Modifiable Disease Risk Factors Research Articles

Association of plant-based diet indexes with the metabolomic profile

Plant-based diets have gained attention for their potential benefits on both human health and environmental sustainability. The objective of this study was to investigate the association of plant-based dietary patterns with the endogenous metabolites of healthy individuals and identify metabolites that may act as mediators of the associations between dietary intake and modifiable disease risk factors. Adherence to plant-based dietary patterns was assessed for 170 healthy adults using plant-based diet indexes (PDI). Individuals with higher healthful PDI had lower BMI and fasting glucose and higher HDL-C, while those with higher unhealthful PDI had higher BMI, triacylglycerol and fasting glucose and lower HDL-C. Unhealthful PDI was associated with higher levels of several amino acids and biogenic amines previously associated with cardiometabolic diseases and an opposite pattern was observed for healthful PDI. Furthermore, healthful PDI was associated with higher levels of glycerophosphocholines containing very long-chain fatty acids. Glutamate, isoleucine, proline, tyrosine, α-aminoadipate and kynurenine had a statistically significant mediation effect on the associations between PDI scores and LDL-C, HDL-C and fasting glucose. These findings contribute to the growing evidence supporting the role of plant-based diets in promoting metabolic health and shed light on the potential mechanisms explaining their beneficial health effects.

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Ambient Air Pollution and Stroke: An Updated Review.

Despite recent advances in treatment and prevention, stroke remains a leading cause of morbidity and mortality. There is a critical need to identify novel modifiable risk factors for disease, including environmental agents. A body of evidence has accumulated suggesting that elevated levels of ambient air pollutants may not only trigger cerebrovascular events in susceptible people (short-term exposures) but also increase the risk of future events (long-term average exposures). This review assesses the updated evidence for both short and long-term exposure to ambient air pollution as a risk factor for stroke incidence and outcomes. It discusses the potential pathophysiologic mechanisms and makes recommendations to mitigate exposure on a personal and community level. The evidence indicates that reduction in air pollutant concentrations represent a significant population-level opportunity to reduce risk of cerebrovascular disease.

Detection of myocardial dysfunction using global longitudinal strain with speckle-tracking echocardiography in patients with vs without rheumatoid arthritis: a systematic review and meta-analysis.

Rheumatoid arthritis (RA) is a systemic autoimmune disorder primarily involving the peripheral joints. Systemic involvement can occur, including myocardial dysfunction. Speckle tracking echocardiography (STE) is a novel diagnostic study which is recently being used to detect subclinical cardiac dysfunction. Global longitudinal strain (GLS) by STE is more sensitive than standard echocardiographic parameters to detect occult cardiac dysfunction. A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the STE parameters between RA and non-RA patients. Left ventricular (LV) GLS was significantly lower in patients with RA compared to non-RA patients with a standard mean difference (SMD) of -1.09 (-1.48--0.70, P < 0.001). LV Global Circumferential Strain (GCS) was reported in five studies, and it was found to be lower in RA patients with an SMD of -1.25 (-2.59--0.10; P < 0.0010). Meta regression analysis studies failed to show any significant impact of disease duration, activity, age, sex and BMI on LV GLS and RV GLS. RA patients have lower LV GLS and LV GCS compared to controls suggesting impaired myocardial dysfunction. Further studies need to be done to delineate the importance of lower GLS in asymptomatic rheumatoid patients to guide disease management and risk factor modification in this selected population.

