Allison H. Christian

National Study of Women’s Awareness, Preventive Action, and Barriers to Cardiovascular Health

Background— There is growing awareness of cardiovascular disease (CVD) as the leading cause of death in women, but whether this greater awareness is associated with increased action by women to lower their personal or family’s risk is unknown. Methods and Results— A nationally representative sample of 1008 women selected through random-digit dialing were given a standardized questionnaire about history of CVD/risk factors, awareness of leading cause of death, knowledge of healthy and personal levels of CVD risk factors, self-reported actions taken to reduce risk, and barriers to heart health. The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 (55% versus 30%) was significantly greater for whites compared with blacks and Hispanics (62% versus 38% and 34%, respectively) and was independently correlated with increased physical activity (odds ratio, 1.35; 95% CI, 1.00 to 1.83) and weight loss (odds ratio, 1.47; 95% CI, 1.14 to 2.02) in the previous year in logistic regression models. Fewer than half of the respondents were aware of healthy levels of risk factors. Awareness that personal level was not healthy was positively associated with action. Most women took steps to lower risk in family members and themselves. The most frequently cited barriers for heart health were confusion in the media (49%), the belief that health is determined by a higher power (44%), and caretaking responsibilities (36%). Conclusions— General awareness of CVD risk among women is associated with preventive action. Educational interventions need to be targeted at racial/ethnic minority women.

A Novel Family-Based Intervention Trial to Improve Heart Health: FIT Heart Results of a Randomized Controlled Trial

Background—Family members of patients with cardiovascular disease (CVD) may be at increased risk due to shared genes and lifestyle. Hospitalization of a family member with CVD may represent a “motivational moment” to take preventive action. Methods and Results—A randomized, controlled clinical trial was conducted in healthy adult family members (N=501; 66% female; 36% nonwhite; mean age, 48 years) of patients hospitalized with CVD to evaluate a special intervention (SI) with personalized risk factor screening, therapeutic lifestyle-change counseling, and progress reports to physicians versus a control intervention (CIN) on the primary outcome, mean percent change in low-density lipoprotein cholesterol (LDL-C), and other risk factors. Validated dietary assessments and standardized risk factors were obtained at baseline and 1 year (94% follow-up). At baseline, for 93% of subjects, saturated fat comprised ≥7% of total caloric intake, and 79% had nonoptimal LDL-C levels (of which 50% were unaware). There was no difference in the SI versus the CIN with respect to the mean percent change in LDL-C (−1% versus −2%, respectively; P=0.64), owing to a similar significant reduction in LDL-C in both groups (−4.4 mg/dL and −4.5 mg/dL, respectively). Diet score significantly improved in the SI versus the CIN (P=0.04). High-density lipoprotein cholesterol declined significantly in the CIN but not in the SI (−3.2% [95% CI, −5.1 to −1.3] versus +0.3% [95% CI, −1.7 to +2.4]; P=0.01). At 1 year, SI subjects were more likely than controls to exercise >3 days per week (P=0.04). Conclusion—The SI was not more effective than the CIN in reducing the primary end point, LDL-C. The screening process identified many family members of hospitalized patients with CVD who were unaware of their risk factors, and further work is needed to develop and test interventions to reduce their CVD risk.

Association of acculturation status with beliefs, barriers, and perceptions related to cardiovascular disease prevention among racial and ethnic minorities.

Acculturation has been correlated with traditional cardiovascular disease risk factors. The purpose of this study was to examine the association between acculturation and health beliefs, barriers, and perceptions related to cardiovascular disease prevention. Racial/ethnic minority participants in the Family Intervention Trial for Heart Health were included in this analysis. Less acculturated minorities were more likely to have health beliefs that may impede prevention, have greater perceived susceptibility to disease, and believe in an external locus of control. Evaluating acculturation in clinical practice may be an opportunity to promote awareness, healthy behaviors, and prevention among immigrants.

A Novel Family-Based Intervention Trial to Improve Heart Health: FIT HeartCLINICAL PERSPECTIVE

Background—Family members of patients with cardiovascular disease (CVD) may be at increased risk due to shared genes and lifestyle. Hospitalization of a family member with CVD may represent a “motivational moment” to take preventive action. Methods and Results—A randomized, controlled clinical trial was conducted in healthy adult family members (N=501; 66% female; 36% nonwhite; mean age, 48 years) of patients hospitalized with CVD to evaluate a special intervention (SI) with personalized risk factor screening, therapeutic lifestyle-change counseling, and progress reports to physicians versus a control intervention (CIN) on the primary outcome, mean percent change in low-density lipoprotein cholesterol (LDL-C), and other risk factors. Validated dietary assessments and standardized risk factors were obtained at baseline and 1 year (94% follow-up). At baseline, for 93% of subjects, saturated fat comprised ≥7% of total caloric intake, and 79% had nonoptimal LDL-C levels (of which 50% were unaware). There was no difference in the SI versus the CIN with respect to the mean percent change in LDL-C (−1% versus −2%, respectively; P=0.64), owing to a similar significant reduction in LDL-C in both groups (−4.4 mg/dL and −4.5 mg/dL, respectively). Diet score significantly improved in the SI versus the CIN (P=0.04). High-density lipoprotein cholesterol declined significantly in the CIN but not in the SI (−3.2% [95% CI, −5.1 to −1.3] versus +0.3% [95% CI, −1.7 to +2.4]; P=0.01). At 1 year, SI subjects were more likely than controls to exercise >3 days per week (P=0.04). Conclusion—The SI was not more effective than the CIN in reducing the primary end point, LDL-C. The screening process identified many family members of hospitalized patients with CVD who were unaware of their risk factors, and further work is needed to develop and test interventions to reduce their CVD risk.

