High Heart Disease Risk Research Articles

Development of Health Monitoring Instrument Based on LabVIEW

Due to the high risk of heart disease，expensive monitoring costs, the unequal distribution of medical resources, the development of home-based health monitoring systems is worth addressing, the construction of a low-cost home-based electrocardiography (ECG) monitor is introduced. It can make related judgments on the health status of the check-up people according to the ECG signal. By utilized the LabVIEW2009 virtual instrument developing platform, a virtual health monitor for common family is set up. It includes some useful functions, such as preliminary ECG monitoring, automatic diagnosis, navigation and remote monitoring, which endow it with a potential value.

Young relatives of sudden cardiac death individuals at high heart disease risk

Young relatives of sudden cardiac death individuals at high heart disease risk

Healthy Eating: Folate

Folate is one of the B vitamins. Our bodies use folate to make new cells. Folate is especially important for women of childbearing age, pregnant and nursing women, growing children, and older people. If you don’t get enough folate in your diet, you could get anemia. You also could be at higher risk for heart disease, stroke, cancer, or memory problems. This revised 1-page large print fact sheet was written by Linda B. Bobroff and published by the UF Department of Family, Youth and Community Sciences, September 2012. FCS8560/FY055: Healthy Eating: Folate (ufl.edu)

Differences in mean and variability of heart rate and ambulatory rate-pressure product when valsartan or carvedilol is added to lisinopril

Guidelines recommend combining β-blockers and angiotensin-converting enzyme (ACE) inhibitors in high-risk heart disease but not in the initial treatment of hypertension. The mechanism of this benefit has not been determined. After 3 weeks of lisinopril (L, 40 mg/day) run-in, 30 subjects entered a single-blinded, forced-titration, crossover study in which carvedilol (C, 20 then 40 mg/day) or a control renin-angiotensin blocker, valsartan (V, 160 then 320 mg/day) were added to L. Ambulatory blood pressure (ABP) and heart rate monitoring was performed at the end of each period. Rate-pressure product (RPP, systolic BP × heart rate, an indicator of cardiac oxygen consumption) was measured over 24 hours, daytime (6 am to midnight), and nighttime (midnight to 6 am) periods. Variability (standard deviation and range) of RPP, BP, and heart rate was also investigated. After 4 weeks, mean 24-hour systolic BP was about 8 mm Hg lower when either V or C was added to L (P < .01 each). Heart rate was consistently lower with C (8 beats/min over 24 hours, P < .000) but was slightly increased with V (about 2 beats/min, P = NS). Consequently, C lowered RPP to a greater degree than V over 24 hours (about 8% vs. 2%, P < .000) and during daytime and nighttime periods (P < .000 each). In addition, RPP variability (SD but not range) was consistently lower on C than V. When added to L, C reduces the mean and variability (SD) of 24-hour heart rate and cardiac workload to a greater degree than valsartan. These effects may contribute to the outcome benefits observed with β-blocker–ACE inhibitor combinations.

Adapting and RE-AIMing a heart disease prevention program for older women with diabetes

Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials-the Mediterranean Lifestyle Program and ¡Viva Bien!. Results from these two trials, including readiness for dissemination, are evaluated using the RE-AIM framework in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Program adaptations produced relative high reach as well as consistent and replicated effectiveness and maintenance, and were adopted by a high percentage of primary care offices and clinicians approached. We discuss key findings, lessons learned, future directions for related research, and use of RE-AIM for program development, adaptation, scale-up, and evaluation.

Dietary Fats and Heart Disease: From Prenatal to Postnatal Environment

Problem statement: Heart disease is the leading cause of death worldwide and is dramatically increasing in developing countries. Preventive approaches, such as dietary and lifestyle changes can have major health implications to prevent the onset of heart disease. Besides healthy nutrition in the adult life, maternal nutrition during pregnancy and lactation can also have a significant impact on the outcome of heart disease in the later life of the offspring. Approach: Higher levels of plasma total cholesterol, especially Low-Density Lipoprotein (LDL) cholesterol and lower levels of high-density lipoprotein cholesterol are associated with an increased risk of heart disease. We have used various animal models and dietary strategies to investigate the regulation of lipid and lipoprotein metabolism. We also manipulated maternal diets during pregnancy and lactation to study the outcome of heart disease in the offspring in later life. Results: Reducing the intake of saturated and trans fatty acids reduce the risk of heart disease, while polyunsaturated fatty acids elicit beneficial health effects. Amongst polyunsaturated fatty acids, omega-3 class of fatty acids, are associated with lower incidence of heart disease however, an increased consumption of omega-6 fatty acids may increase the risk of heart disease. Higher intake of saturated fat during pregnancy and lactation inhibits the gene expression of LDL receptor which leads to an increase in plasma LDL-cholesterol levels of the offspring thereby putting the offspring at a higher risk of heart disease. Conclusion/Recommendations: An optimum ratio of omega-6 to omega-3 fatty acids is critical to reduce the risk of heart disease. Developing countries need to pay a special attention to dietary guidelines to reduce the burden of heart disease.

