Dana E. King

Adherence to healthy lifestyle habits in US adults, 1988-2006.

BACKGROUND Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006. METHODS Analysis of adherence to 5 healthy lifestyle trends (>or=5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m(2)], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years. RESULTS Over the last 18 years, the percent of adults aged 40-74 years with a body mass index >or=30 kg/m(2) has increased from 28% to 36% (P <.05); physical activity 12 times a month or more has decreased from 53% to 43% (P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P <.05), and moderate alcohol use has increased from 40% to 51% (P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions. CONCLUSIONS Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.

Prehypertension and Cardiovascular Morbidity

PURPOSE The Seventh Report of the Joint National Commission (JNC 7) on High Blood Pressure established prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic) as a new risk category. We aim to determine the risk of major cardiovascular events associated with blood pressure in the prehypertensive range in a longitudinal, population-based cohort. METHODS Analyses were conducted on participants in the National Health and Nutrition Examination Survey I (1971–1975) observed for 18 years for major cardiovascular disease events. Cox proportional hazard ratios were calculated to assess relative risk of cardiovascular disease, including stroke, myocardial infarction, and heart failure, in participants with prehypertension and normal blood pressure (<120/80 mm Hg). RESULTS Prehypertension was associated with increased risk for cardiovascular disease (1.79 [95% confidence interval (CI) 1.40–2.24]) in unadjusted analysis. After adjustment for cardiovascular risk factors, the relationship of prehypertension to cardiovascular disease was diminished but persisted (1.32 [95% CI 1.05–1.65]). Ninety-three percent of prehypertensive individuals had at least 1 cardiovascular risk factor. Low prehypertension (120–129/80–84 mm Hg) was associated with increased cardiovascular disease in unadjusted analyses (1.56 [95% CI 1.23–1.98]) but was not statistically significant in adjusted analyses (1.24 [95% CI 0.96–1.59]). High-normal blood pressure (130–139/85–89 mm Hg) remained a predictor of cardiovascular disease in unadjusted (2.13 [95% CI 1.64–2.76]) and adjusted (1.42 [95% CI 1.09–1.84]) analyses. CONCLUSIONS In a longitudinal, population-based, US cohort, prehypertension was associated with increased risk of major cardiovascular events independently of other cardiovascular risk factors. These findings, along with the presence of cardiovascular risk factors in the majority of participant sample with prehypertension, support recommendations for physicians to actively target lifestyle modifications and multiple risk reduction in their prehypertensive patients.

Dietary Magnesium and C-reactive Protein Levels

Objective: Current dietary guidelines recommend adequate intake of magnesium (310–420mg daily) in order to maintain health and lower the risk of cardiovascular disease. Recent evidence from animal and clinical studies suggests that magnesium may be associated with inflammatory processes. The objective of this study was to determine whether dietary magnesium consumption is associated with C-reactive protein (CRP), a marker of inflammation, in a nationally representative sample. Methods: Analysis of adult (≥17 years) participants in a cross-sectional nationally representative survey (National Health and Nutrition Examination Survey 1999–2000 [NHANES]) who were not taking magnesium or magnesium-containing supplements. The primary outcome measure was high sensitivity CRP (elevated ≥3.0mg/L). Results: Among US adults, 68% consumed less than the recommended daily allowance (RDA) of magnesium, and 19% consumed less than 50% of the RDA. After controlling for demographic and cardiovascular risk factors, adults who consumed <RDA of magnesium were 1.48–1.75 times more likely to have elevated CRP than adults who consumed ≥RDA (Odds Ratio [OR] for intake <50% RDA = 1.75, 95% Confidence Interval [CI] 1.08–2.87). Adults who were over age 40 with a BMI >25 and who consumed <50% RDA for magnesium were 2.24 times more likely to have elevated CRP (95% CI 1.13–4.46) than adults ≥RDA. Conclusions: Most Americans consume magnesium at levels below the RDA. Individuals with intakes below the RDA are more likely to have elevated CRP, which may contribute to cardiovascular disease risk.

