Cardiovascular disease risk factors are related to adult adiposity but not birth weight in young guatemalan adults

Fetal undernutrition has been hypothesized to program inappropriate metabolic responses to nutritional abundance in later life. Most studies have been conducted in industrialized countries. We studied the relationship between birth weight and risk factors for cardiovascular disease (CVD) among 187 men and 198 women age 20-29 y (mean age 24 y) who had participated in a longitudinal study conducted in Guatemala between 1969 and 1977. In women, birth weight was positively associated with adult body mass index (BMI; P < 0.01), systolic (P < 0.001) and diastolic blood pressure (P < 0.05), but not with glucose or any lipid measure. In men, birth weight was not associated with adult BMI, blood pressure or glucose, and was weakly and inversely related to total cholesterol and LDL cholesterol (test for trend: P = 0.06 and P = 0.09, respectively). Adult BMI was associated with increased prevalence of CVD risk factors in both men and women. Our data offer no support for the fetal programming of cardiovascular disease risk hypothesis in young adult women, and weak support in young adult men. Overweight in adults is a strong determinant of variance in CVD risk factor prevalence.     

Smoking,blood pressure and serum cholesterol-effects on 20-year mortality

BACKGROUND: To study the impact of smoking and blood pressure conditional on serum total cholesterol levels, we investigated the 20-year mortality risk associated with high systolic blood pressure (> or =140 mmHg) and smoking, at low (<5.2 mmol/Liter), medium (5.2-6.49mmol/Liter), and high (> or =6.5 mmol/Liter) serum total cholesterol levels. METHODS: The study population comprised a cohort of 50,000 men and women age 30-54 years, examined between 1974 and 1980, in five Dutch towns. The duration of follow-up averaged 20 years. Age-adjusted relative risks (RRs) for mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes were estimated, for six risk profiles (based on levels of total cholesterol, systolic blood pressure and smoking), using Cox proportional hazards analysis. RESULTS: Given a low cholesterol level, smoking had a larger impact than elevated blood pressure on CHD, CVD and all-cause mortality. The combination of elevated blood pressure and smoking among persons with low cholesterol was associated with RRs of 3.0 for CHD, 6.0 for CVD and 4.1 for all-cause mortality in men, and 2.3, 3.6 and 2.6, respectively, in women. Among persons with high cholesterol, the combination of high blood pressure and smoking was associated with RRs of 9.7 for CHD, 13.9 for CVD and 5.7 for all-cause mortality in men, and 15.9, 9.3 and 4.3, respectively, in women. For each risk profile, the absolute number of CHD, CVD and total deaths was larger in men than in women. CONCLUSIONS: The results demonstrate the potential power of a multifactorial approach to risk factor reduction in the prevention of cardiovascular diseases and all-cause mortality.     

Low dehydroepiandrosterone and ischemic heart disease in middle-aged men: prospective results from the Massachusetts Male Aging Study

The adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) have been characterized as "protective" against ischemic heart disease (IHD), especially in men, on the basis of sparse epidemiologic evidence. The authors used data from the Massachusetts Male Aging Study, a random sample prospective study of 1,709 men aged 40-70 years at baseline, to test whether serum levels of DHEA or DHEAS could predict incident IHD over a 9-year interval. At baseline (1987-1989) and follow-up (1995-1997), an interviewer-phlebotomist visited each subject in his home to obtain comprehensive health information, body measurements, and blood samples for hormone and lipid analysis. Incident IHD between baseline and follow-up was ascertained from hospital records and death registries, supplemented by self-report and evidence of medication. In the analysis sample of 1,167 men, those with serum DHEAS in the lowest quartile at baseline (<1.6 microg/ml) were significantly more likely to incur IHD by follow-up (adjusted odds ratio = 1.60, 95 percent confidence interval: 1.07, 2.39; p = 0.02), independently of a comprehensive set of known risk factors including age, obesity, diabetes, hypertension, smoking, serum lipids, alcohol intake, and physical activity. Low serum DHEA was similarly predictive. These results confirm prior evidence that low DHEA and DHEAS can predict IHD in men.     

