Reduce Cardiovascular Disease Risk Factors Research Articles

Evaluation of the Effectiveness of Tai Chi versus Brisk Walking in Reducing Cardiovascular Risk Factors: Protocol for a Ranomized Controlled Trial.

Physical inactivity is one of the major modifiable lifestyle risk factors for cardiovascular disease (CVD). This protocol aims to evaluate the effectiveness of Tai Chi versus brisk walking in reducing CVD risk factors. This is a randomized controlled trial with three arms, namely, Tai Chi group, walking group, and control group. The Tai Chi group will receive Tai Chi training, which consists of two 60-min sessions each week for three months, and self-practice for 30 min every day. The walking group will perform brisk walking for 30 min every day. The control group will receive their usual care. 246 subjects with CVD risk factors will be recruited from two outpatient clinics. The primary outcome is blood pressure. Secondary outcomes include fasting blood for lipid profile, sugar and glycated haemoglobin (HbA1c); body mass index, waist circumference, body fat percentage; perceived stress level and quality of life. Data collections will be conducted at baseline, 3-month, 6-month and 9-month. Generalized estimating equations model will be used to compare the changes in outcomes across time between groups. It is expected that both the Tai Chi and walking groups could maintain better health and have improved quality of life, and that Tai Chi will be more effective than brisk walking in reducing CVD risk factors.

Chronic kidney disease from screening, detection, and awareness, to prevention.

Chronic kidney disease from screening, detection, and awareness, to prevention.

Workplace Digital Health Is Associated with Improved Cardiovascular Risk Factors in a Frequency-Dependent Fashion: A Large Prospective Observational Cohort Study.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US. Emerging employer-sponsored work health programs (WHP) and Digital Health Intervention (DHI) provide monitoring and guidance based on participants’ health risk assessments, but with uncertain success. DHI–mobile technology including online and smartphone interventions–has previously been found to be beneficial in reducing CVD outcomes and risk factors, however its use and efficacy in a large, multisite, primary prevention cohort has not been described to date. We analyzed usage of DHI and change in intermediate markers of CVD over the course of one year in 30,974 participants of a WHP across 81 organizations in 42 states between 2011 and 2014, stratified by participation log-ins categorized as no (n = 14,173), very low (<12/yr, n = 12,260), monthly (n = 3,360), weekly (n = 651), or semi-weekly (at least twice per week). We assessed changes in weight, waist circumference, body mass index (BMI), blood pressure, lipids, and glucose at one year, as a function of participation level. We utilized a Poisson regression model to analyze variables associated with increased participation. Those with the highest level of participation were slightly, but significantly (p<0.0001), older (48.3±11.2 yrs) than non-participants (47.7±12.2 yr) and more likely to be females (63.7% vs 37.3% p<0.0001). Significant improvements in weight loss were demonstrated with every increasing level of DHI usage with the largest being in the semi-weekly group (-3.39±1.06 lbs; p = 0.0013 for difference from weekly). Regression analyses demonstrated that greater participation in the DHI (measured by log-ins) was significantly associated with older age (p<0.001), female sex (p<0.001), and Hispanic ethnicity (p<0.001). The current study demonstrates the success of DHI in a large, community cohort to modestly reduce CVD risk factors in individuals with high participation rate. Furthermore, participants previously underrepresented in WHPs (females and Hispanics) and those with an increased number of CVD risk factors including age and elevated BMI show increased adherence to DHI, supporting the use of this low-cost intervention to improve CVD health.

Cardiovascular Disease Risk Among Young Urban Women.