Abstract 10171: Higher Rates of Major Adverse Cardiac and Cerebrovascular Events in Non-White Patients Among Nationwide Hospitalizations of Young Adults: A Race and Sex-Stratified Analysis

Introduction: Cardiovascular disease rates among young adults have been increasingly affected by racial and gender disparities and detailed evidence regarding these differences and their impact on cardiovascular events in young adults hospitalizations remain unknown. Methods: The National Inpatient Sample (Oct2015-2017) was queried to identify young adult hospitalizations (18-44 years). Socio-demographics, comorbidities, and rates of major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, AMI, cardiac arrest, and stroke) were retrieved for males and females and with a more granular comparative analysis for different racial subgroups. A p&lt;0.05 was considered statistically significant. Results: Of 19,448,301 (median age 31 years [25-37], 69.1% non-elective) young adult hospitalizations, 315,290 (1.6%) were identified with MACCE. Black patients followed by Hispanics were most likely hospitalized non-electively. Overall, the MACCE rate was higher in males than in females. Among males, MACCE were higher (5.3%) in Asian or Pacific Islanders (API), whereas in females, black patients were affected the most (1.3%) (Fig. 1). Traditional cardiovascular comorbidities were more prevalent in black and Native American patients (among both male/females) followed by Hispanic/API whereas Caucasians had higher rates of drug abuse including smoking and depression (p&lt;0.001) (Table 1). Conclusions: Among young hospitalizations, non-white, male patients were more frequently admitted non-electively and had higher rates of cardiovascular comorbidities that could have translated into higher MACCE. Special emphasis needs to be laid on gender and racial differences for CVD disease prevention and risk factor modification in young adults.

Oral Health Status of 3- to 5 -Year-old Children Attending Early Childhood Care and Development Centers in Bhutan: A Pilot Study

Introduction: Early Childhood Caries (ECC) is a common childhood dental disease worldwide. To date, dental disease prevalence in children in Bhutan is unknown. Objectives: This study was conducted to estimate the prevalence of early childhood caries and its modifiable risk factors. Methods: We conducted a cross-sectional survey in 3-5-years old children attending Early Childhood Care and Development Centers in Bhutan. Mouth examination recorded teeth with decay (d), missing due to decay (m) and filled (f), to calculate caries experience (mean dmft and standard deviation=SD). Parents and caregivers were interviewed about their children’s oral health status, oral hygiene practices and diets among others. The prevalence of modifiable risk factors for disease was described based on parental responses. The association between decay and selected sociodemographic characteristics and oral health variables were investigated with bivariate analyses (X2). Results: Overall, 80.5% children had caries experience with mean dmft + or - SD (4.9 + 4.2). In fact, 79.9% had untreated decay. Only few had fillings as an evidence for availing dental care with mean filled 0.2 (SD=0.7). The percentage of decay increased significantly as maternal education increased and with low socioeconomic status (p=0.02). Conclusions: Early Childhood Caries are highly prevalent in Bhutan. Very few young children sought dental care. We recommend engaging relevant stakeholders in efforts to promote dental care and educate parents to use fluoridated toothpastes.

Digital Storytelling Interventions for Cardiovascular Disease Risk Factor Modification: A Scoping Review

Digital Storytelling Interventions for Cardiovascular Disease Risk Factor Modification: A Scoping Review

Mortality, morbidity, and risk factors in Taiwan, 1990–2017: findings from the Global Burden of Disease Study 2017

Taiwan has implemented a national health insurance system since 1995 with high coverage and utilization rate. However, the health care system in Taiwan is facing immense challenges due to rapid population ageing. We have evaluated the landscape of population health by revisiting the results of GBD 2017 study. Taiwan vital registration data (1980-2016) and Taiwan national health insurance database (2016) were used. We also conducted benchmarking comparisons with selected countries in East Asia from 1990 to 2017. The age-standardized disability-adjusted life-year (DALY) rates decreased by one-quarter from 1990 to 2017; however, progress was relatively slow compared to the comparator countries and has been stagnant recently. The Social-demographic Index (SDI) level in Taiwan in 2017 was 0.86, which is similar to Japan, Singapore, and South Korea in 2017, while the SDI level of China in 2017 was similar to that of Taiwan (0.69) in 1990. Although Taiwan's SDI reached the same level as those in Japan, Singapore, and South Korea in 2017, modifiable risk factors still contributed to nearly half of Taiwan's total disease burden. Five leading risk factors (high fasting plasma glucose, high body-mass index, alcohol use, illicit drug use, and impaired kidney function) accounted for a higher DALY rate in Taiwan than comparator countries in 2017. Taiwan made marked progress in health from 1990 to 2017. However, interventions targeted on major modifiable disease risk factors should be prioritized to realize the full potential of heath improvement in the process of rapid socioeconomic development.