Iron stores and cardiovascular disease risk factors in women of reproductive age in the United States

BACKGROUND: The increasing proportion of iron-replete individuals in industrialized countries and the possible increased risk of cardiovascular disease (CVD) among men with high iron stores raise concerns regarding improved iron status in women of reproductive age. OBJECTIVE: This study examined the association between iron stores and a set of established CVD risk factors among nonpregnant women aged 20-49 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to examine the relation between race-ethnicity-specific quartiles of serum ferritin (SF) and a set of CVD risk factors [body mass index (BMI), total cholesterol, triacylglycerol, HDL cholesterol, plasma glucose, and blood pressure (BP)]. Women with a history of CVD or liver disease were excluded. We controlled for age, session of measurement, prevalent infection, recent blood donation, and treatment with iron for anemia. RESULTS: Mean SF values were 53.22 +/- 2.08 micro g/L (n = 1178), 58.93 +/- 2.39 micro g/L (n = 1093), and 43.33 +/- 1.39 micro g/L (n = 1075) among non-Hispanic white, non-Hispanic black, and Mexican American women, respectively. Iron stores were positively associated with CVD risk factors only among non-Hispanic black and Mexican American women after adjustment for confounding variables. The strongest associations were seen among Mexican American women: compared with the middle 2 quartiles, the lowest and highest quartiles of SF had lower and higher values, respectively, for BMI, total cholesterol, triacylglycerol, glucose, and diastolic BP. CONCLUSION: These findings suggest that CVD risk factors, especially those related to glucose and lipid metabolism, are positively associated with iron status in women.     

The relationship between blood pressure and biochemical risk factors in a general population.

The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.     

Commuting physical activity is favourably associated with biological risk factors for cardiovascular disease

Background Little is known about the effects of commuting physical activity on biological cardiovascular risk factors although such knowledge may form an important basis for interventions aimed at reducing cardiovascular disease (CVD) by increasing physical activity. We examined the associations between commuting, leisure time and total physical activity and biological risk factors for CVD. Design A cross-sectional study of men and women, who participated in a health screening programme. Methods The study population comprised persons aged 30–60 years from a population-based random sample, response rate 53% (n = 6,906). Weight, height, waist circumference and blood pressure were measured and blood samples were collected. Physical activity was assessed by a self-administered questionnaire. Results Time spent on commuting, leisure time and total physical activity was positively associated with high-density lipoprotein cholesterol and negatively associated with low-density lipoprotein cholesterol, triglycerides, waist circumference and body mass index. Time spent on total physical activity was negatively associated with total cholesterol and diastolic blood pressure. Among men there was no relationship between time spent on physical activity and systolic blood pressure. Time spent on commuting physical activity and total physical activity was negatively associated with systolic blood pressure among women. Conclusion Commuting physical activity, independent of leisure time physical activity, was associated with a healthier level of most of the cardiovascular risk factors. An increase in commuting physical activity in the population may therefore reduce the incidence of CVD.     

Blood pressure and cardiovascular morbidity and mortality in a Dutch population: the Nijmegen cohort study

