Changes In Coronary Heart Disease Risk Factors Research Articles

Explaining the decline in coronary heart disease mortality rates in the Slovak Republic between 1993-2008.

ObjectiveBetween the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008.MethodsWe identified, obtained and scrutinised the data required for the model. These data detailed trends in the major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics (National Health Information Centre and Statistical Office of the Slovak Republic) and national representative studies (AUDIT, SLOVAKS, SLOVASeZ, CINDI, EHES, EHIS). The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence-based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs) attributable to risk factor changes or treatments. Uncertainties were explored using sensitivity analyses.ResultsBetween 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic (SR) decreased by 23% in men and 26% in women aged 25–74 years. This represented some 1820 fewer CHD deaths in 2008 than expected if mortality rates had not fallen. The IMPACT model explained 91% of this mortality decline. Approximately 50% of the decline was attributable to changes in acute phase and secondary prevention treatments, particularly acute and chronic treatments for heart failure (≈12%), acute coronary syndrome treatments (≈9%) and secondary prevention following AMI and revascularisation (≈8%). Changes in CHD risk factors explained approximately 41% of the total mortality decrease, mainly reflecting reductions in total serum cholesterol. However, other risk factors demonstrated adverse trends and thus generated approximately 740 additional deaths.ConclusionOur analysis suggests that approximately half the CHD mortality fall recently observed in the SR may be attributable to the increased use of evidence-based treatments. However, the adverse trends observed in all the major cardiovascular risk factors (apart from total cholesterol) are deeply worrying. They highlight the need for more energetic population-wide prevention policies such as tobacco control, reducing salt and industrial trans fats content in processed food, clearer food labelling and regulated marketing of processed foods and sugary drinks.

OP54 Explaining the decline in coronary heart disease mortality in the Slovak Republic between 1993–2008

<h3>Background</h3> Although cardiovascular diseases remain the most important cause of death in the Slovak Republic, mortality rates from coronary heart disease (CHD) have substantially decreased in the last two decades. The aim of this modelling study was therefore to try and quantify the main contributions to this mortality decline. <h3>Methods</h3> Data covering adults aged 25–74 years in the Slovak Republic (population 3.5 million) between the years 1993–2008 were identified, obtained and scrutinised. These data detailed trends in major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics, national representative studies, published trials and meta-analyses, and the Slovak CINDI studies. The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs). Uncertainties were explored using probabilistic sensitivity analyses. <h3>Results</h3> Between 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic decreased by 23% in men and 26% in women aged 25–74 years, representing 1950 fewer CHD deaths in 2008. Improvements in the uptake of evidence based treatments explained approximately 48% of the mortality fall (mainly reflecting contributions from treatments for acute coronary syndrome, acute and chronic heart failure and primary prevention, ie. statins and anti-hypertensives). Changes in CHD risk factors explained approximately 43% of the total mortality decrease (resulting mainly from positive changes in total serum cholesterol). However, most other risk factors demonstrated adverse trends and thus generated approximately 575 additional deaths. Results remained relatively stable under a range of sensitivity analyses. <h3>Conclusion</h3> This preliminary analysis suggests that approximately half the coronary heart disease mortality fall recently observed in the Slovak Republic may be attributable to evidence based treatments, with much of the remainder coming from large falls in total serum cholesterol. The adverse trends observed in all the other major cardiovascular risk factors (smoking, blood pressure, BMI, diabetes and physical inactivity) in the Slovak Republic are deeply worrying, and emphasise the need for more energetic population-wide prevention policies.

Designing and implementing a comparative effectiveness study of two strategies for delivering high quality CHD prevention: Methods and participant characteristics for the Heart to Health study

BackgroundAlthough lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial. MethodsWe conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35–79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up. ResultsWe randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African-American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%. ConclusionWe have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.

Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007

Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades. The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments. The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies. Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively. More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.

