Fleetwood Loustalot

Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

CONTEXT Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet. OBJECTIVE To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk. DESIGN, SETTING, AND PARTICIPANTS Study of a nationally representative sample of 44,959 US adults (≥20 years), using data from the National Health and Nutrition Examination Survey (NHANES) 1988-1994, 1999-2004, and 2005-2010 and the NHANES III Linked Mortality File (through 2006). MAIN OUTCOME MEASURES All-cause, CVD, and ischemic heart disease (IHD) mortality. RESULTS Few participants met all 7 cardiovascular health metrics (2.0% [95% CI, 1.5%-2.5%] in 1988-1994, 1.2% [95% CI, 0.8%-1.9%] in 2005-2010). Among NHANES III participants, 2673 all-cause, 1085 CVD, and 576 IHD deaths occurred (median follow-up, 14.5 years). Among participants who met 1 or fewer cardiovascular health metrics, age- and sex-standardized absolute risks were 14.8 (95% CI, 13.2-16.5) deaths per 1000 person-years for all-cause mortality, 6.5 (95% CI, 5.5-7.6) for CVD mortality, and 3.7 (95% CI, 2.8-4.5) for IHD mortality. Among those who met 6 or more metrics, corresponding risks were 5.4 (95% CI, 3.6-7.3) for all-cause mortality, 1.5 (95% CI, 0.5-2.5) for CVD mortality, and 1.1 (95% CI, 0.7-2.0) for IHD mortality. Adjusted hazard ratios were 0.49 (95% CI, 0.33-0.74) for all-cause mortality, 0.24 (95% CI, 0.13-0.47) for CVD mortality, and 0.30 (95% CI, 0.13-0.68) for IHD mortality, comparing participants who met 6 or more vs 1 or fewer cardiovascular health metrics. Adjusted population-attributable fractions were 59% (95% CI, 33%-76%) for all-cause mortality, 64% (95% CI, 28%-84%) for CVD mortality, and 63% (95% CI, 5%-89%) for IHD mortality. CONCLUSION Meeting a greater number of cardiovascular health metrics was associated with a lower risk of total and CVD mortality, but the prevalence of meeting all 7 cardiovascular health metrics was low in the study population.

Trend and Prevalence Estimates Based on the 2008 Physical Activity Guidelines for Americans

BACKGROUND According to the 2008 Physical Activity Guidelines for Americans, adults need to engage in at least 150 minutes/week of moderate-intensity activity or its equivalent (defined as aerobically active) to obtain substantial health benefits and more than 300 minutes/week (defined as highly active) to obtain more extensive health benefits. In addition to aerobic activity, the 2008 Guidelines recommend that adults participate in muscle-strengthening activities on 2 or more days/week. PURPOSE This study examined the prevalence and trends of meeting the activity criteria defined by the 2008 Guidelines among U.S. adults. METHODS Prevalence and trends of participation in leisure-time physical activity were estimated from the 1998-2008 National Health Interview Survey (analyzed in 2010). RESULTS In 2008, 43.5% of U.S. adults were aerobically active, 28.4% were highly active, 21.9% met the muscle-strengthening guideline, and 18.2% both met the muscle-strengthening guideline and were aerobically active. The likelihood of meeting each of these four activity criteria was similar and were associated with being male, being younger, being non-Hispanic white, having higher levels of education, and having a lower BMI. Trends over time were also similar for each part of the 2008 Guidelines, with the prevalence of participation exhibiting a small but significant increase when comparing 1998 to 2008 (difference ranging from 2.4 to 4.2 percentage points). CONCLUSIONS Little progress has been made during the past 10 years in increasing physical activity levels in the U.S. There is much room for improvement in achieving recommended levels of physical activity among Americans, particularly among relatively inactive subgroups.

Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study.

Objective Comparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality. Design Non-institutionalised population surveys. Setting and participants England (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years. Outcomes Stroke and IHD mortality rates were plotted against countries’ specific prevalence data. Results Mean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality. Conclusions While the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.

