Improve Cardiovascular Health Research Articles

A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors

Purpose: The aim of this study was to examine the effects of an Advanced Practice Nurse (APN)-led self-management program on cardiovascular health status among Korean women at risk of developing or progressing cardiovascular disease. Methods: This pilot study used one-group pre- and post- test experimental design. At health fairs in a community, 30 women who had one or more risk factors for metabolic syndrome were recruited and agreed to participate in the study. A total of 25 women completed the study. The intervention consisted of weekly follow-up calls and self-monitoring diary after an hour of individual counseling regarding risk factors, fast walking, and healthy diet tailored to the participants’ needs. Physical activity was assessed with the World Health Organization International Physical Activity Questionnaire and a pedometer. Results: Participants showed statistically significant improvements in blood pressure, body mass index, levels of triglyceride, total cholesterol and low density lipoprotein, numbers of metabolic syndrome factors, and the 10-year CV risk estimate after one month of concentrated intervention. In addition, their physical activity behavior significantly improved after the intervention. Conclusion: This APN-led self-management program targeting modifiable risk factors by offering tailored counseling and concentrated support during the transition might be effective in preventing progression to the cardiovascular disease.

A Rapid Assessment Study on the Implementation of a Core Set of Interventions to Improve Cardiovascular Health in Latin America and the Caribbean.

Cardiovascular diseases (CVD) are the leading cause ofdeathintheAmericaswith1.6milliondeathsperyear,halfamillion of which occur before age 70 years. CVD (Interna-tional Classification of DiseaseseTenth Revision, I00eI99)represent 38% of all causes of death in the region [1].Although mortality due to CVD in the region declined at arate of 1.9% per year from 2000 to 2010, low- income andmedium-income countries, compared with high-incomecountries, had an excess of CVD mortality of 56.7% and20.6%, respectively [2].The 2013 World Health Assembly, in response to the2011 U.N. political declaration on noncommunicable dis-eases (NCD), established a goal of 25% reduction in pre-mature mortality due to 4 major NCD by 2025 (25 25goal). These NCD are CVD, cancer, diabetes, and chronicrespiratory diseases. Achieving a reduction of this magni-tude will depend primarily on successes in the preventionand control of CVD.The2010regionalconsultationoncardiovascularhealth(CVHregionalconsultation)ledbythePanAmericanHealthOrganization (PAHO) established a list of priority in-terventions to improve CVH in the Americas. The list, pre-pared before the U.N.’s 2011 high-level meeting on NCD,serves as a road map for the region beyond that importantevent. A regional expert group, including PAHO technicaladvisors, representatives of health ministries, professionalsocieties, academic institutions, and several nongovern-mentalorganizations,definedasetofinterventionsaround4main areas: 1) public policy and advocacy; 2) health pro-motion; 3) surveillance; and 4) disease management andintegrated control for risk factors [3].Much progress has been made by PAHO’s memberstates since the CVH regional consultation [4]. Although4 years is a relatively short time to fully implement acomprehensive package of interventions, it may be anappropriate interval to assess progress and make neces-sary course corrections. It is unlikely that progress willoccur at the same rate among all countries. Our aim is toinvestigate the state of implementation of the core set ofinterventions recommended by the 2010 CVH regionalconsultation.

Strategies for improving cardiovascular health in women with diabetes mellitus: a review of the evidence.

Knowledge about cardiovascular (CV) disease in women with diabetes mellitus (DM) has changed substantially over the past 20years. Coronary artery disease, strokes, and peripheral vascular disease affect women with DM at higher rates than the general population of women. Lifestyle therapies, such as dietary changes, physical activity, and smoking cessation, offer substantial benefits to women with DM. Of the pharmacotherapies, statins offer the most significant benefits but may not be well tolerated in some women. Aspirin may also benefit high-risk women. Other pharmacotherapies, such as fibrates, ezetimibe, niacin, fish oil, and hormone replacement therapy, remain unproven and, in some cases, potentially dangerous to women with DM. To reduce CV events, risks to women with DM must be better publicized and additional research must be done. Finally, advancements in health care delivery must target high-risk women with DM to lower risk factors and effectively improve cardiovascular health.

