Heart Disease Prevention Program Research Articles

Cardiovascular risk factors in Mexican American adults: a transcultural analysis of NHANES III, 1988-1994.

This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States. Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken. Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-speaking men and women was demonstrated for each of the 5 cardiovascular disease risk factors. These findings illustrate the heterogeneity of the Mexican American population and identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs.

Ethnic Variation in Cardiovascular Disease Risk Factors Among Children and Young Adults

Knowledge about ethnic differences in cardiovascular disease (CVD) risk factors among children and young adults from national samples is limited. To evaluate ethnic differences in CVD risk factors, the age at which differences were first apparent, and whether differences remained after accounting for socioeconomic status (SES). Third National Health and Nutrition Examination Survey, 1988-1994. Eighty-nine mobile examination centers. A total of 2769 black, 2854 Mexican American, and 2063 white (non-Hispanic) children and young adults aged 6 to 24 years. Ethnicity and household level of education (SES) in relation to body mass index (BMI), percentage of energy from dietary fat, cigarette smoking, systolic blood pressure, glycosylated hemoglobin (HbA1c), and non-high-density lipoprotein cholesterol (non-HDL-C [the difference between total cholesterol and HDL-C]). The BMI levels were significantly higher for black and Mexican American girls than for white girls, with ethnic differences evident by the age of 6 to 9 years (a difference of approximately 0.5 BMI units) and widening thereafter (a difference of >2 BMI units among 18- to 24-year-olds). Percentages of energy from dietary fat paralleled these findings and were also significantly higher for black than for white boys. Blood pressure levels were higher for black girls than for white girls in every age group, and glycosylated hemoglobin levels were highest for black and Mexican American girls and boys in every age group. In contrast, smoking prevalence was highest for white girls and boys, especially for those from low-SES homes (77% of young men and 61% of young women, aged 18-24 years, from low-SES homes were current smokers). All ethnic differences remained significant after accounting for SES and age. These findings show strong ethnic differences in CVD risk factors among youths of comparable age and SES from a large national sample. The differences highlight the need for heart disease prevention programs to begin early in childhood and continue throughout young adulthood to reduce the risk of atherosclerosis.

Exploring the use of action research to stimulate and evaluate workplace health promotion

This article describes a health authority's approach to setting up and evaluating a coronary heart disease prevention programme through the workplace. The Bedfordshire Healthy Workplace Project was set up in 1992 'to stimulate interest and activity in workplace health promotion' and has developed an action research model to evaluate the impact of working with local employers on coronary heart disease risk behaviour. Action research as a methodology for health promotion research, and some of the main benefits and barriers are discussed.

Prevalence of congenital heart disease among school children of Sahafa Town, Sudan

The prevalence of congenital heart disease among schoolchildren aged 5-15 years was studied as part of Phase 1 of the WHO Global Rheumatic Fever/Rheumatic Heart Disease Prevention Programme in Sudan. A total of 13 322 schoolchildren in Sahafa Town, Khartoum, was examined from 1986 to 1990 representing 70% of the total target population. There were 27 cases of congenital heart disease giving a prevalence rate of 2.0 per 1000. Ventricular septal defect, atrial septal defect [ASD], patent ductus arteriosus [PDA] and tetralogy of Fallot made up 85% of the cases. PDA and ASD were twice as common in females as in males. The prevalence rate is comparable to that of similar African countries but lower than European and north American rates

Heart disease education and prevention program targeting immigrant Latinos: using focus group responses to develop effective interventions.

Although research has provided considerable knowledge concerning the positive effects of behavioral change on morbidity and mortality from heart disease and related risk factors, some segments of the population have not benefited equitably from this information. In April 1995, the National Heart, Lung, and Blood Institute (NHLBI) conducted seven focus groups to determine knowledge and attitudes about heart disease and associated risk factors, identify media usage and preferences, and assess publications usage and preferences among Spanish-speaking Latino immigrants residing in the Washington, D.C., metropolitan area. This information was gathered to assist in the development of key messages and strategies for the NHLBI Latino Community Cardiovascular Disease Prevention and Outreach Initiative, Salud para su Corazón--a heart disease prevention and education campaign. Findings from these focus groups indicate that Latinos may not benefit from heart disease prevention messages developed for the general population because of language and cultural differences. The researchers concluded that health education and disease prevention programs targeting the Latino community should develop educational materials and interventions that address language preferences and cultural values. Furthermore, to be effective, these programs should show people how to make positive behavioral changes based on their current circumstances, while remaining sensitive to the fact that Latino immigrants face major life adjustments and many are still greatly influenced by their country of origin.