Although young women are presumed to have low cardiovascular disease (CVD) risk and mortality, the mortality benefits secondary to ischemic heart disease have plateaued among young women, <50 years. Women, 18-49 years (n = 595) among all participants (n = 1,045) in the Columbia University Heart Health in Action Study, were assessed for CVD risk burden, that is, presence of hypertension, diabetes mellitus, current tobacco use, hyperlipidemia, physical inactivity, and/or obesity. Anthropometrics (height, weight, waist circumference, and body mass index [BMI]); demographics; socioeconomic status, CVD risk factors, body size perception; knowledge and awareness of CV disease; and attitudes toward lifestyle perception were determined. Most were Hispanic (64.0%); non-Hispanic white (20.0%); or non-Hispanic black (8.7%), age = 35.9 ± 8.0 years. BMI was categorized as obese (≥30 kg/m2, 27.0%; 160/592); overweight (25.0-29.1 kg/m2, 29.1%; 172/592); normal weight (18.5-24.9, 41.7%; 247/592); and underweight (≤18.4; 2.2%; 13/592). More than half (57.9%; 337/582) had CVD risks: 45.9% (267/582) had >1 CVD risk factor exclusive of obesity, including physical inactivity (18.4%), hypertension (17.2%), hyperlipidemia (11.3%), current tobacco use (9.8%), and diabetes (5.6%). Regardless of CVD risk burden, most knew blood pressure, blood sugar, and cholesterol. Women with increased CVD risk burden, however, were less likely to correctly identify body size (53.3% vs. 66.1%, p = 0.002). Obese and overweight women with CVD risk factors exclusive of obesity were more likely to cite cost (23.4% vs. 10.7%, p = 0.003) and fatigue (32.2% vs. 18.8%, p = 0.006) as barriers to weight loss. Among these young women, the majority had CVD risks and the CVD risk burden is high among young women, particularly among the overweight and obese and physically inactive. Strategies to encourage healthy lifestyles and reduce CVD risk factors among this vulnerable at-risk population are vital.

Comparison of Cardiovascular Risk Factors Between Subjects With and Without Diabetes Mellitus: An Analytical Study

Background: Cardiovascular Disease (CVD) is developing treacherously along industrialization and development of urbanization Objectives: The aim of this study was to compare cardiovascular risk factors between subjects with and without diabetes mellitus in the Minoodar district of Qazvin. Patients and Methods: This analytical study was conducted on 100 subjects with diabetes and 140 subjects without diabetes in Qazvin from September 2010 to April 2011. Standardized measurements were available for waist circumference (WC), blood pressure (BP), fasting serum cholesterol, high-density lipoprotein cholesterol (HDL), and triglycerides (TGs). Cardiovascular risk factors were defined according to the diagnostic criteria proposed by the national cholesterol education program. Data were analyzed using the t-test, Mann-Whitney U test, and Chi-square test. Results: Overall, 12% of subjects with diabetes and 17.9% of subjects without diabetes were smokers (P = 0.277). The WC, TGs, systolic and diastolic BP were significantly higher in subjects with diabetes compared to subjects without diabetes. The prevalence of high WC, high BP, low HDL, and high TGs were significantly higher in subjects with diabetes compared to subjects without diabetes. Conclusions: Cardiovascular risk factors were higher in subjects with diabetes compared to subjects without diabetes. Lifestyle intervention programs should be focused on community education about reduction of CVD risk factors in patients with diabetes. Keywords: Risk Factor, Coronary Heart Disease, Diabetes Mellitus

Effectiveness of the Complete Health Improvement Program in Reducing Risk Factors for Cardiovascular Disease in an Appalachian Population.

In 11 counties in Appalachian Ohio, the self-reported prevalence of diabetes mellitus (11.3%) is higher than the state (7.8%) or national (7.2%) average. Direct medical costs for diabetes in the United States are estimated at $176 billion annually. Indirect costs from disability, work loss, and premature death add up to another $69 billion. To determine the effectiveness of the Complete Health Improvement Program (CHIP) in reducing cardiovascular disease (CVD) risk factors in a sample of Appalachian participants with elevated fasting blood glucose (FBG) levels or a diagnosis of type 2 diabetes mellitus (T2DM). In a retrospective study, data from 6 CHIP cohorts conducted in Appalachian Ohio from 2011 to 2012 were combined and analyzed for short-term changes in CVD risk factors from baseline. This study focused on a subsample of the overall CHIP, whose participants had elevated FBG levels or T2DM. Statistical analysis was completed by calculating means and SDs and using paired t tests to compare differences in variables. After the CHIP intervention, 110 participants with baseline elevated FBG levels showed notable reductions in FBG levels, total cholesterol, low-density lipoprotein cholesterol, body mass index, and systolic blood pressure (all P values <.001). Likewise, participants in the subsample with T2DM experienced reductions in all CVD risk factors (all P values <.05). The CHIP lifestyle intervention was effective in reducing CVD risk factors in this Appalachian population with elevated FBG levels or with T2DM.

