Self-reported Cardiovascular Risk Research Articles

Exploring the link between self-rated poor oral health and cardiovascular risk: a cross-sectional study using SCORE2

BackgroundPoor oral health is associated with several non-communicable diseases including cardiovascular disease. There are also well-known associations between lifestyle habits, cardiovascular disease, and oral health. In Europe, SCORE2 is a recommended instrument for assessing an individual's risk of a cardiovascular event within 10 years. However, no previous studies have examined the association between self-rated oral health and SCORE2.Using data from a cohort of 40- and 50-year-old individuals in Swedish primary healthcare, the present cross-sectional study investigated the association between self-reported poor oral health and cardiovascular risk assessed with targeted health dialogues and SCORE2.Methods40- and 50-year-old individuals registered at 180 primary healthcare centres in southern Sweden were invited to participate in targeted health dialogues. Self-reported oral health and lifestyle habits were collected using a web questionnaire. Anthropometric measurements, blood pressure, and blood tests were collected. Data were analysed using group comparisons and regression models.ResultsA total of 9499 individuals agreed to participate in the study and completed a targeted health dialogue between January 1, 2021, and January 10, 2024. The group who reported poor oral health had a higher proportion of high waist-hip ratio, insufficient physical activity, poor eating habits and tobacco use compared with individuals with good self-reported oral health. Significantly higher blood pressure was also noted, as well as elevated plasma glucose levels and low-density lipids. The regression analysis showed a significant association between poor self-rated oral health and cardiovascular risk by SCORE2 among both men and women. In the fully adjusted model, the association remained significant only for women.ConclusionsOur results indicate that individuals with poor self-rated oral health have higher cardiovascular risk and should be offered screening for unhealthy lifestyle habits to prevent cardiovascular events. We suggest that primary healthcare and dental care cooperate in identifying individuals at risk and intervene using evidence-based methods to prevent and address cardiovascular and oral diseases.Trial registrationClinicalTrials.gov registration number. NCT04912739. Registration date 2021–06-03, retrospectively registered. Ethical approval was secured from the Swedish Ethical Review Authority (registration number 2020–02689 with subsequent amendments).

A digital tool for self-reporting cardiovascular risk factors: The RADICAL study.

A digital tool for self-reporting cardiovascular risk factors: The RADICAL study.

Isokinetic assessment of muscle function according to physical activity level and cardiovascular risk in asymptomatic adults aged 20 to 80 years

As limb muscle function is age- and sex-related, both elbow and knee isokinetic muscle functions and their main predictors, such as physical activity level and cardiovascular risk factors, should be determined. We aimed to describe the percentiles of normality of the isokinetic muscle function of the knee and elbow joints. Secondarily, we developed equations to predict muscle function in apparently healthy adults aged 20-80 years, including cardiovascular risk factors. We conducted a cross-sectional study with 1,334 adults. We collected sociodemographic data, self-reported cardiovascular risk, anthropometry, body composition (bioelectrical impedance), moderate-to-vigorous physical activity (MVPA) (triaxial accelerometry), and isokinetic muscle function. Multiple regression analysis was used to develop equations to predict isokinetic muscle function. Percentiles of normality for muscle function were described by sex and age (20-39, 40-59, and >60 years). The models accounted for 49.6-70.9% of the total variability of muscle function, but MVPA and cardiovascular risk slightly influenced the coefficient of determination (additional ΔR2=0.003-0.006). Demographic and anthropometric variables were more relevant predictors of isokinetic muscle function (R2=0.50-0.70) than MVPA and cardiovascular risk. Even though they correlated with muscle function, cardiovascular risk and MVPA failed to explain the variability of muscle function largely determined by anthropometric and sociodemographic data. The percentile values and equations developed will help in interpreting the isokinetic muscle function and improve its clinical use.

