scholarly journals The Structure of Relationships between the Human Exposome and Cardiometabolic Health: The Million Veteran Program

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1364
Author(s):  
Kerry L. Ivey ◽  
Xuan-Mai T. Nguyen ◽  
Daniel Posner ◽  
Geraint B. Rogers ◽  
Deirdre K. Tobias ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Glycemic Control ◽  
Total Cholesterol ◽  
Common Factors ◽  
Validation Dataset ◽  
Cardiometabolic Health ◽  
Latent Construct ◽  
Us Veterans ◽  
Time Varying Covariates

The exposome represents the array of dietary, lifestyle, and demographic factors to which an individual is exposed. Individual components of the exposome, or groups of components, are recognized as influencing many aspects of human physiology, including cardiometabolic health. However, the influence of the whole exposome on health outcomes is poorly understood and may differ substantially from the sum of its individual components. As such, studies of the complete exposome are more biologically representative than fragmented models based on subsets of factors. This study aimed to model the system of relationships underlying the way in which the diet, lifestyle, and demographic components of the overall exposome shapes the cardiometabolic risk profile. The current study included 36,496 US Veterans enrolled in the VA Million Veteran Program (MVP) who had complete assessments of their diet, lifestyle, demography, and markers of cardiometabolic health, including serum lipids, blood pressure, and glycemic control. The cohort was randomly divided into training and validation datasets. In the training dataset, we conducted two separate exploratory factor analyses (EFA) to identify common factors among exposures (diet, demographics, and physical activity) and laboratory measures (lipids, blood pressure, and glycemic control), respectively. In the validation dataset, we used multiple normal regression to examine the combined effects of exposure factors on the clinical factors representing cardiometabolic health. The mean ± SD age of participants was 62.4 ± 13.4 years for both the training and validation datasets. The EFA revealed 19 Exposure Common Factors and 5 Physiology Common Factors that explained the observed (measured) data. Multivariate regression in the validation dataset revealed the structure of associations between the Exposure Common Factors and the Physiology Common Factors. For example, we found that the factor for fruit consumption was inversely associated with the factor summarizing total cholesterol and low-density lipoprotein cholesterol (LDLC, p = 0.008), and the latent construct describing light levels of physical activity was inversely associated with the blood pressure latent construct (p < 0.0001). We also found that a factor summarizing that participants who frequently consume whole milk are less likely to frequently consume skim milk, was positively associated with the latent constructs representing total cholesterol and LDLC as well as systolic and diastolic blood pressure (p = 0.0006 and < 0.0001, respectively). Multiple multivariable-adjusted regression analyses of exposome factors allowed us to model the influence of the exposome as a whole. In this metadata-rich, prospective cohort of US Veterans, there was evidence of structural relationships between diet, lifestyle, and demographic exposures and subsequent markers of cardiometabolic health. This methodology could be applied to answer a variety of research questions about human health exposures that utilize electronic health record data and can accommodate continuous, ordinal, and binary data derived from questionnaires. Further work to explore the potential utility of including genetic risk scores and time-varying covariates is warranted.

Abstract P216: Prevalence of Life’s Simple Seven Cardiovascular Health Metrics in the Million Veteran Program

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Xuan-Mai T Nguyen ◽  
Rachel M Quaden ◽  
Rebecca J Song ◽  
Yuk-Lam Ho ◽  
Kelly Cho ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Total Cholesterol ◽  
Plasma Glucose ◽  
Cardiovascular Health ◽  
Smoking Status ◽  
Dietary Factors ◽  
Cross Sectional ◽  
Ideal Cardiovascular Health ◽  
Us Veterans

