Cardiovascular Disease Risk Factor Screening Research Articles

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.

Evaluation of a community-based participatory physical activity promotion project: effect on cardiovascular disease risk profiles of school employees

BackgroundThe efficacy of physical activity in improving cardiovascular disease (CVD) risk profiles has been well established. However, the effectiveness of health promotion programs implemented at the community level remains controversial. This study evaluated a school-based work-site physical activity program.MethodsUsing a community-based participatory research model, a work-site wellness intervention was implemented in a rural public school system in Southwestern Oklahoma. During the 2005-2006 school year, 187 participants (mean age 45 years) completed a pre intervention screening for CVD risk factors followed by a physical activity promotion program. Post intervention screening was conducted after a 6 month period. During both screening sessions, body composition, blood pressure, lipids, glucose and self-reported physical activity levels were assessed. The focus of the intervention was on promoting physical activity. Opportunities for in school physical activity were created by marking hallways, adding a treadmill in each school, and allowing teachers to use planning periods for physical activity.ResultsDuring the post intervention screening, compared to pre intervention levels, participants had lower total, low, and high density lipoprotein-cholesterol (t = 5.9, p < 0.0001, t = 2.6, p = 0.01, and t = 13.2, p < 0.0001 respectively), lower systolic blood pressure (t = 2.9, p = 0.004), and higher self-reported physical activity levels (Sign t = -1.901, p = 0.06).ConclusionsA successful participatory program was associated with improvements in several CVD risk factors among school employees. Limitations of this study such as seasonal variation in the outcome variables and lack of a control group limit our ability to draw solid conclusions about the effectiveness of the intervention.

Impact of a nurse-led intervention to improve screening for cardiovascular risk factors in people with severe mental illnesses. Phase-two cluster randomised feasibility trial of community mental health teams

BackgroundPeople with severe mental illnesses (SMI) are at increased risk of cardiovascular disease (CVD). Clinical guidelines recommend regular screening for CVD risk factors. We evaluated a nurse led intervention to improve screening rates across the primary-secondary care interface.MethodsSix community mental health teams (CMHTs) were randomised to receive either the nurse led intervention plus education pack (n = 3) or education pack only (n = 3). Intervention (6 months): The nurse promoted CVD screening in primary care and then in CMHTs. Patients who remained unscreened were offered screening by the nurse. After the intervention participants with SMI were recruited from each CMHT to collect outcome data. Main outcome: Numbers screened during the six months, confirmed in General Practice notes.ResultsAll six CMHTs approached agreed to randomisation. 121 people with SMI participated in outcome interviews during two waves of recruitment (intervention arm n = 59, control arm n = 62). Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year, with less than 20% having been screened for each risk factor. After the trial, CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure (96% vs 68%; adjusted Odds Ratio (OR) 13.6; 95% CI: 3.5-38.4), cholesterol (66.7% vs 26.9%, OR 6.1; 3.2-11.5), glucose (66.7% vs 36.5% OR 4.4; 2.7-7.1), BMI (92.5% vs 65.2% OR 6.5; 2.1-19.6), and smoking status (88.2% vs 57.8% OR 5.5; 3.2-9.5) and have a 10 year CVD risk score calculated (38.2% vs 10.9%) OR 5.2 1.8-15.3). Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse.ConclusionsThe nurse-led intervention was superior, resulting in an absolute increase of approximately 30% more people with SMI receiving screening for each CVD risk factor. The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention, but the response rate for outcome collection was disappointing; possibly a result of the cluster design. The trial was not large or long enough to detect changes in risk factors.Trial RegistrationInternational Standard Randomised Controlled Trial Registration Number (ISRCTRN) 58625025.

A Lifestyle Approach to Reducing Cardiovascular Risk Factors in Underserved Women: Design and Methods of the Illinois WISEWOMAN Program

Few lifestyle intervention programs address the needs of financially disadvantaged, low literacy populations. The overall goal of the Illinois WISEWOMAN Program (IWP) was to design such a program and test its effectiveness in reducing cardiovascular disease (CVD) risk, specifically physical activity and nutrition factors. The purpose of this paper is to describe the IWP study design and methods, development of the evidence-based curriculum appropriate for a low socioeconomic status (SES) population, and baseline characteristics of IWP participants. The Cooper Institute, in collaboration with the Illinois Department of Public Health and the University of Illinois at Chicago, adapted evidence-based interventions for financially disadvantaged, low literacy populations. The study used a randomized, two-group, experimental design. In total, 1021 women were recruited from the Illinois Breast and Cervical Cancer Program, which serves uninsured and underinsured women, aged 40-64, at or below 200% of poverty. The women were randomized to either a minimum intervention (MI) or an enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational materials. Additionally, the EI group received a 12-week lifestyle intervention. Baseline comparisons show equivalent groups. IWP participants had a higher prevalence of obesity and smoking than similar national samples. IWP addressed many of the cultural and implementation barriers in programs that seek to improve the health of financially disadvantaged, low literacy populations. Because of the high burden of disease, the unique study population, and the sound design, we anticipate that our future results will contribute to the translation literature, which has largely ignored significant health disparities.

