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Objective: The TIMI Risk Score for secondary prevention (TRS2°P), a simple scoring system based on presence/absence of nine clinical factors, was developed to stratify the risk of secondary events in patients with a history of myocardial infarction (MI), but its performance has not been evaluated in patients with peripheral artery disease (PAD). Since MI and PAD are caused by similar biology and underlying atherosclerotic disease it is possible that TRS2°P is also informative in PAD patients. Methods: TRS2°P was calculated with a point value of 1 assigned for heart failure, hypertension, age ≥75 years, diabetes, stroke, coronary artery bypass graft, PAD, kidney dysfunction, and current smoking (since all patients had PAD, the lowest possible score was 1). We evaluated prediction statistics of TRS2°P for major adverse cardiovascular disease (MACE) (a composite of cardiovascular death, myocardial infarction, or ischemic stroke) in 386,458 patients with PAD in five international cohorts from New Zealand, South Korea, Sweden, and the US participating in the Chronic Kidney Disease Prognosis Consortium. Results: Overall, there were 134,827 cases of MACE outcomes reported across five cohorts over a mean follow-up of 5 years, and overall MACE rate ranged from 1.5 to 8.6 (per 100 person-years). The TRS2°P showed modest calibration (Brier score ranged from 0.061 to 0.160) and discrimination (c-statistics ranged from 0.59 to 0.69) across cohorts (Brier score was 0.098 and c-statistic was 0.67 in the TRS2°P derived dataset). Although there was some heterogeneity across cohorts, the predictors in the TRS2°P were generally associated with MACE in patients with PAD, with the strongest association for a history of heart failure (meta-analyzed adjusted hazard ratio [HR] 2.1), followed by age ≥75 years (HR 1.8), stroke (HR 1.7), kidney dysfunction (HR 1.4), and current smoking (HR 1.2). Hypertension and coronary artery bypass graft surgery did not reach statistical significance. Conclusion: TRS2°P was reasonably predictive of MACE outcomes when applied in patients with PAD and thus can be a reasonable tool for risk assessment in two common leading atherosclerotic diseases, MI and PAD. [ABSTRACT FROM AUTHOR]

Background: High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at the time of myocardial infarction (MI) are strong prognostic predictors. However, whether their pre-morbid (before MI occurrence) levels at middle age are associated with prognosis after incident MI is unknown. Methods: In 1,192 participants from the Atherosclerosis Risk in Communities (ARIC) study with incident MI after baseline (1990-92), we evaluated premorbid levels of hs-cTnT (<3 [reference], 3-5, 6-8, 9-13, and ≥14 ng/L) and NT-proBNP (<35.2 [reference], 35.2-68.4, 68.5-121.2, 121.3-223.9, and ≥224.0 pg/mL; divided at the same percentiles) measured, on average, 8.0 [IQR 3.7-13.5] years prior to incident MI, and evaluated their associations with composite and individual outcomes of all-cause mortality, cardiovascular mortality, recurrent MI, heart failure, and stroke through 2016. Cox regression models were used to adjust for potential confounders at the time of incident MI. Results: During a median follow-up of 2.7 years after MI, 911 participants developed the composite outcome. Both hs-cTnT and NT-proBNP were independently associated with composite outcome after incident MI (e.g., HR 1.60 [95%CI 1.27-2.02] for hs-cTnT ≥14 vs. <3 ng/L and 1.76 [1.41-2.21] for NT-proBNP ≥224.0 vs.<35.2 pg/mL). Both cardiac markers were associated with all-cause and cardiovascular mortality, and heart failure after incident MI, and NT-proBNP generally demonstrated a dose-response relationship with heart failure after incident MI. The associations were consistent even after accounting for MI severity score. The addition of hs-cTnT and NT-proBNP to conventional risk factors significantly improved risk prediction of heart failure after incident MI (C-statistic differences of 0.009 [95% CI 0.001-0.018] for heart failure, from 0.706 with conventional risk factors). Conclusions: Premorbid levels of hs-cTnT and NT-proBNP assessed, on average, almost a decade prior to incident MI were associated with adverse outcomes after incident MI. These results may highlight a prognostic value of pre-MI cardiac condition. [ABSTRACT FROM AUTHOR]