Population-Based Study of Risk Factors for Coronary Heart Disease Among HIV-Infected Persons

Preventing coronary heart disease (CHD) is critical to further extending survival among human immunodeficiency virus (HIV)-infected persons. Previously published findings of CHD risk factors in HIV-infected persons have been derived from facility-based cohort studies, which have limited representativeness for the HIV-infected population. State-specific, population-based surveillance data can assist health care providers and public health agencies in planning and evaluating programs that reduce CHD among HIV-infected persons. We describe CHD risk factors from the 2007-2008 Oregon Medical Monitoring Project, a population-based survey of HIV-infected persons receiving care that included both patient interview and medical record review. Among the 539 HIV-infected patients interviewed, the mean age was 45.5 years. Diagnoses from the medical record associated with CHD risk included preexisting CHD (5%), diabetes (11%), and hypertension (28%). Current smoking was reported by 46%; college graduates were less likely to smoke compared with those with lesser education (21% versus 53%, respectively; P <.0001). Obesity was present among 17%. Among the 65% of the survey group with lipid values available, 55% had high-density lipoprotein cholesterol (HDL) <40 mg/dL and 42% had triglycerides ≥ 200 mg/dL. Among the 15% of the survey group with either preexisting CHD or diabetes, 42% had a non-HDL <130 mg/dL (target goal) and 38% smoked. Risk factors for CHD among HIVinfected persons, particularly smoking and dyslipidemia, should be managed aggressively. Ongoing surveillance is warranted to monitor changes in CHD risk factors in the HIV-infected population.

P03 *Explaining the decline in coronary heart disease mortality in Northern Ireland between 1987 and 2007

PurposeIn 1987, Northern Ireland had one of the highest rates of coronary heart disease (CHD) mortality in the world. However, CHD mortality has declined substantially over the last 2 decades....

PPARG Genotype Accounts for Part of Individual Variation in Body Weight Reduction in Response to Calorie Restriction

Several studies indicate that expression of the peroxisome proliferator-activated receptor gamma (PPARG) gene is influenced by calorie restriction. The aim of this study was to investigate whether PPARG gene variations are associated with weight reduction and changes in coronary heart disease (CHD) risk factors in response to a 14-week calorie restriction. In total, 95 middle-aged, Japanese women (BMI>or=25 kg/m2) enrolled as subjects for 14 weeks and attended weekly dietary lectures instructing them on how to consume a nutritionally balanced diet of 1,200 kcal/day. Eight single-nucleotide polymorphisms (SNPs) in the PPARG gene (rs1801282 (Pro/Ala), rs2292101, rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were analyzed. Body weight decreased significantly (-7.7+/-3.1 kg; -11.3+/-4.4%) during the intervention. Six PPARG SNPs (rs2959272, rs1386835, rs709158, rs1175540, rs1175544, and rs1797912) were significantly associated with the weight reduction, with rs1175544 having the strongest association (P=0.004). No differences across the rs1175544 genotypes were observed in any of the blood analyses or in blood pressure. In a multiple regression analysis, the rs1175544 genotypes accounted for 7% of the total weight reduction variance. These data suggest that one SNP of the PPARG genotype accounted for a significant portion of the total body weight reduction variance in response to a short-term intervention consisting of calorie restriction; however, no relationship was found between these SNPs and the changes in CHD risk factors which accompanied weight loss.

Longitudinal Change in Coronary Heart Disease Risk Factors in Older Runners

it is currently not clear how coronary heart disease (CHD) risk factors change over time in chronic exercisers. Therefore, the purpose of this study is to describe the longitudinal change in CHD risk factors in chronically endurance-trained men and women, and to determine the exercise and nutritional factors associated with those respective changes. ninety-one middle-aged runners (56 male, 35 female) were tested on two occasions approximately 10 years apart (aged 50.8 +/- 8.0 versus 60.0 +/- 7.9 years at respective visits). Body composition, VO2max, blood pressure (BP) and blood chemistries were measured, and the subjects' self-reported training and nutritional history. Data were analysed by factorial analysis of variance (ANOVA) and multivariate step-wise regression. Among the entire sample, training volume decreased (61.1 +/- 28.2 versus 44.7 +/- 24.6 km/week, P<0.05) but nutritional variables did not change. Body fat (16.9 +/- 5.3% for men versus 21.1 +/- 5.3% for women, P<0.05), blood lipids, blood glucose and systolic and diastolic BP all changed negatively over the study duration. These changes occurred similarly in both genders and irrespective of menstrual and hormone replacement status among the women. Lastly, the changes in CHD risk factors were not predicted by change in exercise or nutritional patterns. despite the maintenance of significant volumes of exercise and the absence of changes in diet, most CHD risk factors demonstrated unfavourable changes over 10 years in chronic men and women runners. However, the absolute values for most CHD risk factors remained better than those reported for sedentary peers of comparable age.

