Modifiable Risk Factor For Cardiovascular Disease Research Articles

Survival Mediterranean Style: Lifestyle Changes to Improve the Health of the US Fire Service.

Cardiovascular disease (CVD) causes almost half of all on-duty deaths in US firefighters and is an important and costly cause of morbidity. In addition, cancer is a growing health concern in this population. Obesity and obesity-associated, cardiometabolic risk clustering are major, modifiable risk factors for fire service CVD and cancer risk. The Mediterranean diet (MedDiet) is proven effective in primary and secondary CVD prevention. It is also associated with a decreased risk of cancer and other chronic diseases. Moreover, it can be adapted into successful workplace interventions. Emerging data from our group regarding the US Fire Service show that greater compliance with the MedDiet is associated with improved CVD risk profiles and less weight gain among career firefighters. Moreover, the fact that career firefighters take a considerable number of meals communally on the job also represents an excellent opportunity for a workplace Mediterranean Diet Nutritional Intervention (MDNI). The devastating effects of obesity, CVD, and cancer on the US fire service are recognized, but currently few effective preventive programs exist. The consistently positive health benefits from following a MedDiet and promising preliminary data in the fire service justify translational research to determine the most effective means of delivering MDNIs to US firefighters. Therefore, a high priority should be assigned to efforts, which can help further disseminate and implement our program of novel behavior change strategies, “Survival Mediterranean Style,” throughout the US fire service and eventually to other occupations.

Evaluation of the National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions Among Military Personnel in Jeddah City, Saudi Arabia, 2016.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Preventive efforts mainly target the reduction of modifiable CVD risk factors through community-based promotion programs. One of these programs is the National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions among military personnel in Jeddah City, Saudi Arabia. Researchers have asserted that to improve every intervention program, especially those targeting public health issues, regular monitoring and evaluation are needed to determine the strength and weakness of the program. The objective of this study was to assess the effectiveness of National Guard Health Promotion Program for Chronic Diseases and Comorbid Conditions among military personnel in Jeddah City by estimating Framingham risk score, diabetes risk score, and satisfaction level for the participants covered by the program for at least 6 months. Through pre- and poststudy design, a systematic random sample of military personnel who fulfilled the inclusion criteria (n = 267) were enrolled in the study. To assess the program's effectiveness, participants were subjected to clinical and laboratory assessment based mainly on Framingham risk scores before and after involvement in the program; satisfaction was assessed concurrently using a self-administered questionnaire. The Wilcoxon signed rank test was used to compare changes in non-normally distributed quantitative variables. Multiple logistic regression analysis was used to identify independent predictors of risk of CVDs. The subjects were all military men, with mean age of 35.8 ± 6.6 years; 6% officers with the remainder "non-officers" primarily working in the combat services. After at least 6 months of the preventive program, there were statistically significant decreases in body mass index (-0.4 ± 1.5 kg/m2), waist circumference (-0.9 ± 6.2 cm), fasting blood glucose (-12.3 ± 29.6 mg/dL), and total cholesterol (-15.4 ± 40.2 mg/dL). Despite this observed improvement, the overall Framingham risk score showed a modest nonsignificant change (-0.1 ± 2.1 points). Similarly, although specific predictors scores of diabetes mellitus showed significant improvement (decreased blood glucose [-0.4 ± 1.8 points] and increased fruit and vegetable consumption [-0.2 ± 0.6 points]), there was no significant change in the overall diabetes risk score (-0.01 ± 2.5). The majority of the participants (96%) expressed that they were satisfied with the program. The National Guard Health Promotion Program is effective in improving specific risk factors such as body mass index, waist circumference, blood glucose, and intake of fruits and vegetables; in addition, it was perceived as being satisfactory. Nevertheless, it had no statistically significant impact on the overall total risk scores for CVDs and diabetes mellitus.

Mortality and Health Service Use Following Acute Myocardial Infarction Among Persons with HIV: A Population-Based Study.

