New report on urbanization and heart disease

The World Heart Federation has released a new report, Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities, which shows how urban life impacts heart-healthy behavior.

Although urbanization brings with it many opportunities—such as employment choices, healthcare, educational prospects, social connections and political mobilization—city life inherently comes with obstacles to adopting heart-healthy behaviors, according to the report.

For example, foods high in salt, sugar and fats are often more cheaply and readily available than fresh fruits and vegetables in urban settings. Children are particularly vulnerable to the negative health aspects associated with city life, as they have the least independence from, and are most manipulated by, their living environment. In addition, unplanned urbanization is accompanied by limitations on space for physical activity including lack of planning, crime, and heavy and dangerous traffic.

Heart disease is not just an issue of lifestyle and individual behavior choices, it is the environment around such diseases that have a major impact, the report emphasizes.

The report presents several case studies showing that informed action by governments and key stakeholders who take a whole-of-society approach can dramatically reduce the level of cardiovascular disease risk.

Download the full report or the executive summary here: www.worldheart.org/urbanization.

Citation:
1. Smith, S. et al. Urbanization and Cardiovascular Disease: Raising Heart-healthy Children in Today’s Cities. Geneva: World Heart Federation, 2012.

Food fried in olive or sunflower oil is not linked to heart disease

Eating food fried in olive or sunflower oil is not associated with an increased risk of coronary heart disease or death, according to a study of more than 40,000 adults aged 29-69 years in Spain.

The benefits of olive or sunflower oil can be attributed to the fact that they are less prone to deteriorating during frying, compared to other oils.
The oil used for frying deteriorates, especially when reused, through oxidation and hydrogenation, leading to a loss of unsaturated fats and an increase in trans fats. When food is fried it loses water and absorbs this degredated oil, increasing its energy density.

The study researchers pointed out that these results are directly applicable only to other Mediterranean countries with frying methods similar to those in Spain. For example, oil (mainly olive and sunflower) rather than solid fat is used for frying in Spain. And these oils are not likely to be reused multiple times for foods eaten at home. Finally, consumption of fried snacks high in salt is fairly low in Spain, whereas in other countries such as the United States they provide an important percentage of energy intake.

“Frying with other types of fats, reusing oils several times, or consuming fried snacks high in salt may still be harmful,” the study concluded.

Citation:
1. Guallar-Castillón P, Rodríguez-Artalejo F, Lopez-Garcia E, et al. Consumption of fried foods and risk of coronary heart disease: Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study. BMJ 2012; 344: published 24 Jan 2012. (open access)

Adults in southern China at high risk of metabolic syndrome

A study indicates that close to eight percent of adults in Guangdong, China, have the metabolic syndrome. The metabolic syndrome is the constellation of cardiovascular risk factors including abdominal obesity, raised blood-sugar and high cholesterol. The metabolic syndrome is known to increase the risk of diabetes, heart disease and subsequent death.

The results of the study translate to a total of about four million adults age 20 years and older with the metabolic syndrome in this Chinese province of 85 million residents. More than 60 percent were found to have at least one individual component of the metabolic syndrome. Urban residence were more likely to have the syndrome than the rural population (close to 11 percent compared to four percent).

As China continues to be the fastest economic development in the world, it is expected to further increase its rate of modernization and urbanization–translating to more people consuming energy-dense diets and living increasingly sedentary lifestyles. The prevalence of the metabolic syndrome and related cardiovascular disease is therefore expected to increase enormously, according to the study.

“Urgent public health actions are needed to control this observed worsening situation in China,” the study concludes.

Citation:
1. Lao XQ, Zhang YH, Wong MCS, et al. The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China. BMC Public Health 2012; 12: 64. (open access)

Mexico study: Heart disease risk determined by quality of fat

Quality, rather than quantity of fat, is the determinant of heart disease risk, according to a study conducted in Mexico. The study found that although fat intake among three-quarters of Mexicans fell within World Health Organization recommendations, their saturated fat and trans fat intake exceeded healthy diet recommendations–placing them at higher risk for heart disease.