BACKGROUND. The objective was to determine the influence of systolic blood pressure and diastolic blood pressure on the development of coronary heart disease over an 18-year period in a Dutch general practice population. METHODS. The Nijmegen Cohort Study is a prospective cohort study with an 18-year follow-up. In 1977 systolic blood pressure, diastolic blood pressure, and other cardiovascular risk factors were measured in 7,092 Caucasians, men and women. The screening took place in six general practices, participating in a university registration network. Cardiovascular disease and all mortality was registrated during the 1977-1995 period. A Cox proportional hazard model was performed separately for men and women with the first onset of a coronary heart disease as the outcome variable. Age, smoking, serum cholesterol, blood pressure, and socioeconomic class were included as independent variables. RESULTS. During the 18-year follow-up period, 205 men and 63 women suffered a nonfatal myocardial infarction. During this time, 205 deaths were identified, of which 54 were cardiovascular. Of all deaths, 139 were noncardiovascular, of which 10% were due to accident or suicide, while in 12 participants the cause of death was uncertain. The analysis indicated that both the systolic and the diastolic blood pressure were independently associated with the likelihood for developing coronary heart disease, as were the other risk factors. For coronary heart disease, the significant risk ratios for the systolic blood pressure were 1.6 for men and 2.1 for women. For the diastolic blood pressure a risk ratio was found of 1.4 for men and 2.0 for women. CONCLUSION. A significant relation between blood pressure and coronary heart disease was demonstrated. As mean blood pressures, cholesterol levels, smoking habits, and socioeconomic class in this cohort did not differ from other figures in The Netherlands, extrapolation of the results to the Dutch population is possible.     

Lifetime overweight status in relation to serial changes in body composition and risk factors for cardiovascular disease: The Fels Longitudinal Study

OBJECTIVE: The aims were to determine if 1) individuals who became and maintained overweight during their entire lifetime differ from those who were never-overweight in terms of annual changes in adiposity and concurrent changes in cardiovascular disease (CVD) risk factors; 2) the changes and their relationships to each other varied between these groups or by sex within the groups; and 3) alcohol usage, smoking habits, and level of physical activity differed between groups. RESEARCH METHODS AND PROCEDURES: Data from 16,315 examinations of 414 individuals were utilized to assess lifetime overweight (body mass index [BMI] > 25 kg/m2) status. A regressive analytic approach was used to determine the average annual changes for each individual over an adult serial interval ranging from 4 to 20 years. RESULTS: Men and women who have become and maintained overweight have higher blood pressure and a poorer lipid/lipoprotein risk profile than those who have never been overweight. There is an accelerated deterioration in the atherogenic profile of overweight men and women as indicated by annual changes in CVD risk factors about double that of their never-overweight counterparts. In women, increased risk is derived from increasing systolic and diastolic blood pressure, whereas in men the increased risk comes not only from increasing diastolic blood pressure but also cholesterol, triglycerides, and low-density lipoprotein cholesterol levels and, to a lesser extent, decreasing high-density lipoprotein cholesterol. DISCUSSION: The reduced physical activity observed in the overweight adults may be related to their accumulation of adipose tissue at a rate about double their never-overweight counterparts, and this may be driving the higher rate of increase of CVD risk factors in the overweight groups.     

Relationships among black families' cardiovascular disease risk factors

BACKGROUND. As participants in the District of Columbia Studies of Children's Activity and Nutrition (D.C. SCAN), 262 black mothers and two of each mother's children (3-4 and 8-10 years of age) were measured in their homes for selected cardiovascular disease risk factors: serum total cholesterol, systolic and diastolic blood pressures, height and weight for body mass index, fitness (sum of pulses), activity, and triceps and subscapular skinfolds. RESULTS. For each measure, mothers in the highest quartile were more likely to have children who were also in the highest quartile, and mothers in the lowest quartile were more likely to have children who were in the lowest quartile. For the physiological measures, (with the exception of systolic blood pressure), correlations tended to be stronger between the siblings than between the younger child and the mother, and older siblings' physiological measures contributed to the prediction of younger siblings' physiological measures after controlling for mothers' physiological measures. Relationships between family cardiovascular disease risk factor history and children's serum total cholesterol, and systolic and diastolic blood pressure levels tended to be gender related; i.e., family cardiovascular disease risk factors on the mother's side were more likely to be related to levels among the female but not the male children and vice versa. When personal characteristics were controlled for, the family's cardiovascular disease history was related more strongly to the younger than to the older sibling's systolic and diastolic blood pressure levels. CONCLUSIONS. Results tend to substantiate the importance of screening and counseling other family members, especially a child of the same gender as the parent with a cardiovascular disease or an elevated risk factor level.     

