Lori Mosca

Tracking Women’s Awareness of Heart Disease An American Heart Association National Study

Background—Cardiovascular disease (CVD) is the leading cause of mortality in men and women in the United States, yet prior research has shown a lack of awareness of risk among women. The purpose of this study was to assess the contemporary awareness, knowledge, and perceptions related to CVD risk among American women and to evaluate trends since 1997, when the American Heart Association initiated a national campaign to improve awareness of CVD among women. Methods and Results—A telephone survey of a nationally representative random sample of women was conducted in June and July 2003, with an oversampling of black and Hispanic women; results were compared with those of similar surveys in 2000 and 1997. The present survey included 1024 respondents age ≥25 years; 68% were white, 12% black, 12% Hispanic, and 8% other ethnicities. Awareness, knowledge, and perceptions about heart disease were evaluated by use of a standard interviewer-assisted questionnaire. A shift in awareness of heart disease as the leading killer of women has occurred since 1997. In 2003, 46% of respondents spontaneously identified heart disease as the leading cause of death in women, up from 30% in 1997 (P <0.05) and 34% in 2000 (P <0.05). In contrast, the percentage of women citing cancer as leading cause of death has significantly decreased. Black, Hispanic, and younger women (<45 years old) had lower awareness of heart disease as their leading cause of death than did white and older women. Nearly all women reported comfort in discussing prevention with healthcare providers, but only 38% of women reported that their doctors had ever discussed heart disease with them. Conclusions—Awareness of CVD has increased, although a significant gap between perceived and actual risk of CVD remains. Educational interventions to improve awareness and knowledge are needed, particularly for minority and younger women.

American Heart Association and American Stroke Association National Survey of Stroke Risk Awareness Among Women

Background—Stroke is the third leading cause of death in the United States and a major cause of morbidity in women. Awareness of risk may be an important first step in stroke prevention. The purpose of this study was to assess knowledge and awareness about stroke in a nationally representative sample of women. Methods and Results—An American Heart Association–sponsored telephone survey using random-digit dialing was conducted in June and July of 2003. Respondents were 1024 women ≥25 years of age, including an oversampling of racial/ethnic minorities (68% white, 12% black, 12% Hispanic). Participants were given a standardized questionnaire about heart disease and stroke risk. Only 26% of women ≥65 years of age reported being well informed about stroke, even though this group carries the highest incidence of stroke. Overall, 20% of women stated that they worried a lot about stroke. Among women aged 25 to 34 years, 37% stated that they were not at all informed about stroke, which was significantly higher than for women between 45 and 64 years (13%, P <0.05) and those ≥65 years of age (14%, P <0.05). More Hispanics reported being not at all informed about stroke compared with whites (32% versus 19%, P <0.05) and blacks (32% versus 20%, P <0.05). More white women were aware that at the onset of a stroke, treatment could be given to break up blood clots compared with blacks (92% versus 84%, P <0.05) and Hispanics (92% versus 79%, P <0.05). Correct identification of the warning signs of stroke was low among all racial/ethnic and age groups. More white respondents correctly identified sudden 1-sided weakness or numbness of the face or a limb as a warning sign compared with Hispanics (39% versus 29%, P <0.05). Whites identified difficulty talking or understanding speech as a sign of stroke significantly more often than did Hispanics (29% versus 17%, P <0.05). Conclusions—Results of this national survey document that awareness and knowledge about stroke is suboptimal among women, especially among racial/ethnic minorities, who are at highest risk. These data support the need for targeted educational programs about stroke risk and symptoms and underscore the importance of public health programs to improve awareness of stroke among women.

Large underground, liquid based detectors for astro-particle physics in Europe: Scientific case and prospects

This document reports on a series of experimental and theoretical studies conducted to assess the astro-particle physics potential of three future large scale particle detectors proposed in Europe as next generation underground observatories. The proposed apparatuses employ three different and, to some extent, complementary detection techniques: GLACIER (liquid argon TPC), LENA (liquid scintillator) and MEMPHYS (water Cherenkov), based on the use of large mass of liquids as active detection media. The results of these studies are presented along with a critical discussion of the performance attainable by the three proposed approaches coupled to existing or planned underground laboratories, in relation to open and outstanding physics issues such as the search for matter instability, the detection of astrophysical neutrinos and geo-neutrinos and to the possible use of these detectors in future high intensity neutrino beams.

Effects of Raloxifene on Fracture Risk in Postmenopausal Women: The Raloxifene Use for The Heart Trial†

Using data from a randomized placebo‐controlled trial of 10,101 postmenopausal women not selected on the basis of osteoporosis, we examined whether the effect of raloxifene treatment on fractures was consistent across categories of fracture risk. Treatment with raloxifene for 5 yr reduced the risk of clinical vertebral fractures, but not nonvertebral fractures, irrespective of the presence or absence of risk factors for fracture.

