Cardiovascular Health Profile Research Articles

‘FIFA 11 for Health’ for Europe. II: effect on health markers and physical fitness in Danish schoolchildren aged 10–12 years

ObjectivesTo evaluate whether a modified ‘FIFA 11 for Health’ programme for non-communicable diseases had effects on body composition, blood pressure and physical fitness of Danish schoolchildren aged 10–12 years.DesignA cluster-randomised...

Abstract 42: Association of Optimism with Cardiovascular Health: Results From the Hispanic Community Health Study/Study (HCHS/SOL) of Latinos Sociocultural Ancillary Study

Introduction: There is mounting evidence linking positive psychological functioning to restorative health processes and favorable medical outcomes. However, very little is known about the relationship between optimism--an indicator of psychological functioning--and the American Heart Association ( AHA ) defined concept of cardiovascular health ( CVH ), particularly in Hispanics/Latinos of diverse backgrounds. Hypothesis: Persons with greater optimism will have more favorable CVH profiles. Methods: We analyzed data from adults ages 18-75 that participated in the Hispanic Community Health Study/Study of Latinos ( HCHS/SOL ) Sociocultural Ancillary Study in 2010-11. Optimism was assessed using the Life-Orientation Test-Revised, with scores ranging from 6-24 and higher scores indicative of greater levels of optimism. AHA classification standards were used to derive a composite CVH score with subsequent grouping into categorizes of poor (0-7 points), intermediate (8-11 points), and ideal (12-14 points). Metrics considered when calculating the overall CVH score included diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose, and smoking status. Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (poor CVH—ref. group), after adjusting for socio-demographic factors and depressive symptoms. Results: Among 4,960 participants with complete data, 9.2% were categorized as having ideal CVH. In multivariable-adjusted models, participants with moderate levels of optimism were more likely to have intermediate [OR = 1.37: 95%CI = 1.08, 1.74] and ideal [OR = 1.61: 95%CI = 1.04, 2.48] CVH when compared to the least optimistic group ( Table 1 ). Conclusions: The current study offers preliminary evidence for an association between optimism and CVH in a large heterogeneous group of Hispanic/Latino adults. Future studies should explore the concept of optimistic bias and whether exaggerated levels of optimism are detrimental to health.

Evaluating a Nationwide Recreational Football Intervention: Recruitment, Attendance, Adherence, Exercise Intensity, and Health Effects.

The present study evaluated a nationwide exercise intervention with Football Fitness in a small-scale society. In all, 741 adult participants (20–72 yrs) were successfully recruited for Football Fitness training in local football clubs, corresponding to 2.1% of the adult population. A preintervention test battery including resting heart rate (RHR), blood pressure, and body mass measurements along with performance tests (Yo-Yo Intermittent Endurance level 1 (Yo-Yo IE1), the Arrowhead Agility Test, and the Flamingo Balance Test) were performed (n = 502). Training attendance (n = 310) was 1.6 ± 0.2 sessions per week (range: 0.6–2.9), corresponding to 28.8 ± 1.0 sessions during the 18 wk intervention period. After 18 wks mean arterial pressure (MAP) was −2.7 ± 0.7 mmHg lower (P < 0.05; n = 151) with even greater (P < 0.05) reductions for those with baseline MAP values >99 mmHg (−5.6 ± 1.5 mmHg; n = 50). RHR was lowered (P < 0.05) by 6 bpm after intervention (77 ± 1 to 71 ± 1 bpm). Yo-Yo IE1 performance increased by 41% (540 ± 27 to 752 ± 45 m), while agility and postural balance were improved (P < 0.05) by ~6 and ~45%, respectively. In conclusion, Football Fitness was shown to be a successful health-promoting nationwide training intervention for adult participants with an extraordinary recruitment, a high attendance rate, moderate adherence, high exercise intensity, and marked benefits in cardiovascular health profile and fitness.

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age.