Carbohydrate intake is associated with diet quality and risk factors for cardiovascular disease in U.S. adults: NHANES III

OBJECTIVES: To determine if carbohydrate intake, as a % of energy, was related to diet quality and risk factors for cardiovascular disease (CVD) in adults in a cross-sectional and population-based study in the U.S. METHODS: Data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) were utilized. The nationally representative sample of the U.S. population (3,754 men, 4,074 women, ages 25 to 64 years) was divided into quintiles of carbohydrate intake (% of energy), which was examined in relation to risk factors for CVD: systolic blood pressure, body mass index (BMI), and concentrations of serum triglyceride, serum total and HDL cholesterol and plasma glucose. RESULTS: When covariates (age, ethnicity, smoking, alcohol intake and total energy intake) were adjusted in multivariate analyses, carbohydrate intakes (% of energy) were inversely associated with BMI and serum total cholesterol concentration in men and BMI in women and positively associated with serum triglyceride concentration in women. When total sugar intake (% of energy) was further controlled as a step to understand the quality of carbohydrate, carbohydrate intakes (% of energy) was a stronger predictor of BMI and plasma glucose in men and BMI in women. A high carbohydrate diet (>57.4% of energy in men and >59.1% of energy in women) was associated with a low serum HDL-cholesterol concentration in men and high serum triglyceride in women. CONCLUSION: Moderately high carbohydrate (50% to 55% of energy) diets were associated with low CVD risks with favorable lipid profiles.     

Low birth weight, adrenal and sex hormones and their correlation with carbohydrate metabolism and cardiovascular physiology, investigated in young adulthood]

It is known that the prevalence of cardiovascular diseases, hypertension, noninsulin dependent diabetes mellitus and dyslipidemia in the late adulthood are in connection with intrauterine retardation, characterized by low birth weight. One possible explanation of this phenomenon is the abnormality of hypothalamus-hypophysis-adrenal cortex axis due to the accelerated growth. The authors investigated the steroid levels of young adults; whom birth weight were under 2500 g, and examined the relationship between hormone levels and some parameters of glucose metabolism and cardiovascular system. 75 subjects (43 female and 32 male patients, mean age: 19.6 and 19.8 years, respectively; range 18-22 ys) with low birth weight and without any sign of chronic disease, and 30 healthy, age-matched controls with normal birth weight were investigated. The basal serum cortisol, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), androstenedione (AD), 17-hydroxyprogesterone (17OHP), estradiol (OE), sex-hormone binding globulin (SHBG), FSH, LH and insulin levels were determined. Moreover, oral glucose tolerance test with 75 g glucose (OGTT), impedance cardiography as well as ambulatory blood pressure monitoring were done by all subjects. In both sexes in subjects with low birth weight the mean serum cortisol level was significantly higher, than in the normal controls. In female patients the serum DHEA, DHEAS, AD, and 17OHP levels were significantly higher than in the controls. Moreover, among these females a relationship was found between the elevations of adrenal and gonadal steroids and hyperinsulinemia, characterized by increased insulin response during OGTT. In male subjects a significant correlation was found between serum cortisol levels and systolic blood pressure and heart rate. In females there was a positive relationship between serum DHEA and heart rate. Summarized, the basic abnormality in patients with low birth weight seems to be a relative hypercortisolism, and in females because of hyperinsulinemia exists a mild hyperandrogenism as well. The hypercortisolism may cause cardiovascular abnormalities in males directly, while in females indirectly through the hyperinsulinemia and hyperandrogenism. These subtle abnormalities can be detected when no clinical signs present themselves, in young adulthood, giving the opportunity of taking preventive actions.     

Factors related to serum lipid levels in women of middle and old age--a community study

Serum lipid levels of 168 women ranging in age from 30 to 69 were measured at a mass health screening in an urban community in Saitama prefecture. Degree of obesity, skinfold thickness and blood pressure were measured and the relation between these physical measurements to serum lipid levels was studied. The results are as follows: (1) Mean total cholesterol level, degree of obesity, systolic blood pressure and diastolic blood pressure increased linearly with advancing age. (2) Simple correlation analysis disclosed that the level of total cholesterol was positively correlated to age, degree of obesity, systolic blood pressure and triglyceride level. HDL-cholesterol level showed a significantly negative correlation to degree of obesity, skinfold thickness and triglyceride level. Degree of obesity was positively correlated to skinfold thickness, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride level, but was negatively correlated to HDL-cholesterol. Systolic blood pressure had a positive correlation with age, degree of obesity, diastolic blood pressure, total cholesterol and triglyceride level. (3) Principal component analysis, when performed with the variables age, degree of obesity, skinfold thickness, systolic blood pressure, diastolic blood pressure, level of total cholesterol, triglyceride and HDL-cholesterol, showed that subjects could be divided into the group having obesity with low HDL-cholesterol (first principal component), the hypertensive group (second principal component), and the group having hyperlipidemia with advancing age (third principal component). (4) Multiple regression analysis was also carried out, taking HDL-cholesterol level as the dependent variable, and age, degree of obesity, systolic blood pressure, total cholesterol and triglyceride level as independent variables. Degree of obesity and triglyceride level were negatively related to HDL-cholesterol.     

The association between physical fitness and cardiovascular disease risk factors in children in a five-year follow-up study

The relation between physical fitness and cardiovascular disease (CVD) risk factors was studied in 633 children selected from all fourth grades in 37 elementary schools in New York. They were participating in the control group of an intervention study to reduce CVD risk factors in children. Blood pressure, total and high-density lipoprotein (HDL) cholesterol and physical fitness were measured at baseline and at four subsequent examinations during five years of follow-up. Systolic blood pressure (SBP) at baseline was highest in children with poor physical fitness. The five-year change in physical fitness was inversely associated with the change in SBP, ie, children with the strongest decline in physical fitness showed the largest rise in SBP. HDL cholesterol at baseline was lowest in boys with poor physical fitness. The five-year change in physical fitness was positively related to the change in HDL cholesterol levels in boys; ie, boys with the largest decline in physical fitness had the largest decrease in HDL cholesterol level. These observations indicate that unfavourable long-term changes in physical condition in childhood may be related to unfavourable changes in blood pressure and serum lipids.     

Trace metals and coronary heart disease risk indicators in 152 elderly men (the Zutphen Study)

Information about trace metals and coronary heart disease risk indicators was collected in 1977 among 152 men aged 57-76 years in the town of Zutphen, the Netherlands. Serum zinc, serum copper, blood cadmium, and blood lead were determined by atomic absorption spectrometry and serum lithium by flame emission spectrometry. After uni- and multivariate regression analysis, the following statistically significant relations were found: serum zinc was inversely related to resting heart rate; serum copper was positively related to cigarette smoking and inversely to high density lipoprotein cholesterol; blood cadmium was strongly positively related to cigarette smoking and inversely to Quetelet index; the positive relation between blood lead and cigarette smoking was of borderline significance; and blood lead was related to blood pressure, with the relation being stronger for systolic than for diastolic blood pressure.     

