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Combined effects of brachial pulse pressure and sialic acid for risk of cardiovascular events during 40 years of follow-up in 37 843 individuals
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology and Acute Internal Medicine, Central Hospital, Karlstad, Sweden .
Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
Department of Medicine, Medical Sciences, University of California, Irvine, USA.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology and Acute Internal Medicine, Central Hospital, Karlstad, Sweden.ORCID iD: 0000-0003-1025-1682
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2012 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 30, no 9, p. 1718-1724Article in journal (Refereed) Published
Abstract [en]

Objective: Pulse pressure (PP) is a risk marker for cardiovascular disease (CVD) in individuals 50 years and older. Inflammation is suggested to influence atherosclerosis, but could also increase PP. We aimed to examine the combined effects of PP and the inflammatory marker sialic acid, and their independent roles on CVD risk.

Methods: From a population-based study in Sweden between 1962 and 1965, 18 429 men and 19 414 women at the age of 50 or older were selected and followed for first CVD event until 2005. We investigated the biological interactions between sialic acid and PP. The associations of PP and sialic acid with risk of CVD were calculated by using Cox proportional hazards model. Adjustments were made for conventional risk factors, mean arterial pressure (MAP) and socioeconomic status.

Results: The mean age was 59.5 (SD 6.5) years and the number of incident CVD events in men and women were 3641 and 3227, respectively. No biological interaction was seen between PP and sialic acid. In men, the adjusted hazard ratio for PP was 0.92 [95% confidence interval (CI) 0.88-0.96, P < 0.0001) for 1 SD of PP, and 1.09 (95% CI 1.05-1.13, P < 0.0001) for 1 SD of sialic acid. In women, the corresponding figures were 1.02 (95% CI 0.97-1.07, P = 0.48) and 1.09 (95% CI 1.05-1.13, P < 0.0001).

Conclusions: Sialic acid but not PP was an independent risk factor for CVD. The risk induced by PP is highly affected by MAP. This suggests that both estimated arterial stiffness and inflammation contribute through different pathways to risk of CVD.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2012. Vol. 30, no 9, p. 1718-1724
Keywords [en]
Blood pressure, cardiovascular, epidemiology, population, pulse pressure, risk, screening
National Category
Medical and Health Sciences Endocrinology and Diabetes
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-26691DOI: 10.1097/HJH.0b013e32835606aeISI: 000308801600008PubMedID: 22743685Scopus ID: 2-s2.0-84865448740OAI: oai:DiVA.org:oru-26691DiVA, id: diva2:578305
Note

 Payam Khalili is also affiliated to Cent Hosp Karlstad, Dept Cardiol & Acute Internal Med, S-65230 Karlstad, Sweden

Johan Jendle is also affiliated to  Cent Hosp Karlstad, Dept Cardiol & Acute Internal Med, S-65230 Karlstad, Sweden

Ingmar Jungner is also affiliated to CALAB Res, Stockholm, Sweden

Peter M. Nilsson is also affiliated to Lund Univ, Univ Lund Hosp, Dept Clin Sci, Malmo, Sweden

Available from: 2012-12-18 Created: 2012-12-18 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Risk factors for cardiovascular events and incident hospital-treated diabetes in the population
Open this publication in new window or tab >>Risk factors for cardiovascular events and incident hospital-treated diabetes in the population
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Well-established risk factors for CVD include increasing age, male sex, sedentary lifestyle, obesity, smoking, diabetes, hypertension, dyslipidaemia and low socio-economic status. Traditional risk factors do, however, not fully explain cardiovascular risk in general. In this thesis we focused on two conventional risk factors (smoking, blood pressure), and two unconventional risk markers (adiponectin, an adipocyte derived protein; and sialic acid (SA), a marker of systemic inflammation) for prediction of CVD events.

Aims: In Paper I we examined to what degree smoking habits modify the risk of CVD in relation to systolic blood pressure levels in middle-aged men. In Paper II we investigated the predictive role of adiponectin for risk of CVD as well as the cross-sectional associations between adiponectin and markers of glucose metabolism, also in men. In Paper III we examined if increasing pulse pressure (PP) and increasing levels of SA both increase the risk of CVD and whether their effects act in synergism. In Paper IV the association of SA with risk of incident diabetes mellitus and related complications, resulting in hospitalization, was studied.

Subjects and Methods: Two large-scale, population-based, screening studies with long follow-up periods have been used. The Malmö Preventive Project (MPP) was used with 22,444 individuals in Paper I and a sub cohort of 3,885 individuals in Paper II. The Värmland Health Survey (VHS) was used in Papers III and IV with 37,843 and 87,035 individuals, respectively.

Results: CVD risk increases with increasing systolic blood pressure levels and this risk is almost doubled in smokers. Total adiponectin level is not associated with increased risk of future CVD but it is inversely associated with markers of glucose metabolism. PP and SA both contribute to risk of future CVD. Adjustment for mean arterial pressure reduces the risk induced by PP. Elevated SA contributes to increased risk of incident diabetes and related complications leading to hospitalization.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 79
Keywords
Adiponectin, blood pressure, cardiovascular risk, diabetes, inflammation, pulse pressure, sialic acid, smoking
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-24173 (URN)978-91-7668-905-9 (ISBN)
Public defence
2012-12-14, Hörsal P1, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
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Available from: 2012-07-30 Created: 2012-07-30 Last updated: 2017-10-17Bibliographically approved

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Khalili, PayamJendle, Johan

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