Change In Individual Risk Factors Research Articles

Effects of Longitudinal Changes in Lifestyle-Related Risk Factors on the Incidence of Major Adverse Cardiac and Cerebrovascular Disease in Young Adults.

Metabolic syndrome (MetS) is one focus of healthcare system reform in Japan. We examined the effects of changes in individual risk factors over time on the incidence of major adverse cardio-cerebrovascular events (MACCE) in adults under the age of 50 years. Study participants under the age of 50 with neither hypertension nor hyperglycemia at baseline were analyzed. We used a parametric proportional hazard model to determine the effect of changes in abdominal circumference, blood pressure, serum lipids, and blood glucose on the incidence of MACCE.A total of 6,125 women and 6,403 men were subject to the analyses. The incidence rate of MACCE per 1,000 person-years was 1.17 for women and 2.42 for men. In men under the age of 50, an increase in abdominal circumference was associated with an increase in MACCE incidence (hazard ratio per 1 cm increase: 1.10; 95% confidence interval [CI], 1.04-1.17), whereas no statistically significant association was observed in women. Compared with Visit 1, if the abdominal circumference increased by 4 cm at Visit 3, the hazard ratio for developing MACCE was approximately 1.5 (hazard ratio 1.48; 95% CI, 1.18-1.86). In men under the age of 50, increases in abdominal circumference and systolic blood pressure were associated with an increased risk of developing MACCE, regardless of the degree of obesity at baseline. Therefore, encouraging young adults to improve their health before developing MetS may reduce the risk of MACCE.

Abstract 11904: Heart Health for South Asians: Improved Cardiovascular Risk Factors and Outcomes With a Culturally Tailored Health Education Program

Introduction: The Kaiser Permanente (KP) Northern California Heart Health for South Asians (HHSA) Program is a two-hour educational class offered at KP Santa Clara, California. The class provides culturally relevant lifestyle and dietary recommendations to South Asian patients, in an effort to reduce the known disproportionate burden of cardiovascular (CV) disease in this population. We aimed to evaluate the impact of the HHSA Program on CV risk factors and major adverse CV events (MACE). Methods: A retrospective cohort study identified 1517 participants of South Asian descent, age ≥ 18 years old from 2006-2019. We evaluated the change in individual risk factors with program attendance (median follow up of 6.9 years) for the following variables: systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), LDL, HDL, BMI, and HbA1c. We also performed a propensity matched analysis to evaluate differences in MACE including stroke, myocardial infarction (MI), coronary revascularization, and all-cause mortality. Results: Differences in individual risk factors are outlined in figure 1A and show a significant improvement in SBP, DBP, TG, LDL, HDL and HbA1c at follow up. In the propensity matched analysis, there was a statistically significant reduction in revascularization (OR 0.33, 95% CI 0.14-0.78, p= 0.011) and mortality (OR 0.41, 95% CI 0.22-0.79, p= 0.008), a trend towards reduction in stroke (OR 0.22 , 95% CI 0.05-1.03, p= 0.054), and no statistically significant difference in the rate of MI (OR 0.93 , 95% CI 0.43-1.98, p= 0.85) (Figure 1B). Conclusions: Our study demonstrates the efficacy of a culturally tailored South Asian health education program in improving CV risk factors and reducing MACE. The program highlights the importance and value of providing culturally tailored, motivational health education in primary CV disease prevention.

RxIALTA: evaluating the effect of a pharmacist-led intervention on CV risk in patients with chronic inflammatory diseases in a community pharmacy setting: a prospective pre–post intervention study

Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.ObjectiveTo evaluate the effect of a pharmacist-led intervention...

Motivational interviewing to support modifiable risk factor change in individuals at increased risk of cardiovascular disease: A systematic review and meta-analysis.

