Assessment Of Cardiovascular Disease Risk Factors Research Articles

Canadian Hypertension Education Program Recommends the Use of Nonfasting Lipid Panels for Routine Laboratory Workup

Hypertension is a well-established risk factor for cardiovascular disease (CVD).2 Assessment of lipids, physical activity, alcohol consumption, and other CVD risk factors in this patient population is an essential component of disease management. The use of nonfasting samples for lipid panels has been a matter of ongoing debate. In 2009, Denmark was the first to use nonfasting lipid panels for routine testing based on recommendations from the Danish Society for Clinical Biochemistry. Although the 2013 American College of Cardiology/American Heart Association guidelines preferred fasting samples for routine lipid panels, the choice of specimen type was left to the clinician's discretion. Recently, the European Atherosclerosis Society (EAS) and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) made a strong …

Spiral artery remodeling and maternal cardiovascular risk: the spiral artery remodeling (SPAR) study.

Women with a history of placental bed disorders, including preeclampsia and intrauterine growth restriction have an increased long-term risk of cardiovascular disease (CVD). Further, similarities exist between atherosclerosis and abnormalities observed in placental bed spiral arteries in pregnancies affected by preeclampsia and intrauterine growth restriction, such as acute atherosis and defective remodeling. This suggests a common pathophysiological pathway underlying both disorders. The aim of this study was to investigate vascular and inflammatory lesions in the placental bed of women with preeclampsia and normal pregnancy using a systematic approach to characterize lesions of the placental bed, and relate spiral artery pathology to postpartum CVD risk assessment. Placental bed punch biopsies were performed following caesarean section and systematically studied to assess vascular pathology, arterial remodeling, and the presence of CD3, CD56, and CD68 cells. In addition, levels of modifiable CVD risk factors were assessed immediately postpartum. We found fewer spiral arteries with complete remodeling in women with preeclampsia than in the control group (21 vs. 68%; P = 0.008). Further, women with preeclampsia showed less presence of CD3 cells in both the decidua and the myometrium. Preliminary findings of CVD risk factor assessment postpartum suggest a correlation between acute atherosis and higher triglyceride and low-density lipoprotein cholesterol levels. Systematic study of vascular pathology in uterine spiral artery biopsy samples in relation to CVD risk factors provides valuable insight into the link between cardiovascular health and placental bed disorders.

A Study to derive distribution of carotid intima media thickness and to determine its COrrelation with cardiovascular Risk factors in asymptomatic nationwidE Indian population (SCORE-India)

BackgroundThere is presently no data to describe normal distribution of carotid intima-media thickness (CIMT), an established measure of subclinical atherosclerosis, in Indian subjects. MethodsIn this multi-centric study, 1229 subjects with age ≥30 years and no previous cardiovascular disease (CVD) underwent CVD risk factor assessment and CIMT measurement. Mean far wall common carotid artery IMT was measured on both sides and averaged. ResultsMean age of the subjects was 48.0±12.0 years and 54.2% were men. CIMT measurement was feasible in 1157 subjects. Mean, median and 75th percentile values of CIMT for different age-groups were derived for men and women separately. There was a progressive increase in CIMT with increasing age (P<0.001) and men had higher CIMT values than women (0.608±0.12mm vs. 0.579±0.11mm, P<0.001). The CIMT values were also higher in diabetics (0.635±0.10mm) and hypertensives (0.624±0.10mm) as compared to non-diabetics (0.589±0.12mm, P<0.001) and non-hypertensives (0.592±0.12, P 0.02) respectively. Among continuous variables, age, systolic blood pressure and fasting blood glucose had strong to modest correlation with CIMT (Pearson's r 0.524, 0.282 and 0.192 respectively, all P values <0.001), whereas body mass index, diastolic blood pressure and serum triglycerides exhibited weak but still statistically significant relationship (Pearson's r 0.069, P 0.019; Pearson's r 0.065, P 0.026; and Pearson's r 0.094, P 0.001, respectively). ConclusionsThis is the first study to provide age- and gender-specific distribution of CIMT in Indian subjects free from CVD. This information should help facilitate further research and clinical work involving CIMT in India.

Are doctors assessing patients with hypertension appropriately at their initial presentation?

The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients' first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient's first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit. A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%-40.8%). Assessments for a history of TOD were found in only 5.8%-11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%-63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered. There was poor assessment of the patients' CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.

