Physiological Risk Factors For Cardiovascular Disease Research Articles

A population-based study of the intersection of sexual identity and race/ethnicity on physiological risk factors for CVD among U.S. adults (ages 18–59)

ABSTRACT Objectives: Sexual minorities face significant psychosocial stressors (such as discrimination and violence) that impact their health. Several studies indicate that sexual minority women (SMW) and bisexual men may be at highest risk for cardiovascular disease (CVD), but limited research has examined physiological CVD risk or racial/ethnic differences. This study sought to examine racial/ethnic differences in physiological risk factors for CVD among sexual minority and heterosexual adults. Design: We analyzed data from the National Health and Nutrition Examination Survey (2001–2016) using sex-stratified multiple linear regression models to estimate differences in physiological CVD risk. We compared sexual minorities (gay/lesbian, bisexual, ‘not sure’) to heterosexual participants first without regard to race/ethnicity. Then we compared sexual minorities by race/ethnicity to White heterosexual participants. Results: The sample included 22,305 participants (ages 18–59). Lesbian women had higher body mass index (BMI) but lower total cholesterol than heterosexual women. Bisexual women had higher systolic blood pressure (SBP). Gay men had lower BMI and glycosylated hemoglobin (HbA1c) relative to heterosexual men. White and Black lesbian women and bisexual women of all races/ethnicities had higher BMI than White heterosexual women; Black bisexual women had higher SBP and HbA1c. Black sexual minority men had higher HbA1c relative to White heterosexual men. Latino ‘not sure’ men also had higher SBP, HbA1c, and total cholesterol than White heterosexual men. Conclusions: Given evidence of higher CVD risk in sexual minority people of color relative to White heterosexuals, there is a need for health promotion initiatives to address these disparities. Additional research that incorporates longitudinal designs and examines the influence of psychosocial stressors on CVD risk in sexual minorities is recommended. Findings have implications for clinical and policy efforts to promote the cardiovascular health of sexual minorities.

Risk of Cardiovascular Disease in American Firefighters

Cardiovascular disease (CVD) is the most common cause of job-related mortality among firefighters in the United States. Although age, family history, and work environments cannot be controlled, other predictors are modifiable. If solutions are to be implemented, it is important to know which health parameters are responsible for the elevated CVD risk in this population. PURPOSE: To examine the cardiovascular health of California firefighters. METHODS: We measured physiological CVD risk factors in 35 firefighters from Northern California. Assessments were age, anthropometry, blood lipids, blood pressure, and blood glucose. Risk factors were summed according to the American College of Sports Medicine guidelines. We evaluated the frequency of individual risk factors and used regression analyses (logistic, negative binomial, and linear as appropriate) to test the effect of age on risk. RESULTS: Firefighters were 33.5 ± 11.8 years old, had a body mass index (BMI) of 26.6 ± 3.4, body fat percent (BF%) of 21.2 ± 6.0%, waist circumference (WC) of 90.3 ± 10.4 cm, and waist-hip ratio of 0.87 ± 0.10. Systolic blood pressure (SBP) was 122.5 ± 8.0 mmHg, diastolic pressure (DBP) was 78.1 ± 10.3 mmHg, fasted blood glucose (FBG) was 98.5 ± 14.3 mg/dL, LDLs were 128.9 ± 40.1 mg/dL, HDLs were 31.6 ± 12.5 mg/dL, triglycerides were 116.8 ± 90.3, and the average number of risk factors was 1.8 ± 1.2. There were 32 firefighters (91.4%) with ≥ 1 risk. The proportion of at-risk firefighters for each variable was: lipid profile (77.1%), obesity (65.7%), FBG (37.1%), blood pressure (34.3%), and age (14.3%). Most of the lipid profile was met by low HDLs (65.7% of all firefighters). Age was a significant predictor of BMI (p=0.001), BF% (p=0.003), WC (p=0.001), and waist-hip ratio (p=0.047), but not SBP (p=0.553), DBP (p=0.590), FBG (p=0.961), HDLs (p=0.369), LDLs (p=0.593), or triglycerides (p=0.688). Increased age significantly predicted an increased number of CVD risk factors (p=0.003). CONCLUSION: As firefighters advanced in age, they experienced elevations in CVD risk, mostly as a consequence of increasing adiposity. Weight loss interventions aimed at improving lipid profile, blood glucose, and blood pressure may help reduce job-related CVD mortality in American firefighters.