People with HIV have higher rates of acute myocardial infarction (AMI) than HIV-negative individuals. We compared mortality risk and health service use following AMI among people with and without HIV between January 1, 2002, and March 31, 2015. We conducted a population-based study using Ontario's administrative databases. Our primary outcomes were risk of inpatient death and death at 30 days following hospital discharge. In secondary analyses, we compared use of revascularization procedures within 90 days of AMI, as well as readmission or emergency department visits for heart disease and cardiology follow-up within 90 days of discharge. We studied 259,475 AMI patients, of whom 345 (0.13%) were people with HIV. AMI patients with HIV were younger than HIV-negative patients (mean age ± standard deviation: 54.4 ± 10.5 years vs. 69.3 ± 14.3 years). Following multivariable adjustment, the odds ratios for inpatient death and death at 30 days following discharge were 1.04 [95% confidence intervals (CI) 0.64-1.56] and 2.42 (95% CI 1.00-4.92), respectively. In secondary analyses, no differences were observed in receipt of revascularization procedures (hazard ratio (HR) 0.98; 95% CI 0.85-1.12), readmission or emergency department visit for heart disease (HR 1.18; 95% CI 0.85-1.62), or cardiology follow-up (HR 0.88; 95% CI 0.76-1.01). People with HIV experience AMI at younger ages and may be at higher risk of death in the 30 days following hospital discharge, underscoring the importance of targeting modifiable cardiovascular disease risk factors in these patients.

Longitudinal Impact of a Park-Based Afterschool Healthy Weight Program on Modifiable Cardiovascular Disease Risk Factors in Youth.

Community-based programs hold significant potential to prevent cardiovascular disease (CVD) risk in youth. We describe here the longitudinal change in several modifiable CVD risk factors after participation in up to 3years of Fit2Play™, a park-based afterschool program. Children ages 6-15years old (N = 2261, mean age 9.0 years, 50% Hispanic, 47% non-Hispanic black, 54% male) who participated in Fit2Play™ for either 1-3 school years between 2010 and 2016 had height, weight, 4-site skinfold thicknesses, systolic and diastolic blood pressure, the progressive aerobic cardiovascular endurance run test, and health/wellness knowledge and behavior scores collected at the beginning and end of the school year(s). Effects of length of Fit2Play™ participation on CVD outcomes were assessed via 2-level repeated measures analysis adjusted for child sociodemographics, park, area poverty, and year. Adjusted models showed overweight/obese children who participated in up to 3 years of Fit2Play™ had a mean reduction of 8mm in skinfold thicknesses; almost 0.5 SD's in BMI z-score; 5 DBP %ile points; 17% reduction in probability of developing hypertension; and a mean increase of 6.4 PACER laps and 17% increase in health/wellness assessment compared to baseline. A dose-response trend was found for years of Fit2Play™ participation and improved CVD risk profile in participating youth. In conclusion, park-based afterschool programs that promote preventive CVD risk strategies can be an equitable, low-cost, high value tool for addressing our national epidemics of obesity, heart disease and diabetes and a rapidly changing healthcare system in need of evidence-based prevention programs.

Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study

BackgroundThe metabolic syndrome (MetS) is a clustering of interrelated risk factors which doubles the risk of cardio-vascular disease (CVD) in 5–10 years and increases the risk of type 2 diabetes 5 fold. The identification of modifiable CVD risk factors and predictors of MetS in an otherwise healthy population is necessary in order to identify individuals who may benefit from early interventions. We sought to determine the prevalence of MetS as defined by the harmonized criteria and its predictors in subjectively healthy black Africans from various urban centres in Kenya.MethodWe used data collected from healthy black Africans in Kenya as part of a global study on establishing reference intervals for common laboratory tests. We determined the prevalence of MetS and its components using the 2009 harmonized criterion. Receiver operator characteristic (ROC) curve analysis was used to determine the area under the curves (AUC) for various predictors of MetS. Youden index was used to determine optimum cut-offs for quantitative measurements such as waist circumference (WC).ResultsA total of 528 participants were included in the analysis. The prevalence of MetS was 25.6% (95% CI: 22.0%–29.5%). Among the surrogate markers of visceral adiposity, lipid accumulation product was the best predictor of MetS with an AUC of 0.880 while triglyceride was the best predictor among the lipid parameters with an AUC of 0.816 for all participants. The optimal WC cut-off for diagnosing MetS was 94 cm and 86 cm respectively for males and females.ConclusionsThe prevalence of MetS was high for a healthy population highlighting the fact that one can be physically healthy but have metabolic derangements indicative of an increased CVD risk. This is likely to result in an increase in the cases of CVD and type 2 diabetes in Kenya if interventions are not put in place to reverse this trend. We have also demonstrated the inappropriateness of the WC cut-off of 80 cm for black African women in Kenya when defining MetS and recommend adoption of 86 cm.

