Suchergebnisse

BACKGROUND: Cardiovascular diseases (CVDs) accounted for over 17 million deaths and 353 million disability-adjusted life years lost in 2016. The risk factors are also high and increasing with high blood pressure, smoking, and high body mass index contributed to up to 212 million disability-adjusted life years in 2016. To help reduce the burden, it is crucial to understand the geographic and socioeconomic disparities in CVD risk factors. METHODS: Employing both geospatial and quantitative analyses, we analyzed the disparities in the prevalence of smoking, physical inactivity, obesity, hypertension, and diabetes in Indonesia. CVD data was from Riskesdas 2018, and socioeconomic data was from the World Bank. RESULTS: Our findings show a very high prevalence of CVD risk factors with the prevalence of smoking, physical activity, obesity, hypertension ranged from 28 to 33%. Results also show the geographic disparity in CVD risk factors in all five Indonesian regions. Moreover, results show socioeconomic disparity with the prevalence of obesity, hypertension, and diabetes are higher among urban and the richest and most educated districts while that physical inactivity and smoking is higher among rural and the least educated districts. CONCLUSION: The CVD burden is high and increasing in particularly among urban areas and districts with higher income and education levels. While the government needs to continue tackling the persistent burden from maternal mortality and infectious diseases, they need to put more effort into the prevention and control of CVDs and their risk factors.

The aim of this study is to evaluate the relationship between the density of green spaces at different buffer sizes (300, 500, 1000 and 1500 m) and cardiovascular risk factors (obesity, hypertension, high cholesterol, and diabetes) as well as to study if the relationship is different for males and females. We conducted cross-sectional analyses using the baseline measures of the Heart Healthy Hoods study (N = 1625). We obtained data on the outcomes from clinical diagnoses, as well as anthropometric and blood sample measures. Exposure data on green spaces density at different buffer sizes were derived from the land cover distribution map of Madrid. Results showed an association between the density of green spaces within 300 and 500 m buffers with high cholesterol and diabetes, and an association between the density of green spaces within 1500 m buffer with hypertension. However, all of these associations were significant only in women. Study results, along with other evidence, may help policy-makers creating healthier environments that could reduce cardiovascular disease burden and reduce gender health inequities. Further research should investigate the specific mechanisms behind the differences by gender and buffer size of the relationship between green spaces and cardiovascular risk factors. ; This project was funded by the Instituto de Salud Carlos III, Subdirección General de Evaluación y Fomento de la Investigación, Government of Spain (PI18/00782) and by the European Research Council under the European Union's Seventh Framework Programme (FP7/2007–2013/ERC Starting Grant Heart Healthy Hoods Agreement no. 623 336893). P.G. was supported by the 2018 Alfonso Martín Escudero Research Grant.

