Cardiovascular Risk Behaviors Research Articles

Effectiveness of the 5As Model-Based Transitional Care Program among Chinese Patients with Type B Aortic Dissection Post-TEVAR: A Randomized Controlled Trial.

Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China. This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge. Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group. This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR. The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).

A Study On Cardiovascular Risk And Lifestyle Behaviors Among Teaching Doctors Of Prakasam District, Andhra Pradesh.

A Study On Cardiovascular Risk And Lifestyle Behaviors Among Teaching Doctors Of Prakasam District, Andhra Pradesh.

Validity of self-assessment tools for cardiovascular risk behaviour: a systematic review

Validity of self-assessment tools for cardiovascular risk behaviour: a systematic review

Cardiovascular disease in patients with systemic autoimmune diseases: The relationship between self-perceived risk and actual risk

IntroductionAutoimmune diseases are known to be associated with an elevated risk of cardiovascular diseases; however, there exists a lack of awareness regarding this increased risk among patients. ObjectiveThis study aimed to assess the prevalence of cardiovascular risk factors and events in various systemic autoimmune diseases, including Systemic Sclerosis (SSc), Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), and Sjögren's syndrome (SS), matched by age, sex, and disease duration. Additionally, the study aimed to evaluate the perceived and actual risks of cardiovascular disease among patients. MethodsA cross-sectional self-reported survey on the patient's perspective of cardiovascular risk was conducted between January and June 2023. Sociodemographic and clinical data, including disease activity, were collected through medical records and questionnaires. Traditional cardiovascular risk factors and events were assessed, alongside the perceived cardiovascular risk. The SCORE calculation and Charlson Comorbidity Index (CCI) were employed for cardiovascular risk assessment. ResultsSurvey responses from 180 patients (45 patients each with SSc, SLE, RA, and SS) with systemic autoimmune diseases revealed that 20% perceived a low risk, 23% perceived neither lower nor higher, and 56% perceived a higher risk of developing cardiovascular diseases in the next ten years. Only 45% agreed that their autoimmune disease could increase the risk of a heart attack, even in the absence of other risk factors, and 46.7% were unaware that NSAIDs pose a cardiovascular risk. An association between cardiovascular risk measured by SCORE, comorbidities, and risk perception was observed in RA, SSc, and SS patients, with no association found in SLE patients (p=0.27). Except for SS patients (p=0.02), no association between CCI and disease activity level was found. Regarding the influence of age, working status, and education in CVD risk perception, an association between CVD risk perception and age was observed (p=0.01), with patients over 40 years exhibiting a higher perception of CVD risk. No differences were found regarding working status (p=0.19) nor education level (p=0.06). ConclusionsPatients with SS, RA, and SSc displayed a heightened perception of cardiovascular risk, correlating with their actual risk and preexisting comorbidities. However, patients exhibited unawareness of certain cardiovascular risk behaviors. This underscores the need for tailored education programs on cardiovascular risk for autoimmune disease patients, to be implemented at the time of diagnosis and during follow-up in outpatient clinics.

Cardiovascular disease in patients with systemic autoimmune diseases: The relationship between self-perceived risk and actual risk

