Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia:A multi-national study

Objectives: Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods: We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1–100, 101–400, &gt;400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results: Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1–100, 160 (16%) had CAC 101–400, and 99 (10%) had CAC &gt;400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1–100 (8% [n = 15] vs 18% [n = 26]), CAC 101–400 (32% [n = 22] vs 40% [n = 36]), and CAC &gt;400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50–59 years were less likely to have obstructive CAD in CAC &gt;400 (55% [n = 6] vs 70% [n = 19]). Conclusion: In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.</p

Chronic inflammatory diseases, subclinical atherosclerosis, and cardiovascular diseases: Design, objectives, and baseline characteristics of a prospective case-cohort study ‒ ELSA-Brasil

Objectives: This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods: A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein&nbsp;&gt;10&nbsp;mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with&nbsp;10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results: The high-risk group (n&nbsp;=&nbsp;2,949; aged 53.6 ± 9.2; 65.5%&nbsp;women) and the ACS (n=1543; 52.2±8.8; 54.1%&nbsp;women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1%&nbsp;vs.&nbsp;24.8%, p &lt; 0.0001), higher BMI (Kg/m2) (28.1&nbsp;vs.&nbsp;26.9, p &lt; 0.0001), higher waist circumference (cm) (93.3&nbsp;vs.&nbsp;91, p &lt; 0.0001), higher frequencies of hypertension (40.2%&nbsp;vs.&nbsp;34.5%, p &lt; 0.0001), diabetes (20.7%&nbsp;vs.&nbsp;17%, p&nbsp;=&nbsp;0.003) depression (5.8%&nbsp;vs.&nbsp;3.9%, p&nbsp;=&nbsp;0.007) and higher levels of GlycA a new inflammatory marker (p &lt; 0.0001) compared to the ACS. Conclusions: The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Polypill Therapy, Subclinical Atherosclerosis, and Cardiovascular Events—Implications for the Use of Preventive Pharmacotherapy MESA (Multi-Ethnic Study of Atherosclerosis)

ObjectivesThis study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill.BackgroundPrior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level.MethodsParticipants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score.ResultsAmong MESA participants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC&nbsp;= 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC&nbsp;= 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores &gt;100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC&nbsp;= 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores &gt;100.ConclusionsIn MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores &gt;100. The group with CAC&nbsp;= 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC&nbsp;= 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit

Polypill Therapy, Subclinical Atherosclerosis, and Cardiovascular Events—Implications for the Use of Preventive Pharmacotherapy MESA (Multi-Ethnic Study of Atherosclerosis)

ObjectivesThis study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill.BackgroundPrior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level.MethodsParticipants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score.ResultsAmong MESA participants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC&nbsp;= 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC&nbsp;= 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores &gt;100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC&nbsp;= 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores &gt;100.ConclusionsIn MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores &gt;100. The group with CAC&nbsp;= 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC&nbsp;= 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit

Are C-reactive protein concentrations affected by smoking status and physical activity levels? A longitudinal study.

Background and objectiveTo compare high-sensitivity C-reactive protein (hsCRP) levels according to smoking status and physical activity (PA) changes in adults.MethodsThe sample consisted of 6028 participants (4833 men) who underwent a voluntary routine health evaluation at the Preventive Medicine Center at the Hospital Israelita Albert Einstein, Sao Paulo, Brazil, from January 2007 to December 2013. Data were collected at baseline and follow-up (2.7±1.6 years). Plasma hsCRP (in mg/L) was analyzed in both moments. Smoking status was obtained through a self-reported questionnaire, being participants classified as non-smokers, once smokers (report smoking at baseline or follow-up), and persistently smokers (reported smoking at both baseline and follow-up). PA was assessed by questionnaire in both moments, being participants classified as persistently inactive, became inactive, became active, and persistently active. The Rank Analysis of Covariance was used to compare hsCRP follow-up values according to smoking and physical activity status.ResultsPersistently smokers showed significantly higher median values of hsCRP at follow-up (1.3 mg/L, IQR:0.6-2.8) than once smokers (1.1 mg/L, IQR: 0.6-2.4) and non-smokers (1.0 mg/L, IQR: 0.5-2.2), even considering covariates (pConclusionPersistently active participants had lower hsCRP values at follow-up than those persistently inactive in all the smoking status groups. Regular practice of PA is an important strategy for facing low-grade inflammation, even among smokers

Prospective associations between multiple lifestyle behaviors and depressive symptoms

Background Our aim was to analyze the associations between multiple lifestyle behaviors and depressive symptoms. Methods We included 4,725 adults (18-59y), that provided data in routine health evaluations of a hospital in Brazil, followed for a mean period of 3.1±1.6 years. Physical activity, alcohol consumption (measured using Alcohol Use Disorders Identification Test) and tobacco smoking were categorized as: (1) absence of the behavior (inactivity i.e. not complying with 150 min of moderate-to-vigorous PA/week, not smoking, no risky drinking, i.e. AUDIT<5) during baseline and follow-up; (2) Absence during baseline and presence during follow-up; (3) Presence during baseline and absence during follow-up; (4) Presence during both time points. Depressive symptoms were measured with the Beck Inventory was adopted to analyze patterns of depressive symptoms over time (as exposure). C-reactive protein [HS-CRP]) was assessed and its role in the association was tested. Incidence indicators of behaviors and depressive symptoms were created and used as outcomes. We used crude and adjusted Poisson regression analysis. Results Fully adjusted models revealed that persistently physical inactive participants (RR:1.71;95%CI:1.33-2.21), those who became physically inactive (1.68;1.19-2.26), with consistently risky drinking (1.62;1.15-2.30), and who became risky drinkers (1.62;1.15-2.30) had higher risk for incidence of elevated depressive symptoms. Vice versa participants with incidence of depressive symptoms over time presented higher risk for physical inactivity (1.44;1.11-1.87) and risky drinking (1.65;1.16-2.34) incidence. HS-CRP did not influence the associations. Limitations Self-reported physical activity, binary tobacco smoking, and non-probabilistic sampling. Conclusions There is a prospective relationship between elevated depressive symptoms and adverse lifestyle behaviors