4088 Longitudinal Assessment of Metabolic Syndrome as a Modifiable Risk factor of World Trade Center Particulate Matter Exposure Associated Lung Disease

OBJECTIVES/GOALS: Metabolic syndrome (MetSyn) is a risk for World Trade Center-Lung Injury (WTC-LI; defined as developing FEV1&lt;lower limit of normal [LLN]). Metabolic health is a modifiable disease risk factor. We propose to characterize how time-dependent covariates of MetSyn are longitudinally associated with WTC-LI. METHODS/STUDY POPULATION: WTC-particulate exposed firefighters, consented, with pre-9/11 FEV1 LLN (N = 5,746). Data assessed from last pre-9/11 till August 1, 2017. Longitudinal MetSyn characteristics were assessed using 3 models: i. A linear mixed effect model to assess the effect size of longitudinal MetSyn and its components on longitudinal FEV1% predicted as an outcome; ii. a time-dependent Cox regression to assess the associations of MetSyn to time of onset of WTC-LI; iii. a novel, partially linear single index regression model with repeatedly measured MetSyn to assess their joint effects and delineate their relative contribution on the longitudinal lung function in the WTC-FDNY cohort. RESULTS/ANTICIPATED RESULTS: In Model I, BMI 30 kg/m2 had the largest effect size compared to ever-smoking, with −2.524 (95%CI: −2.708,−2.340) compared to −1.681(−2.325,−1.038) respectively. Having MetSyn, defined as 3/5 risk factors, had an effect size of −2.319(−2.526,−2.112). In Model II, hazards of triglycerides 150mg/dL were highest at 1.497(1.336, 1.677), followed by BMI 30 kg/m2 at 1.406(1.256, 1.575), and HDL&lt;40mg/dL 1.355(1.176-1.561), compared to ever-smoking (1.201, p = 0.002). Having high exposure to PM by being present in the morning of 9/11 was a significant covariate only in Model II investigating HDL&lt;40mg/dL or triglycerides 150mg/dL. Model III The proposed methods will be applied to our cohort study. DISCUSSION/SIGNIFICANCE OF IMPACT: MetSyn is both a predictor and concurrent marker of WTC-LI. The single index model can not only reduce dimensionality of the covariates, but also provides efficient estimates of the joint MetSyn effects, allowing linear or nonlinear effects. Future studies will investigate dietary intervention as a potential disease-modifying factor. CONFLICT OF INTEREST DESCRIPTION: NA, nothing to disclose.

INTEREST GROUP SESSION—SLEEP, CIRCADIAN RHYTHMS AND AGING INTEREST GROUP: SLEEP, PHYSICAL ACTIVITY, AND BRAIN AGING

As the US population ages, the prevalence of Alzheimer’s Disease (AD) and related dementias is expected to increase, making dementia prevention efforts a major public health priority. Impaired sleep and circadian rhythms, along with other lifestyle factors, have emerged as important modifiable disease risk factors—recent studies demonstrate the importance of sleep in preventing the development of key biomarkers for AD/dementia pathology. In this symposium, we will highlight findings on the associations of sleep, circadian rhythm disruptions, and daytime activity patterns on development of cognitive decline and dementia, exploring not only the mechanisms driving these associations, but the potential impact of sleep and lifestyle interventions in promoting healthy brain aging. The symposium consists of four presentations which use data from large national cohort studies. First, we will present analyses on patterns of 24-hour (circadian) activity rhythms (e.g., usual time of day for peak activity, regularity of circadian patterns) and incident dementia risk. The second presentation will present findings pertaining to understanding the link between sleep disturbance and inflammation (a substantial contributor to cognitive aging). The third will examine whether detailed daytime activity patterns associate with imaging-based brain volumes, independent of sleep disturbance. The final presentation will explore whether initiation of sleep disorder treatments may have the potential to change trajectories of cognitive performance as individuals age. Overall, the symposium will highlight the importance of sleep and activity patterns to brain health and stimulate discussion about improving sleep and circadian disruption as a target for dementia prevention efforts.