Aging and obesity are associated with undiagnosed hypertension in a cohort of males in the Central Province of Sri Lanka: a cross-sectional descriptive study

BackgroundLifestyle factors associated with hypertension (HT) in South Asian populations are relatively unknown. The objective of the current study was to investigate the prevalence rates of undiagnosed HT and factors associated with it in a cohort of males from the Central Province of Sri Lanka.MethodsThe study group consisted of 2462 males (mean age 31 years, range: 16–72 years) who underwent a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. Participants with previously diagnosed heart disease, diabetes, hypertension or other chronic illnesses were excluded from this study. Dietary and other lifestyle factors were studied using validated self-administered questionnaires. Body Mass Index (BMI) cut-off values for Asians were used to categorize the subjects according to weight status. The association of individual dietary and lifestyle patterns with HT was assessed by fitting into binary logistic regression models.ResultsThe mean systolic (SBP) and diastolic blood pressures (DBP) of the individuals were 125.9 mmHg and 80.5 mmHg, respectively. The prevalence rate of undiagnosed HT was 31.7%. Both SBP and DBP showed significant positive correlations with age, weight, BMI and waist circumference. After adjusting for potential confounders, HT was associated with older age (p = 0.001) and increased weight status (p < 0.001) with trends of association for level of education (p = 0.058). Level of income, alcohol consumption, sleeping hours, smoking, physical activity level, ethnic difference, consumption of fruits, fish, meat, dairy, sweets or fried snacks were not significantly associated with HT. Obese males were 92.1% [odds ratio: 1.9 (1.4–2.7)] more likely to be hypertensive compared to normal weight males.ConclusionsUndiagnosed HT is prevalent at an alarming rate among adult males in the Central Province of Sri Lanka. Its association with age and BMI (weight status) highlights the importance of routine screening for HT as well as interventions targeted at reducing obesity to curb the rise of this modifiable cardiovascular disease risk factor.

The ticking time bomb in lifestyle-related diseases among women in the Gulf Cooperation Council countries; review of systematic reviews

BackgroundThis study aims to review all published systematic reviews on the prevalence of modifiable cardiovascular disease risk factors among women from the Gulf Cooperation Council countries (GCC). This is the first review of other systematic reviews that concentrates on lifestyle related diseases among women in GCC countries only.MethodLiterature searches were carried out in three electronic databases for all published systematic reviews on the prevalence of cardiovascular disease risk factors in the GCC countries between January 2000 and February 2016.ResultsEleven systematic reviews were identified and selected for our review. Common reported risk factors for cardiovascular disease were obesity, physical inactivity, diabetes, metabolic syndrome and hypertension. In GCC countries, obesity among the female population ranges from 29 to 45.7%, which is one of the highest rates globally, and it is linked with physical inactivity, ranging from 45 to 98.7%. The prevalence of diabetes is listed as one of the top ten factors globally, and was reported with an average of 21%. Hypertension ranged from 20.9 to 53%.ConclusionsThe high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social and political changes. These findings highlight the need for comprehensive work among the GCC to strengthen the regulatory framework to decrease and control the prevalence of these factors.

Primary Cardiovascular Disease Risk Factors Predicted by Poor Working Conditions in the GAZEL Cohort.