HDL-C levels modify the association between C-reactive protein and coronary artery calcium score

Backgrounds and aimsC-reactive protein (CRP) levels predict incident and recurrent cardiovascular disease (CVD) events; however, associations between CRP and pre-clinical atherosclerosis is less certain. Since high concentrations of high-density lipoprotein cholesterol (HDL-C) are inversely associated with CVD risk, we investigated whether HDL-C modified the association between CRP concentration and measures of preclinical atherosclerosis. Methods and resultsData were analyzed from a Korean occupational cohort of 12,030 male subjects who underwent a cardiac computed tomography (CT) estimation of coronary artery calcification (CAC) score and an assessment of CVD risk factors. Logistic regression was used to describe associations between CRP and measures of pre-clinical atherosclerosis, such as CAC scores >0. As many as 1351 (11.2%) participants had a CAC score>0. CRP was stratified into 3 groups based on clinical category: <1 mg/L, 1 to <2 mg/L, and ≥ 2 mg/dL. In the bottom CRP group, 907/8697 (10.4%) of subjects had a CAC score >0, compared with 242/1943 (12.5%) in the middle group and 202/1396 (14.5%) in the top CRP group (p < 0.0001). After adjustment for multiple CVD risk factors, there was a positive association between CRP and CAC score>0 (OR between top and bottom CRP groups, 1.41 [1.04, 1.90], p = 0.027) in the lowest HDL-C quartile but not in the highest HDL-C (OR between top and bottom CRP group, 0.80 [0.46, 1.39], p = 0.425). ConclusionThe association between CRP concentration and CAC score differed according to HDL-C levels.

Contribution of cardiorespiratory fitness, relative to traditional cardiovascular disease risk factors, to common carotid intima-media thickness.

Studies have suggested that being slightly overweight but fit is better for cardiovascular health than being somewhat leaner but unfit. Here, we sought to determine the contribution of cardiorespiratory fitness (CRF), relative to the presence of risk factors, to common carotid intima-media thickness (CIMT), a measurement of atherosclerosis and cardiovascular disease risk. Data were analysed from a cohort of 7300 German employed individuals aged 46 (±7)years who participated in a preventive health check-up at a specialized prevention centre. In addition to traditional cardiovascular disease risk factor assessment, participants performed an exercise test with spirometry to exhaustion, and common CIMT was measured. Individuals were defined as being fit or unfit based on the median age- and sex-specific relative maximum oxygen consumption. In a multivariable analysis, there was a strong inverse association between CRF and common CIMT. Individuals who were considered fit and did not have any cardiovascular disease risk factors had the lowest common CIMT values (reference group). Those who were unfit and had an increased risk factor level always had the highest common CIMT values. Good CRF partly compensated for the increased common CIMT due to a risk factor. However, unfit individuals without increased risk factor levels had a common CIMT that was not significantly different from that of the reference group, whereas fit individuals who smoked, had a high body mass index, a low HDL cholesterol concentration or a high systolic blood pressure had an increase in common CIMT. Cardiorespiratory fitness is a major determinant of common CIMT. Improved CRF does slightly, but not completely, abolish the adverse consequences of cardiovascular disease risk factors on common CIMT.

Subclinical Atherosclerosis among HIV-Infected Adults Attending HIV/AIDS Care at Two Large Ambulatory HIV Clinics in Uganda

