Cardiovascular Disease Risk Reduction Program Research Articles

Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women.

Cardiovascular disease (CVD) is the leading cause of mortality for US women; lack of health insurance contributes to poor control of risk factors and increased mortality. Health coaching including motivational interviewing can support primary and secondary CVD prevention, but among uninsured women, improving health outcomes is dependent on successfully reaching priority populations. We evaluated the implementation and reach of health coaching with motivational interviewing among clients in the Illinois WISEWOMAN Program (IWP), a CVD screening and risk-reduction program for uninsured women aged 40 to 64. Following CVD screening, motivational interviewing is offered to all IWP clients via four 30-min one-on-one health coaching sessions to offer personalized guidance on setting and achieving health behavior goals. Our analysis included clients from the eight community-based Illinois agencies that implemented IWP from 2019 to 2023. We assessed client demographic and baseline health characteristics among all IWP clients, those who participated in health coaching by attending at least one session, and those who completed health coaching by attending at least three of four sessions. We also assessed health coaching participation and completion by agency and examined agency-specific associations between client characteristics and health coaching participation and completion. Among IWP enrollees (n =3094), 89.7% participated in at least one health coaching session but only 31.4% completed health coaching by attending at least three sessions. Over 90% of IWP clients participated in at least one health coaching session at 4 IWP agencies. Further, over 85% of health coaching participants completed health coaching at four agencies. Across agencies, no client-level characteristics were consistently associated with health coaching participation or completion. High motivational interviewing participation rates support its acceptability among uninsured women, but agency-level community-level barriers likely prevent client engagement in multiple sessions. Reducing CVD risk requires working with partner agencies to address barriers to reaching the priority population.

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. DERR1-10.2196/44830.

Impact of transitioning to virtual delivery of a cardiovascular health improvement program for Latinos during the COVID-19 pandemic

BackgroundCommunity Heart Health Actions for Latinos at Risk (CHARLAR) is a promotora-led cardiovascular disease (CVD) risk-reduction program for socio-demographically disadvantaged Latinos and consists of 11 skill-building sessions. The COVID-19 pandemic has led to worsening health status in U.S. adults and necessitated transition to virtual implementation of the CHARLAR program.MethodsA mixed-methods approach was used to evaluate virtual delivery of CHARLAR. Changes in health behaviors were assessed through a pre/post program survey. Results from virtual and historical (in-person delivery) were compared. Key informant interviews were conducted with promotoras and randomly selected participants and then coded and analyzed using a thematic approach.ResultsAn increase in days of exercise per week (+ 1.52), daily servings of fruit (+ 0.60) and vegetables (+ 0.56), and self-reported general health (+ 0.38), were observed in the virtual cohort [all p < 0.05]. A numeric decrease in PHQ-8 (-1.07 p = 0.067) was also noted. The historical cohort showed similar improvements from baseline in days of exercise per week (+ 0.91), daily servings of fruit (+ 0.244) and vegetables (+ 0.282), and PHQ-8 (-1.89) [all p < 0.05]. Qualitative interviews revealed that the online format provided valuable tools supporting positive behavior change. Despite initial discomfort and technical challenges, promotoras and participants adapted and deepened valued relationships through additional virtual support.ConclusionImproved health behaviors and CVD risk factors were successfully maintained through virtual delivery of the CHARLAR program. Optimization of virtual health programs like CHARLAR has the potential to increase reach and improve CVD risk among Latinos.

Cardiovascular Disease Risk in Rural Adults: A Pilot Intervention Study Using Registered Nurse/Community Health Worker Teams.

Cardiovascular disease (CVD) risk reduction programs led by a nurse/community health worker team are effective in urban settings. This strategy has not been adequately tested in rural settings. A pilot study was conducted to examine the feasibility of implementing an evidence-based CVD risk reduction intervention adapted to a rural setting and evaluate the potential impact on CVD risk factors and health behaviors. A 2-group, experimental, repeated-measures design was used; participants were randomized to a standard primary care group (n = 30) or an intervention group (n = 30) where a registered nurse/community health worker team delivered self-management strategies in person, by phone, or by videoconferencing. Outcomes were measured at baseline and at 3 and 6 months. A sample of 60 participants was recruited and retained in the study. In-person (46.3%) and telephone (42.3%) meetings were used more than the videoconferencing application (9%). Mean change at 3 months differed significantly between the intervention and control groups for CVD risk (-1.0 [95% confidence interval (CI), -3.1 to 1.1] vs +1.4 [95% CI, -0.4 to 3.3], respectively), total cholesterol (-13.2 [95% CI, -32.1 to 5.7.] vs +21.0 [95% CI, 4.1-38.1], respectively), and low-density lipoprotein (-11.5 [95% CI, -30.8 to 7.7] vs +19.6 [95% CI, 1.9-37.2], respectively). No between-group differences were seen in high-density lipoprotein, blood pressure, or triglycerides. Participants receiving the nurse/community health worker-delivered intervention improved their risk CVD profiles, total cholesterol, and low-density lipoprotein levels at 3 months. A larger study to explore the intervention impact on CVD risk factor disparities experienced by rural populations is warranted.

