European Journal of Preventive Cardiology

Isolated systolic hypertension (ISH) of the young has been associated with both normal and increased cardiovascular risk, which has been attributed to differences in central systolic blood pressure and arterial stiffness.

We assessed the prevalence of ISH of the young and compared differences in central systolic blood pressure and arterial stiffness between ISH and other hypertensive phenotypes in a multi-ethnic population of 3744 subjects (44% men), aged <40 years, participating in the HELIUS study.

The overall prevalence of ISH was 2.7% (5.2% in men and 1.0% in women) with the highest prevalence in individuals of African descent. Subjects with ISH had lower central systolic blood pressure and pulse wave velocity compared with those with isolated diastolic or systolic-diastolic hypertension, resembling central systolic blood pressure and pulse wave velocity values observed in subjects with high-normal blood pressure. In addition, they had a lower augmentation index and larger stroke volume compared with all other hypertensive phenotypes. In subjects with ISH, increased systolic blood pressure amplification was associated with male gender, Dutch origin, lower age, taller stature, lower augmentation index and larger stroke volume.

ISH of the young is a heterogeneous condition with average central systolic blood pressure values comparable to individuals with high-normal blood pressure. On an individual level ISH was associated with both normal and raised central systolic blood pressure. In subjects with ISH of the young, measurement of central systolic blood pressure may aid in discriminating high from low cardiovascular risk.

The role of endothelial dysfunction in predicting angina recurrence after percutaneous coronary intervention is unknown.

We assessed the role of peripheral endothelial dysfunction measured by reactive-hyperaemia peripheral-artery tonometry (RH-PAT) in predicting recurrence of angina after percutaneous coronary intervention.

We enrolled consecutive patients undergoing percutaneous coronary intervention with second-generation drug-eluting stents. RH-PAT was measured at discharge. The endpoint was repeated coronary angiography for angina recurrence and/or evidence of myocardial ischaemia at follow-up. Patients with in-stent restenosis and/or significant de novo stenosis were defined as having angina with obstructed coronary arteries (AOCA); all other patients as having angina with non-obstructed coronary arteries (ANOCA).

Among 100 patients (mean age 66.7 ± 10.4 years, 80 (80.0%) male, median follow-up 16 (3–20) months), AOCA occurred in 14 patients (14%), ANOCA in nine patients (9%). Repeated coronary angiography occurred more frequently among patients in the lower RH-PAT index tertile compared with middle and upper tertiles (14 (41.2%) vs. 6 (18.2%) vs. 3 (9.1%), p = 0.006, respectively). ANOCA was more frequent in the lower RH-PAT index tertile compared with middle and upper tertiles. In the multivariate regression analysis, the RH-PAT index only predicted angina recurrence. The receiver operating characteristic curve of the RH-PAT index to predict the angina recurrence demonstrated an area under the curve of 0.79 (95% confidence interval: 0.69–0.89; p < 0.001), with a cut-off value of 1.705, having sensitivity 74% and specificity 70%.

Non-invasive assessment of peripheral endothelial dysfunction using RH-PAT might help in the prediction of recurrent angina after percutaneous coronary intervention, thus identifying patients who may need more intense pharmacological treatment and risk factor control.

Lifestyle factors are important targets for prevention. The cumulative impact of healthy lifestyle on atrial fibrillation in the population has not been quantified.

Prospective population-based cohort study.

Four lifestyle factors (normal weight, currently not smoking, no or moderate alcohol intake, and physically not inactive) were assessed in apparently healthy 21,499 men and women aged 39–79 years participating in the EPIC study in Norfolk, UK. The age and sex-adjusted hazard (95% confidence interval) of hospital admission with a diagnosis of atrial fibrillation during an average follow-up of 17.1 years was examined for each factor separately and for a health score comprising factors with significant impact.

Normal weight, currently not smoking and low alcohol intake were associated with a significantly lower risk of atrial fibrillation, whereas not being physically inactive showed no significant association. We used a score of one point each for not smoking, low alcohol intake and body mass index 25 to 27.5 kg/m², and two points for body mass index < 25 kg/m². Compared with men and women with four health points, hazard ratios of atrial fibrillation were 1.25 (1.11–1.41), 1.56 (1.39–1.75), 1.83 (1.56–2.16) and 2.82 (1.85–4.29) for participants with three, two, one and no health points, respectively (p < 0.0001 for trend). Results were consistent by sex, age, education level, social class and after excluding participants with hypertension and diabetes.

Three lifestyle factors combined predict an almost 2.8-fold difference in the risk of atrial fibrillation in men and women.

There is increasing evidence of an association between social relationships and morbidity in general, and cardiovascular disease in particular. However, recent syntheses of the evidence raise two important questions: is it the perceived quality or the more objective quantity of relationships that matters most; and what are the implications of changes in relationships over time? In this study, we investigate the cumulative effects of loneliness and social isolation on incident cardiovascular disease.

A secondary analysis of prospective follow-up data from the English Longitudinal Study of Ageing (ELSA).

To assess the association between social isolation or loneliness and incident cardiovascular disease, lagged values of exposure to loneliness and isolation were treated as time-varying variables in discrete time survival models controlling for potential confounders and established cardiovascular disease risk factors.