Background: While previous studies have reported the prevalence of Life’s Simple Seven (LSS) in the general population, no data exist in a national sample of US veterans. Objective: To assess the prevalence of ideal LSS in a cross-sectional study of 500,000 US Veterans participating in the Million Veteran Program (MVP) from 2011-2016. Methods: We assigned one of three possible values (0=poor, 1=intermediate, 2=ideal) for each of the seven LSS metrics (adiposity /BMI), smoking status, total cholesterol, blood pressure, plasma glucose, diet, physical activity) at baseline using self-reported data and electronic health records. A total score of 0 across all seven metrics indicated overall poor cardiovascular health and a score of 14 indicated ideal cardiovascular health. Results: Complete data on all LSS factors were available for 171,146 Veterans (92% men and mean age 65.5yrs ±11.5 SD). Average LSS score was 6.1 ±1.9. Ideal BMI, smoking status, total cholesterol, blood pressure and plasma glucose (fasting and non-fasting) was present in 23.8%, 30%, 22.2%, 22.5% and 42.9%, respectively, in the study population (Fig). Prevalence of ideal diet was 0.4%. Among dietary factors, recommendation for fruits and vegetables (at least 4.5cups/day) was the least likely to be achieved. Physical activity at the workplace, home or at leisure was reported among 25.6% of Veterans (21.8% intermediate and 3.8% ideal physical activity). Conclusions: Our data show a low prevalence of ideal LSS among Veterans in the MVP, especially diet (0.4%) and physical activity (3.8%). Compared to NHANES 2005-2006 unadjusted prevalence estimates for AHA 2020 goals, Veterans in MVP have a lower prevalence of all ideal LSS metrics except for diet: BMI (23.8 vs 33%), physical activity (3.8 vs 45%), smoking status (30 vs 73%), total cholesterol (22.2 vs 45%) blood pressure (22.5 vs 42%) and glucose (42.9 vs 58%). These findings underscore the need to improve adherence to modifiable lifestyle factors with subsequent reduction in CVD burden among Veterans.

Light-Intensity Physical Activity and Cardiometabolic Risk Among Older Adults With Multiple Chronic Conditions

2018 ◽  
Vol 33 (4) ◽  
pp. 507-515 ◽  
Author(s):  
Yueyao Li ◽  
Kellee White ◽  
Katherine R. O’Shields ◽  
Alexander C. McLain ◽  
Anwar T. Merchant
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Older Adults ◽  
Light Intensity ◽  
Total Cholesterol ◽  
Chronic Conditions ◽  
Cardiometabolic Risk ◽  
Multiple Chronic Conditions ◽  
Intensity Physical Activity

Purpose: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions. Design: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012). Setting: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults. Participants: Adults aged 50 years and older (N = 14 996). Measures: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA1c], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions. Analysis: Weighted multivariate linear regression models. Results: Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA1c, or non-HDL-C. Conclusions: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.

scholarly journals The Clustering of Low Diet Quality, Low Physical Fitness, and Unhealthy Sleep Pattern and Its Association with Changes in Cardiometabolic Risk Factors in Children

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 591
Author(s):  
Xianwen Shang ◽  
Yanping Li ◽  
Haiquan Xu ◽  
Qian Zhang ◽  
Ailing Liu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Diet Quality ◽  
Cardiometabolic Risk ◽  
Fasting Glucose ◽  
Density Lipoprotein ◽  
Sleep Pattern ◽  
Cardiometabolic Health ◽  
Z Scores

The clustering of diet quality, physical activity, and sleep and its association with cardiometabolic risk (CMR) factors remains to be explored. We included 5315 children aged 6–13 years in the analysis. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by −1), and triglycerides. Low diet quality and low cardiorespiratory fitness (CRF) were more likely to be seen in a pair, but low diet quality was less likely to be clustered with unhealthy sleep patterns. Low diet quality, low CRF, and unhealthy sleep pattern was associated with a 0.63, 0.53, and 0.25 standard deviation (SD) higher increase in CMRS, respectively. Compared to children with no unhealthy factor (−0.79 SD), those with ≥1 unhealthy factor had a higher increase (−0.20 to 0.59 SD) in CMRS. A low diet quality-unhealthy sleep pattern resulted in the highest increase in CMRS, blood pressure, and triglycerides. A low diet quality–low CRF-unhealthy sleep pattern resulted in the highest increase in fatness and fasting glucose. Unhealthy factor cluster patterns are complex; however, their positive associations with changes in CMR factors are consistently significant in children. Some specific patterns are more harmful than others for cardiometabolic health.