Programmes using motivational interviewing show potential in facilitating lifestyle change, however this has not been well established and explored in individuals at risk of, yet without symptomatic pre-existent cardiovascular disease. The objective of this systematic review and meta-analysis was to determine the effectiveness of motivational interviewing in supporting modifiable risk factor change in individuals at an increased risk of cardiovascular disease. Systematic review and meta-analysis with results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-related databases were searched for randomised controlled trials from 1980 to March 2020. Criteria for inclusion included; preventive programmes, motivational interviewing principles, modification of cardiovascular risk factors in adults of both genders, different ethnicities and employment status, and having at least 1 or more modifiable cardiovascular risk factor/s. Two reviewers independently extracted data and conducted a quality appraisal of eligible studies using an adapted Cochrane framework. The Cochrane framework supports to systematically identify, appraise and synthesize all the empirical evidence that meets the pre-specified eligibility criteria to answer a specific question. A total of 12 studies met the inclusion criteria. While completeness of intervention reporting was found to be adequate, the application of motivational interviewing was found to be insufficiently reported across all studies (mean overall reporting rate; 68%, 26% respectively). No statistical difference between groups in smoking status and physical activity was reported. A random effects analysis from 4 studies was conducted, this determined a synthesized estimate for standardised mean difference in weight of -2.00kg (95% CI -3.31 to -0.69 kg; p = 0.003), with high statistical heterogeneity. Pooled results from 4 studies determined a mean difference in LDL-c of -0.14mmol/l (5.414mg/dl), which was non-significant. The characteristics of interventions more likely to be effective were identified as: use of a blended approach delivered by a nurse expert in motivational interviewing from an outpatient-clinic. The application of affirmation, compassion and evocation, use of open questions, summarising, listening, supporting and raising ambivalence, combining education and barrier change identification with goal setting are also important intervention characteristics. While motivational interviewing may support individuals to modify their cardiovascular risk through lifestyle change, the effectiveness of this approach remains uncertain. The strengths and limitations of motivational interviewing need to be further explored through robust studies.

An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT.

An intervention to improve the quality of life in children of parents with serious mental illness: the Young SMILES feasibility RCT.

Abstract WP179: Global Risk Reduction: A Novel Method To Estimate The Impact Of Multiple Intervention Trials To Reduce Stroke Disparities

Introduction: Reduction of recurrent stroke risk requires a comprehensive suite of proven interventions but most community-based trials are insufficiently powered to compare observed rates of “hard” outcomes such as time to recurrent stroke. Demand exists for innovative approaches to estimate the cumulative impact of interventions addressing multiple risk factors. Hypothesis: estimation of the cumulative relative effect on recurrent CVD events of multi-component risk factor interventions is feasible. Methods: For each of four stroke risk factors we identified meta-analyses of RCTS and observational studies. We modeled global risk reduction assuming a multiplicative relationship for the relative risks for each risk factor. We then used data on observed changes in systolic blood pressure (SBP) and LDL cholesterol and on medication adherence from the SUSTAIN trial (a multi-ethnic randomized community trial) to model estimated relative reduction in risk for recurrent stroke due to the SUSTAIN intervention Estimates of uncertainty capture two sources of variation in the outcome of estimated CVD risk: bootstrap methods capture sample-related uncertainty, and probabilistic sensitivity analysis capture uncertainty related to the benefit associated with each risk factor. Results: Among 272 SUSTAIN participants with complete 12-month data, most were non-white (73%) and Spanish speaking (62%). Changes in individual risk factors and medications, including SBP, smoking, aspirin and warfarin were similar in intervention and control groups (p>0.2) with the exception of LDL cholesterol, which was lowered by 11.4 mg/dL more in the intervention group (p=0.04). The estimated combined reductions in the relative risks of stroke were 0.42 and 0.37 in the intervention and control groups, respectively, with a non-significant relative risk difference of 5% (uncertainty interval -6 to 21). Conclusions: Data from community trials can be used to estimate the combined impact of multi-component interventions on risk of recurrent stroke and stroke disparities. We propose this global risk approach as an a priori secondary outcome for SUCCEED, an ongoing community-based trial.

Cardiometabolic risk factor response to a lifestyle intervention: a randomized trial.

