Prevalence and social correlates of cardiovascular disease risk factors in Harlem

OBJECTIVES: This study examined the prevalence, social correlates, and clustering of cardiovascular disease risk factors in a predominantly Black, poor, urban community. METHODS: Associations of risk factor prevalences with sociodemographic variables were examined in a population-based sample of 695 men and women aged 18 to 65 years living in Central Harlem. RESULTS: One third of the men and women were hypertensive, 48% of the men and 41% of the women were smokers, 25% of the men and 49% of the women were overweight, and 23% of the men and 35% of the women reported no leisure-time physical activity over the past month. More than 80% of the men and women had at least 1 of these risk factors, and 9% of the men and 19% of the women had 3 or more risk factors. Income and education were inversely related to hypertension, smoking, and physical inactivity. Having 3 or more risk factors was associated with low income and low education (extreme odds ratio [OR] = 10.2, 95% confidence interval [CI] = 3.0, 34.5 for education; OR = 3.7, CI = 1.6, 8.9 for income) and with a history of unstable work or of homelessness. CONCLUSIONS: Disadvantaged, urban communities are at high risk for cardiovascular disease. These results highlight the importance of socioenvironmental factors in shaping cardiovascular risk.     

Prevalence of selected cardiovascular disease risk factors among American Indians and Alaska Natives--United States, 1997

Heart disease and stroke, the principal causes of cardiovascular disease (CVD), are the first and fifth leading causes of death among American Indians and Alaska Natives (AI/AN) (1,2). Risk factors for CVD frequently cluster, which may increase CVD risk multiplicatively (3). To characterize the prevalence of risk factors for CVD (i.e., hypertension, current cigarette smoking, high cholesterol, obesity, and diabetes) among AI/AN, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated that 63.7% of AI/AN men and 61.4% of AI/AN women who participated in the survey had one or more CVD risk factors.     

Changes in cardiovascular disease risk factors among American Indians. The Strong Heart Study

PURPOSE: This study describes changes in cardiovascular disease (CVD) risk factors in older American Indians over a 4-year period. METHODS: The Strong Heart Study, a longitudinal population-based study of CVD and CVD risk factors among American Indians aged 45-74 years, measured CVD risk factors among 3638 members of 13 tribes in three geographic areas during examinations in 1989 to 1991 and 1993 to 1995. RESULTS: Changes in mean low-density lipoprotein (LDL) cholesterol and the prevalence of elevated LDL cholesterol were inconsistent. Mean high- density lipoprotein (HDL) cholesterol decreased, and the prevalence of low HDL cholesterol increased throughout. Mean systolic blood pressure and hypertension rates increased in nearly all center-sex groups, and hypertension awareness and treatment improved. Smoking rates decreased but remained higher than national rates except among Arizona women. Mean weight and percentage body fat decreased in nearly all center-sex groups but the prevalence of obesity did not change significantly in any group. Diabetes and albuminuria prevalence rates increased throughout the study population. The prevalence of alcohol use decreased, but binge drinking remained common in those who continued to drink. CONCLUSIONS: Improvements in management and prevention of hypertension, diabetes, renal disease, and obesity, and programs to further reduce smoking and alcohol abuse, are urgently needed.     

Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.     

Prevalence of Postpartum Depression in a Native American Population

Objectives: Data were collected on postpartum depression from 151 women, ages 16–40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic make-up of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. Methods: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. Results: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. Conclusions: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.     

Clustering of cardiovascular disease risk factors

In a population-based cardiovascular disease study we analyzed the associations among five risk factors—cholesterol, triglycerides, blood pressure, obesity, and cigarette smoking. Two methods were used: standard correlation analysis, and a percentile analysis method limited to associations at higher levels of these risk factors. The study population, 4,839 men and women aged 30–89, showed significantly positive standard and age-adjusted correlation coefficients for all comparisons between any two risk factors except for those comparisons involving smoking. In the percentile analysis, subjects with moderate or greater (?70th percentile) or high (?90th percentile) levels on one of these risk factors showed clustering of elevations in other risk factors in that observed/expected ratios were generally greater than unity, again excepting smoking comparisons. Clustering was strongest in subjects at the highest levels of these risk factors, a phenomenon which has not, to our knowledge, previously been reported. Because of the particularly high risk of subjects with several risk factors, this finding should caution clinicians who identify a patient with an elevation of one of these risk factors to evaluate the patient carefully for elevations of other risk factors.     

Shift work, risk factors and cardiovascular disease.

The literature on shift work, morbidity and mortality from cardiovascular disease, and changes in traditional risk factors is reviewed. Seventeen studies have dealt with shift work and cardiovascular disease risk. On balance, shift workers were found to have a 40% increase in risk. Causal mechanisms of this risk via known cardiovascular risk factors, in relation to circadian rhythms, disturbed sociotemporal patterns, social support, stress, behavior (smoking, diet, alcohol, exercise), and biochemical changes (cholesterol, triglycerides, etc) are discussed. The risk is probably multifactorial, but the literature has focused on the behavior of shift workers and has neglected other possible causal connections. In most studies methodological problems are present; these problems are related to selection bias, exposure classification, outcome classification, and the appropriateness of comparison groups. Suggestions for the direction of future research on this topic are proposed.     