The mechanisms by which work environment might influence cardiovascular disease (CVD) risk are still a matter of debate. In particular, the involvement of the main behavioral and clinical risk factors and their relationships with working conditions are not always clear, despite an abundant body of literature. Most studies have investigated the impact of a limited number of characteristics of the work environment on the occurrence of 1 or a few risk factors. In contrast, in this study we used a global approach in which 30 objective and subjective indicators of working conditions were tested as predictors of 9 modifiable CVD risk factors in a well-characterized cohort of 20,625 middle-aged French workers who were followed from the 1990s until they retired or until December 31, 2013. The incidence of 3 CVD risk factors (obesity, sleep complaints, and depression) was predicted by a large number of indicators of working conditions in both age- and sex-adjusted and multivariate-adjusted Cox regression models, whatever the significance threshold retained. These results suggest the existence of close relationships between a poor work environment and a higher risk of developing obesity, sleep complaints, or depression. These risk factors may contribute to increased CVD risk not only when workers are exposed to poor working conditions but also after retirement, as predictors of the appearance of other risk factors.

Obesity and Modifiable Cardiovascular Disease Risk Factors Among Chinese Americans in New York City, 2009-2012.

We used the Racial and Ethnic Approaches to Community Health Across the US (REACH US) Risk Factor Survey from 2009 through 2012 to examine the association between body mass index (BMI, calculated as kg/m2) and 3 cardiovascular disease risk factors among Chinese Americans in New York City. We used traditional BMI cut points and cut points modified for the Asian population. Compared with normal/underweight Chinese American adults (BMI <23.0), obese Chinese American adults (BMI ≥27.5) had significantly higher odds of having each risk factor in fully adjusted logistic regression models: diabetes (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.8–6.2), high blood pressure (OR, 5.5; 95% CI, 3.9–7.7), and high cholesterol (OR, 1.7; 95% CI, 1.2–2.4). Regression results were similar across BMI definitions, suggesting that both BMI categorizations should be considered in CVD research among Chinese Americans.

Hypertension in Women

Cardiovascular disease (CVD) is the leading cause of death in women in every major developed country and most emerging countries.1,2 Hypertension, the most common modifiable risk factor for CVD, is estimated to occur in 85.7 million adults in the United States (44.9 million women and 40.8 million men).3 Elevated blood pressure (BP) >140/90 mm Hg is associated with a shorter life expectancy overall, shorter life expectancy free of CVD, and more years lived with CVD.3–5 Hypertension is less common in women, compared with men, in those younger than 65 years of age, but is more common in elderly (65 years and older) women than men. In the United States, between 2011 and 2014, the prevalence of hypertension in women and men by age group was 8% versus 11% (20–34 years), 23% versus 23% (35–44 years), 33% versus 36% (45–54 years), 56% versus 58% (55–64 years), 66% versus 64% (65–74 years), and 81% versus 73% (≥75 years).3 Globally, the prevalence of hypertension differs between sexes. Mills et al6 conducted a systematic analysis of population-based studies from 90 countries with 968 419 individuals to estimate the prevalence of hypertension in various countries grouped by income. Women in middle-/low-income countries, across all age groups, had a higher prevalence of hypertension compared with high-income countries. Awareness rates were higher in women than in men in both high-income countries (72% women versus 62% men) and middle-/low-income countries (45% women versus 31% men). Furthermore, women in both high-income countries (62% women versus 49% men) and middle-/low-income countries (36% women versus 22% men) reported a higher rate of antihypertensive medication use compared with men, and hypertension control rates (BP <140/90 mm Hg) were higher in women than in men in both high-income countries (52% women versus 49% men) and middle-/low-income countries …

Abstract 111: Effect of Thyroxin Treatment on Carotid Intima Media Thickness (CIMT) Reduction in Patients With Subclinical Hypothyroidism (SCH)-A Meta-Analysis of Randomized Clinical Trials