BackgroundMiddle‐aged adults with ideal blood pressure, cholesterol, and glucose levels exhibit substantially lower cardiovascular mortality than those with unfavorable levels. Four healthy lifestyle components—optimal body weight, diet, physical activity, and not smoking—are recommended for cardiovascular health (CVH). This study quantified associations between combinations of healthy lifestyle components measured in young adulthood and loss of the ideal CVH profile into middle age.Methods and ResultsAnalyses included 2164 young adults in the Coronary Artery Risk Development in Young Adults study with the ideal CVH profile (defined as untreated blood pressure <120/80 mm Hg, total cholesterol <200 mg/dL, fasting blood glucose <100 mg/dL, and absence of cardiovascular disease) at baseline. Cox proportional hazards regression models estimated hazard ratios for loss of the ideal CVH profile over 25 years according to 4 individual and 16 combinations of optimal healthy lifestyle components measured in young adulthood: body mass index, physical activity, nonsmoking status, and diet quality. Models were adjusted for age, sex, race, education, study center, and baseline blood pressure, cholesterol, and glucose. Eighty percent (n=1737) of participants lost the ideal CVH profile by middle age; loss was greatest for young adults with no optimal healthy lifestyle components at baseline. Relative to young adults with no optimal healthy lifestyle components, those with all 4 were less likely to lose the ideal CVH profile (hazard ratio 0.59, 95% CI 0.44–0.80). Combinations that included optimal body mass index and nonsmoking status were each associated with lower risk.ConclusionsOptimal body mass index and not smoking in young adulthood were protective against loss of the ideal CVH profile through middle age. Importance of diet and physical activity may be included through their effects on healthy weight.

Association of Ideal Cardiovascular Health and Long-term Healthcare Costs.

The American Heart Association's (AHA's) 2020 Strategic Impact Goals introduced the concept of ideal cardiovascular (CV) health based on seven health factors and behaviors associated with lower CV disease (CVD) risk. The association between CV health and healthcare costs has not been reported; therefore, we evaluated the association between CV health profile and later-life healthcare costs. Cooper Center Longitudinal Study participants (N=4,906; mean age, 56 years) receiving Medicare coverage from 1999 to 2009 were included. CV health behaviors (diet, physical activity, BMI, smoking) and CV health factors (blood pressure, total cholesterol, blood glucose) were categorized as unfavorable (zero to two ideal components); intermediate (two to four); and favorable (five to seven). Healthcare costs were cumulated from Medicare claims data, adjusted for inflation. Associations between midlife CV health status and non-CVD and CVD-related costs were estimated using multivariable quantile regression. Analyses were conducted in 2013 and 2014. Favorable CV health was prevalent in 14.8% of men and 30.1% of women, with <1% having ideal levels of all health metrics. After 31,945 person-years of Medicare follow-up, individuals with favorable CV health exhibited 24.9% (95% CI=11.7%, 36.0%) lower median annual non-CVD costs and 74.5% (57.5%, 84.7%) lower median CVD costs than those with unfavorable CV health. Annualized differences were greater for non-CVD costs than for CVD costs ($1,175 vs $566). Having more ideal CV health components in middle age, as outlined by the AHA 2020 Goals, is associated with lower non-CVD and CVD healthcare costs in later life.

Abdominal obesity is associated with arterial stiffness in middle-aged adults

Background and aimsThe relation between adiposity and arterial stiffness remains controversial. We determined whether abdominal and visceral adipose tissue may be a better predictor of arterial stiffness than general obesity in middle-aged adults. Methods and resultsA total of 146 participants (76 men, 70 women; 50 years) were studied. The automatic vascular screening device (Omron VP-1000plus) was used to measure blood pressure simultaneously in the arms and ankles and to determine arterial stiffness by pulse wave velocity (PWV). Using multiple linear regressions, the relations between indicators of obesity and arterial stiffness were examined after adjustment for confounders. Both carotid-femoral PWV and brachial-ankle PWV were significantly associated with BMI (both P < 0.05) but not with body fat percentage. Measures of abdominal obesity, including waist circumference and visceral fat mass (via DXA), were strongly associated with PWV and remained positively associated with arterial stiffness after adjustment for age and gender. Cardiovascular fitness as assessed by maximal oxygen consumption was related to body fat percentage but not with visceral fat. More favorable cardiovascular health profile was associated with both lower visceral fat mass and PWV (both P < 0.001). ConclusionAbdominal obesity and visceral fat are associated with large artery stiffness. These findings support the importance of adiposity measures as a risk factor for arterial stiffening in middle-aged adults.