Moving Focus from Weight to Health. What Are the Components Used in Interventions to Improve Cardiovascular Health in Children?

IntroductionObesity in childhood impacts on many areas of the child’s current and future health, including their cardiovascular health. To date many attempts have been made to design interventions to tackle excess childhood weight but with limited success. We aimed to establish the components common to interventions in children that improve cardiovascular health parameters.MethodsWe searched the following databases: EMBASE 1974-week 3 November 2014, Ovid Medline 1946 Present, and PsychINFO 1967-Present for studies reporting interventions in healthy young people under the age of 18. Included interventions had to contain an education component and have been carried out in a community, school, or clinical setting. Papers had to report on at least one of the pre-specified CVD risk parameters and at least one non-biological outcome from knowledge, attitudes or behaviours.ResultsWe retrieved 2451 papers, from which 12 studies (18 papers) of 3046 participants were included. From the selected papers we identified four component themes; Health Behaviours, Self-Concept, Practical and Cognitive Tools, and Intervention Characteristics. The subcomponents that made up these themes were fairly consistent across the studies analysed although the studies varied in their duration, settings and children with which they were carried out. Nine of the studies were able to bring about positive change in at least one biological and one non-biological aspect of child cardiovascular health.ConclusionThe component themes identified here were common to intervention studies that had success in improving parameters of cardiovascular health. We suggest that the focus of childhood health interventions be moved from weight onto cardiovascular health parameters and that future interventions use the lessons learned by their predecessors to incorporate those components that are associated with successful interventions.

A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients.

BackgroundGreater interdialytic weight gain (IDWG) is associated with risk of all-cause mortality and hospitalization. Dialysis patients are also at greater risk of cardiovascular (CV) events than patients without kidney disease. This retrospective study examined the potential association between IDWG and specific types of CV events.MethodsData were obtained from United States Renal Data System claims and the electronic health records of Medicare patients who initiated hemodialysis between 01 January 2007 and 31 December 2008 at a large dialysis organization. Absolute IDWG was defined as predialysis weight minus postdialysis weight from the prior treatment, and relative IDWG was calculated as percentage of postdialysis weight with mean values for each, calculated over dialysis days 91 to 180. Patient outcomes were considered beginning on day 181, continuing until death, discontinuation of care, censoring, or study end (31 December 2009). Outcomes included all-cause mortality, CV mortality, hospitalization for nonfatal heart failure/volume overload, hospitalization for nonfatal myocardial infarction, MACE (a composite measure of nonfatal myocardial infarction, nonfatal ischemic stroke, or CV death), and MACE+ (events comprising MACE as well as arrhythmia, nonfatal hemorrhagic stroke, or hospitalization for heart failure). Associations between IDWG and outcomes over the exposure period were estimated using proportional hazards regression and adjusted for baseline characteristics.Results39,256 patients qualified for analysis. In general, associations of relative IDWG with outcomes were more potent, consistent, and monotonic than those for absolute IDWG. Relative IDWG > 3.5 % body weight was independently associated with all outcomes studied: point estimates ranged from 1.18 (myocardial infarction) to 1.26 (CV mortality) and were consistent among patients with and without diabetes, and with and without baseline heart failure. Absolute IDWG > 3 kg was associated with outcomes other than myocardial infarction: point estimates ranged from 1.11 (MACE) to 1.20 (heart failure).ConclusionsGreater IDWG is associated with an increased risk of CV morbid events. Strategies that mitigate IDWG may improve CV health and survival among hemodialysis patients.

Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health

The American Heart Association's 2020 Strategic Impact Goal is “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.” To monitor progress towards this goal, a new construct “ideal cardiovascular health” (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal.