Inflammatory markers and exercise: Differences related to exercise type

PURPOSE To examine the relationship between elevated inflammatory markers (CRP, fibrinogen, and white blood cell levels) and various forms of exercise for the adult U.S. population while controlling for factors that might influence the relationship. METHODS An analysis of the adults age 17 and over who participated in the National Health and Nutrition Examination Survey (NHANES) III was conducted. The main goal of the analysis was to determine whether exercise type was associated with systemic markers of inflammation. Bivariate statistics using chi-square to evaluate different types of exercise according to the presence of elevated and nonelevated inflammatory markers was initially performed. In addition, multivariate models were constructed using each type of exercise activity as the predictor variable and each inflammatory marker as the dependent variable. RESULTS A total of 4072 people were included in the analysis. In bivariate analyses, compared with nonexercisers in a specific exercise type, a significant lower likelihood of elevated inflammatory markers was found among regular participants in jogging, swimming, cycling, aerobic dancing, calisthenics, and weight lifting but not for gardening. After controlling for possible confounding factors including age, race, sex, body mass index, smoking, and health status in logistic regression analysis, only regular participants in jogging and aerobic dancing remained significantly less likely to have elevated cardiovascular markers. CONCLUSIONS The results of this study indicate that some forms of physical activity are associated with a lower likelihood of elevation of inflammatory markers, although we cannot exclude the possibility that differences may be due to exercise intensity or duration. Future research should be directed toward further exploration of the effects of different types of exercise activity on inflammatory markers and the role of exercise in the prevention of cardiovascular disease.

Dietary Fiber for the Treatment of Type 2 Diabetes Mellitus: A Meta-Analysis

Background: The evidence of the relationship between fiber intake and control of diabetes is mixed. The purpose of this study was to determine if an increase in dietary fiber affects glycosylated hemoglobin (HbA1c) and fasting blood glucose in patients with type 2 diabetes mellitus. Methods: Randomized studies published from January 1, 1980, to December 31, 2010, that involved an increase in dietary fiber intake as an intervention, evaluated HbA1c and/or fasting blood glucose as an outcome, and used human participants with known type 2 diabetes mellitus were selected for review. Results: Fifteen studies met inclusion and exclusion criteria. The overall mean difference of fiber versus placebo was a reduction of fasting blood glucose of 0.85 mmol/L (95% CI, 0.46–1.25). Dietary fiber as an intervention also had an effect on HbA1c over placebo, with an overall mean difference of a decrease in HbA1c of 0.26% (95% CI, 0.02–0.51). Conclusion: Overall, an intervention involving fiber supplementation for type 2 diabetes mellitus can reduce fasting blood glucose and HbA1c. This suggests that increasing dietary fiber in the diet of patients with type 2 diabetes is beneficial and should be encouraged as a disease management strategy.

Elevation of C-Reactive Protein in People With Prehypertension

The objective of this study was to determine the relationship of C‐reactive protein (CRP) and blood pressure (BP) across the range of BP categories including prehypertension. The Third National Health and Nutrition Examination Survey (NHANES III) data collected from 1988 to 1994 were analyzed. In unadjusted analyses, there was a step‐wise increase in the probability of elevated CRP across a wide range of BP categories. Prehypertensive participants had a higher prevalence of elevated CRP than normotensive people (27.4% vs. 19.8%; p<05). After adjustment for age, gender, race, smoking, body mass index, exercise, diabetes, and medication usage, participants with systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg were more likely to have elevated CRP than people with systolic BP <120 (odds ratio, 1.36; 95% confidence interval, 1.14–1.62; odds ratio, 1.20; 95% confidence interval, 1.02–1.41, respectively). CRP and BP are positively related across a wide range of BP categories. A substantial proportion of prehypertensive individuals have elevated CRP independent of multiple confounders.