Background: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking.Objectives: The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study.Methods: We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD.Results: Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk.Conclusions: Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population. [ABSTRACT FROM AUTHOR]

Background and Aims: Several studies reported an increased cancer risk related to lower-extremity peripheral artery disease (PAD) but had important caveats: not accounting for key confounders like smoking, follow-up <10 years, or no race-specific results. To assess the long-term independent association of PAD with cancer incidence in a bi-racial community-based cohort., Methods: We categorized 13,106 ARIC participants without cancer at baseline (mean age 54.0 [SD 5.7] years, 45.7 % male, and 26.1 % Black) into symptomatic PAD (clinical history or intermittent claudication), asymptomatic PAD (ankle-brachial index [ABI] ≤0.9), and five ABI categories (0.1-interval between 0.9 and 1.3 and > 1.3). We used cancer registries and medical records to ascertain cancer cases and ran multivariable Cox models., Results: During the median follow-up of 25.3 years, there were 4143 incident cancer cases. 25-year cumulative incidence was 37.2 % in symptomatic PAD, 32.3 % in asymptomatic PAD, and 28.0-31.0 % in the other categories. Symptomatic and asymptomatic PAD remained significantly associated with cancer incidence after adjusting for potential confounders, including smoking and diabetes (hazard ratio [HR] 1.42 [1.05-1.92] and 1.24 [1.05-1.46], respectively). When stratified by smoking status, we observed a robust association of PAD (symptomatic and asymptomatic combined) vs. no PAD with cancer risk in ever smokers (HR 1.42 [1.21-1.67]) but not in never smokers. The results were most evident for lung cancer (HR 2.16 (95 %CI 1.65-2.83) for PAD vs. no PAD within ever smokers)., Conclusions: Symptomatic and asymptomatic PAD conferred cancer risk, particularly among ever smokers and for lung cancer. Patients with PAD should receive evidence-based cancer prevention and screening., Competing Interests: Declaration of competing interest Dr. Matsushita received personal fees from Fukuda Denshi, Kowa Company, and RhythmX AI outside of the submitted work. The other authors report no relationships that could be construed as a conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: High to moderate levels of physical activity (PA) are associated with low risk of incident cardiovascular disease. However, it is unclear whether the benefits of PA in midlife extend to cardiovascular health following myocardial infarction (MI) in later life., Methods: Among 1,111 Atherosclerosis Risk in Communities study participants with incident MI during Atherosclerosis Risk in Communities follow-up (mean age 73 [SD 9] years at MI, 54% men, 21% Black), PA on average 11.9 (SD 6.9) years prior to incident MI (premorbid PA) was evaluated as the average score of PA between visit 1 (1987-1989) and visit 3 (1993-1995) using a modified Baecke questionnaire. Total and domain-specific PA (sport, nonsport leisure, and work PA) was analyzed for associations with composite and individual outcomes of mortality, recurrent MI, and stroke after index MI using multivariable Cox models., Results: During a median follow-up of 4.6 (IQI 1.0-10.5) years after incident MI, 823 participants (74%) developed a composite outcome. The 10-year cumulative incidence of the composite outcome was lower in the highest, as compared to the lowest tertile of premorbid total PA (56% vs. 70%, respectively). This association remained statistically significant even after adjusting for potential confounders (adjusted hazard ratio [aHR] 0.80 [0.67-0.96] for the highest vs. lowest tertile). For individual outcomes, high premorbid total PA was associated with a low risk of recurrent MI (corresponding aHR 0.64 [0.44, 0.93]). When domain-specific PA was analyzed, similar results were seen for sport and work PA. The association was strongest in the first year following MI (e.g., aHR of composite outcome 0.66 [95% CI 0.47, 0.91] for the highest vs. lowest tertile of total PA)., Conclusions: Premorbid PA was associated positively with post-MI cardiovascular health. Our results demonstrate the additional prognostic advantages of PA beyond reducing the risk of incident MI., Competing Interests: Conflict of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: We sought to evaluate the associations of chest pain and dyspnea with the long-term risk of cardiovascular disease including