DNA methylation signatures associated with cardiometabolic risk factors in children from India and The Gambia: results from the EMPHASIS study

Abstract Background The prevalence of cardiometabolic disease (CMD) is rising globally, with environmentally induced epigenetic changes suggested to play a role. Few studies have investigated epigenetic associations with CMD risk factors in children from low- and middle-income countries. We sought to identify associations between DNA methylation (DNAm) and CMD risk factors in children from India and The Gambia. Results Using the Illumina Infinium HumanMethylation 850 K Beadchip array, we interrogated DNAm in 293 Gambian (7–9 years) and 698 Indian (5–7 years) children. We identified differentially methylated CpGs (dmCpGs) associated with systolic blood pressure, fasting insulin, triglycerides and LDL-Cholesterol in the Gambian children; and with insulin sensitivity, insulinogenic index and HDL-Cholesterol in the Indian children. There was no overlap of the dmCpGs between the cohorts. Meta-analysis identified dmCpGs associated with insulin secretion and pulse pressure that were different from cohort-specific dmCpGs. Several differentially methylated regions were associated with diastolic blood pressure, insulin sensitivity and fasting glucose, but these did not overlap with the dmCpGs. We identified significant cis-methQTLs at three LDL-Cholesterol-associated dmCpGs in Gambians; however, methylation did not mediate genotype effects on the CMD outcomes. Conclusion This study identified cardiometabolic biomarkers associated with differential DNAm in Indian and Gambian children. Most associations were cohort specific, potentially reflecting environmental and ethnic differences.

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Risk factors for cardiovascular diseases and development of prehypertension

ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia» ◽

10.25557/0031-2991.2018.03.37-43 ◽

2018 ◽

pp. 37-43

Author(s):

В.В. Шерстнев ◽

М.А. Грудень ◽

В.П. Карлина ◽

В.М. Рыжов ◽

А.В. Кузнецова ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Serum Levels ◽

Left Ventricular ◽

Optimal Blood Pressure

Цель - исследование взаимосвязи факторов риска сердечно-сосудистых заболеваний и развития предгипертонии. Методика. Проведен сравнительный и корреляционный анализы показателей модифицируемых и немодифицируемых факторов риска сердечно-сосудистых заболеваний у обследованных лиц в возрасте 30-60 лет с «оптимальным» артериальным давлением, (n = 63, АД <120/80 мм рт.ст.) и лиц с предгипертонией (n = 52, АД = 120-139/80-89 мм рт.ст.). Результаты. Показано, что лица с предгипертонией по сравнению с группой лиц, имеющих «оптимальное» артериальное давление характеризуются статистически значимо повышенным содержанием холестерина и холестерина липопротеидов низкой плотности, интеллектуальным характером трудовой деятельности, а также значимыми сочетаниями факторов риска: повышенный уровень холестерина липопротеидов низкой плотности с интеллектуальным характером трудовой деятельности; повышенное содержание креатинина с уровнем триглициридов; наследственная отягощенность по заболеваниям почек и интеллектуальным характером трудовой деятельности; наследственная отягощенность по сахарному диабету и гипертрофия левого желудочка сердца. У лиц с предгипертонией документированы перестройки структуры взаимосвязи (количество, направленность и сила корреляций) между показателями факторов риска в сравнении с лицами, имеющими «оптимальное» артериальное давление. Заключение. Выявленные особенности взаимосвязей факторов риска сердечно-сосудистых заболеваний при предгипертонии рассматриваются как проявление начальной стадии дизрегуляционной патологии и нарушения регуляции физиологических систем поддержания оптимального уровня артериального давления. The aim of the study was to investigate the relationship between risk factors for cardiovascular disease and development of prehypertension. Methods. Comparative and correlation analyses of modifiable and non-modifiable risk factors for cardiovascular disease were performed in subjects aged 30-60 with «optimal» blood pressure (n = 63, BP <120/80 mm Hg) and prehypertension (n = 52, BP = 120-139 / 80-89 mm Hg). Results. The group with prehypertension compared with the «optimal» blood pressure group had significantly increased serum levels of low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, sedentary/intellectual type of occupation, and significant combinations of risk factors. The risk factor combinations included an increased level of LDL cholesterol and a sedentary/intellectual occupation; increased serum levels of creatinine and triglycerides; hereditary burden of kidney disease and a sedentary/intellectual occupation; hereditary burden of diabetes mellitus and cardiac left ventricular hypotrophy. In subjects with prehypertension compared to subjects with «optimal» blood pressure, changes in correlations (correlation number, direction, and strength) between parameters of risk factors were documented. Conclusion. The features of interrelationships between risk factors for cardiovascular disease observed in prehypertension are considered a manifestation of early dysregulation pathology and disordered regulation of physiological systems, which maintain optimal blood pressure.

