Background Highly controlled research projects demonstrated success in preventing and controlling cardiovascular diseases. Community-based programs have yet to demonstrate significant influence. Data on large-scale community-level interventions targeting minority communities are limited. The aim of this study is to measure the impact of the Racial and Ethnic Approaches to Community Health ( REACH 2010) project, a community-based intervention to eliminate racial/ethnic disparities in blood cholesterol screening in minority communities.Methods Annual survey data from 2001 to 2006 were gathered in 22 communities. Trends in the prevalence of age-standardised blood cholesterol screening were examined for four racial/ethnic groups ( black, Hispanic, Asian and American Indian/Alaska Native), stratified by education level, and compared with national data from the Behavioral Risk Factor Surveillance System.Results The prevalence of cholesterol screening increased among persons in black, Hispanic and Asian REACH communities (p<0.001), whereas prevalence decreased in the total US and Hispanic populations (p<0.001) and remained similar among blacks and Asians nationwide. The relative disparity between the total US population and most REACH communities decreased (p<0.05). Relative disparity in cholesterol screening related to education level decreased (p<0.05) within REACH communities, whereas relative disparity related to education level nationwide remained similar in blacks and increased (p<0.001) in Hispanics.Conclusion The REACH project decreased racial and ethnic disparities in cholesterol screening between REACH communities and the total US population, as well as disparities related to education level within REACH communities.

To examine the effect of systolic blood pressure (SBP) and total cholesterol adjusted for the effect of age, race, and sex. The effect estimate of SBP is also independent of cholesterol level and vise versa. The focus of the study is to determine if the effect strength of these two variables changes along their whole ranges. 26,913 participants of this study were from 4 study samples: Charleston Heart Study, Evans County Study, NHANES I and NHANES II. Of these 26,913 participants, 12,366 were Caucasian (Cau) females, 9,888 were Cau males, 2,725 were African American (AA) females, and 1,934 were AA males. These individuals were followed an average for 16 years (SD = 6 years). Starting age for them was from 25 years to 97 years (mean = 51 and SD = 14). Lowess curves were used to provide initial heuristics about possible segments if any is needed for the risk factors. Then, the most efficient Cox PH model was identified from the models with alternate function forms. Two segments were needed to best reflect the effect of total cholesterol (below 220 mg/dl, 220 mg/dl or above); 3 segments were needed to best reflect the effect of SBP (below 110 mmHg, 110 to 139 mmHg, 140 mmHg or above). The hazard ratio related to 20 mg/dl increase in cholesterol is 0.980 (not significantly different from 1) until it reaches 220 mg/dl. Beyond this cutoff, 20 mg/dl increase is related to 6% increase (p < 0.0001) in the hazard for CVD mortality. The variation in SBP under 110 mmHg does not have a significant effect on the hazard for CVD mortality (p = 0.14); from 110 to 139 mmHg, 20 mmHg increase in SBP is related to 49% (p < 0.0001) hazard increase and above this range the same amount increase in SBP is related to 27% hazard increase for CVD mortality (p < 0.0001). The relative hazard for CVD mortality related to prehypertension is high (greater effect in the range from 110 to 139 mmHg than in the range beyond). Cholesterol effect is as expected.

Waist circumferences (WC) >/=102 cm for men and >/=88 cm for women have been proposed by an expert panel as cut-points for identifying increased risk for the development of obesity comorbidities for most adults. The aim of this investigation was to examine the predictive values of these WC cut-points for hypercholesterolemia, low concentration of high (HDL-C), and high concentration of low (LDL-C) density lipoprotein cholesterol, hypertriglyceridemia, type 2 diabetes, and hypertension in overweight American adults. Data from NHANES III were utilized for the analysis. Predictive abilities were determined by calculating sensitivity, specificity, positive (PV+) and negative (PV-) predictive values in overweight subjects with BMI 25-29.9 kg/m(2). Sensitivity of WC cut-point was stronger for high LDL-C compared to other risk factors with the highest values recorded in the 40-59 and 60-69 year age groups in men and women, respectively. PV+ of WC cut-points for dyslipidemia, type 2 diabetes, and hypertension were low in men compared to women. PV+ tended to increase with age, from 19-39, 40-59 to 60-90 year age groups in Whites, Blacks, and Hispanic men. In men, the highest PV+ were recorded for hypertriglyceridemia in the 60-90 years old groups, with values of 71.6%, 52.5%, and 43.3% in Whites, Blacks, and Hispanics, respectively. The CVD risk factor associated with the highest PV+ in women was diabetes with values of 97.2% in Whites and 88.9% in Blacks, and hypertriglyceridemia with a value of 93.8% in the 17-39 year age group in Hispanics. Among Black men 40-59 years of age, only 32% of a population of overweight hypertensives were detected by the WC cut-points, and among Black women, 40-59 years of age, only 54% were detected. Given the low sensitivity of these cut-points for detecting hypertension, one of the major co-morbidities of obesity, these cut-points failed to provide adequate evidence for the use of WC in determining or evaluating patients as to co-morbid states. We recommend further studies to determine a set of specific cut-points associated with increased risk of CVD in different population groups.

