Improvements In Cardiovascular Disease Risk Factors Research Articles

Communicating cardiovascular health information and improving coordination with primary care: A Childhood Cancer Survivor Study randomized trial.

10011 Background: Childhood cancer survivors are at risk of early cardiovascular disease (CVD). We conducted a survivorship care plan (SCP)-based counseling intervention to improve CVD risk factor control in adult-aged survivors. Methods: Randomized (1:1) trial of survivors at high CVD risk based on history of anthracycline or chest radiotherapy exposures with undertreated hypertension (≥130/80 mmHg), dyslipidemia (LDL ≥160 mg/dL or triglyceride ≥200 mg/dL), and/or glucose intolerance (threshold varied if history of pre-diabetes or diabetes) based on in-home testing. Approximating a survivorship clinic visit, the intervention consisted of a remotely delivered session with an advanced practice provider to review results, a SCP with personalized CVD risk information, and an action plan to help manage CVD risk factors. A remote booster session was provided 4 months later with the action plan updated. Control participants only received a copy of their in-home results with abnormalities noted and written encouragement to follow-up with their primary care provider (PCP). Blood pressure, lipid profile, and glucose tolerance were retested after 1y. For both groups, all participant materials were sent to PCPs throughout the study, and PCP medical records were abstracted at study completion. Logistic regression assessed the odds ratio (OR) for undertreatment at 1y associated with the intervention, adjusting for pre-specified variables (sex, current age, time since cancer, insurance status, recent history of survivorship clinic visit, and undertreated CVD risk factor). Results: Among 644 survivors who completed in-home testing, 347 met inclusion criteria and were randomized (175 intervention; overall 52% male, mean age 40y, 31y since cancer diagnosis); 264 with 1y follow-up (126 intervention). At baseline, rates of hypertension, dyslipidemia, and glucose intolerance were 53%, 52%, and 49%, respectively; 43% had > 1 undertreated condition. Although the intervention achieved > 95% satisfaction, it was not associated with reduced undertreatment vs control (OR 0.9, 95% CI 0.7-1.3). Notably, 48% of intervention and 44% of control participants had less undertreatment after 1y. In secondary analysis, greater internal locus of control was associated with less undertreatment at 1y (OR 0.7, 95% CI 0.6-0.9). The intervention group was more likely than controls to have CVD risk (+10 vs -1%), SCP (+17 vs -2%), and some late effects surveillance plan (+8 vs +2%) documented within PCP records at 1y vs baseline (p < 0.05 for all). Conclusions: While a remotely delivered counseling intervention did not reduce CVD risk factor undertreatment compared with provision of test results alone, both study arms had > 40% reduction in undertreatment. These results suggest that simply providing a formal CVD risk assessment to high-risk cancer survivors and their PCPs may be effective. Clinical trial information: NCT03104543 .

Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors

Background: Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors. Hypothesis: Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes. Methods: Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes. Results: Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health. Conclusions: Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.

Improvements in cardiovascular disease risk factors associated with modest weight loss following treatment in patients with binge-eating disorder and obesity.

Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%). Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss. At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure). Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes. Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.

Optimising targeted dietary intervention strategies based on regional disparities of the related burden of cardiovascular disease in China

Optimising targeted dietary intervention strategies based on regional disparities of the related burden of cardiovascular disease in China

Il cambiamento che possiamo ottenere produce effetti clinicamente rilevanti?