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age

Optimal Lifestyle Components in Young Adulthood Are Associated With Maintaining the Ideal Cardiovascular Health Profile Into Middle Age

Association of a favorable cardiovascular health profile with the presence of coronary artery calcification.

To examine the association between the American Heart Association's 7 metrics of ideal cardiovascular health (ICH) and the presence of subclinical coronary atherosclerosis as assessed by coronary artery calcification (CAC) using electron-beam computed tomography. This study is a cross-sectional analysis of data obtained on 3121 male and female patients evaluated at the Cooper Clinic in Dallas, Texas, between 1997 and 2007. We included men aged ≥45 and women aged ≥55 without known cardiovascular disease and for whom information on all ICH metrics and a CAC score were available. Patients were grouped into 3 categories according to their number of ICH metrics: favorable (4-7 ICH metrics), intermediate (3 metrics), and unfavorable (0-2 metrics). Patients with favorable ICH profiles had a lower prevalence and severity of subclinical atherosclerosis than those with unfavorable or intermediate ICH profiles as estimated by CAC. This inverse association of CAC with ICH metrics was evident whether the presence of coronary calcium was defined as CAC score>0, CAC score>100, or CAC score>400. Patients with favorable ICH profiles had odds of coronary calcium (CAC>0) less than half of those for patients with unfavorable profiles (odds ratio 0.41; 95% confidence interval, 0.34-0.50) and patients with intermediate ICH profiles had odds of detectable CAC 32% lower (odds ratio 0.68; 95% confidence interval, 0.57-0.82). A statistically significant association was found between a favorable level of ICH metrics and less or absent subclinical atherosclerosis as measured by CAC underscoring the importance of primordial prevention.

Football training improves cardiovascular health profile in sedentary, premenopausal hypertensive women

The present study examined the effects of short-term recreational football training on blood pressure (BP), fat mass, and fitness in sedentary, 35-50-year-old premenopausal women with mild hypertension. Forty-one untrained, hypertensive women were randomized into a football training group (n = 21; FTG) and a control group (n = 20; CON). FTG performed 45 ± 1 1-h small-sided football training sessions during the 15-week intervention period. BP, body composition (dual-energy x-ray absorptiometry), blood lipid profile, and fitness level were determined pre- and post-intervention. After 15 weeks, systolic and diastolic BP, respectively, were lowered more (P < 0.05) in FTG (-12 ± 3 and -6 ± 2 mmHg) than in CON (-1 ± 1 and 1 ± 2 mmHg). Total body fat mass decreased more (P < 0.05) in FTG than in CON during the 15-week intervention period (-2.3 ± 0.5 kg vs 0.4 ± 0.3 kg). After 15 weeks, both total cholesterol (-0.4 ± 0.1 mmol/L vs 0.1 ± 0.2 mmol/L) and triglyceride (-0.2 ± 0.1 mmol/L vs 0.3 ± 0.2 mmol/L) were lowered more (P < 0.05) in FTG than in CON. Yo-Yo intermittent endurance level 1 test performance increased more (P < 0.05) in FTG than in CON (111 ± 18% vs 1 ± 3%) during the 15-week intervention period. In conclusion, short-term football training resulted in a marked reduction in BP and induced multiple improvements in fitness and cardiovascular health profile of untrained, premenopausal women with mild hypertension.

A simple healthy lifestyle index as a proxy of wellness: a proof of concept.