Effects Of Rebound After Weight Loss On Coronary Heart Disease Risk Factors

Many studies have revealed that comprehensive lifestyle therapy, involving diet, exercise, and behavioral modification, can lead to weight losses of 2 to 10 kg over 10 to 20 weeks and reduce coronary heart disease (CHD) risk factors. To sustain the effects of lifestyle therapy, long-term maintenance of the reduced weight would be required. However, many persons experience weight gain after relapsing toward their pre-intervention lifestyle. Few reports are currently available to indicate how much weight gain will reverse the effects on CHD risk factors. PURPOSE To examine longterm weight changes and correlative changes in CHD risk factors. METHODS One hundred fourteen overweight and obese women (age 46.5 ± 8.0 years, BMI 27.6 ± 2.8 kg/m2) were assigned to 2 groups: diet only (n = 35) and diet and exercise (n = 79). The women had participated in a 14-week weight-loss program and were retested 2 to 5 (3.6 ± 1.4) years later. RESULTS The mean weight before and after the program, and at follow-up was 67.7 ± 7.5 kg, 59.1 ± 7.0 kg, and 63.2 ± 8.0 kg, respectively. With the moderate rebound of weight, total cholesterol (219 ± 32 mg/dl, 197 ± 29 mg/dl, 218 ± 35 mg/dl), triglycerides (109 ± 84 mg/dl, 68 ± 29 mg/dl, 95 ± 57 mg/dl), and low-density lipoprotein cholesterol (133 ± 29 mg/dl, 120 ± 26 mg/dl, 134 ± 32 mg/dl) rebounded completely, while systolic blood pressure (132 ± 18 mmHg, 121 ± 15 mmHg, 123 ± 17 mmHg) and diastolic blood pressure (82 ± 10 mmHg, 76 ± 9 mmHg, 76 ± 11 mmHg) did not change after the program. Moderate rebounds were found in fasting plasma glucose (98 ± 25 mg/dl, 88 ± 13 mg/dl, 92 ± 15 mg/dl) and visceral fat (94.7 ± 49.5 cm2, 58.9 ± 34.5 cm2, 68.3 ± 41.1 cm2). No significant group differences in terms of rebound were found, although systolic blood pressure significantly regained in the diet only group, and visceral fat significantly regained in the diet and exercise group. CONCLUSIONS Weight gain (+3.9 kg) after weight loss (−8.6 kg) may reverse effects on CHD risk factors. Greater efforts to maintain reduced weight are needed for preventing CHD. Supported partly by Uehara Memorial Foundation, the 21st century COE program, and Tsukuba Advanced Research Alliance (TARA).

Relation of generalized and central obesity to cardiovascular risk factors and prevalent coronary heart disease in a sample of American Indians: the Strong Heart Study.

To examine the hypothesis linking measures of obesity including body mass index (BMI), waist circumference (waist) and percentage body fat to coronary heart disease (CHD) prevalence and its risk factors in American Indians. The Strong Heart Study assesses the prevalence of CHD and its risk factors in American Indians in Arizona, Oklahoma and South/North Dakota. Participants underwent a physical examination and an electrocardiogram; anthropometric and blood pressure measurements were taken, as were measurements of glucose, lipoproteins, fibrinogen, insulin, hemoglobin A1c and urinary albumin. Data were available for 4549 men and women between 45 and 74 y of age. Obesity, measured using body mass index, waist circumference and percentage body fat, was correlated with prevalent CHD and its risk factors. More than 75% of participants were overweight (BMI>25 kg/m2). Measures of obesity were greater in women than in men, in younger than in older participants, and in participants with diabetes than in nondiabetic participants. CHD risk factors were associated with measures of obesity but, except for insulin concentration, changes in metabolic variables with increasing obesity were small. Associations were not stronger with waist than with BMI. The prevalence of CHD in those whose BMI and/or waist measurements lay in the lowest and highest quintiles, by gender and diabetic status, was similar. Although CHD risk factors are associated with obesity in American Indians, distribution of obesity (ie waist) is no more closely related to risk factors than is generalized obesity (ie BMI), and changes in CHD risk factors with obesity were small. Thus, the relations among obesity, body fat distribution and CHD risk may differ in this population.

