Additional Cardiovascular Disease Risk Factors Research Articles

Effect of gender and adiposity on in vivo vascular function in young African Americans

The relationship between obesity and high blood pressure is not as strong among African Americans (AA) as compared to Caucasians. We designed the current study to determine the effect of adiposity on vascular endothelial function (a harbinger of hypertension) among young healthy AA without additional cardiovascular disease risk factors. A total of 108 AA subjects (46 women) between the ages of 18 and 45 years were recruited. All the subjects were normotensive, nonsmokers, and normoglycemic. Anthropometric and cardiovascular disease risk factor measurements (lipid, insulin resistance, and inflammatory markers) were obtained. Vascular endothelial function was measured by brachial artery flow-mediated dilation (FMD). Adiposity distribution was measured by using magnetic resonance imaging scan. There were no gender differences in age and levels of blood pressure, lipids, insulin resistance, and inflammatory markers. Women had higher total body fat percentage and higher peripheral adiposity compared to men. We observed that total and central adiposity did not correlate significantly with brachial artery FMD in women (r = −0.12 and r = 0.23, respectively; P = NS). However, in men, waist circumference was positively associated with FMD (r = 0.3, P ≤ .05). Hyperemic flow was negatively correlated significantly with total and central adiposity in men (r = −0.34 and r = −0.48, respectively; P < .05), but not in women (r = −0.26 and r = 0.03, respectively; P = NS). Our study suggests that increased adiposity may pose greater risk to AA men compared to AA women by adversely affecting resistance vessel function (as measured by hyperemic flow). Larger studies are necessary to validate these findings.

Isolated Elevation of Lipoprotein(A) is Uncommon Among Patients Admitted to Coronary Care

Elevated lipoprotein(a) [Lp(a)] is an important inherited cardiovascular disease (CVD) risk factor. However, levels are not routinely measured in coronary care units (CCU). The clustering of elevated Lp(a) with other conventional CVD risk factors in this setting is also unknown. We aimed to audit the frequency of elevated Lp(a) in patients admitted to the CCU at Royal Perth Hospital, and to assess the spectrum of CVD risk factors in patients with high levels. Plasma Lp(a) was measured in all patients admitted to the CCU for 6.5 months. Elevated Lp(a) was defined as ≥0.50 g/L based on previous associations with CVD. Hypertension, type-2 diabetes and smoking status were recorded, and LDL-cholesterol documented from discharge summaries. LDL-cholesterol was adjusted for the cholesterol content of Lp(a) and lipid-lowering therapy. Lp(a) was measured in 345 patients; 69.6% were male, and average age was 61.8 years (range = 23.0 to 90.8). Elevated Lp(a) was identified in 27% (n = 93) of patients. In patients with elevated Lp(a), 33.3% (n = 31) had type-2 diabetes, 53.8% (n = 50) hypertension, and 36.6% (n = 34) were current or previous smokers; 71.0% (n = 66) had an adjusted LDL-cholesterol exceeding the recommended guideline of 2.5 mmol/L. Of those with elevated Lp(a), 35.5% (n = 33) had one, 25.8% (n = 24) two, 25.8% (n = 24) three, and 7.5% (N = 7) four of these additional CVD risk factors. There were 5 patients (5.4%) with isolated elevated Lp(a). These findings indicate that elevated Lp(a) co-exists with conventional CVD risk factors in most patients admitted to the CCU, suggesting that elevated Lp(a) may be a conditional CVD risk factor.

Obesity, Cardiovascular Disease and Sleep Disorders: Insights into the Rising Epidemic.

Cardiovascular disease (CVD) is the main cause of death among adult men and women in the USA and impacts millions around the globe. Traditional risk factors for CVD include obesity, diabetes, hypertension and dyslipidemia. The modern-day epidemic of obesity not only increased the rate of CVD but also ushered in an additional CVD risk factor to be added to the list; that is obstructive sleep apnea (OSA). In this review, we discuss the growing epidemic of obesity and OSA, highlighting the common pathogenic hypotheses linking these risk factors to CVD. We will also highlight the therapeutic rationale of OSA as a way to reduce CVD risk.