Background: Research shows that subclinical hypothyroidism (SCH) is related to increased carotid intima media thickness (CIMT), a surrogate marker of stroke and subclinical cardiovascular disease (CVD). It is controversial whether SCH should be treated or not to reduce risk of stroke and CVD morbidity and mortality. The aim of this meta-analysis was to determine whether SCH is associated with an increase in CIMT as compared to Euthyroidism (EU) and whether thyroxin therapy in SCH can reverse the change in CIMT. Methods: Two independent reviewers did an extensive database search up to December 2016. Total of 12 randomized clinical trials discussed effect of thyroxin treatment on CIMT values at pre-and-post treatment in SCH subjects. Results: CIMT was significantly higher among SCH (n=280) as compared to EU controls (n=263) at baseline, pooled standardized mean difference (SMD) of CIMT was 0.44 mm [95%CI 0.14, 0.74], SE=0.15; p=0.004 with heterogeneity I 2 = 65%. After treatment with thyroxin in SCH subjects (n=314), there was a statistically significant decrease in CIMT from pre-to-post treatment, pooled SMD of CIMT decrease was [SMD -0.32; 95%CI (-0.47, -0.16), SE=0.08; p&lt;0.0001, with heterogeneity I 2 = 2%], and was no longer different from EU controls [SMD 0.13 mm; 95% CI (-0.04, 0.30); p= 0.14; I 2 = 27%]. The total cholesterol, triglycerides, and low density lipoprotein were higher in SCH as compared to EU controls and decreased significantly after treatment with thyroxin. Conclusion: This meta-analysis shows that thyroxin therapy in SCH subjects significantly decreases CIMT and improves lipid profile, modifiable risk factors for stroke and CVD. Thyroid hormone replacement in SCH subjects might have a role in slowing down or preventing progression of atherosclerosis.

The Effects Of A Six-week HIIT Program On CVD Risk Factors In Sedentary Individuals

Regular physical activity is linked to improved cardiovascular (CV) health. High intensity interval training (HIIT) is a type of CV exercise that involves interchanging intervals of high intensity exercise (usually 80-100% of maximum heart rate) with lower intensity recovery periods. PURPOSE: The purpose of this study was to assess the effect of a six-week HIIT program on modifiable cardiovascular disease (CVD) risk factors. METHODS: Total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, fasting plasma glucose (FPG), blood pressure (BP), resting heart rate (RHR), and body fat percentage (BF %) were assessed before, halfway through, and after the six-week program in nine sedentary young adults. Subjects performed three sessions per week for six weeks at a work-to-rest (W:R) ratio of 1:4, where they were required to sprint and walk. RESULTS: There was a significant increase in FPG from the pre-program to the post-program assessment (P=0.03). There was also a significant decrease in diastolic BP (DBP) (P=0.03) and RHR (P=0.04) from the pre-program to post-program assessment. CONCLUSIONS: These data suggest that HIIT is effective in significantly reducing DBP and RHR. However, a six-week, 18 session HIIT program at a 1:4 W:R ratio may not be effective for reducing the risk for CVD through idealizing blood lipids, SBP, body composition, or anthropometry measurements in this population. This study contributes to the necessity to find an optimal HIIT program length, training session duration, and W:R ratio to help establish the most advantageous training program to reduce the risk of CVD.

METABOLIC SYNDROME;

Background: Metabolic syndrome and diabetes mellitus are the modifiable riskfactors of cardiovascular diseases that double the chance of illness when occur together. Littlework has been reported on the superlative criteria to diagnose metabolic syndrome amongdiabetics from the country. Therefore, the study was aimed to find the agreement betweenmetabolic syndrome diagnostic criteria among type 2 diabetics. Methods: The retrospectivedata of 373 known type 2 diabetics who had reported history of taking antidiabetic medicineswas analyzed. The new International Diabetes Federation definition, the World HealthOrganization criteria and the NCEP Adult Treatment Panel III criteria were used to diagnosemetabolic syndrome. Data was analyzed by using Statistical Package for Social Sciencesversion 21. Results: Mean age of 373 diabetics was 49±10 years. Participants included 36.5%males and 63.5% females. Mean BMI, WC and BP were high in females; while HDL-C waslow in males (p &lt;0.05). The frequency of MS by ATP III, IDF and WHO criteria were 88.2%;87.4%; and 86.3%, respectively. Significant association was present between femininity, highersocioeconomic status and MS (p &lt;0.05). ATP III criteria diagnosed the maximum number of MSfollowed by IDF and WHO criteria. The highest agreement was found between ATP III and IDFcriteria (k 0.487). More than 85.0% diabetics were diagnosed as true positive and true negativeon all three criteria. The disagreement between the studied criteria ranged from 5.1% to 8.0%.Conclusion: The ATP III, IDF and WHO criteria can equally be used to diagnose metabolicsyndrome among type 2 diabetics in the settings. However, ATP III and IDF criteria have anedge over WHO criteria. Increased rate of metabolic syndrome among diabetics have need ofserious attention to reduce the risk of cardiovascular events.