The Role and Clinical Significance of High-Sensitivity C-Reactive Protein in Cardiovascular Disease

The Role and Clinical Significance of High-Sensitivity C-Reactive Protein in Cardiovascular Disease

Beyond beliefs: risk assessment technologies shaping patients’ experiences of heart disease prevention

Social science research on lifestyle-related diseases typically focuses on patients' understandings and beliefs and takes the clinical risk for granted. We interviewed 30 healthy UK patients at high risk of heart disease, recruited from a family history trial at 2 weeks and 6 months after a discussion with a clinician about their risk, lifestyle and medications. The participants took four different paths: (i) pharmaceutical (most common, risk reduction with cholesterol lowering statins), (ii) mixed (statins and behaviour change), (iii) behavioural (behaviour change, focus on wellbeing) and (iv) 'lost' (no prevention, difficult social/personal circumstances). Drawing on Berg we argue that coronary heart disease (CHD) risk assessment technologies are formal tools that generate, rather than represent, high risk in a way that patients often experience lifestyle change as futile, because it rarely reduces their cholesterol to targets defined by the tools. We suggest social scientists studying incipient or 'proto-diseases', such as CHD risk, should not only focus on understandings but also investigate the technologies (and the associated guidelines, policies, clinical practice and pharmaceutical industry operations) that generate incipient diseases and patients' experiences of them. However, technologies do not determine experience and we also discuss elements that direct patients down other than the pharmaceutical path.

XIENCE V India single arm study: 2-year clinical follow-up

Background and ObjectivesEnvironmental and genetic data indicate that India contains a population at uniquely high risk for heart disease and diabetes when compared to other ethnicities. Past drug eluting stent...

Lipoprotein(a): Genotype–Phenotype Relationship and Impact on Atherogenic Risk

In 2010, more than 45 years after the initial discovery of lipoprotein(a) [Lp(a)] by Kare Berg, an European Atherosclerosis Society Consensus Panel recommended screening for elevated Lp(a) in people at moderate to high risk of atherosclerotic cardiovascular disease (CVD). This recommendation was based on extensive epidemiological findings demonstrating a significant association between elevated plasma Lp(a) levels and coronary heart disease, myocardial infarction, and stroke. In addition to those patients considered to be at moderate to high risk of heart disease, statin-treated patients with recurrent heart disease were also identified as targeted for screening of elevated Lp(a) levels. Taken together, recent findings have significantly strengthened the notion of Lp(a) as a causal risk factor for CVD. It is well established that Lp(a) levels are largely determined by the size of the apolipoprotein a [apo(a)] gene; however, recent studies have identified several other LPA gene polymorphisms that have significant associations with an elevated Lp(a) level and a reduced copy number of K4 repeats. In addition, the contribution of other genes in regulating Lp(a) levels has been described. Besides the strong genetic regulation, new evidence has emerged regarding the impact of inflammation as a modulator of Lp(a) risk factor properties. Thus, oxidized phospholipids that possess a strong proinflammatory potential are preferentially carried on Lp(a) particles. Collectively, these findings point to the importance of both phenotypic and genotypic factors in influencing apo(a) proatherogenic properties. Therefore, studies taking both of these factors into account determining the amount of Lp(a) associated with each individual apo(a) size allele are valuable tools when assessing a risk factor role of Lp(a).