Abstract The increase in the prevalence of overweight and obesity parallels the increase in physical inactivity and sedentary lifestyle, and leads to the worsening of cardiorespiratory fitness. Both overweight and physical inactivity are recognised risk factors for the development of cardiovascular disease, insulin resistance and type 2 diabetes, but the independent effects of cardiorespiratory fitness and obesity on cardiovascular risk factors remain debated. Lifestyle interventions are the key treatment for overweight and obesity. There are however, limited data from large population-based studies on the efficacy of exercise in modifying cardiovascular risk factors in young adults. Many of the mechanisms underlying the changes in body composition and metabolism achieved by exercise interventions are not well understood. The role of adipokines, and particularly unacylated ghrelin has been proposed in relation to changes in glucose metabolism. Individuals also vary in their response to exercise, which is, at least in part, explained by genetic factors. Improved understanding of the gene-exercise interaction is needed for the development of more targeted intervention strategies. In Finland, military service is compulsory for men. Military service includes large amounts of physical exercise but no dietary restriction. The current study evaluated the health benefits of exercise in young men attending military service in the Sodankylä Jaeger Brigade from 2005 to 2006 (N=1,112, mean age 19.2 years). Changes in endurance and strength performance, body composition, cardiometabolic risk factors and unacylated ghrelin levels were recorded at the beginning and end of the military service (6 to 12 months follow-up). Improvement in cardiometabolic risk factors was observed with improved exercise performance, an association which was attributable to changes in weight and waist circumference. Increase in unacylated ghrelin level was associated with beneficial changes in body composition and fat distribution, as well as in lipid and glucose metabolism. Significant gene-exercise interactions were observed for variants in PPARG, IRS1 and TCF7L2 on changes in weight and/or body composition. This study shows the efficacy of physical activity for the improvement of cardiometabolic health among young men. It shows that unacylated ghrelin plays an important role in the improvement of body composition, and glucose and lipid metabolism achieved by exercise. Finally, the harmful effects of common genetic variants on body composition can be counteracted by improvement in exercise performance. ; Tiivistelmä Viimeaikaiset tutkimukset ovat osoittaneet, että väestötasolla ylipaino ja lihavuus lisääntyvät ja liikunta vähenee. Sekä ylipaino että vähäinen liikunta ovat tunnettuja sydän- ja verisuonitautien, insuliiniresistenssin ja tyypin 2 diabeteksen vaaratekijöitä. Monet interventiotutkimukset ovat osoittaneet, että elämäntapamuutokset ovat avainasemassa ylipainon ja lihavuuden hoidossa. Suurista väestöpohjaisista tutkimuksista saatu tieto liikunnan vaikutuksista nuorten aikuisten sydän- ja verisuonitautien vaaratekijöihin, kehonkoostumukseen ja aineenvaihduntaan on kuitenkin vähäistä. Greliinillä on ehdotettu olevan tärkeitä vaikutuksia glukoosiaineenvaihduntaan, mutta greliinin ja liikunnan yhteisvaikutuksista aineenvaihdunnan ja kehon muutoksiin on vain vähän tietoa. Vasteessa liikunta-interventioihin on lisäksi yksilökohtaisia eroja, jotka saattavat ainakin osittain selittyä geneettisillä tekijöillä. Näin ollen lisätieto geenien ja liikunnan välisistä interaktioista on tärkeää uusien, yksilökohtaisten hoitomuotojen kehittämiseksi. Varusmiespalvelus on maassamme pakollinen kaikille miehille, ja siihen sisältyy huomattava määrä liikuntaa ilman merkittäviä muutoksia ruokavaliossa. Tässä tutkimuksessa selvitettiin varusmiespalveluksen aikana tapahtuvan liikunnan ja kuntomuutosten terveyshyötyjä. Tutkimusaineiston muodostivat Sodankylän Jääkäriprikaatissa vuonna 2005 palvelukseen astuneet miehet (N=1112, keski-ikä 19.2 vuotta). Muutokset kestävyys- ja lihaskunnossa, kehonkoostumuksessa, sydän- ja verisuonisairauksien vaaratekijöissä, sekä asyloimattoman greliinin plasmatasoissa määritettiin palveluksen alussa ja lopussa (seuranta-aika 6-12 kk). Parantuneen fyysisen suorituskyvyn todettiin vaikuttavan edullisesti sydän- ja verisuonisairauksien vaaratekijöihin, joka liittyi samanaikaiseen painonlaskuun ja keskivartalolihavuuden vähenemiseen. Liikunnan ansiosta asyloimattoman greliinin plasmataso lisääntyi ja se oli yhteydessä edullisiin muutoksiin kehonkoostumuksessa ja rasvanjakautumisessa sekä glukoosi- ja lipidiaineenvaihdunnassa. Tärkeitä geeni-liikunta interaktioita todettiin insuliiniherkkyyttä säätelevien geenien (PPARG, IRS1 ja TCF7L2) vaikutuksissa painon ja/tai kehonkoostumuksen muutoksiin. Tutkimus osoitti liikunnan edullisen vaikutuksen nuorten miesten sydän- ja verisuonitautien vaaratekijöiden tasoihin. Tutkimus osoitti lisäksi, että liikunnan aiheuttamalla lisääntyneen asyloimattoman greliinin pitoisuudella oli edullisia vaikutuksia kehonkoostumukseen sekä glukoosi- ja lipidiaineenvaihduntaan. Myös insuliiniresistenssiä säätelevien geenien epäedullinen vaikutus kehonkoostumukseen väheni parantuneen fyysisen suorituskyvyn myötä.

