Heidi Mochari

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.

Coronary Heart Disease in Ethnically Diverse Women: Risk Perception and Communication

OBJECTIVES To assess perceived vs calculated risk of coronary heart disease (CHD), preferred methods of communicating risk, and the effect of brief educational intervention to improve accurate perceptions of personal risk. SUBJECTS AND METHODS Of 1858 women who underwent screening mammography between April and September 2003 at the Columbia University Medical Center in New York, NY, we assessed 125 women with no history of cardiovascular disease who participated in a risk factor screening and education program. Demographic variables were evaluated by interviewer-assisted standardized questionnaires. Absolute 10-year CHD risk was calculated using the Framingham global risk assessment. Perceived 10-year risk and preferred method of communicating risk were evaluated systematically. RESULTS Among 110 research participants who were eligible for risk estimation, 59% had a 10-year risk of less than 10%. However, only half of those women accurately perceived their risk as low. After a brief educational intervention, the womens ability to correctly categorize their personal CHD risk improved significantly. Preferred methods to communicate risk varied by level of education and age. Older women (> or = 65 years) and those with a high school education or less were more likely to prefer simple methods of having CHD risk communicated compared with their counterparts. CONCLUSIONS These data underscore the need to determine preferences for providing risk information and to test various formats for communicating CHD risk to improve awareness and management of CHD risk factors, especially among women of different age groups and education levels.

Validation of the MEDFICTS Dietary Assessment Questionnaire in a Diverse Population

BACKGROUND The National Cholesterol Education Program (NCEP) recommends MEDFICTS, a rapid screening instrument for dietary fat, to assess adherence to the Adult Treatment Panel (ATP) III Therapeutic Lifestyle Changes (TLC) diet (score <40 points indicates intake of <7% of energy from saturated fat, <30% of energy from total fat, and <200 mg dietary cholesterol/day). MEDFICTS has only been validated in small, select populations and its utility in diverse clinical settings is unknown. OBJECTIVE To evaluate the ability of MEDFICTS to identify individuals who are nonadherent to a TLC diet in an ethnically diverse population that includes both English- and Spanish-speakers. DESIGN MEDFICTS was administered concurrently with the Gladys Block Food Frequency Questionnaire to participants (n=501; mean age 48+/-13.5 years; 36% nonwhite; 66% female) in the National Heart, Lung, and Blood Institute Family Intervention Trial for Heart Health (FIT Heart) at the baseline screening visit. Reliability and validity analyses were conducted overall and by sex, age, and race/ethnicity. RESULTS MEDFICTS score correlated significantly with percentage of energy from saturated fat (r=0.52, P<0.0001), percentage of energy from total fat (r=0.31, P<0.0001), and milligrams per day of dietary cholesterol (r=0.54, P<0.0001). Sensitivity of MEDFICTS to correctly identify TLC diet adherence was 85.7% and did not differ significantly by sex, age, or race/ethnicity. Specificity of MEDFICTS to correctly identify nonadherence to the TLC diet was low (56.9%) and significantly worse for women than men (48.4% vs 72.9%; P<0.0001), but did not differ significantly in older vs younger participants or among white, black, or Hispanic participants. CONCLUSION Our data suggest that sex-specific recalibration of MEDFICTS may improve specificity and clinical utility.

Clinical utility of a fingerstick technology to identify individuals with abnormal blood lipids and high-sensitivity C-reactive protein levels.

Purpose. The purpose of this study was to determine the ability of a commonly used fingerstick technology to identify individuals with abnormal blood levels of total cholesterol (TC), calculated low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and high-sensitivity C-reactive protein (hsCRP) compared with a standardized laboratory. Methods. Participants (n = 250; mean age, 48.0 + 13.5 years; 66% female; 36% nonwhite) were eligible for primary prevention of cardiovascular disease (CVD). Blood lipids and hsCKP were measured simultaneously by (1) fingerstick analyzed by Cholestech LDX analyzers and (2) fresh venous blood that was analyzed by Columbia University General Clinical Research Center (GCRC) Core Laboratory. Pearson correlation coefficients, kappa, sensitivity, and specificity were calculated for fingerstick versus GCRC laboratory values for lipids and hsCRP. Results. The correlations between fingerstick and core laboratory for TC, LDL-C, HDL-C, TG, and hsCRP were .91, .88, .77, .93, and .81, respectively (all p < .01). Sensitivity and specificity of the fingerstick to identify those with abnormal lipids and hsCRP ≥ 1 mg/L were all ≥ 75%. Conclusion. Fingerstick screening is accurate and has good clinical utility to identify persons with abnormal blood lipids and hsCRP at the point of care in a diverse population that is eligible for primary prevention of CVD. These results may not be generalizable to patients at high risk for CVD or who have known hyperlipidemia.

Waist circumference, body mass index, and their association with cardiometabolic and global risk.

Total body fat and adipose tissue distribution are associated with cardiometabolic risk, yet there are conflicting data as to whether waist circumference (WC) or body mass index (BMI) is a better predictor of cardiovascular risk. To determine whether WC or BMI was more strongly associated with cardiometabolic risk, family members of patients with cardiac disease were studied (N=501; mean age, 48 years; 66% female; 36% nonwhite). Height, weight, WC, BMI, blood pressure, high-density lipoprotein cholesterol, triglycerides, glucose, high-sensitivity C-reactive protein, and lipoprotein-associated phospholipase A(2) were systematically measured. Global risk was calculated using the Framingham function. Increased WC and BMI were equally strong predictors of cardiometabolic and global risk. The prevalence of cardiometabolic risk factors and their correlation with WC and BMI varied by race/ethnicity. Our data support inclusion of WC and BMI in screening guidelines for diverse populations to identify individuals at increased cardiometabolic risk.

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 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.