A total of 5397 men and women aged over 50 years were followed up for new fatal and non-fatal diagnoses of heart disease and stroke between 2004 and 2010. Over a mean follow-up period of 5.4 years, 571 new cardiovascular events were recorded. We found that loneliness was associated with an increased risk of cardiovascular disease (odds ratio 1.27, 95% confidence interval 1.01–1.57). Social isolation, meanwhile, was not associated with disease incidence. There was no evidence of a cumulative effect over time of social relationships on cardiovascular disease risk.

Loneliness is associated with an increased risk of developing coronary heart disease and stroke, independently of traditional cardiovascular disease risk factors. Our findings suggest that primary prevention strategies targeting loneliness could help to prevent cardiovascular disease.

The food environment has been hypothesized to influence cardiovascular diseases such as hypertension and coronary heart disease. This study determines the relation between fast-food outlet density (FFD) and the individual risk for cardiovascular disease, among a nationwide Dutch sample.

After linkage of three national registers, a cohort of 2,472,004 adults (≥35 years), free from cardiovascular disease at January 1st 2009 and living at the same address for ≥15 years was constructed. Participants were followed for one year to determine incidence of cardiovascular disease, including coronary heart disease, stroke and heart failure. Street network-based buffers of 500 m, 1000 m and 3000 m around residential addresses were calculated, while FFD was determined using a retail outlet database. Logistic regression analyses were conducted. Models were stratified by degree of urbanization and adjusted for age, sex, ethnicity, marital status, comorbidity, neighbourhood-level income and population density.

In urban areas, fully adjusted models indicated that the incidence of cardiovascular disease and coronary heart disease was significantly higher within 500 m buffers with one or more fast-food outlets as compared with areas with no fast-food outlets. An elevated FFD within 1000 m was associated with an significantly increased incidence of cardiovascular disease and coronary heart disease. Evidence was less pronounced for 3000 m buffers, or for stroke and heart-failure incidence.

Elevated FFD in the urban residential environment (≤1000 m) was related to an increased incidence of cardiovascular heart disease and coronary heart disease. To better understand how FFD is associated with cardiovascular disease, future studies should account for a wider range of lifestyle and environmental confounders than was achieved in this study.

Exercise is a cornerstone of therapy for Parkinson's disease. This study addressed the association between physical fitness and the onset of Parkinson's disease and association with cardiovascular risk factors.

Male veterans (N = 7347, 59.0 ± 11.2 years) from the Veterans Exercise Testing Study cohort were evaluated. Physical fitness was measured objectively by maximal exercise testing. Onset of Parkinson's disease was abstracted from the Veterans Affairs computerized patient records system.

After a mean follow-up of 12.5 ± 6.3 years, a total of 94 (1.3%) developed Parkinson's disease. Incidence was 86 cases per 100,000 person-years. The strongest multivariate factors associated with incidence of Parkinson's disease were higher age (hazard ratio: 1.067, 95% confidence interval (CI): 1.043–1.093, p < .001), current smoking (hazard ratio: 0.511, 95% CI: 0.274–0.953, p = .035) and physical fitness (high vs. low: hazard ratio: 0.239, 95% CI: 0.079–0.725, p = .011). Compared with patients with no or only one of these risk factors, patients with two risk factors had a 3.7-fold (p < .001) increased risk for incidence of Parkinson's disease; those with all three risk factors had a 7.8-fold (p < .001) higher risk.

High physical fitness, current smoking and younger age were associated with a lower incidence of Parkinson's disease. These findings parallel those of several epidemiological studies focusing on physical activity and the onset of Parkinson's disease. Together, these observations provide strong support for recommending physical activity to diminish risk of Parkinson's disease.

Epidemiological studies on smoking and atrial fibrillation have been inconsistent, with some studies showing a positive association while others have found no association. It is also unclear whether there is a dose–response relationship between the number of cigarettes smoked or pack-years and the risk of atrial fibrillation. We conducted a systematic review and meta-analysis to clarify the association.

Systematic review and meta-analysis.

We searched the PubMed and Embase databases for studies of smoking and atrial fibrillation up to 20 July 2017. Prospective studies and nested case–control studies within cohort studies reporting adjusted relative risk estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with smoking were included. Summary relative risks (95% CIs) were estimated using a random effects model.

Twenty nine prospective studies (22 publications) were included. The summary relative risk was 1.32 (95% CI 1.12–1.56, I²= 84%, n = 11 studies) for current smokers, 1.09 (95% CI 1.00–1.18, I²= 33%, n = 9) for former smokers and 1.21 (95% CI 1.12–1.31, I²= 80%, n = 14) for ever smokers compared to never smokers. Comparing current versus non-current smokers the summary relative risk was 1.33 (95% CI 1.14–1.56, I²= 78%, n = 10). The summary relative risk was 1.14 (95% CI 1.10–1.20, I²= 0%, n = 3) per 10 cigarettes per day and 1.16 (95% CI 1.09–1.25, I²= 49%, n = 2) per 10 pack-years and there was no evidence of a non-linear association for cigarettes per day, P_{non-linearity} = 0.17.

The current meta-analysis suggests that smoking is associated with an increased risk of atrial fibrillation in a dose-dependent matter, but the association is weaker among former smokers compared to current smokers.