Healthy Lifestyle and Decreasing Risk of Heart Failure in Women : The Women's Health Initiative Observational Study

Background

The impact of a healthy lifestyle on risk of heart failure (HF) is not well known.

Objectives

The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact.

Methods

Participants were 84,537 post-menopausal women from the WHI (Women’s Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology.

Results

There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension.

Conclusions

An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.     

Women hospitalized with atrial fibrillation: Gender differences,trends and outcome from a 20-year registry in a middle eastern country (1991–2010)

Background

Most of the published research on atrial fibrillation (AF) is limited to studies in the developed world and included mainly Caucasian patients. Data about women with AF among other ethnicities is very limited.

Objectives

The aim of this study was to compare the clinical characteristics, treatment and outcome of women to men hospitalized with AF in a middle-eastern country.

Methods

Retrospective analysis of prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Clinical characteristics, management, and outcomes of AF patients were compared according to gender.

Results

During the 20-years period; 1417 women and 2432 men were hospitalized for AF. Women were 5 years older and more likely to have diabetes mellitus, hypertension, and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men. There was no gender preference in the use of anticoagulation. The prevalence of concomitant ischemic heart disease and hypertension increased, while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period. In-hospital mortality and stroke rates were comparable between the two groups.

Conclusions

Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas, mortality and stroke rates were comparable.     

Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: Results from the Korea National Health and Nutrition Examination Survey, 1998–2012

Background

Mortality from coronary heart disease in Korea has increased continuously, but there are few comprehensive national data on trend in the prevalence of risk factors for cardiovascular disease in this population. We examined the trends in the prevalence of major risk factors for cardiovascular disease, including smoking, obesity, hypertension, diabetes, and hypercholesterolemia, from 1998 through 2012 in a representative Korean population.

Methods

Using data from the Korea National Health and Nutrition Examination Survey I (1998) to V (2010–2012), we selected the adults aged ≥ 30 yr who participated in both a health examination and health interview survey.

Results

From 1998 to 2012, significant decrease in the prevalence of hypertension was observed in both men (32.5 to 31.5%) and women (26.9 to 24.3%). Smoking rates decreased only in men (65.1 to 47.0%), whereas the prevalence of diabetes did not change over time. Conversely, the prevalence of hypercholesterolemia significantly increased from 7.2% to 12.6% for men and from 8.4% to 14.9% for women, whereas the rates of awareness and treatment for hypercholesterolemia were relatively lower than that of hypertension and diabetes. During the period, prevalence of obesity significantly increased from 26.8% to 38.1% only in men.

Conclusions

The increased prevalence of hypercholesterolemia and obesity may have contributed to the increasing trend in the mortality from coronary heart disease in Korea. Further population-based surveillance of blood cholesterol levels and obesity needs to be performed, and national strategies for improvement of these factors should be established in Korea.     

Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: Rationale and study design

Aims

Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study.

Methods

The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3–12 months postpartum, and 13–24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change.

Conclusions

Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.     

Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men : A Population-Based Prospective Cohort Study

Background

Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI).

Objectives

The aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men.

Methods

The population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference <95 cm).

Results

During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population.

Conclusions

Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.     

Life course socioeconomic conditions,adulthood risk factors and cardiovascular mortality among men and women: A 17-year follow up of the GLOBE study

Background

Our goal was to study associations between childhood socioeconomic position (SEP), adulthood SEP, adulthood risk factors and cardiovascular disease (CVD) mortality, by investigating the critical period and pathway models.

Methods

The prospective GLOBE study in the Netherlands, with baseline data from 1991, was linked with cause of death register data from Statistics Netherlands in 2007. At baseline, respondents reported information on childhood SEP (i.e. occupational level of respondent's father), adulthood SEP (educational level), and adulthood risk factors (health behaviours, material circumstances, and psychosocial factors). Analyses included 4894 men and 5572 women. Data were analysed by Cox proportional hazard ratios (HR) with CVD mortality as the outcome.