Progress in the care of familial hypercholesterolaemia: 2016.

Familial hypercholesterolaemia (FH) is the most common autosomal dominant condition, with a prevalence of between one in 200 and one in 350 people in the general population. Untreated FH is associated with premature atherosclerotic cardiovascular disease (CVD). The prevalence of homozygous or compound heterozygous FH is now considered to be about one in 300 000 people. Treating children with FH reduces progression of atherosclerotic CVD and future CVD events. Most individuals with FH are undiagnosed, which together with the recent frequency data in the population and in individuals with premature coronary disease creates a public health challenge and mandates a key role for primary care. Childhood is the optimal period for detecting FH, since low-density lipoprotein cholesterol (LDL-c) concentrations better differentiate affected from unaffected individuals. In an Australian community setting, over 70% of adults with an LDL-c level ≥ 6.5 mmol/L have clinical FH; of these, 30% have a detectable mutation. The community laboratory has an important role in identifying FH, with interpretive comments leading to additional reductions in LDL-c concentrations, and a phone call from the pathologist to the general practitioner improving detection of cases. Cascade screening using DNA testing is cost-effective and acceptable to screenees. Next generation genetic sequencing may differentiate people with polygenic hypercholesterolaemia alone from those with FH. Smoking, hypertension, elevated lipoprotein(a) levels, chronic kidney disease and diabetes are additional atherosclerotic CVD risk factors in FH. Equations for assessing absolute risk of CVD in primary prevention underestimate risk in FH. The adult LDL-c goal is a greater than 50% reduction in LDL-c levels, followed by a target of <2.5 mmol/L, or <1.8 mmol/L for individuals with CVD or other CVD risk factors. Proprotein convertase subtilisin/kexin type 9 inhibitors significantly reduce LDL-c and lipoprotein(a) levels in people with FH. Registries are essential for improving the care of people with FH.

Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes: A Pragmatic Pilot Randomized Trial.

The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes.

Menopausal hot flashes and white matter hyperintensities.

Hot flashes are classic symptoms of menopause. Emerging data link hot flashes to cardiovascular disease (CVD) risk, yet whether hot flashes are related to brain health is poorly understood. We examined the relationship between hot flashes (measured via physiologic monitor and self-report) and white matter hyperintensities (WMH) among midlife women. Twenty midlife women (aged 40-60 y) without clinical CVD, with an intact uterus and ovaries, and not taking hormone therapy were recruited. Women underwent 24 hours of ambulatory physiologic and diary hot flash monitoring to quantify hot flashes; magnetic resonance imaging to assess WMH burden; 72 hours of actigraphy to quantify sleep; and a blood draw, questionnaires, and physical measures to quantify demographics and CVD risk factors. Tests of a priori hypotheses regarding relationships between physiologically monitored and self-reported wake and sleep hot flashes and WMH were conducted in linear regression models. More physiologically monitored hot flashes during sleep were associated with greater WMH, controlling for age, race, and body mass index (β [SE] = 0.0002 [0.0001], P = 0.03]. Findings persisted after controlling for sleep characteristics and additional CVD risk factors. No relationships were observed for self-reported hot flashes. More physiologically monitored hot flashes during sleep are associated with greater WMH burden among midlife women without clinical CVD. Results suggest that the relationship between hot flashes and CVD risk observed in the periphery may extend to the brain. Future work should consider the unique role of sleep hot flashes in brain health.

Adults Eligible for Cardiovascular Disease Prevention Counseling and Participation in Aerobic Physical Activity - United States, 2013.

Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is a major risk factor (1). Health care professionals have a role in counseling patients about physical activity for CVD prevention. In August 2014, the U.S. Preventive Services Task Force (USPSTF) recommended that adults who are overweight or obese and have additional CVD risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Although the USPSTF recommendation does not specify an amount of physical activity, the 2008 Physical Activity Guidelines for Americans state that for substantial health benefits adults should achieve ≥150 minutes per week of moderate-intensity aerobic physical activity or ≥75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. To assess the proportion of adults eligible for intensive behavioral counseling and not meeting the aerobic physical activity guideline, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). This analysis indicated that 36.8% of adults were eligible for intensive behavioral counseling for CVD prevention. Among U.S. states and the District of Columbia (DC), the prevalence of eligible adults ranged from 29.0% to 44.6%. Nationwide, 19.9% of all adults were eligible and did not meet the aerobic physical activity guideline. These data can inform the planning and implementation of health care interventions for CVD prevention that are based on physical activity.

Clinical attributes, treatment, and control in hypertension (CATCH)-a French and Italian longitudinal patient database study.

IntroductionHypertension, a risk factor for cardiovascular disease (CVD), is frequently associated with other CVD risk factors. Despite recent improvement in blood pressure (BP) control in Europe, a substantial proportion of patients fail to achieve BP targets.MethodsThis retrospective cohort study used longitudinal patient databases (LPDs) in France and Italy to examine CVD risk profiles, treatment patterns, and BP goal attainment in hypertensive patients treated in real-world clinical practice between 2007 and 2008. Overall, 147,964 and 140,189 eligible patients from LPDs in France and Italy, respectively, were prescribed an antihypertensive medication in 2007.ResultsAmong patients with hypertension with other risk factors (France 88 %, Italy 83 %), the most prevalent risk factors were being elderly (France 66.9 %, Italy 70. 9 %), followed by hypertension combined with dyslipidemia (France 36.7 %, Italy 23.9 %) and isolated systolic hypertension (France 32.5 %, Italy 24.2 %). The odds ratios for target BP attainment were significantly (p < 0.001) higher in patients with hypertension without other risk factors vs patients with hypertension with other risk factors (1.41 [95 % confidence interval 1.35, 1.48] in France; 1.38 [1.31, 1.46] in Italy). The odds of BP control were significantly lower for patients with vs patients without an associated CVD risk factor (range 0.54 to 1.10 France; 0.59 to 1.17 Italy).DiscussionThis study demonstrates that the majority of treated hypertensive patients in France and Italy have at least one additional CVD risk factor. Despite treatment with antihypertensive medications, blood pressure attainment was substantially less optimal in patients with an associated CVD risk factor compared to patients without an associated CVD risk factor.Electronic supplementary materialThe online version of this article (doi:10.1186/s40885-015-0029-2) contains supplementary material, which is available to authorized users.

Cardiovascular risk profiles of adults with type-2 diabetes treated at urban hospitals in Riyadh, Saudi Arabia

Diabetes mellitus substantially increases cardiovascular disease (CVD) risk. Among Saudi Arabian citizens with diabetes, little is known about the prevalence and control of other CVD risk factors.We extracted data from medical records of a random selection of 422 patients seen between 2008 and 2012 at two diabetic clinics in Riyadh, Saudi Arabia. We calculated the proportion of patients who had additional CVD risk factors: obesity (body mass index⩾30kg/m2), hypertension (BP⩾140/90mmHg), elevated cholesterol fractions, and multiple risk factors). Further, we calculated the proportion of patients meeting the American Diabetes Association’s recommended care targets for each risk factor.Of 422 patients (mean age, 52years), half were women, 56% were obese, 45% had hypertension, and 77% had elevated LDL concentrations. In addition to diabetes, 70% had two or more CVD risk factors. Although 9% met both target HbA1c and BP values, only 3.5% had optimum HbA1c, BP, and lipid values.In Saudi Arabia’s best diabetes clinics, most patients have poor control of their disease. This huge disease burden and related care gaps have important health and financial implications for the country.

Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement.

Update and refinement of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on dietary counseling for adults with risk factors for cardiovascular disease (CVD). The USPSTF reviewed the evidence on whether primary care-relevant counseling interventions for a healthful diet and physical activity modify self-reported behaviors, intermediate physiologic outcomes, diabetes incidence, and cardiovascular morbidity or mortality in adults with CVD risk factors, as well as the adverse effects of counseling interventions. This recommendation applies to adults aged 18 years or older in primary care settings who are overweight or obese and have known CVD risk factors (hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). The USPSTF recommends offering or referring adults who are overweight or obese and have additional CVD risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. (B recommendation).

