Using Cluster Analysis to Identify Subgroups of College Students at Increased Risk for Cardiovascular Disease

Background and Purpose: To examine the co-occurrence of cardiovascular risk factors and cluster subgroups of college students for cardiovascular risks. Methods: A cross sectional descriptive study was conducted using co-occurrence patterns and hierarchical clustering analysis in 158 college students. Results: The top co-occurring cardiovascular risk factors were overweight/obese and hypertension (10.8%, n = 17). Of the total 34 risk factors that co-occurred, 30 of them involved being overweight/obese. A six-cluster-solution was obtained, two clusters displayed elevated levels of lifetime and 30-year cardiovascular disease risks. Conclusions: The hierarchical cluster analysis identified that single White males with a family history of heart disease, overweight/obese, hypertensive or diabetes, and occasionally (weekly) consumed red meat, take antihypertensive medication, and hyperlipidemia were considered the higher risk group compared to other subgroups

Competing risks of cancer mortality and cardiovascular events in individuals with multimorbidity

Background: Cancer patients with cardiovascular and other comorbidities are at concurrent risk of multiple adverse outcomes. However, most treatment decisions are guided by evidence from single-outcome models, which may be misleading for multimorbid patients. Objective: We assessed the interacting effects of cancer, cardiovascular, and other morbidity burdens on the competing outcomes of cancer mortality, serious cardiovascular events, and other-cause mortality. Design: We analyzed a cohort of 6,500 adults with initial cancer diagnosis between 2001 and 2008, SEER 5-year survival ≥26%, and a range of cardiovascular risk factors. We estimated the cumulative incidence of cancer mortality, a serious cardiovascular event (myocardial infarction, coronary revascularization, or cardiovascular mortality), and other-cause mortality over 5 years, and identified factors associated with the competing risks of each outcome using cause-specific Cox proportional hazard models. Results: Following cancer diagnosis, there were 996 (15.3%) cancer deaths, 328 (5.1%) serious cardiovascular events, and 542 (8.3%) deaths from other causes. In all, 4,634 (71.3%) cohort members had none of these outcomes. Although cancer prognosis had the greatest effect, cardiovascular and other morbidity also independently increased the hazard of each outcome. The effect of cancer prognosis on outcome was greatest in year 1, and the effect of other morbidity was greater in individuals with better cancer prognoses. Conclusion: In multimorbid oncology populations, comorbidities interact to affect the competing risk of different outcomes. Quantifying these risks may provide persons with cancer plus cardiovascular and other comorbidities more accurate information for shared decision-making than risks calculated from single-outcome models. Journal of Comorbidity 2014:4(1):29–3

The Effects of Caffeine on Health: The Benefits Outweigh the Risks

This literature review examines the relationship between caffeine and various health effects. This paper will review the research on health risks related to caffeine consumption and weigh the balance between the risks and benefits that caffeine can provide. Although there are several risks correlated with caffeine consumption, this literature review highlights how the benefits may offset any potentials risks. The main benefits that will be discussed are enhancing physical performance, alertness, pain relief, reducing cognitive impairment, hydration, and reducing the risk of cardiovascular and cerebrovascular diseases

Liraglutide and renal outcomes in type 2 diabetes

In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown

The air we breathe

Air pollution has been associated with respiratory ill health for centuries and in recent years much research effort has gone into quantifying the risks and elucidating the mechanisms. Respiratory disease, mostly of the airways is second only by a narrow margin, to cardiovascular disease as the commonest reason for admission to hospital. In this article the author describes the health risks associated with air pollution specifically with asthma as being the commonest respiratory disease in Malta.peer-reviewe

Sex differences in lifetime risk and first manifestation of cardiovascular disease: Prospective population based cohort study

Objective: To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework. Design: Prospective population based cohort study. Setting: People living in the community in Rotterdam, the Netherlands. Participants: 8419 participants (60.9% women) aged ≥55 and free from cardiovascular disease at baseline. Main outcome measures: First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death. Results: During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1

Prevalence of clustering of lifestyle cardiovascular risks and its association with cardiovascular screening activities among apparently healthy government servants in ‘Wisma Persekutuan’ Kuala Terengganu, Terengganu

Introduction: Cardiovascular diseases are the leading cause of death and disability among men and women in nearly all nations, including Malaysia and are projected to remain the single leading cause of death up to 2030. Lifestyle cardiovascular risks such as dietary habits, physical inactivity and smoking are considered fundamental risk factors for cardiovascular disease. Some studies in developed countries have found that lifestyle risk factors occur in combination with each other and are not randomly distributed across populations. Methodology: This cross-sectional study was done from June to August 2013 to determine the prevalence of lifestyle risks, clustering of lifestyle risks, and optimal screening; to determine the association of clustering of lifestyle risks with cardiovascular screening activities among government servants in Kuala Terengganu, Malaysia. A questionnaire which consisted of a case report form, International Physical Activity Questionnaire (IPAQ) and the dietary component of WHO STEPs were used as tools. The questionnaires were distributed to 121 government servants aged ≥20 years without any established cardiovascular disease. Cardiovascular screening for a history of blood pressure, blood glucose, serum lipids and BMI measurement were done for each participant. Findings: The study response rate was 90.9% (110 of 121). Prevalence of smoking, physical inactivity and unhealthy diet were 20%, 50% and 87% respectively. Prevalence was more in the lower socio-economic group. The prevalence of clustering of lifestyle cardiovascular risks was 57%. The prevalence of optimal cardiovascular screening for age was 49%. Clustering of lifestyle risks was significantly associated with non-optimal screening (p=0.004). Other significant factors associated with non-optimal screening were female gender, age and last visit to medical practitioner more than one year. Conclusion: Measures needed to be done to promote affordable healthier diet and healthy lifestyle activities. Promotion of healthy lifestyle behaviors should be done via synergistic action of public health and primary care sectors and emphasis should be made at primary care level to screen those with multiple lifestyle cardiovascular risks in order to optimize cardiovascular disease prevention

International variation in outcomes among people with cardiovascular disease or cardiovascular risk factors and impaired glucose tolerance: insights from the NAVIGATOR Trial

Background: Regional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial. Methods and Results: NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified. Conclusions: Major regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials