Lifestyle-related Cardiovascular Risk Factors Research Articles

Prevention of dementia using mobile phone applications (PRODEMOS): a multinational randomised controlled effectiveness-implementation trial

Abstract Background The expected increase of dementia prevalence in the coming decades will mainly be within low-and middle-income countries and those with low socioeconomic status (SES) in high income countries. Forty percent of dementia is associated with modifiable, lifestyle-related cardiovascular risk factors. Mobile health interventions with remote coaching can help reach underserved high-risk populations globally. Methods This open label, blinded endpoint, hybrid effectiveness-implementation randomised controlled trial (RCT) investigated whether a coach-supported mHealth intervention can reduce dementia risk in persons aged 55-75 years of low SES in UK or from the general population in China with at least two dementia risk factors. The primary effectiveness outcome was change in CAIDE dementia risk score (including age, education, sex, systolic blood pressure, total cholesterol, BMI, physical exercise) after 12-18 months of intervention. Main implementation outcomes were coverage, acceptability, appropriateness, adoption, feasibility, sustainability, fidelity, and costs using a mixed methods approach. Findings Between 15th January 2021 and 18th April 2023, 1,488 persons were included and randomised (734 intervention, 754 control), with 1,229 (82·6%) available for analysis of the primary effectiveness outcome. After a mean follow-up of 16 months, the mean CAIDE score improved by 0·16 points in the intervention group vs. 0·01 in the control group (Mean Difference (MD) 0·16, 95% Confidence Interval (CI) 0·03-0·29). The effect was larger in those who adhered to the intervention (MD 0·27, 95%CI 0·12-0·44) and those planning to change lifestyle (MD 0·33, 95%CI 0·10-0·57). Ten percent of those invited participated; of these, 81% adopted the intervention and 50% continued active participation throughout the study. For the individual components of the CAIDE score, there were no statistically significant differences for systolic blood pressure, total cholesterol and BMI, but in the intervention group physical inactivity was reduced more than in the control group (MD 6·7%, 95%CI 2·1 to 11·2) and more participants quit smoking (MD -3·1%, 95%CI -4·8 to -1·5). Interpretation A coach-supported mHealth intervention to improve lifestyle is modestly effective in reducing dementia risk factors in those with low SES in the UK and any SES in China. Implementation is challenging in these populations, but those reached actively participated. Whether this will result in less cognitive decline and dementia requires a larger RCT with long follow-up.

Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal.

Lifestyle modifications and medication compliance are key strategies. To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension. A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16. Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group. The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.

Physical activity among first-onset myocardial infarction patients: Case-control MAVERIK study

Cardiovascular diseases (CVD), such as myocardial infarction (heart attacks), are the main cause of deaths globally. The Malaysian Acute Vascular Events Risk (MAVERIK) Study aimed to determine lifestyle-related cardiovascular risk factors in Malaysia. An active lifestyle has been reported to reduce the incidence of CVD.

Występowanie czynników ryzyka sercowo-naczyniowego zależnych od stylu życia u studentów kierunków medycznych

Introduction: Knowledge about the importance of a healthy lifestyle in the prevention of cardiovascular diseases should be an integral part of the medical education of future physicians and other healthcare professionals. The aim of the study was to assess the presence of selected cardiovascular risk factors in comparison to cardioprotective factors in the group of students of the Medical University of Warsaw. Material and methods: The study was conducted using a lifestyle questionnaire based on the questionnaire developed at the Loma Linda University with the participation of the American College of Lifestyle Medicine. It covered 280 students of medicine and physiotherapy. Results: Although 81% of the respondents have a normal BMI, 77% of the surveyed population does not eat the recommended 5 portions of vegetables and fruits a day. 44% of physiotherapy students and 32% of medical students do not attain the recommended minimum of 30 minutes a day of moderate or vigorous physical activity. 76 out of 212, i.e. almost 36% of students, declare using nicotine in the last year. Conclusions: Medical students are not free from lifestyle-related cardiovascular risk factors. The percentage of people using nicotine is high and further studies are needed to assess what factors contribute to the lack of adherence to healthy lifestyle recommendations among this group of respondents.

Greater burden of risk factors and less effect of cardiac rehabilitation in elderly with low educational attainment: The Eu-CaRE study.