Healthy hearts: a cross-sectional study of clinical cardiovascular disease risk factors in Northern Colorado school children (1992-2013).

BackgroundDespite significant declines in cardiovascular disease (CVD), it remains the number one cause of death in the United States. Determining factors that may be associated with CVD risk at a young age may allow us to better prevent CVD deaths in the future. The purpose of this paper is to determine the prevalence of CVD risk factors among 4th grade children who participated in a community-wide CVD education program; as well as the association of these risk factors with weight status and the prevalence of CVD risk factors among family members.MethodsThe Poudre Valley Health Systems, Healthy Hearts Club has provided a cardiovascular screening program (1992–2013) to identify risk factors among students in six Northern Colorado school districts. There were 9,694 children (mean age, 10.3 years, 50 % female) included. Data were collected cross-sectionally with objective measures of total and high-density lipoprotein cholesterol (HDL-C), blood pressure and body mass index (BMI). Surveys were filled out by the parent and/or legal guardian and included questions about risk factors among family members. Means and frequencies were compared using SPSS software version 22 (IBM, Inc.).ResultsThere were a significant number of children with elevated risk factors, including 35 % with total cholesterol ≥ 170 mg/dl, 22 % with HDL-C < 40 mg/dl, 13 % with Non-HDL-C ≥ 145 mg/dL, 6 % and 7 % with systolic and diastolic blood pressure ≥ 120 mmHg, and ≥ 80 mmHg respectively, and 21 % with BMI ≥ 85 % for age and sex. All the risk factors increased significantly when comparing normal weight to overweight and obese children. Further, among children with zero risk factors, 32.2 % reported a family member (other than the child) being overweight, while 56.5 % reported such among those children with five or six risk factors.ConclusionsOverall, the prevalence of CVD risk factors in these children is similar to national levels and these factors are meaningfully associated with overweight and obesity, both within the child as well as within the family. This data suggests CVD risk factor reduction and prevention must focus on overweight and obesity and not be done in isolation of the family.

Estimates of Global and Regional Premature Cardiovascular Mortality in 2025

United Nations member states have agreed to reduce premature cardiovascular disease (CVD) mortality 25% by 2025. Global CVD risk factor targets have been recommended. We produced estimates to show how selected risk factor reduction would affect CVD mortality for different regions and countries. We used mortality, risk factor, and relative risk data from the Global Burden of Disease, Risk Factors, and Injuries (GBD) 2013 study to project CVD mortality for 188 countries up to the year 2025. We disaggregated observed CVD mortality in 1990 and 2013 into deaths attributable and unattributable to hypertension, tobacco smoking, diabetes mellitus, and obesity using an age- and sex-specific population-attributable fraction. Risk factors were projected to 2025 assuming that current trends continue. Counterfactual scenarios were then constructed reflecting CVD premature mortality if United Nations risk factor targets are achieved in the year 2025, adjusting for joint effects of risk factors. We estimate 7.8 million premature CVD deaths in 2025 if current risk factor trends continue. Premature CVD deaths would be reduced to 5.7 million if these risk factors targets are achieved as a result of a 26% reduction for men and a 23% reduction for women in the global risk of premature CVD death. Globally, decreasing the prevalence of hypertension accounted for the largest risk reduction, followed by a reduction in tobacco smoking for men and obesity for women, but these results varied by region. The impact of meeting all risk factor targets on CVD mortality varied widely by region and sex. The United Nations target of a 25% reduction in premature CVD mortality by the year 2025 appears achievable for some countries, but more aggressive risk factor targets may be required if all regions are to reach this goal. Without these reductions in CVD risk factors, many countries will see no change or even an increase in premature CVD mortality.