Adopting and maintaining a physically active lifestyle provides si¬gnificant health benefits to people with diabetes and prediabetes by increasing energy expenditure, insulin sensitivity, and physical fitness and decreasing chronic low-grade inflammation. Physical activity (PA)/exercise favors control of hyperglycemia and other risk factors for cardiovascular disease (CVD) and, therefore, it is recommended for diabetes prevention and treatment and for improving overall health. According to current guidelines, people with type 2 diabetes are re-commended to perform at least 150 min/week of moderate-to-vigorous intensity aerobic exercise plus 2-3 sessions/week of resistance exercise on non-consecutive days. Unfortunately, these individuals are usually well below the recommended level of PA and, hence, it is difficult for them to put into action guideline recommendations for a number of external and internal barriers, thus suggesting the need for effective strategies to promote a sustained behavior change. Several randomi¬zed clinical trials have shown that supervised exercise programs are effective in improving surrogate endpoints such as blood glucose and other CVD risk factors, physical fitness, and well-being. However, such programs are not suitable for long-term implementation in rou¬tine clinical practice and adherence to PA/exercise is usually strictly dependent on participation to supervised sessions and falls once the intervention ends. In this regard, counseling interventions appear to be more feasible and adequate to promote a true, long-lasting beha¬vior change. A limited number of studies have tested the efficacy of counseling interventions designed to promote walking through the provision of pedometers. These interventions resulted in modest and transient increases in moderate-to-vigorous PA (MVPA) and, accor¬dingly, failed to significantly improve CVD risk factors and other sur¬rogate outcomes or to produce sustained increases in cardiorespiratory fitness. These results are in contrast with those of several epidemio¬logical surveys, showing that, in physically inactive and sedentary or unfit individuals, even modest amounts of (MV)PA, corresponding to one-third to one-half of those recommended by guidelines, exert a beneficial impact on morbidity and mortality. This discrepancy might be explained by the fact that walking-based interventions are focused only on leisure-time MPVA. Conversely, current guidelines consider also other domains, such as sedentary behavior and light-intensity PA (LPA), and other settings, such as home, work and commuting, as they recommend also to decrease the amount of sedentary (SED)-time and to interrupt prolonged sitting with bouts of LPA every 30 min. In fact, in the Italian Diabetes and Exercise Study 2 (IDES_2), a counse¬ling intervention targeting both MVPA and sedentary behavior was effective in promoting increases in MVPA, which were modest but sustained over a three-year follow-up and associated with larger de¬creases in SED-time and corresponding increases in LPA. This resulted in clinically meaningful improvements in physical fitness and, to a les¬ser extent, in CVD risk factors and scores over a three-year follow-up. Conversely, no clinically meaningful effects were observed in counse¬ling intervention targeting only SED-time. In conclusion, counseling interventions are effective in producing clinically meaningful effects, even when resulting in only modest increments in leisure-time MVPA, provided that they also target the other domains and settings of PA/sedentary behavior.

Achievements of primary prevention targets in individuals with high risk of cardiovascular disease: an 8-year follow-up of the Tromsø study.

AimsTo study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among individuals with high CVD risk in a general population.Methods and resultsWe followed 2524 women and men aged 40–79 years with high risk of CVD attending the population-based Tromsø study in 2007–08 (Tromsø6) to their participation in the next survey in 2015–16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol <5 mmol/L, 27.3% for LDL cholesterol <3 mmol/L, 43.4% for BP <140/90 (<135/85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement.ConclusionWe found an overall improvement in CVD risk factors among high-risk individuals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge.

Ketogenic diet, African American women, and cardiovascular health: A systematic review.

Cardiovascular disease (CVD) is the number one cause of death in the United States of America and across the world. The high prevalence of obesity (56.9%) in African American women contributes to high rates of CVD. Ketogenic nutritional therapy has been shown to be a safe and effective therapy for weight loss and reduction in other CVD risk factors (e.g., HgbA1C and blood pressure). However, the evidence investigating ketogenic nutritional therapy among African American women to improve CVD risk factors has not yet been synthesized. To conduct a systematic review of the evidence on CVD risk reduction and ketogenic nutrition therapy among African American women. CINAHL Plus, Cochrane, EMBASE, MEDLINE/PubMed, SCOPUS, and Web of Science were searched for quantitative studies focused on ketogenic nutritional therapy and CVD risk factors among African American women. Included studies measured beta-hydroxybutyrate as an indicator of dietary adherence. Of 4,799 articles identified, six articles representing five studies were included in this review. The majority of participants were female, with very few identified as African American women. Primary outcomes included weight, body mass index (BMI), blood pressure, and lipids. Dietary adherence was difficult to assess. Significant reductions in weight and BMI were noted. Heterogeneity in study design, intervention length, and measurement of dietary adherence made generalizations difficult. Few studies continually monitored dietary adherence using beta-hydroxybutyrate levels, thus threatening the internal validity of the studies. A gap in our understanding remains concerning CVD risk and ketogenic nutritional therapy among African American women specifically. Ketogenic nutritional therapy is effective in women to reduce weight and BMI. Ketogenic nutritional therapy may be beneficial in reducing CVD risk factors. Monitoring dietary adherence using beta-hydroxybutyrate levels with commercially available monitors is key to intervention success.

