CV Health Research Articles

0133: The Log Book as a new tool for the secondary prevention of coronary artery disease

The Log book (LB) project was created by a multidisciplinary team of healthcare professionals from a regional care network and aimed to improve secondary prevention (SP) after acute myocardial infarction (MI) in Cote d’Or. LB includes information and advices for increasing self management of risk factors by the patient. A prospective interventional study on 469 patients hospitalised for an acute MI in the 2 Intensive Coronary Care unit of Côte d’Or (CHU Dijon and Clinique de Fontaine les Dijon) in 2012 and surviving at 1 year follow-up (FU). LB was randomly given at the time of their hospitalisation by the nursing team, also providing oral advices on risk factors management and CV health self care. Patients who received LB (LB+) were compared with patients without LB (LB-). Patients from LB+ group (n=307(65%)) were younger (57 vs 63y, p<0.001)) and less frequently women (16 vs 32%, p<0.001), diabetic (17 vs 30%, p<0.001) or with prior CAD (7 vs 15%, p=0.008) than patients without LB (LB- group, n=162(35%)). After matching patients LB+ with LB- based on age, sex, diabetes and GRACE risk score (n=127 in each group), baseline characteristics, were similar in the 2 groups. At 1 year FU, there was a trend for more frequent visits to the cardiologist in the LB+ group (2±1 vs 1±1, p=0.056) and cardiac rehabilitation program was more often performed in LB+ patients (69 vs 54%, p=0.015). Moreover, weight loss in obese patients and smoke withdrawal rates also showed a trend for improvement in LB+ patients (respectively 71 vs 59%, p=0.311 and 69 vs 53%, p=0.109). Finally, patients with LB showed a trend toward a lower rate of combined outcomes including recurrent MI, hospitalisation for heart failure and unscheduled PCI than in the LB- group (3 vs 7%, p=0.155). These preliminary data of our ongoing regional study suggest the efficacy of LB as a support for CV risk factor self management. In addition, our study provides encouraging data on the potential clinical benefits of this pioneer tool for SP.

Abstract 18634: Favorable Cardiovascular Health and the Compression of Morbidity: Findings From the Chicago Heart Detection Project in Industry Study

Introduction: We sought to determine the association of CV health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. Methods: The Chicago Heart Association (CHA) study is a longitudinal cohort of employed men and women aged 18-59 years at baseline exam in 1967-1973. Baseline risk factor levels included blood pressure, cholesterol, diabetes, BMI and smoking. Individuals were classified into one of four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. Linked CMS/NDI data from 1984-2010 were used to determine morbidity in older age providing up to 40 years of follow-up. We included participants who were age 65+ between 1984 and 2010 and enrolled in Medicare FFS. All-cause morbidity was defined using the Gagne score. A CV morbidity score was defined as the sum of 4 CVDs including CHD (includes MI), PVD, cerebrovascular disease and CHF. Results: We included 25,390 participants (43% female, 90% White, mean age 44 at baseline); 6% had favorable levels, 19% had 1+ risk factors at elevated levels, 40% had 1 high risk factor and 35% had 2+ high risk factors. As compared to those with 2+ high risk factors, favorable CV health had lower levels of all-cause and CV morbidity from age 65-90 years, and a lower cumulative morbidity burden (p&lt;0.001) translating to lower average annual healthcare costs ($15,905 vs $20,791 per year, p&lt;0.001). Favorable CV health postponed the onset of all-cause morbidity by 4.5 years, the onset of CV morbidity by almost 7 years and extended life by almost 4 years resulting in a compression of morbidity on both the absolute and relative scale (see figure). Conclusion: Individuals in favorable CV health live a longer, healthier life and a greater proportion of life free of morbidity. These findings provide support for prevention efforts aimed at preserving cardiovascular health and reducing the burden of disease in older ages.