IntroductionAutoimmune diseases are known to be associated with an elevated risk of cardiovascular diseases; however, there exists a lack of awareness regarding this increased risk among patients. ObjectiveThis study aimed to assess the prevalence of cardiovascular risk factors and events in various systemic autoimmune diseases, including Systemic Sclerosis (SSc), Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), and Sjögren's syndrome (SS), matched by age, sex, and disease duration. Additionally, the study aimed to evaluate the perceived and actual risks of cardiovascular disease among patients. MethodsA cross-sectional self-reported survey on the patient's perspective of cardiovascular risk was conducted between January and June 2023. Sociodemographic and clinical data, including disease activity, were collected through medical records and questionnaires. Traditional cardiovascular risk factors and events were assessed, alongside the perceived cardiovascular risk. The SCORE calculation and Charlson Comorbidity Index (CCI) were employed for cardiovascular risk assessment. ResultsSurvey responses from 180 patients (45 patients each with SSc, SLE, RA, and SS) with systemic autoimmune diseases revealed that 20% perceived a low risk, 23% perceived neither lower nor higher, and 56% perceived a higher risk of developing cardiovascular diseases in the next ten years. Only 45% agreed that their autoimmune disease could increase the risk of a heart attack, even in the absence of other risk factors, and 46.7% were unaware that NSAIDs pose a cardiovascular risk. An association between cardiovascular risk measured by SCORE, comorbidities, and risk perception was observed in RA, SSc, and SS patients, with no association found in SLE patients (p=0.27). Except for SS patients (p=0.02), no association between CCI and disease activity level was found. Regarding the influence of age, working status, and education in CVD risk perception, an association between CVD risk perception and age was observed (p=0.01), with patients over 40 years exhibiting a higher perception of CVD risk. No differences were found regarding working status (p=0.19) nor education level (p=0.06). ConclusionsPatients with SS, RA, and SSc displayed a heightened perception of cardiovascular risk, correlating with their actual risk and preexisting comorbidities. However, patients exhibited unawareness of certain cardiovascular risk behaviors. This underscores the need for tailored education programs on cardiovascular risk for autoimmune disease patients, to be implemented at the time of diagnosis and during follow-up in outpatient clinics.

Association of early life adversity with cardiovascular disease and its potential mechanisms: a narrative review.

Strong epidemiological evidence has shown that early life adversity (ELA) has a profound negative impact on health in adulthood, including an increased risk of cardiovascular disease, the leading cause of death worldwide. Here, we review cohort studies on the effects of ELA on cardiovascular outcomes and the possible underlying mechanisms. In addition, we summarize relevant studies in rodent models of ELA. This review reveals that the prevalence of ELA varies between regions, time periods, and sexes. ELA increases cardiovascular health risk behaviors, susceptibility to mental illnesses, and neuroendocrine and immune system dysfunction in humans. Rodent models of ELA have been developed and show similar cardiovascular outcomes to those in humans but cannot fully replicate all ELA subtypes. Therefore, combining cohort and rodent studies to further investigate the mechanisms underlying the association between ELA and cardiovascular diseases may be a feasible future research strategy.

Chronic pain-mental health comorbidity and excess prevalence of health risk behaviours: a cross-sectional study.

Chronic musculoskeletal pain and anxiety/depression are significant public health problems. We hypothesised that adults with both conditions constitute a group at especially high risk of future cardiovascular health outcomes. To determine whether having comorbid chronic musculoskeletal pain and anxiety/depression is associated with the excess prevalence of selected known cardiovascular health risk behaviours. A cross-sectional survey of adults aged 35+ years randomly sampled from 26 GP practice registers in West Midlands, England. Respondents were classified into four groups based on self-reported presence/absence of chronic musculoskeletal pain (pain present on most days for six months) and anxiety or depression (Hospital Anxiety and Depression Score 11+). Standardised binomial models were used to estimate standardised prevalence ratios and prevalence differences between the four groups in self-reported obesity, tobacco smoking, physical inactivity, and unhealthy alcohol consumption after controlling for age, sex, ethnicity, deprivation, employment status and educational attainment. The excess prevalence of each risk factor in the group with chronic musculoskeletal pain-anxiety/depression comorbidity was estimated. Totally, 14519 respondents were included, of whom 1329 (9%) reported comorbid chronic musculoskeletal pain-anxiety/depression, 3612 (25%) chronic musculoskeletal pain only, 964 (7%) anxiety or depression only, and 8614 (59%) neither. Those with comorbid chronic musculoskeletal pain-anxiety/depression had the highest crude prevalence of obesity (41%), smoking (16%) and physical inactivity (83%) but the lowest for unhealthy alcohol consumption (18%). After controlling for covariates, the standardised prevalence ratios and differences for the comorbid group compared with those with neither chronic musculoskeletal pain nor anxiety/depression were as follows: current smoking [1.86 (95% CI 1.58, 2.18); 6.8%], obesity [1.93 (1.76, 2.10); 18.9%], physical inactivity [1.21 (1.17, 1.24); 14.3%] and unhealthy alcohol consumption [0.81 (0.71, 0.92); -5.0%]. The standardised prevalences of smoking and obesity in the comorbid group exceeded those expected from simple additive interaction.