Prevalence of problem drinking in a Venezuelan Native American population

This is the first study of alcohol-related problems among a Latin American indigenous population using the Alcohol Use Disorders Identification Test (AUDIT). A randomly selected community sample consisting of 3% of the adult population of the tribe completed oral interviews (n = 105 adults, completion rate 86%). The majority of both men (98%) and women (53%) had drunk alcohol at some time in their lives, with 94 and 26% respectively having consumed alcohol within the past 12 months. Using a cut-off score of 8 for the AUDIT, 86.5% of all men and 7.5% of all women were found to be problem drinkers. Focus group discussions revealed that traditional patterns of binge drinking of corn liquor had gradually been replaced by consumption of commercial beer and rum at more frequent intervals and with more negative social consequences. This male population demonstrates one of the highest prevalence rates for problem drinking reported in the world literature. Both the magnitude of problems detected and participants' concerns about them suggest that broad-scale interventions are warranted at the community level.     

Prevalence of cardiovascular risk factors in a rural community in mukim dengkil, selangor

Hypertension and obesity are established and independent risk factors for cardiovascular diseases. There are important inter-relationships between these two factors that may explain the aetiology of coronary heart disease. To determine the prevalence of hypertension and obesity in a rural community setting in Malaysia, and to identify their associated factors, a cross-sectional study was conducted among residents aged 15 years and above in Mukim Dengkil, Selangor from June to October 1999. Sample size was 570, giving a response rate of 86.7%. Prevalence of hypertension was 26.8%, with the highest prevalence among those aged 60 years and above (57.3%), and 50 to 59 years old (53.3%). Factors found to be significantly associated with hypertension were male (χ2=4.71, df=1, p<0.05) and age (t=10.7, df=568, p<0.01). Prevalence of obesity was 11.4%, with the highest prevalence among those aged 40 to 49 years (22.7%) and 30 to 39 years (14.4%). The factors associated with obesity were age (p<0.01), female (χ2=12.45, df=1, p<0.05) and ethnicity (Fisher's Exact probability, p<0.05) with Chinese and Malays having a higher prevalence compared to other ethnic groups. However, there was no significant association between hypertension and obesity (OR=1.14, 95% CI=0.65, 2.02). The prevalence of hypertension and obesity in this study is high. There is a need for prevention programs for these risk factors in rural communities in Malaysia.     

Levels of cardiovascular disease risk factors in Singapore following a national intervention programme.

OBJECTIVE: To evaluate the impact of the National Healthy Lifestyle Programme, a noncommunicable disease intervention programme for major cardiovascular disease risk factors in Singapore, implemented in 1992. METHODS: The evaluation was carried out in 1998 by the Singapore National Health Survey (NHS). The reference population was 2.2 million multiracial Singapore residents, 18-69 years of age. A population-based survey sample (n = 4723) was selected by disproportionate stratified and systematic sampling. Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis. FINDINGS: The 1998 results suggest that the National Healthy Lifestyle Programme significantly decreased regular smoking and increased regular exercise over 1992 levels and stabilized the prevalence of obesity and diabetes mellitus. However, the prevalence of high total blood cholesterol and hypertension increased. Ethnic differences in the prevalence of diabetes mellitus, hypertension, and smoking; and in lipid profile and exercise levels were also observed. CONCLUSION: The intervention had mixed results after six years. Successful strategies have been continued and strengthened.     

Heart disease risk factors in the Vietnamese community of southwestern Sydney

Abstract: Despite low mortality from heart disease in the New South Wales Vietnamese community, the prevalence of risk factors for heart disease has been increasing. This study sought to identify the prevalence of heart disease risk factors in the Vietnamese community in southwestern Sydney. In 1991, 389 randomly selected Vietnamese-born residents of southwestern Sydney (79.2 per cent response rate) were interviewed by telephone about their risk status. Sixty-one per cent of this sample agreed to a second interview in their homes where physical measurements were taken. Smoking prevalence was high in males (53 per cent), whereas raised blood pressure (5.1 per cent), high blood cholesterol (21.1 per cent) and overweight (14.0 per cent) had a low prevalence compared to National Heart Foundation data for the general population. Interventions targeting males about smoking should be a health promotion priority, and the maintenance of the traditional Vietnamese diet should be encouraged.     

军队干部心血管疾病危险因素和临界危险因素调查分析

目的了解军队干部心血管疾病危险因素和临界危险因素的流行现状,为下一步实施有效个体化干预提供数据资料。方法采用心血管疾病流行病学调查表,整群调查陆军机关、院校、野战部队干部809人,分析军队干部心血管疾病危险因素及临界危险因素的流行现状。结果军队干部多数存在不健康生活方式,其中摄盐过多者为43.0%,喜欢食肉者为58.59%,不喜欢运动者为53.89%。心血管疾病危险因素患病率为43.51%,临界危险因素患病率为74.29%,17.06%的人无任何危险因素。其中心血管疾病危险因素患病率位居前3位的分别是吸烟(29.42%)、肥胖(10.38%)、高血压(10.01%);临界危险因素患病率位居前三位的分别是超重(50.56%)、临界高血脂(40.67%)、临界高血压(34.73%)。分组研究结果显示,心血管疾病危险因素,年龄每增加10岁就有显著性增多(P<0.05);临界危险因素,在50岁之前,年龄每增加10岁就有显著性增多(P<0.05),然后进入一个平台期。结论军队干部心血管疾病危险因素患病率明显低于社会普通人群,但临界危险因素存在现象较为普遍。