생활습관개선 프로그램이 성인의 식이행동과 신체활동 및 심혈관위험요인에 미치는 효과: 중재 3개월 결과를 중심으로

Objectives: The aim of this study was to evaluate the effects of a lifestyle modification program for Korean adults with cardiovascular disease risk factors on their health behaviors and health status. Methods: A total of 448 adults with abdominal obesity and additional cardiovascular disease risk factors(high blood pressure, low HDL-cholesterol, high triglyceride or high blood glucose) were randomly assigned to either an intensive intervention group (IIG, n=216) or a minimal intervention group(MIG, n=232). Participants in the IIG received lifestyle modification program which consisted of health counseling with nutrition assessment, health booklet and health diary, while those in MIG received minimal information. Results: The participants in the IIG significantly improved dietary habits(p<.05), retrained eating(p<.001), external eating(p<.01) behaviors, leisure time physical activity(p<.05), dietary self-efficacy(p<.01), exercise self-efficacy(p<.01) and MetS score(p<.001) after 3 months. In addition, the participants in the IIG showed more improvement in dietary habits(p<.05) compared with those in the MIG. Conclusion: The lifestyle modification program was effective in improving some health

Dyslipidemia

Dyslipidemia

Dose-Response Association of Uncontrolled Blood Pressure and Cardiovascular Disease Risk Factors with Hyperuricemia and Gout

BackgroundFirst-line therapy of hypertension includes diuretics, known to exert a multiplicative increase on the risk of gout. Detailed insight into the underlying prevalence of hyperuricemia and gout in persons with uncontrolled blood pressure (BP) and common comorbidities is informative to practitioners initiating antihypertensive agents. We quantify the prevalence of hyperuricemia and gout in persons with uncontrolled BP and additional cardiovascular disease (CVD) risk factors.Methods and FindingsWe performed a cross-sectional study of non-institutionalized US adults, 18 years and older, using the National Health and Nutrition Examination Surveys in 1988–1994 and 1999–2010. Hyperuricemia was defined as serum uric acid >6.0 mg/dL in women; >7.0 mg/dL in men. Gout was ascertained by self-report of physician-diagnosed gout. Uncontrolled BP was based on measured systolic BP≥140 mmHg and diastolic BP≥90 mmHg. Additional CVD risk factors included obesity, reduced glomerular filtration rate, and dyslipidemia. The prevalence of hyperuricemia was 6–8% among healthy US adults, 10–15% among adults with uncontrolled BP, 22–25% with uncontrolled BP and one additional CVD risk factor, and 34–37% with uncontrolled BP and two additional CVD risk factors. Similarly, the prevalence of gout was successively greater, at 1–2%, 4–5%, 6–8%, and 8–12%, respectively, across these same health status categories. In 2007–2010, those with uncontrolled BP and 2 additional CVD risk factors compared to those without CVD risk factors had prevalence ratios of 4.5 (95% CI 3.5–5.6) and 4.5 (95% CI: 3.1–6.3) for hyperuricemia and gout respectively (P<0.01).ConclusionsHealth care providers should be cognizant of the incrementally higher prevalence of hyperuricemia and gout among patients with uncontrolled BP and additional CVD risk factors. With one in three people affected by hyperuricemia among those with several CVD risk factors, physicians should consider their anti-hypertensive regimens carefully and potentially screen for hyperuricemia or gout.