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study.

Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04-1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07-1.29) in fully adjusted analyses. Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers. A commentary on this paper appears in this issue on page 1629.

Effects of a 12-week Exercise Program on Physiological Cardiovascular Disease Risk Factors.

Effects of a 12-week Exercise Program on Physiological Cardiovascular Disease Risk Factors.

Significance of the development of a cardiovascular disease surveillance and reporting system in India

Cardiovascular disease (CVD) is the single largest cause of global morbidity and mortality and is the leading cause of death in the Indian subcontinent projected to contribute to deaths expected to double by 2015. The social and economic impact of these staggering projections highlight the need for a centralized effort to monitor and evaluate behavioral and physiological risk factors for CVD. Limited evidence on existing surveillance systems suggest that the key to an effective monitoring and evaluation (M and E) program for CVD surveillance in India relies upon the World Health Organization's STEP-wise model. Key recommendations for the Ministry of Health include the development of a national CVD surveillance program with expertise and a quality-improvement mechanism to receive continuous input from similar surveillance programs in likeminded countries. Structure of the surveillance system would include; (1) the development of process measures for CVD risk factor’ based surveillance M and E systems for early detection of CVD at the local-level, (2) the development of trigger based data reporting responsibilities to State-based monitoring teams including incentives for accuracy in data reporting and the use of data-driven evidence to target risk specific intervention and prevention on Central Government monitoring teams with reporting feedback to the State and local-levels and (3) the creation of health policy to require the use of data to target risk specific prevention for intervention and developing local technical capacity. Such a system would provide significant cost and social benefits, presenting an evidence based data driven cost-effective business case for scale-up and potential use in areas comprising similar demographics. Future research should focus on the inclusion of a systematic critique of the reported data for the challenges to surveillance systems in India and the examination of the effect of an incentivized reporting system on the states. Further inquiry into the types of reporting and lessons from other countries’ surveillance programs with alternative strategies to a national approach should address potential imitations at the ground or peripheral levels.

Individual-based primary prevention of cardiovascular disease in Cambodia and Mongolia: early identification and management of hypertension and diabetes mellitus.

BackgroundTo assess the coverage of individual-based primary prevention strategies for cardiovascular disease (CVD) in Cambodia and Mongolia: specifically the early identification of hypertension and diabetes mellitus, major proximate physiological CVD risk factors, and management with pharmaceutical and lifestyle advice interventions.MethodsAnalysis of data collected in national cross-sectional STEPS surveys in 2009 (Mongolia) and 2010 (Cambodia) involving participants aged 25-64 years: 5433 in Cambodia and 4539 in Mongolia.ResultsMongolia has higher prevalence of CVD risk factors than Cambodia --hypertension (36.5% versus 12.3%), diabetes (6.3% versus 3.1%), hypercholesterolemia (8.5% versus 3.2%), and overweight (52.5% versus 15.5%). The difference in tobacco smoking was less notable (32.1% versus 29.4%).Coverage with prior testing for blood glucose in the priority age group 35-64 years remains limited (16.5% in Cambodia and 21.7% in Mongolia). Coverage is higher for hypertension. A large burden of both hypertension and diabetes remains unidentified at current strategies for early identification: only 45.4% (Cambodia) to 65.8% (Mongolia) of all hypertensives and 22.8% (Mongolia) to 50.3% (Cambodia) of all diabetics in the age group 35-64 years had been previously diagnosed.Approximately half of all hypertensives and of all diabetics in both countries were untreated. 7.2% and 12.2% of total hypertensive population and 5.9% and 16.1% of total diabetic population in Cambodia and Mongolia, respectively, were untreated despite being previously diagnosed.Only 24.1% and 28.6% of all hypertensives and 15.9% and 23.9% of all diabetics in Mongolia and Cambodia, respectively were adequately controlled. Estimates suggest deficits in delivery of important advice for lifestyle interventions.ConclusionsMultifaceted strategies are required to improve early identification, initiation of treatment and improving quality of treatment for common CVD risk factors. Periodic population-based surveys including questions on medical and treatment history and the context of testing and treatment can facilitate monitoring of individual-based prevention strategies.