Heritability of Longitudinal Changes in Coronary-Heart-Disease Risk Factors in Women Twins

Numerous studies have demonstrated genetic influences on levels of coronary heart disease (CHD) risk factors, but there also may be genetic effects on the intraindividual variation in these risk factors over time. Changes in risk factors are likely to reflect genetic-environmental interactions and may have important implications for understanding CHD risk. The present study examines the heritability of changes in CHD risk factors, using data from the two examinations by the Kaiser Permanente Women Twins Study, performed a decade apart. The sample consisted of 348 pairs of women twins who participated in both examinations, including 203 MZ pairs and 145 DZ pairs. Average ages at the two examinations were 41 and 51 years, respectively. By means of three different statistical analytic approaches, moderate heritability estimates were demonstrated for changes in LDL cholesterol (h2 = .25-.36) and in HDL cholesterol (h2 = .23-.58), some of which were statistically significant. Although small to moderate heritability estimates were found for systolic blood pressure (.18-.37; P < .05 for some estimates), no genetic influence on changes in diastolic blood pressure was detected. Based on longitudinal twin data in women, this study demonstrates a genetic influence on changes in both lipoprotein risk factors and systolic blood pressure over a decade. In addition to environmental factors, which clearly are operating, the effect of various "variability genes" may be acting independently of the genetic influences on the absolute levels of these risk factors. Both mapping the gene(s) underlying intraindividual variations in these CHD risk factors and understanding their function(s) could lead to targeted intervention strategies to reduce CHD risk among genetically susceptible individuals.

Cardiovascular Risk Factors and Dietary Plant Omega-3 Verus Omega-6 Fatty Acids

LEARNING OUTCOME: To compare the effects on selected risk factors for coronary heart disease when α-linolenic acid is substituted for linoleic acid in an American Heart Association Step 1 type-diet.Increased intakes of the plant omega-3 fatty acid, a-linolenic acid (ALA) may protect against coronary heart disease (CHD). It has been demonstrated that feeding the marine omega-3 fatty acid, eicosapentenoic acid (EPA) can result in decreased triglycerides, fibrinogen and platelet aggregation which are considered beneficial for CHD. ALA can be converted to EPA in the body so that increased consumption of ALA should result in increased concentrations of EPA. The aim of the current study was to compare two low saturated fat diets, both similar to the American Heart Association Step I diet, with the only variable being the ratio of ALA to linoleic acid (ALA:LA). This was achieved by the substitution of flaxseed oil for safflower oil. After consuming a stabilisation diet with 37% energy (en) from fat (16 % en, saturated fat) for two weeks, healthy men aged 18 to 35 years (n=30) consumed the low saturated fat diet, 10% en saturated fat, 13% en monounsaturated fat and 7% en polyunsaturated fat. Half ate a diet with ALA:LA of 1.4:1 (ALA-rich) and the remainder ALA:LA of 1:34 (ALA-poor). Subjects maintained their weight throughout the study and all food was supplied. Blood was sampled at the beginning, middle and end of six weeks on the test diets to measure changes in CHD risk factors. This included analyses of plasma cholesterol, triglycerides, factor VIIc and fibrinogen. In addition, platelet aggregation induced by collagen was measured and platelet membrane fatty acids were determined It was expected the reduction of saturated fat from 16% to 10% en would result in decreased cholesterol and factor VIIc but while LDL cholesterol declined in both groups during the stabilisation diet, no further reductions occurred on either test diet and factor VIIc was unchanged. The percentage of platelet EPA tripled from 0.2 to 0.6% (P<0.0001) on the ALA-rich diet. Triglycerides, fibrinogen and platelet aggregation were unaltered by the test diets. Hence while an increase in platelet EPA was achieved no apparent benefit of the ALA-rich diet over the ALA-poor diet in modifying these risk factors resulted. These findings were in young men who entered the study with normal concentrations of analytes and may differ from older populations with already established pathologies.