Cardiovascular health declines with age, increasing the risk of hypertension and elevated heart rate in middle and old age. Here, we used multivariate techniques to investigate the associations between cardiovascular health (diastolic blood pressure, systolic blood pressure, and heart rate) and white matter macrostructure (lesion volume and number) and microstructure (as measured by diffusion-weighted imaging) in the cross-sectional, population-based Cam-CAN cohort (N = 667, aged 18-88). We found that cardiovascular health and age made approximately similar contributions to white matter health and explained up to 56% of variance therein. Lower diastolic blood pressure, higher systolic blood pressure, and higher heart rate were each strongly, and independently, associated with white matter abnormalities on all indices. Body mass and exercise were associated with white matter health, both directly and indirectly via cardiovascular health. These results highlight the importance of cardiovascular risk factors for white matter health across the adult lifespan and suggest that systolic blood pressure, diastolic blood pressure, and heart rate affect white matter health via separate mechanisms. ; DF, DN, JBR, DP and RAK are supported by the UK Medical Research Council. The Cambridge Centre for Ageing and Neuroscience (Cam-CAN) was supported by the Biotechnology and Biological Sciences Research Council (grant number BB/H008217/1). RAK is supported by the Sir Henry Wellcome Trust (grant number 107392/Z/15/Z) and MRC Programme Grant MC-A060-5PR60. This project has also received funding from the European Union's Horizon 2020 research and innovation programme (grant agreement number 732592).

Abstract Metabolic syndrome (MetS) is a cluster of obesity-related cardiometabolic risk factors. It predicts the development of cardiovascular disease and type 2 diabetes, which are major public health concerns. Visceral obesity and insulin resistance are the predominant underlying factors of MetS, other diagnostic components being elevated blood pressure, high triglycerides, and low HDL-cholesterol. The most important treatment of MetS is through lifestyle changes. There are limited data concerning the prevalence of MetS among young populations. Furthermore, even though the effects of physical activity on MetS components are well established at an individual basis and in some subpopulations, large population-based data about associations of young men's fitness and MetS-related cardiometabolic risk factor changes are warranted. In Finland, military service is compulsory for males. In 2005, 1,160 young men (mean age 19.2 years, range 18–28 years) were followed throughout their military service (6–12 months) in the Sodankylä Jaeger Brigade. The military service period includes high amounts of physical exercise, but no dietary restrictions. Physical fitness, anthropometrics, body composition, and cardiometabolic risk factors were assessed at the beginning and at the end of military service. Among the entire study population, the prevalence of MetS was 3.5–6.8 %, depending on the definition used, and increased in parallel with an increasing body mass index. On the average, the military training period resulted in a decrease in body weight and amount of fat tissue, especially visceral fat, and improved physical fitness. Body composition and fitness improvements were more pronounced in overweight and obese service men. Beneficial changes in body composition and related cardiovascular risk factor improvements were associated with increased physical fitness, especially aerobic fitness. This study indicates that an improvement in physical fitness is related to improvements in body fat distribution and cardiovascular health at population level in young men. This is an age when co-morbidities are usually as yet non-existing, but might be most efficiently prevented by lifestyle changes, such as becoming physically active. ; Tiivistelmä Metabolinen oireyhtymä on tyypin 2 diabeteksen ja valtimosairauksien riskitekijäryväs. Sen osatekijöitä vyötärölihavuuden lisäksi ovat kohonnut verenpaine, insuliiniresistenssi, korkea veren triglyseridipitoisuus ja HDL-kolesterolin pitoisuus. Viime vuosina metabolinen oireyhtymä on yleistynyt lihavuuden lisääntymisen myötä. Lihavuuden ja sen liitännäissairauksien tärkeimpiä hoitokeinoja ovat laihtumiseen tähtäävät elintapamuutokset. Liikunnan tiedetään johtavan edullisiin kehonkoostumusmuutoksiin sekä kardiovaskulaaririskitekijöiden parantumiseen. Laajat väestötason tutkimukset nuorten aikuisten kunnon ja varhaisten valtimosairausriskitekijöitten muutosten välisistä yhteyksistä kuitenkin puuttuvat. Varusmiespalvelus tarjoaa ainutlaatuisen mahdollisuuden tarkastella nuoria miehiä laajassa, lähes valikoitumattomassa väestöotoksessa, sillä Suomessa varusmiespalvelus on pakollinen kaikille miehille. Vuonna 2005 1160 miestä (keski-ikä 19,2 vuotta, vaihteluväli 18–28 vuotta) astui palvelukseen Sodankylän jääkäriprikaatissa. Kehonkoostumus, fyysinen kunto, antropometria sekä veren rasva-arvot mitattiin varusmiespalveluksen (6–12 kk) alussa ja lopussa. Metabolisen oireyhtymän vallitsevuus oli 3,5–6,8 % käytetystä määritelmästä riippuen. Se oli yleisempi korkeimmissa painoindeksiluokissa. Keskimäärin koko aineistossa varusmiesten paino laski, kehon rasvan määrä väheni ja kunto parani palvelusaikana. Edulliset muutokset fyysisessä kunnossa ja kehon koostumuksessa korostuivat ylipainoisilla ja lihavilla varusmiehillä. Nämä muutokset, erityisesti painon ja sisälmysrasvan väheneminen, olivat yhteydessä kestävyyskunnon paranemiseen. Vastaavasti kardiovaskulaaririskitekijöiden edulliset muutokset olivat yhteydessä erityisesti kestävyyskunnon paranemiseen ja vyötärölihavuuden vähenemiseen. Tämän tutkimuksen perusteella voidaan todeta, että nuorten miesten valtimosairauksien riskitekijöiden muutos on yhteydessä fyysisen kunnon nousuun. Nuoret miehet tulee saada lisäämään vapaa-ajan liikuntaa myös siviilielämässä. Keski-iässä yleistyvät valtimosairaudet ja diabetes voisivat olla huomattavissa määrin torjuttavissa vaikuttamalla nuorten miesten liikuntatottumuksiin.

