Cardiovascular Health Promotion Research Articles

Application of obesity indicators based on body fat in the screening of persistent dyslipidemia among school-aged children

Objective: To explore the screening effect of obesity assessed by body fat indicators on persistent dyslipidemia among children. Methods: Data were obtained from the baseline and follow-up survey of 'School-based Cardiovascular and Bone Health Promotion Program.' BMI, fat mass index (FMI), and fat mass percentage (FMP) were used to define obesity. Dyslipidemia, diagnosed both in the baseline and a follow-up survey, was defined as persistent dyslipidemia. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive capabilities of obesity defined by different indicators on persistent dyslipidemia. Results: A total of 10 783 children (boys accounted for 49.6%) were included in the analysis, with the average age as (10.9±3.3) years old. The detection rates of persistent high TC, high LDL-C, low HDL-C, high TG, and high non-HDL-C were 1.3%, 1.2%, 4.3%, 1.3%, and 0.8%, respectively. In boys, the capabilities of FMI- and FMP-defined obesity in the prediction of persistent high LDL-C [FMI: AUC=0.626 (95%CI: 0.558-0.694), P=0.024; FMP: AUC=0.642 (95%CI: 0.574-0.710), P=0.004] and high non-HDL-C [FMI: AUC=0.637 (95%CI: 0.584-0.689), P=0.017; FMP: AUC=0.641 (95%CI: 0.588- 0.693), P=0.018] were significantly higher than BMI-defined obesity. Besides, obese boys defined by FMI had the stronger capability in predicting persistent low HDL-C than that defined by BMI [AUC=0.784 (95%CI: 0.742-0.826) vs. 0.750 (95%CI: 0.726-0.773), P=0.047]. In girls, the capabilities of FMI- and FMP-defined obesity in the prediction of persistent dyslipidemia were not statistically different from BMI. Conclusions: The obesity assessed by body fat performed better in predicting persistent high LDL-C, low HDL-C, and high non-HDL-C than that assessed by BMI among boys, which can be further applied to cardiovascular disease prevention.

Comprehensive Cardiovascular Health Promotion for Successful Prevention of Cardiovascular Disease

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Abstract 14193: Depression Worsens Cardiovascular Health: A Population-based Cohort Study (NHANES, 2015-16)

Introduction: Depression increases cardiovascular risk, but associations between depression and cardiovascular risk profiles have had limited investigation. We hypothesized that depression is associated with cardiovascular risk factors in a population-based cohort. Methods: We selected participants from the 2015-16 National Health and Nutrition Examination Survey (NHANES) and age ≥25 years. Participants completed the Patient Health Questionnaire (PHQ), a 9-item, validated instrument categorizing minimal (0-4), mild (5-9) or moderate-to-severe (≥10) depression. We employed the American Heart Association’s assessment of cardiovascular health, Life’s Simple 7 (LS7) which uses risk factors (smoking status, BMI, physical activity, diet, cholesterol, blood pressure, and glycohemoglobin) to categorize cardiovascular health as poor (0-1), intermediate (5-9) or ideal (10-14). We related PHQ scores to cardiovascular health as measured by LS7 in regression analyses adjusted for relevant covariates (age, sex, race, education, health insurance and poverty-income level). Results: Among 5053 NHANES participants, 4003 (79%) had data for the PHQ and determination of LS7 scores (age 51±16; 52% female; 67% white race). Individuals with mild depression (PHQ 5-9) had 1.4-times greater likelihood (95% CI, 1.07-1.92) of lower cardiovascular health compared to those without depression in multivariable-adjusted models. Likewise, individuals with moderate depression (PHQ≥10) had 3-times greater likelihood (95% CI, 1.90-4.97) of lower cardiovascular health compared to those without depression. Conclusions: In a socially diverse cohort, individuals with depression were more likely to have significantly lower cardiovascular health compared to those without depression. Our findings show that depression may be a barrier to cardiovascular health promotion. Addressing depression appears essential to improve cardiovascular health.

Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population

BackgroundThe South Asian population in Canada is growing and has elevated risk of cardiovascular disease and diabetes. This study sought to adapt an evidence-based community risk assessment and health promotion program for a South Asian community with a large proportion of recent immigrants. The aims were to assess the feasibility of implementing this program and also to describe the rates of cardiometabolic risk factors observed in this sample population.MethodsThis was a feasibility study adapting and implementing the Community Paramedicine at Clinic (CP@clinic) program for a South Asian population in an urban Canadian community for 14 months. CP@clinic is a free, drop-in chronic disease prevention and health promotion program implemented by paramedics who provide health assessments, health education, referrals and reports to family doctors. All adults attending the recreation centre and temple where CP@clinic was implemented were eligible. Volunteers provided Hindi, Punjabi and Urdu translation. The primary outcome of feasibility was evaluated using quantitative process measures and a qualitative key informant interview. For the secondary outcome of cardiometabolic risk factor, data were collected through the CP@clinic program risk assessments and descriptively analyzed.ResultsThere were 26 CP@clinic sessions held and 71 participants, predominantly male (56.3–84.6%) and South Asian (87.3–92.3%). There was limited participation at the recreation centre (n = 19) but CP@clinic was well-attended when relocated to the local Sikh temple (n = 52). Having the volunteer translators was critical to the paramedics being able to collect the full risk factor data and there were some challenges with ensuring enough volunteers were available to staff each session; as a result, there were missing risk factor data for many participants. In the 26 participants with complete or almost complete risk factor data, 46.5% had elevated BP, 42.3% had moderate/high risk of developing diabetes, and 65.4% had an indicator of cardiometabolic disease.ConclusionImplementing CP@clinic in places of worship is a feasible approach to adapting the program for the South Asian population, however having a funded translator in addition to the volunteers would improve the program. Also, there is substantial opportunity for addressing cardiometabolic risk factors in this population using CP@clinic.

Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group.

Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2‐day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long‐term health. These changes demand a repositioning of existing evidence‐based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.

Cardiovascular health in China: Low level vs high diversity

Cardiovascular health in China: Low level vs high diversity

Rural Health: The Continuing Challenge to Promote Cardiovascular Health.

Rural Health: The Continuing Challenge to Promote Cardiovascular Health.

Prevention of Atherosclerotic Cardiovascular Disease in Childhood.

Atherosclerotic-CVD processes begin early in life and are influenced over the life course by interaction of genetic and potential modifiable risk factors, behaviors, and environmental exposures. The purpose of this review is to highlight importance of primordial and primary prevention beginning early in the life course. Evidence-based guidelines and recommendations for primordial and primary prevention support importance of individual/clinical and population-based approaches to CVD prevention beginning early in life with goal of reducing the risk and burden of CVD. Substantial evidence supports the individual and societal benefits of prevention of CVD and promotion of optimal cardiovascular health beginning early in life and extending across the life course and the need for additional research to guide and inform practices and policies enabling optimal cardiovascular health for all.

Use of educational technologies in the promotion of children's cardiovascular health: a systematic review.

The aim of this study was to investigate the effectiveness of educational technologies for cardiovascular health promotion in children. A systematic review was carried out through a search in Biblioteca Virtual de Saúde, Comissão de Aperfeiçoamento de Pessoal do Nível Superior, EBSCOHot Information Services, and US National Library of Medicine National Institutes of Health databases, using the descriptors: play and plaything, cardiovascular diseases, child, and health promotion, between 2012 and 2019. Eight articles were selected for this review. The identified technologies were based on low-tech interventions, such as play workshops, using tools such as CARDIOKIDS, the SI! program, MOVI-2, and activities with wide-ranging digital tools such as Fooya!, Fit2PlayTM, and the exergame cycling program. It is noteworthy that all of the analyzed interventions were effective and those that involved playing were better accepted by the children.