Patient reported physical and mental health changes associated with a comprehensive cardiovascular risk reduction program for women with breast cancer receiving potentially cardiotoxic chemotherapy

ObjectiveWomen with breast cancer (BCA) and cardiovascular disease (CVD) risk factors are at increased risk of developing cardiovascular complications when exposed to potentially cardiotoxic cancer therapy. The benefit of aggressive CVD risk factor modification to reduce adverse treatment-related psychologic and biologic effects is not well established.MethodsUsing a single group pre-test, post-test design, 33 women with BCA receiving anthracycline and/or trastuzumab therapy participated in a 6-month comprehensive CVD risk reduction program involving formal cardio-oncology evaluation along with regular motivational counseling for improved nutrition and physical activity. Study parameters were assessed at baseline and 6 months with paired t-tests used to evaluate changes after the intervention.ResultsThe mental component summary score assessed by SF-36V2 improved significantly after program completion (45.0 to 48.8, effect size 0.37, p = 0.017), however the physical component summary score declined (46.2 to 40.9, effect size − 0.53, p = 0.004). Despite this decline in perceived physical health, markers of health-related fitness and nutritional status were maintained or improved. Systolic and diastolic blood pressure also improved after the intervention (136.7 to 124.1 mmHg, p = 0.001 and 84.0 to 78.7 mmHg, p = 0.031, respectively). No significant change in resting heart rate, body mass index, lipids, hemoglobin A1C, or left ventricular ejection fraction was observed.ConclusionsPatient-reported mental health improved significantly in women with BCA enrolled in a comprehensive CVD risk reduction program despite exposure to potentially cardiotoxic therapies. This study provides preliminary data for future randomized controlled trials evaluating the effects CVD risk reduction program in high-risk breast cancer cohorts.

Comparison of Muscular Endurance and Hypertrophy Resistance Training on Cardiovascular Disease Risk in Sedentary Male Smokers

Background: Cardiovascular disease (CVD) exemplifies a major medical problem as it is the most considerable cause of morbidity and mortality. While sport conditioning specialists understand and differentiate the different benefits of resistance training (RT) subtypes on athletic performance, this distinction is less clear for health professionals when designing CVD risk reduction programs. Objectives: This study attempted to investigate and compare the effects of hypertrophy and muscular endurance RT on CVD risk in sedentary males. Methods: Sedentary male smokers were randomly assigned to either an eight-week hypertrophy RT group (HTG) (n = 15), muscular endurance RT groups (METG) (n = 15), or a non-exercising control group (CON) (n = 15) to assess their impact on smoking, blood pressure, cholesterol, and cardiorespiratory fitness (VO2max) variables associated with the four most prominent CVD risk factors. Data were analyzed using SPSS-25 software using a paired sample t-test and ANOVA. Results: Significant (P ≤ 0.05) improvements were found in three of the 15 measured variables in the HTG (resting mean arterial pressure (RMAP) (P = 0.024); total cholesterol (TC): HDL-C ratio (P = 0.009), and HDL-C: low-density lipoprotein cholesterol (LDL-C) ratio (P = 0.038), with a deleterious decrease in high-density lipoprotein cholesterol (HDL-C) (P = 0.027). In turn, significant improvements were found in the METG in 10 of the 15 measured variables, namely; cigarettes smoked per day (P = 0.037), resting systolic blood pressure (RSBP) (P = 0.002), resting diastolic blood pressure (RDBP) (P = 0.006), RMAP (P = 0.000), TC (P = 0.010), triglycerides (TG) (P = 0.010), LDL-C (P = 0.007), HDL-C: LDL-C (P = 0.018), non-HDL-C (n-HDL-C) (P = 0.010), and VO2max (P = 0.001), and a deleterious decrease in HDL-C (P = 0.026). Conclusions: While the oversimplification of RT design for CVD reduction has resulted in cardio-centric CVD training programs, this study demonstrates that some subtypes of RT (i.e. muscular endurance training) may prove more useful than others in reducing multiple CVD risk factors simultaneously.

Cardiovascular Health After Preeclampsia: Patient and Provider Perspective.