Sodium Intake and Blood Pressure Among US Children and Adolescents

OBJECTIVE: To assess the association between usual dietary sodium intake and blood pressure among US children and adolescents, overall and by weight status. METHODS: Children and adolescents aged 8 to 18 years (n = 6235) who participated in NHANES 2003–2008 comprised the sample. Subjects’ usual sodium intake was estimated by using multiple 24-hour dietary recalls. Linear or logistic regression was used to examine association between sodium intake and blood pressure or risk for pre-high blood pressure and high blood pressure (pre-HBP/HPB). RESULTS: Study subjects consumed an average of 3387 mg/day of sodium, and 37% were overweight/obese. Each 1000 mg per day sodium intake was associated with an increased SD score of 0.097 (95% confidence interval [CI] 0.006–0.188, ∼1.0 mm Hg) in systolic blood pressure (SBP) among all subjects and 0.141 (95% CI: –0.010 to 0.298, ∼1.5 mm Hg) increase among overweight/obese subjects. Mean adjusted SBP increased progressively with sodium intake quartile, from 106.2 mm Hg (95% CI: 105.1–107.3) to 108.8 mm Hg (95% CI: 107.5–110.1) overall (P = .010) and from 109.0 mm Hg (95% CI: 107.2–110.8) to 112.8 mm Hg (95% CI: 110.7–114.9; P = .037) among those overweight/obese. Adjusted odds ratios comparing risk for pre-HBP/HPB among subjects in the highest versus lowest sodium intake quartile were 2.0 (95% CI: 0.95–4.1, P = .062) overall and 3.5 (95% CI: 1.3–9.2, P = .013) among those overweight/obese. Sodium intake and weight status appeared to have synergistic effects on risk for pre-HBP/HPB (relative excess risk for interaction = 0.29 (95% CI: 0.01–0.90, P < .05). CONCLUSIONS: Sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese.

Association between usual sodium and potassium intake and blood pressure and hypertension among U.S. adults: NHANES 2005-2010.

Objectives Studies indicate high sodium and low potassium intake can increase blood pressure suggesting the ratio of sodium-to-potassium may be informative. Yet, limited studies examine the association of the sodium-to-potassium ratio with blood pressure and hypertension. Methods We analyzed data on 10,563 participants aged ≥20 years in the 2005–2010 National Health and Nutrition Examination Survey who were neither taking anti-hypertensive medication nor on a low sodium diet. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their associations with blood pressure, and logistic regression to assess their associations with hypertension. Results The average usual intakes of sodium, potassium and sodium-to-potassium ratio were 3,569 mg/d, 2,745 mg/d, and 1.41, respectively. All three measures were significantly associated with systolic blood pressure, with an increase of 1.04 mmHg (95% CI, 0.27–1.82) and a decrease of 1.24 mmHg (95% CI, 0.31–2.70) per 1,000 mg/d increase in sodium or potassium intake, respectively, and an increase of 1.05 mmHg (95% CI, 0.12–1.98) per 0.5 unit increase in sodium-to-potassium ratio. The adjusted odds ratios for hypertension were 1.40 (95% CI, 1.07–1.83), 0.72 (95% CI, 0.53–0.97) and 1.30 (95% CI, 1.05–1.61), respectively, comparing the highest and lowest quartiles of usual intake of sodium, potassium or sodium-to-potassium ratio. Conclusions Our results provide population-based evidence that concurrent higher sodium and lower potassium consumption are associated with hypertension.

Status of Cardiovascular Health Among Adult Americans in the 50 States and the District of Columbia, 2009

Background With ideal cardiovascular health metrics, the American Heart Association established a goal of improving cardiovascular health for all Americans by 20% by 2020. Determining how the metrics vary by state is important to the individual states as well as to researchers and policy makers nationwide. Methods and Results Using 2009 data from Behavioral Risk Factor Surveillance System, a state‐based telephone survey with 356 441 eligible participants, we examined the 7 metrics defined by the American Heart Association: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and consumption of fruits and vegetables. The 3 primary outcomes of this study were (1) the percentage of the population achieving ideal health status on all 7 factors, (2) the percentage of the population with only 0 to 2 of the 7 metrics (poor cardiovascular health); and (3) the mean overall score (number of ideal metrics). Overall, 3.3% of population was in ideal cardiovascular health, and 9.9% was in poor cardiovascular health. The mean overall score was 4.42. The percentage with ideal cardiovascular health varied from 1.2% (Oklahoma) to 6.9% (District of Columbia ). The adjusted prevalence ratio of ideal cardiovascular health ranged from 0.38, 95% confidence interval 0.29 to 0.52 (Oklahoma), to 1.91, 95% confidence interval 1.51 to 2.42 (District of Columbia), with Illinois as the referent. Conclusions In the United States, the cardiovascular health status of the population varies substantially by state. The estimates here could help state programs charged with preventing heart disease and stroke to set their goals for reducing risk and improving cardiovascular health in their jurisdictions.

Household Transmission of Pandemic (H1N1) 2009, San Antonio, Texas, USA, April–May 2009

Transmission rates were lower than those for seasonal influenza.