Unhealthy habits persist: The ongoing presence of modifiable risk factors for disease in women.

ObjectivesVascular disease remains a leading cause of death. There are several vascular risk factors identified that can mitigate development of disease in ageing. We examine reported rates of modifiable risk factors in women responding to an online health questionnaire advertised by popular media.MethodsA sample of 26 620 women aged over 18 was examined in 2015 with a cross-sectional health questionnaire. The questionnaire included self-reported health, mood, lifestyle and vascular risk factors.ResultsThere remains high rates of modifiable risk factors present in women. The vast majority of women (80%) reported not eating enough fruit and vegetables. Compared to the guidelines for health, the majority did not perform enough weekly physical activity (70%) and more than half the participants were overweight (54%). Sufficient fruit, vegetables, fish, legumes and physical activity were reported in less than 30% of women!ConclusionsWomen continue to report low rates of physical activity, fruit and vegetable intake and higher BMI than recommended for good health, despite worldwide health promotion activities aimed at changing these lifestyle factors. Programs to support healthy living need to be reviewed and revised to reduce the burden of vascular disease and dementia in women. Previous guidelines are not having the important impact they should, particularly in women.

Weight following birth and childhood dietary intake: A prospective cohort study

ObjectivesUnhealthy childhood dietary habits track through life and are independent and modifiable risk factors for disease. Therefore, it is essential to understand the factors involved. We aimed to evaluate the associations of birthweight (BW) and newborn weight change (NWC) during the first 96 h of life and childhood longitudinal weight trajectories with dietary intake at age 4. MethodsAs part of the Generation XXI birth cohort (G21), children were recruited in 2005 and 2006 at all public units providing obstetrical and neonatal care in Porto, Portugal. Information was collected by face-to-face interview and abstracted from clinical records. At age 4, weight measurements recorded from birth to current age were abstracted and weight trajectories estimated. Food frequency questionnaires were applied, and three dietary patterns (DPs) were identified: “Energy-dense food (EDF)+Dairy,” “Lower in Healthy Food,” and “Healthier.” Logistic regression models were used to compute the odds ratio (OR) and 95% confidence intervals (CIs) (OR [95% CI]) in a sample of 775 children. ResultsChildren with higher BW were less frequently in the “EDF+Dairy” DP (0.94 [0.89–0.98] per 100 g increase in BW). Children with higher NWC had lower odds of eating fruit ≥3/d (0.93 [0.87–0.99] per 1% increase in NWC). Children with higher weight during childhood had higher odds of belonging to the “EDF+Dairy” DP (1.90 [1.04–3.47]) and lower odds of eating vegetable soup ≥2/d (0.56 [0.34–0.91]). Children showing catch-up grow in the first year of life had higher odds of eating dairy products ≥3/d (3.76 [1.31–10.80]). ConclusionsThe way that children grow during childhood played a major role on dietary intake at age 4.

Biomarkers and the prediction of atrial fibrillation: state of the art.