Abstract P100: Improving Ideal Cardiovascular Health in a Pediatric Preventive Cardiology Practice

Introduction: Achieving ideal cardiovascular health (iCVH) for children necessitates both public health and individual interventions. Hypothesis: We hypothesized that children referred to a multidisciplinary preventive cardiology clinic would demonstrate improved iCVH after clinic-based lifestyle counseling. Methods: We analyzed data from youth ages 8-19 years seen for ≥2 consecutive visits in the Boston Children’s Hospital Preventive Cardiology clinic between 2010-2017. Demographic information, smoking status, diet, and physical activity were self-reported. Anthropometric data, blood pressure, fasting cholesterol, and fasting glucose were measured using standard protocols. We applied AHA definitions of ideal, intermediate, and poor iCVH with minor adaptations to data extracted from a clinical registry. Each iCVH metric had a possible range of 0 (poor) to 2 (ideal); the total iCVH score could range from 0 (all poor) to 14 (all ideal). Results: Median age of the 767 children in the study was 12.5 years [IQR 10.2,15.9]; 414 (54%) were female and 32 (5%) had a moderate or high CVD risk condition (diabetes, renal disease, Kawasaki, congenital heart disease, or heart transplant). Over a median of 3.9 [IQR 3.2, 6.0] months from initial assessment to first follow-up, mean iCVH score improved from 7.7 (SD 2.2) to 8.1 (SD 2.2) (p &lt; 0.001). Females had higher iCVH scores at baseline and follow-up (females 7.9 to 8.4 vs. males 7.5 to 7.9, p&lt;0.001), as did children younger than 14 years of age (data not shown). iCVH score improved to a mean of 8.3 (SD 2.4) for the 449 children returning for a third visit. The largest improvement was observed in total cholesterol and dietary habits (Figure); only 61 (8%) of children were prescribed statin therapy. Conclusion: Multidisciplinary clinical care can improve the iCVH of children who present with non-optimal levels, largely without the use of medications. Further work is needed to determine the scalability and long-term effectiveness of cardiovascular health promotion efforts in pediatric care.

Abstract 09: The Health Freedom Path to Wellness Program: A Novel Educational and Behavioral Intervention to Promote Cardiovascular Health Equity

Background: African Americans (AAs) and adults living in urban communities continue to experience disproportionately high rates of cardiovascular disease (CVD) and associated risk factors (e.g., hypertension, diabetes, obesity) despite decades of recognition of these disparities. Methods: The Health Freedom Path to Wellness Program is an innovative community-based educational and behavioral intervention to reduce disparities in CVD risk factors. The goal of this study was to test the effectiveness of the Circle of Friends (COF) educational and social support component of the Health Freedom intervention. The Health Freedom-COF incorporated six weekly one-hour long sessions led by lay health workers trained in CVD health education based on the AHA’s Simple 7 guidelines, blood pressure (BP) measurement, physical activity, and behavior change strategies, and culminated in a 5K celebration walk that gives participants an opportunity to learn about Maryland’s important role in the Underground Railroad. Results: Study participants included 353 adults in Maryland (93% AAs, mean age: 53 years; 85% female; and 35% with annual incomes &lt;$50,000). At baseline, mean BP(SD) was 127.4 (17.6)/77.1 (10.8) mmHg; mean weight in pounds (SD) was 191.6 (45.2); 43.1% had diagnosed hypertension, and 15.0% had diabetes. Compared with their pre-intervention assessments, adults who completed the intervention experienced an average reduction of -5.2 mm Hg systolic blood pressure (95% CI: 4.1-6.3, p&lt;0.001) and -3.3 mm Hg diastolic BP (95% CI: 2.5-4.1, p&lt;0.001). At baseline, only 3.3% of participants reported a weekly consumption of 5+ fruit servings; 5.9% reported 5+ vegetable servings, and 12.8% reported 5+ days of physical activity. However, after completing the program, 22.4% of participants reported a weekly consumption of 5+ fruit servings; 28.6% reported 5+ vegetable servings, and 46.7% reported 5+ days of physical activity. Conclusions: The Health Freedom educational and behavioral intervention was associated with improvements in blood pressure, diet, and physical activity among socially at-risk adults.

