Increased visceral adiposity, but not total or subcutaneous adiposity, was robustly associated with incident hypertension. Additional studies will be needed to elucidate the mechanisms behind this association.

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clinicaltrials.gov Identifier: NCT01035255.

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Background: High density lipoprotein cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and with myocardial infarction (MI) among women and Blacks has not been well studied. We hypothesized that HDL-P would be consistently associated with MI and stroke among women and Blacks compared with HDL-C. Methods: We analyzed individual level participant data in a pooled cohort of four large population studies without baseline atherosclerotic cardiovascular disease (ASCVD) - the Dallas Heart Study (DHS) (n=2,535), Atherosclerotic Risk in Communities (ARIC) Study (n=1,595), Multi Ethnic Study of Atherosclerosis (MESA) (n=6,632) and Prevention of Renal and Vascular Endstage Disease (PREVEND) (n=5,022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke. Results: In the overall population (n=15,784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors, [hazard ratio (HR) for Q4 vs Q1 0.64, 95% confidence interval [CI] 0.52 to 0.78] as was HDL-C (HR for Q4 vs Q1: 0.76, 95% CI 0.61 to 0.94). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and ASCVD, while adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual endpoints of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR Q4 vs Q1 for White 0.49, 95%CI 0.35-0.69; for Black 1.22, 95%CI 0.76-1.98; p interaction = 0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR Q4 vs Q1 0.53, 95%CI 0.36-0.78) but had a weak direct association with MI among Black participants (HR Q4 vs Q1 1.75, 95%CI 1.08-2.83; p interaction < 0.0001). Conclusions: In comparison to HDL-C, HDL-P was consistently associated with MI and ischemic stroke in the overall population. Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that ASCVD risk may differ by vascular domain and ethnicity. Future studies should examine individual outcomes separately.

AimsThe present study aimed to assess the association between left atrial (LA) structure and function and the risk for cardiovascular (CV) death or heart failure (HF) hospitalization in a population with atrial fibrillation (AF).Methods and resultsIn a prospective echocardiographic substudy of the Effective Anticoagulation with Factor Xa Next Generation in AF‐Thrombolysis in Myocardial Infarction 48 (ENGAGE AF‐TIMI 48) study, 971 patients underwent transthoracic echocardiography. The associations between LA structure (LA volume index [LAVi]) and function (LA emptying fraction [LAEF] and LA expansion index [LAEi]) and risk for the composite endpoint of CV death or HF hospitalization, and its components, were assessed. Over a median follow‐up of 2.5 years, 142 patients (14.6%) experienced CV death or HF hospitalization. Higher LAVi and lower LAEF and LAEi were each associated with a higher unadjusted risk for the composite outcome and its components. After adjustment for clinical and echocardiographic confounders, only measures of impaired LA function were predictive of the composite outcome (hazard ratio [HR] per 1 standard deviation [SD] decrease in LAEF: 1.35; 95% confidence interval [CI] 1.09–1.67 [P = 0.005]; HR per 1 SD decrease in LAEi: 1.34; 95% CI 1.06–1.69 [P = 0.012]). These findings were similar regardless of left ventricular ejection fraction, history of HF or whether patients were in AF or sinus rhythm at the time of the echocardiographic examination.ConclusionsIn patients with AF, LA dysfunction was significantly associated with an increased risk for CV death or HF hospitalization and was more predictive of these outcomes than LA size. These parameters may help to identify AF patients at greatest risk for the development of HF.Clinical Trial Registration: ClinicalTrials.gov, NCT00781391.