Age- and sex-dependent associations between self-reported physical activity levels and self-reported cardiovascular risk factors: a population-based cross-sectional survey

BackgroundThe amount of regular physical activity (PA) can modulate the prevalence of traditional risk factors for cardiovascular disease (CVD) such as obesity, systemic hypertension, hypercholesterolemia, and type 2 diabetes (T2D). However, how different PA levels either below (< 600 MET min/week), within (600–1200 MET min/week), or above (> 1200 MET min/week) the range of the minimal WHO recommendations impact the age- and sex-dependent prevalence of these risk factors remains to be elucidated.MethodsThis cross-sectional study was performed to evaluate these relationships using population-based self-reported data collected in a central European country (Austria, 2019). The sample included a total of 15,461 persons (7166 males: 16–95 + years, BMI 26.6 ± 4.4; 8295 females: 16–95 + years, BMI 25.1 ± 5.0). Besides various lifestyle factors (e.g., dietary habits, smoking, and alcohol consumption), variables of particular interest were the age- and sex-dependent amount of weekly PA and prevalence of risk factors for CVD. Sex-specific logistic regression analyses were applied to estimate adjusted odds ratios (ORs) for the associations between self-reported PA and risk factor prevalence.ResultsRelatively small beneficial effects were found regarding the prevalence of risk factors for CVD when achieving PA levels corresponding to 600–1200 MET min/week as compared to those who did not meet these recommendations. However, exceeding the WHO recommendations provided much more pronounced benefits, especially in younger and older age groups. Adjusted ORs revealed that high volumes of PA (> 1200 MET min/week) were associated with a 32–43% reduction in the prevalence of obesity and T2D compared to those who did not achieve the WHO recommendations (< 600 MET min/week), as well as with a lower prevalence of systemic hypertension only in women and a lower prevalence of hypercholesterolemia only in men.ConclusionsExceeding minimal WHO recommendations for PA promises large beneficial effects, particularly on the prevalence of obesity and T2D. Demonstrated sex differences in PA levels and their association with cardiovascular risk factors may provide an important basis for preventive health counseling.

Effects of Occupational and Leisure-Time Physical Activity on the Risk of Dementia: Results From the Copenhagen City Heart Study.

Leisure-time physical activity (LTPA) decreases the risk of dementia, whereas occupational physical activity (OPA) possibly increases the risk. Yet, previous findings are mixed. We therefore aimed to investigate the effect of LTPA and OPA, respectively, on dementia among men and women. In this observational, longitudinal study, we used data from the second wave of a population-based cohort from the municipality of Copenhagen as baseline. Data were collected in 1981-1983, and 10 343 participants were followed until the end of 2016. LTPA and OPA were self-reported, and information on dementia diagnoses and redemption of dementia medication was obtained at an individual level from national health registers. We used Poisson regression to analyze the association between LTPA/OPA and dementia and adjusted for self-reported age, socioeconomic factors, stress, and cardiovascular risk factors (smoking, alcohol, body mass index, and blood pressure). A higher level of LTPA was associated with a lower dementia risk among men, but we found no clear association among women. OPA and dementia were not associated among men, but occupationally active women who reported OPA in terms of walking, lifting, and heavy work had a higher risk of dementia than women with sedentary jobs. This study supported earlier findings of a protective effect of LTPA on dementia among men. Women in physically demanding jobs possibly have a higher risk of dementia, yet this finding warrants further investigation in future studies.

Impact of the COVID-19 pandemic from the perspective of patients with cardiovascular disease in Australia: mixed-methods study

ObjectivesThe study explored the perceived impacts of COVID-19 and its associated policies and social restrictions on health, self-management and access to healthcare.DesignCross-sectional observational (online survey) and qualitative study (semi-structured interviews...

Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups.

Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.