Effects of endurance, circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients.

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake ([Formula: see text]), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (-18 %), [Formula: see text] (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (-11 %), [Formula: see text] (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in [Formula: see text], mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.

Anti-inflammation Effect of Polysaccharide Peptide (Ganodermalucidum)in Diabetes Mellitus

Background: High prevalence of diabetes mellitus (DM) in the world is one of the leading cardiovascular risk factor that associated with high morbidity and mortality. Atherosclerotic heart disease is one of the major cardiovascular disease related to DM from the current study. Polysaccharide peptide, extract from Ganodermalucidum, a popular medicinal mushroom in traditional Chinese medicine, has anti-inflammatory effect in several studies. In this study, we investigated alteration of tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) levels as risk factors for cardiovascular disease bypolysaccharide peptide indiabetes mellitus. Methods: Diabetes mellitus rat models which induced by high fat diet (HFD) and streptozotozin (STZ)were randomly divided into five groups, diabetes mellitus models with high fat diet, low-dose PsP (SLH, Indonesia) treatment group [50 mg/kgBW], medium-dose PsP treatment group [150 mg/kgBW], high-dose PsP treatment group [300 mg/kgBW], and normal rats as negative control group respectively. Results: After 5 weeks of treatment, we found significantly higher level of IL-10 in diabetes mellitus rat models with increasing dose of PsP (95% CI, p = 0.027). On the other hand, TNF-α level not significantly lowered with increasing dose of PsP (95% CI, p = 0.066). Conclusion: Polysaccharide peptideiseffective in reducingcardiovascular disease risk factors in diabetes mellitus rat models, thus potential to be developed as anti-inflammatory in diabetes mellitus.

Effectiveness of popular weight loss diets on cardiovascular risk reduction.

Effectiveness of popular weight loss diets on cardiovascular risk reduction.

Effects of Light Intensity Activity on CVD Risk Factors: A Systematic Review of Intervention Studies.

The effects of light intensity physical activity (LIPA) on cardiovascular disease (CVD) risk factors remain to be established. This review summarizes the effects of LIPA on CVD risk factors and CVD-related markers in adults. A systematic search of four electronic databases (PubMed, Academic Search Complete, SPORTDiscus, and CINAHL) examining LIPA and CVD risk factors (body composition, blood pressure, glucose, insulin, glycosylated hemoglobin, and lipid profile) and CVD-related markers (maximal oxygen uptake, heart rate, C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and tumor necrosis factor receptors 1 and 2) published between 1970 and 2015 was performed on 15 March 2015. A total of 33 intervention studies examining the effect of LIPA on CVD risk factors and markers were included in this review. Results indicated that LIPA did not improve CVD risk factors and CVD-related markers in healthy individuals. LIPA was found to improve systolic and diastolic blood pressure in physically inactive populations with a medical condition. Reviewed studies show little support for the role of LIPA to reduce CVD risk factors. Many of the included studies were of low to fair study quality and used low doses of LIPA. Further studies are needed to establish the value of LIPA in reducing CVD risk.

Cochrane Corner: Yoga to prevent cardiovascular disease

It is widely accepted that both stress and physical inactivity are important risk factors for cardiovascular disease (CVD) [1]. Strategies which promote a healthy lifestyle, including exercise and stress management, have been shown to be beneficial in terms of reducing CVD risk factors [1]. Yoga has been demonstrated to reduce stress [2] and the holding of poses that is involved provides surprising robust exercise [3] and so, theoretically, yoga could be effective as a primary prevention intervention for CVD. This Cochrane review included all controlled trials of any type of yoga lasting at least three months, with a comparison group of either no or minimal intervention [4]. 11 trials with around 800 participants in total, and two ongoing studies were included, and clinical CVD events and major CVD risk factors were the outcomes assessed. Around half of the participants recruited to the studies were considered to be at high risk of CVD, and around half were considered to be healthy. None of the included studies provided CVD or all-cause mortality data, or reported non-fatal CVD endpoints. However, in terms of CVD risk factors, 9 of the 11 studies measured blood pressure, and although meta-analysis was not possible for systolic blood pressure, all but 1 study reported that yoga led to a reduction, which was statistically significant in 3 studies. Metaanalysis was possible for diastolic blood pressure as there was less heterogeneity between studies, and yoga was found to significantly lower diastolic blood pressure (MD 2.90, 95% CI 4.52 to 1.28). Five trials measured lipid levels. The data for total cholesterol could not be pooled for meta-analysis, but two of the studies found A R T I C L E I N F O