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Short-Term Tea Consumption Is Not Associated with a Reduction in Blood Lipids or Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Journal of Nutrition ◽

10.1093/jn/nxaa295 ◽

2020 ◽

Vol 150 (12) ◽

pp. 3269-3279

Author(s):

Ebuwa Igho-Osagie ◽

Kelly Cara ◽

Deena Wang ◽

Qisi Yao ◽

Laura P Penkert ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

At Risk ◽

Ldl Cholesterol ◽

Meta Analysis ◽

Hdl Cholesterol ◽

Black Tea ◽

Tea Consumption ◽

Short Term ◽

High Quality

ABSTRACT Background A recent systematic review of epidemiological evidence suggests that higher amounts of tea intake are associated with lower risks of cardiovascular disease (CVD) incidence and mortality. Objectives Our study objective was to assess mechanisms by which tea consumption may influence CVD risks. Methods A systematic review and meta-analysis was conducted to investigate the effects of green and/or black tea consumption (≥4 wk) on systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride (TG) in healthy populations and among at-risk adults (analyzed separately) with metabolic syndrome, prediabetes, and hypercholesterolemia. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the strength of evidence (SoE). Results A total of 14 unique RCTs which randomly assigned 798 participants to either green tea, black tea, or placebo controls were included in our analyses. Intervention durations ranged from 4 to 24 wk (mean: 7.4 wk). Individual studies were judged as moderate to high quality based on risk of bias assessments. SoE was low to moderate owing to low sample sizes and insufficient power for most included studies to observe changes in the measured CVD biomarkers. Meta-analyses showed no significant effects of tea consumption on SBP, DBP, total cholesterol, LDL cholesterol, HDL cholesterol, and TG in healthy and at-risk adults (i.e., adults with obesity, prediabetes, borderline hypercholesterolemia, and metabolic syndrome). Conclusions Short-term (4–24 wk) tea consumption does not appear to significantly affect blood pressure or lipids in healthy or at-risk adults, although the evidence is limited by insufficient power to detect changes in these CVD biomarkers. High-quality RCTs with longer durations and sufficient sample sizes are needed to fully elucidate the effects of tea. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020134513.

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Plasma Imidazole Propionate Is Positively Correlated with Blood Pressure in Overweight and Obese Humans

Nutrients ◽

10.3390/nu13082706 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2706

Author(s):

Jamie van Son ◽

Mireille J. Serlie ◽

Marcus Ståhlman ◽

Fredrik Bäckhed ◽

Max Nieuwdorp ◽

...

Keyword(s):

Blood Pressure ◽

Insulin Sensitivity ◽

Diastolic Blood Pressure ◽

Ldl Cholesterol ◽

Metabolic Diseases ◽

Hdl Cholesterol ◽

Plasma Metabolites ◽

Cvd Risk ◽

Gold Standard Method ◽

Obese Subjects

Background: The gut microbiota and its metabolites are essential for host health and dysbiosis has been involved in several pathologic conditions such as type 2 diabetes (T2D) and cardiovascular disease (CVD). Recent studies have identified that plasma imidazole propionate (ImP), a microbial-produced metabolite, is increased in patients with prediabetes and T2D. More recently, ImP was found to be significantly increased in patients with overt CVD. Here, we aimed to investigate the association between ImP and CVD risk factors: blood pressure, HDL-cholesterol, LDL-cholesterol and insulin-resistance in overweight and obese subjects without T2D or use of any metabolic diseases-related medication. Methods: Plasma metabolites, including ImP, were determined in 107 male or post-menopausal women with overweight/obesity, but without T2D. Insulin-sensitivity was assessed with the gold standard method: the hyperinsulinemic-euglycemic clamp using the isotope [6,6-2H2] glucose and expressed as glucose rate of disposal (Rd) for peripheral insulin sensitivity and suppression of endogenous glucose production (EGP) for hepatic insulin sensitivity. Results: Partial correlation analysis controlled for BMI and age showed a significant correlation between ImP and diastolic blood pressure (rs = 0.285, p = 0.004) and a borderline significance with systolic blood pressure (rs = 0.187, p = 0.060); however, systolic and diastolic blood pressure did not correlate with ImP precursor histidine (rs = 0.063, p = 0.526 and r = −0.038, p = 0.712, respectively). We did not find a correlation between ImP with LDL-cholesterol or HDL-cholesterol (rs = −0.181, p = 0.064 and rs = 0.060, p = 0.546, respectively). Furthermore, there was no association between plasma ImP concentrations and Rd and EGP suppression. Conclusion: In this cohort with overweight/obese subjects without T2D, plasma ImP concentrations were positively correlated with diastolic blood pressure but not with insulin-sensitivity.