Background Recently, cardiovascular disease (CVD) research has focused on sex- and gender-related cardiovascular risk factors, in addition to conventional risk factors. This raises the question which factors are perceived by the target group (patients with CVD) as priorities for further research. Methods We carried out a survey to study priority setting for more research into conventional and sex- and gender-related risk factors according to 980 men and women with CVD or those at increased risk of CVD in the Netherlands. Data on conventional and sex- and gender-related risk factors were descriptively analysed, stratified by gender group. Results The most frequently prioritised conventional factors according to men were heritability, overweight and unhealthy diet, while women most frequently listed stress, heritability and hypertension. The most frequently prioritised sex- and gender-related risk factors were depression or depressive feelings, migraine and having many caretaking responsibilities (men), and pregnancy complications, contraceptive pill use and early age at menopause (women). New research on sex- and gender-related risk factors was perceived roughly as relevant as that on conventional factors by men (mean 7.4 and 8.3 on a 1–10 scale, respectively) and women (8.2 and 8.6, respectively). Ethnic and gender minority groups placed more emphasis on risk factors related to sociocultural aspects (gender) than the majority group. Conclusion Men and women with CVD or those at increased risk of CVD perceived new research on conventional and sex- and gender-related risk factors as a priority. These findings may guide researchers and funders in further prioritising new CVD research. ; This work was supported by a grant from the ZonMw Gender and Health Program, grant number 849200008. H.L. Tan has received funding from the European Union's research and innovation programme Horizon 2020 under acronym ESCAPE-NET, grant number 733381.

Purpose To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees. Design Cross-sectional study. Setting Voluntary survey of health system employees during an annual CVD awareness and screening event. Subjects 759 health system employees. Measures We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested. Analysis Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee's willingness to undergo further comprehensive screening. Results African American, Hispanic, and Asian employees were younger than white employees ( P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups ( P = .001). The rate of self-reported diabetes was highest in African American and Asian employees ( P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24−.91, P = .025). Conclusion Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.

Intake of industrially produced trans fatty acids (iTFAs) has previously been associated with dyslipidemia, insulin resistance, hypertension and inflammation, as well as increased cardiovascular (CV) morbidity and mortality. iTFA intake declined in Norway after the introduction of legislative bans against iTFA consumption. However, the relationship between the current iTFA intake and CV health is unclear. The aim of the present study was to investigate the association between current iTFA intake, reflected by plasma iTFA levels, and established CV risk factors. We also examined the associations between plasma ruminant TFA levels and CV risk factors. In this cross-sectional study, we included 3706 participants from a Norwegian general population, born in 1950 and residing in Akershus County, Norway. The statistical method was multivariable linear regression. Plasma iTFA levels were inversely associated with serum triglycerides (p < ; 0.001), fasting plasma glucose (p < ; 0.001), body mass index (p < ; 0.001), systolic and diastolic blood pressure (p = 0.001 and p = 0.03) and C-reactive protein (p = 0.001). Furthermore, high plasma iTFA levels were associated with higher education and less smoking and alcohol consumption. We found that plasma ruminant trans fatty acids (rTFA) levels were favorably associated with CV risk factors. Furthermore, plasma iTFA levels were inversely associated with CV risk factors. However, our results might have been driven by lifestyle factors. Overall, our findings suggest that the current low intake of iTFAs in Norway does not constitute a threat to CV health.