Socioeconomic status is a strong predictor of cardiovascular health. The aim of this study was to describe the immediate and long-term effects of cardiac rehabilitation (CR) across socioeconomic strata in elderly cardiac patients in Europe. The observational EU-CaRE study is a prospective study with eight CR sites in seven European countries. Patients ≥65 years with coronary heart disease or heart valve surgery participating in CR were consecutively included. Data were obtained at baseline, end of CR and at one-year follow up. Educational level as a marker for socioeconomic status was divided into basic, intermediate and high. The primary endpoint was exercise capacity (peak oxygen consumption (VO2peak)). Secondary endpoints were cardiovascular risk factors, medical treatment and scores for depression, anxiety and quality of life (QoL). A total of 1626 patients were included; 28% had basic, 48% intermediate and 24% high education. A total of 1515 and 1448 patients were available for follow-up analyses at end of CR and one-year, respectively. Patients with basic education were older and more often female. At baseline we found a socioeconomic gradient in VO2peak, lifestyle-related cardiovascular risk factors, anxiety, depression and QoL. The socioeconomic gap in VO2peak increased following CR (p for interaction <0.001). The socioeconomic gap in secondary outcomes was unaffected by CR. The use of evidence-based medication was good in all socioeconomic groups. We found a strong socioeconomic gradient in VO2peak and cardiovascular risk factors that was unaffected or worsened after CR. To address inequity in cardiovascular health, the individual adaption of CR according to socioeconomic needs should be considered.

Behavioural cardiovascular risk factors and prevalence of diabetes in subjects with familial hypercholesterolaemia.

A low prevalence of type 2 diabetes mellitus has been reported in familial hypercholesterolaemia. Whether a healthier lifestyle could explain it has not been explored. This cross-sectional study determines the prevalence of lifestyle-related cardiovascular risk factors in heterozygous familial hypercholesterolaemia (HeFH) from the Dyslipidaemia Registry of the Spanish Atherosclerosis Society and in the ENRICA study, a representative sample of the adult Spanish general population, weighted to match the age and sex distribution of the HeFH sample. A total of 2185 HeFH patients and 11,856 individuals from ENRICA were included. HeFH had lower body mass index and fewer of them were smokers than in the reference population. A model adjusted for age, sex and body mass index showed that HeFH more frequently had cardiovascular disease (odds ratio (OR) 23.98; 95% confidence interval (CI) 18.40-31.23) and hypertension (OR 1.20; 95% CI 1.07-1.35), and took anti-hypertensive medication (OR 1.36; 95% CI 1.18-1.56) and anti-diabetic medication (OR 1.25; 95% CI 1.00-1.56), but less frequently were smokers (OR 0.79; 95% CI 0.71-0.89). In a HeFH subsample (n = 513) with complete blood glucose information, those patients without cardiovascular disease showed lower prevalence of smoking and type 2 diabetes mellitus, lower body mass index and glucose, and higher diastolic blood pressure than the Spanish population. The differences in type 2 diabetes mellitus were justified mostly by the difference in body mass index. Body mass index adjustment also showed higher prevalence of hypertension and use of anti-hypertensive drugs in HeFH. In summary, HeFH patients had lower body mass index, which may contribute to explaining the lower prevalence of diabetes, and lower current smoking but higher hypertension.

Lifestyle-related cardiovascular risk factors among adults in Delta State, Nigeria using WHO STEPS approach: prevalence and rural-urban differences

Objective: To describe the prevalence and rural-urban differences in lifestyle-related cardiovascular risk factors. Method: A cross-sectional survey of apparently healthy adults in an urban and a rural community in Delta State, Nigeria using the WHO STEPS questionnaire. Ethical approval was granted by the Delta State University Teaching Hospital. Results: Of the 866 respondents, 56% were urban dwellers and 44% were males. The mean age was 42.5(±16.05) years. The prevalence of current smokers was 13.6%. It was significantly higher among rural dwellers (22.3% vs 6.8%, p<0.001). Alcohol was consumed by 58.5% of the respondents in the last 12 months; rural more than urban dwellers (79.5% vs 42.1%, p<0.001). About 75% of the respondents ate <5 servings / portions of fruits daily. This was significantly higher among rural dwellers (83.7% vs 67.4%, p<0.001). Table salt was added to cooked food by 30.8% of the respondents. The rural-urban difference was not significant. In a typical week, 40.2% of respondents do not walk or ride a bicycle continuously for at least 10 minutes to-and-from places; urban (47.6%) more than rural (30.7%) dwellers (p<0.001). Conclusion: Lifestyle-related cardiovascular risk factors are common in this study; more so in the rural setting. There is a need to increase cardiovascular health education and promotion activities. Keywords: Lifestyle, cardiovascular risk factors, adults, WHO STEPS

Heart rate variability, but not heart rate, is associated with handgrip strength and mortality in older Africans at very low cardiovascular risk: A population-based study