A very intense neutrino super beam experiment for leptonic CP violation discovery based on the European spallation source linac

Very intense neutrino beams and large neutrino detectors will be needed in order to enable the discovery of CP violation in the leptonic sector. We propose to use the proton linac of the European Spoliation Source currently under construction in Lund, Sweden, to deliver, in parallel with the spoliation neutron production, a very intense, cost effective and high performance neutrino beam. The baseline program for the European Spoliation Source linac is that it will be fully operational at 5 MW average power by 2022, producing 2 GeV 2.86 ms long proton pulses at a rate of 14 Hz. Our proposal is to upgrade the linac to 10 MW average power and 28 Hz, producing 14 pulses/s for neutron production and 14 pulses/s for neutrino production. Furthermore, because of the high current required in the pulsed neutrino horn, the length of the pulses used for neutrino production needs to be compressed to a few mu s with the aid of an accumulator ring. A long baseline experiment using this Super Beam and a megaton underground Water Cherenkov detector located in existing mines 300-600 km from Lund will make it possible to discover leptonic CP violation at 5 sigma significance level in up to 50% of the leptonic Dirac CP-violating phase range. This experiment could also determine the neutrino mass hierarchy at a significance level of more than 3 sigma if this issue will not already have been settled by other experiments by then. The mass hierarchy performance could be increased by combining the neutrino beam results with those obtained from atmospheric neutrinos detected by the same large volume detector. This detector will also be used to measure the proton lifetime, detect cosmological neutrinos and neutrinos from supernova explosions. Results on the sensitivity to leptonic CP violation and the neutrino mass hierarchy are presented

Influence of Caregiving on Lifestyle and Psychosocial Risk Factors Among Family Members of Patients Hospitalized with Cardiovascular Disease

BackgroundFew data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk.ObjectiveThe purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among family members of recently hospitalized CVD patients.Design and ParticipantsParticipants in the NHLBI Family Intervention Trial for Heart Health (FIT Heart) who completed a 6-month follow-up were included in this analysis (nu2009=u2009263; mean age 50u2009±u200914xa0years, 67% female, 29% non-white).MeasurementsAt 6xa0months, standardized information was collected regarding depression, social support, and caregiver strain (high caregiver strain = ≥7). Information on lifestyle risk factors, including obesity, physical activity, and diet, were also collected using standardized questionnaires. Logistic regression models on the association between caregiving and CVD risk factors were adjusted for significant confounders.ResultsThe prevalence of serving as a CVD patient’s primary caregiver or caring for the patient most of the time was 50% at 6xa0months. Caregivers (primary/most) were more likely to be women (81% vs 19%, pu2009<u2009.01), married/living with someone (pu2009<u2009.01), >50xa0years old (pu2009<u2009.01), have ≤ high school education (pu2009<u2009.01), be unemployed (pu2009<u2009.01), get less physical activity (pu2009<u2009.01), and have a higher waist circumference (pu2009<u2009.01) than non-caregivers (some/occasional/none). Mean caregiver strain scores were significantly higher among those with depressive symptoms (pu2009<u2009.01) and low social support (pu2009<u2009.01) in a multivariable adjusted model.ConclusionsCaregivers of cardiac patients may be at increased risk themselves for CVD morbidity and mortality compared to non-caregivers due to suboptimal lifestyle and psychosocial risk factors.Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk. The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among family members of recently hospitalized CVD patients. Participants in the NHLBI Family Intervention Trial for Heart Health (FIT Heart) who completed a 6-month follow-up were included in this analysis (nu2009=u2009263; mean age 50u2009±u200914xa0years, 67% female, 29% non-white). At 6xa0months, standardized information was collected regarding depression, social support, and caregiver strain (high caregiver strain = ≥7). Information on lifestyle risk factors, including obesity, physical activity, and diet, were also collected using standardized questionnaires. Logistic regression models on the association between caregiving and CVD risk factors were adjusted for significant confounders. The prevalence of serving as a CVD patient’s primary caregiver or caring for the patient most of the time was 50% at 6xa0months. Caregivers (primary/most) were more likely to be women (81% vs 19%, pu2009<u2009.01), married/living with someone (pu2009<u2009.01), >50xa0years old (pu2009<u2009.01), have ≤ high school education (pu2009<u2009.01), be unemployed (pu2009<u2009.01), get less physical activity (pu2009<u2009.01), and have a higher waist circumference (pu2009<u2009.01) than non-caregivers (some/occasional/none). Mean caregiver strain scores were significantly higher among those with depressive symptoms (pu2009<u2009.01) and low social support (pu2009<u2009.01) in a multivariable adjusted model. Caregivers of cardiac patients may be at increased risk themselves for CVD morbidity and mortality compared to non-caregivers due to suboptimal lifestyle and psychosocial risk factors.