Randomized Double-Blind Controlled Trial of Freeze-Dried Strawberry Powder Supplementation in Adults with Overweight or Obesity and Elevated Cholesterol

Objective Recommended dietary patterns improve cardiovascular disease (CVD) risk factors such as blood pressure and LDL-C, as well as emerging markers that confer residual risk. Strawberry consumption has been shown to improve CVD risk factors, but further research is needed to better understand these effects using a dose-response model that evaluates a standard serving and a higher (but still achievable) dose. Methods A randomized, placebo-controlled, double-blinded crossover trial was conducted in middle-aged adults with overweight or obesity (n = 40; mean BMI = 29.4 ± 0.2 kg/m2; mean age = 50 ± 1.0 years) and moderately elevated LDL-C (mean LDL-C: 140 ± 3 mg/dL) to investigate the effect of two doses of strawberry supplementation on LDL-C and other CVD risk factors. Study interventions were: 0 g/d (control), 13 g/d (low-dose), and 40 g/d (high-dose) of freeze-dried strawberry powder (4-week supplementation periods separated by a 2-week compliance break). Results There was a significant main effect of treatment for the primary outcome of LDL-C, with a 4.9% reduction following the low-dose strawberry supplement compared to the high-dose (P = 0.01), but not compared to the control. There was also a significant effect on total cholesterol (TC), with a 2.8% and 2.4% reduction following the low-dose compared to the control and high-dose, respectively (P ≤ 0.05 in post-hoc analyses). There was a near significant effect for direct LDL-C (P = 0.07). There were no significant treatment effects for other atherogenic lipoprotein characteristics, indices of vascular function, measures of inflammation, or HDL efflux. Conclusion Low-dose supplementation with freeze-dried strawberry powder, equivalent to ∼1 serving/day of fresh strawberries, improved cholesterol in adults with overweight or obesity, compared to both the high-dose (∼3 servings/day of fresh strawberries) and control, but did not alter other markers of CVD. Supplemental data for this article is available online at

Effectiveness of the Complete Health Improvement Program in a Geriatric Population

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level ( P &lt; .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables ( P &gt; .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.

Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival

BackgroundCancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD. MethodsPatients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates. ResultsAmong 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254). ConclusionCompleting a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.

Obesity Management in Cardiometabolic Disease: State of the Art.

To summarize research from the last 5years on the effects of weight loss treatments, including lifestyle changes, anti-obesity medications, and bariatric procedures on cardiovascular disease (CVD) risk factors and CVD outcomes in adults. This narrative review includes and summarizes the contemporary evidence of the effects of these different weight loss approaches individually. A literature search was performed using the key words obesity, weight loss, CVD, cardiometabolic, and risk factors and included key clinical trials from the past 5years. Obesity management through weight loss is associated with improvements in CVD risk factors, such as improved blood pressure, lipid profiles, and glycemic control, with greater weight loss leading to greater improvements in CVD risk factors. Bariatric surgery is associated with greater weight loss than the other procedures and treatments for obesity, and for this, and possibly for other reasons, it is associated with greater reductions in CVD outcomes and mortality. Obesity is an independent risk factor and modulator of other CVD risk factors, and thus, treatment of obesity should be an integral part of management strategies to reduce CVD risk. Future trials and real-world studies of longer duration are needed to inform providers and patients on how to individualize the approach to modifying risks of cardiometabolic disorders through obesity management.

Rescuing kidney patients from early demise: role of anti-cytokine therapies

Biomarkers of the inflammatory state are elevated in individuals with chronic kidney disease (CKD) and are also robust predictors of cardiovascular disease (CVD) and mortality in this population. In addition to its predictive ability, inflammation has been implicated in the pathogenesis of atherosclerotic CVD, primarily through NLRP3 inflammasome and interleukin-1 (IL-1) and interleukin-6 (IL-6) signaling pathways.1 On the basis of these data, it has been suggested that ameliorating the inflammatory response through anti-cytokine therapies could improve CVD risk factors and potentially survival in CKD.