Improved Cardiovascular Health Outcomes with Health Club Membership

Many individuals purchase health club memberships (hereafter membership) in order to improve their fitness and health. However, there is little evidence showing the effectiveness of a membership on improving fitness and health. PURPOSE: We examined the associations between a membership and cardiovascular health outcomes: peripheral blood pressure (BP), resting heart rate (RHR), and cardiorespiratory fitness (CRF). METHODS: We conducted a cross-sectional study of 413 adults (mean age: 48, range: 30-64). Approximately half had health club memberships (n = 209) and half did not (n = 204). Participants completed measurements of resting BP, RHR, and a self-report questionnaire about health club and lifestyle physical activity (PA) over the past month. We used a population based CRF estimation equation developed and validated in the Aerobics Center Longitudinal Study. RESULTS: The average values (SD) of resting systolic/diastolic BP, RHR, and CRF were 115/76 (14/9) mmHg, 67(10) bpm, and 38 (7) mL/kg/min for those with a membership and 116/77 (17/10) mmHg, 71(10) bpm, and 36(7) mL/kg/min for those without a membership, respectively. In multivariable linear regression analyses, having a membership was significantly (p < 0.01) associated with a lower RHR (ß = -4.60, 95% CI -6.55, -2.65) and a higher CRF (ß = 1.57, 95% CI 1.14, 1.99) after adjusting for age, sex, body mass index, health status, and smoking status. Even after further adjustment for PA and sedentary time, RHR and CRF remained significant (p < 0.01). Although not significant, participants with a membership also had lower systolic/diastolic BP (ß = -0.88, 95% CI -3.41, 1.65, p = 0.49 / ß = -1.00, 95% CI -2.67, 0.67, p=0.24). In the combined logistic regression analyses, there appears to be stronger and more favorable associations with cardiovascular risk factors in individuals with a membership plus meeting the aerobic PA guidelines or having a lower sedentary time. In addition, membership duration was likely to be associated with more favorable cardiovascular health outcomes. CONCLUSION: Having a health club membership was associated with improved cardiovascular disease risk factors and was stronger in those individuals also meeting the aerobic PA guidelines or having a lower sedentary time. Supported by Iowa State University College of Human Sciences seed grant.

Deep Water Exercise Training is Associated with Decreased Arterial Stiffening in Women

Metabolic syndrome (MetS) is associated with an increase in cardiovascular (CV) mortality, partially due to arterial stiffening, which can be measured non‐invasively via pulse wave velocity (PWV). Arterial stiffness is a clinically relevant CV marker of mortality, an increase in PWV by only 1 SD is associated with an increase of CV risk by 15%. We tested the hypothesis that 8 weeks, 3 days per week, of deep water exercise can lower the PWV in individuals with MetS.10 women (age=58±5) were recruited to participate in the study. Carotid to femoral PWV was measured using applanation tonometry; radial artery waveforms were used for pulse wave analysis and to calculate central pressures. Aquatic exercise significantly lowered PWV by 0.53 m/s (p&lt;0.05). Other significant changes that were observed were BMI (p=0.03) from 33.5±1.5 to 32.9±1.5, blood glucose (p=0.01, from 110±8 to 101±7), insulin (p=0.02, from 20±2 to 14±1), insulin resistance (p=0.01, from 5.39±0.81 to 3.55±0.50), augmentation index (p=0.05, from 25±2 to 22±2), and aerobic capacity (p=0.02, from 15.9±1.3 to 17.8±1.7).These findings indicate that the introduction of deep‐water exercise positively influences the PWV. This decrease in PWV portends improvements in overall CV health and it may be useful in managing other CV related diseases. Much of the data showed significant improvement in clinical measures and this shows the efficacy of deep‐water exercise. While the benefits of land based exercise have long been well known, these findings show that aquatic based exercise is also a very effective method for improving CV health.

More Ambulatory Activity Improves Cardiovascular Health in Patients at High Risk

Higher levels of self-reported physical activity have been associated with lower risk for cardiovascular (CV) morbidity and mortality. But no studies have documented this association when physical activity is measured objectively. In a randomized pharmacotherapy trial (NAVIGATOR trial; NEJM JW Cardiol Mar 14 2010), 9306 patients (age, ≥50) …

A Systematic Review of Internet-Based Worksite Wellness Approaches for Cardiovascular Disease Risk Management: Outcomes, Challenges &amp; Opportunities

ContextThe internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs.Evidence AcquisitionWe conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose.Evidence SynthesisA total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners.ConclusionInternet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.