Evaluation of an application for the self-assessment of lifestyle behaviour in cardiac patients.

Currently, no uniform, well-validated and comprehensive lifestyle behaviour self-assessment instrument exists for patients with cardiovascular disease. To evaluate the usability of anovel mobile application (LifeStyleScore) based on validated instruments for the assessment of cardiovascular risk behaviours. Secondly, the application's acceptance by healthcare professionals (HCPs) and its association with improved patient activation and lifestyle behaviour was evaluated. In this single-centre, non-randomised observational pilot study, patients with coronary artery disease or atrial fibrillation entering cardiac rehabilitation (CR) completed the LifeStyleScore application, the Patient Activation Measure (PAM-13®), and the System Usability Scale (SUS) during the CR intake and after CR completion. Afocus group interview was performed with the HCPs involved. We analysed 20participants, 3of whom were women, with amean age of 61.9 ± 6.7years. The LifeStyleScore application was rated with aSUS score above average (> 68) before (69.6 ± 13.4) and after CR (68.6 ± 15.1). All HCPs (n = 8) found the application usable. Patient activation did not increase significantly after CR compared with baseline (62.0 ± 8.6 versus 59.2 ± 9.5, respectively, p = 0.28) and only physical activity levels improved significantly (2.4 ± 0.7 (standardised score) at baseline, 2.8 ± 0.4 after CR, p = 0.04). The LifeStyleScore application was found to be usable for patients receiving CR. Its use did not result in increased patient activation, and of the lifestyle behaviours only physical activity levels improved. Further research is needed to evaluate how such applications can be optimally incorporated in CR programmes.

Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation. Purpose The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement. Methods In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals. Results All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (>68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2). Conclusions The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.

Patients’ understanding of long-term cardiovascular risks and associated health-seeking behaviours after pre-eclampsia

ObjectiveThe lifelong risks of cardiovascular disease following hypertensive disorders of pregnancy are well described. Awareness of these risks and associated health-seeking behaviours among affected individuals remains unclear. We aimed to...

What is the effect of the interventions for reducing sedentary behaviour in people with stroke? A Cochrane Review summary with commentary.

Many stroke survivors are both sedentary and physically inactive, even those who have adequate mobility. This increases cardiometabolic risk and has impacts on physical and other functions. The aim of this Cochrane Review summary is to discuss from a rehabilitation perspective the results of the Cochrane review investigating the effects of the interventions designed to reduce sedentary behavior after stroke on mortality, secondary vascular events, cardiovascular risk, adverse events and sedentary behavior. The review authors searched for randomized controlled trials that had been published up to December 2019, comparing the effects of the interventions aimed to reduce sedentary behavior in patients after stroke with usual care, no intervention, sham intervention. The results of the review showed that the interventions included did not affect the number of deaths or the incidence of recurrent cardiovascular or cerebrovascular events, falls or other adverse events in stroke patients. Evidence for their impact on sedentary behavior is currently inconclusive. The evidence about reducing sedentary behavior in patients after stroke is incomplete, since research in this field is relatively new. Practitioners may also encourage reduction in sitting during daytime by considering interventions for other therapeutic targets (e.g. increasing physical activity and mobility), besides the studied interventions that proved to be safe and harmless.

A Systematic Review to Identify Targets of Mindfulness-Based Interventions for Cardiovascular Risk to Enhance Engagement with Racial/Ethnic Minorities

Cardiovascular disease (CVD) is a persistent public health challenge and racial/ethnic minority populations experience disparities in CVD risk factors. Mindfulness-based interventions (MBIs) have been examined as a strategy to address CVD risk factors, though their potential for implementation with racial and ethnic minorities remains unclear. This review examines primary intervention studies testing the impact of MBI on CVD risk, with a focus on critical appraisal of implementation characteristics (i.e., intervention design, delivery, uptake, and contextual factors) relevant to the engagement of racial/ethnic minority populations. A systematic review identified 30 studies published through January 2022 for inclusion. Included studies were randomized controlled trials testing meditation or mindfulness-based interventions against any control to measure change or improvement in cardiovascular health measures or risk behaviors in adults living in the US or territories. The Oxford Implementation Index was utilized to identify and extract relevant implementation data, and critical analysis of each study’s implementation process was conducted. All identified studies were published between 2011 and 2021 and represent early or pilot stages of research. As such, limitations and barriers in implementation strategies for racial/ethnic minority populations were identified. This review outlines several potential targets for future research to enhance engagement with racial/ethnic minorities. Trial Registration. PROSPERO CRD42019141454.