The Effects of a Community‐Based Multi‐lifestyle Intervention on CV Health in Rural Populations

The rate of cardiovascular diseases (CVD) mortality has decreased over the last few years. However, in rural areas, this reduction is less substantial compared to urban areas despite the effort to translate lifestyle intervention which was successful in urban areas. The purpose of this study is to use community‐based participatory research principles to conduct a pilot study to test the feasibility and acceptability of a lifestyle intervention in a rural community to improve CVD health.We assessed the feasibility and acceptability using retention and recruitment rate along with CV parameters i.e., Framingham risk score, 6‐min walk test, reactive hyperemia index, carotid thickness, and arterial stiffness, pre and post 10 week intervention.10 patients with CVD were screened with their family member, yielding 20 individuals screened (recruitment rate 59%). 17 patients were enrolled and retained (retention rate 100%). The 6‐min walk distance significantly (p=0.01) increased (1536±53 to 1651±55) with a tendency of improved HR and diastolic function represented by sub‐endocardial viability ratio after 10 wks intervention, although these parameters did not reach statistical significance. In contrast, there were no significant changes in the other CVD parameters. These findings provide valuable evidence to conduct lifestyle intervention for CVD patients in rural areas.

Abstract P389: Effects of Dietary Patterns on Vitamin D and Other Markers of Bone-Mineral Metabolism: Results From the Dash Trial

Background: The relationship of CVD with vitamin D levels and other markers of bone-mineral metabolism is of substantial interest. The Dietary Approaches to Stop Hypertension (DASH) diet effectively lowers blood pressure and is now recommended to promote CV health. The effects of the DASH diet on vitamin D and other markers of bone-mineral metabolism is unknown. Objective: To determine the effect of dietary patterns on blood levels of vitamin D, PTH, and ionized calcium, and urinary excretion of calcium and phosphate. Methods: Data on study outcomes were available in 334 participants from the original DASH trial. Baseline levels were obtained from blood and urine collected at the end of the run-in while on the control diet. Participants were then randomized to control diet (37% kcal total fat); fruits &amp; vegetable diet (also 37% kcal total fat); or the DASH diet (27% kcal total fat). Follow-up levels were obtained during the last week of the eight-week intervention period. Results: Mean (±SD) baseline blood levels of vitamin D, PTH , and ionized calcium were 15.1±3.7ng/ml, 46.1±18.5 ng/ml and 1.3±0.06 mmol/l, respectively. For urinary calcium and phosphate were 126.8±45.3mg/dl and 715.0±277.3 mg/dl, respectively. See table for within-diet changes. The DASH diet, net of control, reduced vitamin D by -1.29ng/ml (P= 0.005). In stratified analyses, the reduction in vitamin D appeared more prominent in blacks, but the p-value for interaction (race*diet) was non-significant (P=0.21). Otherwise, the DASH diet had no significant effect on the other markers, net of control. Compared to control, the fruit &amp; vegetable diet reduced urinary calcium and phosphorus excretion. Conclusion: The DASH diet modestly reduced vitamin D levels among all participants, with potentially larger effects in blacks. The reduction in vitamin D levels might have resulted from the lower fat content of the DASH diet. Overall, during the eight-weeks of intervention, no major harm or benefit of the DASH diet was documented on biomarkers related to bone-mineral metabolism.

Abstract 18085: Heart Healthy Living: A community Based, Culturally Sensitive Cardiovascular Disease Education Program for Chinese Women at Roxbury Tenants of Harvard

