Lifestyle-related habits and factors before and after cardiovascular diagnosis: a case control study among 2,548 Swedish individuals

Associations of Pesticide Residue Exposure from Fruit and Vegetable Intake with Ovarian Reserve

BACKGROUND

We previously reported that the intake of fruits and vegetables (FV) known to have high-pesticide contamination in the United States food supply is related to lower sperm counts. Whether the same is true for ovarian reserve is unknown.

OBJECTIVE

We evaluated the relation between FV intake, overall and when taking into consideration pesticide residue status, with the markers of ovarian reserve among reproductive-aged females.

METHODS

Participants were 633 females, 21-45 y, presenting to an academic fertility center. We combined surveillance data from the United States Department of Agriculture and self-reported food intake data to characterize exposure to pesticide residues through FV intake. Poisson and linear regression were used to evaluate associations of high-pesticide residue, low-pesticide residue, and total FV intake with markers of ovarian reserve (antral follicle count [AFC], follicle-stimulating hormone [FSH], anti-Müllerian hormone [AMH]) adjusting for potential confounders.

RESULTS

There was no association of FV intake, overall or according to pesticide residue status, with day 3 FSH or AMH concentrations in multivariable-adjusted models. Regardless of pesticide residue status, FV intake was inversely related to AFC in these models. This pattern was magnified among females who had had a fertility evaluation before joining the study (n = 508). Among females who had not had a fertility evaluation before joining the study (n = 103), however, there were diverging patterns of association for high- and low-pesticide residue FV intake and markers of ovarian reserve. In this group, day 3 FSH was 71.6% (95% confidence interval: 39.5%, 111.2%) higher among females in the highest quintile of high-pesticide residue FV intake than among females in the lowest quintile (P-trend <0.001). Low-pesticide residue and total FV intake were unrelated to day 3 FSH in this group, with differences between top and bottom quintile of intake of -8.3% (-25.8%, 13.3%) and 7.5% (-13.8%, 34.0%), respectively.

CONCLUSIONS

High-pesticide residue FV intake may be related to lower ovarian reserve among females without a history of infertility treatment. Replication in populations with larger sample sizes and less susceptible to reverse causation is important.

Health beliefs mediates the association between the number of non-communicable diseases and preventive behaviors in middle-aged and older adults in southern China

BACKGROUND

The triadic relationship among the number of NCDs, preventive behaviors and health beliefs has not been fully explored, especially the role of health beliefs.

AIMS

To explore the association between the number of NCDs and preventive behaviors, as well as the mediating effect of health beliefs and its dimensions among middle-aged and older adults. Provide scientific evidence for developing targeted behavior intervention.

METHODS

Data from 2095 middle-aged and older adults who completed demographic information, health beliefs and preventive behaviors questionnaire. Mediation analysis was used to explore the association of health beliefs and its dimensions between the number of NCDs and preventive behaviors.

RESULTS

Health beliefs and self-efficacy positively impacted preventive behaviors, whereas perceived severity, while perceived barriers had negative effects. Health beliefs (β = - 0.1809, 95% CI - 0.2658 to - 0.0960) and its dimensions(Perceived barriers:β = - 0.0881, 95% CI - 0.1533 to - 0.0232, self-efficacy: β = - 0.2706, 95% CI - 0.3592 to - 0.1892) partially mediated the associations between the number of NCDs and preventive behaviors. The negative mediation effects indicates that as the number of NCDs increases, preventive behaviors decrease, partly due to a decline in health beliefs and self-efficacy, as well as an increase in perceived barriers (scored inversely, meaning higher barriers). These mediation pathways exhibited modest strength, highlighting the importance of health beliefs on behavior change.

CONCLUSIONS

An increasing number of NCDs is associated with reduced engagement in preventive behaviors. Health beliefs and its dimensions play a partial mediating role in this relationship. Effective intervention targeting health beliefs may help promote positive behavioral changes.

Digital Health Solutions for Cardiovascular Disease Prevention: Systematic Review

BACKGROUND

Cardiovascular disease (CVD) is a major global health issue, with approximately 70% of cases linked to modifiable risk factors. Digital health solutions offer potential for CVD prevention; yet, their effectiveness in covering the full range of prevention strategies is uncertain.

OBJECTIVE

This study aimed to synthesize current literature on digital solutions for CVD prevention, identify the key components of effective digital interventions, and highlight critical research gaps to inform the development of sustainable strategies for CVD prevention.

METHODS

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a comprehensive search in Web of Science, Scopus, and PubMed to identify original English-language studies published between January 2000 and May 2024 that examined primary or secondary CVD prevention through digital solutions. The exclusion criteria included: telephone-only interventions, abstract-only publications, methodology-focused studies without primary data, studies without participants or specific groups, and studies with no follow-up period. The literature search used the string with terms like "digital health," "mHealth," "mobile health," "text message," "short message service," "SMS," "prevention," "prevent," "cardiovascular disease," "CVD," etc. Study bias was assessed using the RoB 2 (Cochrane Collaboration) and the ROBINS-I tool (Cochrane Collaboration). Data on prevention components, prevention types, study design, population, intervention, follow-up duration, personnel, and delivery settings were extracted.