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, and it places a substantial burden on the health care system. Despite improvements in our understanding of AF pathophysiology, we have yet to develop targeted preventive therapies. Recently, numerous biological markers have been identified to aid in the prediction of future AF events. Subclinical markers of atrial stress, inflammation, endothelial dysfunction, kidney dysfunction, and atherosclerosis have been linked to AF. The connection between these markers and AF is the identification of subclinical states in which AF propagation is likely to occur, as these conditions are associated with abnormal atrial remodeling and fibrosis. Additionally, several risk scores have been developed to aid in the identification of at-risk patients. The practicing clinician should be aware of these subclinical markers, as several of these markers improve the predictive abilities of current AF risk scores. Knowledge of these subclinical markers also provides clinicians with a better understanding of AF risk factors, and the opportunity to reduce the occurrence of AF by incorporating well-known cardiovascular disease risk factor modification strategies. In this review, we highlight several novel biological markers that have improved our understanding of AF pathophysiology and appraise the utility of these markers to improve our ability to predict future AF events.

PS012 Evaluating Outcomes of Cardiac Rehabilitation in Cardiovascular Disease Risk Factor Modification: An Experience from a Tertiary Hospital in the Philippines

PS012 Evaluating Outcomes of Cardiac Rehabilitation in Cardiovascular Disease Risk Factor Modification: An Experience from a Tertiary Hospital in the Philippines

An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial.

Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment. This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.

Expert position paper on air pollution and cardiovascular disease.

Air pollution has wide-ranging and deleterious effects on human health and is a major issue for the global community. The Global Burden of Disease study has described the worldwide impact of air pollution with as many as 3.1 million of 52.8 million all-cause and all-age deaths being attributable to ambient air pollution in the year 2010.1 Moreover, ambient air pollution ranked ninth among the modifiable disease risk factors, being listed above other commonly recognized factors, such as low physical activity, a high-sodium diet, high cholesterol, and drug use. Finally, air pollution accounts for 3.1% of global disability-adjusted life years, an index that measures the time spent in states of reduced health.1 Although it is intuitive that air pollution is an important stimulus for the development and exacerbation of respiratory diseases, such as asthma, chronic obstructive pulmonary disease, and lung cancer, there is generally less public awareness of its substantial impact on cardiovascular disease. Historically, the 1952 Great Smog of London led to an increase in cardiovascular death as well as deaths due to respiratory disease. Subsequent studies in the 1990s, such as the Harvard Six Cities2 and American Cancer Society cohort studies,2,3 established an enduring positive association between long-term exposure to air pollution and total and cardiovascular mortality, mainly due to coronary artery disease.4 In Europe, the first study that supported this association between long-term exposure and mortality was the Netherlands Cohort Study on Diet and Cancer.5 Associations with cardiovascular morbidity and mortality are also seen with short-term (e.g. day-to-day fluctuations) pollutant exposures of residents in large urban areas worldwide, including the United States of America6 …

Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening.

BackgroundPeripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool.MethodA self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.ResultsThe survey response rate was 20%. ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%). It is infrequently (73% < 4 times per month) and often incorrectly used (42% out of compliance with current ABI guidance). Only 52% of general practitioners and 16% of nurses reported that patients with an ABI of ≤ 0.9 require aggressive cardiovascular disease risk factor modification (as recommended by current national and international guidelines).ConclusionABI measurement is an under-utilised and often incorrectly performed procedure in the surveyed general practices. Prior to its potential adoption as a formalised screening tool for cardiovascular disease, there is a need for a robust training programme with standardised methodology in order to optimise accuracy and consistency of results. The significance of a diagnosis of PAD, in terms of associated increased cardiovascular risk and the necessary risk factor modification, needs to be highlighted.

