Changes In Cardiovascular Disease Risk Factors Research Articles

Abstract P40: The Impact of a COSEHC Physician Education Program on Patient Cardiovascular Disease Risk Variables in a Large South Carolina Medical Practice

COSEHC is conducting an 18-month prospective nested cohort design study, COSMIC [ CO SEHC Cu S tomized Model of Intervention and Care], which evaluates the effectiveness of a physician process improvement education program to reduce gaps in physicians’ application of cardiovascular disease (CVD) guidelines in a primary care South Carolina (SC) practice. The COSMIC project evaluates patient CVD risk variable outcomes as a measure of physician improvement. This study evaluates changes in patient CVD risk between baseline (BL) and 6 months (6-mo) among physician cohort 1 (CH1; n=1200 patient records) receiving COSMIC physician education and the control group (cohort 2 (CH2); n=1200 patient records). The COSMIC program involves educational modules that promote clinical care systems changes using JNC 7 and ATP III revised guidelines followed by a repeat process based on reassessed outcomes. At 6-mo, there was statistically more improvement in diastolic blood pressure (DBP) for CH2 than CH1. However, no other CVD outcomes changes were noted between CH1 and CH2 for systolic blood pressure (SBP) total, LDL, or HDL cholesterol (TC, LDL-C, HDL-C), triglycerides, hemoglobin A1c (HgA1c), creatinine, or body mass index (BMI)] using the last observation carried forward method ( Table 1 ). While improvements in TC, triglycerides, and HgA1c increased for both groups at 6-mo, CH1 tended to have smaller increases than CH2, respectively. Changes in LDL-C showed improvement for CH1 at 6-mo while CH2 did not improve. Additionally, CH1 had a higher percentage of total patients with return values/visits for each CVD risk factor. This project, while showing no statistically significant changes over 6-mo other than DBP, reveals a trend for modest improvements with physician education for 6-mo in a SC primary care practice. Continuation of this program inclusive of improved clinical care systems will determine the ultimate impact on improving CVD risk in the Southeast United States. Table 1. A comparison of changes in CVD risk factors between BL and 6-mo among CH1 and CH2. * p < 0.05 Cohort 1 (mean ± SD) Cohort 2 (mean ± SD) Changes in Systolic Blood Pressure (mm Hg) -0.91 ± 15.56 -1.79 ± 15.11 Chanegs in Diastolic Blood Pressure (mm Hg) -0.76 ± 9.47 * -1.74 ± 8.63 Changes in Total Cholesterol (mg/dL) 0.92 ± 22.79 1.57 ± 22.39 Changes in LDL Cholesterol (mg/dL) -0.34 ± 19.58 0.08 ± 18.15 Changes in HDL Cholesterol (mg/dL) 1.04 ± 5.87 1.01 ± 5.34 Changes in Triglycerides (mg/dL) 0.55 ± 37.01 0.74 ± 37.81 Changes in Hemoglobin A1c (%) 0.003 ± 0.59 0.062 ± 0.68 Changes in Creatinine (mg/dL) -0.03 ± 0.16 -0.03 ± 0.13 Changes in Body Mass Index (BMI) 0.07 ± 2.12 0.08 ± 1.69

Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes

OBJECTIVEOverweight and obese individuals are encouraged to lose 5–10% of their body weight to improve cardiovascular disease (CVD) risk, but data supporting this recommendation are limited, particularly for individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted an observational analysis of participants in the Look AHEAD (Action For Health in Diabetes) study (n = 5,145, 40.5% male, 37% from ethnic/racial minorities) and examined the association between the magnitude of weight loss and changes in CVD risk factors at 1 year and the odds of meeting predefined criteria for clinically significant improvements in risk factors in individuals with type 2 diabetes.RESULTSThe magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight.CONCLUSIONSModest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.

Changes in CVD risk factors in the activity counseling trial.

Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35–74 years. Participants were randomly assigned to one of three arms that varied by level of counseling, intensity, and resource requirements. Because there were no significant differences in change over time between arms on any of the CVD risk factors examined, all arms were combined, and the effects of time, independent of arm, were examined separately for men and women. Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status. Significant improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, the ratio of total cholesterol to HDL-C, and triglycerides were seen in both men and women who had high (or low for HDL-C) baseline levels of risk factors, whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels. There were no improvements in any risk factors among participants with normal baseline levels. Changes in fitness were associated with changes in a number of CVD risk factors. However, most relationships disappeared after controlling for changes in body weight. Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%–26% in men and 11%–16% in women. Interventions that can be implemented in health care settings nationwide and result in meaningful population-wide changes in CVD risk factors are needed. The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors.

