CARDIOVASCULAR RISK FACTORS Edited by Armen Yuri Gasparyan Cardiovascular Risk Factors Edited by Armen Yuri Gasparyan Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Silvia Vlase Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Cardiovascular Risk Factors, Edited by Armen Yuri Gasparyan p. cm. ISBN 978-953-51-0240-3 Contents Preface IX Chapter 1 Cardiovascular Risk Investigation: When Should It Start? 1 Anabel Nunes Rodrigues, Gláucia Rodrigues de Abreu and Sônia Alves Gouvêa Chapter 2 Early Identification of Cardiovascular Risk Factors in Adolescents and Follow-Up Intervention Strategies 17 Heather Lee Kilty and Dawn Prentice Chapter 3 Novel and Traditional Cardiovascular Risk Factors in Adolescents 61 Alice P.S. Kong and Kai Chow Choi Chapter 4 Cardiovascular Risk Factors in the Elderly 81 Melek Z. Ulucam Chapter 5 Vascular Inflammation: A New Horizon in Cardiovascular Risk Assessment 103 Vinayak Hegde and Ishmael Ching Chapter 6 Alterations in the Brainstem Preautonomic Circuitry May Contribute to Hypertension Associated with Metabolic Syndrome 141 Bradley J. Buck, Lauren K. Nolen, Lauren G. Koch, Steven L. Britton and Ilan A. Kerman Chapter 7 Cardiometabolic Syndrome 161 Alkerwi Ala’a, Albert Adelin and Guillaume Michèle Chapter 8 Relationship Between Cardiovascular Risk Factors and Periodontal Disease: Current Knowledge 193 Sergio Granados-Principal, Nuri El-Azem, Jose L. Quiles, Patricia Perez-Lopez, Adrian Gonzalez and MCarmen Ramirez-Tortosa VI Contents Chapter 9 Cardiovascular Risk Assessment in Diabetes and Chronic Kidney Diseases: A New Insight and Emerging Strategies 217 Ali Reza Khoshdel Chapter 10 Non Invasive Assessment of Cardiovascular Risk Profile: The Role of the Ultrasound Markers 251 Marco Matteo Ciccone, Michele Gesualdo, Annapaola Zito, Cosimo Mandurino, Manuela Locorotondo and Pietro Scicchitano Chapter 11 Endothelial Progenitor Cell Number: A Convergence of Cardiovascular Risk Factors 265 Michel R. Hoenig and Frank W. Sellke Chapter 12 Nitric Oxide Signalling in Vascular Control and Cardiovascular Risk 279 Annette Schmidt Chapter 13 An Anti-Inflammatory Approach in the Therapeutic Choices for the Prevention of Atherosclerotic Events 301 Aldo Pende and Andrea Denegri Chapter 14 Gender-Specific Aspects in the Clinical Presentation of Cardiovascular Disease 327 Chiara Leuzzi, Raffaella Marzullo, Emma Tarabini Castellani and Maria Grazia Modena Chapter 15 The Role of Stress in a Pathogenesis of CHD 337 Taina Hintsa, Mirka Hintsanen, Tom Rosenström and Liisa Keltikangas-Järvinen Chapter 16 Pulse Pressure and Target Organ Damage 365 Adel Berbari and Abdo Jurjus Chapter 17 Low-Level Exposure to Lead as a Cardiovascular Risk Factor 387 Anna Skoczynska and Marta Skoczynska Chapter 18 Obstructive Sleep Apnoea Syndrome as a Systemic Low-Grade Inflammatory Disorder 411 Carlos Zamarrón, Emilio Morete and Felix del Campo Matias Chapter 19 New Cardiovascular Risk Factors and Physical Activity 433 Nicolás Terrados and Eduardo Iglesias-Gutiérrez Contents VII Chapter 20 Dietary Supplements and Cardiovascular Disease: What is the Evidence and What Should We Recommend? 449 Satoshi Kashiwagi and Paul L. Huang Chapter 21 Mediterranean Diet and Cardiovascular Risk 465 Javier Delgado-Lista, Ana I. Perez-Caballero, Pablo Perez-Martinez, Antonio Garcia-Rios, Jose Lopez-Miranda and Francisco Perez-Jimenez Preface An Insight on Cardiovascular Risk Factors: Challenges and Opportunities Our understanding of the implications of cardiovascular risk factors has greatly improved over the past two decades. It has been postulated that numerous risk factors and markers of inflammation and immune response trigger pathologic changes in the vascular wall from early life, leading to atherosclerotic cardiovascular disease in later life [1]. It has also been widely recognized that no single risk factor causes atherosclerotic disease, and that the likelihood of the disease depends on a multifactorial genetic and environmental background. The complex nature of risk factors and their interdependence implies the need of multidirectional preventive measures, which should be monitored and assessed with the use of multiple demographic, clinical, genetic and laboratory parameters. Over the past decades, the dominating concept of cardiovascular prevention has been based on the initial results of the landmark Framingham Heart Study, which linked the burden of cardiovascular disease with a combination of traditional risk factors, such as age, sex, arterial hypertension, hyperlipidemia, smoking, obesity, diabetes, and sedentary lifestyle. The study led to the validation and