A Cardiac Rehabilitation Program for Breast Cancer Survivors: A Feasibility Study.

Purpose The purpose of this study was to determine the feasibility and preliminary efficacy of a cardiac rehabilitation (CR) intervention in the breast cancer population. Methods This single-arm feasibility study evaluated a 14-week CR intervention program in breast cancer survivors. Feasibility was defined as completion of at least 30/36 sessions of the program without serious adverse events (SAE) in 80% of patients. Secondary endpoints included the change in VO2 max, cardiovascular disease (CVD) risk factors, Duke Activity Secondary Index (DASI), Brief Fatigue Inventory (BFI), and QLQ-C30. All outcomes were reported as mean change and compared using paired t-tests. Results A total of 25 patients were enrolled in the study. 18 patients of the 25 enrolled (72%) completed the 14 weeks program without SAE. The overall adherence to the study protocol was 60%. Of the 18 participants who did not withdraw from the program, 15 (83%) adhered to the study protocol and completed 30 or more sessions. There was a nonsignificant improvement in VO2 max (mean Δ0.5, p=0.6). The scores for DASI, BFI, and QLQ-C30 improved from baseline to posttreatment. Conclusion A CR intervention in breast cancer survivors had high adherence in those who were able to complete the 14-week program. The program significantly improved patient reported physical activity, fatigue, and quality of life (QoL), without significant improvement in CVD risk factors. Implications for cancer patients are that early implementation of a CR program should be considered by practitioners as it improves QoL and exercise tolerance in breast cancer survivors.

Update on cardiovascular risk in nonalcoholic fatty liver disease.

To summarize recent evidence demonstrating increased cardiovascular disease (CVD) risk, and how CVD risk may be reduced, in patients with nonalcoholic fatty liver disease (NAFLD). NAFLD is a multisystem disease, defined by a spectrum of liver fat-associated conditions extending from simple steatosis, to inflammation, fibrosis and cirrhosis. NAFLD not only increases the risk of liver morbidity and mortality but also increases the risk of CVD morbidity and mortality and is associated with recognized CVD risk factors such as hypertension, atherogenic dyslipidaemia, type 2 diabetes mellitus and chronic kidney disease. Evidence suggests that the liver fibrosis stage may be a strong CVD risk factor. Lifestyle measures (e.g. weight loss and increased physical activity) are effective in improving CVD risk factors. Hypoglycaemic agents, such as the peroxisome proliferator-activated receptor gamma agonist pioglitazone and the glucagon-like peptide-1 receptor agonist liraglutide, reduce cardiovascular risk and may improve liver histology. Statin and antihypertensive treatments are well tolerated and currently it is unclear whether novel antifibrotic drugs will reduce CVD risk. Assessment and treatment of increased cardiovascular risk is important in patients with NAFLD. If not contra-indicated, pioglitazone or a glucagon-like peptide 1 agonist should be considered and may benefit both CVD risk and early liver disease.

Effect of DASH Diet Versus Healthy Dietary Advice on the Estimated Atherosclerotic Cardiovascular Disease Risk

Introduction:Cardiovascular disease (CVD) is the most leading cause of mortality worldwide. Changes in diet can reduce subclinical cardiac injury and inflammation in parallel with reductions of other CVD risk factors.Aim:The study aimed to evaluate the beneficial effect of the DASH diet versus usual healthy dietary advice (HDA) on the estimated risk of atherosclerotic cardiovascular disease (ASCVD).Methods:It was a prospective interventional nonrandomized controlled study, conducted on 92 participants attending Family Medicine Outpatient Clinics, Cairo University. The participants were assigned to 2 dietary groups, the DASH and HDA groups, for 12 weeks. All subjects were subjected to anthropometric measurement, assessment of lipid profile, and the estimated cardiovascular risk pre-and post-intervention.Results:The estimated cardiovascular risk was reduced significantly in both the DASH and HDA groups, with no statistically significant difference between the 2 groups regarding the risk reduction. By comparing the percent change between pre and post-intervention in both DASH and HDA groups, the following are the results: BMI dropped by 6.5% versus 2.5%, systolic blood pressure decreased by 6.9% and 4.1%, fasting blood sugar dropped by 5.5% and 3.1%, total cholesterol dropped by 5.2% and 3.1%, LDL dropped by 8.2%, and 3.1%, and HDL increased by 8.2% and 2.4%, in DASH and HDA groups, respectively.Conclusion:Both the DASH diet and HDA are associated with improvement in CVD risk factors. Although better risk factors decline with the DASH diet, there was no statistically significant difference between the 2 groups.