The evidence supporting the importance of a healthy lifestyle (active life, healthy diet, not smoking, and low stress) as a part of programs for primary and secondary prevention of cardiometabolic diseases is strong, compelling, and continuously growing. In this study, we test whether a simple web-based healthy lifestyle index, using self-reports, is related to indices of cardiovascular health and metabolic syndrome and could be employed in large wellness programs intended to promote healthy lifestyle. We studied 411 workers in an Italian multinational factory who were enrolled in a voluntary program consisting of a health checkup and an online questionnaire on lifestyle. These domains were combined into a single simple index. Participants were subdivided into three healthy lifestyle index (HI) groups (red, yellow, and green) ranging from poor to good HI quality (HI from red to green: 41.8 ± 14.6; 75.7 ± 8.5; 93.8 ± 2.2; p < 0.05). The groups differed in indicators of cardiovascular and metabolic health (waist circumference females: 82.1 ± 9.56, 78.9 ± 9.3, 72.7 ± 6.6; males: 95.2 ± 11.7, 90.0 ± 9.5, 85.7 ± 6.1 cm; group difference p < 0.05). Moreover, they differed significantly in the likelihood of having more components of the metabolic syndrome and, conversely, fewer components of the ideal cardiovascular health profile (with red having the worst profile). The red group was also characterized by the highest absenteeism. We report for the first time that a web-based self-reported poor health behavior was significantly associated with clinical and laboratory (partial correlation between HI and high-density cholesterol 0.192; body mass index -0.288; systolic blood pressure -0.130; all p < 0.05) results indicating a negative cardiometabolic profile.

Exercise performance and cardiovascular health variables in 70-year-old male soccer players compared to endurance-trained, strength-trained and untrained age-matched men

The aim was to investigate performance variables and indicators of cardiovascular health profile in elderly soccer players (SP, n = 11) compared to endurance-trained (ET, n = 8), strength-trained (ST, n = 7) and untrained (UT, n = 7) age-matched men. The 33 men aged 65–85 years underwent a testing protocol including measurements of cycle performance, maximal oxygen uptake (VO2max) and body composition, and muscle fibre types and capillarisation were determined from m. vastus lateralis biopsy. In SP, time to exhaustion was longer (16.3 ± 2.0 min; P < 0.01) than in UT (+48%) and ST (+41%), but similar to ET (+1%). Fat percentage was lower (P < 0.05) in SP (–6.5% points) than UT but not ET and ST. Heart rate reserve was higher (P < 0.05) in SP (104 ± 16 bpm) than UT (+21 bpm) and ST (+24 bpm), but similar to ET (+2 bpm), whereas VO2max was not significantly different in SP (30.2 ± 4.9 ml O2 · min−1 · kg−1) compared to UT (+14%) and ST (+9%), but lower (P < 0.05) than ET (−22%). The number of capillaries per fibre was higher (P < 0.05) in SP than UT (53%) and ST (42%) but similar to ET. SP had less type IIx fibres than UT (−12% points). In conclusion, the exercise performance and cardiovascular health profile are markedly better for lifelong trained SP than for age-matched UT controls. Incremental exercise capacity and muscle aerobic capacity of SP are also superior to lifelong ST athletes and comparable to endurance athletes.

Abstract P312: Measuring the Food, Tobacco, Alcohol and Physical Activity Urban Environments in Relation to Cardiovascular Health: The Heart Healthy Hoods Pilot Study in Madrid, Spain