Adherence to a Mediterranean Diet (MedDiet) for 6 months improves dietary quality and dietary inflammatory index in a western population: results from the Mediterranean diet for cognition and cardiovascular health in the elderly (MedLey) study

Inflammation is thought to be an underlying pathophysiological cause of a range of chronic diseases including cardiovascular disease (CVD). Diet is a modifiable risk factor for CVD and can influence the inflammatory process depending on the quality of the diet. Western diets, typically characterised by processed foods, red and processed meats, refined carbohydrates and added sugars, have been shown to be positively associated with inflammatory markers, while a Mediterranean diet, rich in plant foods and low in processed foods, has been shown to have a contrasting effect. The dietary inflammatory index (DII) was developed to determine the inflammatory potential of a dietary pattern. Positive DII scores indicate a pro‐inflammatory diet and negative scores indicate an anti‐inflammatory diet. This opportunistic study sought to evaluate the change in dietary quality and dietary inflammatory index following the administration of a traditional MedDiet in older Australian adults.152 Australian men and women (mean age 71±5yrs) were recruited for the MedLey study. Participants were randomly allocated either a MedDiet (n=80) or continue their habitual diet (HabDiet) (n=72) for 6 months. Volunteers followed a prescribed MedDiet plan under dietetic supervision. All volunteers attended the clinic on a fortnightly basis to have their weight measured, discuss the intervention and receive study foods. Dietary intake was calculated using 3‐day weighed food records. Data was analysed using linear regression.137 volunteers completed the trial (MedDiet n=70, HabDiet n=67). Our volunteers were able to comply with the MedDiet throughout the intervention (92% compliance rate) according to daily monitoring of food intake. At baseline, 14% of the population were meeting recommended intakes for vegetables and 54.9% for fruits, and 5.1% for dairy foods.. With administration of a traditional MedDiet, the MedDiet group increased their mean daily intake of vegetables (+60g), fruit (+123g), dairy (+98g), fish (+42g), nuts (+33g), legumes (29g,) and decreased their intake of meat (−21g) and discretionary foods (−168g). The HabDiet achieved only minor changes at 4 months, although decreased their intake of discretionary foods 95g but in contrast also decreased their mean daily intake of dairy foods (−19g) and fish (−12g). The baseline DII was −0.10±1.71 (mean±SD) for our Australian population (n=152). For the MedDiet group the DII score was −1.40±0.20 and −1.47±0.20 at 2 and 4 months of the intervention, respectively, whilst the HabDiet DII score did not change significantly (0.47±0.21 at 2 months and 0.54±0.21 at 4 months).This dietary pattern was sustainable to follow for 6 months as evident by the high compliance rate and facilitated improves in the quality of the diet by increases plant based foods and decreases in discretionary food. This resulted in changes in the DII promoting a low inflammatory diet which could be beneficial for healthy ageing and the avoidance of chronic disease.Support or Funding InformationThis project was supported by a grant from the National Health Medical Research Council of Australia.

The educational gradient in cardiovascular risk factors: impact of shared family factors in 228,346 Norwegian siblings

BackgroundVarious indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design.MethodsNorwegian health survey data (1980–2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7–9 years, 10–11 years, 12 years, 13–16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings.ResultsEducational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings.ConclusionAbout one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD.