RESULTS

A total of 2871 studies were identified through the search. After excluding ineligible studies, 30 studies remained, including 24 randomized controlled trials. The reviewed digital solutions for CVD prevention focused on baseline assessment (29/30, 97%), physical activity counseling (18/30, 60%), tobacco cessation (14/30, 47%), blood pressure management (13/30, 43%), and medication adherence (10/30, 33%). The technologies used were categorized into 3 types, smartphones and wearables (16/30, 53%), email and SMS communications (12/30, 40%), and websites or web portals (3/30, 10%). The majority of the study outcomes addressed blood pressure (14/30, 47%), exercise capacity (12/30, 40%), weight (12/30, 40%), and lipid profile (11/30, 37%), while fewer focused on nicotine dependence (9/30, 30%), medication use (8/30, 27%), quality of life (7/30, 23%), dietary habits (5/30, 17%), intervention adherence (4/30, 13%), waist circumference (4/30, 13%), and blood glucose levels (2/30, 7%).

CONCLUSIONS

Digital solutions can address challenges in traditional CVD prevention by improving preventive behaviors and monitoring health indicators. However, most evaluated interventions have focused on medication use, quality of life, dietary habits, adherence, and waist circumference. Further studies are needed to assess the long-term impact of more comprehensive interventions on key cardiovascular outcomes.

Association of Glycemic Index, Glycemic Load, and Carbohydrate Intake with Antral Follicle Counts Among Subfertile Females

BACKGROUND/OBJECTIVES

Few studies have investigated the association of dietary glycemic index (GI), glycemic load (GL), and carbohydrate intake with antral follicle count (AFC). This study aimed to investigate the association of total carbohydrate intake and carbohydrate quality, measured by dietary GI and GL, with ovarian reserve assessed by AFC.

METHODS

This study included 653 females from the Environment And Reproductive Health Study who completed AFC and food frequency questionnaire. Of these, 579 female individuals had a quantifiable AFC in both ovaries and were included in the primary analysis. We estimated average GI and GL for each participant from self-reported intakes of carbohydrate-containing foods and divided participants into tertiles. Poisson regression models were used to quantify the relations of GI, GL, carbohydrates, and AFC while adjusting for potential confounders.

RESULTS

Participants had a median age of 35 y. Compared to participants in the lowest tertile of dietary GI, those in the highest tertile had a 6.3% (0.6%, 12.3%) higher AFC (p, trend 0.03) after adjustment for potential confounders. Stratified analyses revealed that the association between GI and AFC was present only among participants who had not undergone infertility evaluations.

CONCLUSIONS

A higher dietary GI was associated with a higher AFC. Subgroup analyses among individuals who had not had a diagnostic evaluation of infertility before joining the study suggest that high-glycemic carbohydrates may be related to PCOM.

Knowledge, attitude and practice towards postoperative management among patients with type A aortic dissection or their relatives: a cross-sectional study in China

OBJECTIVES

To assess the knowledge, attitude and practice (KAP) of patients with type A aortic dissection (AD) or their relatives regarding postoperative management.

DESIGN

Cross-sectional study.

SETTING

The participants were recruited from three hospitals between October 2022 and February 2023.

PARTICIPANTS

Patients diagnosed with type A AD or their relatives.

INTERVENTIONS

No interventions were administered. A structured questionnaire was used to gather the demographic and KAP data from the participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures included the levels of KAP regarding postoperative management.

RESULTS

A total of 483 participants were included. They exhibited poor knowledge (15.52±7.67, possible score: 0-32), positive attitude (31.10±5.86, possible score: 9-45) and poor practice (21.96±4.83, possible score: 8-40) towards postoperative management. The multivariable logistic analysis showed that knowledge scores (OR=1.09, 95% CI 1.05 to 1.12, p<0.001), attitude scores (OR=1.22, 95% CI 1.16 to 1.29, p<0.001) and diagnosis for ≤5 years (OR=1.97, 95% CI 1.23 to 3.15, p=0.005) were independently associated with good practice. The structured equation modelling analysis showed that knowledge directly influenced attitudes (β=0.22, p<0.001) and practice (β=0.15, p<0.001), while attitude directly impacted practice (β=0.52, p<0.001) and mediated the relationship between knowledge and practice (β=0.11, p<0.001).

CONCLUSIONS

Patients with type A AD and their relatives have poor knowledge, positive attitudes and poor practice towards postoperative management. Knowledge might be the prerequisite for practice, and attitudes have a mediating effect.