Prevention of cardiovascular risk factor elevations in healthy premenopausal women

Abstract Background. A number of factors contribute to increased risk of coronary heart disease (CHD) among postmenopausal women, including atherogenic changes in serum cholesterol profiles, weight gain, and decreases in physical activity during the menopause. To date, no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause. Methods. A sample of 535 healthy premenopausal women, ages 44-50, were recruited for an ongoing B-year randomized prevention trial testing whether increases in low-density lipoprotein cholesterol (LDL-C) and body weight can be prevented during the menopause with a dietary and behavioral intervention. The aim was to reduce total dietary and saturated fat and cholesterol, prevent weight gain, and increase physical activity levels. Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment-only control participants. Results. The intervention group showed significant reductions in total cholesterol (−0.34 mmol/liter), LDL-C (−0.28 mmol/liter), triglycerides (−0.04 mmol/liter), weight (−4.8 kg), waist-hip ratio (−0.008), systolic blood pressure (−3.5 mm Hg), diastolic blood pressure (−2.2 mm Hg), serum glucose levels (−0.06 mmol/liter), and HDL-C (−0.06 mmol/liter) and significant increases in physical activity (+383 kcal). No significant changes were observed in the control group. Conclusion. Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes. Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause.

Prevention of Cardiovascular Risk Factor Elevations in Healthy Premenopausal Women

Background. A number of factors contribute to increased risk of coronary heart disease (CHD) among postmenopausal women, including atherogenic changes in serum cholesterol profiles, weight gain, and decreases in physical activity during the menopause. To date, no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause. Methods. A sample of 535 healthy premenopausal women, ages 44-50, were recruited for an ongoing B-year randomized prevention trial testing whether increases in low-density lipoprotein cholesterol (LDL-C) and body weight can be prevented during the menopause with a dietary and behavioral intervention. The aim was to reduce total dietary and saturated fat and cholesterol, prevent weight gain, and increase physical activity levels. Changes in CHD risk factors after the first 6 months of treatment were analyzed comparing 253 intervention and 267 assessment-only control participants. Results. The intervention group showed significant reductions in total cholesterol (−0.34 mmol/liter), LDL-C (−0.28 mmol/liter), triglycerides (−0.04 mmol/liter), weight (−4.8 kg), waist-hip ratio (−0.008), systolic blood pressure (−3.5 mm Hg), diastolic blood pressure (−2.2 mm Hg), serum glucose levels (−0.06 mmol/liter), and HDL-C (−0.06 mmol/liter) and significant increases in physical activity (+383 kcal). No significant changes were observed in the control group. Conclusion. Six-month results suggested that participants were receptive to the preventive approach to CHD risk reduction and were successful in making initial positive lifestyle changes. Follow-up data will evaluate long-term adherence to the intervention and the interaction between adherence and physiological changes during menopause.

Fifteen-Year Trends in Coronary Risk Factors in Finland, with Special Reference to North Karelia

The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, was begun in an eastern province of Finland in 1972. A number of national CHD prevention activities have been undertaken, quite a few of them since 1977. This paper reports the 15-year changes in CHD risk factors (serum cholesterol, blood pressure, and smoking) in North Karelia and in the original reference area of the project, and more recent changes in a third area in southwestern Finland. The results are based on well-standardized, comparable surveys of cross-sectional populations, aged 30 to 59 years. The results indicate that risk factors reduced markedly in North Karelia from 1972-1977, to a lesser extent from 1977-1982, and only a little from 1982-1987. There was also a decline in the reference area during the first ten years (1972-1982) but the changes did not exceed those in North Karelia and during the second phase, from 1982-1987, risk factor changes were minor. Risk factor levels in the third area in southwestern Finland changed little from 1982-1987. Present serum cholesterol and blood pressure levels in North Karelia are still higher than in southwestern Finland, but smoking is less common among North Karelian men. These findings are discussed in the light of the recent information on Finnish dietary changes and CHD mortality; their bearing on the need for new cardiovascular disease prevention activities in Finland is also discussed.