Background: Acculturation is strongly associated with increased cardiovascular disease (CVD) risk and risk factors among Chinese immigrants into Western societies. There is a paucity in community-based health interventions targeted towards Chinese immigrants, and a growing need to develop such programs among this rapidly expanding population. We adapted the Heart Healthy Living (HHL) seminar series, a tailored health, nutrition, and physical activity education program, to address the challenges that Chinese immigrants face. Methods: HHL is a six week culturally suitable CV health program targeted towards Chinese women residing at Roxbury Tenants of Harvard (RTH). Each session was held in Chinese and consisted of an interactive lecture component on CVD prevention, followed by an exercise activity. Each participant completed a validated Heart Disease Knowledge Questionnaire (HDKQ) both pre- and post-seminar series, in addition to blood pressure, weight, height, and waist circumference measurements at each time. Results: A total of 30 women registered with median age of 65.5 years old. At baseline, 33% of the women suffered from hypertension and 30% of women had BMI considered at minimum “overweight” at an average of 26.33 kg/m2 with a mean waist circumference of 32.6 inches (+/- 4.3 inches). Overall, there were no significant changes in weight, blood pressure, or waist circumference. However, we found a 117% increase in proficiency of CVD knowledge in the HDKQ, from 34.6% correct to 75.3% correct upon completion of the seminar series (Figure 1). Conclusions: There was a profound increase in CVD literacy with HHL completion. Not unexpectedly, there were no changes in metrics taken during the seminar series. Longer and larger studies are necessary to determine reproducibility and changes in measurements taken. Furthermore, one year follow up and long-term interventions are necessary to assess the translation of knowledge into health-related outcomes.

Effect of smoking ban at home on adult cardiovascular health: Scottish Health Survey, 2012

It has been known that active smoking and passive smoking [1] have contributed increased risks of cardiovascular diseases (CVD), mental health, and mortality including in the Scottish adults (data in 1998–2003 and 2008–2011) [2,3]. The law banning smoking in public places in Scotland has been approved and implemented after scientific evidence was provided [4]. The considerable benefits achieved included air quality improvement, avoidance of adverse health outcomes and broader policy empowerment in Scotland while the importance of learning from other administrations, and political and professional leadershipwere also noted until 2008. In this study, it was aimed to examine the effect of home smoking ban on adult CV health in a country-wide and population-based setting. As described elsewhere in detail [5], Scottish Health Survey (http:// www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-healthsurvey) has been a country-wide, population-based, multi-year study. It provides a detailed picture of the health of the Scottish population in private households and is designed to make a major contribution to the monitoring of health in Scotland. It is essential for the Scottish Government's forward planning, for identifying gaps in health service provision and for identifying which groups are at particular risk of future ill-health. Formore surveydesigndetails including sample sizeestimation, they can be found here: http://www.scotland.gov.uk/Topics/Statistics/ Browse/Health/scottish-health-survey/SurveyDesignContent. In the current analysis, the most recent study wave in 2012 with available data on demographics, lifestyle factors, smoking rule at home, and self-reported ever CVD and events occurred in the last year in adults aged 20 and above which was obtained by household interview was included. Study exposure variables included age, sex, education level, bodymass index, smoking status (current, past, or never), alcohol status (current, past, or never), high blood pressure status, and home smoking rule (anywhere, in certain areas, outdoor areas, or not allowed). Study outcomes were self-reported ever CVD and events occurred in the last year including angina, heart attack, abnormal heart rhythm, other heart troubles, and stroke. In the first step, associations between home smoking rule and adult ever CVDwere carried out. In the second step, associations between home smoking rule and adult CVD occurred in the last yearwere examined. Effects were estimated by using odds ratios (OR) and 95% confidence intervals (CI), with P b 0.05 considered statistically significant. Statistical software STATAversion13.0 (STATA, College Station, Texas,USA) was used to perform all the analyses. Since it is only a secondary data analysis in the present study, no further ethics approval was required. Of 4646 adults included in the study cohort, 4635 with valid data on all exposures and outcomeswere eligible for statistical analysis. Themean age was 12.5 while the range was 20–99. 566 (12.2%) adults reported no restriction of smoking at home and 695 (15.0%) reported smoking was allowed in certain areas of the housing. 2810 (60.6%) adults reported smoking only allowed in outdoor areas while 564 (12.2%) reported nonsmoking was allowed in the households. Table 1 shows associations between home smoking rule and self-reported CVD by subtypes in adults. Adults less reported angina (OR 0.60, 95%CI 0.43–0.86, P = 0.005) and heart attack (OR 0.55, 95%CI 0.37–0.81, P = 0.003) if smoking were only allowed in outdoor areas, compared to no restriction at home. In addition,