Call to Action: Cardiovascular Disease in Asian Americans

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need. Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research. Because health surveys and questionnaires almost universally combine persons of Asian ancestry into a single group, the heterogeneity within this classification is masked. Socioeconomic and cultural factors have been found to be associated with CVD and its risk factors, which is why it is important to understand these differences among Asian subgroups. The Table shows the number of persons in each group based on the most recent US Census data available (American Community Survey, 2008), with the recognition that …

Cardiovascular disease risk factors and dietary habits of farmers from Crete 45 years after the first description of the Mediterranean diet

Farmers from Crete as first studied within the framework of the Seven Countries Study, were historically known for holding the title of the 'gold standard' of health status globally and had a very low prevalence of both cardiovascular disease (CVD) and cancer. Taking the above into account we evaluated the changes in CVD risk factors among farmers in Crete, Greece and compared our findings with data from the 1960s. Cross-sectional. Five hundred and two farmers (18-79 years old) from the Valley of Messara in Crete were randomly selected and examined in 2005. Complete clinical, biochemical, dietetic, anthropometrical and lifestyle CVD risk factors were assessed, matched and compared with published data from the 1960s. In comparison with 45 years ago, present day male farmers from Crete were found to have a 30% higher BMI (29.8 vs. 22.9 kg/m, P<0.001) and a 16% higher total cholesterol level (239.6 vs. 206.9 mg/dl, P<0.001) and also a not so favourable daily dietary intake (increase in meat and saturated fat and decrease in fruit, P<0.001, respectively), while a significant reduction in systolic blood pressure and energy intake was noticed. In regards to changes in subcutaneous adipose tissue fatty acid composition, a decrease in monounsaturated (P<0.001) and an increase in saturated fatty acids (P<0.001) was also found elucidating the temporal change in dietary habits. The population's lack of adherence to the Mediterranean diet, have led to the fact that currently farmers from Crete are likely to be at a higher risk for developing CVD in comparison with earlier generations.

Community Programs for the Prevention of Cardiovascular Disease: A Systematic Review

In this systematic review, the authors aimed to assess the effectiveness of community programs for prevention of cardiovascular disease (CVD). They searched numerous electronic databases (CDSR, DARE, HTA, EED, and CENTRAL via the Cochrane Library, MEDLINE, MEDLINE In Process, EMBASE, CINAHL, PsycINFO, HMIC, and ASSIA) and relevant Web sites from January 1970 to mid-July 2008. Controlled studies of community programs for the primary prevention of CVD were included. Net changes in CVD risk factors were used to generate an overall index for net change in 10-year CVD risk. The authors identified 36 relevant community programs that took place between 1970 and 2008. These programs were multifaceted interventions employing combinations of media, screening, and counseling activities and environmental changes and were primarily evaluated using controlled before-after studies. In 7 studies, investigators reported changes in CVD/total mortality rates, and in 5 they reported net changes. In all cases, these net changes were positive but were largely nonsignificant. In 22 studies, investigators reported changes in physiologic CVD risk factors, and there was a positive trend in the calculated CVD risk score. The average net reduction in 10-year CVD risk was 0.65%. Community programs for CVD prevention appear to have generally achieved favorable changes in overall CVD risk and, with adaptation to current circumstances, deserve continued consideration as possible approaches to preventing CVD.

Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population

OBJECTIVESThe aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.METHODSA total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.RESULTSWith regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.CONCLUSIONImprovements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.

Effects of smoking cessation and weight gain on cardiovascular disease risk factors in Asian male population

Objective Smoking cessation leads to both beneficial and harmful changes in cardiovascular disease (CVD) risk factors. The basis of the harmful changes, however, is unknown. Our objective was to determine whether they are associated with the weight gain that accompanies smoking cessation. Methods Study subjects were male cigarette smokers aged at least 30 years who visited the Health Promotion Center of Seoul National University Hospital between 1995 and 2007 repeatedly with a 1- to 3-year interval between first and second visit. Self-reporting questionnaires gathered clinical and socio-economic characteristics on the initial visit, and CVD risk factors (blood pressure, fasting blood glucose, and serum lipid profile) were measured on both the visits. Results We compared the CVD risk factors between smoking quitters and smoking continuers. The quitters were more likely than the continuers to have harmful health changes such as increase in body weight ( P < 0.01), in systolic blood pressure, and in serum levels of total cholesterol, LDL-cholesterol, and non-HDL cholesterol ( P < 0.05). When stratified by body weight change, quitters who had gained more than the median (1.3 kg) were more likely than those who had not to have increase in blood pressure ( P < 0.01) and in serum levels of total cholesterol, triglycerides, non-HDL cholesterol, and fasting glucose ( P < 0.05). Conclusions Harmful changes in CVD risk factors associated with smoking cessation were mainly secondary to weight gain. To reduce the risk of cardiovascular disease in quitters, therefore, more attention should be focused on preventing weight gain.

