Caroline Schmidt

Aims: The present study aimed to evaluate the association between body mass index (BMI) during childhood and puberty and blood pressure and hypertension in midlife and to explore midlife BMI as a potential mediator of these associations. Methods and results: We linked the BMI Epidemiology Study Gothenburg with developmental BMI, with the Swedish CArdioPulmonary bioImage Study (SCAPIS) with blood pressure and hypertension in midlife (n = 2394). The associations between childhood BMI (7–8 years) and pubertal BMI change (young adult BMI minus childhood BMI), and blood pressure and hypertension in midlife, were evaluated using linear or logistic regression models. Mediation analysis was conducted to evaluate the indirect effect, via midlife BMI, and the direct effect on blood pressure and hypertension. The analyses were adjusted for birth year and smoking. The pubertal BMI change was positively associated with systolic and diastolic blood pressures and hypertension in midlife, independent of childhood BMI, in both men and women (P < 0.01). For men but not for women, childhood BMI was positively associated with systolic and diastolic blood pressures in midlife, independent of the pubertal BMI change (P < 0.01). No significant independent association was observed for childhood BMI with hypertension. Mediation analyses for the association between the pubertal BMI change and blood pressure and hypertension in midlife indicate that these associations were largely mediated by BMI in midlife. Conclusion: These findings indicate that high blood pressure may originate in early life. A life-course approach for targeted prevention, starting already during the developmental years, could reduce the risk of high blood pressure.

Background: The association between common carotid artery intima‐media thickness (CCA‐IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA‐IMT and carotid plaque development. Methods and Results: We undertook an individual participant data meta‐analysis of 20 prospective studies from the Proof‐ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA‐IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA‐IMT was 0.71 mm (SD, 0.17 mm). Over a median follow‐up of 5.9 years (5th–95th percentile, 1.9–19.0 years), 8278 individuals developed first‐ever carotid plaque. We combined study‐specific odds ratios (ORs) for incident carotid plaque using random‐effects meta‐analysis. Baseline CCA‐IMT was approximately log‐linearly associated with the odds of developing carotid plaque. The age‐, sex‐, and trial arm–adjusted OR for carotid plaque per SD higher baseline CCA‐IMT was 1.40 (95% CI, 1.31–1.50; I ² =63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low‐ and high‐density lipoprotein cholesterol, and lipid‐lowering and antihypertensive medication was 1.34 (95% CI, 1.24–1.45; I ² =59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29–1.47]; I ² =57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions: Our large‐scale individual participant data meta‐analysis demonstrated that CCA‐IMT is associated with the long‐term risk of developing first‐ever carotid plaque, independent of traditional cardiovascular risk factors.

Ola Hjelmgren, Anders Gummesson, Göran Bergström, Caroline Schmidt. JOMES 1999;0:. https://doi.org/10.7570/jomes19078

Background: Hyperuricemia is closely associated with cardiovascular disease (CVD). However, it has not been definitively established whether this association is independent of traditional cardiovascular risk factors (CVRFs) and whether it is gender-dependent. The aim of this study was to investigate in a population-based cohort (age range, 50–64 years) stratified by sex the association between the serum urate (SU) concentration and subclinical atherosclerosis, as reflected in the coronary artery calcification (CAC) score, common carotid intima-media thickness (CIMT), and carotid plaque score. Methods: The study involved participants in the Swedish CArdioPulmonary bioImage Study (SCAPIS) Pilot cohort (N = 1040; 48.8% males). This pilot cohort is part of the large population-based SCAPIS with 30,000 participants in the age range of 50–64 years, aimed at improving risk prediction for CVD. Subjects with a self-reported previous history of CVD (N = 68) or gout (N = 3) were excluded. The CAC score was assessed with the Agatston method using computed tomography. CIMT and carotid plaques were quantified by ultrasound. The associations between the SU quartiles and different levels of CAC, CIMT, and carotid plaques were assessed by multivariable logistic regression. Results: Age, BMI, education level, smoking, physical activity, hs-CRP, hypertension, and dyslipidemia showed no differences between males and females, while CAC (score > 0) and diabetes were both twice as common in men than in women (58% vs 26% and 8% vs 4%, respectively). Higher SU quartiles were in both sexes associated with BMI, hs-CRP, and the prevalence of hypertension, and in women, they were also associated with the prevalence of dyslipidemia. The three upper quartiles of SU (>308μmol/L) were linked to higher CAC scores in men, when adjusting for CVRFs, but not in women. CIMT and carotid plaques showed no correlation to SU in either sex. Conclusions: Higher levels of SU are associated with the presence of CAC in men but not in women, whereas SU is not associated with CIMT or carotid plaques in either men or women. This implies that the biological effects of SU differ in men and women or that SU has varying effects on different vascular beds or during the different stages of the atherosclerotic process.

