Explore the vast range of titles available.

Purpose of Review To characterize the barriers and opportunities associated with racial and ethnic disparities in blood pressure (BP) control. Recent Findings Blood pressure (BP) control rates in the USA have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups, with non-Hispanic (NH) Black persons having 10% lower control rates compared to NH White counterparts. Many factors contribute to BP control including key social determinants of health (SDoH) such as health literacy, socioeconomic status, and access to healthcare as well as low awareness rates and dietary habits. Numerous pharmacologic and non-pharmacologic interventions have been developed to reduce racial and ethnic disparities in BP control. Among these, dietary programs designed to help reduce salt intake, faith-based interventions, and community-based programs have found success in achieving better BP control among people from racial and ethnic minority groups. Summary Disparities in the prevalence and management of hypertension persist and remain high, particularly among racial and ethnic minority populations. Ongoing efforts are needed to address SDoH along with the unique genetic, social, economic, and cultural diversity within these groups that contribute to ongoing BP management inequalities.

Background/objectives: Cardiovascular disease (CVD) is the leading cause of death in the United States and the world. Clinical trials have suggested that soybean protein lowers lipids and blood pressure. The effect of soybean protein on novel CVD risk factors has not been well studied. The objective of this study was to examine the effect of soybean protein on biomarkers of inflammation, endothelial dysfunction and adipocytokines. Subjects/methods: The effect of 8 weeks of 40 g of soybean protein supplement (89.3 mg isoflavones), 40 g of milk protein supplement and 40 g of complex carbohydrate placebo was examined in a randomized, placebo-controlled, double-blind, three-phase crossover trial among adults in New Orleans, Louisiana and Jackson, Mississippi. Plasma levels of inflammation biomarkers (C-reactive protein, interleukin-6, tumor necrosis factor-α), endothelial dysfunction biomarkers (E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, thrombomodulin) and adipocytokines (high-molecular weight adiponectin, leptin, resistin) were measured at baseline and at the end of each intervention using immunoturbidimetric and enzyme-linked immunosorbent assay techniques. Results: Soy protein supplementation resulted in a significant mean net change (95% confidence interval) in plasma E-selectin of −3.93 ng/ml (−7.05 to −0.81 ng/ml; P =0.014) compared with milk protein, and in plasma leptin of −2089.8 pg/ml (−3689.3 to −490.3 pg/ml; P =0.011) compared with carbohydrate. There were no significant changes in any other risk factors. Conclusions: Soy protein supplementation may reduce levels of E-selectin and leptin. Further research is warranted to investigate the mechanisms through which protein may confer protective effects on novel CVD risk factors.

To assess the influence of exercise capacity and body mass index (BMI) on 10-year mortality in patients with heart failure (HF) and to synthesize these results with those of previous studies. This large biracial sample included 774 men and women (mean age, 60±13 years; 372 [48%] black) with a baseline diagnosis of HF from the Henry Ford Exercise Testing (FIT) Project. All patients completed a symptom-limited maximal treadmill stress test from January 1, 1991, through May 31, 2009. Patients were grouped by World Health Organization BMI categories for Kaplan-Meier survival analyses and stratified by exercise capacity (<4 and ≥4 metabolic equivalents [METs] of task). Associations of BMI and exercise capacity with all-cause mortality were assessed using multivariable-adjusted Cox proportional hazards models. During a mean follow-up of 10.1±4.6 years, 380 patients (49%) died. Kaplan-Meier survival plots revealed a significant positive association between BMI category and survival for exercise capacity less than 4 METs (log-rank, P=.05), but not greater than or equal to 4 METs (P=.76). In the multivariable-adjusted models, exercise capacity (per 1 MET) was inversely associated, but BMI was not associated, with all-cause mortality (hazard ratio, 0.89; 95% CI, 0.85-0.94; P<.001 and hazard ratio, 0.99; 95% CI, 0.97-1.01; P=.16, respectively). Maximal exercise capacity modified the relationship between BMI and long-term survival in patients with HF, upholding the presence of an exercise capacity-obesity paradox dichotomy as observed over the short-term in previous studies.

Heart rate (HR) at rest is associated with adverse cardiovascular events; however, the biologic mechanism for the relation is unclear. We hypothesized a strong association between HR at rest and subclinical inflammation, given their common interrelation with the autonomic nervous system. HR at rest was recorded at baseline in the Multi-Ethnic Study of Atherosclerosis, a cohort of 4 racial or ethnic groups without cardiovascular disease at baseline and then divided into quintiles. Subclinical inflammation was measured using high-sensitivity C-reactive protein, interleukin-6, and fibrinogen. We used progressively adjusted regression models with terms for physical activity and atrioventricular nodal blocking agents in the fully adjusted models. We examined inflammatory markers as both continuous and categorical variables using the clinical cut point of ≥3 mg/L for high-sensitivity C-reactive protein and the upper quartiles of fibrinogen (≥389 mg/dl) and interleukin-6 (≥1.89 pg/ml). Participants had a mean age of 62 years (SD 9.7), mean resting heart rate of 63 beats/min (SD 9.6) and were 47% men. Increased HR at rest was significantly associated with higher levels of all 3 inflammatory markers in both continuous (p for trend <0.001) and categorical (p for trend <0.001) models. Results were similar among all 3 inflammatory markers, and there was no significant difference in the association among the 4 racial or ethnic groups. In conclusion, an increased HR at rest was associated with a higher level of inflammation among an ethnically diverse group of subjects without known cardiovascular disease.