wide-spread use of the Framingham Risk Score, which is an indispensable tool for stratifying cardiovascular risk and treatment by clinicians and deploying strategies for community-based primary preventive measures by health administrators [2, 3]. The decades-long application of the Framingham Risk Score in different populations worldwide has also revealed its inherent limitations and led to the development of several alternative tools (e.g., SCORE [Systematic Coronary Risk Evaluation], Reynolds Risk Score, QRISK [QRESEARCH Cardiovascular Risk Algorithm]) [4]. Though the new tools have addressed some problems, none of these has been universally accepted, raising concerns over ethnicity, psychosocial background, comorbidities, drug therapies, and validity of biomarkers incorporated in the risk scores. For example, a recent large study showed that currently available risk scores do not provide precise estimates of cardiovascular risk in patients with rheumatoid arthritis [5], leaving the issue of risk-score-based cardiovascular prevention in this particular population uncertain. The guidance based on cardiovascular risk scores in patients with inflammatory disorders may either underestimate, which is more likely, X Preface or overestimate the real risk. Given the results of statistical analyses in large cohorts, an attempt was made to correct values of risk scores in patients with rheumatoid arthritis by using a 1.5 multiplier [6]. In practice, however, the latter approach was not regarded as realistic [7], necessitating more research into cardiovascular pathophysiology and therapies in inflammatory disorders. There are still many uncertainties over the interaction between traditional and novel risk factors leading to premature cardiovascular morbidity and mortality in the general population and in patients with diseases predisposing to vascular damage and accelerated atherothrombosis. Systemic inflammation has long been regarded as a crucial factor of premature cardiovascular disease. Initial evidence for this stems from the Physicians’ Health Study [8], which highlighted the significance of subclinical inflammation and slight elevation of C-reactive protein (CRP) level undetectable by conventional laboratory tests. A more recent large trial, the Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), reaffirmed that the suppression of low-grade inflammation (CRP just above 2 mg/l) can bring benefits in terms of primary cardiovascular prevention in the general population [9]. The JUPITER study also proved that the greatest cardiovascular risk reduction as a result of antiinflammatory therapy with rosuvastatin is expected in subjects with the highest levels of CRP. Whether the same or even greater risk reduction can be derived in high- and low-grade inflammatory disorders and whether statins can occupy their niche in the combined treatment of the patients are still a matter of debate, which may be resolved once the results of specifically designed and powered trials become available [10-12]. Several lines of evidence, mainly derived from retrospective cohort studies, suggest that systemic inflammation drives atherogenesis in cohorts of patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The exposure to high-grade inflammation is a crucial pathogenic factor in these patients, justifying aggressive antiinflammatory treatment, which, in turn, proved to reduce atherosclerotic burden among other disease-modifying effects [13-15]. The link between inflammation and atherosclerotic cardiovascular disease, however, is not universally evident across cohorts of patients with inflammatory disorders [16]. A recent systematic review on vascular function in RA revealed discrepancies across numerous cross-sectional and longitudinal studies, and questioned the direct link between rheumatoid inflammation and vasculopathy [17]. Moreover, numerous studies of varying levels of evidence suggested the lack of association between persistent low-grade inflammation and atherosclerotic vascular disease in patients with systemic vasculitides, including those with Wegener granulomatosis [18] and Behçet disease (BD) [19], the latter viewed as a model of venous thrombosis [20]. Obviously, the reported discrepancies indicate the complexity of atherogenic pathways and warrant further research into novel cardiovascular risk markers. Over the past decade, several promising markers of inflammation-mediated atherosclerosis have emerged. Of these, markers of activated platelets, such as platelet- bound P-selectin, CD40 ligand, beta-thromboglobulin, platelet factor 4, platelet- [...]