Cardiovascular (CV) disease (CVD) is a leading cause of morbidity and mortality worldwide. Most CV events are caused by atherosclerosis. Diabetes and impaired glucose tolerance are associated with greater carotid intima–media thickness (IMT) and increased risk for CVD. The present study examined if common carotid artery IMT (CCAIMT) is predictive of CVD irrespective of glucose tolerance category and glycated hemoglobin (HbA1c) in a sample of 639 women with different glucose tolerance categories. During 7-year follow-up, 30 events in the cardiac and 32 events in the cerebral territory were documented. Unadjusted Cox hazard models showed that CCAIMT, glucose tolerance category, and HbA1c were associated with increased risk. An adjusted and extended model, including CCAIMT, glucose tolerance category, and HbA1c, showed that CCAIMT was still associated with events with an almost unchanged hazard ratio. In conclusion, this study suggests that CCAIMT is predictive of major CV events during 7-year follow-up, irrespective of glucose tolerance category, HbA1c, and other established risk factors in a cohort of 64-year-old women.

Ischemic heart disease is the leading cause of death worldwide, accounting for approximately 11% of all deaths in 2011. Numerous studies have shown that cardiovascular risk correlates positively and powerfully with total or LDL-cholesterol (LDL-C) and correlates inversely with HDl-cholesterol (HDL-C). Much effort has spent comparing proatherogenic cholesterol markers LDL-C, non-HDL-C, apoB and LDL particle number, while little effort has been spent comparing the markers of the antiatherogenic marker apoA-I and HDL-C. Therefore, this review focused on comparing apoA-I and HDL-C in the prediction of heart disease and myocardial infarction. We identified 28 studies of which 12 indicated that the HDL-C was likely to be a superior marker of risk for heart disease and myocardial infarction compared with eight studies that identified apoA-I to be a superior marker of risk.

As the understanding of how different aspects of the physical activity (PA) pattern relate to health and disease, proper assessment is increasingly important. In clinical care, self-reports are the most commonly used assessment technique. However, systematic comparisons between questions regarding concurrent or criterion validity are rare, as are measures of predictive validity. The aim of the study was to examine the concurrent (using accelerometry as reference) and predictive validity (for metabolic syndrome) of five PA questions. A sample of 948 middle-aged Swedish men and women reported their PA patterns via five different questions and wore an accelerometer (Actigraph GT3X) for a minimum of 4 days. Concurrent validity was assessed as correlations and ROC-analyses. Predictive validity was assessed using logistic regression, controlling for potential confounders. Concurrent validity was low-to-moderate (r <0.35 and ROC AUC <0.7) with large misclassifications regarding time spent sitting/sedentary and in moderate-to vigorous PA. The predictive validity of the questions was good, and one question (PHAS) showed an 80 % decreased odds-ratio of having metabolic syndrome, after taking potential confounders into consideration. In this mixed sample of adults, both concurrent and predictive validity vaired between items and between measures of the physical activity pattern. The PHAS and WALK items are proposed for assessment of adherence to PA recommendations. Assessing PA patterns using self-report measures results in methodological problems when trying to predict individual risk for the metabolic syndrome, as the concurrent validity generally was low. However, several of the investigated questions may be useful for assessing risk at a group level, showing better predictive validity.

Self-efficacy has been determined to be a strong predictor of who will engage in physical activity. We aimed to evaluate the associations between self-efficacy to perform physical activity, self-reported leisure-time physical activity and cardiovascular events in a population-based cohort of middle-aged Swedish men with no previous cardiovascular disease, or treatment with cardiovascular drugs. Analyses are based on 377 men randomly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men (n = 1728) and who had answered a question about their competence to perform exercise (as an assessment of physical self-efficacy). The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity. Cardiovascular events were recorded during 13-years of follow-up. The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy (32.1 % vs 17.1 %, p < 0.01). Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 (95 % CI 1.2 to 3.0), of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio, heart rate, fasting plasma glucose, serum triglycerides, systolic blood pressure, apoB/apoA-I ratio and leisure-time physical activity. Self-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men, without known CVD or treatment with cardiovascular drugs.

The concentration of low-density lipoprotein cholesterol has long been generally accepted as one of the strongest, independent risk factors for the development of cardiovascular disease. However, an increasing number of studies suggest that the ratio of apolipoprotein B (apoB) to apolipoprotein A-I (apoA-I) is a better risk predictor. In the present review, we focus on apoB and apoA-I as factors in predicting vascular risk in epidemiological studies only, and not in studies involving pharmaceutical intervention. The majority of studies in the present review show that apoB and the apoB/apoA-I ratio are independently and more strongly associated with vascular risk across varying age-groups and geographic regions than are conventional lipids, lipoproteins and lipid ratios.