scholarly journals Stroke Disparities: From Observations to Actions

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3392-3405 ◽  
Author(s):  
Ralph L. Sacco
Keyword(s):  
Risk Factor ◽  
Ethnic Groups ◽  
Cardiovascular Health ◽  
Disease Incidence ◽  
Human Populations ◽  
Stroke Incidence ◽  
Ideal Cardiovascular Health ◽  
Awareness Campaigns ◽  
Study Results ◽  
Improvement Programs

Numerous epidemiological studies have demonstrated stroke disparities across race and ethnic groups. The goal of the NOMAS (Northern Manhattan Study) was to evaluate race and ethnic differences in stroke within a community with 3 different race-ethnic groups. Starting as a population-based incidence and case-control study, the study evolved into a cohort study. Results from NOMAS have demonstrated differences in stroke incidence, subtypes, risk factors, and outcomes. Disparities in ideal cardiovascular health can help explain many differences in stroke incidence and call for tailored risk factor modification through innovative portals to shift more diverse subjects to ideal cardiovascular health. The results of NOMAS and multiple other studies have provided foundational data to support interventions. Conceptual models to address health disparities have called for moving from detecting disparities in disease incidence, to determining the underlying causes of disparities and developing interventions, and then to testing interventions in human populations. Further actions to address race and ethnic stroke disparities are needed including innovative risk factor interventions, stroke awareness campaigns, quality improvement programs, workforce diversification, and accelerating policy changes.

Abstract P113: The Probability of Maintaining Ideal Levels of Glucose in US Populations: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the National Health and Nutrition Examination Survey (NHANES)

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Christy L Avery ◽  
Donglin Zeng ◽  
Sujatro Chakladar ◽  
Katelyn M Holliday ◽  
Dan Yu Lin ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Cardiovascular Health ◽  
Markov Models ◽  
Fasting Glucose ◽  
Heart Association ◽  
Health Study ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
Glucose Levels ◽  
Race Ethnicity

Ideal cardiovascular health is a novel concept adopted by the American Heart Association (AHA) that is operationalized through measurement and classification (ideal; intermediate; poor) of seven health metrics, including fasting glucose. Declines in the prevalence of ideal fasting glucose levels have been consistently associated with higher rates of cardiovascular disease, yet few studies have examined the ages at which such declines begin. We used cross-sectional data from NHANES (2007-2010, n=5,961) and the HCHS/SOL (n=14,357) to estimate the age-specific prevalence of ideal (<100 mg/dl without medication), intermediate (100-125 mg/dl or treated to <100 mg/dl) and poor (≥126 mg/dl) fasting glucose levels defined per AHA criteria among European American (EA), African American (AA), and Hispanic/Latino (H/L) participants ≥16 years of age. Race/ethnicity-stratified age-specific net probabilities of transitioning between ideal, intermediate and poor glucose levels were then calculated from cross-sectional estimates using state-of-the-art Markov models that accommodated complex sampling under the assumption that transitions remained stable across time. In all race/ethnic groups, approximately 80% of participants ≤20 years of age had ideal glucose levels. However, the estimated probability of maintaining ideal glucose levels after age 20 varied by race/ethnicity. For example, by the age of 40, the estimated probability of maintaining ideal levels of glucose over the next five years was approximately 90% for EAs and AAs and slightly higher for H/Ls (five-year probability: 92.1%, 95% CI: 91.1%, 93.1%). Among individuals with intermediate glucose levels at age 40, the estimated five-year probability of transitioning to poor levels of glucose was twice as high for AAs (five-year probability: 8.1%, 95% CI: 4.3%, 11.9%) and H/Ls (five-year probability: 9.8%, 95% CI: 8.0%, 11.6%) compared to EAs (five-year probability = 3.9%, 95% CI: 2.7%, 5.3%). Unfortunately, among participants with poor glucose levels, the estimated probability of transitioning to ideal glucose levels remained 0% for all race/ethnic groups and across all ages. Our results suggest that efforts to maintain ideal glucose levels should target young adults and extend through 40 years of age, given the sizeable prevalence of intermediate and poor levels of glucose observed by age 20, the estimated acceleration in the transition to intermediate and poor glucose levels that occurs between the second and fourth decade of life, and the negligible estimated probability of successfully re-attaining ideal glucose levels among those with intermediate or poor glucose levels. Enhanced efforts to identify and treat populations with poor glucose levels also are needed, since these populations would include persons with undiagnosed and therefore untreated type 2 diabetes.