Cardiovascular health risk behaviors among college students of Pokhara, Nepal

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated 17.9 million lives each year. However, most cardiovascular diseases can be prevented by addressing behavioral risk factors. The objective of this study was to identify cardiovascular health risk behaviors among college students of Pokhara.
 Method: Descriptive, cross sectional, web based study was conducted among 390 college students of Pokhara from 10 June to 30 July, 2021. Online self-administered structured questionnaire was used for data collection using purposive and snowball sampling technique. The collected data were analyzed using descriptive (frequency, percentage, mean, standard deviation) and inferential statistics (Chi square).
 Result: In this study, smoking, tobacco use and alcohol consumption were present among 33(8.5%), 13(3.3%) and 45(11.5%) respondents respectively. Further consumption of junk food was found among 349(89.5%) followed by screen time of more than two hours among 300(76.9%) respondents. A statistically significant association was found in age (p=0.17) and gender (p<0.001) with smoking. Similarly, statistically significant association was found in gender (p<0.001) with tobacco use and in age (p=0.028), gender (p<0.001), education (p=0.026) and family type (p=0.009) with alcohol consumption.
 Conclusion: Cardiovascular health risk behaviors such as smoking, tobacco use and alcohol intake was found more among male students. Further consumption of junk food along with screen time of more than two hours was found among most of the college students.

Provincial heterogeneity in the management of care cascade for hypertension, diabetes, and dyslipidaemia in China: Analysis of nationally representative population-based survey.

BackgroundThis study aims to examine (1) province-level variations in the levels of cardiovascular disease (CVD) risk and behavioral risk for CVDs, (2) province-level variations in the management of cascade of care for hypertension, diabetes, and dyslipidaemia, and (3) the association of province-level economic development and individual factors with the quality of care for hypertension, diabetes, and dyslipidaemia.MethodsWe used nationally representative data from the China Health and Retirement Longitudinal Study in 2015, which included 12,597 participants aged 45 years. Using a care cascade framework, we examined the quality of care provided to patients with three prevalent NCDs: hypertension, diabetes, and dyslipidaemia. The proportion of WHO CVD risk based on the World Health Organization CVD risk prediction charts, Cardiovascular Risk Score (CRS) and Behavior Risk Score (BRS) were calculated. We performed multivariable logistic regression models to determine the individual-level drivers of NCD risk variables and outcomes. To examine socio-demographic relationships with CVD risk, linear regression models were applied.ResultsIn total, the average CRS was 4.98 (95% CI: 4.92, 5.05), while the average BRS was 3.10 (95% confidence interval: 3.04, 3.15). The weighted mean CRS (BRS) in Fujian province ranged from 4.36 to 5.72 (P < 0.05). Most of the provinces had a greater rate of hypertension than diabetes and dyslipidaemia awareness and treatment. Northern provinces had a higher rate of awareness and treatment of all three diseases. Similar patterns of regional disparity were seen in diabetes and dyslipidaemia care cascades. There was no evidence of a better care cascade for CVDs in patients who reside in more economically advanced provinces.ConclusionOur research found significant provincial heterogeneity in the CVD risk scores and the management of the cascade of care for hypertension, diabetes, and dyslipidaemia for persons aged 45 years or more. To improve the management of cascade of care and to eliminate regional and disparities in CVD care and risk factors in China, local and population-based focused interventions are necessary.

Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study

IntroductionWe delivered a video-based, cardiovascular disease prevention focused intervention in cardiology waiting rooms that increased motivation to improve cardiovascular risk behaviours and satisfaction with clinic services. To better understand the...