Sexual Maturation Affects Diet–Blood Total Cholesterol Association in Children: Project HeartBeat!

Cardiovascular disease (CVD) does not become clinically manifest until adulthood. However, children and young adults have evidence of atheromatous lesions and fatty streaks in their aortas and coronary vessels. Most longitudinal studies in children are not designed to evaluate the dynamics of change in CVD risk factors. There is a need to describe the trajectory of CVD risk factors as growth processes, to better understand their relationships. This study assesses the associations between dietary variables and blood total cholesterol concentration (BTCC) among children and adolescents aged 8-18 years after adjustment for sexual maturation.There were 678 boys and girls aged 8, 11, and 14 years at baseline who were followed for up to 4 years, allowing the creation of a synthetic cohort analytically, from ages 8-18 years. Multilevel modeling was used to longitudinally assess BTCC, dietary intake, Tanner stage, and BMI.For every 1-mg/day increase in dietary cholesterol, BTCC increased by 0.012 mg/dL. However, no associations were evident between BTCC and dietary total fat, saturated fatty acids, polyunsaturated fatty acids, or monounsaturated fatty acids. In girls, none of the dietary variables was significantly associated with BTCC after controlling for Tanner stage for breast. In boys, with the exception of dietary cholesterol, no other dietary variable was significantly associated with BTCC after controlling for Tanner stage for genitalia.Sexual maturation exerts a strong influence on BTCC in children and adolescents aged 8-18 years, obscuring most associations between diet and BTCC. The inclusion of sexual maturity stage is important in studies of blood lipids among children and adolescents.

A Lifestyle Approach for Primary Cardiovascular Disease Prevention in Perimenopausal to Early Postmenopausal Women

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A large proportion of deaths attributable to CVD occur in asymptomatic women, making early detection and diagnosis difficult. As a result, women tend to be diagnosed at later stages of disease when compared with men. In addition, women have not experienced as great a decline in CVD mortality in recent decades as have men. Therefore, the development of primary CVD prevention strategies to decrease the CVD risk in women has become a major public health priority and creates the need for alternate strategies to be developed to decrease CVD risk in women. The success of a nonpharmacological, lifestyle approach for primary CVD prevention has recently been demonstrated in perimenopausal to early postmenopausal women. Two clinical trials, the Women's Healthy Lifestyle Project (WHLP) and Women On the Move through Activity and Nutrition (WOMAN) study, examined the role of lifestyle to prevent unfavorable CVD risk factor changes that typically occur as a woman transitions through menopause. In both studies, a lifestyle intervention approach, with modest dietary restrictions and increased leisure physical activity, was effective for weight loss and/or weight maintenance and CVD risk factor reduction. More research is needed to determine the long-term benefits of a lifestyle intervention to prevent CVD in women. The existing evidence suggests that the promotion of healthy lifestyle practices by health care providers is a valuable strategy for CVD risk factor reduction in women transitioning through menopause.

Adipocytokine and ghrelin levels in relation to cardiovascular disease risk factors in women at midlife: longitudinal associations

There are limited data concerning the relationships between changes in adipocytokines and cardiovascular disease (CVD) risk factors. To examine the longitudinal associations between leptin, adiponectin, resistin and ghrelin levels and CVD risk factor levels in women at midlife. Prospective, observational study. Leptin, adiponectin, resistin, ghrelin levels and CVD risk factors were measured in specimens collected from 40 women at 3 points in time corresponding to the pre-, peri- and postmenopause stages of their natural menopause transition. In longitudinal analyses adjusted for CVD risk factors and leptin at the previous menopausal stage, aging, education, smoking and physical activity, greater increases in leptin over the menopause transition were associated with greater decreases in high-density lipoprotein cholesterol (HDL-c) and greater increases in diastolic blood pressure, glucose, insulin and insulin resistance (all P < 0.05). Larger decreases in adiponectin over the menopause transition were associated with greater increases in systolic blood pressure, insulin and insulin resistance and with greater decreases in HDL-c. Greater increases in ghrelin levels over the menopausal transition were associated with greater low-density lipoprotein cholesterol increases (P = 0.014). Resistin was not associated with CVD risk factor changes. There were significant adverse associations of adipocytokines and ghrelin with multiple CVD risk factor changes in women across midlife. Given that this time period is dynamic for CVD risk, these data underscore the need for additional prospective studies.

