Prevalence of multiple cardiovascular disease risk factors among women in the United States, 1992 and 1995: the Behavioral Risk Factor Surveillance System

Geographic Variations in Cardiometabolic Risk Factors in Luxembourg

Cardiovascular disease (CVD) and associated behavioural and metabolic risk factors constitute a major public health concern at a global level. Many reports worldwide have documented different risk profiles for populations with demographic variations. The objective of this study was to examine geographic variations in the top leading cardio metabolic and behavioural risk factors in Luxembourg, in order to provide an overall picture of CVD burden across the country. The analysis conducted was based on data from the nationwide ORISCAV-LUX survey, including 1432 subjects, aged 18-69 years. A self-reported questionnaire, physical examination and blood sampling were performed. Age and sex-adjusted risk profile maps were generated using multivariate Bayesian geo-additive regression models, based on Markov Chain Monte Carlo techniques and were used to evaluate the significance of the spatial effects on the distribution of a range of cardio metabolic risk factors, namely smoking, high body mass index (BMI), high blood pressure, high fasting plasma glucose, alcohol use, high total cholesterol, low glomerular filtration rate, and physical inactivity. Higher prevalence of smoking was observed in the northern regions, higher overweight/obesity and abdominal obesity clustered in the central belt, whereas hypertension was spotted particularly in the southern part of the country. Maps revealed that subjects residing in Luxembourg canton were significantly less likely to be hypertensive or overweight/obese, whereas they were less likely to practice physical activity of ≥8000 Metabolic Equivalent of Task (MET)-min/week. These patterns were also observed at the municipality level in Luxembourg. Statistically, there were non-significant spatial patterns regarding smoking, diabetes, total serum cholesterol and low glomerular filtration rate risk distribution. This comprehensive risk profile mapping showed remarkable geographic variations in cardio metabolic and behavioural risk factors. Considering the prominent burden of CVD this research provides opportunities for tailored interventions and may help to better fight against this escalating public health problem.

Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings & Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

The utility of biomarkers in sorting out the complex patient

Today's patients present with a complexity of illness far more significant than ever before. Risk factors, in particular for cardiovascular, renal, and metabolic diseases, often interact with each other at core pathophysiological levels. Biomarkers are inexpensive tools that may help differentiate disease states in complex patients. Ideal biomarkers are both sensitive and specific to the disease state being examined. Natriuretic peptides are the prototype of ideal biomarkers and are adjuncts for the diagnosis and exclusion of heart failure in the dyspneic patient, especially those presenting with comorbidities such as lung disease. Just as natriuretic peptide levels can be considered the arbiter of congestive heart failure, cardiac troponins are decisive for myocardial necrosis. Novel assays with higher sensitivity will aid in earlier diagnosis, albeit with some decreased specificity. Nevertheless, the patient presenting with comorbidities and atypical symptoms of myocardial infarction will not be arbitrarily sent home. In the future, other novel biomarkers, such as neutrophil gelatinase-associated lipocalin for acute kidney injury, may come to the forefront for diagnosis of disease in the complex patient.

Coronary heart disease in ethnically diverse women: risk perception and communication

OBJECTIVES

To assess perceived vs calculated risk of coronary heart disease (CHD), preferred methods of communicating risk, and the effect of brief educational intervention to improve accurate perceptions of personal risk.

SUBJECTS AND METHODS

Of 1858 women who underwent screening mammography between April and September 2003 at the Columbia University Medical Center in New York, NY, we assessed 125 women with no history of cardiovascular disease who participated in a risk factor screening and education program. Demographic variables were evaluated by interviewer-assisted standardized questionnaires. Absolute 10-year CHD risk was calculated using the Framingham global risk assessment. Perceived 10-year risk and preferred method of communicating risk were evaluated systematically.