BackgroundThe increased immune activation and inflammation of chronic HIV-infection and the characteristic dyslipidemias associated with HIV infection and antiretroviral therapy (ART) contribute to an increased risk of atherosclerotic vascular disease among HIV-infected adults. There is an emerging need to understand determinants of cardiovascular disease (CVD) among individuals aging with HIV in sub-Saharan Africa. We determined the prevalence of subclinical atherosclerosis [carotid intima media thickness (CIMT) ≥0.78 mm] and its correlation with traditional CVD risk factors among HIV-infected adults.MethodsIn a cross-sectional study, HIV-infected adults (ART-naïve and ART-treated) were consecutively selected from patients' enrollment registers at two large HIV clinics at Mulago Hospital, Kampala, Uganda. We measured traditional CVD risk factors including age, biophysical profile, fasting blood sugar and serum lipid profile as well as biomarkers of inflammation. High resolution ultrasound was used to measure common carotid CIMT.ResultsOf 245 patients, Median age [Interquartile range (IQR)] 37 years (31–43), 168 (69%) were females; and 100 (41%) were ART-treated for at least 7 years. Overall, 34/186 (18%) had subclinical atherosclerosis; of whom 15/108 (14%) were ART-naïve whereas 19/78 (24%) were ART-treated. Independent predictors of subclinical atherosclerosis included age [odds ratio (OR) 1.83 per 5-year increase in age; 95% confidence interval (CI) 1.24–2.69; p = 0.002], body mass index (BMI); OR 1.15; CI 1.01–1.31; p = 0.041 and high low density lipoprotein (LDL) [OR 2.99; CI 1.02–8.78, p = 0.046]. High sensitivity C-reactive protein (hsCRP) was positively correlated with traditional cardio-metabolic risk factors including waist circumference (r = 0.127, p = 0.05), triglycerides (r = 0.19, p = 0.003) and Total Cholesterol: High Density Lipoprotein ratio (TC:LDL) (r = 0.225, p<0.001).ConclusionThe prevalence of subclinical atherosclerosis was 18% among HIV-infected adults in Uganda. Traditional CVD risk factors were associated with subclinical atherosclerosis. We recommend routine assessment of traditional CVD risk factors within HIV care and treatment programs in sub-Saharan Africa.

Is there a higher cardiovascular disease risk in Japanese-Brazilians?

e read the article “Predictors Cardiovascular risk in Japanese-Brazilian subjects” written by Gomes and cols. with interest (1). The authors intended to evaluate the prevalence of risk factors for cardiovascular disease (CVD) in Japanese-Brazilian subjects. We found the study very valuable because it discusses an important public health issue and builds awareness.CVD is one of the most common causes of death worldwide (2). Therefore, as-sessment of CVD risk factors is important to prevent deaths in the population at risk. Metabolic syndrome (MS) consists in abdominal obesity, impaired glucose tolerance, elevated triglyceride levels, reduced high-density lipoprotein (HDL) cholesterol levels, hypertension, and it is mostly accompanied by a proinflammatory picture. Subjects with MS are at increased risk of cardiovascular diseases (3). The incidence of metabolic syndrome varies according to the age and there is a positive correlation between age and MS prevalence (4). In the present study, mean age of the patients was relatively high (56.7 ± 15.9). Prevalence of MS was defined as 47 (35.8%) in total, 30 (63.8%) in women, and 17 (36.2%) in men; and the difference regarding gender was not sta-tistically significant (p = 0.31). However, prevalence of MS in Brazil is 29.8% (5). In addition, it was estimated to be less frequent in Japan; 25.3% for men and 10.6% for women in the 2008 National Nutritional and Health Survey (6). Waist circumference was measured as a MS criteria in the study. Some newer an-thropometric measurements are defined in the literature, such as waist to height ratio (WHtR), body adiposity index (BAI), and visceral adiposity index (VAI). WHtR has been suggested as the best discriminator for hypertension, diabetes, and dyslipidemia by Lee and cols. (7). VAI is postulated to be a good indicator of visceral adiposity and insulin sensitivity. In addition, a high correlation between BAI and percentage of body fat was defined by Bergman and cols. (8). We think that it would better if these parameters were also mentioned in the study.

The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

The physical demands and hazards associated with emergency service work place particular stress on responders' cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel. A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format. Fifteen studies were rated 'Weak' and one study was rated 'Strong'. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk. Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

Focused Community-based Research for Eliminating CVD Risk Disparities in a Rural Underserved Population

Background Cardiovascular disease (CVD) is the leading cause of death and chronic illness in the U.S. In parts of the rural south disparities in both health care access and CVD health outcomes are pervasive. Descriptive analyses of community-based CVD risk factors are valuable to begin to unfold the complex nature of CVD mortality in specific rural, underserved populations. Objective To evaluate the prevalence of cardiovascular disease (CVD) risk factors among patients age 25 and over at a primary rural healthcare setting in a specific rural, medically underserved population to guide the development of community-based CVD treatment and prevention strategies. Methods This study used a descriptive retrospective explorative design. Data were collected through chart audits from a random sample of 197 patients at a rural health center in northwest Alabama, U.S. Cardiovascular risk factors were identified using health data, anthropometric measures and ICD-9 codes. Prevalence was evaluated and descriptive statistics were used to describe cardiovascular risk factors as well as socio-demographics variables. Findings In this rural medically underserved cohort (n= 197), the prevalence of selected cardiovascular risk factors was: smoking: 39.1%; hypertension: 58.4%; dyslipidemia: 15.1%; diabetes mellitus: 27.9%; and obesity: 44.5%. Smoking, hypertension and diabetes were noted to be higher in men, while women had higher rates of dyslipidemia and obesity. Rates of hypertension and diabetes increased with age as seen in similar studies. More than 48% of the study population ages 41-55 years were noted to have dyslipidemia. Conclusions This community-based CVD risk factor assessment can be used to guide future community-based research and interventions. The high prevalence and inadequate control of CVD risk factors seen in this population coupled with an existing shortage of physicians is an opportunity for nursing interventions. The use of advanced practice nurses for CVD assessment and interventions may be one practical strategy for this rural, medically underserved population. Key Words Prevalence, Cardiovascular Disease, Risk Factors, Disparities, Community-based research, Rural, Underserved, Appalachian