Decrease in accelerometer assessed physical activity during the first-year post-myocardial infarction: a prospective cohort study

OBJECTIVES

To elucidate physical activity in the first year after myocardial infarction (MI), and to explore differences in various subgroups, delineated by age, participation in exercise-based cardiac rehabilitation (exCR), or restrictions due to the covid-19 pandemic. Secondly, to explore associations between changes in physical activity variables with blood pressure and lipid levels.

METHODS

A longitudinal study in 2017-2023. Physical activity variables were assessed via accelerometers at two- and twelve months post-MI. The intensity was divided into, sedentary, light, moderate, and vigorous-intensity physical activity, according to established cut-offs. Blood pressure and lipids were measured by standardized procedures at the same time points.

RESULTS

There were 178 patients included at baseline, 81% male, mean age of 64 (9 SD) years. Patients spent 72% of their time sedentary, followed by light (19%), moderate (8%), and vigorous physical activity (1%). Patients included during covid-19 restrictions and younger patients had a higher level of moderate-intensity physical activity compared to patients included during non-pandemic restrictions and older patients. At 12-month follow-up, patients overall increased time (1%) in sedentary behavior (p = 0.03) and decreased time (0.6%) in moderate-intensity physical activity (p = 0.04), regardless of participation in exCR or age. There was a positive association between the change in mean physical activity intensity and HDL-cholesterol (p = 0.047).

CONCLUSIONS

Participants had a low fraction of time in moderate-to-vigorous-intensity physical activity two months post-MI, which deteriorated during the first year. This emphasizes the need for improved implementation of evidence-based interventions to support and motivate patients to perform regular physical activity.

The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study

AIMS

The Southern European Atlantic diet (SEAD) is the traditional dietary pattern of northwestern Spain and northern Portugal, but it may resemble that of central, eastern, and western European countries. The SEAD has been found associated with lower risk of myocardial infarction and mortality in older adults, but it is uncertain whether this association also exists in other European populations and if it is similar as that found in its countries of origin.

METHODS AND RESULTS

We conducted a prospective analysis of four cohorts with 35 917 subjects aged 18-96 years: ENRICA (Spain), HAPIEE (Czechia and Poland), and Whitehall II (United Kingdom). The SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and moderate wine consumption. Associations were adjusted for sociodemographic variables, energy intake, lifestyle, and morbidity. After a median follow-up of 13.6 years (range = 0-15), we recorded 4 973 all-cause, 1 581 cardiovascular, and 1 814 cancer deaths. Higher adherence to the SEAD was associated with lower mortality in the pooled sample. Fully adjusted hazard ratios and 95% confidence interval per 1-standard deviation increment in the SEAD were 0.92 (0.89, 0.95), 0.91 (0.86, 0.96), and 0.94 (0.89, 0.99) for all-cause, cardiovascular, and cancer mortality, respectively. The association of the SEAD with all-cause mortality was not significantly different between countries [Spain = 0.93 (0.88, 0.99), Czechia = 0.94 (0.89,0.99), Poland = 0.89 (0.85, 0.93), United Kingdom = 0.98 (0.89, 1.07); P for interaction = 0.16].

CONCLUSION

The SEAD was associated with lower all-cause, cardiovascular, and cancer mortality in southern, central, eastern, and western European populations. Associations were of similar magnitude as those found for existing healthy dietary patterns.

Changes in Physical Activity and Incidence of Nonfatal Cardiovascular Events in 47 153 Survivors of Myocardial Infarction

Background The majority of patients survive the acute phase of myocardial infarction (MI) but have an increased risk of recurrent cardiovascular disease (CVD) events. To be regularly physically active or change activity level is associated with a lower risk of all-cause mortality. The objective was to explore to what extent physical activity (PA) levels or change in PA levels during the first year post-MI was associated with any recurrent nonfatal CVD events and specific CVD events (eg, MI, ischemic stroke, and vascular dementia). Methods and Results This cohort study among MI survivors was based on Swedish national registries between 2005 and 2020. PA levels were self-rated at 2 and 12 months post-MI, and patients were classified into remaining physically inactive, increasing, decreasing, or remaining active. A total of 6534 nonfatal CVD events occurred during 6 years of follow-up among the 47 153 included patients. In fully adjusted analyses, the risk of any nonfatal CVD event was lower (P<0.05) among patients remaining active (37%), increasing (22%), or decreasing (18%) PA level compared with remaining inactive. Compared with remaining inactive, the risk of recurring MI and stroke was lower (P>0.05) among remaining active (41% versus 52%, respectively), increasing (20% versus 35%, respectively), or decreasing PA level (24% versus 34%, respectively). For vascular dementia, patients remaining physically active had an 80% lower risk compared with remaining inactive (P<0.05). Conclusions Remaining physically active or change in PA levels during the first year post-MI was associated with a lower risk of recurrent nonfatal CVD events. This emphasizes the importance of supporting patients to continue to be or become physically active.