Empiric Support for Cardiovascular Health: The Case Gets Even Stronger.
Circulation. 2012 Jan 30;
Authors: Appel LJ
Abstract
Recently, the American Heart Association (AHA) adopted a new and ambitious strategic goal – “by 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular disease by 20%”(1). In the process, it defined a new concept, cardiovascular health, which is comprised of 7 components: 4 ideal health behaviors (nonsmoking, body mass index < 25 kg/m(2), physical activity at goal levels, and a diet consistent with current recommendations) together with 3 ideal health factors (untreated total cholesterol < 200mg/dL, untreated blood pressure <120/<80 mm Hg, and fasting blood glucose<100 mg/dL). This new approach emphasizes prevention with a focus on achieving and sustaining desirable behaviors. At the time of the AHA report, the health benefits of each of the 7 individual components were well-supported by available literature. A few studies had also defined the relationship of clusters of ideal levels of risk factors and behaviors and had assessed their relationship with health outcomes, quality of life, and cost(2-6). Specifically, Stamler defined low cardiovascular risk as a cluster of optimal levels of traditional cardiovascular risk factors,(3) while Stampfer defined a cluster of ideal lifestyle behaviors(4).Yet, in 2010, when the AHA published its 2020 strategic goal, there was no available research on the new metric, cardiovascular health. In this issue of Circulation, two papers address this gap and provide complementary data related to cardiovascular health, or at least a forme fruste. (SELECT FULL TEXT TO CONTINUE).
PMID: 22291125 [PubMed - as supplied by publisher]
Ideal Cardiovascular Health and Mortality from All Causes and Diseases of the Circulatory System among Adults in the United States.
Circulation. 2012 Jan 30;
Authors: Ford ES, Greenlund KJ, Hong Y
Abstract
BACKGROUND: Recently, the American Heart Association (AHA) developed a set of seven ideal health metrics that will be used to measure progress towards their 2020 goals for cardiovascular health. The objective of the present study was to examine how well these metrics predicted mortality from all-causes and diseases of the circulatory system in a national sample of adults in the United States. METHODS AND RESULTS: We used data from 7622 adults aged ≥20 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2002 and whose mortality through 2006 was determined via linkage to the National Death Index. For the dietary and glycemic metrics, we used alternative measures. During a median follow-up of 5.8 years, 532 deaths (186 deaths from diseases of the circulatory system) occurred. About 1.5% of participants met none of the seven ideal cardiovascular health metrics, and 1.1% of participants met all seven metrics. The number of ideal metrics was significantly and inversely related to mortality from all-causes and diseases of the circulatory system. Compared to participants who met none of the ideal metrics, those meeting five or more metrics had a reduction of 78% (adjusted hazard ratio [aHR]: 0.22; 95% confidence interval [CI]: 0.10, 0.50) in the risk for all-cause mortality and 88% (aHR: 0.12; 95% CI: 0.03, 0.57) in the risk for mortality from diseases of the circulatory system. CONCLUSIONS: The number of ideal cardiovascular health metrics is a strong predictor of mortality from all-causes and diseases of the circulatory system.
PMID: 22291126 [PubMed - as supplied by publisher]
Healthy Lifestyle through Young Adulthood and Presence of Low Cardiovascular Disease Risk Profile in Middle Age.
Circulation. 2012 Jan 30;
Authors: Liu K, Daviglus ML, Loria C, Colangelo LA, Spring B, Moller A, Lloyd-Jones DM
Abstract
BACKGROUND: A low cardiovascular disease (CVD) risk profile (untreated cholesterol < 200 mg/dl, untreated blood pressure < 120/<80 mmHg, never smoking, and no history of diabetes and myocardial infarction) in middle age is associated with markedly better health outcomes in older age, but few middle aged adults have this low risk profile. We examined whether adopting a healthy lifestyle throughout young adulthood is associated with presence of the low CVD risk profile in middle age. METHODS AND RESULTS: The CARDIA study sample consisted of 3,154 black and white participants aged 18 to 30 years at Year 0 (Y0, 1985-86) who attended the Year 0, 7 and 20 (Y0, Y7 and Y20) examinations. Healthy lifestyle factors (HLFs) defined at Y0, Y7 and Y20 included: 1) Average BMI < 25 kg/m(2); 2) No or moderate alcohol intake; 3) higher healthy diet score; 4) higher physical activity score; and 5) Never smoking. Mean age (25 years) and percentage of women (56%) were comparable across groups defined by number of HLFs. The age-, sex- and race-adjusted prevalences of low CVD risk profile at Y20 were 3.0%, 14.6%, 29.5%, 39.2% and 60.7% for people with 0 or 1, 2, 3, 4, and 5 HLFs, respectively (p-trend <0.0001). Similar graded relationships were observed for each sex-race group (all p-trend<0.0001). CONCLUSIONS: Maintaining a healthy lifestyle throughout young adulthood is strongly associated with low CVD risk profile in middle age. Public health and individual efforts are needed to improve adoption and maintenance of healthy lifestyles in young adults.
PMID: 22291127 [PubMed - as supplied by publisher]
Increasing Referral and Participation Rates to Outpatient Cardiac Rehabilitation: The Valuable Role of Healthcare Professionals in the Inpatient and Home Health Settings: A Science Advisory From the American Heart Association.
Circulation. 2012 Jan 30;
Authors: Arena R, Williams M, Forman DE, Cahalin LP, Coke L, Myers J, Hamm L, Kris-Etherton P, Humphrey R, Bittner V, Lavie CJ,
PMID: 22291128 [PubMed - as supplied by publisher]
Rheb is a Critical Regulator of Autophagy during Myocardial Ischemia: Pathophysiological Implications in Obesity and Metabolic Syndrome.
Circulation. 2012 Jan 31;
Authors: Sciarretta S, Zhai P, Shao D, Maejima Y, Robbins J, Volpe M, Condorelli G, Sadoshima J
Abstract
BACKGROUND: Rheb is a GTP-binding protein that promotes cell survival and mediates the cellular response to energy deprivation (ED). The role of Rheb in the regulation of cell survival during ED has not been investigated in the heart. METHODS AND RESULTS: Rheb is inactivated during cardiomyocyte (CM) glucose deprivation (GD) in vitro, and during acute myocardial ischemia in vivo. Rheb inhibition causes mTORC1 inhibition, because forced activation of Rheb, through Rheb overexpression in vitro and through inducible cardiac-specific Rheb overexpression in vivo, restored mTORC1 activity. Restoration of mTORC1 activity reduced CM survival during GD and increased infarct size after ischemia, both of which were accompanied by inhibition of autophagy, whereas Rheb knockdown increased autophagy and CM survival. Rheb inhibits autophagy mostly through Atg7 depletion. Restoration of autophagy, through Atg7 re-expression and inhibition of mTORC1, increased cellular ATP content and reduced endoplasmic reticulum stress, thereby reducing CM death induced by Rheb activation. Mice with high fat diet-induced obesity and metabolic syndrome (HFD mice) exhibited deregulated cardiac activation of Rheb and mTORC1, particularly during ischemia. HFD mice presented inhibition of cardiac autophagy and displayed increased ischemic injury. Pharmacological and genetic inhibition of mTORC1 restored autophagy and abrogated the increase in infarct size observed in HFD mice, but they failed to protect HFD mice in the presence of genetic disruption of autophagy. CONCLUSIONS: Inactivation of Rheb protects CMs during ED through activation of autophagy. Rheb and mTORC1 may represent therapeutic targets to reduce myocardial damage during ischemia, particularly in obese patients.
PMID: 22294621 [PubMed - as supplied by publisher]