Glycogen Synthase Kinase-3β and Cathepsin B in Diabetic Endothelial Progenitor Cell Dysfunction: An Old Player Finds a New Partner

Microvascular and macrovascular complications associated with type 2 diabetes are leading causes of morbidity and mortality. In fact, cardiovascular (CV) complications account for a major portion of health care costs in patients with diabetes. Although lifestyle changes and pharmacotherapy aimed at CV disease risk factor modification are the mainstay of medical treatment, revascularization (surgical and endovascular) is often necessary to restore tissue perfusion and function. Indeed, nearly 25% of coronary revascularization procedures performed in the U.S. occur in individuals with diabetes (1). Furthermore, diffuse atherosclerosis, impaired ability to form vascular collaterals, and restenosis contribute to higher rates of repeat revascularization in these patients (1). Consequently, cell-based therapy with bone marrow cells and endothelial progenitor cells (EPCs) aimed at inducing angiogenesis and reendothelialization is a promising strategy that is under active investigation in both preclinical and clinical studies (2,3). EPCs constitute a very small subset of circulating blood cells. They are progenitors of endothelial cells and have the ability to proliferate and differentiate to form perfused blood vessels in vivo and tube-like structures in vitro (4). EPC-induced neovascularization in response to tissue hypoxia and injury is a highly coordinated, temporally regulated, and complex set of events that involves mobilization, migration, and homing of EPCs to the target tissue (5,6). Endothelial injury and hypoxia activate the transcription factor hypoxia-induced factor (HIF) to initiate the expression and release of growth factors and chemokines. These include stromal cell–derived factor 1 (SDF-1), vascular endothelial growth factor (VEGF), c-Kit ligand (or SCF), angiopoietin, and interleukin-8 (IL-8), among others (5,6). Platelet aggregation leads to high levels of platelet-derived SDF-1 at the site of endothelial injury (7). EPCs are retained in the bone marrow in distinct niches by their interaction with stromal cells. …

Women and Cardiovascular Disease: Gender-Based Issues Regarding Detection and Primary Prevention

Society has come a long way over the past several decades from the old fashion belief that cardiovascular disease (CVD) is a man’s disease. Throughout the years, gender-based studies have provided compelling evidence to uncover several unique features in disease presentation, pathology and primary prevention in women. Studies reviewing differences among men and women have placed specific emphasis on cardiovascular risk factors, symptoms and vascular pathology as potential etiologies for the higher cardiovascular mortality and disability among women. In addition, although weight loss and exercise have been shown to promote cardiovascular health in men, more recently findings have presented data to support the importance of these interventions among women. Although tremendous strides have been made throughout the years in the gender-based cardiovascular research, more questions than answers remain and additional research efforts are still needed to better understand the disease process in women. The objectives of this review are two-fold: First, to present a comparative analysis focusing on evidence-based similarities and differences among males and females in cardiovascular disease presentation, detection and clinical pathology; Second, to offer insights highlighting recent findings regarding primary prevention and treatment protocols in women. Based on our current knowledge, continued efforts geared toward optimal diagnostic testing and screening protocols for primary disease detection and risk factor modification programs are recommended. This would include further investigations of the potential role that genetics and/or environment play/plays in the natural progression of the disease process. Additionally, comprehensive lifestyle interventions aimed at reducing cardiovascular disability and mortality in women is also recommended.

A cross-sectional examination of modifiable risk factors for chronic disease among a nationally representative sample of youth: are Canadian students graduating high school with a failing grade for health?

BackgroundSubstance use and weight gain among youth increase the risk for future disease. As such, the purpose of this study is to examine how many Canadian youth are currently failing to meet substance use and weight gain related public health guidelines.MethodsData from the 2010–11 Youth Smoking Survey were used to examine grade 9 to 12 students meeting seven different guidelines by sex and by grade.ResultsAmong Canadian youth, 8.8% were current smokers, 18.8% were current marijuana users, 25.5% were current binge drinkers, 22.5% were considered overweight or obese, 31.2% did not meet physical activity guidelines, 89.4% exceeded sedentary behaviour guidelines, and 93.6% reported inadequate fruit and vegetable intake. The mean number of risk factors per student was 2.9 (±1.2); only 0.5% of youth reported having none of the risk factors.ConclusionStudents rarely met all seven public health guideline examined, and the vast majority of actually reported having two or more modifiable risk factors for disease.