Self-Reported Cardiovascular Risk Factors among Medical Students

Cardiovascular diseases are the leading cause of death in the world, with smoking, diabetes, high blood pressure, dyslipidemia and a sedentary lifestyle being among the main risk factors. The objective of this study was to evaluate the self knowledge about cardiovascular risk factors among medical students. Methodology: Observational and cross-sectional study on students from the first to the eighth semester of medicine using anonymous questionnaires containing questions about cardiovascular risk factors. Results: A total of 288 students paticipeted. There was a higher percentage of self-declared emotional stress (p&lt;0.001), and high blood pressure (p=0.007), family history of coronary heart disease (CAD) or stroke (0.049) in the female group; The group under 20 years old practiced more physical activity (p=0.023) and reported a balanced diet (p=0.047), the age group between 20 and 29 years old reported a higher percentage of smoking (p=0.001) and alcohol consumption (p=0.048), those older than 30 years old reported a higher knowledge about family history of CAD or stroke.

Reliability and Validity of Self-Reported Vascular Risk Factors: Hypertension, Diabetes, and Heart Disease, in a Multi-Ethnic Community Based Study of Aging and Dementia.

Queries for the presence of cardiovascular and cerebrovascular risk factors are typically assessed through self-report. However, the reliability and validity of self-reported cardiovascular and cerebrovascular risk factors remain inconsistent in aging research. To determine the reliability and validity of the most frequently self-reported vascular risk factors: hypertension, diabetes, and heart disease. 1,870 individuals aged 65 years or older among African Americans, Caribbean Hispanics, and white non-Hispanic individuals were recruited as part of a community study of aging and dementia. We assessed the reliability, validity, sensitivity, specificity, and percent agreement of self-reported hypertension, diabetes, and heart disease, in comparison with direct measures of blood pressure, hemoglobin A1c (HbA1c), and medication use. The analyses were subsequently stratified by age, sex, education, and ethnic group. Reliability of self-reported hypertension, diabetes, and heart disease was excellent. Agreement between self-reports and clinical measures was moderate for hypertension (kappa: 0.58), good for diabetes (kappa: 0.76-0.79), and moderate for heart disease (kappa: 0.45) differing slightly by age, sex, education, and ethnic group. Sensitivity and specificity for hypertension was 88.6% -78.1%, for diabetes was 87.7% -92.0% (HbA1c ≥6.5%) or 92.7% -92.8% (HbA1c ≥7%), and for heart disease was 85.8% -75.5%. Percent agreement of self-reported was 87.0% for hypertension, 91.6% -92.6% for diabetes, and 77.4% for heart disease. Ascertainment of self-reported histories of hypertension, diabetes, and heart disease are reliable and valid compared to direct measurements or medication use.

Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort

Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort

PS-P04-1: RISK FACTOR PROFILE AND LACK OF TREATMENT INTENSIFICATION AS A MAIN FACTOR OF INCREASED STROKE MORTALITY IN BULGARIA

Objective: Bulgaria is one of the leading countries in terms of premature mortality due to stroke with 6406,4 years of life lost per 100000 (95% CI 5211,7 to 7763,4) according to the data from Global Burden of Disease for 2019. In the same year The May Measurement Month (MMM) initiative was implemented in the country aiming to raise hypertension awareness and control. The aim of the study was to identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 3678 participants during MMM2019 campaign. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2019. Hypertension was defined as a raised BP (systolic BP &gt; 140 mmHg or diastolic BP &gt; 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Overall we notice a relatively high proportion of participants with a previous stroke 237 (6.4%). Stroke survivors were older (69 vs 58,1, p &lt; 0.001), with higher levels of systolic BP (139,4 vs 134,9 mmHg), but lower diastolic BP (80,2 vs 82,5 mmHg) and significantly more frequent concomitant coronary and peripheral arterial diseases, diabetes or heart failure (p &lt; 0.001 for all). The proportion with previous atrial fibrillation was also higher among previous stroke patients 13,9 vs 5,6%. Stroke mortality increased, on average, by 680 per 100,000 per 1% increase in the proportion of individuals with raised BP (p = 0.006) and by 909 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.012). The corresponding years of life lost due to ischemic stroke were 736 (p = 0.015) and 172 per 100000 (p = 0.0005) due to hemorrhagic stroke per 1% increase in proportion with suboptimally treated BP. Conclusions: There was a significant association between national stroke mortality from GBD and the proportions of participants with raised BP and of hypertensives treated but uncontrolled in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means not only of screening for hypertension, but of improving control of the patients already treated. The data presented gives rational for using estimates to inform policy and to start national campaign in order to change the existing tendencies.

Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study.

BackgroundThere are currently more than 200 million smartphones in Brazil. The potential of mobile technologies for favorable changes in health behavior such as physical activity has been previously described in the literature. Results of surveys in developed countries indicate that applications (APPs) are developed for people who are better educated, younger, and with higher incomes compared to non-users. However, the profile of users in developing countries like Brazil is not well-known. Understanding the profile of APP users might ease the development turned to physically inactive people and those at higher cardiovascular risk. Furthermore, the physiological and functional factors associated with the use of such APP are unknown.ObjectivesTo characterize the profile of APP users to monitor the physical activity level (PAL) and assess the demographic, socioeconomic, clinical, physiological, and functional characteristics associated with the use of smartphone APPs to monitor physical activity in Brazilian adults.MethodsWe assessed 176 asymptomatic men and 178 women (43 ± 12 years; 27 ± 5 kg/m2). We initially asked participants about their current use of a smartphone APP containing PAL monitoring functionality, such as exercise session logs and/or step counts. In a cross-sectional design, we investigated schooling, socioeconomic status (Critério Brasil), and classic self-reported cardiovascular risk factors. We evaluated several physiological and functional variables such as maximum O2 consumption on a treadmill (VO2 max), blood pressure, body composition (bioelectrical impedance), handgrip strength, and isokinetic muscle strength of the dominant lower limb. Participants used a triaxial accelerometer for 7 days to quantify daily physical activity. We also assessed health-related quality of life (WHOQOL BREF), perceived stress (PSS14 Scale), and the built environment (NEWS Scale). We compared continuous variables using the Student's t-test and categorical variables using the χ2 test, between APP users and non-users. After univariate analysis, we included the main variables associated with the use of APP in a multiple logistic regression model.ResultsOne hundred and two participants (28.3%), unrelated to gender, reported using a smartphone APP for physical activity at the time of assessment. Except for perceived stress and the built environment that were not associated with the use of APP, users of APP were younger and had higher education, lower cardiovascular risk, better socioeconomic status, a better quality of life, better cardiorespiratory function, better body composition, greater physical fitness and more moderate to vigorous physical activity in daily life. The results of the multiple logistic regression showed that age, hypertension, VO2 max, socioeconomic status (Critério Brasil), and quality of life (WHOQOL BREF total score) were the variables most significantly associated with the use of the APP.ConclusionsOur results indicate that smartphone APPs to monitor physical activity are developed for younger adults with better socioeconomic status, lower cardiovascular risk, higher quality of life, and greater cardiorespiratory fitness. Greater efforts are needed to develop a science-based APP for people who most need this technology, enabling greater potential to prevent undesirable health outcomes in asymptomatic adults.

INCIDENT ATRIAL FIBRILLATION AND THROMBO-EMBOLIC RISK – A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA

Objective: Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The use of automatic devices for blood pressure measurement with AFIB technology during May Measurement Month (MMM) give a unique possibility to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF using a validated BP machine and its feasibility to identify new cases. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from participants during MMM2019 campaign in Bulgaria. BP was measured using a Microlife WatchBP Office BP monitor with patented AFIB algorithm in 2075 participants. A regression analysis was performed excluding all the subjects with previous AF to establish clinical factors significantly associated with incident AF. Results: The mean age of participants was 62.11 ± 14.9 years, 65% were female and 66% with known hypertension with a median duration of 11 years. Past history of AF was present in 223 (10,7%) and during the campaign additional 83 (4%) cases were identified. Among 306 subjects with AF, low-risk patients (i.e. CHA2DS2VASc score 0 in males or CHA2DS2VASc score 1 in females) was found in 5 (3.8%) males and in 13 (7.6%) females, respectively. We didn’t found any significant difference in classical risk factors or cardiovascular diseases between the groups of previous and incident AF and both groups had identical CHA2DS2VASc score 3.56 vs 3.62, p = 0.8. On multivariable logistic regression CHF (P = 0.011), age 65–74 (P &lt; 0.001) and = &gt;75 (P &lt; 0.001), diabetes (P &lt; 0.01), previous stroke (P &lt; 0.01) or vascular disease (P &lt; 0.01), and prolonged history of hypertension with uncontrolled systolic BP during the screening (P = 0.012) or home systolic BP (P = 0.05) were significantly associated with incident AF. Conclusions: The use of automatic devices for BP measurement with AFIB technology is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this arrhythmia.