coronary disease, heart failure, atrial fibrillation, and stroke., Methods: In 13,200 participants without cardiovascular disease in the Atherosclerosis Risk in Communities study (1987-1989), chest pain was categorized into definite angina, possible angina, non-anginal chest pain, and no chest pain using the Rose questionnaire. Dyspnea was categorized into grades 3-4, 2, 1, and 0 by the modified Medical Research Council scale. The associations of chest pain and dyspnea with incident myocardial infarction, heart failure, atrial fibrillation, and stroke over a median follow-up of ∼27 years were quantified with multivariable Cox models., Results: Definite angina and possible angina were associated with myocardial infarction (adjusted hazard ratios [HR] 1.80 [95%CI 1.45-2.13] and 1.65 [1.27-2.15]). Although lesser magnitude than myocardial infarction, both definite and possible angina were associated with heart failure. For atrial fibrillation, possible angina showed higher HR than definite angina. Dyspnea showed similar HRs for myocardial infarction and heart failure in grades 3-4 (2.00 [1.61-2.49] and 1.94 [1.62-2.32]). Stroke was least associated with chest symptoms. Chest pain and dyspnea significantly improved the discrimination of cardiovascular disease except stroke, beyond traditional risk factors., Conclusions: In individuals without cardiovascular disease, chest pain and dyspnea were independently associated with incident cardiovascular disease for about three decades, suggesting the need for evaluating chest pain from a broader perspective of cardiovascular disease beyond coronary disease and the importance of dyspnea for cardiovascular risk assessment including myocardial infarction., Competing Interests: Declaration of competing interest Dr Rosamond received grants from National Heart, Lung, and Blood Institute. Dr Shah received consulting fees from Phillips Ultrasound and Jansen. Dr Blaha received grants from Amgen, American Heart Association, Bayer, Food and Drug Administration, National Institute of Health, and Novo Nordisk; consulting fees from Agepha, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lily, Merck, Novartis, and Novo Nordisk; honoraria for lectures from Novo Nordisk; payment for expert testimony from Novo Nordisk and US FTC. Dr Mathews received grants from National Heart, Lung, and Blood Institute. Dr Matsushita received grants from Resolve to Save Lives; consulting fees from AMGA, Kowa Company, and Rhythm X AI; honoraria for lectures fee from Fukuda Denshi. The other authors have nothing to declare., (Copyright © 2024. Published by Elsevier Inc.)

Background: Coronary artery calcium testing using noncontrast cardiac computed tomography is a guideline-indicated test to help refine eligibility for aspirin in primary prevention. However, access to cardiac computed tomography remains limited, with carotid ultrasound used much more often internationally. We sought to update the role of aspirin allocation in primary prevention as a function of subclinical carotid atherosclerosis., Methods and Results: The study included 11 379 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and ARIC (Atherosclerosis Risk in Communities) studies. A harmonized carotid plaque score (range, 0-6) was derived using the number of anatomic sites with plaque from the left and right common, bifurcation, and internal carotid artery on ultrasound. The 5-year number needed to treat and number needed to harm as a function of the carotid plaque score were calculated by applying a 12% relative risk reduction in atherosclerotic cardiovascular disease (ASCVD) events and 42% relative increase in major bleeding events related to aspirin use, respectively. The mean age was 57 years, 57% were women, 23% were Black, and the median 10-year ASCVD risk was 12.8%. The 5-year incidence rates (per 1000 person-years) were 5.5 (4.9-6.2) for ASCVD and 1.8 (1.5-2.2) for major bleeding events. The overall 5-year number needed to treat with aspirin was 306 but was 2-fold lower for individuals with carotid plaque versus those without carotid plaque (212 versus 448). The 5-year number needed to treat was less than the 5-year number needed to harm when the carotid plaque score was ≥2 for individuals with ASCVD risk 5% to 20%, whereas the presence of any carotid plaque demarcated a favorable risk-benefit for individuals with ASCVD risk >20%., Conclusions: Quantification of subclinical carotid atherosclerosis can help improve the allocation of aspirin therapy.