scholarly journals Blueberry Consumption Improves Glycemic Control, Triglycerides and Liver Enzymes in US Veterans with Type 2 Diabetes (P06-124-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kim Stote ◽  
Margaret Wilson ◽  
Deborah Hallenbeck ◽  
Krista Thomas ◽  
Joanne Rourke ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Hemoglobin A1c ◽  
Liver Enzymes ◽  
Cardiometabolic Health ◽  
Treatment Groups ◽  
Freeze Dried ◽  
Us Veterans ◽  
Study Participants

Abstract Objectives The study investigated the effects of blueberry consumption on biomarkers of glycemic control in US veterans with type 2 diabetes. Methods In a double-blind, placebo-controlled parallel study, fifty-five men (mean baseline characteristics: 67 years; weight, 103 kg; body mass index, 34 kg/m2) with type 2 diabetes were randomly assigned to 1 of 2 treatment groups for 8 weeks. The treatment groups were either 22 g of a freeze-dried whole blueberry powder (equivalent to 1 cup of fresh blueberries; containing 845 mg phenolics and 470 mg anthocyanins) or 22 g of a blueberry placebo treatment (matched in energy and carbohydrate content to the blueberry treatment). The study participants were asked to consume 11 g of freeze-dried (equivalent to ½ cup of fresh blueberries) blueberry powder or placebo, reconstituted with 240 ml water, with their morning and evening meals along with their typical diet. Fasting blood samples were collected at the beginning and at the end of the study. Results Fructosamine (275.5 ± 4.1 µmol/L vs. 292.4 ± 7.9 µmol/L, respectively; P = 0.04) and hemoglobin A1C (7.1 ± 0.1% vs. 7.5 ± 0.2%, respectively; P = 0.03) were significantly lower for study participants consuming blueberries for 8 weeks compared with the placebo. In addition, triglycerides (160.6 ± 13.1 mg/dl vs. 183.9 ± 10.7 mg/dl, respectively; P = 0.03), aspartate transaminase (AST) (23.2 ± 1.4 units/L vs. 30.5 ± 2.7 units/L, respectively; P = 0.02) and alanine transaminase (ALT) (35.6 ± 1.5 units/L vs. 48.3 ± 2.9 units/L, respectively; P = 0.0003), were significantly lower for those consuming blueberries compared with the placebo. Glucose, insulin, total cholesterol, LDL cholesterol, HDL cholesterol and body weight were not significantly different after 8 weeks of consumption of blueberries compared with the placebo. Conclusions Consumption of 22 g of freeze-dried blueberries daily for 8 weeks results in better glycemic control, such as lowering of fructosamine and hemoglobin A1C. These results along with lower triglyceride concentrations show improvement in the liver enzymes, AST and ALT, which may beneficially affect the cardiometabolic health status of men with type 2 diabetes. Funding Sources The U.S. Highbush Blueberry Council; the study is the result of work supported with resources and the use of facilities at the Stratton VA Medical Center, Albany, NY, USA.

Mediation of the Relationship of Acculturation With Glycemic Control in Asian Americans With Diabetes

2021 ◽  
pp. 089011712110525
Author(s):  
Namrata Sanjeevi
Keyword(s):  
Physical Activity ◽  
Glycemic Control ◽  
Asian Americans ◽  
Asian American ◽  
Leisure Time ◽  
Healthcare Access ◽  
Cardiometabolic Health ◽  
Cross Sectional ◽  
Time Activity ◽  
Leisure Time Activity