Exercise on prescription: guidelines for health professionals

Exercise has the capability to improve many aspects of health, yet national surveys have indicated that the general population is not exercising su¤ciently for such bene¢ts to accrue.With a great proportion of the population attending general practices each year, general practitioners have a unique opportunity to increase the prevalence of exercise. With such a realization, `exercise on prescription' schemes, in which general practitioners prescribe exercise as an alternative to medication, have become increasingly popular within the United Kingdom. However, few guidelines as to good practice exist. This paperaims tobridge this gapprior to theavailability of detailed evaluations, by drawing upon the experiences of a scheme established in 1993 by the LIFE Project, a community-based heart disease prevention programme. The scheme currently has 22 general practices referring patients to a coordinator who decides upon the most appropriate form of exercise prescribed after an introductory consultation and a health check. To date, over 600 patients have been referred. The paper focuses upon various aspects associated with exercise on prescription including patient selection, targeting of general practices and leisure venues, ethical considerations, adherence issues, and the most appropriate speci¢c exercise options.

The field of health communication today: an up-to-date report.

One important starting point for the field of health communication was the Stanford Heart Disease Prevention Program, a multiyear community intervention that began 25 years ago. Health communication is a specialty field of communication study that includes the media agenda-setting process for health issues; media advocacy for health; scientific communication among biomedical scientists; doctor-patient communication; and, particularly, the design and evaluation of preventive health communication campaigns, the focus of this article. Health communication study today is a well-established, expanding specialty in the United States and abroad.

Fibrinogen and Factor Vllag in Healthy Adolescents: The Floren-teen (Florence Teenager) Study

At least five studies based on more than twenty thousand healthy subjects indicated that fibrinogen is an independent risk factor for cardiovascular events; less clear-cut is the relation between factor VII and risk for arterial thrombotic disorders, which was demonstrated in two of the three studies investigating this association. However, no study has investigated the behaviour of fibrinogen and factor VII in an adolescent population. In a study of Preventive Medicine and Education Program, fibrinogen (clotting method) and factor VIIag (ELISA), in addition to other metabolic parameters, life-style and familial history, were investigated in 451 students (313 females and 138 males, age 15-17 years) from two high schools of Florence. Fibrinogen levels were significantly higher in women than in men, whereas factor VIIag levels did not significantly differ. Both fibrinogen and factor VIIag significantly correlated with total cholesterol (p < 0.05) while only fibrinogen correlated with body mass index (p < 0.01). Factor VIIag was significantly correlated with systolic blood pressure (p < 0.001). This study provides information on coagulation risk factors in a population of adolescents which may be of importance in planning coronary heart disease prevention programs.

Community worry about heart disease: a needs survey in the Coalfields and Newcastle areas of the Hunter region

A needs survey was administered by mail in the Coalfields area of the Hunter region (a lower socioeconomic area around Cessnock) and in a higher socioeconomic area of Newcastle. The purpose was to assist planning for Coalfields Healthy Heartbeat--a community-action heart disease prevention program. Response rates from random samples of residents were 435/897 (49 per cent) for the Coalfields and 565/875 (65 per cent) for Newcastle. In both study areas heart attack was ranked eleventh from a list of 17 potential community worries, well below drugs, crime, road safety, the environment, cancer and 'loss of health'. Coalfields respondents were more worried about all issues on the list than were the residents in Newcastle and were less likely to have heard about recent health promotion campaigns. Coalfields respondents felt that heart disease prevention was the responsibility of the individual, the family, and the medical profession, in that order, and much less the responsibility of local community groups. Results suggest that health promotion strategies incorporating values, language and symbols that are meaningful to distinct subgroups may be more successful than disease-specific programs aimed at the general population.