Around 60 percent of Mexicans surveyed had a high intake of saturated fats and a low intake of polyunsaturated fats, which help reduce the risk of heart disease and promote cardiovascular health.

“Public policies should be enacted to reduce the intake of saturated fats by improving the quality of baking lard and promoting the consumption of defatted milk,” the study recommended. These two foods are among the main sources of saturated fats in the Mexican diet.

In addition, consumption of foods rich in n-3 and n-6 fatty acids (such as fish and nuts) are very low in the typical Mexican diet; thus, alternatives like promoting a larger consumption of canola or soy bean oils or addition of n-3 fatty acids to cooking oils from other sources must be considered, the study concluded.

Citation:
1. Ramírez-Silva I, Villalpando S, Moreno-Saracho JE, Bernal-Medina D. Fatty acids intake in the Mexican population. Results of the National Nutrition Survey 2006. Nutrition & Metabolism 2011; 8: 33. (open access)

Management of diabetes and associated cardiovascular risk factors in seven countries

A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries, according to a multi-country study using nationally representative health examination surveys from Colombia, England, Iran, Mexico, Scotland, Thailand and the United States.

The figures range from 24 percent of women in Scotland and the United States to 62 percent of men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from one percent of male patients in Mexico to about 12 percent in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.

Based on this comparison of how well these seven countries are performing in terms of population-level management of diabetes, hypertension and high cholesterol, the study researchers make the following recommendations:

1. It is critical to track diabetes care at the population level and to focus on actual outcomes, rather than on the process of care. It is also critical to study other countries with larger numbers of individuals with diabetes, such as China and India, for which nationally representative studies are not readily available.
2. It is important to prioritize the development and implementation of national guidelines and the use of new incentive programs for the management of hypertension and high cholesterol among individuals with diabetes in developing countries. The study findings suggest that such progress may be more feasible and more likely to have a larger population health impact than blood glucose control.
3. There are opportunities for innovation in providing incentives, in the technology of diabetes management and in improving financial access to care.

Real progress at the population level in the management of diabetes will likely require all three: monitoring performance in meeting treatment targets, expanding management of hypertension and high cholesterol in individuals with diabetes, and innovations in the delivery of and access to care.

The estimated global prevalence of diabetes is around 6.4 percent and more than 280 million people in the world have diabetes—the majority live in the developing world. Projections indicate that diabetes accounted for almost four million deaths worldwide in 2010. The burden of diabetes will only continue to grow, since the number of adults with diabetes in developing countries is projected to rise by more than two-thirds between 2010 and 2030.

Source:
1. Gakidou E, Mallinger L, Abbott-Klafter J, et al. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 2011; 89: 172-183. (open access)

High blood pressure, high cholesterol and diabetes rates in Switzerland

High blood pressure, high cholesterol and diabetes rates in Switzerland have increased in the last decade, according to data from three national health surveys conducted in 1997-2007.

The prevalence of self-reported hypertension, hypercholesterolemia and diabetes was 22.1 percent, 11.9 percent and 3.3 percent in 1997, respectively; and increased to 24.1 percent, 17.4 percent and 4.8 percent in 2007.

Self-reported treatment rates among people with these three cardiovascular risk factors also increased from 52.1 percent, 18.5 percent and 50 percent in 1997 to 60.4 percent, 38.8 percent and 53.3 percent in 2007 for hypertension, hypercholesterolemia and diabetes, respectively.

Self-reported control levels increased from 56.4 percent, 52.9 percent and 50 percent in 1997 to 80.6 percent, 75.1 percent and 53.3 percent in 2007. Finally, screening during the last 12 months increased from 84.5 percent, 86.5 percent and 87.4 percent in 1997 to 94 percent, 94.6 percent and 94.1 percent in 2007.