A study of the risk factor profile of cardiovascular diseases in rural Punjabi male patients

One hundred rural Punjabi males (40-60 years old) admitted to Hero DMC Heart Institute, Ludhiana with first cardiac attack were studied to identify major determinants of cardiovascular diseases (CVD) among this group. The results revealed that 20% and 56% of the subjects were smokers and alcohol takers, respectively. Smoking had a significant (p< or =0.01) correlation with serum LDL-C, triglycerides and systolic blood pressure. 84% had sedentary life style. 36% and 7% of the subjects were overweight and obese. The body mass index was positively and significantly (p< or =0.01) correlated with serum triglycerides. 32% and 20% of the subjects had systolic and diastolic blood pressure above normal. 22% were diagnosed for hyperglycemia. 6% suffered from hypercholesterolemia and 28% had borderline high values of serum cholesterol. 22% and 6% had high triglyceride and LDL-C levels, respectively. The study concluded that the etiology of CVD is multifactorial and no single factor is an absolute cause among the rural Punjabi male patients. Therefore, desirable modification in diet and life style can significantly reduce the risk of CVD among rural males of Punjab.     

Associations of prepregnancy cardiovascular risk factors with the offspring's birth weight

Low birth weight of offspring has been associated with increased risk of maternal cardiovascular mortality, and cardiovascular risk factors measured within pregnancy have been related to offspring birth weight. It is not clear whether cardiovascular risk factors assessed prior to pregnancy are associated with the offspring's birth weight. The authors combined baseline data from 3,461 women in the HUNT Study (1995-1997) and data on deliveries from the Medical Birth Registry of Norway up to 2005. They used linear regression to prospectively study associations between diastolic and systolic blood pressures, concentrations of triglycerides, serum total cholesterol, and high density lipoprotein cholesterol measured before conception and birth weight for gestational age of the offspring. Blood pressure measured before pregnancy was inversely associated with birth weight for gestational age, whereas unfavorable levels of serum total cholesterol, high density lipoprotein cholesterol, triglycerides, and glucose were positively associated with birth weight for gestational age. Thus, women with relatively high blood pressure tend to deliver small babies, whereas women with unfavorable lipid levels tend to give birth to large babies, suggesting reduced glucose tolerance. These findings suggest that low as well as high birth weight of the offspring may indicate increased cardiovascular risk for the mother.     

Dietary patterns and levels of blood pressure and serum lipids in a Japanese population

Background

Associations between dietary patterns and cardiovascular disease risk factors remain unclear. The objective of this study was to evaluate the association between dietary patterns derived from factor analysis and the levels of blood pressure and serum lipids in a Japanese population.

Methods

We conducted a cross-sectional analysis among 6886 (in the analysis on blood pressure) and 7641 (in the analysis on serum lipids) Japanese subjects aged 40-69 years. Dietary patterns were identified from a food frequency questionnaire by factor analysis. Associations between dietary patterns and blood pressure and serum lipids were examined after taking potential confounders into account.

Results

Three dietary patterns were identified: vegetable, meat, and Western. In men, the meat pattern was associated with higher total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol. The Western pattern was associated with higher total and LDL cholesterol. In women, the vegetable pattern was associated with lower systolic and diastolic blood pressure and pulse pressure, and higher HDL cholesterol. The meat pattern was associated with higher total and HDL cholesterol. The Western pattern was associated with higher total, HDL, and LDL cholesterol, and the least intake pattern of Western diet was associated with higher systolic and diastolic blood pressures.

Conclusions

Dietary patterns of a Japanese population were related to cardiovascular disease risk factors, especially in women.Key words: Diet, Factor Analysis, Statistical, Blood Pressure, Cholesterol, Japan     

Cardiovascular disease risk factor intervention in low-income women: the North Carolina WISEWOMAN project