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Effects of strawberry intervention on cardiovascular risk factors: a meta-analysis of randomised controlled trials

British Journal Of Nutrition ◽

10.1017/s000711452000121x ◽

2020 ◽

Vol 124 (3) ◽

pp. 241-246

Author(s):

Qi Gao ◽

Li-Qiang Qin ◽

Ahmed Arafa ◽

Ehab S. Eshak ◽

Jia-Yi Dong

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Blood Glucose ◽

Randomised Controlled Trials ◽

Ldl Cholesterol ◽

Meta Analysis ◽

Fasting Blood Glucose ◽

Controlled Trials ◽

Baseline Levels ◽

Randomised Controlled

AbstractWe conducted a meta-analysis of randomised controlled trials (RCT) to examine the effects of strawberry interventions on cardiovascular risk factors. We searched multiple databases including PubMed, Web of Science and Scopus to identify eligible studies published before 19 May 2019. The endpoints were blood pressure, total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, TAG, fasting blood glucose, endothelial function and inflammatory factors. Pooled analyses were performed using random- or fixed-effects models according to a heterogeneity test. We also conducted sub-group analyses by baseline endpoint levels. We included eleven RCT in this meta-analysis (six for blood pressure, seven for lipid profile, seven for fasting blood glucose and six for C-reactive protein (CRP)). Overall, the strawberry interventions significantly reduced CRP levels by 0·63 (95 % CI −1·04, −0·22) mg/l but did not affect blood pressure, lipid profile or fasting blood glucose in the main analyses. Our analysis stratified by baseline endpoint levels showed the strawberry interventions significantly reduced TC among people with baseline levels >5 mmol/l (−0·52 (95 % CI −0·88, −0·15) mmol/l) and reduced LDL-cholesterol among people with baseline levels >3 mmol/l (−0·31 (95 % CI −0·60, −0·02) mmol/l). There was little evidence of heterogeneity in the analysis and no evidence of publication bias. In summary, strawberry interventions significantly reduced CRP levels and may improve TC and LDL-cholesterol in individuals with high baseline levels.

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Abstract 3448: Differences in the Associations between Various Ultrasound-Based Markers of Peripheral Atherosclerosis at Carotid and Femoral Levels and Risk factors in a general Middle-Aged Population

Circulation ◽

10.1161/circ.116.suppl_16.ii_779-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Patrick O Yerly ◽

Nicolas Rodondi ◽

Fred Paccaud ◽

Pierre Vogt ◽

Pascal Bovet

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Systolic Blood Pressure ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Intima Media Thickness ◽