Cardiovascular co-morbidity in early rheumatoid arthritis

Rheumatoid arthritis (RA) is associated with increased morbidity and mortality due to cardiovascular disease (CVD), mostly accelerated atherosclerotic CVD, and there is evidence that this occurs early in the inflammatory disease process. Both traditional and novel CVD risk factors as well as the effects of the RA disease process and its treatment interact and contribute to the development of CVD in RA. In this review we discuss the evidence for co-morbid CVD complicating early RA. This includes examining studies of mortality outcome and CVD events in cohorts of early RA patients as well as studies using surrogate markers for atherosclerotic CVD in RA. The evidence for shared risk factors for RA and CVD is presented. Screening and modification of CVD risk factors should be an integral part of care for any patient diagnosed with RA. Novel methods to diagnose CVD in high-risk asymptomatic RA patients need to be evaluated.

Predictors and Barriers to Timely Medical Follow-Up after Cardiovascular Disease Risk Factor Screening According to Race/Ethnicity

The purpose of this study was to assess followup practices among individuals found to have elevated cardiovascular disease (CVD) risk factors in a screening and educational outreach. Participants in the National Heart, Lung and Blood Institute Family Intervention Trial for Heart Health (FIT Heart) who were found to have hypertension, prehypertension, suboptimal lipids and/or abnormal blood glucose were included in this study (N = 214, mean age 49 +/- 13, 64% female, 33% nonwhite). Contact was made at two weeks, six weeks and three months to determine if medical follow-up was initiated. Barriers to nonadherence were assessed. After two weeks, significantly more whites had medical follow up compared to nonwhites (34% vs. 20%, p = 0.04). Racial/ethnic minorities were more likely to report that not having a doctor was a barrier (30% vs. 11%, p = 0.02). Non-whites were more likely to return to the study staff for followup rather than an outside physician (32% vs. 15%, p = 0.001). Racial/ethnic minorities with elevated CVD risk factors may have delayed medical follow-up compared to whites, and this may be attributable to lack of access to a doctor. These data suggest that improving access to care may reduce racial/ethnic disparities in risk factor management and CVD outcomes.

Deprivation status and mid-term change in blood pressure, total cholesterol and smoking status in middle life: a cohort study

Individuals of lower socioeconomic status have an adverse cardiovascular disease risk factor profile. We examined whether deprivation status influences within-individual change over time in blood pressure (BP), cholesterol and smoking status during middle life. Records of participants of a primary care-based cardiovascular disease risk factor screening programme who were aged 35-55 years and had a first screening episode between 1989 and 1993 and a subsequent screening episode, were analysed. Deprivation status was defined using quintiles of the Townsend score. Using regression, mean annual change in BP, and total cholesterol was calculated for each deprivation group; and the effect of deprivation group status was examined. The probability of quitting smoking was also examined by deprivation group. Of all participants, 13,812 (72.1%) men and 16 932 (77.0%) women had complete follow-up (i.e. two screening episodes). Mean annual increase in systolic BP was significantly greater with increasing deprivation group [by +0.24 and +0.28 mmHg/incremental deprivation group in men and women, respectively (95% confidence interval: +0.09 to +0.39 men, and +0.13 to +0.42 women)]. Deprivation status did not influence change in cholesterol (P=0.620, men, P=0.289, women). The probability of quitting smoking was significantly greater with increasing deprivation group in women [odds ratio 1.06 (95% confidence interval: 1.01-1.12)], but no effect was observed in men (P=0.389). The results are suggestive of a 'mixed' picture of widening (e.g. systolic and diastolic BP) as well as narrowing (e.g. smoking in women) socioeconomic inequalities in cardiovascular risk factor inequalities.

