Improvements In Cardiovascular Disease Risk Factors Research Articles

The effects of time and intensity of exercise on novel and established markers of CVD in adolescent youth

This article examines the effects of brief, intense exercise in comparison with traditional endurance exercise on both novel and traditional markers of cardiovascular disease (CVD) in youth. Forty seven boys and ten girls (16.4 ± 0.7 years of age) were divided into a moderate (MOD), high intensity (HIT), or a control group. The MOD group (12 boys, 4 girls) and HIT group (15 boys, 2 girls) performed three weekly exercise sessions over 7 weeks. Each session consisted of either four to six repeats of maximal sprint running within a 20 m area with 20-30 s recovery (HIT) or 20 min continuous running within a 20 m area at ∼70% maximal oxygen uptake (VO(2) max). Total exercise time commitment over the intervention was 420 min (MOD) and 63 min (HIT). Training volume was 85% lower for the HIT group. Total estimated energy expenditure was ∼907.2 kcal (HIT) and ∼4410 kcal (MOD). Significant improvements (P ≤ 0.05) were found in systolic blood pressure, aerobic fitness, and body mass index (BMI) postintervention (HIT). In the MOD group, significant (P ≤ 0.05) improvements were noted in aerobic fitness, percentage body fat (%BF), BMI, fibrinogen (Fg), plasminogen activator inhibitor-1, and insulin concentrations. These findings demonstrate that brief, intense exercise is a time efficient means for improving CVD risk factors in adolescents.

The effect of one avocado per day on established and emerging cardiovascular disease (CVD) risk factors: study design

Clinical studies have demonstrated consistently that diets high in monounsaturated (MUFA) and low in saturated fatty acids (SFA) lower total cholesterol and low density lipoprotein cholesterol (LDL‐C) as effectively as lower‐fat, low SFA diets. Avocados are a good source of MUFA and also are rich in vitamins, minerals and phytosterols which could beneficially affect CVD risk. A randomized, 3‐period cross‐over, controlled feeding study was designed to evaluate the effects of avocados on established and emerging risk factors for CVD. Overweight and obese (BMI 25–35 kg/m2) men and women with moderately elevated LDL‐C (25 – 90th) will consume 3 treatment diets with a 2 week run‐in Western diet. Treatment diets are matched for SFA (<7% energy) and include a low‐fat diet (LF: 24% fat, 12% MUFA), a moderate fat diet (MF: 34% fat, 18% MUFA), and a moderate fat diet providing 1 avocado per day (AV: 34% fat, 18% MUFA) with the equivalent fatty acid profile of the MF diet. We hypothesize that the inclusion of 1 avocado per day in a cholesterol‐lowering moderate fat diet will improve CVD risk factors including lipids, lipoproteins, markers of oxidative stress and inflammation, and improve reverse cholesterol transport compared to a heart‐healthy low fat diet and a moderate fat diet without avocado.This study is supported by the Hass Avocado Board of California. ClincalTrials.gov identifier: NCT0123582

Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors.

People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV-infected adults relative to standard of care treatment in a matched control group. Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were: 2-h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T-cell count and plasma HIV RNA, and the Medical Outcomes Study Short Form (SF)-36 health-related QOL inventory. Resting systolic and diastolic blood pressures improved more (P=0.04) in the yoga group (-5 +/- 2 and -3 +/- 1 mmHg, respectively) than in the standard of care group (+1 +/- 2 and+2 +/- 2 mmHg, respectively). However, there was no greater reduction in body weight, fat mass or proatherogenic lipids, or improvements in glucose tolerance or overall QOL after yoga. Immune and virological status was not adversely affected. Among traditional lifestyle modifications, yoga is a low-cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors.

Effect of the Look AHEAD Study Intervention on Medication Use and Related Cost to Treat Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes

OBJECTIVETo examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with type 2 diabetes.RESEARCH DESIGN AND METHODSLook AHEAD is a multicenter randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45–76 years. An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension, and hyperlipidemia were compared at baseline and 1 year. Medication costs were conservatively estimated using prices from a national online pharmacy.RESULTSParticipants randomized to an ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared with those assigned to DSE. At 1 year, average number of medications prescribed to treat CVD risk factors was 3.1 ± 1.8 for the ILI group and 3.6 ± 1.8 for the DSE group (P < 0.0001), with estimated total monthly medication costs of $143 and $173, respectively (P < 0.0001). DSE participants meeting optimal care goals at 1 year were taking an average of 3.8 ± 1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2 ± 1.7) at lower cost ($154/month) (P < 0.001).CONCLUSIONSAt 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.