Cardiovascular Diseases in Central and Eastern Europe: A Call for More Surveillance and Evidence-Based Health Promotion.

Objectives:The paper aims to identify the priorities for cardiovascular health promotion research in Central and Eastern Europe (CEE), the region with the highest cardiovascular diseases (CVD) burden in the world.Methods:This narrative review covered peer-reviewed publications and online databases using a nonsystematic purposive approach.Results:In despite of a steady decrease in CVD burden in the region, the East-West disparities are still significant. There is minimal continuity in the past and current CVD prevention efforts in the region. Many challenges still exist, including an opportunity gap in research funding, surveillance and population-based preventive interventions. A comprehensive approach focusing on multisectoral cooperation, quality and accessibility of healthcare and equity-oriented public policies and supported by well-designed epidemiologic studies is needed to overcome these challenges.Conclusion:The current level of effort is not adequate to address the magnitude of the CVD epidemic in CEE. It is imperative to strengthen the epidemiological base concerning cardiovascular health in the region, to foster surveillance and progress in implementation of CVD preventive strategies in the most affected populations of Europe.

A comparative study on diagnostic cut points of dyslipidemia in children and adolescents in China

Objective: To compare the power of dyslipidemia diagnosis by different sets of cut points in the prediction of cardiovascular metabolic risk factors and identify the appropriate cut points for the diagnosis of dyslipidemia in children and adolescents in China. Methods: Data were obtained from the baseline survey of 'School-based Cardiovascular and Bone Health Promotion Program' in Beijing in 2017. Dyslipidemia was diagnosed by using two set of cut points. Receiver operating characteristic curve analysis was conducted to assess the power of dyslipidemia diagnosis by the two set of cut points to predict the prevalence of hypertension, obesity, high fat mass percentage and impaired fasting glucose. Results: A total of 14 390 children and adolescents were in included in the study. The prevalence rates of high TC, high LDL-C, low HDL-C, and high TG in the participants were 2.7%, 2.7%, 14.4%, and 3.7% according to 'Chinese Reference Standard', and 5.0%, 3.7%, 13.3%, and 3.5% according to 'China Expert Consensus'. Low HDL-C and high TG defined by the 'Chinese Reference Standard' had better performance for the prediction of high fat mass percentage and obesity in boys, but worse performance in girls (P<0.001). Conclusions: Using 'China Reference Standard' can increase the true positive rate in the prediction of obesity or high fat mass percentage in boys, and reduce the false positive rate in girls. The cut points for the diagnosis of dyslipidemia in Chinese children and adolescents need to be further validated by using national representative sample and in longitudinal study.

Lifestyle Impact on Cognitive Decline and Neurodegeneration Overview groupview

Cognitive decline is a part of a natural phenomenon that eventually happens to almost everyone as they age. It results from a combination of lifestyle habits, genetic factors, trauma or just gradual wearing-out of one’s nervous system. The effects of lifestyle and behavior which include patterns of dietary intake, physical activities as well as practicing unhealthy habits such as smoking and alcohol consumption, have been globally emphasized and embraced time and again as a crucial component to avoid serious health complications. It is also been included as an evidence-based guideline for children, adolescents and adults from diverse populations in all countries. Healthy lifestyle behaviors and therapeutic lifestyle changes were emphasized and reaffirmed as central to cardiovascular health promotion and risk reduction, respectively. Certain healthy behaviors known to combat cancer, cardiovascular disease, diabetes and may also reduce the risk of cognitive decline. Simple lifestyle changes might delay the start of cognitive decline and dementia or slow its progression. Activities that boost your body and brain are such as staying mentally active, engaging in regular physical activity and eating a heart-healthy diet. There are also evidences where people may benefit from staying socially engaged with friends, family and the community. People can reduce the risk of cognitive decline by making key lifestyle changes. There are measures which can be taken to modify their lifestyle while they still can before it’s too late to stop if not to minimize the onset of neuron degeneration.