Arterial disease in the young

ESC CardioMed ◽  
2018 ◽  
pp. 775-778
Author(s):  
Marietta Charakida ◽  
John Deanfield
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Risk Factor ◽  
Congenital Heart ◽  
Cardiovascular Health ◽  
Adult Population ◽  
Arterial Disease ◽  
Ideal Cardiovascular Health ◽  
Reduce Risk ◽  
Reduce Risk Factor

The growing adult population with congenital heart disease (CHD) are getting older and their clinical presentation and outcomes are likely to be determined not only by their underlying CHD, but also by the development of acquired cardiovascular diseases such as atherosclerosis. This begins in childhood. The adult CHD population have multiple cardiovascular risk factors, as found in the general population, including obesity, smoking, and sedentary behaviour. Adults with complex congenital heart circulation are likely to be particularly vulnerable to the development of acquired arterial disease. Maintenance of ‘ideal cardiovascular health’ from childhood, is a key target, as leveraged gains can be achieved by early intervention to reduce risk factor exposure.

scholarly journals Using Cluster Analysis to Explore Associations between Cardiovascular Risk and Lifestyle Factors in a Workplace Wellness Program

2021 ◽  
Vol 5 (1) ◽  
pp. 30-41
Author(s):  
Heather Carter-Templeton ◽  
Gary Templeton ◽  
Barbara Ann Graves ◽  
Leslie G. Cole
Keyword(s):  
Risk Factors ◽  
Cluster Analysis ◽  
Risk Factor ◽  
Cardiovascular Health ◽  
The United States ◽  
Workplace Wellness ◽  
Wellness Program ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Ideal Cardiovascular Health

Background: Cardiovascular disease (CVD) is the number one cause of death in the United States with risk factors including hypertension, hyperlipidemia, diabetes, obesity, smoking, physical inactivity, age, genetics, and unhealthy diets. A university-based workplace wellness program (WWP) consisting of an annual biometric screening assessment with targeted, individualized health coaching was implemented in an effort to reduce these risk factors while encouraging and nurturing ideal cardiovascular health.Objective: The purpose of this study was to examine and describe the prevalence of single and combined, or multiple, CVD risk factors within a workplace wellness dataset.Methods: Cluster analysis was used to determine CVD risk factors within biometric screening data (BMI, waist circumference, LDL, total cholesterol, HDL, triglycerides, blood glucose age, ethnicity, and gender) collected during WWP interventions.Results: The cluster analysis provided visualizations of the distributions of participants having specific CVD risk factors. Of the 8,802 participants, 1,967 (22.4%) had no CVD risk factor, 1,497 (17%) had a single risk factor, and 5,529 (60.5%) had two or more risk factors. The majority of sample members are described as having more than one CVD risk factor with 78% having multiple.Conclusion: Cluster analysis demonstrated utility and efficacy in categorizing participant data based on their CVD risk factors. A baseline analysis of data was captured and provided understanding and awareness into employee health and CVD risk. This process and analysis facilitated WWP planning to target and focus on education to promote ideal cardiovascular health.

scholarly journals 217Using excess heat factor to measure effect of heatwave severity on foodborne disease incidence

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Adriana Milazzo
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Health ◽  
Disease Incidence ◽  
Oldest Old ◽  
Cardiovascular Prevention ◽  
Ideal Cardiovascular Health ◽  
Disability Rate ◽  
Excess Heat Factor ◽  
Iadl Disability