Effect of the PPAR-Alpha L162V Polymorphism on the Cardiovascular Disease Risk Factor in Response to n–3 Polyunsaturated Fatty Acids

Background: Dietary n–3 polyunsaturated fatty acids (PUFAs) decrease the risk of cardiovascular disease (CVD). Yet, genetic variations of the gene encoding the peroxisome proliferator-activated receptor-α (PPARα) can also modulate CVD risk factors. Since fatty acids, including n–3 PUFAs, are natural ligands of PPARα, a gene-diet interaction effect could be observed. Aims: To examine whether n–3 PUFA- induced changes in CVD risk factors are influenced by the PPARα L162V polymorphism. Methods: Fourteen men, carriers of the V162 allele and 14 L162 homozygotes, were matched according to age and body mass index. Subjects followed, for 8 weeks, a low-fat diet and then were supplemented daily with 5 g of fish oil for 6 weeks. Results: Baseline characteristics were similar for both genotype groups. Independently of the genotype, the supplementation was associated with a significant decrease in plasma triacylglycerol and fasting glucose concentrations, diastolic blood pressure, and with an increase in total apolipoprotein B concentrations. The extent of the decrease in plasma triacylglycerol concentrations was comparable for both genotype groups (p < 0.03). A significant genotype-by-diet interaction effect was observed for plasma C-reactive protein concentrations (p = 0.01). Conclusions: The PPARα L162V polymorphism may contribute to the interindividual variability in the CVD risk factor response to n–3 PUFAs.

Discontinuing Hormone Replacement Therapy: Attenuating the Effect on CVD Risk With Lifestyle Changes

Concern about the potential risks associated with hormone replacement therapy (HRT) has left post-menopausal women and healthcare providers searching for safe and effective means for cardiovascular disease (CVD) risk factor reduction. The Woman On the Move through Activity and Nutrition study is a 5-year clinical trial (2002-2006) designed to test whether a lifestyle intervention will reduce measures of subclinical CVD. Participants were randomized at baseline to a health education or lifestyle change group. The impact of lifestyle intervention on CVD risk factors was examined in 240 women who were initially on HRT at baseline and either continued (n = 110) or discontinued (n = 130) by 18 months. The lifestyle-change group significantly decreased weight, body mass index, waist circumference (all p<0.0001), total cholesterol (p=0.02), and LDL cholesterol (LDL-C) (p= 0.01), improved fat intake (p<0.0001), and increased leisure physical activity (p=0.005) when compared with the health education group. HRT discontinuation resulted in increased total cholesterol (p=0.04) and LDL-C (p=0.009). CVD risk factor changes were further explored by the HRT group, stratified by randomized group assignment. Within the health education arm, HRT discontinuers averaged over a 22-mg/dL increase in total cholesterol and LDL-C, while HRT continuers averaged less than 4 mg/dL (p=0.004 and 0.002, respectively). No such differences were noted in the lifestyle-change group (p=0.78 and 0.90, respectively). Lifestyle modification was effective for CVD risk factor reduction in post-menopausal women. HRT discontinuation resulted in increased total cholesterol and LDL-C, which were successfully attenuated by a lifestyle intervention incorporating weight loss, physical activity, and dietary modification.

Can a Lifestyle Intervention Attenuate the Effect of Discontinuing Hormone Therapy on CVD Risk Factors?