Background: Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. Methods: The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for risk reduction; and 4) next steps. Stakeholders included the Preeclampsia Foundation, patients, clinicians who had initiated CVD risk reduction programs for women with prior preeclampsia, researchers, and national task force members. Results: Participants agreed there is insufficient awareness and action to prevent CVD after preeclampsia. Patients suggested a clinician checklist to ensure communication of CVD risks, enhanced training for clinicians on the link between preeclampsia and CVD, and a post-delivery appointment with a clinician knowledgeable about this link. Clinical programs primarily served patients in the first postpartum year, bridging obstetrical and primary care. They recommended CVD risk modification with periodic blood pressure, weight, lipid and diabetes screening. Barriers included the paucity of programs designed for this population and gaps in insurance coverage after delivery. The American Heart Association, the American College of Obstetricians and Gynecologists, and the Preeclampsia Foundation have developed guidelines and materials for patients and providers to guide management of women with prior preeclampsia. Conclusions: Integrated efforts of patients, caregivers, researchers, and national organizations are needed to improve CVD prevention after preeclampsia. This meeting's recommendations can serve as a resource and catalyst for this effort.

Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management.

Background:Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness.Objective:The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process.Methods:This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally.Key Results:Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health.Conclusions:Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104–e118.]Plain Language Summary:Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.

Effects of the Strong Hearts, Healthy Communities Intervention on Functional Fitness of Rural Women.

The purposes of these analyses were to determine whether Strong Hearts, Healthy Communities (SHHC), a multilevel, cardiovascular disease risk reduction program for overweight, sedentary rural women aged 40 or older, led to improved functional fitness, and if changes in fitness accounted for weight loss associated with program participation. Sixteen rural communities were randomized to receive the SHHC intervention or a control program. Both programs involved groups of 12-16 participants. The SHHC program met 1 hour twice a week for 24 weeks where participants engaged in aerobic exercise and progressive strength training. Program content addressed diet and social and environmental influences on heart-healthy behavior. The control group met 1 hour each month for 6 months, covering current dietary and physical activity recommendations. Objective measures of functional fitness included the 30-second arm curl, 30-second chair stand, and 2-minute step test. Self-reported functional fitness was measured by the Physical Functioning Subscale of the MOS Short Form-36 (SF-36 PF). The SHHC program was associated with increased strength and endurance, as represented by greater improvement in the chair stand and step test; and with increased physical function, as represented by the SF-36 PF. Adjustment for change in aerobic endurance, as measured by the step test, accounted for two-thirds of the intervention effect on weight loss at the end of the intervention. SHHC participants experienced improved performance on objective measures of functional fitness and self-reported measures of physical function, and changes in weight were partially accounted for by changes in aerobic fitness.

Adapting an Evidence-Based Cardiovascular Disease Risk Reduction Intervention to Urban American Indians.

Using the RE-AIM framework, the primary purpose of this qualitative study was to conduct focus groups to identify areas for future adaptation of an evidence-based cardiovascular disease (CVD) risk intervention (COACH) developed for an urban primary care setting to urban American Indian (AI)-serving settings. This qualitative study involved conducting three focus groups with 31 urban AI patients with two or more CVD risk factors to maximize reach and efficacy of COACH. The patients had not yet participated in an adapted COACH program. Findings from the focus groups indicate that a culturally adapted CVD risk reduction program modeled after COACH would be acceptable among urban AI populations. Recommendations for cultural adaptation include a need for images of AI people, traditional AI exercise activities and AI foods, information on the portion sizes of traditional foods, and expanded information on tobacco use and resources. With cultural adaptations, the COACH program can be pilot-tested in urban AI-serving primary care settings to address health concerns and behaviors that affect cardiovascular health outcomes.

Adapting an Evidence-based Cardiovascular Disease Risk Reduction Intervention to Rural Communities.

Using the RE-AIM framework, the primary purpose of this qualitative study was to assess focus group data to generate information on the applicability of an evidence-based cardiovascular disease (CVD) risk intervention developed for an urban setting for rural areas in Nebraska. We also sought to determine potential adaptations that may be necessary to implement the study in a rural setting. The CVD risk reduction intervention is based on the Community Outreach and Cardiovascular Health (COACH) program, which included nurse practitioner/community health worker teams. This qualitative study involved conducting 3 focus groups with patients with CVD risk factors to assess community readiness for participating in the intervention, the mode of the delivery of the intervention, the setting of the intervention, program content, and raising awareness of the intervention. Findings from the focus groups indicate acceptability toward a CVD risk reduction program modeled after the COACH. Participants favored initial in-person face-to-face interactions with a nurse practitioner that could transition to phone-based meetings and Skype. In addition, participants underscored that confidentiality can be a concern in small communities and therefore community health workers need to be trusted individuals. Calls for additions to COACH materials were very specific and participants underscored the need for social support. With minor adaptations, the COACH program can be pilot tested in rural settings to address key health concerns and behaviors that affect risk for cardiovascular health.

Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis

BackgroundColorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases.MethodsWe identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors’ experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded.ResultsThe 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers.ConclusionsExperiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.

Reduction in Cardiovascular Risk Among Latino Participants in a Community-Based Intervention Linked With Clinical Care

Community Heart Health Actions for Latinos at Risk is a community health worker-led cardiovascular disease risk reduction program targeting low-income urban Latinos. The impact of community programs linked with clinical care has not been well characterized. Community Heart Health Actions for Latinos at Risk provided 12 weeks of lifestyle education. Changes in risk factors were assessed before and after completion. Univariate, bivariate, and multivariate analyses were used to determine factors associated with changes in risk factors. From 2009 to 2013, a total of 1,099 participants were recruited and 768 had risk factors measured at baseline and 12 weeks. All analyses were performed in 2016. In participants with abnormal baseline risk factors, significant (all p<0.001) median reductions in systolic blood pressure (-11 mmHg, n=244); low-density lipoprotein cholesterol (-14 mg/dL, n=201); glucose (-8 mg/dL, n=454); triglycerides (-57 mg/dL, n=242); and Framingham risk score (-2.3%, n=301) were observed. Program completion (eight of 12 classes) was associated with the reduction in low-density lipoprotein cholesterol (p=0.03) and systolic blood pressure (p=0.01). After adjustment, low-density lipoprotein cholesterol reduction was greatest in participants newly prescribed lipid-lowering drugs (-30%, 95% CI= -48, -15). A community health worker-led intervention lowered cardiovascular disease risk among vulnerable Latinos. Integration with primary care services was an essential program component.

The Role of Family in a Dietary Risk Reduction Intervention for Cardiovascular Disease.

Diet is an essential strategy for the prevention of primary and secondary cardiovascular disease (CVD) events. The objectives were to examine: how families at increased risk of CVD perceived personal risk, their motivations to make dietary changes, their understanding of diet, and the influence of other family members. Individuals (>18 years) who completed an Australian family-based CVD risk reduction program were invited to a semi-structured telephone interview. Responses were recorded, transcribed verbatim and analysed using a systematic deductive approach with coding derived from key concepts developed as part of the interview structure. Seventeen participants from eight families were interviewed (aged 18–70 years, 47% male, five with CVD diagnosis). Key themes indicated both intrinsic and extrinsic motivations to improve heart health, variations in risk perception, recognition of the role diet plays in heart health, and the extent of family influences on eating patterns. Discrepancies between perceived and actual CVD risk perception impacted on perceived “need” to modify current dietary patterns towards heart health recommendations. Therefore, strategies not reliant on risk perception are needed to engage those with low risk perception. This could involve identifying and accessing the family “ringleader” to influence involvement and capitalising on personal accountability to other family members.

Ecological Correlates of Cardiovascular Disease Risk in Korean Blue-collar Workers: A Multi-level Study

The purpose of this study was to investigate individual and organizational level of cardiovascular disease (CVD) risk factors associated with CVD risk in Korean blue-collar workers working in small sized companies. Self-report questionnaires and blood sampling for lipid and glucose were collected from 492 workers in 31 small sized companies in Korea. Multilevel modeling was conducted to estimate effects of related factors at the individual and organizational level. Multilevel regression analysis showed that workers in the workplace having a cafeteria had 1.81 times higher CVD risk after adjusting for factors at the individual level (p=.022). The explanatory power of variables related to organizational level variances in CVD risk was 17.1%. The results of this study indicate that differences in the CVD risk were related to organizational factors. It is necessary to consider not only individual factors but also organizational factors when planning a CVD risk reduction program. The factors caused by having cafeteria in the workplace can be reduced by improvement in the CVD-related risk environment, therefore an organizational-level intervention approach should be available to reduce CVD risk of workers in small sized companies in Korea.