Abstract 335: Population Well-being and Cardiovascular Disease

Background: Increasingly, policies and payment structures are holding health care systems accountable for the health of their population, refocusing attention on community attributes that influence health. However, the complex and contextual aspects of a community make it challenging to know which community attributes may affect the health risk of individuals. Methods: We investigated the relationship of CVD prevalence and risk factors with a novel index of well-being, the Gallup-Healthways Well-being Index (GHWBI, 2010), consisting of 55 survey responses organized into 6 domains: life evaluation ( LE ); emotional health (EH) ; work environment (WE) ; physical health (PH) ; healthy behaviors (HB) ; and basic access [to food, shelter, and health care] (BA) . Individuals &gt;18y were randomly selected for telephone survey (n=348,846). Overall index and domain scores were made available to us aggregated to the Congressional District (CD) level. Prevalence of heart disease, stroke, hypertension, and diabetes, as well as CV health (absence of these factors), were determined using the 2011 Behavioral Risk Factor Surveillance System (BRFSS) sub-group study (224 counties). We linked datasets by assigning average BRFSS item responses at the county level to county zip codes; we then re-aggregated to CD and weighted by zip code. We used weighted linear regression to assess: (1) rates of CVD/CV health across GHWBI quintiles, and (2) independent effects of the 6 GHWBI domains on CVD/CV health, reported as t-scores. Because the PH domain included survey items related to CVD, we repeated this analysis excluding PH as an independent variable. Results: Higher CD well-being scores (n=316 CDs) were associated with lower prevalence of CVD and higher rates of CV health (Table). Independent effects of the GHWBI domains revealed inverse associations between CVD and HB , and heart disease and LE . CV health was positively associated with EH and BA, but negatively associated with HB . Excluding PH from this analysis did not meaningfully affect the results. Discussion: Population well-being is associated with reduced CVD and improved CV health, even at the CD level. Future research should investigate these relationships within smaller more homogeneous community populations, in order to identify targets for intervention.

Self-Fitness Assessment and Exercise Motivation.

Background: Cardiovascular disease (CVD) is a common etiology of patient morbidity and mortality after kidney transplantation. Exercise favorably impacts the risk factors for CVD. We conducted an observational study in prevalent transplant patients to measure their self perceived level of fitness and to determine their interest in improved fitness and motivation to exericse. Patients who were interested in improving their fitness were enrolled in an exercise rehabilitation program. Methods: Stable kidney transplant (KT) recipients >2 months (m) after transplant completed a survey about their fitness. Patients who were interested in improved fitness were enrolled into the 6m study. Subjects were asked to exercise ≥2 times/week. An exercise physiologist met individually with each patient to design a regimen focused on strength and CV health. Baseline body mass index (BMI) and monthly BMIs were recorded. Results: 83 patients completed the survey. 98% of patients who perceived themselves as not-fit were interested in increasing their fitness compared to 41% of patients who saw themselves as fit. 82% of not-fit patients were interested in a free gym/trainer but only 24% of not-fit patients were willing to pay for a gym. To date, 5 of 10 patients have completed the 6m study. 4 of 5 patients achieved the exercise frequency goal. 4 of 5 patients felt their energy level to be improved at the end of the study. 3 of 5 study patients joined a gym at study completion. 3 of 5 patients lowered or maintained their BMI. Twenty age-/sex-matched recipients were used as a control group of which 6 lowered or maintained their BMI over the same period. There were no adverse events.Table: No Caption available.Table: No Caption available.Conclusion: KT patients are interested in improving their fitness. An initial barrier is the cost of a gym membership. After participation in a free exercise program, KT patients may be more willing to pay for a gym perhaps due to positive reinforcement from improved weight management and energy levels. Investigating ways to make gym memberships more accessible to new KT patients may help reduce CVD risk factors.

Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost &gt;5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

Abstract 18648: Heart Healthy Living: A Community-Based, Tailored Educational Program to Improve the Cardiovascular Knowledge and Health of African American Women

Background: Low health literacy is a potential contributor to poor cardiovascular outcomes. Health literacy is lowest among the elderly, racial/ethnic minorities, those with low education level, the uninsured, and the publicly insured. African American (AA) women suffer from a disproportionate burden of CV risk factors (RF) and low health literacy. We developed a community-based, tailored health education, nutrition, and exercise program, Heart Healthy Living (HHL) to address the unique challenges in AA women. Methods: HHL consisted of a 6-week program to improve the CV health literacy of AA women aged 18 years or older with at least one CV risk factor. The program consisted of weekly tailored CV health education and exercise classes. In weeks 1 and 6, participants completed a validated Heart Disease Knowledge Questionnaire, blood pressure and weight were checked. Results: Participants included 32 AA women with an average age of48 years. Participants had high rates of hypertension (55%) and obesity (68%). Participants experienced an age-adjusted weekly weight loss of 0.5 lbs and an age-adjusted total weight loss of 2.7 lbs (p&lt;0.001). There was a 40% relative decline in rates of HTN after completion of the program. At baseline, participants scored &lt;50% on the validated Heart Disease Knowledge Questionnaire; however after completion of the program this improved significantly (Figure). Conclusion: We found that a tailored health education and exercise program resulted in improved CV health literacy in AA Women. Our data suggests an intensive CV education and exercise program, improved health literacy disparities and CV RF in AA women. Larger and longer studies of HHL are ongoing to determine whether these results are replicable and sustainable.

Abstract MP08: Cardiovascular Health and Incident Cardiovascular Disease and Cancer

Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. A favorable risk factor and behavior profile, reflected by a metric of cardiovascular health (CV health) recently introduced by the AHA, predict a lower risk of CVD in younger populations, yet has not been well-characterized in older adults. Achieving ideal CV health may also lower cancer risk, since cancer and CVD share common risk factors. We used multivariable Cox regression to estimate hazard ratios (HR) for the association between CV health and incident CVD and cancer, respectively, among Women’s Health Initiative (WHI) participants. We characterized CV health as the number [0 (worst) - 7 (best)] of ideal CV health behaviors and factors at baseline: 1) never smoking, or quit for &gt;1 yr; 2) body mass index &lt;25 kg/m 2 ; 3) physical activity of ≥150 min/wk moderate, ≥75 min/wk vigorous, or ≥150 min/wk moderate and vigorous; 4) at least 4 of 5 healthy diet components (≥4.5 cups/day of fruits and vegetables; ≥3.5 oz servings/wk of fish; ≥3 1-oz servings/day of whole grains; &lt;1,500 mg/day of sodium; and ≤36 oz/wk of sugar-sweetened beverages); 5) total cholesterol (untreated) &lt;200 mg/dL; 6; blood pressure (untreated) &lt;120 mmHg / &lt;80 mmHg; and 7) fasting glucose (untreated) &lt;100 mg/dL. Approximately 300 women (&lt;1%) had a CV health score of 7 (best) in both CVD- and cancer-free groups at baseline. Among 115,302 women free of CVD at baseline, the hazard of CVD was inversely related to CV health (Figure 1a), controlling for age, race/ethnicity, family history, marital status, and education. Among 129,145 women free of cancer at baseline (Figure 1b), we observed a similar pattern, controlling for the same factors, although HRs were of smaller magnitude. Lower CV health is associated with an increased risk of CVD and cancer in older post-menopausal women, emphasizing the importance of prevention efforts among older adults. Figure 1. HRs and 95% CIs for (a) incident CVD and (b) incident cancer by ideal CV health score: WHI observational study participants

Abstract P438: Cardiovascular Health in Adolescents with Type 1 Diabetes: The SEARCH CVD Study

