Quantifying Options for Reducing Coronary Heart Disease Mortality By 2020

Huffman, Mark D.; Lloyd‐Jones, Donald M.; Ning, Hongyan; Castillo, M Guzman; O’Flaherty, Martı́n; Ford, Earl S.; Capewell, Simon

doi:10.1161/circulationaha.112.000769

Cited by 62 publications

(43 citation statements)

References 21 publications

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“…Each 1 point greater on the 14‐point CVH scale has been associated with 18% lower risk of developing stroke or myocardial infarction in a multiracial sample 25. As previous studies have noted, if CVH trends continue without rapid improvement, prevention goals will go unmet 15, 26. Likewise, if the racial/ethnic trends in CVH persist, goals to eliminate health disparities will also go unmet.…”

Section: Discussionmentioning

confidence: 94%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

Self Cite

156

105

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BackgroundIn the United States, there are persistent racial and ethnic disparities in cardiovascular disease morbidity and mortality. National efforts have focused on reducing these disparities; however, little is known about the long‐term trends in racial/ethnic disparities in cardiovascular health (CVH).Methods and ResultsWe included 11 285 adults aged ≥20 years from the National Health and Nutrition Examination Surveys survey cycles 1999/2000 through 2011/2012. CVH includes 7 health factors and behaviors—diet, physical activity, smoking status, body mass index, blood pressure, blood glucose, and total cholesterol—each scored as ideal (2 points), intermediate (1 point), or poor (0 points). Overall CVH is a summation of these scores (range, 0–14) points. Age‐adjusted mean CVH scores were calculated by race/ethnicity (non‐Hispanic black, non‐Hispanic white, or Mexican American) and sex for each survey cycle. Non‐Hispanic black women had significantly lower mean CVH scores as compared with non‐Hispanic white women at each survey cycle (difference=0.93; P=0.001 in 2011/2012) and Mexican‐American women had significantly lower mean score as compared with non‐Hispanic white women at almost all survey cycles (difference=0.71; P=0.02 in 2011/2012). Differences between racial/ethnic groups were smaller for men and were mostly nonsignificant.ConclusionsFrom 1999/2000 to 2011/2012, there were enduring disparities in CVH for non‐Hispanic black and Mexican‐American women as compared with non‐Hispanic white women. Disparities that were present in 1999/2000 were present in 2011/2012, though no racial/ethnic differences became more pronounced over time. These findings provide US nationally representative data to evaluate health factors and behaviors of particular concern regarding racial/ethnic disparities in cardiovascular health.

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Section: Discussionmentioning

confidence: 94%

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Pool

Ning

Lloyd‐Jones

et al. 2017

JAHA

Self Cite

156

105

View full text Add to dashboard Cite

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“…The ongoing increase in prevalence of type 2 diabetes mellitus (T2DM), affecting 9% of US adults,1, 2 has impeded public health efforts to slow the incidence of cardiovascular disease (CVD) 3, 4, 5. Individuals with T2DM but without prior CVD are at similar risk for myocardial infarction as those with current CVD but without T2DM,6 such that in prompting treatment with lipid‐lowering agents, T2DM has been considered a coronary heart risk equivalent 7.…”

Section: Introductionmentioning

confidence: 99%

Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

Gurka

Filipp

Pearson

et al. 2018

JAHA

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BackgroundType 2 diabetes mellitus (T2DM) is considered a cardiovascular disease (CVD) risk equivalent, thereby linking assessment of cardiometabolic risk with that of CVD risk over time. Our goal was to determine how commonly used CVD risk scores and metabolic syndrome (MetS) severity performed in predicting T2DM with and without ultimate CVD.Methods and ResultsWe assessed data from 8273 participants of the ARIC (Atherosclerosis Risk in Communities) Study, using the pooled cohort atherosclerotic CVD risk score, the Framingham Risk Score, and a MetS severity Z score to assess their association with future risk for CVD alone, T2DM alone, or both over 20 years of follow‐up. Baseline levels of all scores were significantly associated with isolated incident T2DM (odds ratios [ORs] for each 1‐SD increase: atherosclerotic CVD=1.7, Framingham risk score=1.7, MetS Z score=5.1). All 3 baseline scores were also significantly associated with isolated incident CVD (atherosclerotic CVD OR=2.4, Framingham risk score OR=2.3, MetS Z‐score OR=1.8), with the 2 CVD scores remaining significant independent of MetS severity. MetS severity was strongly associated with future T2DM leading to CVD (MetS Z‐score OR=7.0, atherosclerotic CVD OR=3.9, Framingham risk score OR=3.5). Furthermore, changes in MetS severity were independently associated with future T2DM‐CVD progression.Conclusions CVD risk scores are associated with risk for future isolated T2DM in addition to isolated CVD. However, MetS severity (both baseline and changes over time) was more strongly associated with T2DM, including T2DM ultimately leading to CVD. Following MetS severity within patients over time may identify those at greatest risk of combined cardiometabolic disease.

