Huimin Zhou

Environment-wide association study to identify novel factors associated with peripheral arterial disease: Evidence from the National Health and Nutrition Examination Survey (1999–2004)

BACKGROUND AND AIMSnAn environment-wide association study (EWAS) may be useful to comprehensively test and validate associations between environmental factors and peripheral arterial disease (PAD) in an unbiased manner.nnnMETHODSnData from cross-sectional cohorts from the US National Health and Nutrition Examination Survey (1999-2004) were randomly 50:50 split into training set and testing set. A value of ankle-brachial index (ABI) <1.0 or >1.4 defined PAD. We performed multiple linear regression analyses associating each of the 417 environmental and self-reported factors with PAD in the training set (false discovery rate <5%). Significant findings were validated in the testing set (p < 0.05) and entered into a logistic regression model with penalized likelihood based on the Akaike Information Criterion (AIC).nnnRESULTSnOverall, 6819 participants >40 years old were included. The validated factors comprised positive associations with smoking-associated factors (cigarette smoker, family smoker and smoked >100 cigarettes, urinary cotinine), cadmium, urinary albumin, C-reactive protein, blood o-xylene and thyroxine 4, and inverse associations with α-carotene and trans-/cis-β-carotene for PAD. Finally, only 4 of these factors were nominally significant in the AIC-selected model: cadmium (OR 1.27, 95% CI 1.12-1.45), cis-β-carotene (OR 0.81, 95% CI 0.72-0.91), CRP (OR 1.19, 95% CI 1.03-1.38) and urinary albumin (OR 1.20, 95% CI 1.04-1.38).nnnCONCLUSIONSnOur systematic evaluation provides new knowledge on the complex array of environmental correlates of PAD. These identified correlates need to be probed in further observational and interventional studies.

GW29-e1253 Risk Assessment Tool in Cardiovascular Disease: a Critical Appraisal of Coronary Heart Disease Guidelines

The study aimed to seek common points and significant differences of cardiovascular risk assessment tools used in coronary heart disease (CHD) guidelines.nnCHD Guidelines published with recommendations on risk assessment tool from January 2007 to September 2017 were searched in MEDLINE, EMBASE, and

Toward a panoramic perspective of the association between environmental factors and cardiovascular disease: An environment-wide association study from National Health and Nutrition Examination Survey 1999–2014

OBJECTIVESnAn environment-wide association study (EWAS) may be useful to comprehensively test and validate associations between environmental factors and cardiovascular disease (CVD) in an unbiased manner.nnnAPPROACH AND RESULTSnData from National Health and Nutrition Examination Survey (1999-2014) were randomly 50:50 spilt into training set and testing set. CVD was ascertained by a self-reported diagnosis of myocardial infarction, coronary heart disease or stroke. We performed multiple linear regression analyses associating 203 environmental factors and 132 clinical phenotypes with CVD in training set (false discovery rateu202f<u202f5%) and significant factors were validated in the testing set (Pu202f<u202f0.05). Random forest (RF) model was used for multicollinearity elimination and variable importance ranking. Discriminative power of factors for CVD was calculated by area under the receiver operating characteristic (AUROC). Overall, 43,568 participants with 4084 (9.4%) CVD were included. After adjusting for age, sex, race, body mass index, blood pressure and socio-economic level, we identified 5 environmental variables and 19 clinical phenotypes associated with CVD in training and testing dataset. Top five factors in RF importance ranking were: waist, glucose, uric acid, and red cell distribution width and glycated hemoglobin. AUROC of the RF model was 0.816 (top 5 factors) and 0.819 (full model). Sensitivity analyses reveal no specific moderators of the associations.nnnCONCLUSIONnOur systematic evaluation provides new knowledge on the complex array of environmental correlates of CVD. These identified correlates may serve as a complementary approach to CVD risk assessment. Our findings need to be probed in further observational and interventional studies.

Influence of baseline systolic blood pressure on the relationship between intensive blood pressure control and cardiovascular outcomes in the Systolic Blood Pressure Intervention Trial (SPRINT)

ObjectiveTo determine whether the effects of intensive (<u2009120xa0mmHg) compared with standard (<u2009140xa0mmHg) systolic blood pressure (SBP) treatments are different among those with different baseline SBP.MethodsDe-identified SPRINT database was used for this post hoc analysis. SPRINT participants were categorized by baseline SBP status, defined as high-SBP (≥u2009140xa0mmHg) group versus the low-SBP (<u2009140xa0mmHg) group. The primary outcome was a composite of myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes. Treatment-related adverse events including hypotension, syncope, and bradycardia were also evaluated. Cox regression was used to calculate hazard ratios for study outcomes with intensive compared with standard SBP treatment between these two groups.ResultsAmong 9361 participants randomized (age 67.9u2009±u20099.4xa0years; 35.5% female), 4964 and 4397 had baseline low SBP (<u2009140xa0mmHg) and high SBP (≥u2009140xa0mmHg), respectively. After a median follow-up of 3.26xa0years, the hazard ratio for the primary outcome was 0.65 (95% CI 0.50, 0.83) and 0.84 (95% CI 0.66, 1.06) among those in the low-SBP group and high-SBP group, respectively (P value for interaction 0.15). For treatment-related adverse events, the hazard ratio with intensive SBP treatment was 2.03 (95% CI 1.44, 2.85) for the low-SBP group and 1.80 (95% CI 1.32, 2.47) for the high-SBP group (P value for interaction 0.28).ConclusionsHypertensive patients with low baseline SBP may benefit from intensive SBP lowering, whereas benefits were inconclusive among those with high baseline SBP.