Background: High dietary calcium and phosphorus may accelerate vascular calcification, but epidemiological data are inconsistent. Most of those studies assessed diet at one point and have not been systematically evaluated., Objectives: The purpose of this study was to assess the associations of dietary calcium and phosphorus intakes in middle age with coronary artery and extra-coronary calcification at older age., Methods: We studied 1,914 participants from the ARIC (Atherosclerosis Risk In Communities) study (mean age 80.5 years) without coronary heart disease who underwent chest computed tomography scans at visit 7 (2018-2019) and completed a 66-item food frequency questionnaire at 2 earlier visits (visit 1 [1987-1989] and visit 3 [1993-1995]). Dietary calcium and phosphorus intakes were averaged between these 2 visits. Calcification was quantified by the Agatston score in coronary artery, ascending aorta, descending aorta, aortic valve ring, aortic valve, and mitral valve., Results: Dietary calcium intake was inversely associated with coronary artery and ascending aorta calcification, whereas the association was not significant for other measures of extra-coronary calcification. For example, the highest vs lowest quartile of calcium intake showed an adjusted OR of 0.66 (95% CI: 0.45-0.98) for coronary artery calcification (Agatston score ≥75th percentile). Dietary phosphorus intake demonstrated similar results, but the magnitude of the association was weaker than dietary calcium intake., Conclusions: Dietary calcium and phosphorus intakes at middle age were not positively associated with vascular and valvular calcification at over 75 years old. Our findings did not support the link between a calcium or phosphorus-rich diet and vascular and valvular calcification., Competing Interests: The ARIC study has been funded in whole or in part with federal funds from the 10.13039/100000050National Heart, Lung, and Blood Institute, 10.13039/100000002National Institutes of Health, 10.13039/100000016Department of Health and Human Services, under contract numbers (75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005). This specific study was supported by R01HL136592 (multiple PIs: Drs Matsushita and Blaha). Dr Rebholz was supported by a grant from the 10.13039/100000050National Heart, Lung, and Blood Institute (R01 HL153178). Dr Nohara was supported by grants-in-aid from the International Research Fund for Subsidy of Kyusyu University School of Medicine Alumni, Japan. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Controlling blood pressure (BP) is essential in the management of patients with chronic kidney disease. Reflecting the intrinsic variability of BP, several parameters of BP over time have been shown to predict adverse outcomes. Systolic BP time in target range has been recently proposed as a new promising parameter. Park et al. confirmed its prognostic value in patients with chronic kidney disease. We review the potential clinical usefulness and challenges of this parameter in nephrology care., (Copyright © 2024 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Background and Aims: The contribution of kidney dysfunction, especially at mild-to-moderate stages, and bone-mineral metabolism (BMM) markers to vascular calcification remains controversial or unclear. We comprehensively evaluated the association of kidney and BMM markers with coronary artery calcification (CAC) and extra-coronary calcification (ECC)., Methods: In 1931 ARIC participants (age 73-95 years) without coronary heart disease at visit 7 (2018-19), we investigated the associations of estimated glomerular filtration rate (eGFR) (with creatinine, cystatin C, and both) and five serum BMM markers (calcium, fibroblast growth factor 23, magnesium, parathyroid hormone, and phosphorus) with high CAC and ECC (sex-race specific ≥75th vs. <75th percentile Agatston score) or any vs. zero CAC and ECC using multivariable logistic regression. For eGFR and BMM markers, we took their weighted cumulative averages from visit 1 (1987-89) to visit 5 (2011-13)., Results: Lower eGFR, regardless of equations used, was not robustly associated with high CAC or ECC. Among BMM markers, only higher phosphorus levels, even within the normal range, showed robust associations with high CAC (only when modeled continuously) and ECC, independently of kidney function (e.g., odds ratio 1.94 [95%CI 1.38-2.73] for high aortic valve calcification, in the highest vs. lowest quartile). Results were generally consistent when analyzing any CAC or ECC, although cystatin C-based