Cardiovascular disease (CVD) continues to be the leading cause of death in postmenopausal (PM) women. Concern about the potential risks associated with hormone therapy (HT) has left women and heath care providers searching for safe and effective means for risk factor reduction. PURPOSE: To determine the impact of a lifestyle intervention on CVD risk factors among women who were initially on HT at baseline and either continued or discontinued HT use at 18 months. METHODS: The Woman On the Move through Activity and Nutrition (WOMAN) study is clinical trial designed to test whether a lifestyle intervention will reduce measures of subclinical CVD. Participants were randomized at baseline to either a health education (HE) or lifestyle change (LC) group. The impact the lifestyle intervention on CVD risk factors was examined in 240 PM [58.3 (2.9) years] women who either continued (n=110) or discontinued HT use (n=130) by 18 months. RESULTS: The lifestyle intervention had a beneficial impact on CVD risk factor reduction. Compared to the HE group, women in the LC group had greater reductions in weight, BMI, and waist circumference (all p<0.0001). The LC group also significantly decreased insulin (p=0.04), improved saturated fat/cholesterol intake (p<0.0001), and increased leisure physical activity (p=0.005) levels. Both groups increased total cholesterol and LDL cholesterol (LDL-C) levels; however, the increases were significantly less in the LC group (p=0.02 and p=0.01, respectively). CVD risk factor changes were further explored by hormone therapy group, stratified by randomized group assignment. The HT group by randomized group interaction was statistically significant with regards to total cholesterol and LDL-C (both p=0.02). Within the HE arm, women who discontinued HT had significantly higher increases in total and LDL-C as compared to HT continuers (both p<0.01), whereas no such differences were observed in the LC arm. CONCLUSIONS: A lifestyle intervention was effective for CVD risk factor reduction in PM women. Negative lipid consequences of discontinuing HT were noted only in the HE group and not among women randomized to the LC group. These findings suggest that a lifestyle behavioral approach can successfully attenuate increases in total cholesterol and LDL-C that result from HT discontinuation.

Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes

The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events. This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin). An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Participants assigned to ILI lost an average 8.6% of their initial weight vs. 0.7% in DSE group (P < 0.001). Mean fitness increased in ILI by 20.9 vs. 5.8% in DSE (P < 0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean A1C dropped from 7.3 to 6.6% in ILI (P < 0.001) vs. from 7.3 to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL cholesterol, and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants (all P < 0.01). At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk.

Aging and the Prevalence of Cardiovascular Disease Risk Factors in Older American Indians: The Strong Heart Study

To describe longitudinal changes in the prevalence of major cardiovascular disease (CVD) risk factors in aging American Indians. Population-based ongoing epidemiological study. The Strong Heart Study is a study of CVD and its risk factors. Standardized examinations were repeated in 1993 to 1995 and again in 1997 to 1999. A diverse cohort of 4,549 American Indians aged 45 to 74 at the initial examinations in 1989 to 1991. Changes in the prevalence of hypertension, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), current smoking, and type 2 diabetes mellitus. The prevalence of hypertension rose rapidly and steadily with aging. A nonsignificant decrease in LDL-C was seen in men, and men and women initially had rapid increases in the prevalence of low HDL-C. The prevalence of smoking decreased, but the prevalence of diabetes mellitus continued to rise for men and women. Overall, unfavorable changes in CVD risk factors were seen in the aging participants and will likely be reflected in worsening morbidity and mortality.

Short and longer term outcomes of a diabetes disease management program in underserved Latino patients

ABSTRACTObjective: We developed a Diabetes Management Program (DMP) located within a county health center for poor, primarily Latino patients. The purpose of this study is to document if our program can achieve global risk reduction in our population, and whether or not this improvement can be sustained through on-going follow-up in primary care.Research design and methods: This is an observational study, using a database into which patient information is entered weekly. Information from the database is used to compare patients at baseline, at discharge from the program and then after a year or more of follow-up in primary care.Main outcomes measures: Change in A1C, low density lipoprotein (LDL) cholesterol, blood pressure (BP) levels; use of cardiovascular disease (CVD) modifying medications.Results: 171 patients had data available at baseline, discharge and annual follow-up. Baseline A1C is 8.5 ± 1.9% (mean ± SD), with a fall to 7.4 ± 1.2% ( p < 0.001) at discharge. After 1 year in primary care the A1C increased back to baseline (8.3 ± 1.7%), without change in diabetes medications. LDL cholesterol and BP levels are reduced by discharge, and these improvements persisted at the annual follow-up. Additionally, patients continued with CVD risk modifying therapy (statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, aspirin) at their annual visits. Limitations to this study include the small number of patients who returned for their annual examination, the lack of a matched control group for comparison and the use of an existing database.Conclusions: Persistent change in CVD risk factors can be made through diabetes disease management; changes in glucose control, however, are more difficult to sustain in spite of continued use of medication. Further research must be undertaken to help improve glycemic outcomes over time.