To estimate the prevalence of diagnosed and undiagnosed diabetes and impaired fasting glucose in the general adult population of China. The International Collaborative Study of Cardiovascular Disease in ASIA, conducted from 2000 to 2001, included a nationally representative sample of 15 540 adults, aged 35 to 74 years. An overnight fasting blood specimen was collected to measure serum glucose and information on history of diabetes and use of hypoglycaemic medications was obtained by a standard questionnaire. Undiagnosed diabetes (fasting glucose > or =7.0 mmol/l) and impaired fasting glucose (6.1-6.9 mmol/l) were defined using the American Diabetes Association criteria. Prevalence of self-reported diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose in Chinese adults were 1.3%, 4.2%, and 7.3%, respectively. Overall, 5.2% or 12.7 million men and 5.8% or 13.3 million women in China aged 35 to 74 years had diabetes (self-reported diagnosis plus undiagnosed diabetes). The age-standardized prevalence of diabetes was higher in residents of northern compared to southern China (7.4% vs 5.4%, p<0.001) and in those living in urban compared to rural areas (7.8% vs 5.1%, p<0.001). Our results show that the prevalence of diabetes in the adult population in China is much higher than previously reported. Three out of every four diabetes patients are undiagnosed, indicative of a lack of population-based screening programmmes and a relatively rapid and recent increase in incidence of diabetes. These results indicate that diabetes has become a major public health problem in China and underscore the need for national strategies aimed at prevention and treatment of diabetes.

The prognostic value of traditional atherosclerotic cardiovascular disease (ASCVD) risk factors may decrease with age. We sought to determine whether the association between traditional ASCVD risk factors and incident coronary artery calcium (CAC) differs for younger versus older persons. We included 5,108 participants with baseline CAC = 0. Repeat CAC scoring occurred over 3 to 11 years of follow-up. Multivariable Cox proportional hazards regression assessed the association between traditional risk factors and incident CAC in young (32 to 45 years), middle-aged (46 to 64 years), and older adults (65 to 84 years). A total of 61% of the participants were women and 37% were Black. The proportion with incident CAC ranged from 22% among young adults, 34% for middle-aged adults, and 45% for older adults. In young adults, traditional risk factors were significantly associated with incident CAC except for diastolic blood pressure and high-density lipoprotein (HDL) cholesterol, whereas only total cholesterol/HDL cholesterol ≥3.5 (p = 0.04) was significantly associated with incident CAC in older persons. Non-HDL cholesterol (p = 0.02) was more strongly associated with incident CAC in young (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09 to 1.31) and middle aged (HR 1.14, 95% CI 1.07 to 1.23) compared to older adults (HR 1.11, 95% CI 0.99 to 1.23). When added to demographics, traditional risk factors provided a greater C-statistic improvement for incident CAC prediction in young (0.752, +0.070, p <0.001) versus middle-aged (0.645, +0.054, p <0.001) and older adults (0.597,+0.025, p = 0.08). In conclusion, traditional risk factors more strongly predict incident CAC in young compared to older adults, underlining the importance of primordial prevention through middle age while identifying the challenges of ASCVD risk assessment in older persons.

Objective: Clinical trials have indicated that water-soluble fiber from oats reduces serum cholesterol among hypercholesterolemic patients on a low-fat diet. We examined the effect of dietary fiber intake on serum lipids among persons without hypercholesterolemia. Design: Randomized controlled trial. Setting and subjects: We recruited 110 participants who were aged 30-65 years and had a serum cholesterol level <240 mg/dl from community. Intervention: Study participants were randomly assigned to receive 8 g per day of water-soluble fiber from oat bran or a control intervention. Results: At baseline, the mean levels of serum cholesterol and other measured variables were comparable between the high-fiber and control groups. Over the 3-month intervention, mean changes (95% confidence interval (CI)) in total, HDL-, and LDL-cholesterol were -2.42 mg/dl (-8.90 to 4.05 mg/dl; P=0.46), -0.24 mg/dl (-2.19 to 1.71 mg/dl; P=0.81), and -1.96 mg/dl (-7.32 to 3.40 mg/dl; P=0.47) in the fiber group and -0.02 mg/dl (-5.29 to 5.26 mg/dl; P=0.99), 1.42 mg/dl (-0.74 to 3.59 mg/dl; P=0.19), and -0.64 mg/dl (-5.30 to 4.03 mg/dl; P=0.79) in the control group, respectively. The net changes (95% confidence interval) in total, HDL-, and LDL-cholesterol were -2.40 mg/dl (-10.6 to 5.81 mg/dl; P=0.56), -1.66 mg/dl (-4.55 to 1.22 mg/dl; P=0.26) and -1.33 mg/dl (-8.33 to 5.68 mg/dl; P=0.71), respectively. Conclusions: Our study does not support the hypothesis that water-soluble fiber intake from oat bran reduces total and LDL-cholesterol in study participants with a normal serum cholesterol level.

