Reduction In Cardiovascular Disease Mortality Research Articles

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011.

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

Did the Great Recession affect mortality rates in the metropolitan United States? Effects on mortality by age, gender and cause of death

ObjectivesMortality rates generally decline during economic recessions in high-income countries, however gaps remain in our understanding of the underlying mechanisms. This study estimates the impacts of increases in unemployment rates on both all-cause and cause-specific mortality across U.S. metropolitan regions during the Great Recession. MethodsWe estimate the effects of economic conditions during the recent and severe recessionary period on mortality, including differences by age and gender subgroups, using fixed effects regression models. We identify a plausibly causal effect by isolating the impacts of within-metropolitan area changes in unemployment rates and controlling for common temporal trends. We aggregated vital statistics, population, and unemployment data at the area-month-year-age-gender-race level, yielding 527,040 observations across 366 metropolitan areas, 2005–2010. ResultsWe estimate that a one percentage point increase in the metropolitan area unemployment rate was associated with a decrease in all-cause mortality of 3.95 deaths per 100,000 person years (95%CI −6.80 to −1.10), or 0.5%. Estimated reductions in cardiovascular disease mortality contributed 60% of the overall effect and were more pronounced among women. Motor vehicle accident mortality declined with unemployment increases, especially for men and those under age 65, as did legal intervention and homicide mortality, particularly for men and adults ages 25–64. We find suggestive evidence that increases in metropolitan area unemployment increased accidental drug poisoning deaths for both men and women ages 25–64. ConclusionsOur finding that all-cause mortality decreased during the Great Recession is consistent with previous studies. Some categories of cause-specific mortality, notably cardiovascular disease, also follow this pattern, and are more pronounced for certain gender and age groups. Our study also suggests that the recent recession contributed to the growth in deaths from overdoses of prescription drugs in working-age adults in metropolitan areas. Additional research investigating the mechanisms underlying the health consequences of macroeconomic conditions is warranted.

Dietary soy and natto intake and cardiovascular disease mortality in Japanese adults: the Takayama study

Background: Whether soy intake is associated with a decreased risk of cardiovascular disease (CVD) remains unclear. A traditional Japanese soy food, natto, contains a potent fibrinolytic enzyme. However, its relation to CVD has not been studied.Objective: We aimed to examine the association of CVD mortality with the intake of natto, soy protein, and soy isoflavones in a population-based cohort study in Japan.Design: The study included 13,355 male and 15,724 female Takayama Study participants aged ≥35 y. At recruitment in 1992, each subject was administered a validated semiquantitative food-frequency questionnaire. Deaths from CVD were ascertained over 16 y.Results: A total of 1678 deaths from CVD including 677 stroke and 308 ischemic heart disease occurred during follow-up. The highest quartile of natto intake compared with the lowest intake was significantly associated with a decreased risk of mortality from total CVD after control for covariates: the HR was 0.75 (95% CI: 0.64, 0.88, P-trend = 0.0004). There were no significant associations between the risk of mortality from total CVD and intakes of total soy protein, total soy isoflavone, and soy protein or soy isoflavone from soy foods other than natto. The highest quartiles of total soy protein and natto intakes were significantly associated with a decreased risk of mortality from total stroke (HR = 0.75, 95% CI: 0.57, 0.99, P-trend = 0.03 and HR = 0.68, 95% CI: 0.52, 0.88, P-trend = 0.0004, respectively). The highest quartile of natto intake was also significantly associated with a decreased risk of mortality from ischemic stroke (HR = 0.67, 95% CI:0.47, 0.95, P-trend = 0.03).Conclusion: Data suggest that natto intake may contribute to the reduction of CVD mortality.

Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults

Background/AimEvidence for the long-term health effects of specific sport disciplines is scarce. Therefore, we examined the associations of six different types of sport/exercise with all-cause and cardiovascular disease (CVD) mortality...