Plaque Morphology ◽

Middle Aged ◽

Plaque Area

Introduction: Ultrasound detection of sub-clinical atherosclerosis (ATS) is a useful mean to identify subjects at high risk of cardiovascular (CV) events. Most studies have evaluated intima-media thickness (IMT) at the carotid artery level, but plaque-based markers (plaque thickness, plaque area) as well as the femoral artery level have been proposed as valid alternatives. The superiority of one method upon the others has not been demonstrated. The aim of this study is to compare the relationships between five indicators of ATS (IMT, mean / maximal plaque thickness, mean / maximal plaque area) at both carotid and femoral levels and conventional cardiovascular risk factors (CVRF) in a population-based sample of middle-aged adults. Methods: High resolution B-mode ultrasound was performed in both right and left carotid and femoral arteries on 496 consecutive participants aged 45– 64 randomly selected from the general population. A plaque was defined as a focal IMT thickening ≥ 1.2 mm. CVRF included age, sex, current smoking, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and diabetes. Results : All CVRF were associated, independently of age, with each of the ATS markers at femoral level but only LDL-cholesterol and systolic blood pressure were consistently associated with ATS markers at carotid level. The table shows the adjusted R-squared values in a multivariate model with all CVRF. Variance (adjusted R 2 ) in predicting any of the ATS markers was larger at femoral than carotid levels. At both carotid and femoral levels, the CVRF accounted for more variance in predicting plaque-based markers than IMT. Conclusion: The stronger association of CVRF with ATS markers at the femoral than carotid levels and with plaque-based markers than with IMT suggest that markers assessed at femoral level and based on plaque morphology might be the most useful tools for assessing cardiovascular risk. These findings need to be confirmed in prospective studies with CV events.

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Abstract P241: Culinary Herbs and Spices and the Effects on Cardiovascular Disease Risk Factors in Adults

Circulation ◽

10.1161/circ.137.suppl_1.p241 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Savannah E Maxwell ◽

Kacie M Dickinson

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Total Cholesterol ◽

Ldl Cholesterol ◽

Fasting Glucose ◽

Hdl Cholesterol ◽

Cochrane Central Register ◽

Culinary Herbs ◽

Herbs And Spices

Introduction: There is growing attention toward the role of culinary herbs and spices in improving heart health. Bioactive compounds of culinary herbs and spices have been found to exert potential health benefits in people at risk of CVD, but no recent review has been conducted to evaluate the types of herbs and spices and their effects in this population. Objectives: The purpose of the review was to evaluate the effects of culinary herbs and spices on biomarkers of cardiovascular disease in adults with risk factors for CVD. Methods: A systematic literature search was conducted using six electronic databases, including Medline (Ovid), Scopus, Cochrane Database of Systematic Reviews, CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trial and Web of Science in February 2017. Studies including subjects who had associated non-modifiable risk factors (older people >70 y, menopausal women), cardiovascular disease or an associated cardiovascular event (stroke or heart attack) and associated liver or kidney complications or disease, were excluded from the review. Seventeen studies were eligible for inclusion in the review. The Cochrane Collaboration risk of bias tool was used to assess bias of the included studies. Results: Twelve randomized controlled trials, 2 randomized trials, 1 non-randomized trial, 1 randomized crossover trial and 1 single-arm met inclusion criteria. In patients with Type 2 diabetes, Cinnamon at 1-1.5g/d and dichrostahys glomerata (DG), at 0.8g/d showed significant decreases in fasting blood glucose, systolic and diastolic blood pressure, triglycerides and LDC-cholesterol and HbA1c and cinnamon showed increased HDL-C while DG showed significant decrease in total cholesterol. Fenugreek at 10g/d doses resulted in significant reductions in fasting glucose and total cholesterol. Nigella satvia (NS) at doses of 1-3g/d showed significant reductions in triglycerides, LDL-cholesterol, total cholesterol and increases in HDL-cholesterol. Ginger at 1-2g/d doses significantly reduced fasting glucose, triglycerides, MDA, Apo B and increase Apo A-1. In obese subjects DG and ginger resulted in significant decreases in TG and DG significantly reduced systolic blood pressure, fasting glucose, total cholesterol, LDL-cholesterol and increased HDL-cholesterol. In subjects with hyperlipidaemia and hypercholesterolemia garlic at 5g/d and 20g/d doses resulted in significant decrease in TG, cholesterol and increases in HDL-C and 20g/d doses resulted in significant reductions in FBG. Conclusion: The evidence does suggest that the use of culinary herbs and spices may have beneficial effects on risk factors for CVD. Due to the presence of bias of studies there is insufficient evidence to conclude that culinary herbs and spices have significant benefits on biomarkers for CVD and that higher quality studies are needed in future research.