eGFR <60 mL/min/1.73 m 2 became significantly associated with mitral valve calcification (odds ratio 1.69 [1.10-2.60])., Conclusions: Among kidney and BMM measures tested, only serum phosphorus demonstrated robust associations with both CAC and ECC, supporting a key role of phosphorus in the pathophysiology of vascular calcification., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: To quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection., Methods: Among 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease., Results: During the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7., Conclusion: Peripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases., (Copyright © 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Background: No previous study has examined racial differences in recurrent acute myocardial infarction (AMI) in a community population. We aimed to examine racial differences in recurrent AMI risk, along with first AMI risk in a community population., Methods: The community surveillance of the Atherosclerosis Risk in Communities Study (2005-2014) included 470,000 people 35 to 84 years old in 4 U.S. communities. Hospitalizations for recurrent and first AMI were identified from ICD-9-CM discharge codes. Poisson regression models were used to compare recurrent and first AMI risk ratios between Black and White residents., Results: Recurrent and first AMI risk per 1,000 persons were 8.8 (95% CI, 8.3-9.2) and 20.7 (95% CI, 20.0-21.4) in Black men, 6.8 (95% CI, 6.5-7.0) and 14.1 (95% CI, 13.8-14.5) in White men, 5.3 (95% CI, 5.0-5.7) and 16.2 (95% CI, 15.6-16.8) in Black women, and 3.1 (95% CI, 3.0-3.3) and 8.8 (95% CI, 8.6-9.0) in White women, respectively. The age-adjusted risk ratios (RR) of recurrent AMI were higher in Black men vs White men (RR, 1.58 95% CI, 1.30-1.92) and Black women vs White women (RR, 2.09 95% CI, 1.64-2.66). The corresponding RRs were slightly lower for first AMI: Black men vs White men, RR, 1.49 (95% CI, 1.30-1.71) and Black women vs White women, RR, 1.65 (95% CI, 1.42-1.92) CONCLUSIONS: Large disparities exist by race for recurrent AMI risk in the community. The magnitude of disparities is stronger for recurrent events than for first events, and particularly among women., (Copyright © 2022. Published by Elsevier Inc.)

Background: Stroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown., Methods: We used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45-64 years old at baseline (1987-1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31 st , 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models., Results: Median (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke., Conclusions: Good and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The association of periodontal disease with atherosclerotic cardiovascular diseases is well known, but not specifically with incident peripheral artery disease (PAD). Therefore, we studied the associations of periodontal disease with incident PAD in a population-based setting., Methods: Among 9,793 participants (aged 53-75 years) without prevalent PAD, self-reported history of periodontal disease was ascertained. Of these, 5,872 participants underwent full-mouth examinations from which periodontal status was defined using the US Centers for Disease Control and Prevention-American Academy of Periodontology (CDC-AAP) definition. We quantified the association of periodontal disease with incident PAD (defined by hospital admission diagnosis or procedures) using multivariable Cox regression models., Results: During a median follow-up of 20.1 years, 360 participants (3.6%) developed PAD. In models accounting for potential confounders including diabetes and smoking pack-years, there was higher hazard of PAD in participants with self-reported tooth loss because of periodontal disease (hazard ratio:1.54 [95% CI:1.20-1.98]), history of periodontal disease treatment (1.37 [1.05-1.80]), and periodontal disease diagnosis (1.38 [1.09-1.74]), compared to their respective counterparts. The clinical measure of periodontal disease (n = 5,872) was not significantly associated with incident PAD in the fully adjusted model (e.g., 1.53 [0.94-2.50] in CDC-AAP-defined severe periodontal disease versus no disease)., Conclusion: We observed a modest association of self-reported periodontal disease, especially when resulting in tooth loss, with incident PAD in the general population. Nonetheless, a larger study with the clinical measure of periodontal disease is warranted., (© 2021 American Academy of Periodontology.)