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“…Most concerning is the minimal improvement in the U. S. diet, which is still considered poor [12,13]. All told, despite all intermediary and putative explanations, the prevalence of ideal cardiovascular health has not meaningfully changed in the past decade, and remains so even when using self-reported data [15,16]. With respect to the six aforementioned items, individual behavior remains the most important factor, rather than guideline failure [17].…”

Section: Editorialmentioning

confidence: 99%

Nutrition Studies, Optimum Cardiovascular Health, and Coronary Atherosclerosis-Ensuring A Solid Foundation for Public Policy

Kones¹,

Rumana²

2016

J Clin Exp Cardiolog

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EditorialCoronary heart disease (CHD), the leading cause of death worldwide, is ideally managed through a combination of lifestyle change, optimum medical care, and interventional therapies, including surgery [1]. These three modalities are partners, rather than competitors, from which cardiologists and patients may chose, according to evidence, patient needs, and preferences. While genetic predisposition is important, diet, lifestyle choices, and other modifiable factors account for about 70% to 90% of CHD pathology [2][3][4][5], and are reviewed elsewhere [6][7][8]. This commentary reflects upon the need for better diet studies, the continuing high burden of cardiovascular risk, particularly obesity and type 2 diabetes (T2D), and the concept that atherosclerosis is a systemic disease.The relationship of diet and lifestyle to heart disease has been appreciated for over 40 years, and yet despite a cohesive basic core of nutrition fundamentals, significant advances, and a tsunami of literature, achieving the potential of cardiovascular prevention remains elusive [9][10][11]. Major barriers do not include lack of knowledge, but involve adoption, implementation, the environment, and social determinants [12][13][14].Counterproductive controversy about some issues has become fashionable, but it is not necessary to cite debated issues when recommending smaller portions, more fresh produce, additional fiber, fewer processed foods (especially meats), controlled salt and sugar intake, and greater physical activity (especially avoidance of prolonged sitting) to the public. Most concerning is the minimal improvement in the U. S. diet, which is still considered poor [12,13]. All told, despite all intermediary and putative explanations, the prevalence of ideal cardiovascular health has not meaningfully changed in the past decade, and remains so even when using self-reported data [15,16]. With respect to the six aforementioned items, individual behavior remains the most important factor, rather than guideline failure [17]. Therefore it is not surprising that background cardiovascular risk and subclinical CHD in asymptomatic individuals remains relatively high, as evidenced by positive calcium artery scores in over half of ostensibly healthy rural U. S. adults younger than 65 years [18]. Since this score is associated with the number, duration, and intensity of risk factors present, including obesity and T2D, behavioral/lifestyle modification as part of prevention programs needs much more attention, as outlined in recent ESC Guidelines [19]. At times, and in combination, these have generally led to a high proportion of both false positive and false negative findings, accompanied by correspondingly poor evaluations [20]. A few of these challenges are discussed, in a number of different forums, by several investigators (Figure 1) [11][12][13][21][22][23][24].In the low-fat vs low-carbohydrate debate, program designs did not succeed in elimination of potential barriers over a period of three decades and considerable investment of...

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Quantifying Options for Reducing Coronary Heart Disease Mortality By 2020

Cited by 62 publications

References 21 publications

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Trends in Racial/Ethnic Disparities in Cardiovascular Health Among US Adults From 1999–2012

Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

Nutrition Studies, Optimum Cardiovascular Health, and Coronary Atherosclerosis-Ensuring A Solid Foundation for Public Policy

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