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. Semistructured interviews of health promotion managers. Wales and two reference health regions in England. Nine health promotion managers in Wales and 18 in England. Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended.

Awareness of high blood pressure influences on psychological and sympathetic responses

The aim of the present study was to examine the effects of awareness of hypertension on psychological factors and whether there was an association between psychological and sympathetic responses. To avoid self-selection bias 32 19-yr old white men, all with mean blood pressure of 116 mm Hg were randomized into two groups. One group was informed that the blood pressure was elevated and asked to come to a second examination while the other was invited to take part in a coronary heart disease prevention program. A cold pressor test was undertaken and the subjects completed the Karolinska Scale of Personality (KSP). Assessed by the KSP, the informed group showed lower verbal aggression ( p < 0.01), irritability ( p < 0.05), monotony avoidance ( p < 0.05) and impulsiveness ( p < 0.05), higher detachment ( p < 0.05) but no significant differences in the other subscales like anxiety, psychasthenia or factors of hostility. Information significantly increased resting blood pressure and increments in heart rate and plasma adrenaline responses to cold pressor test. Thus, both psychological and sympathetic responses were influenced by awareness of high blood pressure. There were significant correlations between less assertive behaviour and increased plasma catecholamines.

Review of community intervention studies on cardiovascular risk factors.

The concept of community intervention in the field of cardiovascular disease prevention was introduced in the late sixties and early seventies. The WHO European Collaborative Trial in the multifactorial prevention of coronary heart disease used communities (factories) in a traditional controlled trial. The intervention used in this trial was an extension of a medical care model with preventive elements. The first two major community intervention projects in CVD prevention--the North Karelia Project and the Stanford Heart Disease Prevention Programme--were the basis of further WHO and NHLBI coordinated projects. They have used community-based population-wide strategies including existing community leadership, social networks, mass campaigns and extensive direct education for the general population. In the evaluation of those projects quasi-experimental models are used because "perfect experiments" are not possible. Some projects have proven the feasibility of community intervention and its positive impact on lifestyles and cardiovascular risk factors in a whole population and that such a development is associated with reduced cardiovascular mortality rates.

You and your heart

This article is focussed on a heart disease prevention program which used a mass media approach to facilitate changes in lifestyle of the population. A radio station, 930 CJCA, in Edmonton, Alberta, Canada aired five consecutive 1 1/2 hour open-line programs in which several aspects of heart disease were addressed by health experts. A public health meeting was held afterwards. Approximately 500 persons attended, 430 of whom filled out questionnaires and were interviewed by telephone six months later. Over half of the respondents made substantive lifestyle changes to reduce heart disease; approximately one-quarter had checked for evidence of diabetes; two-thirds had their blood pressure checked within the six month follow-up period. People in this group seemed to exercise more and smoke less. The importance of utilizing the mass media to alter lifestyles of the public is documented. Most authors agree that primary prevention programs are needed to enhance the general health of the population.

Effects of Exercise Training on Serum Lipid and Lipoprotein Levels in Post-MI Patients

Exercise training is a central activity in most primary and secondary coronary heart disease (CHD) prevention programs. In healthy persons, training often results in beneficial changes in the lipid and lipoprotein profile. Data are not clear regarding lipid and other risk factor changes following training in CHD patients after myocardial infarction (MI). Using meta-analysis, the authors examined the results of 15 reports on the effects of exercise training in post-MI patients on lipid and lipoprotein levels. Four hundred and ninety male patients, average age 52 years, trained an average of 24 weeks at 76 % HRmax, Triglyceride levels decreased from 169 mg/dL to 149 mg/dL (P < 0.01), total cholesterol levels decreased from 232 mg/dL to 221 mg/dL (P < 0.01), LDL-cholesterol levels decreased from 145 mg/dL to 140 mg/dL (P < 0.01), and the cholesterol/'HDL-cholesterol ratio decreased from 5.7 to 5.0 (P < 0.001). High-density lipoprotein cholesterol levels increased from 41 mg/dL to 45 mg/dL (P < 0.001). Thus, exercise training following MI appears to have beneficial effects on lipid and lipoprotein levels in middle-aged men. The effects of these changes on subsequent morbidity and on natural history are as yet, not known.