The relationship of lipoprotein(a), C-reactive protein and homocysteine with metabolic syndrome in South Asians

IntroductionElevated serum lipoprotein(a) (Lp(a)), C-reactive protein (CRP), and homocysteine are associated with increased risk for cardiovascular disease (CVD). Metabolic syndrome is yet another known risk factor for cardiovascular disease. However, the relationship between metabolic syndrome and these three prevalent CVD biomarkers in South Asians is not known. We describe the relationships between the metabolic syndrome and Lp(a), CRP, and homocysteine in South Asians. MethodsThis was a cross-sectional study of 1000 South Asian participants in a CVD risk reduction program in the San Francisco Bay Area. Metabolic syndrome was defined by the International Diabetes Federation definition. ResultsMetabolic syndrome was present in 25.3% (n = 253) of the cohort. A significantly higher proportion of participants with metabolic syndrome had elevated CRP (p < 0.05) and homocysteine (p < 0.05) but not Lp(a) (p = 0.16). We identified a trend between increasing CRP (p < 0.05) and homocysteine (p < 0.05) with number of component risk factors of metabolic syndrome. After adjustment for confounders, Lp(a) was 5.93 ± 2.4 mg/dL lower in individuals with versus without metabolic syndrome, homocysteine was 0.68 ± 0.28 μmol/mL higher, and CRP was 0.50 ± 0.22 mg/dL higher (p < 0.05 for all). ConclusionsWe describe a positive association between homocysteine and metabolic syndrome in South Asians and confirm prior studies of other racial groups showing a positive relationship between CRP and metabolic syndrome. To our knowledge, this is the first study to identify the negative relationship between Lp(a) and metabolic syndrome in South Asian men.

Optimizing approaches to addressing depression in cardiac patients: a comment on O'Neil et al.

Optimizing approaches to addressing depression in cardiac patients: a comment on O'Neil et al.

Efficacy and Feasibility of a Tele-health Intervention for Acute Coronary Syndrome Patients with Depression: Results of the “MoodCare” Randomized Controlled Trial

Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable. We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood. A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome. Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change] = -1.8; p = 0.025; effect size: d = 0.36) for the overall sample, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change] = -2.7; p = 0.043; effect size: d = 0.65). MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy. ( ACTRN1260900038623.).

Intensive Cardiovascular Risk Reduction Induces Sustainable Changes in Expression of Genes and Pathways Important to Vascular Function

Healthy lifestyle changes are thought to mediate cardiovascular disease risk through pathways affecting endothelial function and progression of atherosclerosis; however, the extent, persistence, and clinical significance of molecular change during lifestyle modification are not well known. We examined the effect of a rigorous cardiovascular disease risk reduction program on peripheral blood gene expression profiles in 63 participants and 63 matched controls to characterize molecular responses and identify regulatory pathways important to cardiovascular health. Dramatic changes in dietary fat intake (-61%; P<0.001 versus controls) and physical fitness (+34%; P<0.001) led to significant improvements in cardiovascular disease risk factors. Analysis of variance with false discovery rate correction for multiple testing (P<0.05) identified 26 genes after 12 weeks and 143 genes after 52 weeks that were differentially expressed from baseline in participants. Controls showed little change in cardiovascular disease risk factors or gene expression. Quantitative reverse transcription polymerase chain reaction validated differential expression for selected transcripts. Lifestyle modification effectively reduced expression of proinflammatory genes associated with neutrophil activation and molecular pathways important to vascular function, including cytokine production, carbohydrate metabolism, and steroid hormones. Prescription medications did not significantly affect changes in gene expression. Successful and sustained modulation of gene expression through lifestyle changes may have beneficial effects on the vascular system not apparent from traditional risk factors. Healthy lifestyles may restore homeostasis to the leukocyte transcriptome by downregulating lactoferrin and other genes important in the pathogenesis of atherosclerosis. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01805492.

Cardiovascular complications among African Americans with HIV

Focus groups were conducted among 50 African American adults with HIV to investigate their perceived risks for cardiovascular disease and perceived benefits and barriers to living a heart healthy lifestyle. In addition, anthropometric measures were obtained (height, weight, blood pressure) and participants completed a written cardiovascular disease risk profile. Analysis of the cardiovascular risk profile data revealed that 48 percent of participants were current smokers 58 percent reported they had hypertension; 50 percent reported hypercholesterolemia; 30 percent that their mother or sister was diagnosed with a heart attack before age 65; and 16 percent as having diabetes. The computed body mass index of 80 percent of participants was categorized as overweight to obese. Participants were aware of cardiovascular risk factors, shared beliefs about the negative effects of HIV on cardiovascular health, and expressed barriers and facilitators to cardiovascular disease risk reduction. The findings suggest that some information has been disseminated about cardiovascular disease to HIV patients, but there is still a lack of information concerning the possible link between HIV disease, HIV medications, and cardiovascular disease. More cardiovascular disease risk reduction programs are needed for persons living with HIV. This research is supported by the National Heart, Lung, and Blood Institute.