Strategies to increase adherence to national dietary and physical activity (PA) guidelines to improve the health in regions such as the Lower Mississippi Delta (LMD) of the United States are needed. Here we explore the cardiometabolic responses to an education and behavior change intervention among overweight and obese adults that adapted the 2010 Dietary Guidelines (DG), with and without a PA component. White and African American overweight and obese adults were randomized to a DG group (n=61) or a DG+PA group (n=60). Both groups received a 12-week dietary education and behavior change intervention, and the DG+PA group also received a PA education and behavior change intervention with a pedometer. Changes in individual risk factors (blood pressure, fasting glucose, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) and a continuous cardiometabolic risk score were determined. General linear models compared mean changes between groups, adjusting for covariates. No main effect of intervention group was found in completers (n=99) and those who engaged with ≥80% of the intervention (n=83) for individual risk factors or the continuous risk score. Pooling both groups, those with higher baseline risk factor values realized greater improvements in individual risk factors. Adapting DG did not produce any cardiometabolic benefits, even with a PA component. Although the sample was ostensibly healthy, they were all overweight to mildly obese (body mass index of 25-34.9 kg/m(2)) and participants with higher baseline risk factor values showed more improvements. Adherence to longer-term behavior change may elicit changes in risk profile, so this should be explored.

Design of the INTEGRATE study: effectiveness and cost-effectiveness of a cardiometabolic risk assessment and treatment program integrated in primary care.

BackgroundThe increasing prevalence of cardiometabolic disease (CMD) in combination with an ageing population is a major public health problem. Early detection and management of individuals at risk for CMD is required to prevent future health problems with associated costs. General practice is the optimal health care setting to accomplish this goal. Prevention programs for identification and treatment of patients with an increased risk for CMD in primary care have been proven feasible. However, the effectiveness and cost-effectiveness have yet to be demonstrated. The ‘Personalized Prevention Approach for CardioMetabolic Risk’ (PPA CMR) is such a prevention program. The objective of the INTEGRATE study is to investigate the effectiveness and cost-effectiveness of PPA CMR, as well as to establish determinants for participation and compliance.MethodsThe INTEGRATE study is designed as a stepped-wedge randomized controlled trial with a waiting list control group. In approximately 40 general practices, all enlisted patients without CMD aged 45–70 years, are invited to participate in PPA CMR. After an online risk estimation, patients with a score above risk threshold are invited to the GP for additional measurements, detailed risk profiling and tailored treatment of risk factors through medication and/or lifestyle counseling. At baseline and after twelve months of follow-up lifestyle, health and work status of all participants are established with online questionnaires. Additionally after twelve months, we will determine health care utilization, costs of PPA CMR and compliance. Primary endpoints are the number of newly detected patients with CMD and changes in individual risk factors between the intervention and waiting list control group. Medical data will be extracted from the GPs’ electronic medical records. In order to assess factors related to participation, we will send questionnaires to non-participants and assess characteristics of participating practices. For all participants, additional demographic characteristics will be available through Statistics Netherlands.DiscussionThe INTEGRATE study will provide insight into the effectiveness and cost-effectiveness of PPA CMR as well as determinants for participation and compliance, which represents essential information to guide further large-scale implementation of primary prevention programs for CMD.Trial registration numberNTR4277, The Netherlands National Trial Register, 26-11-2013.

Contribution of Individual Risk Factor Changes to Reductions in Population Absolute Cardiovascular Risk

Background. Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention. Design. Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme. Methods. The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated. Results. Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed. Conclusion. Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.

Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

ObjectiveTo quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared...

One-year cardiovascular risk and quality of life changes in participants of a health trainer service

To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme. Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified 'high risk' (≥20% CVD risk) at baseline. At baseline, 33.6% of participants were classified as 'high CVD risk' and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In 'high-risk' participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change. Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.

Randomised controlled trial of additional lifestyle support for the reduction of cardiovascular disease risk through primary care in Stoke-on-Trent, UK

The purpose of this trial is to evaluate the effectiveness of providing additional support in modifying lifestyles and in reducing population cardiovascular disease risk compared with usual primary prevention care. A prospective, individually randomised controlled trial design is used, within which groups of patients are clustered by general practice. Multi-level modelling is proposed to account for clustering effects by practice and a two-stage least squares regression approach to account for expected contamination at the analysis stage. The research is set in Stoke-on-Trent, a mid-sized urban city in central England with a generally poor health profile. Patients included will be those aged between 35 and 74 years who have been identified as being at increased risk of developing cardiovascular disease. Approximately 920 patients will be recruited in each arm of the trial (20 control, 20 treatment in each of 46 practices). Usual primary prevention care (control) will be compared with usual primary prevention care plus bespoke lifestyle support (treatment). The primary outcome measure is the Framingham 10-year cardiovascular disease risk at one year. Intermediate outcomes: weight, physical activity and health-related quality of life, will be determined at six months to monitor progress with treatment. Change in individual risk factors: blood pressure, lipid profile, weight, body mass index, waist circumference, smoking, diabetes and cardiovascular disease status and medications will also be measured at one year to help understand the specific mechanisms by which the primary endpoint was achieved.