Epidemiologic studies suggest that vegetable protein intake is inversely related to blood pressure. To examine the effect of soybean protein supplementation on blood pressure in persons with prehypertension or stage 1 hypertension. Randomized, double-blind, controlled trial. Three communities in the People's Republic of China. 302 participants 35 to 64 years of age with an initial untreated systolic blood pressure of 130 to 159 mm Hg, diastolic blood pressure of 80 to 99 mm Hg, or both. Study participants were randomly assigned to receive 40 g of isolated soybean protein supplements per day or complex carbohydrate control for 12 weeks; 91.4% completed the intervention. Blood pressure measurements were obtained by using random-zero sphygmomanometers at baseline and at 6 and 12 weeks. At baseline, the mean systolic and diastolic blood pressures were 135.0 mm Hg (SD 10.9) and 84.7 mm Hg (SD 6.9), respectively. Compared with the control group, the net changes in systolic blood pressure and diastolic blood pressure were -4.31 mm Hg (95% CI, -2.11 to -6.51 mm Hg; P < 0.001) and -2.76 mm Hg (CI, -1.35 to -4.16 mm Hg; P < 0.001), respectively, after the 12-week intervention. The net changes in systolic and diastolic blood pressure reductions were -7.88 mm Hg (CI, -4.66 to -11.1 mm Hg) and -5.27 mm Hg (CI, -3.05 to -7.49 mm Hg), respectively, in persons with hypertension and -2.34 mm Hg (CI, 0.48 to -5.17 mm Hg) and -1.28 mm Hg (CI, 0.52 to -3.07 mm Hg), respectively, in those without hypertension. This trial did not examine whether the blood pressure reduction was due to protein or isoflavones in soybean. Soybean protein supplementation resulted in a reduction in systolic and diastolic blood pressure. These findings suggest that increased intake of soybean protein may play an important role in preventing and treating hypertension.

Cardiovascular disease is the main cause of death in virtually all industrialised countries. The limited information available from developing countries suggests that a similar epidemic is inevitable if current trends go unchecked. Treatment of patients with clinical manifestations is an important element in overall management but on its own is an insufficient and incomplete response. Sudden death is often the first manifestation of cardiovascular disease and, even when treatment of disease is applicable and effective, it is usually palliative rather than curative. Thus treatment and prevention directed at the underlying risk factors, including high blood pressure, constitute a complementary and more fundamental approach to reducing the burden of illness. Epidemiological studies provide the scientific foundation for such an approach by identifying the distribution and determinants of high blood pressure in the general population, by establishing the role of high blood pressure as a risk factor for cardiorenal complications, and by quantifying the potential value of treating and preventing high blood pressure in the general population.

Results from national surveys of prevalence, awareness, treatment and control provide the most meaningful basis for assessing the burden of hypertension in the community. National surveys conducted in a variety of countries in North America, Europe, Australia, Asia and Africa have identified a strikingly similar relationship between age and blood pressure (BP), with a progressive and steep increase in systolic BP throughout adult life and a less steep increase in diastolic BP from adolescence until the fifth or sixth decade. In most countries surveyed, there was a high prevalence of hypertension. Approximately, one quarter of all adults in the United States and Egypt had hypertension (systolic BP>/=140 mmHg or diastolic BP>/=90 mmHg or use of antihypertensive medication) in national surveys conducted in 1988-1991 and 1991-1993, respectively. The corresponding percentage was somewhat lower (14.4%) for adults surveyed in China during 1991, but temporal trends indicate that the prevalence of hypertension is increasing rapidly in that country. In the 1988-1991 national survey, more than 25% of US adults were unaware of their diagnosis, only 55% were being treated with antihypertensive medication and only 29% were on antihypertensive medication with a systolic/diastolic BP >140/90 mmHg. The situation was much worse in Egypt and China, with only 8% and <5% of adults with hypertension, respectively, being treated with antihypertensive medication and having a systolic/diastolic BP <140/90 mmHg. These survey results underscore the fact that hypertension is highly prevalent, poorly treated and controlled, and an escalating health challenge in economically developing countries.