimed to compare non-HDL cholesterol and LDL cholesterol as a CVD risk factor in confirmed diabetic subjects. Materials and methods: In this cross-sectional observational study, 1042 confirmed diabetic subjects selected randomly were included. HbA1cResults: In the total subjects, 767 (74%) subjects had LDL cholesterol > 100 mg/dL and 822 (79%) subjects had non- HDL cholesterol > 130 mg/dL. HbA1c values were different (p<0.02) in five groups and showed upward trend (p<0.01). All the lipid parameters studied were significantly different in five groups (p<0.0001) and TC, TG and non-HDL cholesterol showed upward trend (p<0.0001), but HDL cholesterol and LDL cholesterol showed downward trend (p<0.0001). Odds ratio (OR) of likelihood of risk individuals regarding non-HDL cholesterol compared to LDL cholesterol were 0.50 (p<0.001), 1.32 (p>0.05), 2.96 (p<0.001), 6.49 (p<0.001) and 9.37 (p<0.001) for TG concentrations of up to 150 mg/dL, 151-200 mg/dL, 201-250 mg/dL, 251-300 mg/dL and 301-400 mg/dL respectively with relative risk of 0.60, 1.24, 2.43, 4.83, 5.10. Conclusion: LDL cholesterol is a better tool for the detection of high-risk individuals than non-HDL cholesterol at TG concentration up to 150 mg/dL, whereas non-HDL cholesterol is better than LDL cholesterol at TG concentration above 200 mg/dL as a CVD risk factor. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21004 J Bangladesh Coll Phys Surg 2013; 31: 199-203

The risk of peripheral artery disease in older adults - seven-year results of the getABI study

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 403-410 ◽  
Author(s):  
Dietmar Krause ◽  
Ina Burghaus ◽  
Ulrich Thiem ◽  
Ulrike S. Trampisch ◽  
Matthias Trampisch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
Current Smoker ◽  
Repeated Measurements ◽  
Peripheral Artery ◽  
Artery Disease

Abstract. Background: To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. Patients and methods: 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. Results: The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). Conclusions: Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD

scholarly journals Determinants of coronary artery disease risk factor management across three world regions

Heart Asia ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. e011112
Author(s):  
Min Zhao ◽  
Ian Graham ◽  
Marie Therese Cooney ◽  
Diederick E Grobbee ◽  
Ilonca Vaartjes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Middle East ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Health ◽  
Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Risk Factor Management ◽  
Logistic Regression Models

BackgroundThe SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.Methods and resultsSURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.ConclusionsOverall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.

scholarly journals Inclisirán as an alternative treatment for Hypercholesterolemia

2021 ◽  
Vol 12 (3) ◽  
pp. 517-521
Author(s):  
Jorge Andrés Ojeda Villota ◽  
Javier Alfredo Pérez Martínez ◽  
Luis Alberto Burgos de Moya ◽  
Rodrigo Alfonso Chavez Vega ◽  
Roxana Rivera Valencia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Pcsk9 Inhibitors ◽  
Cholesterol Levels ◽  
Lowering Therapy

Hypercholesterolemia (CH) is defined as the elevation of serum cholesterol levels, especially low-density lipoprotein (LDL) cholesterol, which is considered to be one of the most relevant risk factors for triggering cardiovascular disease, for This is vitally important to start treatment, there are several highly useful pharmacological groups for lipid-lowering therapy, among them we highlight the PCSK9 inhibitors, among the molecules that are part of this group we find inclisirán, this being a structure that promises a lot in regarding the management of hypercholesterolemia.

scholarly journals Assessment of Risk Factors for Atherosclerosis in Individuals of Different Categories of Cardiovascular Risk Using the Aterostop Calculator

Kardiologiia ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 12-17
Author(s):  
M. Y. Zubareva ◽  
P. P. Malyshev ◽  
A. A. Ansheles ◽  
I. V. Sergienko
Keyword(s):  
Risk Factors ◽  
Comprehensive Evaluation ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Lipid Lowering ◽  
Cross Sectional ◽  
National Medical ◽  
Extreme Risk ◽  
First Results

Aim        To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods        A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results   45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75 % vs. 3.7 %, respectively).Conclusion            The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.

scholarly journals Hypertriglyceridemic-Waist Phenotype is Strongly Associated With Cardiovascular Risk Factor Clustering In Chinese adolescents