Genetic interactions between MTHFR (C677T), methionine synthase (A2756G, C2758G) variants with vitamin B12 and folic acid determine susceptibility to premature coronary artery disease in Indian population

Background:Researchers have determined that Indians face a higher risk of heart disease, despite the fact that nearly half of them are vegetarians and lack many of the other traditional risk factors. In the below-30 age group, coronary artery disease mortality among Indians is three-fold higher than in the whites in United Kingdom and ten-fold higher than the Chinese in Singapore. High levels of homocysteine have been widely linked to the early onset of heart diseases in other populations, although a definite proof among Indians is lacking, which needs to be investigated by way of screening for factors responsible for high homocysteine levels.Objective:To screen for genetic factors responsible for hyperhomocysteinemia and the risk for premature coronary artery disease.Materials and Methods:A total of 100 individuals with proven premature coronary artery disease and 200 age-and-sex matched controls were screened for polymorphisms in Methylenetetrahydrofolate reductase (MTHFR) (C677T) Methionine synthase (MS) genes (A2756G, C2758G), and the B12 and Folate levels were estimated.Results:Results from the mutational analysis revealed that in the study group, seven individuals had a polymorphism for the C677T allele in the MTHFR gene (one homozygous and six heterozygous) (Fischer's Exact test P > 0.046) (OR: 0.2711 95% CI 0.0774 to 0.9491). Six were heterozygous for the A2756G polymorphism in the MS gene (Fischer's Exact test P > 0.0012). None showed a polymorphism at the C2758G allele in the MS gene. Four controls showed heterozygosity for the C677T polymorphism and none for the MS gene. The B12 and Folate levels were significantly lower in the study group as compared to the controls.Conclusions:It is important to know which factors determine the total homocysteine concentrations. In the general population, the most important modifiable determinants of tHcy are folate intake and coffee consumption. Smoking and alcohol consumption are also associated with the total homocysteine concentrations, but more research is necessary to elucidate whether these relations are not originating from residual confounding due to other lifestyle factors.

Identification of high-risk acute coronary syndromes by spectral analysis of ear photoplethysmographic waveform variability

There is a need for robust techniques for early and accurate diagnosis of acute coronary syndromes (ACSs), to avoid inappropriate discharge of patients. This study examined the use of frequency spectrum analysis of heart rate variability (HRV) and photoplethysmogram (PPG) waveform variability for the identification of high-risk ACS patients defined by an elevated cardiac troponin level. The study cohort comprised a convenience sample of adult patients presenting to the emergency department of the Prince of Wales Hospital over a 4 month period complaining of non-traumatic chest pain. Valid electrocardiogram (ECG) and earlobe PPG waveforms together with troponin I test results were obtained from 52 patients at presentation, 4 of which were troponin I positive (Trop 0+). Frequency spectrum analysis was performed on the beat-to-beat HRV and PPG waveform variability (PPGV). The Trop 0+ were found to have significantly higher normalized mid-frequency power (MFnu) in HRV (P = 0.017), PPG amplitude variability (P = 0.009) and the cross-spectrum of HRV and PPGV (P = 0.001), which were attributed to reflex sympathetic response to myocardial ischemia. MFnu of PPG amplitude had the best overall performance in detecting Trop 0+, with ROC area under the curve of 0.93. The results demonstrate the potential use of ear PPG waveform to identify high-risk heart disease patients, and further highlight the utility of frequency spectrum analysis of PPGV in critical care.

Healthy Bodies, Healthy Souls: Design of a church‐based environmental intervention program to prevent diabetes risk behaviors

Churches have great potential to engage communities and sustain health interventions. We are conducting a diabetes risk behavior intervention trial in 12 African American churches in Baltimore city, divided into 4 cohorts (3 churches/cohort) matched by size and denomination. One church in each cohort is randomly selected to receive a workshop intervention (American Diabetes Association's Project POWER), while a second church receives an environmentally‐enhanced intervention plus workshop intervention, and a third church is comparison. The enhanced program includes changes to church food and physical activity environments. The program will be evaluated in 375 non‐diabetic adults, using psychosocial, behavioral (diet, physical activity) and health (BMI, blood pressure, waist circumference) measures. Initial baseline data (n=138) show that 68% are female, mean age 48 years. Over 78% of respondents have a high school degree, and 73% have household incomes &gt;$30,000. 32.4% of the sample is obese and 51.8% are overweight. 44.2% are prehypertensive and 24.6% are hypertensive. Mean waist circumference is 100.8cm (SD: 16.9) for men and 97.2cm (SD: 18.2) for women, which indicate that 40.9% of men and 69.1% of women at high risk for heart disease. This study will test church‐specific interventions to reduce diabetes risk behaviors and improve health measures in a high‐risk minority population.Grant Funding Source: American Diabetes Association Clinical Research Award

