Background Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision-making. We compared thirteen negative risk markers using diagnostic likelihood ratios (DLR), which model the change in risk for an individual after the result of an additional test. Methods and Results We examined 6,814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium (CAC) =0, carotid intima-media thickness (CIMT) <25th percentile, absence of carotid plaque, brachial flow-mediated dilation >5% change, ankle brachial index (ABI) >0.9 and <1.3, high sensitivity C-reactive protein (hsCRP) <2 mg/L, homocysteine <10 µmol/L, NTpro-BNP <100 pg/mL, no microalbuminuria, no family history of coronary heart disease (CHD) (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all, hard CHD and all CVD events over 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers CAC=0 was the strongest, with adjusted mean DLR (SD) of 0.41 (0.12) for all CHD and 0.54 (0.12) for CVD, followed by CIMT <25th percentile (DLRs 0.65 [0.04] and 0.75 [0.04], respectively). HsCRP <2 mg/L and normal ABI had DLRs >0.80. Among clinical features, absence of any family history of CHD was the strongest (DLRs 0.76 [0.07] and 0.81 [0.06], respectively). Net Reclassification Improvement (NRI) analyses yielded similar findings, with CAC=0 resulting in the largest, most accurate downward risk reclassification. Conclusions Negative results of atherosclerosis-imaging tests, particularly CAC=0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions regarding identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.

The risk of nonalcoholic fatty liver disease (NAFLD) among obese individuals without obesity-related metabolic abnormalities, a condition referred to as metabolically healthy obese (MHO), is largely unexplored. Therefore, we examined the association between body mass index (BMI) categories and the development of NAFLD in a large cohort of metabolically healthy men and women. METHODS:A cohort study was conducted in 77,425 men and women free of NAFLD and metabolic abnormalities at baseline, who were followed-up annually or biennially for an average of 4.5 years. Being metabolically healthy was defi ned as not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5. The presence of fatty liver was determined using ultrasound. RESULTS:During 348,193.5 person-years of follow-up, 10,340 participants developed NAFLD (incidence rate, 29.7 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confi dence intervals) for incident NAFLD comparing overweight and obese with normal-weight participants were 2.15 (2.06-2.26) and 3.55 (3.37-3.74), respectively. In detailed dose-response analyses, increasing baseline BMI showed a strong and approximately linear relationship with the incidence of NAFLD, with no threshold at no risk. This association was present in both men and women, although it was stronger in women ( P for interaction <0.001), and it was evident in all clinically relevant subgroups evaluated, including participants with low infl ammation status. CONCLUSIONS:In a large cohort of strictly defi ned metabolically healthy men and women, overweight and obesity were strongly and progressively associated with an increased incidence of NAFLD, suggesting that the obese phenotype per se , regardless of metabolic abnormalities, can increase the risk of NAFLD. Am J Gastroenterol 2016; 111:1133-1140 doi: 10.1038/ajg.2016 Specifi cally, it is unclear whether obesity is a risk factor for NALFD in subjects who do not have any of the metabolic abnormalities associated with excess adiposity, a group oft en described as metabolically healthy obese (MHO) ( 11,12 ). Th e health implications of . Only one study has evaluated the association of MHO with NAFLD ( 16 ). In this study, MHO subjects had an increased prevalence of NAFLD compared with metabolically healthy non-obese subjects, but the cross-sectional design of this study limited its ability to establish a temporal relation between obesity and NAFLD.No cohort study has evaluated the role of MHO as a determinant of incident NAFLD among subjects free of NAFLD at baseline. Th erefore, we examined the association between body mass index (BMI) categories and the development of NAFLD in a large cohort of metabolically healthy men and women who participated in a health screening examination program. METHODS Study populationTh e Kangbuk Samsung Health Study is a cohort study of men and women 18 years of age or older who underwent a comprehensive annual or biennial health examination at the clinics of the Kangbuk Samsu...

BackgroundHeart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level.Methods and resultsPopulation-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (<1 year) HF admission. We analyzed 1year all-cause and HF hospitalizations, and all-cause mortality. Logistic regression was used to identify the independent predictors of each of those outcomes. A total of 88,195 patients were included. Mean age was 77 years, 55% were women. Comorbidities were frequent. Fourteen percent of patients had never been hospitalized, 71% had a remote HF hospitalization and 15% a recent hospitalization. At 1-year follow-up, all-cause and HF hospitalization were 53% and 8.8%, respectively. One-year all-cause mortality rate was 14%, and was higher in patients with a recent HF hospitalization (24%). The presence of diabetes mellitus, atrial fibrillation or chronic kidney disease was independently associated with all-cause and HF hospitalization and all-cause mortality. Hospital admissions and emergency department visits the previous year were also found to be independently associated with the three study outcomes.ConclusionsOutcomes are different depending on the HF population studied. Some comorbidity, an all-cause hospitalization or emergency department visit the previous year were associated with a worse outcome.

Health care in the United States has seen many great innovations and successes in the past decades. However, to this day, the color of a person’s skin determines—to a considerable degree—his/her prospects of wellness; risk of disease, and death; and the quality of care received. Disparities in cardiovascular disease (CVD)—the leading cause of morbidity and mortality globally—are one of the starkest reminders of social injustices, and racial inequities, which continue to plague our society. People of color—including Black, Hispanic, American Indian, Asian, and others—experience varying degrees of social disadvantage that puts these groups at increased risk of CVD and poor disease outcomes, including mortality. Racial/ethnic disparities in CVD, while documented extensively, have not been examined from a broad, upstream, social determinants of health lens. In this review, we apply a comprehensive social determinants of health framework to better understand how structural racism increases individual and cumulative social determinants of health burden for historically underserved racial and ethnic groups, and increases their risk of CVD. We analyze the link between race, racism, and CVD, including major pathways and structural barriers to cardiovascular health, using 5 distinct social determinants of health domains: economic stability ; neighborhood and physical environment ; education ; community and social context ; and healthcare system . We conclude with a set of research and policy recommendations to inform future work in the field, and move a step closer to health equity.