Introduction: Several features of the residential environment have been related to cardiovascular risk. This pilot study tested the feasibility of measuring four specific domains of the urban environment (food, tobacco, alcohol and physical activity) in 12 census sections within the Heart Healthy Hoods Study in Madrid, Spain. Methods: 12 census sections within the city limits of Madrid were selected using the Median Neighborhood Index (MNI). The MNI selects median clusters (in terms of aging, education, segregation and urban form) of contiguous areas within a city using the SaTSCAN statistic. Well-trained data collectors conducted the fieldwork during 3 weeks. To assess the food environment they collected data on the number and type of stores as well as the healthy food availability within stores, using an abbreviated and adapted version of the NEMS-S inventory. For the tobacco and alcohol environment they collected data on the type and number of points of sale. For the physical activity environment they directly measured the attributes of 169 street segments associated with walking and cycling within the 12 census sections using the SPACES inventory. The same tool was used to virtually assess the 169 segments using Google Street View. All data collected were geolocated to produce relevant maps. The cardiovascular health profile of the residents over 40 was assessed using the Primary Care Electronic Health Records from two Health Care Center in the area. Results: The food environment included 2 public markets, 41 food stores and 61 food places. In terms of healthy food availability (score ranges from 0-27), the assessed stores had a mean score of 12.03, higher for supermarkets compared to other types of stores. The tobacco and alcohol environment included 64 and 94 points of sale respectively. The physical activity environment score includes function, safety, aesthetics and destinations for walking and cycling. For walking, the total score has a mean of 4.27 (ranges from 0-6.96); and 3.50 (ranges from 0-5.97) for cycling. Of the 15715 residents living in the study area, 23,4% were above 65 years of age, 49,6% did not complete secondary education, and 25,9% were foreign-born. The cardiovascular health profile of 8357 residents over 40 showed the following prevalence estimates: Obesity 9.3%, Diabetes 10.4%, Hypertension 29.8%, Hypercholesterolemia 28.7%. Conclusions: This pilot study showed a feasible way to measure four important features of the Urban Environment (food, tobacco, alcohol and physical activity) in direct relation to Cardiovascular Health. We aim to use these assessment tools for the future Heart Healthy Hoods Study that will be conducted in 90 neighborhoods of Madrid in order to study the effect of residential environments on the cardiovascular health of its residents.

Cardiovascular health profile of elite female football players compared to untrained controls before and after short-term football training

This study examined the intermittent exercise performance and cardiovascular health profile in elite female football players in comparison to untrained young women, as well as a subgroup subjected to football training 2x1 h · week−1 for 16 weeks. Twenty-seven Danish national team players (elite trained, ET) and 28 untrained women (UT) underwent dual-energy X-ray absorptiometry-scanning (DXA), comprehensive transthoracic echocardiography, treadmill and Yo-Yo Intermittent Endurance level 2 (IE2) testing. Eight women in UT were also tested after the football training period. Maximal oxygen uptake rate (VO2max), peak ventilation and peak lactate were 40, 18 and 51% higher (P< 0.01) in ET than UT, respectively. Cardiac dimensions and function were greater in ET than UT, with left ventricular diastolic diameter, right ventricular diastolic diameter, tricuspid annular plane systolic excursion (TAPSE) and peak transmitral flow in early diastole divided by peak transmitral flow velocity in late diastole during atrial contraction (E/A-ratio) being 13, 19, 27 and 41%, respectively, greater in ET than UT (P< 0.001 to< 0.05). Yo-Yo IE2 performance was 7-fold higher in ET than UT (1772 ± 508 vs. 234 ± 66 m, P< 0.001), fat mass was 51% lower (P< 0.001) and high density lipoprotein (HDL) cholesterol levels were 20% higher (P< 0.01). Sixteen weeks of football elevated VO2max and Yo-Yo IE2 performance by 16 and 40%, respectively, and lowered fat mass by 6%. Cardiac function was markedly improved by 16 weeks of football training with 26 and 46% increases in TAPSE and E/A ratio, respectively, reaching levels comparable to ET. In summary, elite female football players have a superior cardiovascular health profile and intermittent exercise performance compared to untrained controls, but short-term football training can markedly improve the cardiovascular health status.