Obesity and Arterial Compliance Alterations

Obesity is associated with increased cardiovascular disease (CVD) risk, especially when excess body fat is distributed preferentially within the abdominal region. Obese subjects usually have increased arterial stiffness compared with non-obese subjects of similar age. The factors associated with increased arterial stiffness in obesity include endothelial dysfunction (decreased nitric oxide bioavailability), impaired smooth muscle cell function, insulin resistance, as well as elevated cholesterol and C-peptide levels. Furthermore, visceral fat, the adipose tissue-related renin-angiotensin-aldosterone system and hyperleptinaemia contribute to the obesity-associated impaired arterial compliance. Weight loss improves CVD risk factors and arterial compliance. Because increased arterial stiffness is a marker of CVD risk these findings support the concept that the presence of obesity has vascular implications.

Case Management to Reduce Risk of Cardiovascular Disease in a County Health Care System

Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (-4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (-6.0 [11.6] vs -3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group. Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics. clinicaltrials.gov Identifier: NCT00128687.

Cardiovascular risk assessment in HIV-infected patients attending a designated lipid clinic

Introduction: Metabolic complications related to HIV infection or therapy increase the risk for cardiovascular disease (CVD). The management of HIV together with their CVD risk factors is complex. The effectiveness of a designated lipid clinic in improving CVD risk factors was assessed. Methods: Data from 217 patients were included. As part of their routine care all patients underwent a cardiovascular risk assessment. Results: The mean age was 49.2(8.2) years; 26.7% were current smokers. 17.1% were referred for secondary prevention and 82.9% for primary prevention.

The effects of a whole grain–enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome

BackgroundWhole-grain foods are associated in observational studies with a lower body mass index and lower cardiovascular disease (CVD) risk. However, few clinical trials have tested whether incorporating whole grains into a hypocaloric diet increases weight loss and improves CVD risk factors. ObjectiveThe aim of this study was to determine whether including whole-grain foods in a hypocaloric (reduced by 500 kcal/d) diet enhances weight loss and improves CVD risk factors. DesignObese adults (25 M, 25 F) with metabolic syndrome were randomly assigned to receive dietary advice either to avoid whole-grain foods or to obtain all of their grain servings from whole grains for 12 wk. All participants were given the same dietary advice in other respects for weight loss. ResultsBody weight, waist circumference, and percentage body fat decreased significantly (P < 0.001) in both groups over the study period, but there was a significantly (P = 0.03) greater decrease in percentage body fat in the abdominal region in the whole-grain group than in the refined-grain group. C-reactive protein (CRP) decreased 38% in the whole-grain group independent of weight loss but was unchanged in the refined-grain group (P = 0.01 for group × time interaction). Total, LDL, and HDL cholesterol decreased in both diet groups (P < 0.05). Dietary fiber and magnesium intakes increased in the whole-grain but not the refined-grain group (P = 0.007 and P < 0.001, respectively, for group × time interaction). ConclusionsBoth hypocaloric diets were effective means of improving CVD risk factors with moderate weight loss. There were significantly (P < 0.05) greater decreases in CRP and percentage body fat in the abdominal region in participants consuming whole grains than in those consuming refined grains.

Domestic Physical Activity in Relationship to Multiple CVD Risk Factors

Public health recommendations emphasize regular participation in moderate intensity physical activity (at least 5 days per week, 30 minutes or more per day), including domestic activities (e.g., heavy housework). The contribution of domestic activities in improving cardiovascular disease risk remains unclear. This cross-sectional study aimed at determining the independent associations of domestic activity and other activity types with multiple cardiovascular disease (CVD) risk factors (resting pulse rate, obesity, total cholesterol, high-density lipoprotein cholesterol, blood pressure, C-reactive protein). The sample comprised of 14,836 adults (ages 16 years and over) living in households in England in 2003. Interviews assessed participation in at least moderate intensity physical activity (domestic activity, walking, and sports), and nurses measured blood pressure and took blood samples. Analyses were done in 2006. A total of 24.2% of men and 19.8% of women met the activity recommendations, dropping to a total of 17.6% and 13.0% when domestic activity was excluded. With the exception of systolic blood pressure in women, domestic activity was not related to a favorable profile of any other CVD risk factors. There was a trend for lower body mass index and waist circumference and higher high-density lipoprotein cholesterol with increased participation in walking. Sports participation was related to a favorable profile for all risk factors excluding systolic blood pressure in men and cholesterol and C-reactive protein in women. The odds of being obese (body mass index more than 30 kg/m(2)) were lower with increased participation in walking and sports. Despite its high prevalence, domestic physical activity was not associated with improvements in CVD risk factors. These results suggest that physical activity recommendations may need to focus on physical activities other than those performed in and around the household.

Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention1,2

Data concerning the long-term improvement of cardiovascular disease (CVD) risk factors after an obesity intervention in children are limited. We studied changes in weight status and CVD risk factors in children in an intervention program and evaluated whether these changes were sustained 1 y after the end of the intervention. We analyzed changes in the SD score (SDS) of body mass index [BMI; in kg/m2 (SDS-BMI)], blood pressure (BP), lipids, and homeostasis model assessment index of insulin resistance (HOMA-IR) over the course of 2 y in 240 obese (BMI > 97th percentile) children aged 6-14 y (x age: 10.4 y; x BMI: 26.9). Of these 240 children, 203 participated in a 1-y intervention program of physical exercise, nutrition education, and behavior therapy. We compared these children with 37 obese children who underwent no intervention and with 12 normal-weight children of the same age and sex. Obese children had significantly (P < 0.05) higher BP, HOMA-IR, and insulin, triacylglycerol, and LDL-cholesterol concentrations and lower HDL-cholesterol concentrations than did normal-weight children. Twenty-nine children dropped out of the intervention. Only in the 126 children who reduced their SDS-BMI did BP (8% and 12% decreases in systolic and diastolic BP, respectively), lipids (12% and 5% decreases in triacylglycerol and LDL cholesterol, respectively; 7% increase in HDL cholesterol), insulin (13% decrease), and HOMA-IR (17% decrease) improve significantly (P < 0.05). Reduction in SDS-BMI and all benefits regarding CVD risk factors were sustained 1 y after the end of the intervention in the children whose SDS-BMI decreased. Long-term multidisciplinary intervention led to a reduction in SDS-BMI in most of the obese children 1 y after the end of the intervention. Reduction in SDS-BMI was accompanied by an improvement in CVD risk factors.

Reduction in Cardiovascular Disease Risk Factors: 6-Month Results from ProjectActive

Background.ProjectActiveis a randomized clinical trial that compares a lifestyle physical activity intervention with a traditional structured exercise intervention. The purpose of this paper is to report 6-month results of these interventions on cardiovascular disease (CVD) risk factors among healthy, sedentary, middle-aged men and women, and to examine the psychological strategies used in each group (Lifestyle and Structured) to reach the level of physical activity recommended by the Centers for Disease Control and Prevention (CDC) and American College of Sports Medicine (ACSM) and to achieve changes in these CVD risk factors.Methods.A total of 116 initially sedentary men (mean ± SD self-reported physical activity, 33.2 ± 1.4 kcal · kg−1· day−1) and 119 women (32.9 ± 1.0 kcal · kg−1· day−1), ages 35–60 years (46.0 ± 6.7 years) were randomly assigned to a 6-month lifestyle physical activity counseling intervention or a 6-month gymnasium-based structured program. At baseline and 6 months, changes in lipid and lipoprotein-cholesterol concentrations, blood pressure, and body composition and cognitive and behavioral measures of change were assessed. One-way analyses of variance with covariate adjustment were used to test for between-group differences in CVD risk factors. Associations between achieving the CDC/ACSM criterion and changes in cognitive and behavioral measures were assessed with multiple logistic regression models.Results.After 6 months of intervention, 78% of Lifestyle participants and 85% of Structured participants were meeting or exceeding the CDC/ACSM recommendation of accumulating 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week. This was verified by a significant increase in cardiorespiratory fitness in both groups. The adjusted mean increase in maximal METs (VO2peak÷ 3.5 ml · kg−1· min−1) between treadmill tests was 0.4 kcal · kg−1· hr−1(P< 0.001) for Lifestyle and 1.1 kcal · kg−1· hr−1(P< 0.001) for Structured. There was a significant difference between intervention groups for this outcome. Both groups had significant reductions in total cholesterol, total cholesterol/HDL-C ratio, diastolic blood pressure, and percentage of body fat. There were no significant between-group differences in changes in these outcomes. Adjusted mean changes in total cholesterol, systolic blood pressure, and percentage of body fat in Lifestyle [in Structured] participants were −0.2 [−0.3] mmol · L−1, −3.2[−1.8] mm Hg, and −1.4 [−1.7] %, respectively. There were significant associations between achieving the CDC/ACSM physical activity criterion and greater use of the cognitive and behavioral strategies of change. Both groups changed self-efficacy and many of the behavioral measures, but there were no significant differences between intervention groups.Conclusions.These results demonstrate that lifestyle physical activity counseling is as effective as structured exercise programs in increasing physical activity and improving CVD risk factors after 6 months among initially sedentary men and women. Furthermore, specific cognitive and behavioral counseling strategies were increased significantly as a result of the intervention. These strategies are effective and could be used in a wide variety of settings.