Cardiovascular prevention: components, levels, early origins, and metrics

Anthropometric and central obesity indices as predictors of long-term cardiometabolic risk among Saudi young and middle-aged men and women

Objectives:

To investigate the prediction of long-term cardiometabolic risk using anthropometric and central obesity parameters.

Methods:

A total of 390 Saudi subjects (men 42.8%) aged 18-50 years were enrolled in a cross-sectional study in King Saud University, Riyadh, Kingdom of Saudi Arabia between August 2014 and January 2016. All participants were instructed to fast for 12 hours before taking blood samples for glucose and lipid panel analyses. A full anthropometric measurement and bioelectric impedance analysis was performed. The anthropometric and central obesity parameters were used for correlation with 30-year Framingham and life-time American College of Cardiology/American Heart Association risk scores. We used receiver operator characteristic curves to select the best predictors with the highest sensitivity and specificity.

Results:

The best discriminators of the long-term cardiometabolic risk among all the studied variables in men were the visceral adiposity index (VAI) (AUC=0.767), conicity index (CI) (AUC=0.817), and mid-arm muscular area (MAMA) (AUC=0.639). The best predictors for women were body mass index (AUC=0.912), waist circumference (AUC=0.752), and lipid accumulation product (AUC=0.632). The Kappa coefficient and 95% confidence interval ranged from 0.1 to 0.35, which suggests that there is a poor to fair agreement between these indices and cardiovascular risk scores.

Conclusion:

Long-term cardiometabolic risk can be predicted using simple anthropometric and central obesity indices, and these discriminators were not the same in Saudi men and women.

Current Treatment of Dyslipidemia: A New Paradigm for Statin Drug Use and the Need for Additional Therapies

Coronary heart disease (CHD) is the leading cause of death in most countries, with the high prevalence currently driven by dual epidemics of obesity and diabetes. Statin drugs, the most effective, evidence-based agents to prevent and treat this disease, have a central role in management and are advised in all published guidelines. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol and assessment guidelines ('new ACC/AHA guidelines') emphasized global cardiovascular (CV) risk reduction as opposed to targeting low-density lipoprotein-cholesterol (LDL-C) levels, stressed the use of statins in two dose intensities, utilized a new risk calculator using pooled cohort equations, and lowered the risk cutoff for initiation of statin therapy. Although there were major strengths of the new ACC/AHA guidelines, substantial controversy followed their release, particulars of which are discussed in this review. They were generally regarded as improvements in an ongoing transition using evidenced-based data for maximum patient benefit. Several guidelines, other than the ACC/AHA guidelines, currently provide practitioners with choices, some depending on practice locations. Cholesterol control with statin drugs is used in all paradigms. However, some patients respond inadequately, approximately 15% are intolerant, and other factors prevent attaining cholesterol goals in as many as 40% of patients. Even after treatment, substantial residual risk for ongoing major events remains. Another readily available modality that can rival statin drugs in effectiveness is vast improvement in diet and lifestyle within the general population; however, despite great effort, existing programs to implement such changes have failed. Hence, despite unrivaled success, there is great need for additional drugs to prevent and treat CHD, whether as monotherapy or in combination with statin drugs. New American guidelines do not discuss or recommend any nonstatin drugs for CHD, and the US FDA has moved away from approving drugs based solely on changes in surrogates in the absence of clinical outcomes trials. Both have significantly altered the realities of developing pharmacotherapies and cardiology practice.

Healthy Hunger-Free Kids Act Increases Phytochemicals in Menus and Curriculum Furthers Identification of Phytochemical-Rich Foods

Objective

This study evaluated whether providing the Fruits and Vegetables (F/V) required by the Healthy Hunger-Free Kids Act (HHFKA) increased phytochemical/antioxidant content of school lunches. Additionally, the ability of adolescents to apply their nutritional knowledge following participation in a nutrition-focused science-based curriculum was assessed.

Methods

Changes in antioxidant/phytochemical content from F/V offered in school lunch menus were analyzed Pre-and Post-HHFKA. Food logs completed by 717 youth aged 10-18 were analyzed for correctly identifying "fighting foods".

Results

Significant increases in antioxidant/phytochemical content resulted following implementation of HHFKA (P<0.05). Seventy-five percent [0, 100] of the time students accurately identified "fighting foods" in their one-day in-school food log (n=468).

Conclusions and Implications

Creatively incorporating nutrition education into core curriculum, when paired with a supportive built environment that increases F/V access (HHFKA), generates a multilevel intervention promoting F/V consumption among school-aged youth.