Source:
1. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health 2011; 11: 114. (open access)

Physical inactivity, depression and heart disease-related death in older adults

Research has indicated that depressed older individuals are at higher risk of dying than their counterparts without depression. In addition, physical inactivity accounted for a significant proportion (25 percent) of the risk of cardiovascular death due to depression in adults age 65 years and older, according to a 5,900-person U.S. study.

“These data suggest that preventive health and wellness programs in older adults, particularly those with depression, should focus on encouraging enrollment and continued participation in exercise programs,” the study concluded.

The study also added that positive financial incentives, health insurance rebates, transportation vouchers or health club memberships might enhance participation of older adults with depression in these programs and thereby reduce healthcare utilization and the risk of cardiovascular events.

Source:
1. Win S, Parakh K, Eze-Nliam CM, et al. Depressive symptoms, physical inactivity and risk of cardiovascular mortality in older adults: the Cardiovascular Health Study. Heart 2011; 97: 500-505. (open access)

Community-based cardiovascular health promotion program for older adults reduced heart disease hospitalization

A collaborative, multi-pronged, community-based heart health promotion program targeted at older adults reduced hospital admissions for cardiovascular disease at the population level, according to a study evaluating the effectiveness of the Cardiovascular Health Awareness Program (CHAP) in 20 communities in Ontario, Canada.

The program offered cardiovascular risk assessment sessions free of charge to patients age 65 years and older. Regular weekly sessions were held in community pharmacies. Volunteers trained to measure blood pressure used validated and accurate blood pressure measuring devices (such as the BpTRU). Patients were linked to appropriate healthcare providers, i.e., family physicians, nurse practitioners, pharmacists. These providers collaborated in order to offer continuity of care.

See the CHAP Implementation Guide for more information.

Source:
1. Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ 2011; 342: d442. (open access)

Effective control of high cholesterol remains low worldwide

The percentage of people with high cholesterol who are effectively treated remains small in selected high- and middle-income countries, according to a World Health Organization study. Many of those affected are unaware of their condition. Lowering total serum cholesterol levels is an ideal strategy for reducing the burden of cardiovascular disease.

The study analyzed data sampling close to 80,000 adults age 40-79 years from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the United States. The proportion of undiagnosed individuals was highest in Thailand (78 percent) and lowest in the United States (16 percent). The fraction diagnosed but untreated ranged from nine percent in Thailand to 53 percent in Japan. The proportion being treated who had attained evidence of control ranged from four percent in Germany to 58 percent in Mexico. Time series estimates showed improved control of high total serum cholesterol over the past two decades in England and the United States.

“These findings support the growing recognition that cardiovascular diseases are not merely ‘diseases of affluence’ and that some middle-income countries are beginning to face a double burden of both chronic and communicable diseases,” the study said.

The study recommended that programs designed to achieve higher detection and control of high blood cholesterol should be developed and implemented. Dried blood spot technology offers a new and affordable approach to screening in low-income settings. At the same time, better chronic disease surveillance is needed to monitor and guide these programs.

“Untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases,” the study concluded.

Source:
1. Roth GA, Fihn SD, Mokdad AH, et al. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bulletin of the World Health Organization 2011; 89: 92-101. (open access)

U.S. cost of heart disease to triple by 2030

A new American Heart Association report projects that the cost of heart disease in the United States will increase from $272.5 billion a year in 2010 to over $800 billion a year in 2030. Currently cardiovascular disease is responsible for 17 percent of national health expenditures and is the leading cause of death in the United States. By 2030, more than 40 percent of the U.S. population (116 million people) will have some form of heart disease.

Indirect costs (the loss of productivity) are projected to increase 61% from $172 billion in 2010 to $276 billion in 2030. Treating high blood pressure accounts for the largest percentage of the overall projected cost, and will increase to $389 billion by 2030.

“Effective prevention strategies are needed if we are to limit the growing burden of CVD [cardiovascular disease].” the study concludes.

Source:
1. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, published online 24 Jan 2011. (open access)