In 2010, the American Heart Association (AHA) identified national goals for ideal cardiovascular health (ICH). Type 1 diabetes (T1D) significantly increases the risk of cardiovascular disease (CVD), and adolescents with T1D are a group particularly relevant for focus on ICH. The purpose of this study was to examine the prevalence of ICH in a population of adolescents with T1D and to examine the association of ICH with measures of CV function [arterial stiffness (AS) measured using pulse-wave velocity (PWV), augmentation index (AIX) and brachial distensibility (BD)], and structure [carotid intima-media thickness (cIMT; bulb, common carotid (CC), and internal carotid (IC))]. We used data from the retrospective cohort component of the SEARCH CVD study, which followed youth with T1D for approximately 6 years. Data collected at baseline (mean age 15 years) include diet, smoking, physical activity, BMI, cholesterol, blood pressure, and fasting plasma glucose. Measures of PWV, AIX, BD, and cIMT were obtained at follow-up (mean age 20 years, diabetes duration 10 years). Complete data were available on 182 subjects. Multiple linear regression models were fit to examine the association between the Number of metrics that met the ICH goal (NICH; range 0 to 7) and the subclinical CVD outcomes. The prevalence of the ICH metrics is shown in Table 1. Prevalence of ICH ranges from none meeting the healthy diet to nearly all being never smokers (88%). While most youth met 3 or 4 goals, only 5% met 5 and none met all 7 criteria. Increasing NICH at baseline was associated with lower AS [lower PWV (β= -0.02, p=0.035), higher BD (β= 0.03, p=0.042)] and lower cIMT of the CC (β= -0.02, p=0.023), adjusted for age, sex, race, hemoglobin A1c, triglycerides, and diabetes duration. In conclusion, youth with T1D are not meeting ICH goals. Meeting more ICH goals was associated with better CV health as indicated by lower AS and cIMT thickness. Measures targeted at increasing ICH in adolescents with T1D are needed in order to reduce the burden of CVD in this high risk population.

Abstract 18593: Impact of National Screening Intervention on AHA's ‰Life's Simple Seven Cardiovascular Metrics

Background: Recent AHA recommendations promote 7 CV health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet to reduce CV morbidity and mortality. As few studies have explored interventions to promote these "Simple 7", we examined the impact of a national screening program on CV health metrics in women. Methods: In 2009, Sister to Sister provided free CV screenings in 12 cities nationwide to 9,443 women, all of which were offered enrollment into a 6-month follow-up survey study. Using data collected from baseline and 6-month surveys on CVD risk, we measured changes in “Simple 7” health metrics (excluding diet) following screening intervention. Results: A total of 1,869 women enrolled into the study, 400 of which completed baseline and 6-month surveys. Among those completing both surveys, we observed significant overall improvement in risk scores between screening intervention and 6-month follow-up (3.8 vs. 4.2, p&lt;0.001). We observed improvements 4 of the 6 health metrics measured (Table 1), although only blood pressure improvements were statistically significant. Conclusion: Screening intervention was effective in improving overall health of women at 6-months, based on optimal CV health metrics. Screenings were particularly effective in improving blood pressure control. Although larger studies are needed to further assess the impact of CV screenings on health metrics, our study suggests that screenings may serve as an effective model to promote CV health metrics, especially among women.

Abstract 18927: Geographic Variation of AHA's ‰Life's Simple Seven in Women

Background: Evidence shows that individuals achieving AHA’s “Life’s Simple 7” cardiovascular health metrics have significantly reduced risk of CVD incidence and mortality. Geographic variation in CVD risk factors has been previously described. We sought to determine whether CV risk as defined by optimal CV health metrics varied geographically among women. Methods: In 2009, Sister to Sister provided free cardiovascular screenings to 9,442 women in 12 cities, including Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Jacksonville, Los Angeles, Miami, St. Louis, Tampa, and Washington, DC. Using biometric data collected from screenings supplemented by surveys on CVD risk, we analyzed variance in the “Simple 7” cardiovascular metrics by city. These metrics were defined as being physically active, having normal blood pressure, weight and blood glucose and total cholesterol levels, and eating a healthy diet. We used 6 of these 7 metrics, excluding diet, to assign each city with a risk score. Results: Few cities were at optimal health. On average, cities achieved 3.8 out of 6 cardiovascular metrics. From a regional perspective, Atlanta, Dallas and Detroit were significantly lower, and Boston and St. Louis were significantly higher than the city-wide average (see figure 1). Conclusion: Significant geographic variation exists in proportion of individuals achieving “ideal CV health” as measured by the AHA’s “Life’s Simple 7”. Given this, solutions to improve community based CV risk will need to be tailored by region.