Elucidating the Relationship Between Insomnia, Sex, and Cardiovascular Disease

Sex differences in cardiovascular disease (CVD) mortality have been attributed to differences in pathophysiology between men and women and to disparities in CVD management that disproportionately affect women compared to men. Similarly, there has been investigation of differences in the prevalence and presentation of insomnia attributable to sex. Few studies have examined how sex and insomnia interact to influence CVD outcomes, however. In this review, we summarize the literature on sex-specific differences in the prevalence and presentation of insomnia as well as existing research regarding the relationship between insomnia and CVD outcomes as it pertains to sex. Research to date indicate that women are more likely to have insomnia than men, and there appear to be differential associations in the relation between insomnia and CVD by sex. We posit potential mechanisms of the relationship between sex, insomnia and CVD, discuss gaps in the existing literature, and provide commentary on future research needed in this area. Unraveling the complex relations between sex, insomnia, and CVD may help to explain sex-specific differences in CVD, and identify sex-specific strategies for promotion of cardiovascular health. Throughout this review, terms “men” and “women” are used as they are in the source literature, which does not differentiate between sex and gender. The implications of this are also discussed.

Updated Reasons and Clinical Implications of New Korean Hypertension Guidelines for Cardiologists.

Leaving behind substantial reflections or skepticisms on the shortage of evidences about blood pressure (BP) thresholds for antihypertensive drug therapy and target BPs, major hypertensive guidelines including Korean hypertension guidelines were recently updated for earlier and more intensive control of BP. Because hypertension is one of the major risk factors for death, stroke, cardiovascular (CV) disease, heart failure, and cognitive impairment, substantial improvement of hypertension management is necessary to reduce disease and socioeconomic burdens and to promote CV health. Theoretically, earlier intervention in terms of age and BP level and thorough control of BP into within normal range would prevent or delay major adverse CV events. Revised hypertension guidelines were developed by the American College of Cardiology/American Heart Association, Korean Society of Hypertension, European Society of Cardiology/European Society of Hypertension, and Japanese Society of Hypertension in order. In this article, recent updates and clinical significances of the Korean hypertension guidelines will be discussed with comparison of foreign hypertension guidelines and considerable changes in the management of hypertension will be introduced for cardiologists and general practitioners.

'I think one of the ways they will help is to create awareness': primary school teachers' perceptions of cardiovascular diseases in Nigeria.

The increasing incidence and prevalence of non-communicable diseases is a major global health concern. Cardiovascular diseases (CVDs) account for the highest percentage of deaths related to non-communicable diseases, and low and middle-income countries (LMIC) face the highest burden of CVDs. Understanding the knowledge and perception of CVDs and their risk factors in an LMIC such as Nigeria may play an important role in cardiovascular health promotion and improvement plans to reduce CVD-related deaths. A qualitative study was conducted using semi-structured interviews to gain an in-depth understanding of some personal and sociocultural views on CVDs and their risk factors. The participants were purposively sampled primary school teachers in South-Eastern Nigeria. Thematic analysis approach was used for data analysis. The study findings include knowledge of heart disease, perceived causes and risk factors of CVDs, spirituality, and the way forward. Overall, the knowledge of CVDs in the setting was found to be related to the psychosocial nature of the participants; the effectiveness of any intervention needs to take these factors into consideration. For example, health policies for CVD health education and awareness should be tailored to address some of the issues of belief, values, and religion, as mentioned in the study.

Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer

BackgroundLong-term survival for children diagnosed with cancer exceeds 80%. Notably, premature cardiovascular disease has become the leading non-cancer cause of late mortality among these survivors. Methods/designThis randomized controlled trial (RCT; NCT03104543) focuses on adult participants in the Childhood Cancer Survivor Study identified as high risk for ischemic heart disease or heart failure due to their cancer treatment. Participants undergo a home-based evaluation of blood pressure and laboratory tests to determine the prevalence of undiagnosed and/or undertreated hypertension, dyslipidemia, and diabetes. Those with abnormal values are then enrolled in an RCT to test the efficacy of a 12-month personalized, remotely delivered survivorship care plan (SCP) intervention designed to reduce undertreatment of these three target conditions. The intervention approximates a clinical encounter and is based on chronic disease self-management strategies. ResultsWith a goal of 750, currently 342 out of 742 eligible participants approached have enrolled (46.1%). Initially, we randomized participants to different recruitment strategies, including shorter approach packets and a tiered consent, but did not find significant differences in participation rates (40.7% to 42.9%; p = .95). Subsequently, slightly greater participation was seen with larger upfront unconditional incentive checks ($50 vs. $25: 50.7% vs. 44.1%; p = .10). Overall, the financial impact of the $50 upfront incentive was cost neutral, and possibly cost-saving, vs. a $25 upfront incentive. ConclusionThe overall study will determine if a National Academy of Medicine-recommended SCP intervention can improve cardiovascular outcomes among long-term survivors of childhood cancer. Modifications to the recruitment strategy may improve participation rates over time.

The role of Hippo signaling pathway in physiological cardiac hypertrophy.

Introduction: The role of Hippo signaling pathway, which was identified by genetic studies as a key regulator for tissue growth and organ size, in promoting physiological cardiac hypertrophy has not been investigated. Methods: Fourteen male Wistar rats were randomly assigned to the exercise and control groups. The exercise group ran 1 hour per day, 5 days/week, at about 65%-75% VO2max on the motor-driven treadmill with 15º slope, and the control group ran 15 min/d, 2 days/week at 9 m/min (0º inclination), throughout the eight-week experimental period. Forty-eight hours after the last session, hearts were dissected and left ventricles were weighed and stored for subsequent RT-PCR analysis. Results: Despite a significant increase in the MAP4k1 expression levels in the exercise group (P = 0.001), the Mst1 expression was inhibited compared to the control group (P < 0.001) which was followed by suppression of Lats1 expression (P = 0.001). Compared with the control group, significant increases were observed in heart weight/body weight (P = 0.024) and left ventricular weight/body weight (P = 0.034) ratios in the exercise group. The H&E staining confirmed the cardiac hypertrophy that may be partly due to a significant increase in Yap1 expression level compared with the control group (P <0.001), which was confirmed by Western blot analysis. Conclusion: Increased MAP4K1 expression did not influence Lats1 activation. The exercise training protocol suppressed Mst1 and Lats1 (Hippo pathway) and caused an increase in Yap1 expression level, which led to physiological cardiac hypertrophy in healthy rats. Further studies are suggested to apply this exercise protocol for the prevention and/or rehabilitation of cardiovascular disease and health promotion.

NEIGHBORHOOD ENVIRONMENTS AND OBESITY: EXPLORING PATHWAYS TO RISK OF CARDIOVASCULAR DISEASE

Modifying neighborhood environments to target well-established risk factors for cardiovascular disease may reduce health disparities by complementing clinical services. Prior research, however, includes limited measures of neighborhoods and does not adequately account for individual-level processes known to mediate health outcomes. We combine baseline data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) dataset with neighborhood-level data to yield a diverse sample of Black and white middle-aged and older residents of Baltimore City (N=2707). We use structural equation modeling to examine associations between neighborhood environments and obesity (BMI>=30), focusing on individual-level mediators. Initial direct associations between neighborhoods and obesity (e.g., presence of businesses, β=-0.062) are mediated by healthcare access and health behaviors. Additional indirect pathways exist through health behaviors (e.g., neighborhood disorder, access to parks). These findings highlight the importance of considering indirect pathways to cardiovascular health promotion among aging adults in different neighborhood contexts.