Correlation between mean platelet volume and total risk of cardiovascular disease

Introduction. The association between mean platelet volume (MPV) and single cardiovascular disease (CVD) risk factors has previously been tested. The aim of our study was to evaluate the association between MPV and total risk of CVD. Materials and Methods. In 216 consecutive outpatients referred for a cardiology assessment because of multiple CVD risk factors, total CVD risk was estimated according to the Framingham Risk Score (FRS) as low ( 20%). Additionally, FRS was adjusted for triglycerides (TG), body mass index (BMI) and a family history of CVD, important CVD risk factors which are not included in the FRS equation. Also, CVD risk was estimated according to terciles of MPV ( 9.1 fL, respectively). Correlation between high sensitivity C-reactive protein (hs-CRP) and FRS was used as confirmation that our study hypothesis was properly set. Results. MPV did not correlate with individual CVD risk factors or with FRS, either before, or after adjustment for additional CVD risk factors. Significant correlation between MPV and total CV risk was observed only in the adjusted high FRS group ; namely, for persons in tercile 3, CVD risk was doubled (OR 2.2 ; 95% CI 1.05-4.64 ; P =0.038). In comparison, there was a strong linear correlation between hs-CRP and unadjusted (r=0.203, P=0.004) and adjusted (r=0.383, P<0.001) FRS. Conclusion. Correlation between MPV and high total CVD risk suggests increased platelet activity primarily as a consequence and sign of atherosclerotic vascular damage. Linear correlation between hs-CRP with FRS confirms inflammation as an important mechanism of atherogenesis.

Fibrinogen and future cardiovascular disease in people with diabetes: Aetiological associations and risk prediction using individual participant data from nine community-based prospective cohort studies

We assessed the associations of fibrinogen levels with cardiovascular disease (CVD) risks in people with and without diabetes, and quantified the value of adding fibrinogen to the established predictive algorithms for CVD. We used Cox models to analyse data from prospective cohorts totalling 33,091 adults (1006 with diabetes) who took part in British and Scottish general population-based health surveys. Discrimination was assessed through c-statistic. During a median follow-up of 116 months, 351 deaths (119 CVD) were recorded in participants with diabetes and 4157 deaths (1167 CVD) in those without. After adjustment for age and sex, fibrinogen (per standard deviation log(e)) was positively associated with a 34% (26-42%) higher risk of cardiovascular disease and 30% (26-35%) greater risk all-cause mortality. These associations were log-linear, similar in people with and without diabetes (p-value for interaction ≥0.21), robust to the adjustment of additional major CVD risk factors. Adding fibrinogen to a model containing conventional CVD risk factors resulted in only modest improvement in risk prediction. The associations of fibrinogen with CVD and all-cause mortality are broadly similar in people with and without diabetes status. Improvement in predictive accuracy after adding fibrinogen to established risk factors is not clinically important.

Health Promotion in Older Chinese

Aging, in conjunction with decreasing physical activity, is associated with a range of health problems. Simple, low-maintenance, population-based means of promoting activity to counteract the age-associated decline are required. We therefore assessed the effect of pedometry and buddy support to increase physical activity. We undertook a clustered randomized trial (HKCTR-346) of 24 community centers involving 399 older Chinese participants (≥ 60 yr). Centers were randomly allocated to 1) pedometry and buddy, 2) pedometry and no buddy, 3) no pedometry and buddy, and 4) no pedometry and no buddy with a 2 × 2 factorial design. The trial simultaneously tested the individual and combined effects of the interventions. The intervention groups also received monthly organized group activities to provide encouragement and support. Outcome measures were assessed at 6 and 12 months, including physical fitness and activity and cardiovascular disease risk factors (anthropometry and blood pressure). From the 24 centers, 356 volunteers (89.2%) completed the study. Those receiving the interventions had higher mean physical activity levels at 12 months of 1820 (95% confidence interval (CI) = 1360-2290) and 1260 (95% CI = 780-1740) MET·min·wk(-1), respectively relative to the decrease in the control groups. The buddy peer support intervention significantly improved mean aerobic fitness (12% [95% CI = 4%-21%]) and reduced both body fat (-0.6% [95% CI = -1.1% to 0.0%]) and time to complete the 2.5-m get-up-and-go test (-0.27 [95% CI = -0.53 to -0.01] s). No other improvements in the cardiovascular disease risk factors were observed. The combination of motivational tools was no better than the individual interventions. Both motivational interventions increased physical activity levels, and the buddy style improved fitness. These tools could be useful adjuncts in the prevention of obesity and age-related complications.

Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control

The Canadian Cardiovascular Society (CCS) published the complete set of 2010 Atrial Fibrillation (AF) Guidelines in the January, 2011 issue of the Canadian Journal of Cardiology. During its deliberations, the CCS Guidelines Committee engaged to a timely review of future evidence, with periodic composition of focused updates to address clinically important advances. In 2011, results were published from 3 pivotal AF trials: the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF), the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden. Each of these large randomized trials provided clear results with major implications for AF management. Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk, stroke risk in paroxysmal-AF patients, risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease, and risk/benefit considerations in the use of antiplatelet agents, alone and in combination with each other or with oral anticoagulants, in AF patients. The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control. This report presents the details of the new recommendations, along with the background and rationale.

Global Cardiovascular Risk Associated With Hypertension and Extent of Treatment and Control According to Risk Group

Hypertension (HTN) confers increased cardiovascular disease (CVD) risk; however, the variation in risk and how treatment and control rates may differ according to extent of risk needs clarification. We examined CVD risk distribution and treatment and control patterns according to risk group. We estimated 10-year Framingham global risk in 1,509 U.S. persons aged ≥30 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 with HTN and the proportion of subjects in low (<10%), intermediate (10-20%), and high (>20%) risk groups, or with pre-existing CVD, or who otherwise had high cardiometabolic risk according to European Society of Hypertension (ESH) criteria (diabetes (DM), metabolic syndrome (MetS), stage 3 HTN, or 3 additional CVD risk factors). We also examined HTN treatment and control rates by risk group. From Framingham risk assessment, 24% of subjects were low risk, 21% intermediate risk, 23% high risk, and 32% had CVD. An additional 39% of low and 51% of intermediate risk subjects were at high or very high risk based on European criteria, for a total of 80% classified high risk or with CVD by either criterion. Treatment rates across Framingham risk groups ranged from 58 to 75%. HTN control rates were over 80% for lower risk persons, but under 50% for higher risk subjects. There is a wide variation in CVD risk in persons with HTN with control rates still suboptimal in higher risk subjects. Future guidelines should consider risk stratification combining shorter and longer-term risk assessment to best identify those who have the greatest CVD risk.

Collaborative Approach to Implementing an Adapted Diabetes Prevention Program Lifestyle Intervention

This study evaluated weight loss and cardiometabolic risk reduction achieved through an adapted Diabetes Prevention Program lifestyle intervention among adults at high risk for cardiovascular disease (CVD) and diabetes. A 16-session lifestyle intervention was delivered through a partnership between a diabetes self-management education (DSME) program and the Young Men's Christian Association (YMCA). Overweight adults with ≥ 1 additional risk factors for CVD or diabetes were enrolled (n = 265). Lifestyle coaches from the DSME program coordinated intervention delivery and taught the curriculum. YMCA staff delivered the physical activity component of the intervention. Two-hundred and nineteen participants (83%) completed the program. Seventy-five percent of participants achieved the physical activity goal (≥ 150 minutes/week), 34% achieved the 7% weight loss goal, and 60% achieved weight loss ≥ 5%. There were significant improvements in cardiometabolic risk factors among participants completing the intervention. Our findings suggest that an adapted lifestyle intervention can be successfully implemented through collaboration between a DSME program and a YMCA. Implementation of effective prevention programs in multiple settings throughout the United States will be needed to ensure that the large subpopulation of adults at high risk for CVD and diabetes have access to this prevention service.

Increased monocyte chemoattractant protein-1 levels indicating early vascular damage in lean young PCOS patients

Serum levels of monocyte chemoattractant protein-1 and C-reactive protein levels, as early signs of vascular damage and cardiovascular disease, were increased in young, lean patients with polycystic ovary syndrome. Serum monocyte chemoattractant protein-1 levels were positively correlated with serum LH, T, and C-reactive protein levels.