Association between self-reported sleep characteristics and cardiovascular risk factors: weight status and physical activity matter

We analyzed the association between self-reported sleep characteristics and the prevalence of major cardiovascular disease (CVD) risk factors attending to the potential effect of physical activity (PA) and weight status. A large cohort of Spanish workers (n = 527,662; 32% female, 44 ± 9yrs) participated in this cross-sectional study. We assessed participants’ self-reported indicators of sleep quantity (short [<6 h/d], normal [6-9 h/d] or long [>9 h/d]) and quality (unrestful or restful, and difficulties or not falling asleep) as well as the presence of major CVD risk factors (diabetes, hypertension and hypercholesterolemia); and categorized participants based on PA (‘inactive’, ‘insufficiently active’ or ‘regularly active’) and weight status (normal weight, overweight or obesity). Impairments in any sleep quantity or quality indicator, respectively, were significantly (p < 0.05) associated with the prevalence of at least one CVD risk factor. Yet, being physically active and having normal weight markedly attenuated these associations. Thus, individuals with poor sleep quantity or quality but who were physically active and had normal weight showed no different risk of hypertension or diabetes than those with normal sleep characteristics, albeit the former still presented a higher risk of hypercholesterolemia if they reported short sleep (+5% vs. normal duration, p = 0.047), unrestful sleep (+9% vs. restful, p < 0.001) or having difficulties to fall asleep (+48% vs. no difficulties, p < 0.001). The present findings support the need for maintaining optimal PA levels and weight status in order to minimize the CVD risk associated with poor sleep quantity or quality.

Prevalence of Self-Reported Venous Thromboembolism and Cardiovascular Risk Factors in Patients with Ulcerative Colitis: The GETAID FOCUS Study.

Patients with inflammatory bowel disease have an increased risk of venous thromboembolism (VTE) and cardiovascular disease (CVD). The study aims to determine the prevalence of CVD and VTE risk factors in a large population of patients with ulcerative colitis (UC). We conducted a cross-sectional study in 33 French and Belgium referral centers. A questionnaire was developed to explore self-reported risk factors for VTE and CVD, based on the latest international guidelines, in consecutive patients with UC. A total of 1071 patients with UC were included. There were 539 women (50.3%), and the median age of patients was 44years [32; 57]. The median disease duration was 10years [6; 17]. In the cohort, 36.5% of patients reported no cardiovascular risk factor (CVRF) and 72% had ≤ 1 CVRF. Regarding cardiovascular risk markers (CVRM) 36.9% of patients reported no CVRM and 78% had ≤ 1 CVRM. Of the 1071 patients, 91.3% of patients reported no VTE strong risk factor and 96% had ≤ 1 VTE moderate risk factor. This is the first cohort specifically designed to assess both VTE and CVD risks in patients with UC. More than one third of patients with UC had no CVRF and around three quarters had ≤ 1 CVRF. In addition, more than nine out of ten patients had no VTE strong risk factor and ≤ 1 moderate risk factor. Physicians should be aware of these factors in their patients.