Results

Childhood SEP was associated with CVD mortality among men with the lowest childhood SEP only (HR 1.32, 95% CI 1.00–1.74), and not among women. The majority of childhood SEP inequalities in CVD mortality among men (88%) were explained by material, behavioural and psychosocial risk factors in adulthood, and adulthood SEP. This was mostly due to the association of childhood SEP with adulthood SEP, and the interrelations of adulthood SEP with risk factors, and partly via the direct association of childhood SEP with adulthood risk factors, independent of adulthood SEP.

Conclusion

This study supports the pathway model for men, but found no evidence that socioeconomic conditions in childhood are critical for CVD mortality in later life independent of adulthood conditions. Developing effective methods to reduce material and behavioural risk factors among lower socioeconomic groups should be a top priority in cardiovascular disease prevention.     

Imaging to Assess Ischemic Heart Disease in Women

Purpose of Review

Ischemic heart disease is a leading cause of morbidity and mortality for women and men around the world. However, traditional cardiovascular risk factors do not fully capture cardiac risk in women. This review summarizes sex-based differences in the clinical presentation, pathophysiology, and risk assessment of ischemic heart disease. We also examine the use of anatomic and functional imaging modalities in the diagnosis of ischemic heart disease in women.

Recent Findings

Recent studies with women subjects have bolstered the predictive value of the coronary artery calcium (CAC) score in predicting atherosclerotic cardiovascular disease risk and major adverse cardiac events in a graded fashion. In addition, combined CAC scoring and coronary computed tomography (CCTA) has shown promise in excluding coronary artery disease (CAD). Using CCTA, data have suggested that increasing cardiovascular risk factors are associated with an increase in noncalcified coronary plaque in women compared with an increase in both calcified and noncalcified plaque in men with cardiac risk factors. Some data have suggested that women obtain greater prognostic benefit from CCTA than from other noninvasive tests. Fractional flow reserve obtained from a CCTA (FFR_CT) is a new mathematical assessment of coronary blood flow that determines the presence of lesion-specific myocardial ischemia.

Summary

Prevention and identification of ischemic heart disease remains a foundation of cardiology and public health. In women, atypical symptoms and limitations in traditional risk factor assessment lead to challenges in the identification of ischemic heart disease. With improvements in technologies such as CAC scoring, CCTA, instantaneous flow reserve (iFR), optical coherence tomography (OCT), and FFR_CT, there is great promise for identification of ischemic heart disease, and the future of prevention in women. Future studies with strong female representation should investigate the role of novel imaging techniques in women.

     

Tako-tsubo Syndrome and Heart Failure: Long-term Follow-up

Introduction and objectives

Tako-tsubo syndrome produces a variable degree of transient left ventricular dysfunction. Our objective was to determine the short- and long-term prognosis of this syndrome, the incidence of and risk factors for the development of heart failure, and the influence on heart failure on the long-term outcome in our patient population.

Methods

We prospectively recorded the clinical features and events during the hospital stay and follow-up of 100 patients with tako-tsubo syndrome. The risk factors for heart failure during hospital stay, considered as Killip class≥II, were assessed.

Results

Most of the patients were women (89%), with a mean age of 68 years. The distribution according to Killip class was: Killip I, 70 patients; Killip II, 15; Killip III, 5; and Killip IV, 10. Cardiovascular risk factors, including diabetes, were common in the overall group, but were more so in the heart failure cohort. The left ventricular ejection fraction was lower in the heart failure group (51% vs 42%; P<.01). There were no differences in preadmission medications or biomarkers of necrosis. Over a median follow-up of 1380 days, the incidence of events reported during the hospital stay and long-term follow-up, both for death and the combined endpoints, was higher in the heart failure cohort.

Conclusions

Although the prognosis in tako-tsubo syndrome is usually good, heart failure occurs quite frequently, mainly in patients with a greater number of comorbidities and poorer previous functional class. Moreover, heart failure is associated with a higher number of early and late adverse events. The overall long-term prognosis is good.     