Preparticipation Evaluation of Novice, Middle-Age, Long-Distance Runners

The purpose of this study was to assess the cardiovascular health and risk profile in middle-age men making an entry to participate for their first time in a long-distance race. Male first-time participants, 45 yr and older, in the world's largest cross-country running race, the Lidingöloppet, were evaluated with a medical history and physical examination, European systematic coronary risk evaluation (SCORE), 12-lead ECG, echocardiography, and blood tests. Further diagnostic workup was performed when clinically indicated. Of 265 eligible runners, 153 (58%, age 51 ± 5 yr) completed the study. Although the 10-yr fatal cardiovascular event risk was low (SCORE, 1%; interquartile range, 0%-1%), mild abnormalities were common, for example, elevated blood pressure (19%), left ventricular hypertrophy (6%), and elevated LDL cholesterol (5%). ECG changes compatible with the "athlete's heart" were present in 82%, for example, sinus bradycardia (61%) and/or early repolarization (32%). ECG changes considered training unrelated were found in 24%, for example, prolonged QTc-interval (13%), left axis deviation (5.3%), and left atrial enlargement (4%). In 14 runners (9%), additional diagnostic workup was clinically motivated, and 4 runners (2%) were ultimately discouraged from vigorous exercise because of QTc intervals >500 ms (n = 2), symptomatic atrioventricular block (n = 1), and cardiac tumor (n = 1). The physician examination and the ECG identified 12 of the 14 participants requiring further evaluation. Cardiovascular evaluation of middle-age men, including a physician examination and a 12-lead ECG, appears useful to identify individuals requiring further testing before vigorous exercise. The additional yield of routine echocardiography was small.

New records in aerobic power among octogenarian lifelong endurance athletes

We examined whole body aerobic capacity and myocellular markers of oxidative metabolism in lifelong endurance athletes [n = 9, 81 ± 1 yr, 68 ± 3 kg, body mass index (BMI) = 23 ± 1 kg/m(2)] and age-matched, healthy, untrained men (n = 6; 82 ± 1 y, 77 ± 5 kg, BMI = 26 ± 1 kg/m(2)). The endurance athletes were cross-country skiers, including a former Olympic champion and several national/regional champions, with a history of aerobic exercise and participation in endurance events throughout their lives. Each subject performed a maximal cycle test to assess aerobic capacity (VO(2max)). Subjects had a resting vastus lateralis muscle biopsy to assess oxidative enzymes (citrate synthase and βHAD) and molecular (mRNA) targets associated with mitochondrial biogenesis [peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and mitochondrial transcription factor A (Tfam)]. The octogenarian athletes had a higher (P < 0.05) absolute (2.6 ± 0.1 vs. 1.6 ± 0.1 l/min) and relative (38 ± 1 vs. 21 ± 1 ml·kg(-1)·min(-1)) VO(2max), ventilation (79 ± 3 vs. 64 ± 7 l/min), heart rate (160 ± 5 vs. 146 ± 8 beats per minute), and final workload (182 ± 4 vs. 131 ± 14 W). Skeletal muscle oxidative enzymes were 54% (citrate synthase) and 42% (βHAD) higher (P < 0.05) in the octogenarian athletes. Likewise, basal PGC-1α and Tfam mRNA were 135% and 80% greater (P < 0.05) in the octogenarian athletes. To our knowledge, the VO(2max) of the lifelong endurance athletes is the highest recorded in humans >80 yr of age and comparable to nonendurance trained men 40 years younger. The superior cardiovascular and skeletal muscle health profile of the octogenarian athletes provides a large functional reserve above the aerobic frailty threshold and is associated with lower risk for disability and mortality.

Abstract 9760: Population-Level Cardiovascular Health Behavior and Health Factor Trends (1988-2008) and Projections to 2020 in US Men and Women: Results from the National Health and Nutrition Examination Surveys (NHANES)

