Lipoprotein (a) and 10-year cardiovascular disease incidence in apparently healthy individuals: A sex-based sensitivity analysis from ATTICA Cohort Study

The association between lipoprotein (a) (Lp(a)) and 10-year first fatal/nonfatal cardiovascular disease (CVD) risk in apparently healthy men and women was evaluated. The ATTICA prospective study was conducted during 2001-2012 and included n = 1514 men and n = 1528 women (age \u3e18 years) from the greater Athens area, Greece. Follow-up CVD assessment (2011-2012) was achieved in n = 2020 participants (n = 317 cases); baseline Lp(a) was measured in n = 1890 participants. The recommended threshold of 50 mg/dL was used to define abnormal Lp(a) status. Ten-year CVD-event rate was 14% and 24% in participants with Lp(a)Lp(a) ≥50 mg/dL, respectively. Multivariate analysis revealed that participants with Lp(a) ≥50 mg/dL versus Lp(a)/dL had about 2 times higher CVD risk (hazard ratio (HR) = 2.18, 95% confidence interval (CI) 1.11, 4.28). The sex-based analysis revealed that the independent Lp(a) effect was retained only in men (HR = 2.00, 95% CI 1.19, 2.56); in women, significance was lost after adjusting for lipid markers. Sensitivity analyses revealed that Lp(a) increased CVD risk only in case of abnormal high-density lipoprotein cholesterol, apolipoprotein A1, and triglycerides as well as low adherence to Mediterranean diet. Certain patient characteristics may be relevant when considering Lp(a) as a therapeutic or risk-prediction target

Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study

Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old. METHODS: ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011-2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas. RESULTS: The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile. CONCLUSIONS: The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health

Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study

Background and aims The lipid accumulation product (LAP) is an index describing lipid over-accumulation based on waist circumference (WC) and fasting triglycerides, and can outperform the body mass index (BMI) in recognizing cardiovascular disease (CVD) risk. We aimed to explore the association of LAP with long-term CVD risk and compare its CVD-predictive value against common anthropometric indices/ratios of obesity. Methods ATTICA is a prospective, population-based cohort that recruited 3042 adults without pre-existing CVD from the Greek general population (age 18–89 years; 1514 men). The 10-year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). Baseline LAP (cm⋅mmol/L) was calculated and analyzed in relation to the 10-year CVD incidence. Results In total, 317 CVD cases (15.7%) were documented during the follow-up. Baseline LAP showed a significant positive association with the 10-year CVD incidence, even after adjusting for hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Mediterranean diet adherence, and key pro-inflammatory biomarkers (Hazard Ratios per 10 cm mmol/L of LAP ranging from 1.1 to 1.21, p = 0.04). Moreover, LAP predicted the 10-year CVD study incidence better than common obesity indices (BMI, WC, waist-to-hip, waist-to-height ratio). Conclusions These findings support and independent positive association between LAP and long-term CVD incidence in CVD-free Caucasian adults from the general population

A sex-specific evaluation of predicted lean and fat mass composition and cardiovascular disease onset and progression: A combined analysis of the ATTICA and GREECS prospective epidemiological studies

Objectives: To evaluate the association of predicted lean and fat mass on 10-year first and recurrent CVD incidence separately for men and women. Methods: Two prospective studies, ATTICA (2002-2012, n = 3042 subjects free-of-CVD, n = 1514 men (46 ± 13 years) and n = 1528 women (45 ± 14 years)) and GREECS (2004-2014, n = 2172 subjects with acute coronary syndrome (ACS), n = 1649 men (65 ± 13 years) and n = 523 women (62 ± 11 years)) were used. Lean mass index (LMI) and fat mass index (FMI) were created through total body lean and fat mass (indirectly calculated through population formulas based on body weight, height and waist circumference) divided by height squared. Follow-up was performed in n = 2020 of ATTICA (n = 317 first CVD events) and in n = 2172 patients of GREECS (n = 811 recurrent CVD events). Results: In ATTICA study, CVD rate from 1st to 3rd FMI tertile was 9.4%, 16.1% and 19.9% while in GREECS 36.2%, 37.0%, 38.3%. The LMI-related rates were 17.1%, 15.0% and 11.9% vs. 38.8%, 35.8% and 36.7%. Multiadjusted analysis revealed U-shape trend between LMI and CVD recurrence with 2nd LMI tertile having the best prognosis; this observation was more evident in women. In apparently healthy subjects, LMI-cardioprotective association was revealed only in 3rd tertile (HR = 0.91 95%CI (0.74, 0.95)); this was more evident in men. The FMI aggravating association (3rd tertile) was retained significant only in healthy women and ACS men. Conclusion: This work expands previous findings regarding body composition and cardiac health, implying that the association of lean and fat mass on long-term CVD incidence varies according to sex and prevention stage