Efficacy of a unique omega-3 formulation on the correction of nutritional deficiency and its effects on cardiovascular disease risk factors in a randomized controlled VASCAZEN(®) REVEAL Trial.

Low blood levels of long chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) have been reported to be associated with increased risk for cardiovascular disease (CVD) deaths. Systematic studies measuring LC n-3 PUFA blood levels (pre and post-treatment) in defined subjects, and monitoring the correction of nutritional deficiency with a pure LC n-3 PUFA formulation in sufficient doses, while monitoring CVD risk factors are lacking. We tested the efficacy of a novel LC n-3 PUFA Medical Food formulation (VASCAZEN®, > 90 % pure with a 6:1 eicosapentaenoic acid-(EPA):docosahexaenoic acid-(DHA) ratio; 6:1-OM3), to correct such deficiency and determine the concomitant effects on lipid profiles. Of 655 subjects screened, 89 % were LC n-3 PUFA deficient (Omega-Score, (OS) = blood EPA + DHA + Docosapentaenoic acid < 6.1 %). From these, a study was conducted on 110 ambulatory cardiovascular subjects. Placebo: corn oil. Primary endpoint: change in OS. Secondary endpoint: changes in blood lipid profiles. At 8 weeks of treatment with 6:1-OM3 (4 g/day), placebo-adjusted median OS levels (n = 56) significantly improved (132 %, P < 0.0001) with a decrease in AA (arachidonic acid): EPA ratio (82 %, P < 0.0001). In hypertriglyceridemic subjects (TG 2.26–5.65 mmol/L), HDL-C improved (9 %, P = 0.0069), TG-reduced (48 %, P < 0.0001), and VLDL-C reduced (30 %, P = 0.0023), without significantly affecting LDL-C levels. This study confirms that LC n-3 PUFA deficiency is prevalent in the US population, and its correction with 6:1-OM3 in CVD subjects improves lipid profiles. The purity, EPA:DHA ratio and dose are determinant factors for optimal efficacy of a formulation in reducing CVD risk factors.

Self-Fitness Assessment and Exercise Motivation.

Background: Cardiovascular disease (CVD) is a common etiology of patient morbidity and mortality after kidney transplantation. Exercise favorably impacts the risk factors for CVD. We conducted an observational study in prevalent transplant patients to measure their self perceived level of fitness and to determine their interest in improved fitness and motivation to exericse. Patients who were interested in improving their fitness were enrolled in an exercise rehabilitation program. Methods: Stable kidney transplant (KT) recipients >2 months (m) after transplant completed a survey about their fitness. Patients who were interested in improved fitness were enrolled into the 6m study. Subjects were asked to exercise ≥2 times/week. An exercise physiologist met individually with each patient to design a regimen focused on strength and CV health. Baseline body mass index (BMI) and monthly BMIs were recorded. Results: 83 patients completed the survey. 98% of patients who perceived themselves as not-fit were interested in increasing their fitness compared to 41% of patients who saw themselves as fit. 82% of not-fit patients were interested in a free gym/trainer but only 24% of not-fit patients were willing to pay for a gym. To date, 5 of 10 patients have completed the 6m study. 4 of 5 patients achieved the exercise frequency goal. 4 of 5 patients felt their energy level to be improved at the end of the study. 3 of 5 study patients joined a gym at study completion. 3 of 5 patients lowered or maintained their BMI. Twenty age-/sex-matched recipients were used as a control group of which 6 lowered or maintained their BMI over the same period. There were no adverse events.Table: No Caption available.Table: No Caption available.Conclusion: KT patients are interested in improving their fitness. An initial barrier is the cost of a gym membership. After participation in a free exercise program, KT patients may be more willing to pay for a gym perhaps due to positive reinforcement from improved weight management and energy levels. Investigating ways to make gym memberships more accessible to new KT patients may help reduce CVD risk factors.