Abstract 10196: A History of Dengue Infection is Associated with Lower Global Longitudinal Strain by Speckle Tracking Echocardiography in Men from the Amazon Basin

Background: Studies have shown that infection with dengue virus may affect the heart in the acute phase, and that men possibly have a higher risk of severe dengue complications. No studies have investigated if dengue infection also may affect long-term cardiovascular function. Hypothesis: We hypothesized that adults from the general population with a self-reported history of dengue infection had lower myocardial strain compared to controls. Furthermore, that strain could be even lower in men with a history of dengue. Methods: We enrolled individuals from the general population in the Amazon Basin. History of self-reported dengue infection and cardiovascular risk factors were collected by questionnaires. All persons underwent physical examination and bedside echocardiography. We analyzed global longitudinal strain (GLS) and circumferential strain (GCS). Results: We included 529 individuals (mean age 39±15 years, 39% men) of which 49% (n=259) had a history of dengue infection. A history of dengue infection was not associated with lower GLS (Figure A). However, when stratifying the population by sex, dengue infection in men was significantly associated with lower GLS (OR 1.13 per 1% decrease [95%CI 1.02 to 1.24], P=0.014) and GCS (OR 1.06 per 1% decrease [95%CI 1.01 to 1.12], P=0.030), whereas no relationship was found for women (Figure A). In multivariable models adjusted for age, blood pressure, heart rate, creatinine, smoking habits, diabetes and income, the association with GLS (OR 1.13 [95%CI 1.02 to 1.25], P=0.016) and GCS (OR 1.07 [95%CI 1.01 to 1.14], P=0.015) remained significant in men (Figure B and C). We found no significant relationship with left ventricular ejection fraction. Conclusion: Dengue may potentially have long term effects on left ventricular systolic function as measured by strain in men. This calls for further studies to assess long-term cardiac sequelae and subclinical myocardial impairment in individuals with a history of dengue.

Cardiovascular Risk Factor and Disease Measures from the Population Assessment of Tobacco and Health (PATH) Study.

Background: Cardiovascular disease is a key health condition associated with tobacco use; however, clinical measures are not typically possible in population-based studies. In this paper, we assess the reliability and validity of self-reported cardiovascular risk factors and diseases in a large nationally representative study of tobacco use and health outcomes. Methods: This paper analyzes self-reported cardiovascular risk factors and disease among adults age 40 years and older based on U.S. nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study. Prevalence of cardiovascular risk factors (self-reported high blood pressure, high cholesterol, diabetes and family history of premature heart disease, BMI ≥ 35, and tobacco use) and cardiovascular disease (self-reported heart attack, stroke and/or congestive heart failure (CHF)) were considered along with ratings of physical functioning, fatigue, and general health. Results: Self-reported cardiovascular disease was found to be associated with functional health measures (walking up a flight of stairs) and general ratings of health. Prospective analyses found strong correlations between sequential data collection waves for history of hypertension, elevated cholesterol and CHF, while more modest correlations were noted for stroke and heart attack. The overall prevalence of cardiovascular disease and hypertension was comparable to those from the National Health and Nutrition Examination Survey (NHANES). Conclusions: These analyses suggest reliability and concurrent validity regarding self-reported cardiovascular risk factors and disease assessed in the PATH Study.

Lessons Learned from Development of a Mobile App for Cardiovascular Health Awareness

Cardiovascular disease (CVD) is a major public health concern in the United States. In response to the federally sponsored Million Hearts Risk Check Challenge, a team of programmers, software developers, health-information technologists, and clinicians in an integrated healthcare system in Wisconsin collaborated to develop Heart Health MobileTM (HHM), designed to improve awareness of cardiovascular disease risk and promote risk factor control among users. This paper outlines the development processes and highlights key lessons learned for mobile health applications. An agile project management methodology was used to dedicate adequate resources and employ adaptive planning and iterative development processes with a self-organized, cross-functional team. The initial HHM iOS app was developed and tested, and after additional modifications, gamified and HTML 5 versions of the app were released. The development of an iOS app is low in cost and sustainable by a healthcare system. Future app modifications to enhance data security and link self-reported cardiovascular risk assessment data to patient medical records may improve performance, patient relevance, and clinician acceptance of HHM in the primary-care setting. Legal and institutional barriers regarding the capture and analyses of protected health information must be mitigated to fully capture, analyze, and report patient health outcomes for future studies.

