Emily J. Jones

Urinary Isoflavone Concentrations Are Inversely Associated with Cardiometabolic Risk Markers in Pregnant U.S. Women

Some evidence suggests that phytoestrogens, such as soy-derived isoflavones, may have beneficial effects on cardiovascular health and glycemic control. These data are mainly limited to postmenopausal women or individuals at elevated cardiometabolic risk. There is a lack of data for pregnant women who have elevated estrogen levels and physiologically altered glucose and lipid metabolism. We analyzed data from 299 pregnant women who participated in the NHANES 2001-2008 surveys. Multivariable linear regression analyses were used to examine the association between urinary concentrations of isoflavonoids and cardiometabolic risk markers, adjusted for body mass index, pregnancy trimester, total energy intake, dietary intake of protein, fiber, and cholesterol, and demographic and lifestyle factors. Cardiometabolic risk markers were log-transformed, and geometric means were calculated by quartiles of urinary concentrations of isoflavonoids. Comparing women in the highest vs. lowest quartiles of urine total isoflavone concentrations, we observed significant, inverse associations with circulating concentrations of fasting glucose (79 vs. 88 mg/dL, P-trend = 0.0009), insulin (8.2 vs. 12.8 μU/mL, P-trend = 0.03), and triglyceride (156 vs. 185 mg/dL, P-trend = 0.02), and the homeostasis model assessment of insulin resistance (1.6 vs. 2.8, P-trend = 0.01), but not for total, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. The concentrations of individual isoflavonoids, daidzein, equol, and O-desmethylangolensin were inversely associated with some cardiometabolic risk markers, although no clear pattern emerged. These data suggest that there may be a relation between isoflavone intake and cardiometabolic risk markers in pregnant women.

Promoting cardiovascular health and reducing disparities among American Indians and Alaska Natives.

Approximately 5.2 million American Indians and Alaska Natives (AI/ANs) reside in the United States (US), making up 1.7% of the total population; however, the prevalence of cardiovascular disease (CVD) in this population is 2 times higher than the US population prevalence. More AI/ANs die of or experience disability each year from CVD than from any other cause. The excess burden of CVD in this population is attributable partially to the alarming increase in type 2 diabetes. Before World War II, diabetes was uncommon among AI/ ANs; however, now, an estimated 12.4% of this population has diabetes, compared with 6% of nonAI/AN populations in the United States. In the Strong Heart Study, a landmark longitudinal study examining cardiovascular risk factors among 13 tribes in Arizona, Oklahoma, North Dakota, and South Dakota, diabetes was the strongest determinant of CVD among all risk factors examined, with 56% of cardiovascular events in men and 78% of events in women occurring in individuals with diabetes. The prevalence of metabolic syndrome, a cluster of risk factors for both CVD and diabetes that greatly increases the likelihood of development of either or both these diseases, is estimated to be around 35% in AI/ANs. There is documented higher prevalence of many modifiable risk factors associated with CVD in this population, including smoking, adverse patterns of dietary intake, sedentary lifestyles, obesity, substance abuse, and lack of access to healthcare, to name a few. Undeniably, the cardiometabolic risk experienced in this population is complexVan interaction of genetic and potentially modifiable behavioral and environmental factors. Unfortunately, the rate of decline of CVD mortality among AI/ANs has been relatively slow since 1972, with almost no decline in the past 2 decades. This is starkly contrasted with the substantial declines in CVD mortality reported for the total US population since the early 1970s. In the early 1970s, CVD death rates for AI/ANs were 21% lower than those for the total US population; by the late 1990s, however, they were 20% higher. In addition to the disproportionate prevalence of CVD in this population, AI/ANs also succumb to CVD at younger ages than other racial and ethnic groups in the United States; more than one-third of CVD deaths occur before the age of 65 years. If clinicians and researchers are to successfully address the factors responsible for the cardiovascular disparities in this population, we must be aware and knowledgeable about a few important facts. First, Native Americans are often mistakenly viewed as a single ethnic minority population; however, they are a culturally and politically diverse population of AI/ANs representing 566 federally recognized tribes and numerous tribes and communities that are not federally recognized. American Indians and Alaska Natives are 1 of 5 racial/ ethnic groups identified by the US Office of Management and Budget; the term AI/AN refers to individuals having origins in any of the

Pregnancy Reveals Evolving Risk for Cardiometabolic Disease in Women.

Pregnancy serves as a cardiometabolic stressor that may unmask underlying metabolic and vascular abnormalities in an evolving continuum of pathophysiology. In 2011, the American Heart Association indicated that a diagnosis of pre-eclampsia, gestational hypertension, or gestational diabetes classified a woman as at risk for cardiovascular disease. In this article, we discuss hypertensive disorders of pregnancy, gestational diabetes, and preterm birth as risk factors for future cardiovascular disease in women.

Working together to bridge the disparity gap in cardiovascular health.

Although population-based prevalence and trend data indicate that cardiovascular mortality is decreasing in the United States, disparities in cardiovascular health continue to persist among vulnerable populations. Cardiovascular diseases account for almost one-third of the disparity in potential life-years lost between blacks and whites. American Indians and Alaska Natives experience cardiovascular disease at twice the rate of the overall population and die of heart disease earlier than expected. Non-Hispanic blacks and Mexican Americans have higher rates of diabetes and obesity than the overall population does. These cardiovascular inequities are linked to a variety of complex social factors including income and education, access to care, as well as communication barriers. Over the last 3 decades, increasing attention has been devoted to addressing the nation’s health disparities. National conversations around healthequitybegan in the1980swhen there was an increasing awareness that racial and ethnic minority populationsexperienceddisproportionately higher rates of disease, disability, and death comparedwith thegeneral population. In 1985, charged by a Task Force on Black and Minority Health convened by the Secretary of Health and Human Services, the National Institutes of Health began to work to understand and reduce these disparities. In 2010, the establishment of the National Institute on Minority Health and Health Disparities reflected renewed congressional commitment to achieving health equity through translational, transformational, and transdisciplinary research. One of the 4 overarching goals of Healthy People 2020 is ‘‘to achieve health equity, eliminate disparities, and improve thehealthofall groups,’’ and in 2011, building upon the AffordableCareAct,HealthandHuman Services issued the first-ever Action Plan to Reduce Racial and Ethnic HealthDisparities. The American Heart Association has been engaged in health equity initiatives aimed at bridging the cardiovascular disparity gap, such as the WISEWOMAN program that provides free screening and lifestyle intervention services to lowincome, uninsured or underinsured women. However, despite collective prioritization of achieving health equity in the United States, over the past 3 decades, cardiovascular disparities have only worsened among minority and vulnerable groups. Similar to other health disparities, these are likely to be ‘‘rooted in social structure inequalities and exist because of inequitable distribution of goods, resources,power,andpoverty inAmerican society.’’ Entrenched inequities in cardiovascular health have clearly motivated and informed interventions over the past2 decades.Davis andcolleagues completed a systematic review of clinically oriented interventions, published between 1995 and 2006, that were designed to reduce cardiovascular disparities among racial and ethnic minorities. They reported a paucity of high-quality research addressing reduction of cardiovascular racial and ethnic disparities; however, they concluded that nurse-led interventions have been most effective in improving the cardiovascular management of communities of color. Building on and extending this important work, the 2006Y2011 systematic reviewofWalton-Mossandcolleagues on community-based cardiovascular