Race, Rural Residence, and Control of Diabetes and Hypertension

PURPOSE African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. METHODS We conducted an analysis of the Third National Health and Nutrition Examination Survey (1988–1994). Non-Hispanic African Americans and non-Hispanic white adults 20 years and older were classified according to rural or urban residence (n = 11,755). Investigated outcomes were previously diagnosed diabetes mellitus and hypertension and control of diabetes and hypertension. RESULTS The prevalence of diagnosed diabetes was 4.5% for urban whites, 6.5% for rural whites, 6.0% for urban African Americans, and 9.5% for rural African Americans. Among patients with diagnosed diabetes, 33% of rural whites, 43% of urban whites, 45% of urban African American, and 61% of rural African Americans had glycosylated hemoglobin (HbA1c) levels of 8% or higher (P <.01). Among patients with diagnosed hypertension, 11% of rural whites, 13% of urban whites, 20% of urban African Americans, and 23% of rural African Americans had diastolic blood pressure greater than 90 mmHg (P <.01). In regression models controlling for relevant variables, including body mass index, health status, access to care, education, income, and insurance, compared with rural African Americans, rural and urban whites were significantly more likely to have better glycemic control and diastolic blood pressure control. Urban African Americans also had better diabetes control than rural African Americans. CONCLUSIONS In this nationally representative sample, rural African Americans are at increased risk for a lack of control of diabetes and hypertension.

Psychosocial Factors and Progression From Prehypertension to Hypertension or Coronary Heart Disease

PURPOSE This study explored the influence of trait anger and long-term psychological stress on progression to hypertension and incident coronary heart disease (CHD) in persons with prehypertension. METHODS A secondary data analysis was performed using the Atherosclerosis Risk in Communities (ARIC) study, a cohort of men and women aged 45 to 64 years at enrollment. Participants with blood pressures in the prehypertension range at the second visit conducted between 1990 and 1992, free of heart disease or stroke, and observed through the end of the ARIC study (1996–1998) were included (N = 2,334). The main outcomes were progression from prehypertension to hypertension and prehypertension to CHD or CHD death. RESULTS After adjusting for various covariates, high levels of trait anger, compared with low/moderate levels (odds ratio [OR] 1.53; 95% confidence interval [CI], 1.05–2.24), were associated with progression from prehypertension to hypertension. After stratifying on sex, trait anger was predictive for men only (OR 1.71; 95% CI 1.04–2.83). In survival analysis, trait anger was associated with progression to CHD for men (hazard ratio [HR] 1.92; 95% CI, 1.07–3.54). Long-term psychological stress was also associated with risk of incident CHD (HR 1.68; 95% CI 1.18–2.40). CONCLUSIONS High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD. Long-term stress was also associated with increased risk of incident CHD in both men and women.

Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism

Objective Cardiovascular disease has been reported to be more common in patients with elevated levels of TSH and with normal thyroxine levels, termed subclinical hypothyroidism (SCH). The aim of this study was to determine whether individuals with SCH were more likely than euthyroid controls to have elevations in inflammatory biomarkers that are associated with cardiac disease.

Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals

Background: Though the benefits of healthy lifestyle choices are well-established among the general population, less is known about how developing and adhering to healthy lifestyle habits benefits obese versus normal weight or overweight individuals. The purpose of this study was to determine the association between healthy lifestyle habits (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking) and mortality in a large, population-based sample stratified by body mass index (BMI). Methods: We examined the association between healthy lifestyle habits and mortality in a sample of 11,761 men and women from the National Health and Nutrition Examination Survey III; subjects were ages 21 and older and fell at various points along the BMI scale, from normal weight to obese. Subjects were enrolled between October 1988 and October 1994 and were followed for an average of 170 months. Results: After multivariable adjustment for age, sex, race, education, and marital status, the hazard ratios (95% CIs) for all-cause mortality for individuals who adhered to 0, 1, 2, or 3 healthy habits were 3.27 (2.36–4.54), 2.59 (2.06–3.25), 1.74 (1.51–2.02), and 1.29 (1.09–1.53), respectively, relative to individuals who adhered to all 4 healthy habits. When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group. Conclusions: Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.