Abstract P322: The Association Between Parity and Sleep Duration: a Study From the AHA Go Red for Women Strategically Focused Research Network (SFRN)

Background: Prior research has shown a J shaped association between parity and increased risk of cardiovascular disease (CVD), and several confounding factors have been identified. Sleep is emerging as an important, potentially modifiable risk factor for CVD, however few data have examined the relationship between parity and sleep. Methods: We studied 50 women in the AHA Go Red for Women Strategically Focused Research Network who provided information on pregnancy history and sleep patterns [56% non-white (n=28), mean age = 41±18 y]. The Pittsburgh Sleep Quality Index was used to assess sleep duration and quality, and the Insomnia Severity Index was used to assess level of insomnia. Parity was assessed using a standardized questionnaire as any pregnancies lasting &gt; 6 mo. We used linear and logistic regression to examine the cross-sectional relation between sleep (duration, quality, and insomnia severity) and parity. Results: Prior pregnancy was reported in 32% (16 of 50) women and 36% (18 of 50) sleep ≤ 6 h/night. Parous women were significantly older (55 vs 34 y), more likely to have a BMI ≥25 kg/m 2 , HTN, and hyperlipidemia compared to nulliparous women. Sleep duration was significantly shorter in parous women (6 h vs 7 h), and the relationship remained significant for primiparous women (1 birth) after adjustment ( Figure ). More than half of parous women reported poor sleep quality (56%, 9 of 16) and insomnia (63%, 10 of 16) compared to 29% of nulliparous women (10 of 34) who reported each sleep disorder. After adjustment for age, there was no difference in sleep quality or insomnia between groups (p&gt;0.05). Conclusion: In a diverse cohort of women, sleep duration was inversely related to parity. Primiparous women may be at heightened risk for the adverse cardiometabolic consequences of inadequate sleep duration, and may represent a teachable moment for CVD prevention. Ongoing studies to examine the relationship between sleep and pregnancy may provide important information on the pathways through which these risk factors modify future CVD.

Abstract P156: Assessing the Effect of the Heart of New Ulm Project: a Population-Based Program to Reduce Cardiovascular Disease

Background: Despite a highly recognized priority for public health and healthcare to implement population-level strategies to reduce the burden of cardiovascular disease (CVD), limited evidence exists on the most effective strategies. Data collection and evaluation of large scale, community based-prevention programs can be challenging and costly to achieve. The Heart of New Ulm (HONU) Project, begun in 2009, is a population-based initiative with healthcare, community, and workplace interventions addressing multiple levels of the social-ecological model designed to reduce modifiable CVD risk factors in rural New Ulm, MN. The community is served by one health system, enabling the use of electronic health record (EHR) data for surveillance. Objective: To assess trends for CVD risk factors, events, and healthcare utilization for New Ulm residents compared to a matched control population. Methods: We matched New Ulm residents (n = 4,077) with controls (n = 4,077) from a regional community served by the same health system using refined covariate balance techniques to match on baseline demographics, CVD risk factors, and health care utilization. Mixed effects longitudinal models with adjustment for age and gender, and an interaction for time by community, were run. Model based estimates were constructed for the entire cohort at each time period. Results: Over the first 6 years of the HONU Project,blood pressure, LDL, total cholesterol, and triglycerides were managed better in New Ulm than the matched comparison community. The proportion of New Ulm residents with controlled blood pressure increased by 6.2 percentage points while the control group increased by 2 points. 10-year ASCVD risk scores showed less decline for New Ulm residents than controls (16 vs. 18.4). The intervention and control groups did not differ with regard to inpatient stays, CVD events, smoking, or glucose. Conclusions: Compared to a matched control population, we found improved control of CVD risk factors in the New Ulm Population exposed to the HONU Project.