The role of stress in heart failure – ground for sex specific pathophysiology

In the last hundred years modern society went through numerous changes in life style, dietary habits, work load, physical activity and other environmental factors. As a species we are not well adapted to new de- mands. Higher levels of stress hormones provoke various effects, especially gradual change in the sensitivity of adrenergic, glucocorticoid and insulin receptors. All these changes are mutually associated and they gradually lead to metabolic syndrome, obesity, diabetes, heart failure and other types of pathology depending on genetic makeup and environmental factors. The aim of this paper is to summarize current knowledge concerning the impact of stress on cardiac function. Whereas stress response is sex specific we would emphasize a potential difference in pathophysiology of ischemic heart failure in men and women. Modern medicine has misinterpreted autonomous nervous system functions for years and this was reflected in heart failure (HF) and arterial hypertension therapy. Stress before the onset of menopause has a lesser effect on cardiac function compared to stress after menopause. Postmenopausal women have a significantly higher risk of heart disease, which is related to the diminished protection of the female hormonal cycle, but low doses of estrogen have not proven protective in postmenopausal women. Potential new targets of sex- specific cardiac therapy would come from better understanding of the molecular mechanisms exerted by nuclear receptors for steroid hormones, transcription factors involved in heart remodeling, cross-talk in adrenergic signaling pathways and their down-stream molecules.

Statins and Primary Prevention for Patients at High Risk for Heart Disease

Statins — which clearly confer an all-cause mortality benefit in patients with known cardiovascular disease (CVD) — are prescribed extensively for

Seven-Year Follow-up of a Multiple-Health-Behavior Diabetes Intervention

To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program. The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors. Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study (at 6, 12, and 24 months) were partially maintained during the nontreatment phase of the study, through 5 years postintervention contact for dietary behavior and stress management, and 1-year posttreatment for PA. This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment.

Higher Risk for Heart Disease and Diabetes Associated with Androgen Deprivation Therapy

Higher Risk for Heart Disease and Diabetes Associated with Androgen Deprivation Therapy

Eating, drinking and smoking: how lifestyle affects the heart

Many public health problems are preventable by changes in lifestyle. Healthcare assistants and assistant practitioners are ideally placed to offer brief interventions to help patients find practical and effective ways to change unhealthy lifestyles and overcome barriers to change. A case study of a patient at high risk of heart disease is used to explore behaviour changes which might be effective and how they can be translated into practice.

A comparison of the fat composition and prices of margarines between 2002 and 2006, when new Canadian labelling regulations came into effect

To examine the effect of the new Canadian labelling regulations on the fat composition and prices of margarines. A survey of all margarines sold in major supermarkets in the Greater Toronto area was conducted in 2006, and results were compared with those of a similar survey conducted in 2002. Average fat composition, proportion of 'trans fat-free' margarines and average prices of margarines were compared. A general linear model procedure was used to compare the relationship between price and fat composition in 2002 and 2006. Average amounts of trans fatty acids (TFA) and MUFA decreased, while average amounts of PUFA increased significantly from 2002 to 2006. The proportion of margarines with less than 0.2 g TFA/10 g serving rose significantly from 31 % in 2002 to 69 % in 2006. Margarines lower in TFA on average cost significantly more than margarines with greater amounts of these fats, and this relationship appeared stronger in 2006 relative to 2002. There is evidence of reductions in TFA in margarines since new labelling regulations came into effect in Canada; however, TFA reductions appeared to be restricted to higher-priced margarines. Results suggest that voluntary approaches (i.e. manufacturer incentives via labelling) to reduce population intakes of TFA will yield little changes in TFA content of low-cost products and thus may have limited benefit for lower-income groups, who are at higher risk of heart disease.

Exposure to environmental carbon monoxide may have a greater negative effect on cardiac autonomic function in people with metabolic syndrome

Carbon monoxide (CO) has been recognized as a risk factor for adverse cardiovascular outcomes. We investigated the effects of CO on cardiac autonomic function by measuring the heart rate variability (HRV) in patients with and without metabolic syndrome (MetS). We also explored the relationship between CO exposure and specific components of MetS. Data were obtained from air pollution measurements and from health examinations on a total of 986 subjects, from a Korean community. Measurements of the 5-min HRV and examinations for MetS were conducted, and a linear regression model with a time lag was evaluated for any association. The group with MetS showed a significant reduction in the standard deviation of the normal-to-normal intervals (SDNN) and in the high frequency domain of HRV. After adjusting for age, sex, smoking status, day of the week effect, month effect, temperature, and relative humidity, these declines were significantly associated with exposure to CO for 25 to 48 h prior to the HRV measurement. Evidence for effect-modification by two specific MetS components, fasting blood glucose and triglycerides, was also observed in relation to CO exposure. These results suggest that CO exposure may trigger changes in cardiac autonomic function, and that subjects at high risk for heart disease may be more susceptible to CO effects.