Association between Chlamydophila pneumoniae infection and risk of coronary heart disease for Japanese: The JPHC study

Background

Chlamydophila pneumoniae infection is considered a risk factor for atherosclerosis and coronary heart disease in western countries. However, evidence of it being a risk for Japanese is very limited because of a lower risk of coronary heart disease than for western people. The aim of this study was to examine further the association between C. pneumoniae infection and risk of coronary heart disease in Japanese.

Methods

We conducted a nested case–control study of 49,011 Japanese men and women who participated in The Japan Public Health Center (JPHC) study. By the end of 2004, 196 cases of coronary heart disease and 155 cases of myocardial infarction had been documented among the participants. Two controls were selected for each case. For these subjects, we examined the association between serum anti C. pneumoniae IgA and IgG on the one hand and risk of coronary heart disease on the other.

Results

Concentration of C. pneumoniae IgA antibody was positively associated with risk of coronary heart disease and more specifically myocardial infarction. Subjects with the highest quartile of IgA antibody showed 2.29 (95%CI, 1.21–4.33) times higher risk of coronary heart disease and 2.58 (95%CI, 1.29–5.19) times higher risk of myocardial infarction than those with lowest quartile. However, no such association was detected for IgG antibody.

Conclusion

C. pneumoniae infection was found to be positively associated with risk of coronary heart disease.     

Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study

Introduction and objectives

To update the prevalence of metabolic syndrome and associated coronary risk in Spain, using the harmonized definition and the new World Health Organization proposal (metabolic premorbid syndrome), which excludes diabetes mellitus and cardiovascular disease.

Methods

Individual data pooled analysis study of 24 670 individuals from 10 autonomous communities aged 35 to 74 years. Coronary risk was estimated using the REGICOR function.

Results

Prevalence of metabolic syndrome was 31% (women 29% [95% confidence interval, 25%-33%], men 32% [95% confidence interval, 29%-35%]). High blood glucose (P=.019) and triglycerides (P<.001) were more frequent in men with metabolic syndrome, but abdominal obesity (P<.001) and low high-density lipoprotein cholesterol (P=.001) predominated in women. Individuals with metabolic syndrome showed moderate coronary risk (8% men, 5% women), although values were higher (P<.001) than in the population without the syndrome (4% men, 2% women). Women and men with metabolic syndrome had 2.5 and 2 times higher levels of coronary risk, respectively (P<.001). Prevalence of metabolic premorbid syndrome was 24% and the increase in coronary risk was also proportionately larger in women than in men (2 vs 1.5, respectively; P<.001).

Conclusions

Prevalence of metabolic syndrome is 31%; metabolic premorbid syndrome lowers this prevalence to 24% and delimits the population for primary prevention. The increase in coronary risk is proportionally larger in women, in both metabolic syndrome and metabolic premorbid syndrome.Full English text available from:www.revespcardiol.org     

Seven modifiable lifestyle factors predict reduced risk for ischemic cardiovascular disease and all-cause mortality regardless of body mass index: A cohort study

Objectives

A healthy lifestyle has an impact on cardiovascular health. Yet, the importance of body mass index (BMI) and gender remains less clear. The aim of this study was to investigate whether healthy lifestyle factors can predict incident cardiovascular disease (CVD) and all-cause mortality.

Methods

Representative population-based prospective cohort study of 60-year-old women (n = 2193) and men (n = 2039). The following factors related to a healthy lifestyle were assessed using a questionnaire: non-smoking, alcohol intake of 0.6–30 g/day, moderate physical activity at least once a week, low intake of processed meats, weekly intake of fish, daily intake of fruit, and daily intake of vegetables. These factors were combined to produce a total score of healthy lifestyle factors (0–7) and classified into four groups: unhealthy (0–2 lifestyle factors), intermediate (3), healthy (4–5), and very healthy (6–7). National registers enabled identification of incident CVD (n = 375) and all-cause mortality (n = 427) over a follow-up of 11 years.

Results

Very healthy women and men exhibited a decreased risk for incident CVD compared with unhealthy individuals, with hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for educational level and BMI of 0.44 (0.26–0.75) and 0.39 (0.25–0.61), respectively. The corresponding HRs (95% CIs) for all-cause mortality for very healthy women and men were 0.25 (0.15–0.44) and 0.35 (0.23–0.54), respectively.