County-Level Variation in Cardiovascular Disease Mortality in the United States in 2009-2013: Comparative Assessment of Contributing Factors.

We examined factors responsible for variation in cardiovascular disease (CVD) mortality across US counties in 2009-2013. We linked county-level census, survey, administrative, and vital statistics data to examine 4 sets of features: demographic factors, social and economic factors, health-care utilization and features of the environment, and population health indicators. County-level associations of these features (standardized to a mean of 0 with a standard deviation of 1) with cardiovascular deaths per 100,000 person-years among adults aged 45-74 years was modeled using 2-level hierarchical linear regression with random intercept for state. The percentage of CVD mortality variation (intercounty disparity) modeled by each set of features was quantified. Demographic composition accounted for 36% of county CVD mortality variation, and another 32% was explained after inclusion of economic/social conditions. Health-care utilization, features of the environment, and health indicators explained an additional 6% of CVD mortality variation. The largest contributors to CVD mortality levels were median income (-23.61 deaths/100,000 person-years, 95% CI: -26.95, -20.26) and percentage without a high school education (20.71 deaths/100,000 person-years, 95% CI: 16.48, 24.94). In comparison, the largest health-related contributors were health-care utilization (19.35 deaths/100,000 person-years, 95% CI: 16.36, 22.34) and CVD risk factors (4.80 deaths/100,000 person-years, 95% CI: 2.14, 7.46). Improving health-care access and decreasing the prevalence of traditional CVD risk factors may reduce county CVD mortality levels, but improving socioeconomic circumstances of disadvantaged counties will be required in order to reduce CVD mortality disparities across counties.

Reduction of cardiovascular disease inequalities in the USA through dietary policy

BackgroundThe burden of cardiovascular disease mortality remains large and unequal in the USA, and is mostly attributable to poor diet. Few data exist about the potential population level impact on inequalities of policies to improve diet such as the Supplemental Nutrition Assistance Program (SNAP). We aimed to estimate reductions in cardiovascular disease mortality and inequalities achievable in the US population up to 2030 through dietary policies. MethodsWe developed a US IMPACT (International Model for Policy Analysis of Agricultural Commodities and Trade) food policy model to estimate the number of deaths prevented or postponed (DPPs) achievable with four feasible scenarios that have been successfully implemented across the world: a national fruit and vegetables and sugar-sweetened beverage mass media campaign, fruit and vegetable price reductions of 10% universally and 30% to SNAP participants, and universal sugar-sweetened beverage price increase of 10%. We further modelled a combination of these policies. We stratified the US population by SNAP eligibility and participation. We estimated number of deaths using the incremental effect of each policy upon the target food groups. Then we estimated the effect upon cardiovascular disease mortality compared with existing baseline of continued trends. Probabilistic sensitivity analyses were conducted. FindingsA universal 10% price reduction of fruit and vegetables could prevent the most deaths—about 150 500 DPPs by 2030 (95% CI 137 800–160 500). This compares with approximately 23 000 DPPs (21 500–24 600) generated through a 1 year mass media campaign, or 21 400 DPPs (18 200–24 500) by a 10% price increase in sugar-sweetened beverages. A 30% price reduction in fruit and vegetables for SNAP participants could result in roughly 35 100 DPPs (31 800–37 700) and also achieve the biggest reduction in inequalities between SNAP participants and the ineligible population. The combined policy approach would save most lives (about 204 800 DPPs) while also reducing inequalities. InterpretationFiscal strategies targeting diet could contribute to reduce the unequal cardiovascular mortality burden in the USA. All four dietary policies would be effective, but a combination of the universal and targeted aspects of policies would be the most effective. Individually, a universal 10% reduction in the price of fruit and vegetables might save most lives, whereas a targeted, 30% price reduction for SNAP participants could reduce inequalities the most. FundingNational Institutes of Health (grant number R01HL115189). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract.