Omega 3 may not improve CV health

Omega 3 may not improve CV health

Functional Study of Tumor Suppressor p53 Gene Variation: Effect on Cardiovascular Adaptation to Exercise Training

Aerobic exercise capacity is inversely related to CVD risk and all cause mortality. p53 plays a crucial role in mitochondrial DNA (mtDNA) maintenance, which is important for mitochondrial function and disease prevention. Here, we extend this concept and investigate whether the p53 codon 72 R/P polymorphism is associated with the adaptive response to aerobic exercise training (AEXT) with respect to enhancing aerobic capacity. 144 sedentary middle‐aged to older females underwent standardized AEXT for 6‐ month. We observed that R allele‐carriers (RR/RP, n = 117) had two‐fold greater improvement in VO2 max in response to the AEXT compared to the non‐carriers (PP, n = 27) (P &lt; .05). To explore the likely molecular mechanisms of p53 being a potential regulator of cardiovascular adaptation to exercise, we further assessed 1) mitochondrial translocation of p53, 2) p53‐mtDNA binding complex, and 3) mtDNA contents in genotyped HUVEC (n = 10, from ten different donors) exposed to exercise‐simulated high flow shear stress (h‐flow, 20 dyne/cm2, 24 h) in vitro. We observed a dramatic increase in mitochondrial p53 level and p53‐mtDNA binding complex under h‐flow (n = 5). Also, RR/RP HUVEC (n = 7) showed significantly higher mtDNA contents compared to PP HUVEC (n = 3) (P &lt; 0.01). Further molecular genetic mechanisms will be discussed. The findings in this study may provide new insights into physiological role of p53 in CV health.

Abstract 044: Trends in Race/Ethnic Disparities in Ideal Cardiovascular Health: NHANES 1999-2006

Background: Significant racial/ethnic disparities exist in the cardiovascular health of the nation. Prior studies have identified differences between groups, but have not summarized trends in these disparities across multiple race/ethnic subgroups, which could allow us to assess the extent to which we are achieving disparity-related goals. Methods: We used NHANES Surveys from cycles 1999–2000, 2001–2002, 2003–2004, and 2005–2006 to examine the age-adjusted prevalence of ideal levels of CV health factors by race/ethnicity. Ideal levels of BMI, cholesterol, glucose, blood pressure, diet, physical activity and smoking were defined according to the AHA 2020 strategic goals. Racial/ethnic groups were categorized as Hispanic, Non-Hispanic White, Non-Hispanic Black and other. Both absolute (Between Group Variance- BGV) and relative measures (Theil Index -T) of disparities were calculated, calculations were weighted by population share. The percentage change in disparities relative to 1999–2000 was examined. Results: Age-adjusted rates of ideal CV health components and the percentage change from 1999–2006 varied by race/ethnicity (see Table). Disparities in the prevalence rates of ideal levels of blood pressure, cholesterol and physical activity have increased dramatically between race/ethnic groups in both men and women (see Table). Disparities in smoking and diet have increased in men but decreased in women. Disparities in BMI have changed little in men (BGV= 0.5%, T=−37.8%), but increased dramatically in women (BGV= 894%, T=280%). Findings were generally similar for both absolute and relative measures of disparities. Conclusions: Representative national data on these summary measures of disparities suggest that disparities between race/ethnic groups have increased for many cardiovascular health factors over the past decade. Understanding the issues underlying these increasing disparities and addressing them will be critical to improving the cardiovascular health of all Americans by 2020 and beyond.