Antioxidant Therapy: Is it your Gateway to Improved Cardiovascular Health?

General use and popularity of over-the-counter supplemental antioxidants have rapidly spread all over the world and are believed to promote cardiovascular health and wellbeing. However, there is a paucity of information and lack of proof that physiological and above-physiological levels of oxidants do harm at the cellular and organismal levels. Instead, several reports demonstrated that reduction in Reactive Oxygen Species (ROS) did not improve vascular function. Interestingly, recent studies show that increased ROS levels play protective role in vascular endothelium and may improve coronary endothelial function. In the current review, we introduce the concept that increased ROS levels, often seen in association with cardiovascular disease, probably is an endothelial-way or ‘oxidative response’ to cope with vascular pathology.

American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update

The goal of this American Heart Association Guide for Improving Cardiovascular Health at the Community Level (AHA Community Guide) is to provide a comprehensive inventory of evidence-based goals, strategies, and recommendations for cardiovascular disease (CVD) and stroke prevention that can be implemented on a community level. This guide advances the 2003 AHA Community Guide1 and the 2005 AHA statement on guidance for implementation2 by incorporating new evidence for community interventions gained over the past decade, expanding the target audience to include a broader range of community advocates, aligning with the concepts and terminology of the AHA 2020 Impact Goals, and recognizing the contributions of new public and private sector programs involving community interventions. In recent years, expanding arrays of programs and policies have been implemented in increasingly diverse communities to provide tools, strategies, and other best practices to potentially reduce the incidence of initial and recurrent cardiovascular events. The AHA Community Guide complements the AHA statement entitled “Population Approaches to Improve Diet, Physical Activity, and Smoking Habits”3 and supports the AHA 2020 goal4 to “improve the cardiovascular health of all Americans by 20%, while reducing deaths from CVDs and stroke by 20%.” The present AHA Community Guide supports the AHA 2020 goal by identifying exemplary regional or national programs that encourage cardiovascular health behaviors and health factors (formerly addressing risk behaviors and risk factors) from which communities might acquire proven strategies, expertise, and technical assistance for improving cardiovascular health. The AHA Community Guide seeks to prevent the onset of disease (primary prevention) and to maintain optimal cardiovascular health (primordial prevention) among broader segments of the population. Prior research indicates that using public health strategies such as sodium reduction in processed foods to lower blood pressure,5–8 tobacco laws to promote smoking cessation,9–11 and modification of …

Improving Cardiovascular Health

The past 30 years have seen major shifts in cardiovascular science and medicine. In the United States, mortality due to cardiovascular disease (CVD) has declined by more than 60% as a result of new therapeutic approaches, including the introduction of statins, better anticoagulants, angiotensin-converting enzyme inhibitors, devices such as implantable cardioverter-defibrillators, and�perhaps foremost�the application of evidence-based scientific guidelines.

In-Home Air Filtration for Improving Cardiovascular Health: Lessons from a CBPR Study in Public Housing

Particulate air pollution, including from motor vehicles, is associated with cardiovascular disease. To describe lessons learned from installing air filtration units in public housing apartments next to a major highway. We reviewed experience with recruitment, retention, and acceptance of the air filtration units. Recruitment and retention have been challenging, but similar to other studies in public housing. Equipment noise and overheated apartments during hot weather have been notable complaints from participants. In addition, we found that families with members with Alzheimer's or mental disability were less able to tolerate the equipment. For this research, the primary lesson is that working closely with each participant is important. A future public health program would need to address issues of noise and heat to make the intervention more acceptable to residents.

