Special Issue of JACC Focuses on CV Health Promotion

Topics Include Dietary Patterns, Physical Activity, Lifestyle Habits and Prevention of CVD

A special issue of the Journal of the American College of Cardiology (JACC), published April 22, on cardiovascular health promotion, covers topics such as healthy behaviors in preschoolers, the importance of eating breakfast, plant-based dietary patters and incident heart failure (HF), sitting time and risk of death, survival among SIHD patients with diabetes, benefits of omega-3 fatty acid supplementation, and more.

Child Health Promotion in Underserved Communities: A multidimensional school-based educational intervention may be an effective strategy for establishing healthy behaviors among preschoolers from a diverse and socioeconomically disadvantaged community, according to results from the FAMILIA trial by Rodrigo Fernandez-Jimenez, MD, PhD, et al. The study enrolled 562 children from 15 preschools in Harlem, NY. Results showed that preschoolers who took part in a health promotion educational program showed a two-fold increase in knowledge, attitudes and habits compared to their classmates who did not take part in the program. The researchers note that early primordial prevention strategies may contribute to reducing the global burden of cardiovascular disease. In an editorial comment, Keith C. Ferdinand, MD, FACC, adds that "the time is now for primordial cardiovascular disease prevention, which is even more critical in minorities and children from families with the lowest incomes and educational attainment."

Association of Skipping Breakfast With CV and All-Cause Mortality: New evidence underscores the importance of eating breakfast every day, according to a study that showed skipping breakfast was significantly associated with an increased risk of death from heart disease. Using data from the National Health and Nutrition Examination Survey from 1988 to 1994, Shuang Rong, MD, PhD, et al., collected information from 6,550 participants on whether they never consumed breakfast, rarely consumed breakfast, consumed breakfast some days or consumed breakfast every day. Participants who never consumed breakfast had an 87 percent higher risk of cardiovascular disease-specific mortality than those who consumed breakfast every day. Researchers also found that skipping breakfast was associated with changes in appetite and decreased satiety, elevated blood pressure, and harmful changes in lipid levels. In an editorial comment, Borja Ibáñez, MD, PhD, et al., notes that "either causally linked or just as an epiphenomenon, skipping breakfast appears as a marker of atherosclerosis presence and poor cardiovascular outcomes."

Dietary Patterns and Incident HF in U.S. Adults: In an attempt to determine the associations of five dietary patterns with incident HF hospitalizations among U.S. adults, Kyla M. Lara, MD, MS, et al., found that adherence to a plant-based dietary pattern was inversely associated with incident HF risk, whereas the Southern dietary pattern was positively associated with incident HF risk. Out of 16,068 participants included in the study that looked at five major dietary patterns over 8.7 years of follow-up, 363 had incident HF hospitalizations. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41 percent lower risk of HF, and highest adherence to the Southern dietary pattern was associated with a 72 percent higher risk of HF. In an editorial comment, Dong D. Wang, ScD, MD, notes that this study "represents an important step forward in establishing a robust evidence base for the dietary prevention of HF."

Sitting Time, Physical Activity and Risk of Mortality in Adults: For less active adults, the amount of time spent sitting may be associated with an increased risk of death; however, increasing physical activity to recommended levels may eliminate this association in some, according to a study by Emmanuel Stamatakis, PhD, et al. Researchers found that out of 149,077 participants over an 8.9-year follow-up, there was a statistically significant interaction between sitting and moderate-to-vigorous intensity physical activity only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting less than 150 moderate-to-vigorous intensity physical activity minutes per week. In an editorial comment, Charles E. Matthews, PhD, adds that "given that sedentary behaviors appear to be vastly outcompeting more healthy physical activity behaviors during our discretionary time, it is more important than ever to attend to our daily physical activity and sitting time and to try to optimize both behaviors for better health."

Lifestyle, A1c and Survival Among SIHD Patients With Diabetes: In the high-risk subset of stable ischemic heart disease patients with diabetes, the number of controlled risk factors – including lifestyle behaviors and glycosylated hemoglobin A1c (A1c) – may be associated with improved survival, according to a study by G.B. John Mancini, MD, FACC, et al. Using data from the COURAGE trial, researchers observed that the higher the number of risk factors controlled one year after randomization, the higher the probability of long-term survival. The most prominent factors were the three lifestyle factors – not smoking, moderate physical activity and adherence to dietary advice – and achievement of an A1c less than 7 percent. In an editorial comment, Michael E. Farkouh, MD, MSc, FACC, et al., notes that this study is a "timely reminder that the cardiovascular community should double up their efforts to ensure compliance with lifestyle interventions."

CV Benefits of Fish-Oil Against Fine Particulate Air Pollution in China: Omega-3 fatty acid supplementation may be associated with short-term subclinical cardiovascular benefits against fine particulate matter exposure among healthy young adults in China, according to a trial among 65 healthy college students in Shanghai, China. Zhijing Lin, PhD, et al., randomly assigned participants to either the placebo group or the intervention group with dietary fish-oil supplementation of 2.5 g/day from September 2017 to January 2018. Compared with the placebo group, the fish-oil group showed relatively stable levels of most biomarkers in response to changes in fine particulate matter exposure. Between-group differences associated with fine particulate matter exposure varied by biomarkers and by lags of exposure. The authors observed beneficial effects of fish-oil supplementation on five biomarkers of blood inflammation, coagulation, endothelial function, oxidative stress and neuroendocrine stress response in the fish-oil group at a false discovery rate of less than .05. In an editorial comment, Sanjay Rajagopalan, MD, FACC, et al., adds that "given the recent spate of emission-related events around the globe … trials to test community- and personal-level protection actions in this setting are desperately needed."

Long-Term CV Risks and Adverse Pregnancy Outcomes: Understanding the risk factors for and pathogenesis of adverse pregnancy outcome-related cardiovascular dysfunction is a critical unmet need that could inform efforts to prevent and more effectively treat cardiovascular disease in women, according to a JACC review paper. Abbi D. Lane-Cordova, PhD, et al., analyze the current information and knowledge gaps regarding the progression from adverse pregnancy outcome to cardiovascular disease. They propose that subclinical forms of cardiovascular disease, such as microvascular dysfunction, arterial stiffness and myocardial dysfunction, emerge during an adverse pregnancy outcome and fail to resolve or progress postpartum due to ongoing cardiovascular damage caused by antiangiogenic or inflammatory mediators. "Future research should determine the pathways by which adverse pregnancy outcomes lead to cardiovascular disease and whether behavioral or pharmacological interventions are useful for reducing adverse pregnancy outcome-related cardiovascular disease risk," the authors conclude.

Read more studies in the full special focused issue of JACC.

Keywords: Child, Preschool, Breakfast, Nutrition Surveys, Pregnancy Outcome, Risk Factors, Blood Pressure, Vascular Stiffness, Fish Oils, Particulate Matter, Sedentary Behavior, Health Behavior, Diet, Exercise, Health Promotion, Habits, Atherosclerosis, Diabetes Mellitus, Myocardial Ischemia, Primary Prevention, Heart Failure, Inflammation, Oxidative Stress, Inflammation Mediators, Fatty Acids, Omega-3, Air Pollution

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