Pathology supported genetic testing and treatment of cardiovascular disease in middle age for prevention of Alzheimer’s disease

Chronic, multi-factorial conditions caused by a complex interaction between genetic and environmental risk factors frequently share common disease mechanisms, as evidenced by an overlap between genetic risk factors for cardiovascular disease (CVD) and Alzheimer’s disease (AD). Single nucleotide polymorphisms (SNPs) in several genes including ApoE, MTHFR, HFE and FTO are known to increase the risk of both conditions. The E4 allele of the ApoE polymorphism is the most extensively studied risk factor for AD and increases the risk of coronary heart disease by approximately 40 %. It furthermore displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors, which may also be due to variation in the CYP2D6 gene in some patients. Disease expression may be triggered by gene-environment interaction causing conversion of minor metabolic abnormalities into major brain disease due to cumulative risk. A growing body of evidence supports the assessment and treatment of CVD risk factors in midlife as a preventable cause of cognitive decline, morbidity and mortality in old age. In this review, the concept of pathology supported genetic testing (PSGT) for CVD is described in this context. PSGT combines DNA testing with biochemical measurements to determine gene expression and to monitor response to treatment. The aim is to diagnose treatable disease subtypes of complex disorders, facilitate prevention of cumulative risk and formulate intervention strategies guided from the genetic background. CVD provides a model to address the lifestyle link in most chronic diseases with a genetic component. Similar preventative measures would apply for optimisation of heart and brain health.

Vascular Biomarkers in the Prediction of Clinical Cardiovascular Disease

We compared the ability of separately measured intimal-medial thickness and atherosclerotic plaque to predict incident cardiovascular disease. American Indian men and women from the Strong Heart Study who were free of cardiovascular disease were evaluated with carotid ultrasound and cardiovascular disease risk factor assessment. End-diastolic intimal-medial thickness of the common carotid arteries was measured and averaged. Arterial mass (cross-sectional area) was calculated from intimal-medial thickness and end-diastolic diameter. Atherosclerosis was defined by focal plaque (discrete thickening >50% relative to the adjacent wall) and the number of carotid segments containing plaque (plaque score); 2441 participants (age 63±8 years) were followed-up for a mean of 7.7±2.8 years, during which time 495 experienced incident cardiovascular disease events. Time-to-event analyses were performed in groups stratified according to diabetes and hypertension status. Cardiovascular disease events were predicted by presence and extent of atherosclerosis in all groups; intima-medial thickness and arterial mass were only associated with outcomes when neither hypertension nor diabetes was present. Unequivocal evidence of atherosclerosis (plaque) and its extent (plaque score) are independently associated with incident cardiovascular disease events in individuals without preexisting cardiovascular disease regardless of diabetes and hypertension status. Hypertension-related increases in intima-media thickness and arterial mass appear to limit their use as measures of early or diffuse atherosclerosis and, hence, association with cardiovascular disease outcomes. These findings support the utility of separate assessment of focal atherosclerosis and intimal-medial thickness in epidemiological studies, trials, and risk stratification protocols.