This study aims to determine the association between 2-minute heart rate recovery (HRR) and cancer risk. Each participant (5379 women; 8485 men) provided HRR obtained from treadmill tests. The outcome was site-specific cancer. Over 9 years of follow-up, 630 cancer events (258 women) were accrued. Slower HRR was associated with increased thyroid cancer risk in women ( P for trend = .0121) and colorectal cancer risk in men ( P for trend = .0034). The lowest HRR (<13 bpm) had higher hazards of thyroid cancer (hazard ratio [HR] = 2.20; 95% CI = 1.28-3.77) in women and colorectal cancer (HR = 3.08; 95% CI = 1.32-7.15) in men. In women, slower HRR and lower proportions of heart rate recovery (PHRR) were associated with higher hazards of thyroid cancer in women and metabolically related cancers (liver and colorectal) in men. Slower HRR and lower PHRR were independent risk factors for thyroid cancer in women and metabolically related cancers in men.

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths., (Copyright © 2017 by the American Society of Nephrology.)

Physical activity has been shown to reduce colorectal cancer risk. However, the association of physical activity levels separately with colon and rectum cancer mortality is less clear. We included 226 089 Korean in a large prospective cohort study. We assessed the associations of physical activity levels (length, frequency, and intensity) with colon and rectum cancer mortality using Cox proportional hazards model. Men, but not women, who had regular physical activity showed a lower risk of death from colon cancer. The association for high intensity of physical activity was borderline significant in men (hazard ratio 0.67; 95% CI = 0.45-1.00 for >17.5 MET-hour/week). The associations were largely consistent among those aged <55 years, body mass index <25 kg/m 2 , low high-density lipoprotein cholesterol, current smoker, and without hypertension or history of cardiovascular disease. In conclusion, higher length or intensity of physical activity decreased colon, but not rectum cancer mortality in men. Regular physical activity may have beneficial effects on colon cancer survival.

Background: Although the increased risk of coronary artery disease (CAD) in the patients with idiopathic pulmonary fibrosis (IPF) has been reported, there was few detailed information on the risk factors for CAD in IPF. The aim of this study was to investigate the prevalence of CAD in IPF with analysis of other risk factors., Methods: The subjects were 460 patients (mean age, 65 years; 79% male; 74% current or ex-smoker) diagnosed as IPF at Asan Medical Center and 1,925 controls matched with age, gender, smoking habits, and date of IPF diagnosis from the cohort of Korean Heart Study. Cardiovascular risk factors and prevalence of CAD in both groups were compared and the incidence of newly developed CAD during follow-up was also analyzed., Results: IPF group was more diabetic, and control group had a higher proportion of hypertension and hypercholesterolemia. The prevalence of CAD in IPF group (7%) was two times higher than that of control group (3%). Multivariate analysis revealed that age (OR, 1.04; 95% CI, 1.02-1.07), hypertension (OR, 2.13; 95% CI, 1.36-3.33), hypercholesterolemia (OR, 3.85; 95% CI, 2.51-5.88), and IPF (OR, 2.64; 95% CI, 1.68-4.14) were significant risk factors for CAD. During follow-up (median: 2.5 years for IPF and 4.4 years for controls), the incidence of newly diagnosed CAD was higher in the patients with IPF (6.8%) compared to controls (2.8%) (RR, 1.92; 95% CI, 1.08-3.43)., Conclusions: IPF itself was an independent risk factor for CAD after the adjustment of age, hypertension, diabetes, and hypercholesterolemia.