Differences in cardiovascular disease mortality between local authorities in England: an ecological analysis

BackgroundLarge inequalities in age-standardised mortality rates of cardiovascular disease (CVD) exist at the local authority level within England, with particular areas consistently having the highest rates. Higher deprivation is associated with higher CVD mortality, but we know little about how the demographics and environments of local areas contribute to variations in mortality rates. The aim of this study was to explore the extent to which demographic, health, and environmental factors explain differences in all ages and premature CVD mortality between local authorities in England. MethodsAll data were sourced for each local authority in England. Outcome variables were age-standardised CVD mortality for all ages and those under 75 years in 2012–14. Data obtained were prevalence of ethnic and socioeconomic groups from the UK 2011 census; Public Health England data on index of multiple deprivation (IMD) score; prevalence of smoking, physical activity, obesity and overweightness; and Ordnance Survey environmental data on percentage of food shops, eating out shops, green or blue space, sporting facilities, and health facilities. We used the Akaike Information Criterion to assess which types of variables provided the best statistical model to explain variation in CVD mortality between local authorities. FindingsInclusion of health, demographic, environment, and IMD variables provided the best fit for explaining variation in CVD mortality at all ages (adjusted r2=0·60). Indian and Pakistani ethnicity and the IMD score in local authorities remained significantly associated with the outcome, with corresponding p values all less than 0·01. CVD mortality was 44 per 100 000 population greater in areas with the highest proportions of Indian and Pakistani ethnicities and 110 per 100 000 greater in the most deprived local authorities than in the least deprived areas. For CVD mortality below age 75, exclusion of environmental data improved the fit of the model (adjusted r2=0·82). Overweight prevalence (p=0·0481), Indian (p=0·0111), Pakistani (p=0·0003), and Bangladeshi (p=0·003) ethnicity, and the IMD score (p<0·0001) all remained significantly associated with premature CVD mortality when the best fitting model was used. Premature mortality was 13 per 100 000 and 18–25 per 100 000 greater in local authorities where the proportion of overweight people and Asian ethnicities was highest. Premature mortality in the most deprived local authorities was 68 per 100 000 greater than in the least deprived authorities. InterpretationThese findings are valuable for understanding which factors might be most useful for local authorities to target to reduce CVD mortality. This study combined a large amount of existing data; however, it was conducted at an ecological level, so analyses using individual-level mortality outcomes are also needed. FundingThe authors' posts are funded by the British Heart Foundation.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Modeling Future Cardiovascular Disease Mortality in the United States: National Trends and Racial and Ethnic Disparities.

Accurate forecasting of cardiovascular disease mortality is crucial to guide policy and programming efforts. Prior forecasts often have not incorporated past trends in rates of reduction in cardiovascular disease mortality. This creates uncertainties about future trends in cardiovascular disease mortality and disparities. To forecast US cardiovascular disease mortality and disparities to 2030, we developed a hierarchical bayesian model to determine and incorporate prior age, period, and cohort effects from 1979 to 2012, stratified by age, sex, and race, which we combined with expected demographic shifts to 2030. Data sources included the National Vital Statistics System, Surveillance, Epidemiology, and End Results (SEER) single-year population estimates, and US Bureau of Statistics 2012 national population projections. We projected coronary disease and stroke deaths to 2030, first on the basis of constant age, period, and cohort effects at 2012 values, as is most commonly done (conventional), and then with the use of more rigorous projections incorporating expected trends in age, period, and cohort effects (trend based). We primarily evaluated absolute mortality. The conventional model projected total coronary and stroke deaths by 2030 to increase by ≈18% (67 000 additional coronary deaths per year) and 50% (64 000 additional stroke deaths per year). Conversely, the trend-based model projected that coronary mortality would decrease by 2030 by ≈27% (79 000 fewer deaths per year) and stroke mortality would remain unchanged (200 fewer deaths per year). Health disparities will be improved in stroke deaths but not coronary deaths. After prior mortality trends and expected demographic shifts are accounted for, total US coronary deaths are expected to decline, whereas stroke mortality will remain relatively constant. Health disparities in stroke but not coronary deaths will be improved but not eliminated. These age, period, and cohort approaches offer more plausible predictions than conventional estimates.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract P281: Comparing the Impact of Price Change and Mass Media Campaigns in Reducing Cardiovascular Disease Mortality and Disparities in the US