A high heart rate and a low heart rate variability at rest are established predictors of various forms of functional impairment, morbidity, and mortality [1–6]. Two explanations can be given for these associations. On one hand, a high heart rate and a low heart rate variability are thought to reflect dysfunction of the flexible autonomic regulation of the heart rate in particular and of the body's functioning in general that arises during ageing [3–5]. On the other hand, a high heart rate and a low heart rate variability are brought about by cardiovascular risk factors, such as obesity, hyperlipidaemia, diabetes, hypertension, and physical inactivity [2,3,7–9]. Since research on heart rate and heart rate variability has almost exclusively been conducted in western populations with an affluent sedentary lifestyle and high prevalences of these risk factors, it has been difficult to determine whether or not heart rate and heart rate variability are associated with functional impairment, morbidity, and mortality independently of cardiovascular risk factors.

An Education Program for Risk Factor Management After an Acute Coronary Syndrome

Lifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve. To determine whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome. The Réseau Insuffisance Cardiaque (RESICARD) PREVENTION: study was a 2-arm, parallel-group, multicenter, randomized clinical trial at 6 tertiary care hospitals in France. Patients hospitalized in a cardiac intensive care unit for an acute coronary syndrome with at least 1 lifestyle risk factor (current smoking, sedentary lifestyle, or overweight or obesity) were randomized according to a computer-generated list with sequentially numbered, sealed envelopes. Patients underwent an education program in a unique non-hospital setting (a House of Education) or were treated according to physicians' usual standard of care. The primary outcome was a composite that included at least 1 of the following: smoking cessation, at least 3 hours per week of physical activity, at least 5% reduction in weight, and at least 4% reduction in waist circumference. Patients were followed up for 1 year. An intent-to-treat analysis was performed. RESULTS From June 21, 2006, to July 30, 2008, a total of 251 patients were randomized to the House of Education and 251 to conventional care. The 2 groups did not differ significantly at 12 months in the primary composite outcome (51.8% vs 49.8% success rate; adjusted relative risk [aRR], 1.11; 95% CI, 0.90-1.37) or with correction of all risk factors (aRR, 1.22; 95% CI, 0.89-1.66). Similarly, the 2 groups did not differ by physical activity (aRR, 1.05; 95% CI, 0.92-1.21), smoking cessation (aRR, 0.99; 95% CI, 0.87-1.13), and weight or waist reduction (aRR, 1.07; 95% CI, 0.84-1.36). Compared with conventional care, the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome. clinicaltrials.gov Identifier: NCT00337480.

Lifestyle‐related cardiovascular risk factors in patients with bipolar disorder

AbstractStudies suggest that people with bipolar affective disorder have higher rates of cardiovascular risk factors such as obesity, hypertension, diabetes, smoking and poor diet; however, there are few studies assessing specific risk factors in the UK population. Dr Brown and colleagues present the results of their study to evaluate lifestyle‐related cardiovascular risk factors in a community cohort of patients with bipolar disorder compared with the UK general population.

Clustering of Major Cardiovascular Risk Factors and the Association with Unhealthy Lifestyles in the Chinese Adult Population

BackgroundPrevious studies indicated that lifestyle-related cardiovascular risk factors tend to be clustered in certain individuals. However, population-based studies, especially from developing countries with substantial economic heterogeneity, are extremely limited. Our study provides updated data on the clustering of cardiovascular risk factors, as well as the impact of lifestyle on those factors in China.MethodsA representative sample of adult population in China was obtained using a multistage, stratified sampling method. We investigated the clustering of four cardiovascular disease (CVD) risk factors (defined as two or more of the following: hypertension, diabetes, dyslipidemia and overweight) and their association with unhealthy lifestyles (habitual drinking, physical inactivity, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and a low modified Dietary Approaches to Stop Hypertension (DASH) score).ResultsAmong the 46,683 participants enrolled in this study, only 31.1% were free of any pre-defined CVD risk factor. A total of 20,292 subjects had clustering of CVD risk factors, and 83.5% of them were younger than 65 years old. The adjusted prevalence of CVD risk factor clustering was 36.2%, and the prevalence was higher among males than among females (37.9% vs. 34.5%). Habitual drinking, physical inactivity, and chronic use of NSAIDs were positively associated with the clustering of CVD risk factors, with ORs of 1.60 (95% confidence interval [CI] 1.40 to1.85), 1.20 (95%CI 1.11 to 1.30) and 2.17 (95%CI 1.84 to 2.55), respectively. The modified DASH score was inversely associated with the clustering of CVD risk factors, with an OR of 0.73 (95%CI 0.67 to 0.78) for those with modified DASH scores in the top tertile. The lifestyle risk factors were more prominent among participants with low socioeconomic status.ConclusionClustering of CVD risk factors was common in China. Lifestyle modification might be an effective strategy to control CVD risk factors.