A Randomized Clinical Trial of Secondary Prevention Among Women Hospitalized with Coronary Heart Disease

BACKGROUND Secondary prevention improves survival, yet implementation is suboptimal. We tested the impact of a systematic hospital-based educational intervention vs. usual care to improve rates of adherence to secondary prevention guidelines among women hospitalized with coronary heart disease (CHD), according to their ethnic status. METHODS Women (n = 304, 52% minorities) hospitalized with CHD were randomly assigned to a systematic secondary prevention educational intervention vs. usual care. Adherence to goals for smoking cessation, weight management, physical activity, blood pressure <140/90 mm Hg, low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (2.59 mmol/L), and use of aspirin/anticoagulants, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors were assessed at 6 months. RESULTS On admission, minority women were less likely than white women to meet the goals for blood pressure (OR = 0.46, 95% CI 0.26-0.80), LDL-C (OR = 0.57, CI 0.33-0.94), and weight management (OR = 0.40, 95% CI 0.20-0.82). There was no difference between the intervention and usual care groups in a summary score of goals met at study completion; however, minority women in the intervention group were 2.4 times more likely (95% CI 1.13-5.03) to reach the blood pressure goal at 6 months compared with minority women in usual care. White women in the intervention group were 2.86 times more likely (95% CI 1.06-7.68) to report use of beta-blockers at 6 months compared with white women in usual care. In a logistic regression model, the interaction term for ethnic status and group assignment was significant for achieving the blood pressure goal (p = 0.009). CONCLUSIONS A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.

A Novel Family-Based Intervention Trial to Improve Heart Health: FIT Heart

Background—Family members of patients with cardiovascular disease (CVD) may be at increased risk due to shared genes and lifestyle. Hospitalization of a family member with CVD may represent a “motivational moment” to take preventive action. Methods and Results—A randomized, controlled clinical trial was conducted in healthy adult family members (N=501; 66% female; 36% nonwhite; mean age, 48 years) of patients hospitalized with CVD to evaluate a special intervention (SI) with personalized risk factor screening, therapeutic lifestyle-change counseling, and progress reports to physicians versus a control intervention (CIN) on the primary outcome, mean percent change in low-density lipoprotein cholesterol (LDL-C), and other risk factors. Validated dietary assessments and standardized risk factors were obtained at baseline and 1 year (94% follow-up). At baseline, for 93% of subjects, saturated fat comprised ≥7% of total caloric intake, and 79% had nonoptimal LDL-C levels (of which 50% were unaware). There was no difference in the SI versus the CIN with respect to the mean percent change in LDL-C (−1% versus −2%, respectively; P=0.64), owing to a similar significant reduction in LDL-C in both groups (−4.4 mg/dL and −4.5 mg/dL, respectively). Diet score significantly improved in the SI versus the CIN (P=0.04). High-density lipoprotein cholesterol declined significantly in the CIN but not in the SI (−3.2% [95% CI, −5.1 to −1.3] versus +0.3% [95% CI, −1.7 to +2.4]; P=0.01). At 1 year, SI subjects were more likely than controls to exercise >3 days per week (P=0.04). Conclusion—The SI was not more effective than the CIN in reducing the primary end point, LDL-C. The screening process identified many family members of hospitalized patients with CVD who were unaware of their risk factors, and further work is needed to develop and test interventions to reduce their CVD risk.

A Novel Family-Based Intervention Trial to Improve Heart Health: FIT HeartCLINICAL PERSPECTIVE: Results of a Randomized Controlled Trial

Background—Family members of patients with cardiovascular disease (CVD) may be at increased risk due to shared genes and lifestyle. Hospitalization of a family member with CVD may represent a “motivational moment” to take preventive action. Methods and Results—A randomized, controlled clinical trial was conducted in healthy adult family members (N=501; 66% female; 36% nonwhite; mean age, 48 years) of patients hospitalized with CVD to evaluate a special intervention (SI) with personalized risk factor screening, therapeutic lifestyle-change counseling, and progress reports to physicians versus a control intervention (CIN) on the primary outcome, mean percent change in low-density lipoprotein cholesterol (LDL-C), and other risk factors. Validated dietary assessments and standardized risk factors were obtained at baseline and 1 year (94% follow-up). At baseline, for 93% of subjects, saturated fat comprised ≥7% of total caloric intake, and 79% had nonoptimal LDL-C levels (of which 50% were unaware). There was no difference in the SI versus the CIN with respect to the mean percent change in LDL-C (−1% versus −2%, respectively; P=0.64), owing to a similar significant reduction in LDL-C in both groups (−4.4 mg/dL and −4.5 mg/dL, respectively). Diet score significantly improved in the SI versus the CIN (P=0.04). High-density lipoprotein cholesterol declined significantly in the CIN but not in the SI (−3.2% [95% CI, −5.1 to −1.3] versus +0.3% [95% CI, −1.7 to +2.4]; P=0.01). At 1 year, SI subjects were more likely than controls to exercise >3 days per week (P=0.04). Conclusion—The SI was not more effective than the CIN in reducing the primary end point, LDL-C. The screening process identified many family members of hospitalized patients with CVD who were unaware of their risk factors, and further work is needed to develop and test interventions to reduce their CVD risk.