Introduction: Cardiovascular disease (CVD) mortality burdens remain large and unequal in the US, and much is attributable to poor diets. However, few data exist regarding the potential population level impact of policies aimed at improving dietary intake, such as the Supplemental Nutrition Assistance Programme (SNAP), and potential effects on disparities. Aim: To estimate reductions in CVD mortality and disparities achievable in the US population up to 2030 through food price changes and mass media campaign interventions targeting fruits and vegetables (F&amp;V) and sugar sweetened beverages (SSBs). Methods: We developed a US IMPACT Food Policy Model to compare four contrasting food policy scenarios targeting dietary intake: A) - national F&amp;V mass media campaign, B) F&amp;V price reductions of 10% universally and C) 30% to SNAP participants, D) - SSB price increase of 10% universally. Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections, and NHANES. We stratified the US population into SNAP participants, SNAP eligible but not participating, and SNAP ineligible. We modelled cumulative deaths prevented or postponed (DPP) and life years gained (LYG) using best-evidence effect sizes for each policy, existing mortality rates and trends, and F&amp;V and SSB mortality effects. We stratified by age, sex, and CVD subtype from 2015 to 2030. Sensitivity analyses were conducted with Monte Carlo simulation. Results: Scenario B (universal 10% price reduction) would yield the greatest national benefits, generating approximately 88,000 DPPs (95% CI: 81,000-94,000) and 1,369,000 LYGs (1,268,000-1,460-000) by 2030. This compares with between 28,000 (26,000-30,000) and 84,000 (79,000-89,000) DPPs in Scenario A, depending on duration of media campaigns; and approximately 27,000 (24,000-30,000) and 29,000 (25,000-33,000) DPPs in scenarios C and D respectively. Scenario C (30% price reduction to SNAP participants) might reduce CVD disparities by about 18% comparing SNAP participants with the ineligible population. Scenarios A, B and D would have negligible effects on mortality disparities. Conclusions: All four dietary policies would be effective in reducing mortality. Reducing fruit and vegetable (F&amp;V) price by 10% to the entire US would save most lives. Reducing F&amp;V price by 30% to SNAP participants would reduce disparities the most, particularly if SNAP program coverage and penetration were improved. These results support population fiscal strategies targeting diet to reduce cardiovascular mortality and disparities in the US.

Abstract MP12: Comparing Effectiveness of Mass Media Campaigns vs. Price Reductions Targeting Fruit and Vegetable Intake on US Cvd Mortality and Race Disparities