Parental education as a predictor of offspring behavioural and physiological cardiovascular disease risk factors

Childhood socio-economic disadvantage has been shown to be associated with an elevated rate of cardiovascular disease (CVD) events in adulthood. The objective of this study is to examine associations between mothers' and fathers' education and offspring CVD risk factors. The Oslo Youth Study (n = 498) was initiated in 1979. Children (age 11-15 years) attending six schools and their parents were included. Information on education was collected for parents and participants. Participants were followed through 2006 (age 40 years). Information about physical activity, diet, smoking, binge drinking, body mass index (BMI), s-cholesterol, s-triglycerides and blood pressure was collected in 1981, 1991 and 2006. Fathers' education was inversely associated with participants' BMI at 15 and 25 years, cholesterol at 25 and 40 years, triglycerides at 25 years and systolic blood pressure at 15 and 25 years (regression coefficients -0.18 to -0.11; P < 0.05 for all). The effects were weakened after adjusting for participants' own education. Maternal education showed no association with these risk factors. After controlling for participants' own education, associations between parental education and behavioural risk factors in adulthood were few. Any impact of parental education on offspring CVD risk factors seemed to be mediated via subject's own education. Parental education offered little predictive capacity for offspring CVD risk factors.

Cardiovascular disease prevalence and risk factors of persons with mental retardation

This paper reviews the recent literature on cardiovascular disease (CVD) prevalence, CVD-related mortality, physiological CVD risk factors, and behavioral CVD risk factors in adults with mental retardation (MR). The literature on the potential influences of modifiable behavioral CVD risk factors and the physiological CVD risk factors are also reviewed. Adults with mild to moderate MR residing in community settings appear to have an elevated disease prevalence, elevated CVD-related mortality, more adverse physiological CVD risk factors, and elevated behavioral risk compared to others with and without MR. Preliminary evidence supports the benefits of participating in the recommended physical activity levels and consuming the recommended diets to reduce the risk for CVD. The lack of large-scale longitudinal or experimental research indicates a gap in the research. The development of research-based, appropriate, primary prevention programs and intervention strategies aimed at lowering the risk for CVD is highly recommended. Programs should focus on educating individuals with MR along with direct care providers and family members on the importance of appropriate dietary concepts, physical activity habits, and regular health screenings by physicians. Programs should be individualized to regional and cultural issues.

Risk factors for cardiovascular disease in children with type I diabetes: Part II

Diabetes is a major risk factor for premature morbidity and mortality caused by cardiovascular disease (CVD). In Part I of this two part series, physiologic risk factors for cardiovascular disease in children with diabetes were presented. In Part II lifestyle CVD risk factors in children with diabetes will be discussed. Dietary factors, smoking behavior, and activity level are the risk factors most amenable to intervention. Two case studies are included to show clinical application of the data presented.

Risk factors for cardiovascular disease in children with type I diabetes: Part 1

Diabetes is a major risk factor for premature morbidity and mortality caused by cardiovascular disease (CVD). Although an increased prevalence of lipid abnormalities in many populations with diabetes has been observed, minimal data exist regarding the distribution, correlates, and determinants of lipid levels of children with diabetes. Early identification of hyperlipidemia and other CVD risk factors is requisite to timely and specific nursing interventions. Part 1 of this two part series will discuss the lipid profile, the link between cardiovascular disease and diabetes, and physiological risk factors for CVD in children with diabetes.

Type A Behavior and Physiological Cardiovascular Risk Factors In School-Age Twin Children

The relationship of Type A behavior pattern (TABP) and its components to physiological cardiovascular disease (CVD) risk factors of blood pressure, obesity, and lipids and lipoproteins was examined in 112 pairs of twin children. Blood pressure, triceps skinfold thickness, and fasting venous specimens for lipid profiles were collected during a home visit. Teachers rated children's Type A-B behaviors using the Matthews Youth Test for Health (MYTH) (Matthews & Angulo, 1980). For statistical analyses, one member of each twin pair was assigned to Group I and the co-twin to Group II. In Groups I and II, significant, p less than or equal to .01, negative correlations between the impatience-aggression component of TABP and atherogenic lipids were observed before and after covariate adjustments. Children were classified as MYTH Type A or B on the basis of a median-split. Marginally significant differences (B greater than A) were found between the mean lipid levels of Type A and Type B children. No significant A-B differences in blood pressure or measures of obesity were observed in either group. Multivariate analysis of variance results suggested that lipid profiles in Group I differed significantly, p less than or equal to .02, by Type A-B classification. The results of this study suggest that TABP and its components are not positively associated with physiological risk factors for CVD; and the impatience-aggression component of TABP is associated with lower levels of atherogenic lipids.