Mid-term Body Mass Index increase among obese and non-obese individuals in middle life and deprivation status: A cohort study

BackgroundIn the UK, obesity is associated with a clear socioeconomic gradient, with individuals of lower socioeconomic status being more likely to be obese. Several previous studies, using individual measures of soecioeconomic status, have shown a more rapid increase in Body Mass Index (BMI) over time among adults of lower socioeconomic status. We conducted a study to further examine whether ecologically defined deprivation status influences within-individual BMI change during middle life, as the answer to this question can help determine optimal preventive strategies both for obesity per se, and its' associated socioeconomic disparities.MethodsAnonymised records of participants to the Stockport population-based cardiovascular disease risk factor screening programme were analysed. Individuals aged 35–55 who had a first screening episode between 1989 and 1993, and a subsequent screening episode were included in the study. Deprivation status was defined using quintiles of the Townsend score. Mean annual BMI change by deprivation group was calculated using linear regression. Subsequently, deprivation group was included in the model as an ordinal variable, to test for trend. The modelling was repeated separately for individuals who were obese (BMI < 30) and non-obese at the time of first screening. In supplementary analysis, regression models were also adjusted for baseline BMI.ResultsOf 21,976 women and 19,158 men initially screened, final analysis included just over half of all individuals [11,158 (50.8%) women and 9,831 (51.3%) men], due to the combined effect of loss to follow-up and incomplete BMI ascertainment. In both sexes BMI increased by 0.19 kg/m2 annually (95% Confidence Intervals 0.15–0.24 for women and 0.16–0.23 for men). All deprivation groups had similar mean annual change, and there was no evidence of a significant deprivation trend (p = 0.801, women and 0.892, men). Restricting the analysis to individuals who were non-obese at baseline did not alter the results in relation to the lack of a deprivation effect. When restricting the analysis to individuals who were obese at baseline however, the findings were suggestive of an association of BMI increase with higher deprivation group, which was further supported by a significant association when adjusting for baseline BMI.ConclusionIn the study setting, the BMI of non-obese individuals aged 35–55 was increasing over time independently of deprivation status; among obese individuals a positive association with higher deprivation was found. The findings support that socioeconomic differences in mean BMI and obesity status are principally attained prior to 35 years of age. Efforts to tackle inequalities in mean BMI and obesity status should principally concentrate in earlier life periods, although there may still be scope for focusing inequality reduction efforts on obese individuals even in middle life.

Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women.

Low to moderate alcohol consumption is associated with reduced mortality, primarily due to a reduction in coronary heart disease (CHD). Conversely, heavy drinking increases mortality, mainly due to haemorrhagic stroke and non-cardiovascular diseases. It is important to identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse. We examine the relationship between reported alcohol consumption, cardiovascular disease (CVD) risk factors, a 10-year CHD risk score and hypertension in women. In all, 14 077 female employees aged 30-64 years, underwent screening for CVD risk factors. Information was available on a range of personal and lifestyle factors, including height, weight, blood pressure, lipids, lipoproteins, apolipoproteins and blood glucose. Age-adjusted means were computed for the risk factors in each of five groups of reported alcohol intake: <1 (non-drinkers), 1-7, 8-14, 15-21, > or = 22 units/week. The relationships between alcohol and a derived coronary risk score and hypertension were also examined. Increasing consumption was associated with an age-adjusted increase in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (both P < 0.001), a decline in body mass index, total cholesterol (TC), TC/HDL-C ratio, low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (all P < 0.001), and no trend in triglycerides (P = 0.06), lipoprotein (a) (P = 0.09) or fasting glucose (P = 0.14). Except for LDL-C (P = 0.06) the relationships remained statistically significant after adjustment for possible confounders. Compared to non-drinkers, there was a decrease in 10-year CHD risk with increasing consumption, with the greatest reduction in risk in women consuming 1-7 units/week, odds ratio (OR) = 0.79, (95% CI: 0.72-0.87), and an increase in the prevalence of hypertension among those consuming 15-21 units/week, OR = 1.68, (95% CI: 1.14-2.46). This study provides biological support for an inverse association between alcohol intake and CHD in women, associated with favourable changes in lipid and lipoprotein risk factors. Women consuming 1-14 units/week had a reduction in CHD risk, but there was an increased prevalence of hypertension among those consuming > or = 15 units/week. These data suggest that, in terms of the reduced risk of CVD, women should be advised to restrict their alcohol consumption to < or = 14 units/week.