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Patterns of Cardiovascular Risk Factors in Old Age and Survival and Health Status at 90

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa043 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2207-2214

Author(s):

Michelle C Odden ◽

Andreea M Rawlings ◽

Alice M Arnold ◽

Mary Cushman ◽

Mary L Biggs ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Old Age ◽

Ldl Cholesterol ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Lower Likelihood

Abstract Background The population age 90 years and older is the fastest growing segment of the U.S. population. Only recently is it possible to study the factors that portend survival to this age. Methods Among participants of the Cardiovascular Health Study, we studied the association of repeated measures of cardiovascular risk factors measured over 15–23 years of follow-up and not only survival to 90 years of age, but also healthy aging outcomes among the population who reached age 90. We included participants aged 67–75 years at baseline (n = 3,613/5,888) to control for birth cohort effects, and followed participants until death or age 90 (median follow-up = 14.7 years). Results Higher systolic blood pressure was associated with a lower likelihood of survival to age 90, although this association was attenuated at older ages (p-value for interaction <.001) and crossed the null for measurements taken in participants’ 80’s. Higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and body mass index (BMI) were associated with greater longevity. Among the survivors to age 90, those with worse cardiovascular profile (high blood pressure, LDL cholesterol, glucose, and BMI; low HDL cholesterol) had lower likelihood of remaining free of cardiovascular disease, cognitive impairment, and disability. Conclusion In summary, we observed paradoxical associations between some cardiovascular risk factors and survival to old age; whereas, among those who survive to very old age, these risk factors were associated with higher risk of adverse health outcomes.

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Relative Telomere Length and Cardiovascular Risk Factors

Biomolecules ◽

10.3390/biom9050192 ◽

2019 ◽

Vol 9 (5) ◽

pp. 192 ◽

Cited By ~ 5

Author(s):

Moritz Koriath ◽

Christian Müller ◽

Norbert Pfeiffer ◽

Stefan Nickels ◽

Manfred Beutel ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Telomere Length ◽

Ldl Cholesterol ◽

Smoking Status ◽

Hdl Cholesterol ◽

Population Based ◽

Relative Telomere Length

(1) Background: Telomeres are repetitive DNA sequences located at the extremities of chromosomes that maintain genetic stability. Telomere biology is relevant to several human disorders and diseases, specifically cardiovascular disease. To better understand the link between cardiovascular disease and telomere length, we studied the effect of relative telomere length (RTL) on cardiovascular risk factors in a large population-based sample. (2) Methods: RTL was measured by a real-time quantitative polymerase chain reaction in subjects of the population-based Gutenberg Health Study (n = 4944). We then performed an association study of RTL with known cardiovascular risk factors of smoking status as well as systolic and diastolic blood pressure, body mass index (BMI), LDL cholesterol, HDL cholesterol, and triglycerides. (3) Results: A significant correlation was shown for RTL, with age as a quality control in our study (effect = −0.004, p = 3.2 × 10−47). Analysis of the relation between RTL and cardiovascular risk factors showed a significant association of RTL in patients who were current smokers (effect = −0.016, p = 0.048). No significant associations with RTL were seen for cardiovascular risk factors of LDL cholesterol (p = 0.127), HDL cholesterol (p = 0.713), triglycerides (p = 0.359), smoking (p = 0.328), diastolic blood pressure (p = 0.615), systolic blood pressure (p = 0.949), or BMI (p = 0.903). In a subsequent analysis, we calculated the tertiles of RTL. No significant difference across RTL tertiles was detectable for BMI, blood pressure, lipid levels, or smoking status. Finally, we studied the association of RTL and cardiovascular risk factors stratified by tertiles of age. We found a significant association of RTL and LDL cholesterol in the oldest tertile of age (effect = 0.0004, p = 0.006). (4) Conclusions: We determined the association of relative telomere length and cardiovascular risk factors in a population setting. An association of telomere length with age, current smoking status, as well as with LDL cholesterol in the oldest tertile of age was found, whereas no associations were observed between telomere length and triglycerides, HDL cholesterol, blood pressure, or BMI.

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Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels and Cardiometabolic Risk Factors: A Population-Based Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.664583 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jie Shi ◽

Xiaoyong Li ◽

Weiwei Zhang ◽

Yixin Niu ◽

Ning Lin ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Cardiometabolic Risk ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Population Based ◽