2021 ◽  
Author(s):  
Rongrong Cai ◽  
Jinyu Zhou ◽  
Lin Bai ◽  
Yangyang Dong ◽  
Wenqing Ding
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Risk Factor ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Hypertriglyceridemic Waist ◽  
Gender And Age

Abstract There is limited research on the relationship between the Hypertriglyceridemic-waist (HTW) phenotype and cardiovascular risk factors (CVRFs) in adolescents, and its association with cardiovascular risk factor clustering (CVRFC) is unclear. The aim of this study was to examine the association between HTW phenotype and CVRFs and CVRFC in adolescents. A total of 1478 adolescents aged 12-18 years were classified into normal triglyceride normal waist (NTNW, 66.4%), hypertriglyceridemia (HTG, 5.5%), enlarged waist (EW, 22.2%) and hypertriglyceridemia-waist (HTW, 5.8%) according to whether triglycerides (TG)≥1.47 mmol/L and waist circumference (WC) ≥90th percentile by gender and age. CVRFs in this study included elevated blood pressure(BP), impaired fasting glucose(IFG), high total cholesterol(TC), low high-density lipoprotein cholesterol (HDL-C), and high low-density lipoprotein cholesterol(LDL-C). After adjusting for gender and age, the HTW phenotype had a higher risk of Elevated BP, High TC, Low HDL-C and High LDL-C compared to the NTNW phenotype(the OR and 95% CI were 6.00 (3.79-9.52), 4.58 (2.68-7.83), 4.21 (2.44-7.26) and 6.15 (3.39-11.14), respectively). And the HTW phenotype increased the risk of CVRFC ≥ 2 and CVRFC ≥ 3 compared to the NTNW phenotype, the OR and 95% CI were 6.64 (4.08-10.80) and 11.74 (5.95-23.13), respectively. And similar results were obtained for both sexes when stratified by gender. The area under the ROC curve (AUC) for TG combining WC in the prediction of the CVRFC ≥ 2 and CVRFC ≥ 3 were 0.690 (0.651-0.728) and 0.697 (0.659-0.734) in boys, and the AUC were 0.684 (0.647-0.722) and 0.695 (0.657-0.732) for girls(all P<0.01), which were higher than TG or WC alone. These results revealed that the HTW phenotype is closely associated with cardiovascular risk factors clustering, and TG combining WC performed better than TG or WC alone in detecting cardiovascular risk factor clustering in both genders.

scholarly journals Bilirubin ameliorates murine atherosclerosis through inhibiting cholesterol synthesis and reshaping the immune system

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Guanmei Wen ◽  
Leyi Yao ◽  
Yali Hao ◽  
Jinheng Wang ◽  
Jinbao Liu
Keyword(s):  
Risk Factors ◽  
Immune System ◽  
Total Cholesterol ◽  
Cholesterol Synthesis ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol

AbstractAtherosclerosis is a chronic inflammatory disease caused mainly by lipid accumulation and excessive inflammatory immune response. Although the lipid-lowering and cardioprotective properties of bilirubin, as well as the negative relationship between bilirubin and atherosclerosis, were well documented, it is not yet clear whether bilirubin can attenuate atherosclerosis in vivo. In this study, we investigated the role of bilirubin in improving atherosclerosis. We found that mildly elevated bilirubin significantly reduced the risk factors of atherosclerosis, such as plasma glucose, total cholesterol, and low-density lipoprotein cholesterol, and the formation of atherosclerotic plaques, liver total cholesterol, and cholesterol ester concentration in apolipoprotein E-deficient (ApoE−/−) mice fed a western-type (high fat) diet. It was further found that bilirubin could promote the degradation of 3-Hydroxy-3-Methylglutaryl-CoA Reductase (HMGCR), a rate-limiting enzyme for endogenous cholesterol synthesis. Using mass cytometry-based high dimensional single cell analysis, we observed a decrease of natural killer cells and an increase of dendritic cells and myeloid-derived suppressor cells, which all are closely associated with atherosclerosis risk factors and contribute to the improvement of atherosclerosis, in ApoE−/− mice treated with bilirubin. By in-depth analysis, modulation of multiple spleen or peripheral blood T cell clusters exhibiting either positive or negative correlations with total cholesterol or low-density lipoprotein cholesterol was detected after bilirubin treatment. In this study, we demonstrate that bilirubin serves as a negative regulator of atherosclerosis and reduces atherosclerosis by inhibiting cholesterol synthesis and modulating the immune system.

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