Screening School Personnel for Cardiovascular Disease Risk Factors: Short-Term Impact on Behavior and Perceived Role as Promoters of Heart Health

Background.Few controlled studies have evaluated the impact of community-based screening to detect risk factors for cardiovascular disease (CVD) on behavior change. This study examined the short-term impact of school-based screening on smoking, leisure time exercise, and fat consumption of personnel working in schools offered CVD risk factor screening. Also, the impact of screening on the perceptions that teachers have of their role in promoting heart health at school and the frequency of discussing heart health issues with students was investigated.Methods.The impact of screening was investigated in a before–after study design comparing behaviors of staff working in eight inner-city elementary schools offered the screening with those of staff working in eight matched comparison schools. Data were collected in self-administered questionnaires 2 weeks before and 4 months after screening.Results.A total of 209 subjects in the intervention schools completed the baseline questionnaire. Of these, 125 (59.8%) participated in the screening and completed the 4-month follow-up questionnaire. In the comparison schools, 135 of 177 subjects who completed the baseline questionnaire (76.3%) also completed the follow-up questionnaire. Multivariate analysis of covariance detected no changes in cigarette or fat consumption, but subjects exposed to the screening significantly increased their level of physical activity. Also, teachers exposed to screening increasingly supported the notion that teachers have a role in promoting heart-healthy behaviors among their students.Conclusions.Although several methodological limitations might have influenced the results, these data suggest that screening and counseling for CVD risk factors is an effective strategy to positively influence level of physical activity. If screening does increase motivation and interest among teachers to become heart-health role models or educators, the benefits of school-based screening could extend well beyond those who actually participate.

Gender differences in type a behavior and hostility within an organizational setting

Abstract Recent investigations suggest that the hostility component of the Type A behavior patter (TABP) is a greater detriment to health than the overall pattern. Some researchers suggest that certain Type A characteristics (e.g., job-involvement) are actually adaptive. This study compared the relative relationship of the TABP and hostility to career-related achievement and psychosocial adjustment among 223 service-delivery employees. Male and female participants completed the Jenkins Activity Survey and the MMPI Hostility Scale as part of a cardiovascular disease risk factor screening. The TABP was positively associated with managerial status for both men and women. However, the TABP was positively related to psychosocial adjustment variables among men only. Hostility was significantly related to undesirable outcomes including lower job status, life dissatisfaction, and unfavorable perceptions of the workplace for both men and women. Discussion addresses organizational factors which might perpetuate hos...

Cardiovascular Risk Factors and Their Modification in Children

Normal levels and trends of cardiovascular disease risk factors in childhood have been well documented by numerous epidemiologic surveys. Expected levels of blood pressure, lipids and lipoproteins, and body size can be determined by the child's physician using race- and gender-specific grids. These grids allow for the identification and follow-up of children with high-risk profiles. Evidence of increased left ventricular mass and vascular changes in renal arteries in association with childhood blood pressure level along with atherosclerotic fatty streak and fibrous plaque development in the aorta and coronary arteries shows that children with elevated risk factors are at risk for early target organ damage. These data demonstrate the potential importance of early intervention on the natural history of cardiovascular disease. Based on our own data from the Bogalusa population, as well as evidence from other epidemiologic investigations in children, the following recommendations can be made, regardless of the risk factor variable under consideration: Cardiovascular disease risk factor variables should be measured carefully and in a serial manner to classify a child as abnormal. Serial measurements serve to reduce the effect of regression to the mean and increase the predictive value of the measurements. The misclassification of normal children into the high-risk category can be avoided by serial and replicate observations. Interventions that have attendant side effects (for example, pharmacologic therapy for high blood pressure) have to be measured against the effectiveness of diet, exercise, and other aspects of primary prevention. Risk factor levels consistently greater than the ninetieth percentile deserve medical attention. Care should be taken prior to using specific grids of normal levels of cardiovascular disease risk factors in children. The measurement techniques employed on individuals should be similar to those used by the epidemiologic study to generate the grids in a reference population. The grids should become part of the child's permanent medical record, as they provide a rapid visual assessment of the cardiovascular disease risk profile over time. High-risk trackers may require more intensive follow-up and will allow for early intervention and an assessment of the efficacy of the intervention program. In conclusion, cardiovascular disease risk factor screening in childhood is quick, effective, and inexpensive. The potential payoff in prevention of adult cardiovascular disease is enormous and allows the physician to provide more comprehensive care to a pediatric population.

Characteristics of Participants and Nonparticipants in a Community Cardiovascular Disease Risk Factor Screening: The Minnesota Heart Health Program

This research attempts to characterize participants and nonparticipants in a cardiovascular risk screening and education program in terms of their beliefs about personal susceptibility to heart disease, integration into the community, and general pattern of health-promoting behaviors. Telephone surveys were conducted with 76 participants and 76 nonparticipants in the risk factor screening. Participation was strongly related to several health-promoting behaviors (dental checkups and seat belt use) and several measures of integration into the community. Health beliefs (in personal threat, susceptibility to disease, and the efficacy of preventive action) were not related to participation. Future research in the area of program participation may need to move beyond the model of disease-specific health beliefs to the realms of social pressures to participate and general health values.