RESULTS

Among 110 research participants who were eligible for risk estimation, 59% had a 10-year risk of less than 10%. However, only half of those women accurately perceived their risk as low. After a brief educational intervention, the women's ability to correctly categorize their personal CHD risk improved significantly. Preferred methods to communicate risk varied by level of education and age. Older women (> or = 65 years) and those with a high school education or less were more likely to prefer simple methods of having CHD risk communicated compared with their counterparts.

CONCLUSIONS

These data underscore the need to determine preferences for providing risk information and to test various formats for communicating CHD risk to improve awareness and management of CHD risk factors, especially among women of different age groups and education levels.

Differences in the prevalence of self-reported risk factors for coronary heart disease among American women by race/ethnicity and age: Behavioral Risk Factor Surveillance System, 2001

BACKGROUND

Heart disease is the leading cause of death among American women. Data are lacking on the prevalence of specific risk factors among women of various ethnic groups. We examined data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) for prevalence of self-reported risk factors among women by race/ethnicity and age.

METHODS

The BRFSS is a state-based, random-digit-dialed telephone survey of the civilian non-institutionalized U.S. population aged > or = 18 years. In 2001, a total of 120,035 women reported whether (1) they had ever been told by a healthcare provider that they had high blood pressure, high cholesterol, or diabetes; (2) they smoked; and (3) they were physically inactive. Obesity status was determined by self-reported height and weight. Data were weighted to each state's population.

RESULTS

Among all women, 26.3% had high blood pressure, 23.2% had high cholesterol levels, 21.1% currently smoked, 6.8% had diabetes, 25.4% were obese, and 28.6% physically inactive. Age-adjusted prevalence of high blood pressure was highest among African Americans (AA) (36.3%) and Hawaiian/Pacific Islanders (HPI) (33.7%), and lowest among Asians (18.0%). High blood cholesterol was highest among HPI (23.9%) and white (22.3%) women. American Indian/Alaska Natives (AI/AN) had the highest percentages of diabetes (12.7%) and current smoking (32.4%). Obesity was highest among AA (38.4%) and AI/AN (31.9%) women and lowest among Asian (7.8%) women. Physical inactivity was most common among Hispanic women (42.4%), and least common among Asian women (23.3%). Thirty-eight percent of women had two or more risk factors, ranging from 20.1% of Asian women to 48.8% of AA women.

CONCLUSIONS

A substantial proportion of American women have two or more risk factors for heart disease, and the prevalence of individual risk factors varies by racial/ethnic background. Aggressive efforts to reduce and control risk factors, including population-specific programs, are crucial for limiting the incidence of heart disease.

Using behavioral risk factor surveillance data for heart disease and stroke prevention programs

An effective state heart disease and stroke prevention program must be able to monitor changes in heart disease and stroke risk factors of the state population. The Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey, has been an important source for monitoring health-related factors and evaluating the success of programs. The BRFSS currently includes modules on hypertension and cholesterol screening and awareness, cardiovascular disease preventive practices, and recognition of the signs and symptoms of heart attack and stroke as well as relevant modules on fruit and vegetable intake, physical activity, tobacco use, and diabetes. Publication topics included monitoring risk factors and clinical services, assessing progress toward national goals, assessing health disparities, and health status and health-related quality of life issues. States have used the BRFSS data for monitoring health risks in the state, assessing state and national health objectives, determining and providing data for public health campaigns, providing information for legislative proposals, and providing information that helps to initiate collaboration. Major methodologic issues involve validating self-reported data against direct measurement and assessing the effects of changes in telecommunications. As Centers for Disease Control's (CDC) national heart disease and stroke prevention program and each state health department program develop, state and even local level data will become more important to measure the burden of disease and program impact. State heart disease and stroke prevention programs are encouraged to work closely with state BRFSS coordinators to obtain vital information to measure the burden of heart disease and stroke in their state and to be able to measure program impact on addressing the first and third leading causes of death in the U.S.