Conclusion

With seven healthy lifestyle factors, it was possible to identify men and women with substantially lower relative risks of incident CVD and death, regardless of BMI and educational level.     

Perceptions of Canadian primary care physicians towards cardiovascular risk assessment and lipid management

Background

Cardiovascular (CV) risk stratification remains the cornerstone of preventive cardiology. This study was performed to gain insight into how Canadian primary care physicians (PCPs) incorporate traditional and emerging risk factors in determining risk.

Methods

Using a tested questionnaire, this cross-sectional survey evaluated the perceptions of 846 PCPs (38% response rate) on CV risk assessment, treatment thresholds, and novel biomarkers of vascular risk.

Results

Most physicians (74%) perform CV risk assessment in eligible patients annually with 69% using the Framingham Risk Score (FRS). Although 89% of the physicians knew that FRS estimates 10-year risk of coronary heart disease death and myocardial infarction, 30% could not characterize FRS thresholds for high risk. Only 44% correctly used a positive family history to double the FRS. Waist circumference was considered by 79% of the physicians as a vital sign but only 6% reported measuring this routinely. Carotid ultrasound was identified by 55% as the preferred imaging technique for screening in primary prevention. Although 99% had heard of high sensitivity C-reactive protein (hs-CRP), only 49% measured it for the purposes of assessing CV risk and 27% were unsure under what clinical scenarios the test is indicated.

Conclusions

Our survey suggests that FRS is employed by approximately 2/3 of Canadian PCPs for risk stratification. Family history and central obesity are considered important additional CV risk markers. There are substantial knowledge gaps on the appropriate use of family history and hs-CRP in risk stratification, particularly in patients who may not present with hyperlipidemia.     

Residual risk of cardiovascular mortality in patients with coronary heart disease: The EUROASPIRE Risk Categories

Background

The EUROASPIRE I, II and III surveys revealed high prevalences of modifiable risk factors in the high priority group of coronary patients all over Europe. The potential to further reduce coronary heart disease (CHD) morbidity and mortality rates is still considerable. We report here on the relative risk of cardiovascular disease (CVD) death associated with common modifiable risk factor levels based on the mortality follow-up of patients participating in the first two EUROASPIRE surveys. We also present a novel simple risk classification system (ERC) that can be used in the management of patients with existing CHD.

Methods

The study cohort consisted of a consecutive sample of CHD patients aged ≤ 70 years from 12 European countries. Baseline data gathered in 1995–2000 through standardized methods, were linked to cardiovascular mortality in 5216 patients according to an accelerated failure time model.

Results

During 28,143 person-years of follow-up, 332 patients died from cardiovascular disease denoting a CVD mortality risk of 12.3 per 1000 person-years in men and 10.2 per 1000 person-years in women. In multivariate analysis, fasting glucose, total cholesterol and smoking emerged as the strongest independent modifiable predictors of cardiovascular mortality.

Conclusions

The results of the mortality follow-up of the EUROASPIRE I and II CHD patients emphasize the continuing risk from elevated glucose and total cholesterol levels and underline the importance of smoking cessation in secondary prevention. The ERC risk tool that we developed may prove helpful to obtain these goals in the setting of secondary prevention.     

Supervivencia de pacientes ambulatorios con insuficiencia cardiaca crónica del área mediterránea. Un estudio de base poblacional

Introduction and objectives

Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors.

Methods

We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007.

Results

During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0,73; 95% confidence interval, 0,64-0,84) had a protective effect.

Conclusions

Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients.Full English text available from:www.revespcardiol.org/en     

Comparison of Cardiovascular Risk Assessment Algorithms to Determine Eligibility for Statin Therapy: Implications for Practice in Canada

Background

New lipid management guidelines in the United States have created controversy regarding risk assessment using the new Pooled Cohort Equations (PCE) which might overestimate cardiovascular risk and identify an excessive number of patients as new candidates for statin therapy.