PurposeHIV‐infected patients present an increased cardiovascular risk (CVR) of multifactorial origin, usually lower in women than in men. Information by gender about prevalence of modifiable risk factors is scarce.MethodsCoronator is a cross‐sectional survey of a representative sample of HIV‐infected patients on ART within 10 hospitals across Spain in 2011. Variables include sociodemographics, CVR factors and 10‐year CV disease risk estimation (Regicor: Framingham score adapted to the Spanish population).ResultsWe included 860 patients (76.3% male) with no history of CVD. Median age 45.6 years; 84.1% were Spaniards; 29.9% women were IDUs. Median time since HIV diagnosis for men and women was 10 and 13 years (p=0.001), 28% had an AIDS diagnosis. Median CD4 cell count was 596 cells/mm3, 88% had undetectable viral load. Median time on ART was 91 and 108 months (p=0.017). There was a family history of early CVD in 113 men (17.9%) and 41 women (20.6%). Classical CVR factors are described in the table. Median (IQR) Regicor Score was 3% (2‐5) for men and 2% (1–3) for women (p=0.000), and the proportion of subjects with mid‐high risk (>5%) was 26.1% for men and 9.4% for women (p=0.000).ConclusionsIn this population of HIV‐infected patients, women have lower cardiovascular risk than men, partly due to higher levels of HDL cholesterol. Of note is the high frequency of smoking, abdominal obesity and sedentary lifestyle in our population.










Men n=656
Women n=204
P value




Age (men >55 y, women >65 y) n (%)
72 (11.0)
8 (3.9)
0.002


Smoking, n (%)
358 (54.9)
110 (53.9)
0.805


Waist >102 cm (men), >88 cm (women), n (%)
84 (12.9)
55 (27.4)
0.000


Hypertension, n (%)
208 (31.8)
45 (22.2)
0.009


Diabetes, n (%)
50 (7.8)
11 (5.4)
0.262


Total cholesterol>240 mg/dL, n (%)
63 (9.8)
24 (11.9)
0.399


HDL‐cholesterol <40 mg/dL, n (%)
239 (37.5)
34 (16.8)
0.000


Total cholesterol/HDL >5, n (%)
197 (30.9)
23 (11.4)
0.000


Physical inactivity, n (%)
324 (56.7)
108 (69.2)
0.005

BACKGROUND: Mass-migration observed in Peru from the 1970s occurred because of the need to escape from politically motivated violence and work related reasons. The majority of the migrant population, mostly Andean peasants from the mountainous areas, tends to settle in clusters in certain parts of the capital and their rural environment could not be more different than the urban one. Because the key driver for migration was not the usual economic and work-related reasons, the selection effects whereby migrants differ from non-migrants are likely to be less prominent in Peru. Thus the Peruvian context offers a unique opportunity to test the effects of migration. METHODS/DESIGN: The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) study was designed to investigate the magnitude of differences between rural-to-urban migrant and non-migrant groups in specific CVD risk factors. For this, three groups were selected: Rural, people who have always have lived in a rural environment; Rural-urban, people who migrated from rural to urban areas; and, Urban, people who have always lived in a urban environment. DISCUSSION: Overall response rate at enrolment was 73.2% and overall response rate at completion of the study was 61.6%. A rejection form was obtained in 282/323 people who refused to take part in the study (87.3%). Refusals did not differ by sex in rural and migrant groups, but 70% of refusals in the urban group were males. In terms of age, most refusals were observed in the oldest age-group (>60 years old) in all study groups. The final total sample size achieved was 98.9% of the target sample size (989/1000). Of these, 52.8% (522/989) were females. Final size of the rural, migrant and urban study groups were 201, 589 and 199 urban people, respectively. Migrant's average age at first migration and years lived in an urban environment were 14.4 years (IQR 10-17) and 32 years (IQR 25-39), respectively. This paper describes the PERU MIGRANT study design together with a critical analysis of the potential for bias and confounding in migrant studies, and strategies for reducing these problems. A discussion of the potential advantages provided by the case of migration in Peru to the field of migration and health is also presented.