Abstract Background This study aims to analyse the distribution characteristics of ideal cardiovascular health (ICH) metrics status of the oldest-old and centenarians, and also to explore the relationships with disability and quality of life. Methods 1002 centenarians and 798 oldest-old were included in the analysis. ICH, disability and quality of life were assessed according to standard methods. Results The median number of ICH metrics among centenarians and oldest-old were 4 (4-5) and 3(3-5) respectively. The highest proportion of ICH metrics at ideal levels were glucose (90.2%), BMI (89.8%), and smoking (89.4%), the lowest proportion of ICH metrics at ideal level was blood pressure (8.3%). The disability rates of BADL and IADL decreased with the number of ICH metrics. BADL disability changed from 100.0% to 73.2%, and the IADL disability rate dropped from 100% to 80.0%. BADL disability rate decreased from 45.0% to 25.3% and IADL disability decreased from 100.0% to 57.1% among the oldest-old. The EQ-5D vas, EQ-5D score showed increasing trend along with the number of ICH metrics (p &lt; 0.05). Compared with centenarians who had only 0-2 ICH metrics, the ORs for BADL disability were 0.82, 0.66, 0.52, 0.44, and the ORs for IADL disability were 0.74, 0.65, 0.58, 0.41 for those with 3, 4, 5, ≥6 ICH metrics. Conclusions ICH metrics of centenarians and oldest-old were at a relatively good level, and there was a strong and independent inverse relationship between ICH metrics with both disability and lower quality of life. Key messages This was the first survey about the distribution of ICH metrics and association with both disability and quality of life based on elderly aged over 80 years old. The results highlighted the importance of cardiovascular prevention even at 80 years and over, which made up for the evidence gap based on this age group.

Abstract 17729: Ideal Cardiovascular Health is Associated With a Lower Prevalence of Adverse Left Ventricular Remodeling Patterns in the Framingham Offspring Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew Nayor ◽  
Danielle Enserro ◽  
Ramachandran S Vasan ◽  
Vanessa Xanthakis
Keyword(s):  
Risk Factor ◽  
Cardiovascular Health ◽  
Left Ventricular ◽  
Lower Prevalence ◽  
Ideal Cardiovascular Health ◽  
Risk Factor Profile ◽  
Geometric Patterns ◽  
Concentric Hypertrophy ◽  
Unit Increase ◽  
Eccentric Hypertrophy

Introduction: The American Heart Association Heart Healthy score (AHA score or Life’s Simple 7™) is inversely associated with atherosclerotic vascular disease including heart failure (HF), but its relationship to adverse left ventricle (LV) geometric patterns (known precursors of HF) is unknown. LV geometry can be categorized into 4 distinct patterns: normal (normal LV mass [LVM] and relative wall thickness [RWT]), concentric remodeling (normal LVM with increased RWT), eccentric hypertrophy (increased LVM with normal RWT) and concentric hypertrophy (increased LVM and RWT). Hypothesis: We hypothesized that ideal cardiovascular health is inversely associated with adverse LV geometric patterns. Methods: We evaluated the cross-sectional relations between the AHA score (range 1-7, based on lifestyle and risk factor profile, 7 being healthiest) and the prevalence of echocardiographic LV geometric patterns in 2392 Framingham Offspring Study participants (mean age 58 years, 56% women). Using generalized logits models, we calculated odds ratios (OR) for each pattern of LV remodeling as compared to the normal pattern (that served as referent) for every unit-increase in AHA score, adjusting for age and sex. Results: Normal geometry was present in 1283 participants (54%), concentric remodeling in 486 (20%), eccentric hypertrophy in 352 (15%) and concentric hypertrophy in 271 (11%). Each unit- increase in the AHA score was associated with lower odds of concentric remodeling and hypertrophy, Table. We did not observe a significant association between the AHA score and the odds of eccentric hypertrophy. Conclusions: Our findings support the association between ideal cardiovascular health and a lower prevalence of adverse cardiac remodeling, consistent with the favorable impact of both a healthy lifestyle and optimal risk factor profile on HF risk.

scholarly journals Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Piers Blackett ◽  
Kerry Farrell ◽  
Minh Truong ◽  
Minu George ◽  
Peggy Turner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Health ◽  
Point Of Care ◽  
Pediatric Endocrinology ◽  
Ideal Cardiovascular Health ◽  
Specialty Clinic ◽  
Clinic Setting ◽  
Pediatric Clinic ◽  
The Ideal

The feasibility of “point-of-care” screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9–18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal “point-of care” non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

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