Methods

We compared the Framingham Risk Score (FRS) used in Canada with PCE, the FRS version used in Adult Treatment Panel III (ATP III), Reynolds Risk Score (RRS), and Systematic Coronary Risk Evaluation (SCORE) using patient profile simulation of 10 cohorts of 100,000 each (total n = 1,000,000 for each comparison). Patients with diabetes, established cardiovascular disease, or family history of premature cardiovascular disease were not considered, mimicking uncomplicated primary prevention. Analyses were performed separately for men and women and for black individuals when feasible.

Results

SCORE (high-risk version) was most concordant with FRS in men, whereas PCE was most concordant in black women. Compared with FRS, all other algorithms except SCORE (high-risk version) identified more simulations as low risk. Reclassification from low FRS to a higher risk was not seen using RRS or ATP III and seen in < 5% of simulations using PCE, affecting predominantly black subject simulations.

Conclusions

Choice of risk calculator leads to systematic differences in risk categorization that can influence eligibility for lipid-lowering therapy. Compared with FRS, an isolated switch to PCE, RRS, or ATP III is unlikely to lead to substantial reclassification from low to higher risk categories in Canada.     

Long-term mortality and hospital readmission after acute myocardial infarction: an eight-year follow-up study

Introduction and objectives

Acute myocardial infarction is responsible for most of the deaths in developed countries and for a very large number of hospital admissions. Specifically in Spain, each year about 140 000 deaths and 5 million hospital stays are due to acute myocardial infarction, corresponding to health care costs reaching 15% of total expenditure. Therefore, this paper presents an exhaustive analysis of acute myocardial infarction and the related prognosis, such as recurrence and mortality.

Methods

This observational study was carried out in Spain. Data were obtained using the Hospital Discharge Administrative Database from 2000 through 2007, inclusive. Specifically, 12 096 cases of acute myocardial infarction (8606 women and 3490 men) were reported during this period, with 2395 readmissions for this diagnosis. Readmissions were analyzed for frequency and duration using logistic regression and the Wang survival model. Mortality was analyzed using logistic regression.

Results

Readmission rates were 50% for patients younger than 45 years and 38% for those older than 75 years (P<.001). Men were readmitted more frequently than women throughout the follow-up period. Variables related to hospital mortality from acute myocardial infarction were the presence of diabetes, previous ischemic heart disease, and cerebrovascular disease.

Conclusions

Mid-term hospital readmissions are highly frequent in acute myocardial infarction survivors. Male sex, previous coronary heart disease, and the number of classical cardiovascular risk factors are the major risk predictors of this readmission. Our results highlight the need for improved medical care during acute myocardial infarction admission, integrated into secondary prevention programs.Full English text available from:www.revespcardiol.org     

Heart failure patients' experiences of a self-management peer support program: A qualitative study

Objectives

Explore the experiences of patients with heart failure in a self-management support program to inform the development of future interventions that support and motivate patients to engage in self-management.

Background

Peer-support programs have led to improved outcomes among patients with other chronic conditions and may result in similar improvements for heart failure patients. Yet, among patients recently hospitalized for heart failure, over half had no or minimal engagement with a reciprocal peer support program.

Methods

Qualitative semi-structured interviews with a purposive sample of 28 patients (mean age 72; 71% Female; 21% African-American; 75% Caucasian) with different levels and types of engagement in a heart failure self-management support program.

Results

Key themes that emerged included the importance of heart failure specific-social support, sharing information, comparing self to others, depression, and functional status.

Conclusions

Useful services for heart failure patients provide comfort, restore confidence, and offer practical solutions.     

Éducation thérapeutique en prévention primaire cardiovasculaire. Intérêts et limites

Goal of the study

Lifestyle improvement is useful in the prevention of cardiovascular disease, but its practical implementation in the general population is limited. Patient therapeutic education can help go beyond these limits.