Muscle-Strengthening Activities and Participation Among Adults in the United States

Purpose: To describe those who reported meeting the 2008 Physical Activity Guidelines for Americans (2008 Guidelines) muscle-strengthening standard of 2 or more days per week, including all seven muscle groups, and to assess the type and location of muscle-strengthening activities performed. Method: Data from HealthStyles 2009, a cross-sectional, consumer mail-panel survey, was used for analyses (n = 4,271). The prevalence estimates with 95% confidence intervals of those meeting the 2008 Guidelines standards were calculated. Pairwise t-tests were performed to examine differences between estimates, tests for linear trends were performed among age, education, and body mass index (BMI) groups, and differences and trends were considered statistically significant at p < .05. Results: Overall, 6.0% of participants reported meeting 2008 Guidelines, and there were no significant differences between sex and racial/ethnic groups. A significant linear increase was noted among education groups, with respondents who reported lower levels of educational attainment having lower levels of participation compared with respondents who reported higher levels of educational attainment. A significant linear decrease was noted among each BMI group, with those classified as underweight/normal reporting higher levels of participation, compared with those classified as obese. Free weights and calisthenics were the most common types of activities; the home was the most common location. Conclusions: Few adults reported meeting current muscle-strengthening standards. Future public health efforts to increase participation should use the most frequently reported type and location of muscle-strengthening activities outlined in this study to guide interventions and communication campaigns.

Non−High-Density Lipoprotein Cholesterol: Distribution and Prevalence of High Serum Levels in Children and Adolescents: United States National Health and Nutrition Examination Surveys, 2005-2010

OBJECTIVES To estimate age-related changes for serum concentration of non-high-density lipoprotein cholesterol (HDL-C), describe non-HDL-C distribution, and examine the prevalence of high non-HDL-C levels in children and adolescents by demographic characteristics and weight status. STUDY DESIGN Data from 7058 participants ages 6-19 years in the 2005-2010 National Health and Nutrition Examination Surveys were analyzed. A high level of non-HDL-C was defined as a non-HDL-C value ≥ 145 mg/dL. RESULTS Locally weighted scatterplot smoothing-smoothed curves showed that non-HDL-C levels increased from 101 mg/dL at age 6 to 111 mg/dL at age 10, decreased to 101 mg/dL at age 14, and then increased to 122 mg/dL at age 19 in non-Hispanic white males. Non-HDL-C levels generally were greater in female than male subjects, lower in non-Hispanic black subjects, and similar in male and slightly lower in female Mexican American subjects, compared with non-Hispanic white subjects. The overall mean was 108 (SE 0.5), and the percentiles were 67 (5th), 74 (10th), 87 (25th), 104 (50th), 123 (75th), 145 (90th), and 158 (95th) mg/dL. Mean and percentiles were greater among age groups 9-11 and 17-19 years than others and greater among non-Hispanic white than non-Hispanic black subjects. The prevalence of high non-HDL-C was 11.8% (95% CI 9.9%-14.0%) and 15.0% (95% CI 12.9%-17.3%) for the age groups 9-11 and 17-19, respectively. It varied significantly by race/ethnicity and overweight/obesity status. CONCLUSION Non-HDL-C levels vary by age, sex, race/ethnicity, and weight classification status. Evaluation of non-HDL-C in youth should account for its normal physiologic patterns and variations in demographic characteristics and weight classification.

Sodium and potassium intakes among US infants and preschool children, 2003–2010

BACKGROUND Data are limited on usual sodium and potassium intakes relative to age-specific recommendations and the sodium:potassium ratio in infants and preschoolers, especially among those aged <2 y, who are black or breastfed. OBJECTIVE The usual sodium intake above the Tolerable Upper Intake Levels (ULs), potassium intakes above Adequate Intakes (AIs), the sodium:potassium ratio, and sodium density (mg/kcal) among US infants and preschoolers by age group, as applicable, were estimated and compared by race-ethnicity and current breastfeeding status. DESIGN Data were analyzed among 3 groups of children (aged 7-11 mo, 1-3 y, and 4-5 y) from the NHANES 2003-2010 by using measurement error models. RESULTS Seventy-nine percent of children aged 1-3 y and 87% of those aged 4-5 y exceeded their sodium UL; among non-Hispanic black children, the estimates were 84% and 97%, respectively. For potassium, 97% of infants, 5% of children aged 1-3 y, and 0.4% aged 4-5 y met their AIs. Compared with non-Hispanic whites and Mexican Americans, non-Hispanic black infants and preschoolers had higher mean sodium density and sodium:potassium ratios. Currently breastfed infants and children consumed, on average, less sodium than those who were not breastfed (382 ± 53 compared with 538 ± 22 mg in those aged 7-11 mo and 1154 ± 88 compared with 1985 ± 24 mg in those aged 1-3 y, respectively), but the sodium:potassium ratio did not differ. CONCLUSIONS Most US preschoolers, particularly non-Hispanic blacks, consume too much sodium, and nearly all do not consume enough potassium. Data that suggest that currently breastfed infants consume less sodium than do those who are not breastfeeding merit further investigation.