Abstract P299: BMI and BP Predict Brachial Distensibility in Healthy Adolescents and Young Adults

Introduction: CV risk-factor (CVRF) related increase in arterial stiffness is associated with adverse CV events in adults. Cross-sectional studies in youth show a relationship between CVRF and arterial stiffness. Longitudinal data are lacking. Hypothesis: CVRFs will predict decreased brachial artery distensibility (BrachD). Methods: Demographics, anthropometrics, BP, fasting glucose, insulin, lipids and BrachD were measured in 425 healthy youth in a school-based longitudinal cohort (age 17.4 +2.1 yrs, 41% male, 61% Caucasian). Anthropometrics, BP and BrachD were repeated 2.1 + 0.3 years later. Mean values for baseline and follow-up variables were evaluated by paired t-test. Characteristics of subjects with decrease in BrachD (N=167) were compared by t-test with subjects without BrachD decrease. The multivariable model to determine predictors of follow-up BrachD contained baseline and change of age, sex, BMI, MAP, HR, baseline lipids, glucose and insulin. Results: Over 2 years, the cohort increased in HT, WT, BMI, SBP and BrachD (all p&lt;0.02). Predictors of decrease in BrachD were greater baseline and change in BMI, MAP and HR (R 2 = 0.36, model p &lt;0.0001, parameter p&lt; 0.02, BrachD at follow-up = 2.7 + 0.04*Age at baseline + 0.4*Sex (male=1, female=2) − 0.02 Age at baseline*Sex − 0.33*BMI at baseline − 0.02*BMI change - 0.005*MAP at baseline - 0.004*MAP change - 0.002*HR at baseline - 0.003*HR change). BMI at baseline and change in BMI contributed the majority of the variance in BrachD at follow-up (16 and 4%). Subjects with decrease in BrachD were more likely to have gained more BMI (1.3 vs 0.6 kg/m 2 ) or increased more in MAP (0.8 vs −1.3 mmHg) and HR (1.1 vs −2.0 beats/min, all p&lt;0.002). Conclusions: Development of obesity with subsequent changes in BP and HR may lead to development of arterial dysfunction. Prevention of obesity may be the most important approach to improve the CV health of adolescents and young adults.

Cardiorespiratory fitness in young adults with a history of renal transplantation in childhood

Limited knowledge exists on cardiorespiratory fitness (CR fitness) in adults having a renal transplant (Rtx) during childhood. Our aim was to assess CR fitness (V0(2peak)) with a maximal treadmill test in former Rtx children reaching adulthood (ped-tx, n = 31), compared to patients Rtx as adults (adult-tx, n = 17) and healthy controls (HC, n = 36). Median age was 26.9 (19-41), 28.6 (23.5-34) and 33.5 (20-42) years, respectively. Median time since first Rtx was 18.1 (7-29) and 3.7 (1.2-12.6) years. Body composition was measured by dual-energy X-ray absorptiometry (DXA). V0(2peak) was median 37.9 (12.5-56.3), 40.8 (26.5-57.5), and 44.4 (29.5-65.6) ml kg (-1)min (-1) in the ped-tx, adult-tx, and HC, respectively. Ped-tx had significantly lower V0(2peak) compared to HC (p = 0.01). Adult-tx had higher exercise capacity (test duration) compared to ped-tx (median 10.5 (7.5-16) and 9 (6-14) min, respectively (p = 0.016). In multiple linear regression analysis, test duration, fat-free mass (FFM, kg) and Hgb (g/dl) were significant predictors of V0(2peak) explaining 86% of its variance. There was no significant difference between ped-tx and adult-tx in V0(2peak.) CR fitness depicts long-term health outcome in Rtx patients both in regard to physical functioning and is a plausible indirect marker of CV health.

Oral Contraceptives and CV Health

Oral contraceptives are the most commonly used form of birth control worldwide [Blackmore KM et al. BMC Womens Health 2011]. Estrogen and progestins have been used by millions of women as effective combined oral contraceptives. Their safety has been documented by years of follow-up, and serious adverse events that may be related to their use are rare in the young population that is exposed to these agents.