Purpose To assess the role of physical activity and healthcare access in mediating the association of acculturation with cardiometabolic health in Asian American adults with diabetes. Design Cross-sectional study. Setting National Health and Nutrition Examination Survey (NHANES) 2011–2018. Subjects Non-pregnant Asian American adults with doctor diagnosed diabetes. Measures Participants were classified into low, moderate, and high acculturation status. Self-reported leisure-time, work, and transportation-based physical activity were summed for overall physical activity. Health insurance, frequency of healthcare receipt, and glycohemoglobin (HbA1c) check in the past year indicated healthcare access. Cardiometabolic health indicators included HbA1c, total and high density lipoprotein-cholesterol, and systolic and diastolic blood pressure. Analysis Linear and logistic regression estimates, standardized using y-standardization, and assessed mediation of acculturation with cardiometabolic health. Results Low acculturation was significantly related to greater leisure-time inactivity odds [OR (95% CI) = 2.25 (1.05, 4.82)], overall insufficient activity [OR (95% CI) = 2.30 (1.12, 4.74)], and uninsured status [OR (95% CI) = 5.62 (1.55, 20.41)]. Asian Americans with low acculturation had significantly higher log HbA1c than those with high acculturation ( β ± SE = .078 ± .038); however, this association was not significant after adjusting for leisure-time activity. Leisure-time activity mediated 48.9% of acculturation and HbA1c association, and the indirect effect was statistically significant [estimate (95% CI) = .021 (.002, 0.047)]. Conclusions Results suggest that promoting sufficient leisure-time activity could improve glycemic control in least acculturated Asian Americans with diabetes.

scholarly journals Supervised training in primary care units but not spontaneous physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

2019 ◽  
Author(s):  
Amana M. Lima ◽  
André O. Werneck ◽  
Edilson Cyrino ◽  
Paulo Farinatti
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Body Mass ◽  
Low Income ◽  
Controlled Trial ◽  
Intention To Treat ◽  
Spontaneous Physical Activity ◽  
Public Health Strategies

Abstract Background: Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’). Methods: Patients were matched for age and assigned into three groups: a) FA (supervised training, n=53; 60.5±7.7 yrs); b) DA (self-reported, n=43; 57.0±11.2 yrs); c) PI (n=48; 57.0±10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform spontaneous physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications. Results: At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P>0.05). However, diabetes prevalence was 10-15% lower in DA vs. FA and PI (P<0.05). Intention-to-treat analysis showed significant reductions after intervention (P<0.05) in FA for total cholesterol (~10%), LDL-C (~15%), triglycerides (~10%), systolic blood pressure (~8%), and diastolic blood pressure (~9%). In DA, only LDL-C decreased (~10%, P < 0.05). Significant increases were found in PI (P<0.05) for total cholesterol (~15%), LDL-C (~12%), triglycerides (~15%), and systolic blood pressure (~5%). FRS lowered 35% in FA (intention-to-treat, P<0.05), remained stable in DA (P>0.05), and increased by 20% in PI (P<0.05). Conclusions: A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing spontaneous physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources. Trial registration: TCTR20181221002 (registered December 21, 2018; retrospectively registered).

scholarly journals Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amana M. Lima ◽  
André O. Werneck ◽  
Edilson Cyrino ◽  
Paulo Farinatti
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Body Mass ◽  
Low Income ◽  
Controlled Trial ◽  
Intention To Treat ◽  
Supervised Training ◽  
Public Health Strategies

Abstract Background Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’). Methods Patients were matched for age and assigned into three groups: a) FA (supervised training, n = 53; 60.5 ± 7.7 yrs); b) DA (self-reported, n = 43; 57.0 ± 11.2 yrs); c) PI (n = 48; 57.0 ± 10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform self-directed physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications. Results At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P > 0.05). However, diabetes prevalence was 10–15% lower in DA vs. FA and PI (P < 0.05). Intention-to-treat analysis showed significant reductions after intervention (P < 0.05) in FA for total cholesterol (~ 10%), LDL-C (~ 15%), triglycerides (~ 10%), systolic blood pressure (~ 8%), and diastolic blood pressure (~ 9%). In DA, only LDL-C decreased (~ 10%, P < 0.05). Significant increases were found in PI (P < 0.05) for total cholesterol (~ 15%), LDL-C (~ 12%), triglycerides (~ 15%), and systolic blood pressure (~ 5%). FRS lowered 35% in FA (intention-to-treat, P < 0.05), remained stable in DA (P > 0.05), and increased by 20% in PI (P < 0.05). Conclusions A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing self-directed physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources. Trial registration TCTR20181221002 (retrospectively registered). Registered December 21, 2018.