... risks Therefore the detection of the risk factors in asymptomatic children can contribute to a decrease in cardiovascular disease, preventing those diseases such as hypertension, obesity and dyslipidemia becomes the epidemic of this new century 2 Cardiovascular risk factors Atherosclerosis begins early in life Thus, it is critical to detect cardiovascular disease risk factors during childhood and adolescence... Research on the prevalence, incidence and concurrence of cardiovascular disease risk factors in adolescents Research on associations and connections between adolescent CV risk factors, adult risk factors and the development of CVD Research methods and instruments used to study, screen, measure and test for cardiovascular risk factors in adolescents at the population health level and at the individual program... incidence of cardiovascular disease is likely to occur when today’s adolescents enter adulthood Thus, it is important to either eliminate or reduce risk factors in young people and other age groups (Williams et al., 2002) Fig 1 Factors associated with cardiovascular risk in children and adolescents 2.1 Atherosclerosis Although AD becomes symptomatic at a later period of life, identifying risk factors early... links between underlying mechanisms of atherogenesis and risk factors Several 4 Cardiovascular Risk Factors studies have examined different circulating markers of inflammations, such as cytokines and adhesion molecules, as potential predictors of the present and the future risk of cardiovascular diseases Moreover,functional and structural changes are documented in arteries of children with a familial predisposition... detecting risk factors during childhood/adolescence is crucial for establishing a prognosis and preventing target organ damage in adults Thus, initiating disease detection and prevention at this stage of life and introducing changes in lifestyle can reduce the incidence and severity of cardiovascular diseases Risk factors are more meaningful when they are integrated Hence, studies of cardiovascular risk factors. .. rising cardiovascular risk factors, and thus to reduce cardiovascular disease in adulthood It is well established that atherosclerosis begins in childhood and adolescence and that cardiovascular risk in early years can be tracked into adulthood cardiovascular disease (CVD) (Berenson et al., 2010; McCrindle et al., 2010; McCusker, et al., 2004; Yoshinga et al., 2008) Research into adolescent cardiovascular. .. childhood risk factors for diseases cardiovascular that may emerge in adult life Thus, the studies involving analysis of cardiovascular risk factors should always register the prevalence and their correlations in childhood, as an essential to identify a population at risk Thus, beyond the direct benefits on children evaluated such studies could point out other family members carrying from such risks Therefore... considered cardiovascular risk factors Prospective studies have shown that obesity appears many years before the onset of insulin resistance (Taskinen, 2003), and insulin resistance is mainly responsible for the hemodynamic and metabolic disturbances of this syndrome (Morton et al., 2001) It is believed that MS is due to a combination of genetic and environmental factors wherein 6 Cardiovascular Risk Factors. .. to most countries (Yusef et al., 2004) 20 Cardiovascular Risk Factors The Canadian Heart and Stroke Foundation’s Annual Report (2010) warns that young Canadian adults are increasingly at risk for heart disease: And that “a perfect storm of risk factors and demographic changes are converging to create an unprecedented burden on Canada’s fragmented system of cardiovascular care, and no Canadian young... Blumenthal RS Screening for cardiovascular risk in asymptomatic patients J Am Coll Cardiol 2010;55(12):1169-1177 [5] Toms TE, Panoulas VF, Douglas KM, Griffiths H, Sattar N, Smith JP, Symmons DP, Nightingale P, Metsios GS, Kitas GD Statin use in rheumatoid arthritis in relation to actual cardiovascular risk: evidence for substantial undertreatment of lipid-associated cardiovascular risk? Ann Rheum Dis 2010;69(4):683-688 . CARDIOVASCULAR RISK FACTORS Edited by Armen Yuri Gasparyan Cardiovascular Risk Factors Edited by Armen Yuri Gasparyan . Identification of Cardiovascular Risk Factors in Adolescents and Follow-Up Intervention Strategies 17 Heather Lee Kilty and Dawn Prentice Chapter 3 Novel and Traditional Cardiovascular Risk Factors. Preface An Insight on Cardiovascular Risk Factors: Challenges and Opportunities Our understanding of the implications of cardiovascular risk factors has greatly improved over