OBJECTIVES: The North Carolina WISEWOMAN project was initiated to evaluate the feasibility of expanding an existing cancer screening program to include a cardiovascular disease (CVD) screening and intervention program among low-income women. METHODS: Seventeen North Carolina county health departments were designated as minimum intervention (MI), and 14 as enhanced intervention (EI). The EI included three specially constructed counseling sessions spanning 6 months using a structured assessment and intervention program tailored to lower income women. RESULTS: Of the 2,148 women screened, 40% had elevated total cholesterol (> or = 240 mg/dL), 39% had low high-density lipoprotein cholesterol (HDL-C) levels (< 45 mg/dL), and 63% were hypertensive (systolic blood pressure 140 and/or diastolic blood pressure > or = 90 mm Hg or on hypertensive medication). The majority of women (86%) had at least one of these three risk factors. Seventy-six percent were either overweight or obese. After 6 months of follow-up in the EI health departments, changes in total cholesterol levels, HDL-C levels, diastolic blood pressure, and BMI were observed (-5.8 mg/dL, -0.9 mg/dL, -1.7 mm Hg, and -0.3 kg/m(2), respectively), but were not significantly different from MI health departments. A dietary score that summarized fat and cholesterol intake improved by 2.1 units in the EI group, compared with essentially no change in the MI group. CONCLUSIONS: Expanding existing cancer screening programs to include CVD intervention was feasible and may be an effective means for promoting healthful dietary practices among low-income women.     

Parental history of coronary heart disease, hypertension, diabetes, and stroke: Relationship to coronary heart disease risk factor variables in their adult children

Relationships of parental (familial) history of coronary heart disease, stroke, hypertension, and diabetes to major coronary heart disease (CHD) risk factors were examined in 738 adults (average age, 40 years) in the Cincinnati Lipid Research Clinics Princeton School study. Men reporting parental CHD had higher plasma triglyceride and higher systolic and diastolic blood pressure than comparison group men reporting no parental CHD, stroke, hypertension, or diabetes. Women reporting parental CHD had higher plasma triglycerides than comparison group women reporting no parental CHD, stroke, hypertension, or diabetes. Men reporting stroke in one parent had higher total plasma cholesterol and triglyceride levels than comparison men. Women reporting stroke in one parent had higher triglyceride levels than comparison group women. Women reporting hypertension in one parent had higher mean triglyceride and systolic blood pressure than comparison women. Men and women reporting diabetes in one parent had higher triglyceride than comparison adults. Matching men whose fathers had died of CHD with those whose fathers were free of CHD revealed significant increments in triglyceride levels, systolic, and diastolic blood pressure in the men with positive family history of CHD. Matching women whose fathers had died of CHD with those whose fathers were free of CHD revealed higher total plasma cholesterol, low-density lipoprotein cholesterol, and Quetelet index. In men, categorical assessment by CHD risk factor levels (low, intermediate, high), revealed that plasma triglycerides and systolic blood pressure were positively associated with a parental history of CHD, while high-density lipoprotein cholesterol was inversely related. In women, similar observations were made for triglycerides. Family history is a practical tool for identification of risk to CHD, hypertension, stroke, and diabetes. Serial risk factor measurements in offspring from CHD-, hypertension-, stroke-, and diabetes-positive families should have considerable utility in early recognition and documentation of CHD risk factor levels which, in turn, should facilitate primary intervention designed to ameliorate or prevent the development of CHD.     

Primary Health Care Pioneer,the Selected Works of Dr. Cecily D. Williams

This study critically examined the relationships between weight loss and changes in serum lipid and blood pressure levels.

Eighty morbidly obese women and men were treated with an intensive very-low-calorie diet (VLCD) and behavioral education program. Body weight and blood pressure were measured weekly. Serum lipids were measured biweekly.

Patients lost an average of 35.3 kg in 25.6 weeks. These values decreased significantly: fasting serum cholesterol, 15.1%; low density lipoprotein cholesterol, 17.0%; triglycerides, 14.2%; systolic blood pressure, 8.7%; and diastolic blood pressure, 10.2%. Changes in serum lipids and blood pressure were significantly (p < 0.001) correlated with baseline values and with changes in body mass index (BMI) after adjustment for baseline values. Patients maintained an average of 19.7 kg of their weight loss at the 2-year follow-up.

Weight reduction through a multidisciplinary VLCD program significantly reduces risk factors for cardiovascular disease; for morbidly obese individuals, improvements in risk factors were significantly and linearly related to changes in the BMI.