Knowledge, Preventive Action, and Barriers to Cardiovascular Disease Prevention by Race and Ethnicity in Women: An American Heart Association National Survey

BACKGROUNDnRacial and ethnic disparities in cardiovascular disease (CVD) outcomes and risk factors are well documented, but few data have evaluated population differences in CVD knowledge, preventive action, and barriers to prevention.nnnMETHODSnA nationally representative sample of 1008 women (17% Hispanic, 22% black, 61% white/other) selected through random digit dialing were given a standardized questionnaire about knowledge of healthy risk factor levels, recent preventive actions, and barriers to prevention. Analysis focused on predictors of knowledge and preventive action in the past year and proportion reporting select barriers to prevention. Logistic regression was used to determine if race/ethnicity was independently associated with knowledge and preventive action after adjustment.nnnRESULTSnNo racial/ethnic differences in risk factor knowledge were identified except Hispanic women were 44% less likely than white/others to know the optimal high-density lipoprotein cholesterol (HDL-C) level (odds ratio [OR] 0.56,95% confidence interval [CI] 0.35-0.91). Knowledge of blood pressure goal was lower among those with less than a college education (OR 0.59,95% CI 0.44-0.79). Hispanics were twice as likely as white/others to help someone else lose weight (OR 1.78,95% CI 1.17-2.71) or add physical activity (OR 1.95,95% CI 1.18-3.22) in the past year. Blacks were more likely than whites/others to report decreased unhealthy food consumption (OR 1.77,95% CI 1.08-2.93), trying to lose weight (OR 1.62,95% CI 1.06-2.47), and taking action when they experienced CVD symptoms (30% vs. 23%,p = 0.03). Physician encouragement was cited as the reason for taking preventive action more often by black (59%,p = 0.002) and Hispanic (54%,p = 0.03) women than whites/others (43%).nnnCONCLUSIONSnContinued initiatives to improve and translate knowledge into preventive action are needed, especially among less educated and Hispanic women who may activate others to reduce risk.

Raloxifene and Risk for Stroke Based on the Framingham Stroke Risk Score

PURPOSEnRaloxifene reduces vertebral fracture and invasive breast cancer risks, but increases fatal strokes in postmenopausal women at increased coronary risk. We assessed whether this risk is concentrated in postmenopausal women already at high stroke risk.nnnMETHODSnRaloxifene Use for The Heart (RUTH) enrolled 10,101 postmenopausal women (mean age 67 years) with or at increased coronary heart disease risk; Multiple Outcomes of Raloxifene Evaluation (MORE) enrolled 7705 osteoporotic postmenopausal women (mean age 66 years). A Framingham Stroke Risk Score (FSRS) was calculated for all women with no prior cerebrovascular events (n = 16,858). The validity of the FSRS was assessed in the placebo groups, and then raloxifene-associated stroke risk was analyzed by FSRS subgroups.nnnRESULTSnFSRS predicted an increased stroke risk in the placebo group of both clinical trials. There was no difference in the incidence of nonfatal strokes between the raloxifene and placebo groups in MORE or RUTH, regardless of baseline Framingham stroke risk. In RUTH, women with FSRS <13 showed no increase in raloxifene-associated fatal stroke risk (hazard ratio [HR] 1.08; 95% confidence interval [CI], 0.49-2.37). Those with FSRS >or=13 had a 75% increased risk of raloxifene-associated fatal stroke (HR 1.75; 95% CI, 1.01-3.02; interaction P = .33). In MORE, where 80% of women had a FSRS <13, no increase in fatal (HR 0.57; 95% CI, 0.19-1.68) stroke risk was observed.nnnDISCUSSIONnRisk of fatal stroke associated with raloxifene was greater in women at high stroke risk. These results might be useful for identifying postmenopausal women at high risk of first stroke who should avoid raloxifene therapy.

Low Social Support Level is Associated with Non-Adherence to Diet at 1 Year in the Family Intervention Trial for Heart Health (FIT Heart)

OBJECTIVEnEvaluate the relationship between low social support (SS) and adherence to diet in a cardiovascular disease (CVD) lifestyle intervention trial.nnnDESIGNnProspective substudy.nnnSETTING AND PARTICIPANTSnBlood relatives/cohabitants of hospitalized cardiac patients in a randomized controlled trial (n=458; 66% female, 35% nonwhite, mean age 50 years).nnnMAIN OUTCOME MEASURESnNon-adherence to diet using MEDFICTS (Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table, and Snacks) tool; SS using the Enhancing Recovery in Coronary Heart Disease Patients Social Support Instrument.nnnANALYSISnLogistic regression models adjusted for confounders.nnnRESULTSnSignificant predictors (P<.05) of non-adherence to diet recommendations at 1 year included low SS, increased body mass index and waist size, lower physical activity, depression, pre-action stages of change, control group assignment, and being male. Those with low SS at baseline 2.7 greater odds of being non-adherent to diet at 1 year vs those with higher SS (95% confidence interval=1.1-6.4); there was no interaction by group assignment.nnnCONCLUSION AND IMPLICATIONSnLow SS at baseline was independently associated with non-adherence to diet at 1 year, suggesting that family members with low SS may be at heightened CVD risk as a result of poor dietary adherence.

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.