EATING OUT A LA HEART IN HACKNEY

In the inner London borough of Hackney four of the 193,000 residents die each week before they reach retirement age. To combat this situation and to encourage healthier lifestyles, the City and Hackney Heart Disease and Stroke Prevention Programme was inaugurated three years ago. This programme consists of various projects designed to increase public awareness of the problem and to help people make more healthy food choices to reduce their risk of cardiovascular disease.

The Heart Healthy Vermonter Program

The Vermont Department of Health has developed a heart disease prevention program which has three major components: community organization and education, professional education, and media development. At the community level both individual lifestyle factors and environmental concerns are addressed through a series of projects. The state health department makes small grants available to community agencies for the purpose of implementing the program at the local level. Evaluation consists of regular monitoring of all program components to determine if each continues to meet objectives. This paper describes funding, methods, and experience in the development and implementation of this program.

The Healthy People Project: Reducing the Risk of Heart Disease in Maryland

The Healthy People Project was organized in 1981 as a state health department program for the primary prevention of heart disease in Maryland. With a limited budget, the Project strove to increase the number of effective health education programs throughout the state in smoking cessation and prevention, low fat and cholesterol diet, exercise, and weight control. The worksite and community demonstration projects were used to develop effective programs and implementation strategies for others to utilize. Health care organizations and employers were successfully engaged to implement these programs. Evaluations of the major risk behavior change programs conducted by the Project are presented in this paper. The following are two examples. One of the Project's most successful large-scale programs was the 34 smoking-cessation incentive campaigns which had 3,060 smokers participating. In a sample of 1,359 participants, an average of 9% were not smoking at the one-year telephone follow-up. A self-help exercise program was developed for the 7,000 people in the Maryland Army National Guard. It achieved a 37% increase over two years in the number of people passing the Army Physical Readiness Test. Implications and programs for use by other state heart-disease prevention programs are identified.

The role of behavioral change procedures in multifactorial coronary heart disease prevention programs.

Coronary risk factor screening and health education programs have constituted the mainstay of intervention in the large-scale community and clinic-based multifactorial CHD intervention trials which have been conducted in recent years. Community-based trials involving intervention along these lines have generally reported significant improvements in self-reported smoking patterns, slight improvements in blood pressure and serum lipid levels, and negligible changes in weight and physical fitness. The findings of controlled clinic-based trials involving nonbehavioral intervention have generally been only slightly more encouraging. Of note are the impressive findings of the Oslo Study (52), in which intervention involving brief personalized counseling and coronary risk factor assessment at 6-monthly intervals resulted in markedly greater improvements in mean serum cholesterol levels (13%) and the prevalence of smoking (15%) than was a case for the "no treatment" control group. The greater improvements in cigarette smoking were validated using serum thiocianate levels. The findings of both the North Karelia project and the MRFIT suggest behavioral intervention to be superior to traditional "exhortative" (i.e., screening; health education; medical counseling) procedures in achieving lasting improvements in the primary coronary risk factors (i.e., blood pressure, serum cholesterol, and cigarette smoking), but to be similarly ineffectual in changing the secondary risk factors (i.e., body weight, physical fitness). The issues of cost effectiveness, and the role of particular behavioral techniques in achieving lasting improvements in target coronary risk-related behaviors remain to be researched.

A framework for evaluating community-based heart disease prevention programs

This paper reviews issues that arise in the evaluation of community-based heart disease prevention programs and offers suggestions for improving future evaluations of these programs. A framework encompassing the evaluation of process, impact and social relevance guides this discussion. The goal of the framework is to divide the question, “do community-based health programs work?”, into more easily answered evaluation questions. in doing so, interventions that promote the health of community residents are likely to be designed and implemented successfully.

Changes in perceived heart disease risk and health during a community-based heart disease prevention program: the North Karelia project.

To test whether the cardiovascular disease declines in North Karelia were accompanied by subjective improvements in health, we analyzed responses to two questions about perceived risk of heart disease and health status on independent random population samples surveyed 10 years apart. Age stratified perceived risk of heart disease declined significantly more (p less than .01) and age stratified perceived health status improved significantly more in North Karelia than in the reference area (p less than .005).