Trends in educational inequalities in cardiovascular risk factors: A longitudinal study among 48,000 middle-aged Norwegian men and women

The aim of the study was to compare educational and gender specific trends in the classical cardiovascular risk factors body mass index (BMI), cholesterol, systolic blood pressure and smoking in a Norwegian population during a period when the coronary heart disease mortality had just reached its peak in the late 1970s and 1980s. We used The Norwegian Counties study: a longitudinal study with three screenings on the same individuals in Oppland, Sogn og Fjordane and Finnmark counties in Norway in the period 1974-1988. All residents aged 35-49 were invited and 48,422 participated (89%) in the baseline screening. To estimate the cardiovascular risk factor change in individuals over time longitudinal statistical methods were used. BMI, cholesterol and blood pressure levels increased with age, while the amount of daily smokers decreased. The higher the educational level the lower the level of BMI, blood pressure, smoking and cholesterol. This pattern persisted through the whole study period. In men, however, the educational gradient in cholesterol diminished in the last screening. Among women there was an increase in inequality in systolic blood pressure, and for smoking there was a steeper decrease for men than women across all educational groups. The educational differences in classical cardiovascular risk factors persisted, except for BMI, cholesterol and daily smokers in men which tended to decrease.

Effect of orlistat on cardiovascular disease risk in obese adults

The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10-year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors treated for 12 months, in conjunction with a fat-reduced, but otherwise ad libitum, diet. A double-blind, randomized, placebo-controlled, parallel study was performed in conjunction with a fat-reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean +/- s.d. age = 52.0 +/- 7.5 years, body mass index (BMI) = 37.6 +/- 5.1 kg/m(2)) or placebo three times daily (n = 89 women, 80 men; age = 52.5 +/- 7.4 years, BMI = 38.0 +/- 4.9 kg/m(2)). The primary efficacy criterion was the 10-year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life. There was no difference in the change in 10-year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL-cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF-36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids. Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low-risk group (approximately 10% of risk of a CVD event over 10 years).

Coronary heart disease risk factors in employees of Iowa's Department of Public Safety compared to a cohort of the general population.

The prevalence of coronary heart disease (CHD) risk factors in law enforcement personnel compared to that in the general population was studied by determining the predicted 10-year risk for developing CHD (CHD10, expressed as %) in subjects from the Iowa Department of Public Safety and comparing it to the average CHD10 for similarly aged subjects in the Framingham Heart Study cohort. The Iowa data included measures on 388 men from 30 to 64 years old, 246 of whom were measured in 1980-1981 and again in 1992-1993. The CHD10 came from an algorithm developed using the Framingham data; it included measures of age, gender, cholesterol, HDL-C, systolic blood pressure, smoking habit, glucose level, and left ventricular hypertrophy (ECG criteria). For this group, average CHD10 was reported by age in five-year increments [Circulation 83:356, 1991]. The Iowa subjects (n = 388) did not show a statistically significant difference in CHD10 from the reference population (8.9% versus 7.9%). The change with age was very similar in the two groups: for Iowa (n = 388) the estimate was CHD10 = -16.5 + .59 (age); for Framingham it was CHD10 = -17.5 + .60 (age). The change in individual risk factors with time was also similar in both groups; the per year change in CHD10 in the Iowa subjects, which was measured twice (n = 246, 0.63%), did not differ statistically from the 0.60% change predicted by the Framingham model. These results suggest that, for the risk factors considered here, the 10-year probability of developing CHD among Iowa law enforcement personnel is similar to that found in the Framingham population.

Estimating effects of change in individual risk factors in a multifactorial intervention trial with group randomization

In purified fractions of immature rye ears (Secale cereale L.), gibberellins A19, A20, A24, A54, A55 and A60 could be identified by GC-MS. From the present knowledge on the endogenous GA spectrum in developing grains of cereals, chemotaxonomy considerations can be made that allow to distinguish between the subtribes Triticinae and Hordeinae of the tribe Triticeae within the Poaceae.