Association Between Multiple Modifiable Risk Factors of Cardiovascular Disease and Hypertension among Asymptomatic Patients in Central Appalachia

The central Appalachian region of the United States is disproportionately burdened with cardiovascular diseases (CVD) and associated risk factors; however, research to inform clinical practice and policies and programs is sparse. This study aimed to examine the association between multiple modifiable risk factors for CVD and hypertension in asymptomatic patients in central Appalachia. Between January 2011 and December 2012, 1629 asymptomatic individuals from central Appalachia participated in screening for subclinical atherosclerosis. Participants were asked to report their hypertension status (yes/no). In addition, data on two nonmodifiable risk factors (sex, age) and five modifiable risk factors (obesity, diabetes mellitus, hypercholesterolemia, smoking, and sedentary lifestyle) were collected. Multivariable logistic regression analyses were conducted to assess association between hypertension and risk factors. Of the 1629 participants, approximately half (49.8%) had hypertension. Among people with hypertension, 31.4% were obese and 62.3% had hypercholesterolemia. After adjusting for sex and age, obesity and diabetes mellitus were associated with a more than twofold increased odds of having hypertension (odds ratio [OR] 2.02, confidence interval [CI] 1.57-2.60 and OR 2.30, CI 1.66-3.18, respectively). Hypercholesterolemia and sedentary lifestyle were associated with higher odds for hypertension (OR 1.26, CI 1.02-1.56 and OR 1.38, CI 1.12-1.70, respectively), compared with referent groups. Having two, three, and four to five modifiable risk factors was associated with increased odds of having hypertension by about twofold (OR 1.72, CI 1.21-2.44), 2.5-fold (OR 2.55, CI 1.74-3.74), and sixfold (OR 5.96, CI 3.42-10.41), respectively. This study suggests that the odds of having hypertension increases with a higher number of modifiable risk factors for CVD. As such, implementing an integrated CVD program for treating and controlling modifiable risk factors for hypertension would likely decrease the future risk of CVD.

Racial variation in cardiovascular disease risk factors among European children on renal replacement therapy-results from the European Society for Paediatric Nephrology/European Renal Association - European Dialysis and Transplant Association Registry.

Racial differences in overall mortality rates have been found in children on renal replacement therapy (RRT). We used data from the European Society for Paediatric Nephrology/European Renal Association - European Dialysis and Transplant Association Registry to study racial variation in the prevalence of cardiovascular disease (CVD) risk factors among European children on RRT. We included patients aged <20 years between 2006-13 who (i) initiated dialysis treatment or (ii) had a renal transplant vintage of ≥1 year. Racial groups were defined as white, black, Asian and other. The CVD risk factors assessed included uncontrolled hypertension, obesity, hyperphosphataemia and anaemia. Differences between racial groups in CVD risk factors were examined using generalized estimating equation (GEE) models while adjusting for potential confounders. In this study, 1161 patients on dialysis and 1663 patients with a transplant were included. The majority of patients in both groups were white (73.8% and 79.9%, respectively). The crude prevalence of the CVD risk factors was similar across racial groups. However, after adjustment for potential confounders, Asian background was associated with higher risk of uncontrolled hypertension both in the dialysis group [odds ratio (OR): 1.27; 95% confidence interval (CI): 1.01-1.64] and the transplant group (OR: 1.37; 95% CI: 1.11-1.68) compared with white patients. Patients of Asian and other racial background with a renal transplant had a higher risk of anaemia compared with white patients (OR: 1.50; 95% CI: 1.15-1.96 and OR: 1.45; 95% CI: 1.01-2.07, respectively). Finally, the mean number of CVD risk factors among dialysis patients was higher in Asian patients (1.83, 95% CI: 1.64-2.04) compared with white patients (1.52, 95% CI: 1.40-1.65). We found a higher prevalence of modifiable CVD risk factors in Asian children on RRT. Early identification and management of these risk factors could potentially improve long-term outcomes.

Association of Traditional Cardiovascular Risk Factors With Venous Thromboembolism

Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. Results: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89−1.07) for hypertension, 0.97 (95% CI: 0.88−1.08) for hyperlipidemia, 1.01 (95% CI: 0.89−1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08−1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68−0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22−1.52) and 1.08 (95% CI: 0.90−1.29), respectively. Conclusions: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE.