Low zinc levels is associated with increased inflammatory activity but not with atherosclerosis, arteriosclerosis or endothelial dysfunction among the very elderly

BACKGROUND: Reduced zinc intake has been related to atherogenesis and arteriosclerosis. We verified this assumption in very old individuals, which are particularly prone to both zinc deficiency and structural and functional changes in the arterial wall. METHODS: Subjects (n = 201, 80-102 years) with uneventful cardiovascular history and who were not in use of anti-inflammatory treatments in the last 30-days were enrolled. Daily intake of zinc, lipid profile, plasma C-reactive protein (CRP), plasma zinc, flow-mediated dilation (FMD), carotid ultrasonography and cardiac computed tomography were obtained. Young\u27s Elastic Modulus, Stiffness Index and Artery Compliance were calculated. RESULTS: There was no significant difference in clinical or laboratorial data between subjects grouped according to plasma zinc tertile, except for CRP (p = 0.01) and blood leukocytes (p = 0.002), of which levels were higher in the upper tertiles. The average daily intake of zinc was not significantly correlated with zinc or CRP plasma levels. The plasma zinc/zinc intake ratio was inversely correlated with plasma CRP levels (- 0.18; p = 0.01). There was no significant difference between the plasma zinc tertiles and FMD, carotid intima-media thickness, coronary calcium score, carotid plaque presence, remodeled noncalcified coronary plaques, or low-attenuation noncalcified coronary plaques. CONCLUSION: Although plasma zinc level is inversely related to systemic inflammatory activity, its plasma levels of daily intake are not associated to alterations in structure or function of the arterial wall. GENERAL SIGNIFICANCE: In the very elderly plasma concentrations or daily intake of zinc is not related to endothelial dysfunction, arteriosclerosis or atherosclerotic burden at coronary or carotid arteries

Association of particles of lipoprotein subclasses with arterial stiffness in a high-risk working population: the Baptist Employee Healthy Heart Study (BEHHS)

Background: Arterial stiffness is an independent predictor of cardiovascular disease (CVD) morbidity and mortality. A risk factor-independent association of arterial stiffness with traditional lipids has been described extensively, but it is still unclear whether an independent relationship exists between arterial stiffness and particles of lipoprotein subclasses. Methods: The Baptist Employee Healthy Heart Study (BEHHS) is a lifestyle intervention study examining the effects of web-based programs on reducing CVD risk in high-risk persons. Participants had their brachial arterial augmentation index (AI, a measure arterial stiffness) assessed using the EndoPAT 2000 device. Cardio IQ™ ion mobility lipoprotein fractionation was utilized for measurement of particles of lipoprotein subclasses. Results: The population consisted of 182 participants, (74% women, 49% Hispanic) with a mean age of 52 ± 9 years. There was a significant trend association between quartiles of AI and total cholesterol, HDL-c, large LDL-p, small IDL-p, large IDL-p, and all subclasses of HDL particles (total HDL-p, small HDL-p, and large HDL-p). In logistic regression analysis, only HDL-c, total LDL-p, large LDL-p, small IDL-p, large IDL-p, total HDL-p, small HDL-p, and large HDL-p demonstrated significant independent association with AI. Conclusion: Several lipoprotein subclasses demonstrate independent significant associations with arterial stiffness. A safe and relatively inexpensive blood test may be useful in identifying subclinical atherosclerosis process in a relatively young high CVD risk population

Estimates of Mortality Benefit From Ideal Cardiovascular Health Metrics: A Dose Response Meta-Analysis

Background Several studies have shown an inverse relationship between ideal cardiovascular health (CVH) and mortality. However, there are no studies that pool these data to show the shape of the relationship and quantify the mortality benefit from ideal CVH. Methods and Results We conducted a systematic internet literature search of multiple databases including MEDLINE, Web of Science, Embase, CINAHL, and Scopus for longitudinal studies assessing the relationship between ideal CVH and mortality in adults, published between January 1, 2010, and May 31, 2017. We included studies that assessed the relationship between ideal CVH and mortality in populations that were initially free of cardiovascular disease. We conducted a dose‐response meta‐analysis generating both study‐specific and pooled trends from the correlated log hazard ratio estimates of mortality across categories of ideal CVH metrics. A total of 6 studies were included in the meta‐analysis. All of the studies indicated a linear decrease in (cardiovascular disease and all‐cause) mortality with increasing ideal CVH metrics. Overall, each unit increase in CVH metrics was associated with a pooled hazard ratio for cardiovascular disease mortality of 0.81 (95% confidence interval, 0.75–0.87), while each unit increase in ideal CVH metrics was associated with a pooled hazard ratio of 0.89 (95% confidence interval, 0.86–0.93) for all‐cause mortality. Conclusions Our meta‐analysis showed a strong inverse linear dose‐response relationship between ideal CVH metrics and both all‐cause and cardiovascular disease–related mortality. This study suggests that even modest improvements in CVH is associated with substantial mortality benefit, thus providing a strong public health message advocating for even the smallest improvements in lifestyle

A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities.

ContextThe internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs.Evidence acquisitionWe conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing--weight, BP, lipids, smoking, physical activity, diet, and blood glucose.Evidence synthesisA total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6-24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners.ConclusionInternet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations

The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima–media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle–brachial index, toe–brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: –3.12, −2.15). Persons with ED also had a 0.09-mm (95% CI: 0.06, 0.12) higher cIMT than those without ED. In subgroup meta-analyses, the mean age of the study population, study quality, ED assessment questionnaire (IIEF-5 or IIEF-15), or the publication date did not significantly affect the relationship between ED and cIMT or between ED and FMD. The results for the association of ED and CAC were inconclusive. In conclusion, this study confirms an association between ED and subclinical CVD and may shed additional light on the shared mechanisms between ED and CVD, underscoring the importance of aggressive CVD risk assessment and management in persons with ED

Lipoprotein sub-fractions by ion-mobility analysis and its association with subclinical coronary atherosclerosis in high-risk individuals

Aims: There is limited knowledge about the association of lipoprotein particles and markers of coronary atherosclerosis such as coronary artery calcification (CAC) in relatively young high-risk persons. This study examines the association of lipoprotein subfractions and CAC in high cardiometabolic risk individuals. Methods: The study presents analysis from baseline data of a randomized trial targeted at high-risk workers. Employees of Baptist Health South Florida with metabolic syndrome or diabetes were recruited. At baseline, all 182 participants had lipoprotein subfraction analysis using the ion mobility technique and participants above 35 years (N =170) had CAC test done. Principal components (PC) were computed for the combination of lipoprotein subclasses. Multiple bootstrapped regression analyses (BSA) were conducted to assess the relationship between lipoprotein subfractions and CAC. Results: The study population (N=170) was largely female (84%) with a mean age of 58 years. Three PCs accounted for 88% variation in the sample. PC2, with main contributions from VLDL particles in the positive direction and large LDL particles in the negative direction was associated with a 22% increase in CAC odds (P value ＜0.05 in 100% of BSA). PC3, with main contributions from HDL lipoprotein particles in the positive direction and small/medium LDL and large IDL particles in the negative direction, was associated with a 9% reduction in CAC odds (P＜0.05 in 88% of BSA). PC1, which had approximately even contributions from HDL, LDL, IDL and VLDL lipoprotein subfractions in the positive direction, was not associated with CAC. Conclusion: In a relatively young but high-risk population, a lipoprotein profile predominated by triglyceride-rich lipoproteins was associated with increased risk of CAC, while one predominated by HDL lipoproteins offered modest protection. Lipoprotein sub-fraction analysis may help to further discriminate patients who require more intensive cardiovascular work-up and treatment