Relationships Between Cardiovascular Disease Risk Factors and Depressive Symptoms as Predictors of Cardiovascular Disease Events in Women

Modifiable risk factors for cardiovascular disease (CVD) account for much of the variability in CVD outcomes and are also related to psychosocial variables. There is evidence that depression can undermine the treatment and advance the progression of CVD risk factors, suggesting that CVD risk factor relationships with CVD events may differ among those with depression. This study tracked CVD events and mortality over a median of 5.9 years among a prospective cohort of 620 women (mean age 59.6 years [11.6]) completing a diagnostic protocol including coronary angiography and CVD risk factor assessment. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). The study outcome was combined cardiovascular mortality and events. Over the follow-up interval, 16.1% of the sample experienced one or more of the cardiovascular outcomes. In separate Cox regression models adjusting for age, education history, ethnicity, and coronary angiogram scores, we observed statistically significant CVD risk factor × BDI score interactions for diabetes, smoking, and waist-hip ratio factors. Simple effect analyses indicated that diabetes and smoking status were more strongly associated with cardiovascular outcomes among participants with lower BDI scores, whereas waist-hip ratio values predicted outcomes only among those with higher BDI scores. These results suggest that the relationship between modifiable CVD risk factors and CVD outcomes may vary with depression status in clinical samples of women. This evidence augments prior research by demonstrating that depression may influence CVD risk jointly with or independent of CVD risk factors. It also provides further support for the inclusion of depression assessment in cardiovascular clinic settings.

Abdominal Aortic Diameter and Vascular Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis

Objectives To gain insight into early mechanisms of aortic widening, we examined associations between the diameter of the abdominal aorta (AD) and cardiovascular disease (CVD) risk factors and biomarkers, as well as measures of subclinical atherosclerosis, in a multi-ethnic population. Design Cross-sectional cohort. Methods A total of 1926 participants (mean age 62, 50% women) underwent chest and abdomen scanning by computed tomography, ultrasound of the carotid arteries, and CVD risk factor assessment. AD was measured 5 cm above and at the bifurcation. Results In a model containing traditional CVD risk factors, biomarkers and ethnicity, only age (standardized β = 0.97), male sex ( β = 1.88), body surface area (standardized β = 0.92), current smoking ( β = 0.42), D-dimer levels ( β = 0.19) and hypertension ( β = 0.53) were independently and significantly associated with increasing AD (in mm) at the bifurcation; use of cholesterol-lowering medications predicted smaller AD ( β = −0.70) ( P < 0.01 for all). These findings were similar for AD 5 cm above the bifurcation with one exception: compared to Caucasian–Americans, Americans of Chinese, African and Hispanic descent had significantly smaller AD 5 cm above the bifurcation ( β′ s = −0.59, −0.49, and −0.52, respectively, all P < 0.01), whereas AD at the bifurcation did not differ by ethnicity. Physical activity, alcohol consumption, diabetes and levels of IL-6, CRP and homocysteine were not independently associated with AD. Higher aortic and coronary artery calcium burden, but not common carotid artery intima-media thickness, were independently, but modestly ( β = 0.11 to 0.19), associated with larger AD. Conclusions Incremental widening of the aortic diameter shared some, but not all, risk factors for occlusive vascular disease.

Cardiovascular Health in the Irish Traveller Community

Irish Travellers are a minority group exposed to a range of social and health inequalities. Traveller men and women live 9.9 and 11.9 years less, respectively, than men and women in the general population. One of the major causes of death is cardiovascular disease (CVD). Information concerning CVD risk factor assessment in this population is lacking. Our pilot study assesses the point prevalence of diabetes, pre-diabetes and the metabolic syndrome in a sample population of Irish Travellers living along the Irish Atlantic seaboard. To date, 187 Travellers have completed the study. The prevalence of diabetes was found to be 2.7%, pre-diabetes 11.2 % and metabolic syndrome 40% compared with 4.3%, 6.4% and 21.0% respectively in the background population. Targeted screening for glucose abnormalities and traditional CVD risk factors is needed in this minority group. Appropriate culturally sensitive interventions to reduce CVD risk factors are expected to lower morbidity and increase life expectancy.