The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial

BackgroundThe additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care.MethodsA single centre, two arm, parallel group randomised controlled trial was performed. Patients with stable established CVD and at least one lifestyle-related risk factor were recruited from the vascular and cardiology outpatient departments of the university hospital. Blocked randomisation was used to allocate patients to the intervention (n = 71) or control group (n = 75) using an on-site computer system combined with allocations in computer-generated tables of random numbers kept in a locked computer file. The intervention group received the comprehensive lifestyle intervention offered in a specialised outpatient clinic in addition to usual care. The control group continued to receive usual care. Outcome measures were the lifestyle-related cardiovascular risk factors: smoking, physical activity, physical fitness, diet, blood pressure, plasma total/HDL/LDL cholesterol concentrations, BMI, waist circumference, and changes in medication.ResultsThe intervention led to increased physical activity/fitness levels and an improved cardiovascular risk factor profile (reduced BMI and waist circumference). In this setting, cardiovascular risk management for blood pressure and lipid levels by prophylactic treatment for CVD in usual care was already close to optimal as reflected in baseline levels. There was no significant improvement in any other risk factor.ConclusionsEven in CVD patients receiving good clinical care and using cardioprotective drug treatment, a comprehensive lifestyle intervention had a beneficial effect on some cardiovascular risk factors. In the present era of cardiovascular therapy and with the increasing numbers of overweight and physically inactive patients, this study confirms the importance of risk factor control through lifestyle modification as a supplement to more intensified drug treatment in patients with CVD.Trial registrationISRCTN69776211 at http://www.controlled-trials.com

Population-wide use of behavioural prevention and counselling programmes for lifestyle-related cardiovascular risk factors in Germany

Background: Behavioural prevention and counselling programmes for lifestyle-related cardiovascular risk factors are widely offered. However, their population-wide use is largely unexplored, particu...

Population-wide use of behavioural prevention and counselling programmes for lifestyle-related cardiovascular risk factors in Germany

Behavioural prevention and counselling programmes for lifestyle-related cardiovascular risk factors are widely offered. However, their population-wide use is largely unexplored, particularly in high-risk persons with known CVD or diabetes. Data were collected within GEDA 2009, a national health survey covering a representative sample of 21,262 adults in Germany. Standardised structured computer-assisted telephone interviews included self-reported physician-diagnosed coronary heart disease, myocardial infarction, heart failure, stroke, diabetes as well as height, weight, usual diet, physical activity, and the use of programmes for weight reduction, healthy diet and improvement of fitness or mobility in the last twelve months. The use of prevention measures was lowest for weight reduction (men 2.1%, women 3.5%), somewhat higher for healthy diet (men 3.2%, women 4.7%), and highest for improvement of fitness or mobility (men 8.6%, women 16.1%). Among individuals with the respective risk factor, programme participation was still low: 5.5% in obese men (women 7.2%) for weight reduction, 2.8% in men (women 3.7%) who did not eat fruit or vegetables daily for healthy diet, and 7.9% in physically inactive men (women 15.7%) for improvement of fitness or mobility. In the presence of known CVD or diabetes, participation increased inconsistently and only moderately. Our results show low participation in behavioural prevention measures for lifestyle-related risk factors even in individuals with known CVD or diabetes. Further studies should investigate knowledge about potential programme benefit, availability and reimbursement in both patients and health care providers.

Lifestyle risk factors for atherosclerosis in adults with type 1 diabetes

The objective of this study was to compare the amount of self-reported physical activity, alcohol and tobacco use in a large sample of adults with type 1 diabetes and non-diabetic subjects. A second aim is to test the hypothesis that these lifestyle risk factors are associated cross-sectionally with coronary artery calcification. In 2000-2002, the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study applied validated questionnaires for smoking, alcohol and physical activity to 582 type 1 diabetes subjects and 724 non-diabetic subjects. More type 1 diabetes subjects reported current smoking than non-diabetic subjects (12.3% versus 8.6%, p=0.027). Overall, reported physical activity did not differ by diabetes status (p=0.79). More type 1 diabetes subjects reported never having consumed alcohol (10% versus 4%, p<0.0001) and those who drank consumed less alcohol (p=0.0015) than non-diabetic subjects. Physical activity and smoking were significantly associated with the presence of coronary artery calcification (adjusted OR=0.9, 95% CI: 0.8-0.996, p=0.045, and OR=1.7, CI: 1.1-2.6, p=0.03, respectively). Type 1 diabetes was independently associated with increased odds of coronary artery calcification (OR=3.5, 95% CI: 2.5-5.0, p<0.0001). Differences exist in lifestyle-related cardiovascular risk factors in men and women with type 1 diabetes compared with non-diabetic subjects in the CACTI study.