Early Menarche and the Development of Cardiovascular Disease Risk Factors in Adolescent Girls: The Fels Longitudinal Study

The purpose of this study was to evaluate the influence of menarcheal age on changes in insulin, glucose, lipids, and blood pressure during adolescence and to assess whether body composition modifies this relationship. We examined 391 girls, a subset of Fels Longitudinal Study female participants (8-21 yr of age). Self-reported menarcheal age was classified based on the National Health and Nutrition Examination Survey III distribution, in which early menarche was at the 25th percentile or less (11.9 yr). Age at menarche was examined in relation to measures of body composition [e.g. fat-free mass (FFM) and percent body fat (PBF)], insulin resistance, blood pressure, and lipid profile. The effects of menarcheal age and body composition on cardiovascular disease risk factor changes were analyzed with serial data mixed models. Median menarcheal age was 12.7 yr (range, 9.8-17.0 yr), with 91 girls (23%) classified as early menarche. Girls with early menarche had more deleterious changes in insulin, glucose, blood pressure, FFM, and PBF levels than girls with average or late menarche. Menarcheal age adversely affected cardiovascular disease risk factor changes independent of age and changes in FFM or PBF. Girls with early menarche exhibited elevated blood pressure and glucose intolerance compared with later maturing girls, independent of body composition.

Relationship between adolescent fitness and fatness and cardiovascular disease risk factors in adulthood: The Aerobics Center Longitudinal Study (ACLS)

To examine the relationship between cardiorespiratory fitness and body fatness during adolescence and cardiovascular disease (CVD) risk factors in adulthood. The sample was 48 participants from the Aerobics Center Longitudinal Study (ACLS) who had one clinical visit during adolescence (mean age = 15.8 years) and a follow-up visit during adulthood (mean age = 26.6 years). Values for treadmill time (TM), body fatness (body mass index [BMI], percent body fat [%BF], and waist circumference [WC]), traditional CVD risk factors (blood pressure [BP], fasting total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], and glucose), and a composite metabolic syndrome risk factor score were adjusted for age and sex. The relationships between adolescent TM and body fatness variables and adult CVD risk factors were examined by partial correlations, controlling for length of follow-up (mean = 11 years). The correlation between changes in TM and body fatness (DeltaTM and Deltabody fatness, respectively) and changes in CVD risk factors between adolescence and adulthood (DeltaCVD risk factors) were also examined. Adolescent cardiorespiratory fitness and body fatness variables also were separated into 2 categories based on the median split: low (below median) and high (above median). TM and body fatness variables showed moderate stability between adolescence and adulthood ( r = 0.44-0.78). Adolescent TM and DeltaTM showed moderate correlations with adult body fatness indicators (BMI, WC, and %BF, r = -0.34 to -0.47) and Deltabody fatness ( r = -0.24 to -0.46), respectively. Adolescent TM was not significantly related to traditional CVD risk factors in adulthood. Adolescent WC was significantly related to adult BP ( r = 0.33 to 0.45), and body fatness variables during adolescence were significantly related to adult TM ( r = -0.32 to -0.44). The DeltaWC was significantly related to DeltaTM ( r = -0.46) and DeltaHDL-C ( r = -0.51), and DeltaBMI was significantly related to DeltaBP ( r = 0.45) and DeltaHDL-C ( r = -0.34). Subjects with a high TM during adolescence showed lower levels of body fatness as adults, and those with high levels of WC during adolescence showed higher BP during adulthood. The results indicate a significant relationship between adolescent cardiorespiratory fitness and adult body fatness and a lack of an association between adolescent cardiorespiratory fitness and adult cholesterol, BP, and glucose levels. Adolescent body fatness is moderately related to selected adult CVD risk factors.

Relation of occupational change to cardiovascular risk factor levels in rural Chinese men: the People's Republic of China-United States Collaborative Study on Cardiovascular and Cardiopulmonary Epidemiology.

During the second half of the 20th century, millions of people in developing countries ceased to be farmers and sought other occupations. Little has been reported of the impact of this transition on risk factors for cardiovascular disease (CVD) and other chronic diseases. Ecological and prospective studies indicate that elevated blood pressure, elevated total cholesterol (TC), obesity, and smoking are major risk factors for stroke and coronary heart disease (CHD) in Chinese populations.1–4 Concurrent with economic development in China, levels of risk factors have tended to rise.5 This study examined men residing in rural areas near big cities who worked as farmers in 1983–1984 and the relation of occupational change from 1983–1984 to 1993–1994 and their CVD risk factor changes.