Lifestyle and cardiovascular health: opinions and behaviors among adults having relatives with cardiovascular diseases

Preeclampsia: Exposing Future Cardiovascular Risk in Mothers and Their Children

Modest Gains Confer Large Impact: Achievement of Optimal Cardiovascular Health in the US Population

Introduction

The conference chairs

Prevention of Cardiovascular Disease in Persons with Type 2 Diabetes Mellitus: Current Knowledge and Rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.” Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3 There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted. The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

The National Heart, Lung, and Blood Institute (NHLBI) has a longstanding appreciation of the value of behavioral research. From the earliest days, when the concept of “coronary prone” behavior was introduced, to the growing recognition of the need for strategies to encourage health-promoting behaviors and lifestyles, to more recent efforts to incorporate health-related quality of life measures into our clinical studies, behavioral research has contributed much to our understanding of cardiovascular disease (CVD). Although still in its infancy, the application of this discipline to lung and blood diseases, sleep disorders, and transfusion medicine issues clearly offers much promise for advances in treatment and prevention. Acknowledging that many opportunities lie in biobehavioral research, in November 1995 the NHLBI convened the Task Force on Behavioral Research in Cardiovascular, Lung, and Blood Health and Disease to chart a course for future research efforts. Composed of national experts, it was charged to review the state of knowledge in biobehavioral research in cardiovascular, lung, and blood diseases and sleep disorders over the past 5 years; identify research opportunities; and develop a comprehensive plan, including scientific priorities, for NHLBI support of research on health and behavior for the next several years. During a series of meetings that spanned nearly 2 years, the task force worked to develop a report of its findings and conclusions. The report provides a detailed summary of accomplishments to date, highlights new scientific opportunities, and identifies specific recommendations for future research. The full text, with graphics, is available on the NHLBI Web site at http://www.nhlbi.nih.gov/nhlbi/sciinf/taskforc.htm. The synopsis that follows was excerpted from the executive summary of the task force report. The Institute is very pleased to have this task force report to guide its activities with respect to research on health and behavior. We are grateful to the task force chair, Dr …

Introduction to the Compendium on Early Cardiovascular Disease.

Basic science: Pathophysiology: the CardioRenal Metabolic Syndrome

Executive Summary: Heart Disease and Stroke Statistics—2011 Update

Cardiovascular (CV) disease (CVD) is the major health burden and cause of death for women. Marked disparities exist in CVD diagnosis, prevention, and treatment between women and men – as well as lack of female-specific data. Population, physiologic, translational, and clinical trial studies of sex and gender differences in CVD [[Unable to Display Character: –]] even when only women are studied[[Unable to Display Character: –]] often do not collect relevant data specific to women that could inform study outcomes. The ISIS CVD Network of the Society for Women’s Health Research compiled an inventory of items specific for women across the lifespan, together with references for methods and strategies to gather and evaluate this information; some items comprise robust measures, others are in development. The objective is to enhance usefulness of CVD research data in understanding sex and gender differences, thereby optimizing healthcare delivery and outcomes for women. Included are hormonal variables (menstrual cycle phase, hormone levels) oral contraceptive use, pregnancy history/complications, polycystic ovary syndrome (PCOS) components, measures of menopause, and menopausal hormone therapy, variables generally not collected in research studies, but essential to determine their role as sex-specific contributors to CV health and disease. Clear associations exist between reproductive health and CV health and disease. For example 25-33% of women experience complications of pregnancy that may precede and predispose to CVD. Vascular complications during pregnancy, antecedent risk factors and subsequent clinical CVD can be ascertained using medical records, birth registries, and/or maternal recall. Evaluating compilations of patient data with known hormonal or menopausal status using reference standards and patient data for PCOS could inform relationships to subsequent CV outcomes. Variables predominant among women that preferentially disadvantage them should be considered; e.g. psychosocial issues and elderly age. Depressive disorders are twice as common among women as men. They adversely affect CVD outcomes in women, yet the effect of reproductive life cycle and of hormonal fluctuations on depression and etiologic contributions of depression to CVD are inadequately explored. In addition to traditional CVD risk factors, diabetes mellitus, chronic inflammatory disorders, oxidative stress, vasomotor dysfunction, coronary microvascular disorders, and other novel risk variables that preferentially impact women should be explored. Along with increased enrollment of women in CVD research studies and analysis of clinical and genetic studies by sex, improvements and expansion of study design must include these understudied uniquely or predominantly female characteristics. This will enhance the quality and quantity of evidence-based medicine to guide CVD care in women and men thereby setting the stage for personalized approach to medicine.