Correlates of the nicotine metabolite ratio in Alaska Native people who smoke cigarettes.

Research on nicotine metabolism has primarily focused on white adults. This study examined associations between nicotine metabolism, tobacco use, and demographic characteristics among Alaska Native adults who smoke cigarettes. Participants (N = 244) were Alaska Native adults who smoked and who provided a plasma sample at baseline (70.1%) or follow-up (29.9%) of a randomized controlled trial of a cardiovascular risk behavior intervention. At baseline, participants self-reported age, sex, Alaska Native heritage, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, tobacco withdrawal symptoms, and past-month tobacco product use, binge drinking, and cannabis use. At 3-, 6-, 12-, and 18-month follow-ups, participants self-reported 7-day point prevalence abstinence from smoking. Height and weight were measured to calculate body mass index (BMI). Participants' nicotine metabolite ratio (NMR), calculated as the ratio of plasma cotinine and trans-3' hydroxycotinine, was log-transformed. The sample (52.0% male, age M = 47.0 years [SD = 13.8], 60.3% of Inupiaq heritage) averaged 12.5 cigarettes per day (SD = 10.5); 64.0% smoked within 30 min of wakening. NMR was not significantly associated with age, sex, Alaska Native heritage, BMI, cigarettes per day, time to first cigarette upon wakening, menthol use, perceived difficulty staying quit, past-month dual tobacco product use, withdrawal symptoms, past-month binge drinking, past-month cannabis use, or abstinence from smoking (all p-values > .050). Characteristics that relate to NMR in Alaska Native adults may differ from those typically identified among white adults. Specifically, results may suggest that Alaska Native adults with slower nicotine metabolism do not titrate their nicotine intake when smoking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cardiovascular risk behavior among industrial workers in the Northeast of Brazil: a cluster analysis.

This research aimed to investigate the occurrence of clusters of cardiovascular risk behaviors and their association with social demographic and occupational characteristics in a population of industrial workers in the metropolitan area of Recife, Brazil. It was a transversal study with 727 workers of both genders. We identified cluster distribution from the variables: smoking, alcohol consumption, physical activity and waist circumference, by a combination of hierarchical and non-hierarchical analysis. We later tested the association with the social demographic and occupational variables with a multi-varied analysis. We have identified a protection cluster (sufficient physical activity, moderate alcohol consumption) and a risk cluster (high waist circumference, sedentarism, smoking, excessive alcohol consumption). The protection cluster was positively associated with night shift or variable shift work (RP: 1.66, IC95%: 1.26-2.17), and the risk cluster was associated with women (RP: 1.15, IC95%: 1.01-1.31). Cluster analysis allowed to identify that, for day shift workers and women, the shortest daytime outside the work environment can influence the adoption of cardiovascular risk behaviors.

A survey-based comparison of cardiovascular health risk behaviours in Indian men and women during the pandemic

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD), the leading cause of mortality globally, is caused by a combination of behavioral, clinical and genetic risk factors. The rising prevalence of unhealthy diet, inadequate exercise, psychosocial factors and tobacco use in urban and rural populations of India has posed a major epidemiological and healthcare threat in the recent past. Purpose This study aims to understand the cardiovascular health risk behaviors in Indian men and women during the pandemic. Methods A survey-based study was conducted at different time points between April 2020 and August 2021. A pre-tested anonymized self-administered questionnaire was distributed online as a pre-program assessment of participants registering for the health awareness webinars conducted by our team. Demographic data and CVD risk behaviors pertaining to dietary consumption, exercise routine, sedentary behavior, psychosocial factors, sleep pattern, tobacco use and alcohol consumption were collected. Not meeting daily intake of whole grains and at least 4 portions of vegetables and fruits, non-performance of at least 150 minutes of brisk aerobic exercise per week, chronic stress and use of tobacco were considered risky behaviors, as per the international guidelines. Results Of the 573 subjects, 305 (53%) were women and 236 (41%) were 15-30 years old. Majority of subjects were not meeting their requirements pertaining to whole grains (76%) and fruits/vegetables (72%). Inadequate exercise (48%), chronic stress (31%) and tobacco use (5%) were noted. Significantly more women than men (p = 0.0001) were falling short in their exercise requirement. Significantly more men than women (p = 0.0001) were using tobacco products (Figure). Conclusion Cardiovascular risk behaviors are highly prevalent in Indian men and women during the pandemic calling for a coordinated effort to increase awareness and modify to a healthy behavior. Abstract Figure. Risk behaviors in study subjects Abstract Figure. Comparison of risk behaviors

Cardiovascular outcome of former late-onset small-for-gestational-age children at 1year of age: CURIOSA study.