Modification of diet, exercise and lifestyle (MODEL) study: a randomised controlled trial protocol

IntroductionMost cardiovascular disease (CVD)-related events could be prevented or substantially delayed with improved diet and lifestyle. Providing information on structural vascular disease may improve CVD risk factor management, but its...

BENEFITS OF EXERCISE-BASED CARDIAC REHABILITATION ON EXERCISE CAPACITY AND SURVIVAL AMONG PATIENTS WITH CANCER AND CARDIOVASCULAR DISEASE

Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Cardiac rehabilitation (CR) improves CVD risk factors, including cardiorespiratory fitness (CRF), and may improve cardiovascular outcomes among patients with comorbid cancer and CVD. The impact of improvements in CRF on survivorship among patients with cancer attending CR has not been investigated. This study aimed to: (1) characterize the impact of CR program completion on survival, and (2) explore whether improvements in CRF translate to increased survival among patients with comorbid cancer and CVD.

Major dietary patterns and predicted cardiovascular disease risk in an Iranian adult population.

Limited data are available on the association of major dietary patterns and predicted risk of cardiovascular disease (CVD) using the Framingham Risk Score (FRS). To investigate the association between major dietary patterns and the predicted 10-year CVD risk in an Iranian population. This cross-sectional study was conducted on 522 apparently healthy adults referred to health centers in Tehran. Usual dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. The association between dietary patterns and the predicted risk of development of CVD was evaluated using linear multiple regression. Principal component analysis was used to identify major dietary patterns. In total, 41% of the men (n = 95) and 46% of women (n = 134) were in the low risk (<10%) and 6% of men (n = 14) and 1% of women (n = 3) were in the high risk (> 20%) category of the FRS. A significant decrease was found for body mass index (p < 0.001), systolic blood pressure (SBP) (p = 0.003), diastolic blood pressure (p = 0.005), and triglyceride (p = 0.02) in the higher tertile of healthy dietary pattern. Adherence to an unhealthy dietary pattern was associated with a significant increase in body weight (p = 0.03) and a significant decrease in high-density lipoprotein cholesterol (p < 0.001). The healthy dietary pattern score was negatively associated with SBP (p = 0.04) and FRS (p < 0.001). Although we observed improvements in CVD risk factors with greater adherence to healthy dietary patterns, there was no association between identified dietary patterns and the predicted risk of 10-year CVD.

Mediterranean-Style Diet for the Primary and Secondary Prevention of Cardiovascular Disease: A Cochrane Review.

Background:Diet plays a major role in cardiovascular disease (CVD) risk.Objectives:To determine the effectiveness of a Mediterranean-style diet for the primary and secondary prevention of CVD.Methods:We searched for randomised controlled trials (RCTs) of Mediterranean-style diets in healthy adults and those at increased risk of CVD (primary prevention) and with established CVD (secondary prevention).Results:Thirty RCTs were included, 22 in primary prevention and eight in secondary prevention. Clinical endpoints were reported in two trials where there was moderate quality evidence for a reduction in strokes for primary prevention, and low quality evidence for a reduction in total and CVD mortality in secondary prevention. We found moderate quality evidence of improvement in CVD risk factors for primary prevention and low quality evidence of little or no effect in secondary prevention.Conclusions:There is still some uncertainty regarding the effects of a Mediterranean-style diet in CVD prevention.

Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study.

Objectives:Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD.Methods:In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores.Results:All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m2 at baseline to 25.8±2.4 kg/m2 at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold.Conclusions:A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.