Introduction: Cardiovascular disease (CVD) accounts for over 800,000 US deaths annually, with substantial disparities by race. Poor diet is a leading CVD risk factor, including low intake of fruit and vegetable (F&amp;V). Few data exist regarding the potential population level impact and effect on race disparities of policies aimed at increasing F&amp;V intake. Aim: To estimate CVD mortality reductions, including by race, potentially achievable by price reduction and mass media campaign interventions in the US population up to 2030. Methods: We developed a US IMPACT Food Policy Model to compare three contrasting policies targeting F&amp;V intake: A - a national mass media campaign (MMC); B and C - a universal F&amp;V price reduction of 10 and 30% respectively. The MMC assumed unequal coverage by age, gender and race, and duration of either 1 or 15 years. Data sources included the National Vital Statistics System, SEER single year population estimates, the US Bureau 2012 National Population projections and NHANES. We used US population and CVD projections to 2030, F&amp;V mortality effect sizes and best evidence effect sizes for each policy. We modelled cumulative deaths prevented or postponed and life years gained (LYG) by age, gender, race and CVD subtype from 2015 to 2030. Results were tested in a probabilistic sensitivity analysis using Monte Carlo simulation. Results: Scenario A (MMC) could result in 27,000 (95% CI: 21,000-33,000) to 85,000 (83,000-89,000) fewer deaths dependent upon media campaign duration (from 1 to 15 years), gaining up to 1,280,000 LYGs (1,250,000-1,320,000) by 2030. Approximately 62% of deaths prevented would be CHD; and 53% would be in men, with 20% being saved in year 1. Scenario B (10% price decrease) could prevent approximately 90,000 deaths (71,000-114,000) and gain 1,450,000 LYGs (1,180,000-1,740,000) by 2030. Scenario C (30% price decrease) could prevent some 270,000 deaths (215,000-338,000) by 2030, representing a 3.9% reduction in expected CVD mortality. Price reduction policies would have equitable effects in non-hispanic whites vs. blacks. In comparison, a MMC would be ~ 35% less effective in preventing CVD deaths in non-Hispanic blacks. Conclusions: Price reduction policies (10 or 30%) and a nationwide MMC would each effectively reduce US CVD mortality. A 30% price reduction policy would save most lives and do so most equitably. Deaths prevented via a MMC might reduce substantially after year 1 and also increase disparities. These results inform potential fiscal and population level strategies to reduce CVD mortality in the US.

Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association.

Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

Global Burden of Cardiovascular Disease

Cardiovascular disease (CVD) is the number one cause of mortality world-wide and places a high medical and socioeconomic burden on developing countries. Our understanding of CVD and its evolution over the last 100 years has altered considerably. Reasons for the increased rate of CVD in the developing world include rapid urbanization and the demographic shift known as the modern epidemiologic transition. The case for intervention is based on both major human and economic impacts of CVD. It has been estimated that cost-effective interventions in developing countries with a high burden of CVD could result in a projected 24 million lives saved. This reduction in CVD mortality could reduce economic costs by $8 billion. Approaches to intervention include: 1) cardiovascular health promotion and CVD prevention and 2) action plans advocated by the World Health Organization.

Cardiovascular mortality risk attributable to ambient temperature in China

ObjectiveTo examine cardiovascular disease (CVD) mortality burden attributable to ambient temperature; to estimate effect modification of this burden by gender, age and education level.MethodsWe obtained daily data on temperature and...

WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly: the CHANCES project

Background: Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly.Objective: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y.Design: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model.Results: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I2 = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I2 = not applicable).Conclusion: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.

Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke.

BackgroundControl of modifiable cardiovascular disease (CVD) risk factors has substantially reduced CVD mortality, but risk factor levels in populations may change and need continuous monitoring. This study aims to provide current estimates of the prevalence of these risk factors in Germany according to sex and history of coronary heart disease (CHD) or stroke.MethodsThe analyses were based on data from the German Health Interview and Examination Survey for Adults (DEGS1; age 40–79 years, n = 5101), which is a cross-sectional population-based examination survey. CVD risk factors were defined according to recommendations in the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2012.ResultsThe mean age was 57 years and 52 % were female; 493 participants had prior CHD and 163 participants a prior stroke. The overall prevalence of behavioural risk factors ranged from 17.9 % for high risk alcohol consumption to 90 % for low vegetable intake. Blood pressure ≥ 140/90 mmHg was found in 21 % and 69 % had total cholesterol ≥ 5.0 mmol/l. Only 16 % met the targets for five behavioural factors combined (smoking, physical activity, fruit intake, alcohol intake and obesity), 13 % of those with and 16 % of those without CHD or stroke. The prevalences of most behavioural risk factors were higher among men compared to women.ConclusionsThere is a high prevention potential from modifiable cardiovascular risk factors in the general population aged 40–79 years in Germany and among those with prior CHD or stroke. Risk factors are often co-occurring, are interrelated and require combined educational, behavioral, medical and policy approaches.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1929-5) contains supplementary material, which is available to authorized users.

Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study

Public health strategies to lower cardiovascular disease (CVD) risk involve reducing dietary saturated fatty acid (SFA) intake to ≤10% of total energy (%TE). However, the optimal type of replacement fat is unclear. We investigated the substitution of 9.5-9.6%TE dietary SFAs with either monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on vascular function and other CVD risk factors. In a randomized, controlled, single-blind, parallel-group dietary intervention, 195 men and women aged 21-60 y from the United Kingdom with moderate CVD risk (≥50% above the population mean) followed one of three 16-wk isoenergetic diets (%TE target compositions, total fat:SFA:MUFA:n-6 PUFA) that were rich in SFAs (36:17:11:4, n = 65), MUFAs (36:9:19:4, n = 64), or n-6 PUFAs (36:9:13:10, n = 66). The primary outcome measure was flow-mediated dilatation; secondary outcome measures included fasting serum lipids, microvascular reactivity, arterial stiffness, ambulatory blood pressure, and markers of insulin resistance, inflammation, and endothelial activation. Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation (primary endpoint) or other measures of vascular reactivity. Of the secondary outcome measures, substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure (-4.9 mm Hg, P = 0.019) and reduced E-selectin (-7.8%, P = 0.012). Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol (-8.4% and -9.2%, respectively), low-density lipoprotein cholesterol (-11.3% and -13.6%), and total cholesterol to high-density lipoprotein cholesterol ratio (-5.6% and -8.5%) (P ≤ 0.001). These changes in low-density lipoprotein cholesterol equate to an estimated 17-20% reduction in CVD mortality. Substitution of 9.5-9.6%TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function. However, the beneficial effects on serum lipid biomarkers, blood pressure, and E-selectin offer a potential public health strategy for CVD risk reduction. This trial was registered at www.clinicaltrials.gov as NCT01478958.

Fruit and vegetable consumption and mortality in Eastern Europe: Longitudinal results from the Health, Alcohol and Psychosocial Factors in Eastern Europe study.

BackgroundIt is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet.DesignThe Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia.MethodsDietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models.ResultsAmong 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest vs lowest quartile hazard ratio (HR) was 0.52 (95% confidence interval (CI): 0.28–0.98). For total mortality, significant interaction (p = 0.008) between F&V intake and smoking was found. The associations were statistically significant in smokers, with HR 0.70 (0.53–0.91, p for trend: 0.011) for total mortality, and 0.62 (0.40–0.97, p for trend: 0.037) for cardiovascular disease (CVD) mortality. The association was appeared to be mediated by blood pressure, and F&V intake explained a considerable proportion of the mortality differences between the Czech and Russian cohorts.ConclusionsOur results suggest that increasing F&V intake may reduce CVD mortality in CEE and FSU, particularly among smokers and hypertensive individuals.

Integrated preclinical cardiovascular prevention: a new paradigm to face growing challenges of cardiovascular disease.

Cardiovascular disease (CVD) still represents the leading cause of mortality and morbidity worldwide. Despite considerable improvements in the prognosis of CVD and the significant reduction of CVD mortality obtained during the past half century, patients developing CVD, even though satisfactorily treated, still carry coronary artery disease and remain at risk for advanced CVD. Thus, the healthcare and socioeconomic burden linked to CVD remains high. As a result, more effective CVD prevention strategies remain crucial. 'Population strategies' and 'high-risk' approaches both have limitations and have often been viewed as alternative solutions. This persistent dualism could be overcome with the promotion of integrated prevention strategies based on a systematic evaluation of the total risk of disease, at both a population and an individual level. New approaches are also needed to reach people earlier in the course of the vascular disease and, possibly, to prevent risk factors and reduce CVD clinical manifestation.