The “Heart Disease and Stroke Statistics—2013 Update,” published by the American Heart Association (AHA) in this issue of Circulation ,1 and the Institute of Medicine (IOM) report, “A National Framework for Surveillance of Cardiovascular and Chronic Lung Diseases,” published last year,2 attest to the importance and value of timely, high-quality, population-based data on the incidence of heart disease and stroke and their risk factors. The annual Heart Disease and Stroke Statistics Update is the authoritative source of annual estimates of incidence, prevalence, and risk factor distribution in the country. It is carefully crafted from a wide variety of separate federally and privately funded studies of various designs, reach, and sample size. In its breath, quality, and style it represents a national treasure of the best available information on the burden of heart disease and stroke events and risk factors that is a highly valued resource in the medical and public health communities. Indeed, the Heart Disease and Stroke Statistics Update is cited nearly 2000 times each year in the scientific literature. However, even this compilation of the best data available does not have national representative or timely data on heart disease and stroke incidence at its disposal. It is our best guess at questions for which we should not be guessing. More comprehensive monitoring of the occurrence of cardiovascular diseases (CVD), which cause more death and disability than any other medical conditions, is important to the physical and economic health of the country. The IOM report is clear in its overall message and resolute in its vision; we need to strengthen our ability to monitor the cardiovascular health of the country and create a national system to capture information on heart disease and stroke. The Heart Disease and Stroke Statistics Update appearing in this issue is our best …

As we reach the midpoint of the first decade of the twenty-first century, we are also at the midpoint in the timeline of the American Heart Association (AHA) strategic plan to reduce coronary heart disease, stroke, and risk by 25% by the year 2010.1,2 Encouraging evidence demonstrates important gains toward that goal, with decreases in coronary heart disease and stroke mortality, as well as reductions in certain risk factors such as cigarette consumption and untreated hypercholesterolemia. Still, troubling evidence indicates that other ominous risk factors—physical inactivity, overweight and obesity, diabetes, and hypertension—are on the rise,3 especially among adolescents and young adults, and these may contribute to the next wave of the cardiovascular epidemic. And there is undeniable evidence that not all Americans have shared equally in the improved cardiovascular outcomes. Individuals in specific subgroups defined by race, ethnicity, socioeconomic status, and geography have a disproportionate burden of myocardial infarction, heart failure, stroke, and other cardiovascular events. These individuals also have a worse outcome after these events, including higher mortality rates, and a higher prevalence of unrecognized and untreated risk factors places them at greater likelihood of experiencing these events. Differences such as these arise not only from disparities in access to care and quality of care but also from disparities in awareness and access to knowledge. Disparities in cardiovascular prevention, diagnosis, treatment, and outcomes have been documented in a number of publications from the US Department of Health and Human Services (DHHS),4–6 the Institute of Medicine,7 and the Kaiser Family Foundation,8 and reports of continuing racial and ethnic disparities appear regularly in cardiovascular scientific journals.9,10 If this unacceptable situation fails to be rectified, it is unlikely that the AHA’s 2010 goals or the DHHS Healthy People 2010 goals can be achieved. In the autumn …

Current guideline statements for primary and secondary prevention of cardiovascular disease (CVD) rely on estimates of absolute risk of coronary events. For example, the American Heart Association guidelines on primary prevention state that persons with ≥10% risk over 10 years of myocardial infarction (MI) or coronary death should be considered for antiplatelet therapy with aspirin.1 Similarly, the National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines2 state that target low-density lipoprotein level should be based on projected absolute risk of future coronary events rather than on presence or absence of specific risk factors. These guidelines state that patients at high risk of MI and coronary death, defined as an absolute 10-year risk of ≥20%, should have a target low-density lipoprotein level <100 mg/dL and should receive statin therapy if needed to achieve this goal. Stroke, however, is not included as one of the outcomes contributing to these absolute risk levels. Included in the group of patients with elevated risk, moreover, are those who already have ischemic heart disease, as well as patients deemed to be “coronary heart disease (CHD) risk equivalents,” indicating those at the same elevated risk as patients with ischemic heart disease. CHD risk equivalents include patients with diabetes mellitus, those with multiple risk factors that put them at elevated risk based on calculation of their Framingham Score, and patients with “other forms of symptomatic atherosclerotic disease.” The latter group is further defined to include those with peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), and carotid artery disease. The category of “risk equivalents” in the ATP III guidelines, however, does not include the vast majority (≈80%3) of ischemic stroke patients without carotid artery disease as cause of their stroke. Ischemic stroke is therefore notably excluded from the list of outcomes contributing to …

Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation