Background: Few prospective studies have examined dairy fat in relation to cardiovascular disease (CVD).

Objective: We aimed to evaluate the association between dairy fat and incident CVD in US adults.

Design: We followed 41,852men in the Health Professionals Follow-Up Study (1986-2010), 70,636women in the Nurses’ Health Study (1980-2010), and 90,056 women in the Nurses’ Health Study II (1991-2011). Dairy fat and other fat intakes were assessed every 4 years by validated food-frequency questionnaires.

Results: During 4,324,477 person-years of follow-up, we documented 10,834 incident CVD cases including 5,107coronary heart disease (nonfatal myocardial infarction or fatal coronary disease) and 5,843 stroke cases. In multivariate analyses, dairy fat intake was not significantly related to the risk of total cardiovascular disease (for a 5% increase in energy from dairy fat, the relative risk (RR) was 1.00, 95% CI: 0.95-1.04), or coronary heart disease [RR: 1.02; 95%CI: 0.95-1.09] or stroke [RR: 0.98; 95%CI: 0.92-1.05]. In models estimating the effects of exchanging different fat sources, compared with equivalent energy from dairy fat, a 5% replacement in energy intake of dairy fat with vegetable fat was associated with a 10% (95%CI: 8%-12%) reduction in the risk of CVD. Substitution of other animal fat with dairy fat was not significantly associated with CVD risk.

Conclusion: These results suggest that replacing dairy fat with carbohydrates or other animal fat was not associated with CVD risk. However, replacing dairy fat with vegetable sources of fat was associated with a lower risk of CVD.

Figure 1. RR and 95% CI for cardiovascular disease associated with isocaloric substitutions (5% of energy) of vegetable fat (A) polyunsaturated fat (B) and other animal fat (C) for dairy fat.

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Abstract P282: Dairy Fat and Risk of Cardiovascular Disease in 3 Cohorts of US Adults

The aim of the review was to assess the effect of patient education in ischaemic heart disease. Thirteen randomised controlled trials of moderate to good quality including 68,556 patients were selected. The effect on mortality, cardiac morbidity, hospitalisation and health-related quality of life was assessed and only non-significant tendencies of effect were found. The authors of the review nevertheless conclude that the review supports current rehabilitation programmes that include patient education. Further research in patient education, especially concerning the most effective methods of education delivery, is needed.

Patient education in the management of coronary heart disease

Importance If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases. Objective To evaluate whether longitudinal patterns of blood pressure (BP) elevation differ between women and men during the life course when considering baseline BP levels as the reference. Design, Setting, and Participants We conducted sex-specific analyses of longitudinal BP measures (144 599 observations) collected for a period of 43 years (1971 to 2014) in 4 community-based US cohort studies. The combined total included 32 833 participants (54% female) spanning ages 5 to 98 years. Data were analyzed between May 4, 2019, and August 5, 2019. Exposures Age and serially assessed longitudinal BP measures: systolic BP, diastolic BP, mean arterial pressure (MAP), and pulse pressure (PP). Main Outcomes and Measures Sex-specific change in each primary BP measure compared with baseline BP levels, derived from multilevel longitudinal models fitted over the age span, and new-onset cardiovascular disease events. Results Of the 32 833 participants, 17 733 were women (54%). Women compared with men exhibited a steeper increase in BP that began as early as in the third decade and continued through the life course (likelihood ratio test χ2 = 531 for systolic BP; χ2 = 123 for diastolic BP; χ2 = 325 for MAP; and χ2 = 572 for PP;Pfor all Conclusions and Relevance In contrast with the notion that important vascular disease processes in women lag behind men by 10 to 20 years, sex-specific analyses indicate that BP measures actually progress more rapidly in women than in men, beginning early in life. This early-onset sexual dimorphism may set the stage for later-life cardiovascular diseases that tend to present differently, not simply later, in women compared with men.

Sex Differences in Blood Pressure Trajectories Over the Life Course

Objective To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Methods Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. Results Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering. Conclusion These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

/pdf/eular-recommendations-for-cardiovascular-risk-management-in-1cjfrm9v.pdf

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

Abstract Aims Obesity is a global health problem, associated with significant morbidity and mortality, often due to cardiovascular (CV) diseases. While bariatric surgery is increasingly performed in patients with obesity and reduces CV risk factors, its effect on CV disease is not established. We conducted a systematic review and meta-analysis to evaluate the effect of bariatric surgery on CV outcomes, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Methods and results PubMed and Embase were searched for literature until August 2021 which compared bariatric surgery patients to non-surgical controls. Outcomes of interest were all-cause and CV mortality, atrial fibrillation (AF), heart failure (HF), myocardial infarction, and stroke. We included 39 studies, all prospective or retrospective cohort studies, but randomized outcome trials were not available. Bariatric surgery was associated with a beneficial effect on all-cause mortality [pooled hazard ratio (HR) of 0.55; 95% confidence interval (CI) 0.49–0.62, P < 0.001 vs. controls], and CV mortality (HR 0.59, 95% CI 0.47–0.73, P < 0.001). In addition, bariatric surgery was also associated with a reduced incidence of HF (HR 0.50, 95% CI 0.38–0.66, P < 0.001), myocardial infarction (HR 0.58, 95% CI 0.43–0.76, P < 0.001), and stroke (HR 0.64, 95% CI 0.53–0.77, P < 0.001), while its association with AF was not statistically significant (HR 0.82, 95% CI 0.64–1.06, P = 0.12). Conclusion The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients.

https://academic.oup.com/eurheartj/article-pdf/43/20/1955/43778069/ehac071.pdf

Hobbs Fdr.

Papers

2016 ESC guidelines on cardiovascular disease prevention in clinical practice