Olive oil consumption and 10-year (2002–2012) cardiovascular disease incidence: the ATTICA study

Olive oil, being rich in mono-unsaturated fatty acids and anti-inflammatory compounds, may have protective effects against cardiovascular disease (CVD). The aim of the present work was to examine the association of olive oil consumption with the 10-year CVD incidence in adults without pre-existing CVD. After controlling for various covariates, an inverse association between exclusive olive oil use and the risk of developing CVD was observed (relative risk 0.07, 95% CI: 0.01-0.66) compared to those not consuming olive oil. Further adjustment for fibrinogen plasma levels (among various inflammatory markers) showed a significant mediation effect on the previous association. These findings support exclusive olive oil consumption, a key component of the Mediterranean diet, for the primary CVD prevention, in adults without pre-existing disease. Circulating fibrinogen levels appear to play a mediating role in this relationship

Decreased Deceleration Capacity of Heart Rate Detects Heart Failure Patients at Risk for Malignant Ventricular Arrhythmias

BACKGROUND: Deceleration capacity (DC) of the heart rate has proved an independent predictor of total mortality in post-myocardial infarction (post-MI) patients but it is unknown whether DC predicts the arrhythmic risk as well. OBJECTIVE: Our aim was to investigate whether DC can predict the arrhythmic sudden cardiac death (SCD) surrogate in patients with heart failure (HF). PATIENTS AND METHODS: We prospectively screened 145 HF patients with electrocardiogram (ECG), signal averaged ECG, echocardiography, and 24-hour Holter ECG. After 41.2 months, patients were divided into high (n=43) and low risk (n=102) groups according to three arrhythmic surrogates: clinical ventricular tachyarrhythmia (ventricular tachycardia -VT/ ventricular fibrillation-VF) (n=18), appropriate activation of the implantable cardioverter defibrillator (ICD) device (n=23) and confirmed SCD (n=2). RESULTS: High risk patients had impaired DC with significantly lower values (3.2±1.8 ms vs 4.0±2.1 ms, p=0.025). In the Cox regression analysis model adjusted for age, gender, diabetes, left ventricular ejection fraction (LVEF), filtered QRS, QTc, nonsustained VT episode(s) ≥ 1/24 h, ventricular premature beats ≥240/24 and DC, DC emerged as an important SCD surrogate predictor with a hazard ratio of 0.804, (95% confidence intervals-CI: 0.671- 0.963, p = 0.018). The cutoff point of DC≤3.352 ms (median) presented a hazard ratio of 2.885 (95% CI: 1.342 - 6.199, p=0.007, log rank test: p=0.003) for SCD surrogate. CONCLUSION: Decreased DC was found to be an important and independent SCD surrogate predictor. The cutoff point of DC≤3.352 ms detects HF patients at increased arrhythmic risk.

Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study

Abstract: By 2050, the global population aged 60 years and over is expected to reach nearly 2.1 billion and affective disorders might be also expected to increase. Although nutrition has been related with affective disorders, there is a lack of studies assessing the relation between dietary habits and anxiety among European and Mediterranean older populations. In the present study, we aimed to evaluate the association between dietary habits, energy intake, and anxiety symptoms using data from 1128 Greek older adults (>50 years) without pre-existing cardiovascular disease (CVD) or any other chronic disease who participated in the ATTICA study. Various socio demographic lifestyle, bio-clinical (e.g., blood pressure), and psychological (e.g., depression) characteristics were used, and dietary habits as well as energy intake were calculated using standard procedures. Older people with anxiety were more likely to be sedentary, to be smokers, and to show symptoms of depression. The saturated fat and added sugars (SFAS) dietary pattern was associated with higher anxiety levels (non-standardized b (95% CI): 5.82 (0.03 to 11.61)). No association between energy intake tertiles and anxiety levels pictured in the later regression model. Moreover, female gender, family status, and depression were positively related to anxiety. Therefore, promoting healthy dietary habits could reduce anxiety symptoms of the older adults