A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo Study

Abstract. Kramer CK, von Mühlen D, Jassal SK, Barrett‐Connor E (University of California, La Jolla, CA; and Hospital de Clinicas de Porto Alegre, RS, Brazil). A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo Study. J Intern Med 2010.Objectives. Little is known about uric acid (UA) levels and mortality in the context of glycaemia. We examined whether serum UA levels predict all‐cause and cardiovascular disease (CVD) mortality differentially in older adults by glucose tolerance status.Design and methods. Between 1984 and 1987, 2342 community‐dwelling men and women had an oral glucose tolerance test, UA measurement, and assessment of traditional CVD risk factors. We defined glucose tolerance status as normoglycaemia (NG), pre‐diabetes (pre‐DM), and type 2 diabetes mellitus (T2DM). Ninety per cent were followed for vital status up to 23 years. Death certificates were coded using the Ninth International Classification of Diseases.Results. Baseline age was 69.5 years; 44.4% were men. At baseline 939 had NG, 957 pre‐DM, and 446 T2DM. The mean UA by glucose tolerance status was 327.1, 362.8, and 374.7 μmol L−1. During follow‐up, there were 1318 deaths 46.8% attributed to CVD. In Cox‐regression analysis, each 119 μmol L−1 (2 mg dL−1) increment in UA levels predicted an increased hazard ratio (HR) for all‐cause deaths independent of age, smoking, body mass index, alcohol, physical activity, diuretic use and estimated glomerular filtration rate in all groups (NG: HR 1.25 95% CI 1.06–1.47, P =0.005; pre‐DM: HR 1.20 95% CI 1.06–1.37, P = 0.04; T2DM: HR 1.20 95% CI 1.01–1.47, P = 0.04). After adjusting for CVD risk factors, the UA association with CVD mortality was significant only in the pre‐DM and T2DM groups.Conclusion. All‐cause mortality was independently associated with UA in all groups, but UA predicted CVD mortality only in those with abnormal glucose tolerance.

A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo Study

Little is known about uric acid (UA) levels and mortality in the context of glycaemia. We examined whether serum UA levels predict all-cause and cardiovascular disease (CVD) mortality differentially in older adults by glucose tolerance status. Between 1984 and 1987, 2342 community-dwelling men and women had an oral glucose tolerance test, UA measurement, and assessment of traditional CVD risk factors. We defined glucose tolerance status as normoglycaemia (NG), pre-diabetes (pre-DM), and type 2 diabetes mellitus (T2DM). Ninety per cent were followed for vital status up to 23 years. Death certificates were coded using the Ninth International Classification of Diseases. Baseline age was 69.5 years; 44.4% were men. At baseline 939 had NG, 957 pre-DM, and 446 T2DM. The mean UA by glucose tolerance status was 327.1, 362.8, and 374.7 micromol L(-1). During follow-up, there were 1318 deaths 46.8% attributed to CVD. In Cox-regression analysis, each 119 micromol L(-1) (2 mg dL(-1)) increment in UA levels predicted an increased hazard ratio (HR) for all-cause deaths independent of age, smoking, body mass index, alcohol, physical activity, diuretic use and estimated glomerular filtration rate in all groups (NG: HR 1.25 95% CI 1.06-1.47, P =0.005; pre-DM: HR 1.20 95% CI 1.06-1.37, P = 0.04; T2DM: HR 1.20 95% CI 1.01-1.47, P = 0.04). After adjusting for CVD risk factors, the UA association with CVD mortality was significant only in the pre-DM and T2DM groups. All-cause mortality was independently associated with UA in all groups, but UA predicted CVD mortality only in those with abnormal glucose tolerance.

(S)Partners for Heart Health: a school-based program for enhancing physical activity and nutrition to promote cardiovascular health in 5thgrade students

BackgroundThe American Heart Association Position Statement on Cardiovascular Health Promotion in Public Schools encourages school-based interventions for the primary prevention of cardiovascular disease (CVD) through risk factor prevention or reduction in children with an emphasis on creating an environment that promotes healthy food choices and physical activity (PA). In an effort to address issues related to CVD risk factors including obesity in Michigan children, a multi-disciplinary team of Michigan State University (MSU) faculty, clinicians, and health profession students was formed to "(S)partner" with elementary school physical education (PE) teachers and MSU Extension staff to develop and implement a cost-effective, sustainable program aimed at CVD risk factor prevention and management for 5th grade students. This (S)partnership is intended to augment and improve the existing 5th grade PE, health and nutrition curriculum by achieving the following aims: 1) improve the students' knowledge, attitudes and confidence about nutrition, PA and heart health; 2) increase the number of students achieving national recommendations for PA and nutrition; and 3) increase the number of students with a desirable CVD risk factor status based on national pediatric guidelines. Secondary aims include promoting school staff and parental support for heart health to help children achieve their goals and to provide experiential learning and service for MSU health profession students for academic credit.Methods/DesignThis pilot effectiveness study was approved by the MSU IRB. At the beginning and the end of the school year students undergo a CVD risk factor assessment conducted by MSU medical students and graduate students. Key intervention components include eight lesson plans (conducted bi-monthly) designed to promote heart healthy nutrition and PA behaviors conducted by PE teachers with assistance from MSU undergraduate dietetic and kinesiology students (Spartners). The final 10 minutes of each lesson, MSU Spartners conduct small breakout/discussion groups with the 5th grade students. Additionally, each Spartner case manages/mentors two to three 5th grade students using a web-based goal setting and tracking protocol throughout the school year.DiscussionThis paper describes the rationale, development, and methods of the Spartners for Heart Health program. This is a multi-level intervention designed to promote heart healthy behaviors and prevent or manage CVD risk factors in children. We believe this will be a viable sustainable intervention that can be disseminated and adopted by other institutions with minimal cost by engaging college students as an integral part of the measurement and intervention teams.