Patients and methods

In primary prevention, we propose a personalized program including one or several individual and collective sessions to help the participants towards a healthier lifestyle. This includes better education about six risk factors (tobacco, sedentary lifestyle, overweight, high blood pressure, high cholesterol, diabetes) as well as advice on better eating habits. The first recommendation is to limit processed meats, the other recommendations advise more fish, green vegetables, whole grains and beans, and fruits. Scores are attributed to six risk factors and five eating habits. These scores are given at the time of the first session and again a year later, thus permitting time comparisons.

Results

For the first 291 participants in the program, we observed at one year a significant improvement in physical activities of endurance and in the consumption of the recommended food groups (fish, green vegetables, fruits, whole grains and beans).

Conclusion

The patient's lifestyle has improved as a whole, certain parameters more than others. Assessed patient therapeutic education should be offered to a larger number of people.     

Plasma homocysteine,dietary B vitamins,betaine, and choline and risk of peripheral artery disease

Objective

Few studies have examined the roles of homocysteine and related nutrients in the development of peripheral artery disease (PAD). We examined the associations between plasma homocysteine, dietary B vitamins, betaine, choline, and supplemental folic acid use and incidence of PAD.

Methods

We used two cohort studies of 72,348 women in the Nurses' Health Study (NHS, 1990–2010) and 44,504 men in the Health Professionals Follow-up Study (HPFS, 1986–2010). We measured plasma homocysteine in nested matched case–control studies of clinically recognized PAD within both cohorts, including 143 PAD cases and 424 controls within the NHS (1990–2010) and 143 PAD cases and 428 controls within the HPFS (1994–2008). We examined the association between diet and risk of incident PAD in the cohorts using a food frequency questionnaire and 790 cases of PAD over 3.1 million person-years of follow-up.

Results

Higher homocysteine levels were positively associated with risk of PAD in men (adjusted IRR 2.17; 95% CI, 1.08–4.38 for tertile 3 vs. 1). There was no evidence of an association in women (adjusted IRR 1.14; 95% CI, 0.61–2.12). Similarly, higher folate intake, including supplements, was inversely associated with risk of PAD in men (adjusted HR 0.90; 95% CI, 0.82–0.98 for each 250 μg increase) but not women (HR 1.01, 95% CI, 0.88–1.15). Intakes of the other B vitamins, betaine, and choline were not consistently associated with risk of PAD in men or women.

Conclusion

Homocysteine levels were positively associated and dietary folate intake was inversely associated with risk of PAD in men but not in women.     

Traditional Cardiovascular Risk Factors and the Presence of Obstructive Coronary Artery Disease in Men and Women

Background

Extensive research has demonstrated the importance of traditional cardiovascular risk factors in predicting acute coronary events. Our main objective was to evaluate the relationship between traditional risk factors and the presence of obstructive coronary artery disease (CAD), and to explore potential differences in men vs women.

Methods

An observational study was conducted in a population-based cohort of stable patients who underwent cardiac catheterization in Ontario, Canada. We examined the relationship of diabetes, hypertension, hyperlipidemia, and smoking with the presence of obstructive CAD in men and women using multivariable logistic regression models.

Results

Of the 46,490 patients who were included in our study, 61.2% were men and 38.8% were women. We found that 97% of patients with obstructive CAD had at least 1 conventional cardiovascular risk factor. The adjusted odds ratios (ORs) for obstructive CAD in women with diabetes (OR, 1.51), hypertension (OR, 1.38), and smoking (OR, 1.39) were statistically significantly greater than in men (OR, 1.20 for diabetes; OR, 1.08 for hypertension; OR, 1.14 for smoking; P < 0.001). The sex difference was even greater for patients with multiple risk factors. For example, the association with obstructive CAD in women with 4 cardiac risk factors (OR, 4.30; 95% confidence interval, 3.49-5.28) was almost doubled compared with men (OR, 2.26; 95%confidence interval, 1.99-2.57; P < 0.001).

Conclusions

Almost all patients with stable CAD undergoing cardiac catheterization had at least 1 traditional cardiac risk factor. Importantly, the association between multiple cardiac risk factors and the presence of obstructive CAD is substantially stronger in women than men.