Poster #S219 THE RELATIONSHIP BETWEEN NEUROCOGNITION AND REAL LIFE FUNCTIONING IN FIRST-EPISODE SCHIZOPHRENIA: RESULTS FROM THE 2-YEAR FOLLOW-UP IN THE OSLO LONGITUDINAL RECOVERY STUDY

It is now well established that severe mental illness (SMI) is associated with a reduced lifespan and increased risk of cardiovascular disease (CVD). Individuals with SMI often have abnormalities of lipid metabolism, glucose homeostasis, an increased prevalence of obesity and hypertension. They also have an increased prevalence of Metabolic Syndrome (MetS). The reasons for this are not entirely clear, but are likely to be multifactorial. Whilst there have been numerous studies investigating the prevalence of MetS in patients with SMI, many have been in small, mixed population samples, that have not been adequately controlled for the background population from which they have been drawn. This is important because of the wide range of prevalence estimates that have been reported, and variations of MetS prevalence with ethnicity. The negative impact of treatment with second-generation antipsychotic (SGA) drugs on the risk of MetS also appears clear in most populations, although the mechanisms accounting for this increased risk are yet to be clarified. Despite this high prevalence of CVD risk factors in patients with SMI, most studies report a poor implementation of screening for CVD risk factors at baseline, and following initiation of treatment with SGAs. Not all patients with SMI are susceptible to the adverse effects of SGAs, but in those that are, switching to an anti-psychotic that is less likely to cause metabolic disturbance, starting statin therapy and a reduction in CVD risk factors through changes in lifestyle may all be important strategies.

Firefighter Health and Fitness Assessment

Sudden cardiac deaths experienced by firefighters in the line of duty account for the largest proportion of deaths annually. Several fire service standards for fitness and wellness have been recommended but currently only 30% of U.S. fire departments are implementing programs for this purpose. The Department of Homeland Security Science and Technology Directorate has initiated the Physiological Health Assessment System for Emergency Responders (PHASER) program aiming to reduce these line-of-duty deaths through an integration of medical science and sensor technologies. Confirming previous reports, PHASER comprehensive risk assessment has identified lack of physical fitness with propensity for overexertion as a major modifiable risk factor. We sought to determine if current levels of fitness and cardiovascular disease (CVD) risk factors in a contemporary cohort of firefighters were better than those reported over the past 30 years. Fifty-one firefighters from a Southern California department were characterized for physical fitness and CVD risk factors using standard measures. Overall, physical fitness and risk factors were not different from previous reports of firefighter fitness and most subjects did not achieve recommended fitness standards. Considering the lack of widespread implementation of wellness/fitness programs in the U.S. fire service together with our findings that low physical fitness and the presence of CVD risk factors persist, we issue a call to action among health and fitness professionals to assist the fire service in implementing programs for firefighters that improve fitness and reduce CVD risk factors. Fitness professionals should be empowered to work with fire departments lending their expertise to guide programs that achieve these objectives, which may then lead to reduced incidence of sudden cardiac death or stroke.

Using Evidence-Based Practice and Scientific Statements in the Clinical Setting: Examples From Cardiac Rehabilitation

Using Evidence-Based Practice and Scientific Statements in the Clinical Setting: Examples From Cardiac Rehabilitation

Worksite Health and Wellness Programs: Canadian Achievements & Prospects

Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area.

A community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia

BackgroundNon-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia.MethodsThe study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention.ResultsFrequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a “cheerful” program.ConclusionA community-empowerment approach can encourage community participation which in turn may improve the citizen’s knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens’ acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country.