Food Preference Questionnaire as a Screening Tool for Assessing Dietary Risk of Cardiovascular Disease within Health Risk Appraisals

Objective Nutrition components of health risk appraisals (HRAs) aim to rapidly and accurately assess dietary behaviors that increase disease risk. Because cognitive research suggests that recalling food likes/dislikes may be simpler and more accurate than recalling intake, we tested whether a preference measure was predictive of cardiovascular disease risk factors within an HRA. Methods HRA participants (422 primarily non-Hispanic white men, mean age 46±10 years) from a manufacturing company completed surveys to assess fat and sweet food/beverage preference; frequency of consuming fat and sweet foods/beverages, alcoholic beverages, fiber-rich foods (whole grains, fruits, and vegetables); and physical activity. Per measured risk factors, 34% had central obesity (waist circumference ≥102 cm), 32% had hypertension (≥140 and/or ≥90 mm Hg), 52% had prehypertension (≥120 to 139 and/or ≥80 to 89 mm Hg), and 52% had an elevated total cholesterol level (≥200 mg/dL [5.2 mmol/L]). Statistical Analyses Multiple linear regression models explaining variability in waist circumference, blood pressure, and serum lipids were tested. Results Although preference and intake pairs for fat and sweets were significantly correlated, intake of fat and sweets failed to associate significantly with any risk factor. Significant variance in waist circumference was explained by age, fat preference, fiber intake, and physical activity. Those with greater circumferences liked fat more, consumed less fiber, and exercised less. Waist circumference in turn contributed significantly to models predicting serum lipid levels and blood pressure. Alcohol intake explained variability in serum lipid levels—higher intakes were associated with higher high-density lipoprotein cholesterol levels. The models predicting risk were generally more explanatory in younger (<50 years) than in older men. Conclusions Including a preference measure within an HRA appears to enhance cardiovascular disease risk factor assessment. Fat preference, intake of fiber-rich foods, and alcohol proved the best dietary determinants of cardiovascular disease risk factors.

Screening Children to Identify Families at Increased Risk for Cardiovascular Disease

Atherosclerotic cardiovascular disease is the leading cause of death in the United States. Atherosclerosis begins early in life; however, children and young and middle-aged adults are not universally screened for the presence of modifiable cardiovascular disease risk factors. The purpose of this study was to investigate whether cardiovascular disease risk-factor assessment in children can identify families who are at increased risk for cardiovascular disease. Family Strategies Concentrating on Risk Evaluation is a community-based participatory research study designed to stratify cardiovascular disease risk in a cohort of children and their parents. Eligible families, consisting of > or = 1 child and > or = 1 biological parent, are recruited through community and faith-based educational and screening programs. In a single, fasted study visit, participants undergo assessment of cardiovascular disease risk factors: obesity, hypertension, dyslipidemia, and metabolic syndrome. Associations of cardiovascular disease risk factors between children and their parents were assessed. Data were analyzed from 94 families: 108 parents (mean age: 38.5 +/- 7.5 years), 141 children (mean age: 10.5 +/- 3.4 years), and 170 child-parent pairs. Child-parent association was strong for many risk factors: BMI, waist circumference, systolic blood pressure, triglycerides, and total cholesterol. Several discrete-defined risk factors in children were found to be significant predictors of the presence of the same risk factors in their parents. Parents of children with hypertension, obesity, or hypertriglyceridemia had 15 times, 6 times, or 5 times increased odds, respectively, of having the same risk factors. Identification of several clinically apparent and silent cardiovascular disease risk factors in children predicts elevated cardiovascular disease risk in their parents. Because children access primary care more frequently than adults, children can potentially serve as the index case to identify families at increased risk for cardiovascular disease.