OBJECTIVE: To determine the types of subcutaneous adiposity represented by different measurements of skinfold thickness that are associated with birth weight in white (n=759), Black (n=916) and Hispanic (n=813) American children aged 5–11 y. We also determined the contribution of birth weight to ethnic differences in subcutaneous and central adiposity. DESIGN AND METHODS: Data for this analysis were from the Third US National Health and Nutrition Examination Survey. The outcome measures were triceps, subscapular, suprailliac and thigh skinfold thicknesses at 5–11 y of age. Central adiposity was defined as ratios of subscapular to triceps (STR) and central–peripheral (CPR) (subscapular+suprailliac)/(triceps+thigh) skinfolds. Partial correlation analyses were used to determine the association between birth weight and measures of subcutaneous fatness, while multiple linear regression analyses were used to determine the independent contribution of birth weight to ethnicity variations in subcutaneous and central adiposity adjusting for sex, age and BMI. RESULTS: Overall, birth weight was negatively associated with subscapular skinfold and central adiposity in White, Black and Hispanic American children (P<0.05). Birth weight was also negatively associated with suprailliac skinfold in both Blacks and Hispanics (P<0.01) and with sum of the four skinfolds in Blacks (P<0.05). Compared with White, Black ethnicity was negatively associated with triceps, suprailliac thigh and sum of skinfold thicknesses controlling for birth weight, sex, age and BMI (P<0.01). Compared with White, Hispanic ethnicity was negatively associated with triceps, thigh and sum of skinfold thicknesses (P<0.01). Both Black and Hispanic ethnicity was positively associated with STR and CPR (P<0.01). CONCLUSIONS: In this population of American children, the association of birth weights with subcutaneous and central fat accumulation may be due to fetal programming. Since the impact of fetal conditions is likely to be modified by life course, defining the interaction between factors that are present at birth and subsequent exposures is one of the essential challenges for future research.

BACKGROUND: Although numerous studies have demonstrated obesity as an aspect of the insulin resistance syndrome in cardiovascular disease (CVD), the mechanism is not clear. Central adiposity, acting through many CVD risk factors, including, plasma glucose, insulin, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and lipoprotein moities-apolipoprotein B (ApoB), apolipoprotein A-I (ApoAI), by atherogenic and thrombotic mechanisms has been proposed as a possible mechanism. In this study, we examined the relationship between central fat distribution (defined by waist circumference) and the ratio of these lipoproteins (ApoB/ApoAI). SUBJECTS AND METHODS: Association between ApoB/ApoAI ratio and waist circumference was compared in Blacks (n=854) and Whites (n=2552) using the NHANES III population-based samples. Correlation analyses and multiple regression analyses were used to determine the association between ApoB/ApoAI and waist circumference, controlling for age, body mass index (BMI), race, gender, plasma glucose, insulin, serum triglyceride and total cholesterol. RESULTS: Adjusting for age, ApoB/ApoAI was significantly correlated with waist circumference (Black men: r=0.38, White men: r=0.26, Black women: r=0.20, White women: r=0.36) (all P<0.01). Adjusting for age and triglyceride or insulin, waist circumference was also positively correlated with CVD risk factors including, ApoB, LDL-C, plasma glucose and fasting insulin, and inversely correlated with ApoAI and HDL-C in Blacks and Whites (P<0.05). Overall, triglyceride and total cholesterol were the strongest predictors of ApoB/ApoAI in Blacks and Whites adjusting for age, BMI and insulin, than waist girth (P<0.01). CONCLUSIONS: The result of this study suggests the need to investigate ApoB/ApoAI as another possible facet in the insulin resistant syndrome.