THE ASSOCIATIONS BETWEEN HYPERTENSION AND STROKE FROM MAY MEASUREMENT MONTH AND BETWEEN NATIONAL HYPERTENSION PARAMETERS WITH STROKE MORTALITY FROM THE GLOBAL BURDEN OF DISEASE

Objective: To characterise the association between stroke history and hypertension from the 2017 and 2018 May Measurement Month (MMM) blood pressure (BP) screening campaigns. To identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 2,515,578 participants in 95 countries. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2017. Hypertension was defined as a raised BP (systolic BP &gt; = 140 mmHg or diastolic BP &gt; = 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Multiple imputation using chained equations was performed to estimate mean BP readings where missing. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Low-middle-SDI countries in MMM had the highest age-sex standardised proportion of participants with a previous stroke (4.9%), compared with high-middle-SDI countries (1.4%). Globally, individuals with a history of stroke had a significantly higher mean BP than those without (6.6/1.7 mmHg higher, p &lt; 0.001). Amongst post-stroke participants, antihypertensive medication appeared to mitigate the impact of lifestyle factors on the odds of hypertension. Stroke mortality increased, on average, by 34 per 100,000 per 1% increase in the proportion of untreated individuals with raised BP (p = 0.006) and by 22 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.003). Stroke mortality decreased, on average, by 14 per 100,000 per 1% increase in the proportion of hypertensives treated (p = 0.01). Conclusions: Our study found suboptimal BP control among participants with a previous stroke globally, especially in low SDI countries. There was a significant association between national stroke mortality from GBD and the proportions of participants with raised or uncontrolled BP and of hypertensives treated in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means of screening for hypertension.

Factors affecting the fruit and vegetable intake in Nepal and its association with history of self-reported major cardiovascular events

BackgroundThe World Health Organization recommends consumption of a minimum of 400 g of fruits and vegetables per day for prevention of cardiovascular disease. Low fruit and vegetable intake is associated with an increased risk of stroke by 11% and ischemic heart disease by 31%. The present study aims to explore factors affecting the fruit and vegetable intake in Nepal and its association with history of self-reported major cardiovascular events (myocardial infarction and stroke).MethodData for this cross-sectional study were collected as part of the study “Community Based Management of Hypertension in Nepal” initiated in the Lekhnath Municipality in 2013. Demographic and nutrition information were collected using the WHO STEPwise approach to a surveillance tool. Descriptive statistics identified the frequency and percentage of fruit and vegetable intake. A Chi-square test examined the association between fruit and vegetable intake and history of self-reported cardiovascular events, socio-demographic and cardiovascular risk factors. Binary logistic regression analysis identified odds ratio with 95% confidence intervals between fruit and vegetable intake and history of self-reported cardiovascular events.ResultsThe mean and median intake of fruits and vegetables were 3.3 ± 0.79 and 3 servings respectively. Of the 2815 respondents, 2% (59) reported having a history of major cardiovascular events. The adjusted odds of having a history of major cardiovascular events was 2.22 (95%CI, 1.06–4.66) for those who consumed < 3 servings compared to those who consumed ≥3 servings of fruits and vegetables a day.ConclusionThe respondents who consumed < 3 servings of fruits and vegetables a day had higher odds of a history of major cardiovascular events in comparison to those who consumed ≥3 servings. This finding may carry a policy recommendation for those settings where the current recommendation of having ≥5 servings of fruits and vegetables a day is not possible. Our findings also suggest that surviving a major cardiovascular event was not enough in itself to modify nutritional intake. As many Nepali consumes low amount of fruits and vegetables, appropriate measures should be taken to increase this consumption to prevent cardiovascular morbidity and mortality.