scholarly journals Diet Quality Index and Health Behavior Index Generated from a Food Liking Survey Explains Variability in Cardiometabolic Factors in Young Adults (P08-027-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Bruce Blanchard ◽  
Jeanne McCaffery ◽  
Stephen Woolley ◽  
Lauren Corso ◽  
Valerie Duffy
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Health Behavior ◽  
Diet Quality ◽  
Quality Index ◽  
Cardiometabolic Health ◽  
Diet Quality Index ◽  
Patient Status ◽  
Food Liking ◽  
Behavior Index

Abstract Objectives To test the relationship of diet quality and health behavior indexes derived from a validated food liking survey with cardiometabolic health in a convenience sample of non-diabetic patients with diagnosed depression from a psychiatric facility and age-gender matched students from a University setting. Methods One hundred six patients and 106 controls (62% female, mean age = 21) completed a 100-item liking survey comprised of foods, beverages, and physical and sedentary activities. Nutritional items were conceptually grouped, weighted and averaged into a Diet Quality Index (DQI). A Healthy Behavior Index (HBI) was the average of the weighted nutritional and physical activity groups. Higher indexes reflected healthier behaviors. Multiple linear regression was used to relate DQI and HBI with blood pressure and fasting insulin, glucose and serum lipids. BMI, biologic sex and patient status were included as covariates. Some serum markers required transformation to approach normal distribution. Results From BMI, 4% were underweight, 57% normal, 25% overweight, and 14% obese. The liking survey took minutes for participants to complete and little processing to generate the indexes. The DQI and HBI were internally reliable (α = 0.68–0.69), reflected greater than one dimension (principal component analysis), and were normally distributed. Higher DQI scores were significantly related to higher HDL (standardized β = 0.16, P = 0.019) and lower glucose (β = –0.19, P = 0.005), insulin (β = –0.18, P = 0.005) and diastolic blood pressure (β = –0.32, P < 0.001). Adding physical activity, HBI also was related to glucose (β = –0.19, P = 0.008), triglycerides (β =–0.14, P = 0.04) and insulin (β = –0.18, P = 0.006). Patient status was not a significant independent contributor in the models. Conclusions A simple liking survey can produce reliable and valid indexes of diet quality and health behaviors that significantly associated with multiple cardiometabolic risk factors. Funding Sources USDA NIFA, Hatch project.

scholarly journals Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

2019 ◽  
Author(s):  
Amana M. Lima ◽  
André O. Werneck ◽  
Edilson Cyrino ◽  
Paulo Farinatti
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Body Mass ◽  
Low Income ◽  
Controlled Trial ◽  
Intention To Treat ◽  
Supervised Training ◽  
Public Health Strategies

Abstract Background: Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’). Methods: Patients were matched for age and assigned into three groups: a) FA (supervised training, n=53; 60.5±7.7 yrs); b) DA (self-reported, n=43; 57.0±11.2 yrs); c) PI (n=48; 57.0±10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform self-directed physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications. Results: At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P>0.05). However, diabetes prevalence was 10-15% lower in DA vs. FA and PI (P<0.05). Intention-to-treat analysis showed significant reductions after intervention (P<0.05) in FA for total cholesterol (~10%), LDL-C (~15%), triglycerides (~10%), systolic blood pressure (~8%), and diastolic blood pressure (~9%). In DA, only LDL-C decreased (~10%, P < 0.05). Significant increases were found in PI (P<0.05) for total cholesterol (~15%), LDL-C (~12%), triglycerides (~15%), and systolic blood pressure (~5%). FRS lowered 35% in FA (intention-to-treat, P<0.05), remained stable in DA (P>0.05), and increased by 20% in PI (P<0.05). Conclusions: A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing self-directed physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources.

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