OBJECTIVES:To assess the mortality of the adult Asian and Pacific Islander population in the United States.METHODS:Cohort study using data from the National Health Interview Survey (1986 to 1994) and the National Longitudinal Mortality Study. Deaths were ascertained by matching the National Death Index with average follow-ups of 5.3 and 9 years, respectively, for the two studies.RESULTS:Respondents from the pooled National Health Interview Surveys included 532,794 non-Hispanic whites, 94,242 blacks, 52,725 Hispanics, and 16,936 Asians and Pacific Islanders, all of whom were at least 18 years of age at baseline. The National Longitudinal Mortality Study included 373,397 non-Hispanic whites, 41,262 blacks, 23,356 Hispanics, and 8,390 Asians and Pacific Islanders. Overall age-standardized mortality was the lowest in Asians/Pacific Islanders, whose risk of death was about 40% lower than whites'. Adjustment for differences in education levels had a minimal influence on the mortality advantage in Asians/Pacific Islanders.CONCLUSIONS:Longitudinal cohorts provide an important source of health status information on Asians and Pacific Islanders. These two studies from representative national samples suggest that overall mortality is substantially lower among Asians and Pacific Islanders than in all other major ethnic groups.

OBJECTIVES:We sought to examine patterns of left ventricular (LV) geometry as determined by echocardiography and their association with mortality in patients with or without coronary artery disease (CAD). BACKGROUND:The independent prognostic role of LV geometry remains uncertain. METHODS:We performed a cohort study based on 988 consecutive patients who underwent both coronary arteriography for presumed CAD and echocardiography and were followed up for a mean of 9 years (range 5 to 13). Patients were classified into four LV geometry patterns: normal, concentric remodeling, eccentric LV hypertrophy (LVH) and concentric LVH. RESULTS:Patients with concentric LVH consistently showed the largest increase in LV posterior wall and septal thickness and LV mass index, as well as relative wall thickness (RWT), regardless of status of the coronary arteries. This pattern conferred the highest risk of both all-cause and cardiac mortality. Eccentric LVH moderately increased the risk of death compared with normal geometry; no substantial increase in mortality was noted in patients with concentric remodeling. When LV index and RWT were analyzed as continuous measures and considered in the same Cox proportional hazards model, increases in LV mass were independently associated with risk, but this outcome was less clear for RWT. CONCLUSIONS:In this series of patients referred to coronary angiography for suspected CAD, LVH conferred most of the predictive information from echocardiography. Patients with both LVH and abnormal RWT--concentric LVH--represent a group with the greatest mortality risk. Concentric remodeling may not be associated with increased risk of death because the predictive value of RWT is not as strong as for LV mass.

An abrupt downturn in mortality rates from coronary heart disease occurred in the United States in the mid-1960s, and for the next decade all four major sex-race groups experienced virtually identical rates of decline. Beginning around the mid-1970s, however, trends for blacks and whites began to diverge, with a deceleration in the annual fall in rates for blacks. The recent release of mortality data extending through 1991, with correction of the denominator estimates in the 1980s using the 1990 census, demonstrate a striking linearity of this trend over the entire decade. In 1989, for the first time since the category of coronary heart disease has been recorded in vital statistics, the age-adjusted death rate for it among black men exceeded that of whites. As a result of the divergent trends among men, an excess of 4,000 deaths of blacks were recorded in 1991 alone. Among women, coronary heart disease mortality was higher among blacks at the beginning of this period, and the average annual percent decline was only two-thirds that of whites. As a result, the absolute mortality gap between blacks and whites steadily increased from 19 to 33 percent (1980 to 1991). This study indicates that the factors that have led to the decline in coronary heart disease have not influenced all demographic groups equally over the last decade.

The impact of aging on pulmonary hemodynamics was investigated in 322 patients who underwent right- and left-sided cardiac catheterization and echocardiographic examination, and were free of coronary disease, impaired left ventricular systolic function and left ventricular dilatation. Most of the patients were black (83%) and hypertensive (78%). Mean pulmonary artery pressures increased progressively with age: 16.7 ± 4.6, 17.9 ± 6.4 and 20.6 ± 8.0 mm Hg for those aged <45 (n = 50), 45 to 64 (n = 238) and ≥65 years (n = 34), respectively (p = 0.020). Pulmonary vascular resistance was 99 ± 42, 116 ± 62 and 160 ± 68 dynes s cm−5, and the ratio of pulmonary to systemic vascular resistance was 78, 80 and 105%, respectively, for the 3 age groups (p < 0.001). Along with these changes, a decrease in cardiac output and an increase in systolic blood pressure and systemic vascular resistance with age were noted. The effect of age on mean pulmonary artery pressure and pulmonary vascular resistance was statistically significant after adjustment for gender, smoking status, body weight, left ventricular hypertrophy, systolic blood pressure and systemic vascular resistance. Consideration should be given to age-related changes in the pulmonary circulation when defining physiologically normal values.