Late-onset small-for-gestational-age (SGA) fetuses usually show normal uterine artery Doppler and were long considered to have a good peri- and postnatal outcome. Recently, these fetuses were identified to have a risk factor for cardiovascular disease. The aim of our study was to evaluate former SGA children concerning their cardiovascular risk and nutrition behavior at the age of 1year. We performed a prospective longitudinal cohort study at the University Hospital "Klinikum rechts der Isar" of the Technical University of Munich. Singleton pregnancies from 32weeks with suspicion of SGA and healthy control pregnancies were included. A total of 100 former SGA children and 113 controls with normal weight (AGA) were examined at 1year of age. Drop-out for 1-year follow-up was 27%. SGA children had significantly higher systolic (92.8 ± 9.8mmHg vs. 87.5 ± 10.7mmHg, p = 0.001), diastolic (63.1 ± 8.5mmHg vs. 60.0 ± 10.3mmHg, p = 0.028) and mean (73.0 ± 7.8 vs. 69.2 ± 9.7mmHg, p = 0.004) blood pressure than AGA children. Comparing two breastfeeding periods (0-4months vs. > 7months), a downward trend in blood pressure values for longer breastfeeding periods was shown. Our study showed that even late-onset small-for-gestational-age fetuses seem to have cardiovascular problems, although they were previously thought to be "healthy". Up to now, blood pressure measurement is not part of indicated health checks in former SGA or even fetal growth-restricted children which should be changed. Further studies are needed to investigate cardiovascular prevention programs in children.

The significant places of African American adults and their perceived influence on cardiovascular disease risk behaviors

BackgroundAA living in rural areas of the southeastern U.S. experience a disproportionate burden of cardiovascular disease (CVD) morbidity and mortality. Neighborhood environmental factors contribute to this disparity and may decrease the effectiveness of lifestyle interventions aimed at preventing CVD. Furthermore, the influence of neighborhood factors on AA CVD risk behaviors (i.e. physical activity) may be obscured by the use of researcher-defined neighborhoods and researcher-defined healthy and unhealthy places. The objective of this study was to elucidate the effects of neighborhood environments on AA CVD risk behaviors among AA adults who recently completed a lifestyle intervention. We specifically sought to identify AA adults’ self-perceived places of significance and their perceptions of how these places impact CVD risk behaviors including diet, physical activity and smoking.MethodsWe conducted semi-structured interviews with AA adults (N = 26) living in two rural North Carolina counties (Edgecombe and Nash, North Carolina, USA). Participants were recruited from a community-based behavioral CVD risk reduction intervention. All had at least one risk factor for CVD. Participants identified significant places including where they spent the most time, meaningful places, and healthy and unhealthy places on local maps. Using these maps as a reference, participants described the impact of each location on their CVD risk behaviors. Data were transcribed verbatim and coded using NVivo 12.ResultsThe average age of participants was 63 (SD = 10) and 92% were female. Places participants defined as meaningful and places where they spent the most time included churches and relatives’ homes. Healthy places included gyms and parks. Unhealthy places included fast food restaurants and relatives’ homes where unhealthy food was served. Place influenced CVD risk behaviors in multiple ways including through degree of perceived control over the environment, emotional attachment and loneliness, caretaking responsibilities, social pressures and social support.ConclusionsAs we seek to improve cardiovascular interventions for rural AA in the American South, it will be important to further assess the effect of significant places beyond place of residence. Strategies which leverage or modify behavioral influences within person-defined significant places may improve the reach and effectiveness of behavioral lifestyle interventions.