Cardiovascular disease in diabetes and the cardiometabolic syndrome: focus on minority women

Diabetes and the cardiometabolic syndrome (CMS) are evolving as global epidemics. In the United States, diabetes affects 20 million people, with 47 million afflicted with the CMS. These disorders have a higher propensity for women, particularly in minority populations with disproportionate increase in cardiovascular disease (CVD) morbidity and mortality. Despite the decline in CVD mortality rates in the general population over the past 35 years parallel to the advances in therapeutic interventions, these rates have increased in women with diabetes. Early preventive measures for CVD risk factor through behavioral and lifestyle modification, smoking cessation, and reduction in psychosocial stressors, as well as pharmacotherapy, are among the currently supported approaches to CVD risk reduction in this high-risk population. In this article, we discuss CVD in people with diabetes and the CMS, with emphasis on minority women, a particularly vulnerable population.

Getting to the heart of social support: a qualitative analysis of the types of instrumental support that are most helpful in motivating cardiac risk factor modification

PURPOSE

This study evaluates the types of instrumental social support that are perceived by patients with coronary artery disease as being most helpful to health behavior modification.

METHODS

A purposive sample of 63 patients with coronary artery disease were enrolled in this qualitative study. Patients described lifestyle changes that they made in an effort to stay healthy and the types of instrumental supports provided by their social networks that helped them make these changes.

RESULTS

The most frequently cited lifestyle changes reported were making dietary changes, reducing responsibilities, keeping doctors' appointments, taking medications, and exercising more. The types of instrumental support that were perceived as being most helpful in making these changes were those that (1) made it easier and practical to engage in healthy behaviors, (2) alleviated stressful situations, and (3) facilitated the process of receiving medical care.

CONCLUSIONS

These findings identify practical ways in which social networks can promote risk factor modification and ultimately contribute to improving coronary artery disease outcomes.

Self-report of high cholesterol: determinants of validity in U.S. adults

BACKGROUND

Hypercholesterolemia is a major cardiovascular risk factor, and cholesterol awareness is important in both clinical practice and in public health. We evaluated the validity of self-reported hypercholesterolemia and identified determinants of validity.

METHODS

The study design was a cross-sectional survey, from 1988 to 1994, of adult participants (N=8236) from the Third National Health and Nutrition Examination Survey for whom self-report of hypercholesterolemia and serum measurement were available. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for self-reported hypercholesterolemia were calculated using total cholesterol > or =5.17 mmol/L (200 mg/dL) and/or taking cholesterol-lowering medication as the criterion standard.

RESULTS

Overall test characteristics for self-report were sensitivity, 51%; specificity, 89%; PPV, 87%; and NPV, 55%. Sensitivity of self-report was higher among older subjects and non-Hispanic whites, specificity was higher among subjects with >12 years of education, PPV was higher in older subjects, and NPV was higher in younger subjects and in those with >12 years of education. Using higher cholesterol thresholds to define hypercholesterolemia led to higher sensitivity, lower specificity, lower PPV, and higher NPV. Sociodemographic and anthropometric predictors of validity were identified by logistic regression.

CONCLUSIONS

Due to low sensitivity, self-reported hypercholesterolemia should be used with caution, both during the patient encounter and for surveillance of trends in hypercholesterolemia in the absence of measured cholesterol levels. Specificity is consistently much higher than sensitivity. The high PPV may be of use in certain clinical situations. Such validation studies should form the foundation for future research based on self-report.

Adrenal response to angiotensin II in black hypertension: lack of sexual dimorphism

Adrenal responsiveness to angiotensin (Ang) II is markedly blunted in black hypertensive patients compared with white hypertensive patients. One characteristic of this blunted adrenal response in whites is a powerful sexual dimorphism: premenopausal white women rarely show blunted responses. This abnormality, most evident when the system is activated by a low-salt diet, is a cardinal feature of the syndrome of nonmodulation, affecting a large percentage of white hypertensive patients. Nonmodulation is also marked by an increase in cardiovascular risk beyond that from hypertension itself. This study investigated whether young black women are likewise spared its expression or whether the adrenal unresponsiveness common among black hypertensive patients is unaccompanied by a gender bias. We compared the adrenal response to Ang II in 382 hypertensive patients (313 white, 69 black; 238 male, 144 female). Ang II was infused when subjects were in balance on a 10-mmol Na(+) intake. As anticipated, white hypertensive patients showed a very strong sexual dimorphism, with women having twice the aldosterone response of men (P=0.0001). Blacks, on the other hand, showed no gender difference (P=0.9). Increasing age had the dramatic effect of reducing responsiveness in white women but not in blacks. Young black women demonstrated the same blunting of adrenal responsiveness as older black women and black men of all ages. Mechanisms protecting against a blunted adrenal response to Ang II in young white women are absent in blacks. These differences may contribute to the markedly increased prevalence of hypertension in young black women.