Prevalence of lifestyle-related cardiovascular risk factors in Peru: the PREVENCION study

To estimate the prevalence of lifestyle-related cardiovascular risk factors in the adult population of Arequipa, the second largest city in Peru. The prevalence and patterns of smoking, alcohol drinking, lack of physical activity, high-fat diet, and low fruit and vegetable intake were evaluated among 1 878 subjects (867 men and 1 011 women) in a population-based study. The age-standardized prevalence of current smoking, former smoking, and never smoking were 21.6%, 14.3%, and 64.1%, respectively. The prevalence of current smoking was significantly higher in men than women (31.1% vs. 12.1%; P < 0.01). The prevalence of current alcohol use was 37.7% and significantly higher in men than women (55.5% vs. 19.7%; P < 0.01). Similarly, the prevalence of binge drinking was 21.2%, and the percentage of men who binge drink (36.1%) was significantly higher than for women (6.4%; P < 0.01). The vast majority of alcohol drinkers reported a pattern of alcohol consumption mainly on weekends and holidays rather than regular drinking with meals during the week. The proportion of insufficiently active people was 57.6% and was significantly higher in women than men (63.3% vs. 51.9%; P < 0.01). Overall, 42.0% of adults reported consuming high-fat diets, 34.5% reported low fruit intake, and 33.3% reported low vegetable intake. The high prevalence of lifestyle-related cardiovascular risk factors found in this Andean population is of concern. Preventive programs are urgently needed to deal with this growing problem.

Relation of nutrient intake to microalbuminuria in nondiabetic middle-aged men and women: International Population Study on Macronutrients and Blood Pressure (INTERMAP)

Microalbuminuria (MA) is a risk factor for cardiovascular and renal disease. However, little is known about the relation of nutritional factors to MA, especially in individuals without diabetes. Data collected by the International Population Study on Macronutrients and Blood Pressure from 1997 to 1999 were used to assess relations of multiple dietary factors (energy intake, macronutrients, and micronutrients) independent of lifestyle-related cardiovascular risk factors to MA (urinary albumin excretion, 30 to <300 mg/24 h). The study population included 4,381 Chinese, Japanese, UK, and US men and women without diabetes aged 40 to 59 years (17 population samples) without macroalbuminuria. MA prevalences ranged from 3.1% to 5.5% for men and 2.6% to 4.6% for women in the 4 countries. With adjustment for age and country, the following nutrients considered singly (of 29) were related in logistic regression analyses to MA prevalence ( P < 0.05): for men, inversely, iron, vitamin C and E, estimated total simple sugar, omega-6 fatty acid, polyunsaturated fatty acid, and calcium (all expressed as caloric density) intake; for women, directly, 24-hour urinary sodium excretion and alcohol intake. In multivariate analyses, sugar, iron, polyunsaturated fats, and vitamin C and E intake (in men) and alcohol intake (women only) remained associated with MA ( P < 0.05). MA also was related directly to body mass index ( P < 0.05), blood pressure ( P < 0.001), and smoking ( P > 0.05) and inversely to education ( P < 0.05 in women). In cross-sectional analyses, several nutrients were related to MA among men. Additional studies are required to confirm these findings.

Changes in coronary risk profiles in employees after three years of multifactorial intervention.

This study was performed with the objective of assessing the effectiveness of the intervention at the work-site on lifestyle-related cardiovascular risk factors in four work-sites in Granada, Spain. Individualized face-to-face counseling was given to 1555 employees (1193 men and 362 women). After 3 years, a blinded assessment of the adequacy of the interventions was carried out. When changes in all employees were analysed together, ('per protocol' analysis) a non-significant reduction (-0.02%; 95% CI: -0.06 to +0.03%) in mean coronary risk was observed. We also distinguished between adequate and inadequate implementation of the intervention protocol. Observed changes in mean coronary risk were compared between both groups (adequate/inadequate implementation). Changes in mean coronary risk were beneficial only in the group that achieved an adequate level of intervention, with an observed significant mean reduction of risk of -0.12% (95% CI: -0.07 to -0.17) whereas changes were in the opposite direction in the other group with a mean change of +0.08% (95% CI: + 0.01 to + 0.16%). Work-site programs of health behaviour modification when appropriately implemented can attain although small, significant changes in cardiovascular risk profiles and thus be especially effective in achieving the population strategy of preventive cardiology.