Introduction: The AHA 2020 Impact Goals recently defined 4 health behaviors (smoking, body mass index [BMI], diet, and physical activity) and 3 health factors (cholesterol, blood pressure, and plasma glucose) that serve as population-level metrics for evaluating cardiovascular (CV) health. However, there have been no forward projections of population trends of these metrics to 2020. Methods: We used data from cardiovascular disease-free individuals from NHANES III (1988-1994) and recent 2-year cycles (1999-2000, 2001-2, 2003-4, 2005-6, 2007-8) to provide population-level, sex-specific trends in prevalence of poor, intermediate and ideal levels of CV health behavior/factors. We also performed age-adjusted forward projections to 2020 using weighted linear regression coefficients. Results: The Table describes prevalence of poor, intermediate and ideal CV health behavior/factor levels from 1988-2008, weighted linear regression coefficients β (SE), and 2020 projections for men. Favorable trends from 1988-2008 included declines in prevalence of current and former smoking, hypercholesterolemia, and hypertension. In contrast, there were adverse trends in BMI, and dysglycemia. Prevalence of physical activity levels and remarkably low diet quality scores showed minimal changes over time. Women had generally similar trends in CV health profiles. Projections to 2020 suggest that obesity and impaired fasting glucose/diabetes could increase to affect more than 45% and 75% of US men, respectively, and 42% and 55% of US women. Conclusions: Improvements in prevalence of smoking, hypercholesterolemia and hypertension since 1988 have been offset by increases in adiposity and dysglycemia in US men and women. If current trends in obesity and dysglycemia are not reversed rapidly (likely through improvements in diet and physical activity), achievement of the 2020 Strategic Impact Goals will be difficult.

Cardiovascular Health vs Cardiovascular Risk A 2011 Update: Cardiovascular Risk Stratification, the Basis to Reach Therapeutic Goals

In this article, we review relevant concepts in Preventive Cardiovascular Medicine. Among the most important concepts analyzed are the following. Ideal Cardiovascular Health: A new construct proposed in 2010 by the American Heart Association (AHA) as a motivational concept, with the aim of communicating the ideal profile of cardiovascular health to the general public. Cardiovascular Risk Factors: In the absence of an ideal cardiovascular health profile in the 99.99% of adults, an objective cardiovascular risk evaluation is an obligated task and one that cannot be postponed by any physician. Cardiovascular Risk Stratification: Cardiovascular event prediction system elaboration, like the Framingham, is based on the incorporation and pondering of the predictive value of immutable variables as are age, gender and other mutable variables that are susceptible to treatment like: hypercholesterolemia, hypertension, hyperglycemia and smoker. These predictive systems allowed cardiovascular risk calculation to treat determining factors and decrease the statistic probability of a fatal or disabling cardiovascular event. Cardiovascular stratification and therapeutic goals: Age is the main risk factor for cardiovascular events, for instance, a man older than 45, or a woman older than 55, even with a blood pressure, total cholesterol and glucose in adequate levels and no smoker will have a calculated cardiovascular risk over 0.5% per year. Any stratification of the cardiovascular risk is not transcendental without a preventive-therapeutic action. Up-today and before the ATP-IV guidelines publication, therapeutic goals are established according to the cardiovascular risk level calculated with the Framingham method 2008. Beyond population approaches that are investigating massive treatments (poly-pill or polycap), and independently from cardiovascular risk stratification method employed, cardiovascular risk assessment is the clinical approach with the greatest impact in a medical practice, this enables to establish strategies to fulfill our most important goal as doctors, which is to show all individuals a way to have long lives and with quality of life. Keywords: Cardiovascular health, cardiovascular risk, body mass index, Blood pressure, synergic modulators, C-reactive Protein, diabetes mellitus, emitting tomography

Short-term street soccer improves fitness and cardiovascular health status of homeless men