Healthy young hearts sharper older minds make

Healthy young hearts sharper older minds make

Aerobic Exercise in Subacute Stroke Improves Cardiovascular Health and Physical Performance

Cardiovascular health is often impaired after stroke. Reduced exercise capacity ((Equation is included in full-text article.)VO(2peak)) and changes in the vascular system in the stroke-affected limb may impact performance of physical activities such as walking. There is little information regarding the role of prescribed moderate- to high-intensity exercise in subacute stroke. The purpose of this study was to examine whether an 8-week aerobic exercise intervention would improve cardiovascular health and physical performance in participants with subacute stroke. Ten subjects were enrolled in the study and 9 of them completed the intervention. Participants were aged 61.2 ± 4.7 years old, were 66.7 ± 41.5 days poststroke, and had minor motor performance deficits (Fugl-Meyer score, 100.3 ± 29.3). Outcome measures were taken at baseline, postintervention, and at 1-month follow-up. Brachial artery vasomotor reactivity (flow-mediated dilation [FMD]) of both arms was used to assess vascular health, and a peak exercise test was used to assess exercise capacity. The 6-minute walk test (6MWT) was used to assess physical performance. Participants exercised on a recumbent stepper 3 times per week for 8 weeks at a prescribed heart rate intensity. At baseline, we identified between-limb differences in brachial artery FMD and low (Equation is included in full-text article.)VO(2peak) values. After the intervention, significant improvements were observed in the FMD in both arms, resting systolic blood pressure, and the 6MWT. Although we also observed improvements in the resting diastolic blood pressure, heart rate, and (Equation is included in full-text article.)VO(2peak) values, these changes were not significantly different. Aerobic exercise in participants with subacute stroke was beneficial for improving cardiovascular health, reducing cardiac risk, and improving physical performance (6MWT).

Abstract 19185: An Employer-Initiated Challenge to Improve Cardiovascular Health in the Workplace

Introduction: Concerted attention is focused on achievement of the AHA’s 2020 Strategic Impact Goal which is aimed at a 20% reduction in deaths due to heart disease and stroke. Innovative strategies for promoting awareness of cardiovascular (CV) risk and maintaining and improving CV health are needed for a variety of community-based settings. Objective: To describe an ongoing employer-initiated program aimed at evaluating the effectiveness and efficacy of a CV health intervention focused on maintaining and improving cardiovascular health in an occupational setting. Methods: Administrators from the Oklahoma City Indian Clinic (OKCIC) implemented a voluntary 9-month “Cardiovascular Health Challenge” based on Life’s Simple 7. The OKCIC is an urban healthcare facility for members enrolled in federally-recognized American Indian tribes. Participants were asked to complete My Life Check assessments of Life’s Simple 7 at the beginning, midpoint, and end of the challenge period and to donate a small financial contribution that will be pooled and awarded to the employee with the greatest changes in CV health at the completion of the program. Several program-based workplace resources have been provided to promote healthy behavior change, including an AHA-sponsored walking path at the clinic facility, encouraged daily walking breaks, Life’s Simple 7 materials posted throughout the workplace, pedometers, cooking classes and smoking cessation workshops. Participant feedback regarding program experiences will be solicited and adherence, efficacy and effectiveness will be evaluated. Results: Approximately one-third (n=44) of OKCIC clinic employees are currently enrolled in the CV health challenge. Initial assessments indicate that baseline My Life Check assessments prompted screening of CV health components for a large proportion of participants who were previously unaware of their CVD risk. Conclusions: Incentive-based workplace programs focused on improving CV health represent a unique opportunity to achieve progress towards achievement of the 2020 goals. Maximization of employer encouragement and co-worker camaraderie may be key factors for improved awareness of CVD risk and promotion of healthy behavior change in the workplace.

Breaking the Paradigm of Clinic-Based Cohort Studies: the Reasons for Geographic and Racial Differences in Stroke (Regards) Study

Breaking the Paradigm of Clinic-Based Cohort Studies: the Reasons for Geographic and Racial Differences in Stroke (Regards) Study

Improving Cardiovascular Health through Physical Activity

Participating in regular physical activity, at least 150 minutes each week, can improve cardiovascular health.

Improving Cardiovascular Health Through Physical Activity

Improving Cardiovascular Health Through Physical Activity