Prevalence and clustering of cardiovascular risk factors among healthy adults in a Chinese population: the MJ Health Screening Center Study in Taiwan

OBJECTIVE

To gain insight into the prevalence and clustering of multiple cardiovascular risk factors in a healthy Chinese adult population in Taiwan.

DESIGN

A cross-sectional study was carried out in 1996.

SUBJECTS

A total of 46,603 subjects (23,485 men and 23,118 women) who were aged 20--59 y and attended a private health screening center for health examination of their own volition.

MEASUREMENTS

Multiple cardiovascular risk factors including cigarette smoking, overweight (23 kg/m(2)< or =body mass index (BMI)<25 kg/m(2)) and obesity (BMI> or =25 kg/m(2)), lipid disorder (a ratio of total cholesterol level to the level of high density lipoprotein cholesterol>5 or use of lipid-lowering drugs), hypertension (systolic blood pressure> or =140 mmHg or diastolic blood pressure> or =90 mmHg or use of anti-hypertensive medications), and diabetes mellitus (fasting serum plasma glucose level> or =126 mg/dl or use of anti-diabetic medications) were determined.

RESULTS

In comparison to women, men had a higher prevalence of current smoking (42.1 vs 5.6%), overweight (25.1 vs 17.1%) and obesity (33.1 vs 21.5%), lipid disorder (45.1 vs 19.6%), hypertension (17.4 vs 13.2%), as well as diabetes mellitus (4.1 vs 3.4%). The prevalence of men or women having two or more of the cardiovascular risk factors of interest was 54.3 and 21.7%, respectively. With advancing age, the prevalence of risk factors became greater for both genders. More importantly, the clustering of risk factors increased monotonically with increasing BMI levels for men and women.

CONCLUSIONS

The prevalence and clustering of cardiovascular risk factors are commonplace in this healthy Chinese adult population. Considering the significant association between clustering of risk factors under study and BMI levels, this study gives an indication that population-based multifactorial interventions may work out favorably for specific groups.

Multiple risk factors and population attributable risk for ischemic heart disease mortality in the United States, 1971–1992

The objective of this study was to assess the associations and population attributable risks (PAR) of risk factor combinations and ischemic heart disease (IHD) mortality in the United States. We used logistic regression models to assess the association of risk factors with IHD in the First National Health and Nutrition Examination Survey (1971-1974) and Epidemiologic Follow-up Study (1982-1992) among white and black men and women. We examined eight modifiable risk factors: hypertension, elevated serum cholesterol, diabetes, overweight, current smoking, physical inactivity, depression, and nonuse of replacement hormones. Risk factors associated with IHD mortality were the same among white and black men (i.e., age, education, smoking, diabetes, hypertension, and serum cholesterol). Age, education, smoking, diabetes, and hypertension were the risk factors among white and black women. Physical inactivity, nonuse of replacement hormones, serum cholesterol, and overweight were the additional risk factors among white women. Adjusted for demographic risk factors, overall PARs for study risk factors were 41.2% for white men, 60.5% for white women (with five risk factors only), 49.2% for black men, and 71.2% for black women. Much IHD mortality attributable to individual risk factors is caused by those factors in combination with other risk factors; relatively little mortality is attributable to each risk factor in isolation. Analysis that does not examine risk factor combinations may greatly overestimate PARs associated with individual risk factors.