Low Hdl

Aims: To evaluate the prospective association of circulating PCSK9 levels with the cardiometabolic risk profiles (high LDL-cholesterol, high triglycerides, low HDL-cholesterol, hypertension, type 2 diabetes, and metabolic syndrome).Methods: A population-based prospective study was conducted among 7,104 Chinese individuals (age 56.2 ± 7.5 years; 32.0% men). Circulating PCSK9 levels were measured using ELISA.Results: Circulating PCSK9 levels were higher in women than men (286.7 ± 90.1 vs. 276.1 ± 86.4 ng/ml, p < 0.001). And circulating PCSK9 was positively correlated with LDL-cholesterol, total cholesterol, and triglycerides both in men and women (all p < 0.001). The positive correlation between PCSK9 and waist circumference, fasting glucose, insulin resistance, systolic blood pressure, diastolic blood pressure and C-reactive protein (all p < 0.01) was observed in women only. According to Cox regression analysis, circulating PCSK9 was positively associated with incidence of high LDL-cholesterol both in men (HR 1.33, 95% CI 1.09–1.65, p < 0.001) and women (HR 1.36, 95% CI 1.12–1.69, p < 0.001). Moreover, PCSK9 was significantly associated with incident high triglycerides (HR 1.31, 95% CI 1.13–1.72, p < 0.001), hypertension (HR 1.28, 95% CI 1.08–1.53, p = 0.011), type 2 diabetes (HR 1.34, 95% CI 1.09–1.76, p = 0.005), and metabolic syndrome (HR 1.30, 95% CI 1.11–1.65, p = 0.009) per SD change in women only. No statistically significant association was observed between circulating PCSK9 and incidence of low HDL-cholesterol (p > 0.1).Conclusions: Elevated circulating PCSK9 was significantly associated with cardiometabolic risk factors and independently contributed to the prediction of cardiometabolic risks in women.

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Abstract P255: The Effects of COSEHC Physician Process Improvement Continuing Medical Education on Patient Cardiovascular Risk Factors Outcomes in Southeastern Primary Care Clinics

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap255 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

JaNae Joyner ◽

Debra R Simmons ◽

Michael A Moore

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Process Improvement ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Scope Of Practice ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Primary Care Clinics

COSEHC has developed and implemented within 20 Southeast primary care clinics a continuous process improvement (CQI) continuing medical education (PI-CME) 18 month program tailored to physicians' scope of practice to reduce physician competency gaps in achieving recommended patient cardiovascular disease (CVD) risk factor goals. Physicians were taught CQI using patient outcomes for JNC7 systolic blood pressure (SBP) and ATP III LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) goals (SBP < 140 mmHg, < 130 mmHg diabetic; LDL-C < 100 mg/dL; HDL-C> 40 mg/dL). A project faculty of CVD experts was trained to utilize slide decks in live or web based formats to improve hypertension, hyperlipidemia, and glycemic control, patient expectations, physician-patient communication, lifestyle/behavior modifications and to utilize the CQI process. At baseline, 300-400 patient charts per clinic (ICD codes 250, 272, 401) were randomly selected (7,481 total patients [54% female, 29% African American, 30% elderly [> 65 years], and 31% with diabetes]). Changes in average CVD risk factors and the percentage of patients achieving JNC-7 and ATP-III goals were determined at baseline and at three months of 18 month follow-up after the initial CME. SBP statistically decreased and HDL-C statistically increased at follow-up compared to baseline in patients having both a baseline and follow-up value. 60% (12 of 20 clinics), 55% (11 of 20 clinics), and 70% (14 of 20 clinics) improved their percentage of total patients at therapeutic target goals for SBP, LDL-C, and HDL-C respectively. The greatest improvement was among the female subpopulation where 65% (13 of 20 clinics), 50% (10 of 20 clinics), and 75% (15 of 20 clinics) improved the percentage of females at therapeutic goal for SBP, LDL-C, and HDL-C, respectively, at 3 months. It is concluded that scope of practice designed PI-CME can improve therapeutic target goal rates for CVD risk factors through a CQI process. Table 1. Changes in Cardiovascular Risk Factor Mean Values between Baseline and 3 Month Follow-up. Baseline 3 Month Follow-up Patient Record Sample Size Systolic Blood Pressure (mm Hg) 131.2 + 17.4 129.2 + 15.6 * 1958 LDL Cholesterol (mg/dL) 99.7 + 34.9 98.9 + 33.4 986 HDL Cholesterol (mg/dL) 46.7 + 15.7 48.2 + 22.4 * 1008 * p< 0.05. Values expressed as mean + standard deviation. Patients had to have both a baseline and follow-up value to be included in this paired t-test.

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