This study examined the effect of 12 weeks of small-sided street soccer (2.2 ± 0.7 sessions/week) and fitness center training (0.5 ± 0.2 sessions/week) on physical fitness and cardiovascular health profile for homeless men. Exercise capacity, maximal oxygen uptake (VO(2max)), body composition (DXA scans), blood pressure (BP), and blood lipid profile were determined before and after the intervention period for 22 soccer-group subjects (SG) and 10 waiting list controls (CO). In addition, time-motion analyses, HR measurements, and pedometer recordings were performed during street soccer training and daily-life activities. During a 60 min 4 versus 4 street soccer session 182 ± 62 intense running bouts were performed; mean HR was 82 ± 4% HR(max) and HR was >90% HR(max) for 21 ± 12% (±SD) of total time. On a day without training the participants performed 10,733 ± 4,341 steps and HR was >80% HR(max) for 2.4 ± 4.3 min. In SG, VO(2max) was elevated (p < 0.05) from 36.7 ± 7.6 to 40.6 ± 8.6 ml/min/kg after 12 weeks and incremental cycle test performance was improved (p < 0.05) by 81 s (95% CI: 47-128 s). After 12 weeks, fat percentage (19.4 ± 8.5 to 17.5 ± 8.6%) and LDL cholesterol (3.2 ± 1.1 to 2.8 ± 0.8 mmol L(-1)) were lowered (p < 0.05) in SG. The observed changes in SG were different (p < 0.05) from CO and no intra-group changes occurred for CO (p > 0.05). BP was unaltered after 12 weeks (p > 0.05), but diastolic BP was lowered for all SG subjects with pre-values >75 mmHg (83 ± 6 to 76 ± 6 mmHg, n = 8, p < 0.05). In conclusion, the exercise intensity is high during street soccer and regular street soccer training can be used as an effective activity to promote physical fitness and cardiovascular health status for homeless men.

Small-sided Soccer Games are an Effective Health Promoting Activity for Homeless Men

Homeless men are known to have an elevated risk of health related diseases and early death (Nordentoft and Wandall-Holm, 2003) due to misuse of alcohol and sedatives, malnutrition and physical inactivity. Regular soccer training has been proven to be an effective health promoting activity for untrained men and women (Krustrup et al, 2009) but a comprehensive soccer study has not yet been carried out for homeless men. Purpose: To examine possible changes in physical fitness and cardio-vascular health profile during 12 wks of regular soccer training. METHODS: 22 homeless men (36±10y) played soccer 3×1h per week for 12 wks organised as small-sided games on a 16×22m asphalt pitch with 1.1m high boards. DXA-scans and incremental bicycle tests to exhaustion were performed before and after the intervention. Blood pressure (BP) and heart rate (HR) were measured after 20 min of rest in the supine position. Results were compared to a control group consisting of 8 homeless males (42±9y) continuing their normal life style. Within-group changes were made using Student's paired t-test. Between-group differences were tested using Student's unpaired t-test. RESULTS: Lean body mass was 0.9 kg higher (p<0.05) and fat mass and fat percentage was 1.3 kg and 1.7% lower (p<0.05) after 12 wks. VO2 max and time to exhaustion were improved by (p<0.05) by 9 and 9% (∼1.5 min). Moreover, resting HR was lowered (p<0.05) by 5 bpm, whereas no change in BP was observed (Table 1). No significant differences were observed between pre-values for the two subject groups and no significant changes occurred for the control group during the 12 wks. CONCLUSION: Regular soccer training can be used to improve physical fitness and cardio-vascular health profile for homeless men.Table

Perfil de saúde cardiovascular de uma população adulta da região metropolitana de São Paulo

To describe the cardiovascular health profile of an adult population from the metropolitan region of São Paulo, according to the European Society of Cardiology (ESC) criteria. Two hundred volunteers of both sexes enrolled in the "Cardiac Evaluation" project of a general outpatient clinic were studied. Data collected included socioeconomic status, cigarette smoking, alcohol consumption, anthropometric measurements, diet, physical activity, serum lipids, blood glucose and blood pressure. Average intake of dietary cholesterol and total lipids was estimated from a 24-hour dietary recall. Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ-8) and exercise stress tests. Sample population composition was 61.5% female and 38.5% male, mean age 41.7 (median = 42.6) and 41.0 (median = 43.0%). Prevalence of smoking (22%) and daily alcohol consumption (14% males; no females) was low. The overweight prevalence was 47% (12% being obese), in addition to high levels of serum total cholesterol (> 190 mg/dl) in 56% and LDL-cholesterol (> 115 mg/dl) in 61%. The IPAQ-8 results showed that 6% were sedentary. The study population showed greater risk of cardiovascular diseases, according to ESC criteria, due especially to the high prevalence of overweight and hypercholesterolemia.