Lifestyle-related education and counseling resource utilization and cardiovascular biomarkers in midlife women with low physical activity.
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ABSTRACT:
SUBMITTER: Badon SE
PROVIDER: S-EPMC8173299 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ContextReproductive hormones are important to the pathophysiology of cardiovascular disease (CVD) in women. However, standard estradiol (E2) and testosterone (T) assays lack sensitivity at the levels of postmenopausal women.ObjectiveInvestigate relations of mass spectrometry-assessed estrone (E1), E2, and T and SHBG and subclinical CVD in women.Design, setting, and participantsThree hundred and four perimenopausal and postmenopausal women aged 40 to 60 years underwent subclinical CVD measurements. E1, E2, and T were assayed using liquid chromatography-tandem mass spectrometry; free T (FT) was estimated using ensemble allostery models. Regression models were adjusted for CVD risk factors.Main outcome measuresCarotid artery intima media thickness, interadventitial diameter (IAD), and plaque; brachial flow mediated dilation (FMD).ResultsHigher E1 was related to higher FMD [?(SE) = 0.77 (0.37), P = 0.04], indicating better endothelial function. Higher E2 was related to lower IAD [?(SE) = -0.07 (0.02), P = 0.004], indicating less carotid remodeling. Higher SHBG was related to higher FMD [?(SE) = 1.31 (0.40), P = 0.001], yet higher IAD [?(SE) = 0.15 (0.06), P = 0.02] and plaque [OR (95% CI) = 1.84 (1.16 to 2.91), P = 0.009]; FT showed a similar yet inverse pattern of relations as SHBG. Thus, higher SHBG and lower FT were associated with better endothelial function, yet greater carotid remodeling and plaque.ConclusionsEndogenous E1 levels were related to endothelial function and E2 to vascular remodeling, suggesting distinct roles of these estrogens. SHBG and FT have complex roles depending on the vessel under study.
| S-EPMC6276700 | biostudies-literature
Project description:BACKGROUND:Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited. OBJECTIVES:This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health. METHODS:Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code-specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars. RESULTS:Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78%). Approximately $2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level >3 mg/l, or coronary artery calcium score (CACS) ?400. Costs varied widely from <$7,700 for low-risk (Framingham risk score <6%, 0 CACS, and normal glucose measurements at baseline) to >$35,800 for high-risk (persons with diabetes, Framingham risk score ?20%, or CACS ?400) subgroups. Among high-risk enrollees, CVD costs accounted for $74 million of the $155 million consumed by MESA participants. CONCLUSIONS:Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals.
| S-EPMC5846485 | biostudies-literature
Project description:IntroductionAs women progress through menopause, they experience changes in sexual functioning that are multifactorial, likely encompassing biological, psychological, and social domains.AimTo examine the effects that physical activity, sleep difficulties, and social support have on partnered sexual activity and sexual functioning in women at different stages of the menopausal progression.MethodsAs part of an ongoing 5-year longitudinal study, we conducted a cross-sectional analysis of sexual functioning data.Main outcome measuresParticipation in partnered sexual activities, reasons for nonparticipation in such activities among sexually inactive women, and, among sexually active women, sexual functioning defined as engagement in and enjoyment of sexually intimate activities.ResultsOf 677 participants aged 41-68, 68% had participated in any partnered sexual activities (i.e., were sexually active) during the past 6 months. Reasons for sexual inactivity included lack of a partner (70%), lack of interest in sex (12%) or in the current partner (5%), and physical problems (4%). Sexually active participants tended to be younger, married, more educated, have more social support in general, fewer comorbid medical illnesses, a lower body mass index, and a higher prevalence of vaginal dryness. Among the sexually active participants, their scores for engagement in activities ranging from kissing to sexual intercourse were higher if they were physically active, had more social support, and lacked sleeping difficulties. Likewise, scores for sexual enjoyment were higher if they were physically active, had more social support, and lacked vaginal dryness. Engagement and enjoyment scores were not associated with marital status or other factors.ConclusionsIn midlife women, having social support and being physically active are associated with enhanced sexual engagement and enjoyment.
| S-EPMC2752308 | biostudies-literature
Project description: Not available
| S-EPMC10580152 | biostudies-literature
Project description:A childhood history of abuse or neglect may be associated with elevated adult cardiovascular disease (CVD) risk. No studies have examined associations between child abuse/neglect and subclinical CVD using a validated measure of abuse and neglect. We hypothesized that midlife women with a history of childhood abuse or neglect would have increased subclinical CVD beyond standard CVD risk factors. We tested moderation of associations by sleep, hot flashes, and race/ethnicity.Two hundred ninety-five midlife women completed the Child Trauma Questionnaire, physiologic hot flash and actigraphic sleep monitoring, blood draw, and carotid ultrasound (intima media thickness [IMT]; plaque). Relations between abuse/neglect and outcomes were tested in linear regression models adjusting for demographic, psychosocial, and CVD risk factors. Interactions with sleep, hot flashes, and race/ethnicity were tested.Forty-five percent of women reported a history of child abuse or neglect. Women with any child abuse or neglect had higher IMT [b(SE) = .039 (.011), p = .001] and carotid plaque [odds ratio (95% [CI] = 1.95 [1.15-3.33]); p = .014] than nonabused/neglected women. Furthermore, physical abuse, emotional abuse, and emotional neglect were associated with higher subclinical CVD. Sexual abuse was associated with higher IMT among nonwhite women. Interactions with sleep time and sleep hot flashes (p values < .05) indicated that higher subclinical CVD with an abuse/neglect history was observed primarily among women sleeping less than 6 hours/night or with sleep hot flashes.A history of child abuse or neglect is associated with higher subclinical CVD in women, particularly when paired with short sleep or hot flashes. Findings underscore the importance of childhood adversity in midlife women's CVD risk.
| S-EPMC5477855 | biostudies-literature
Project description:Background: Childhood abuse has been associated with poor health outcomes in adulthood. However, the physiologic pathways by which abuse is linked to health are not fully elucidated. Inflammation plays a significant role in the pathophysiology of multiple chronic diseases. We tested whether childhood trauma exposure was related to increased systemic inflammation in midlife women. Materials and Methods: Participants were 304 nonsmoking perimenopausal and postmenopausal women aged 40 to 60 years and free of cardiovascular disease. They completed questionnaires assessing psychosocial and behavioral factors, including childhood trauma, anthropometric measures, wrist actigraphy sleep measurements, and a fasting blood draw for inflammatory markers high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Associations between childhood trauma and inflammatory markers were tested in linear regression models controlling for age, race/ethnicity, education, body mass index, anti-inflammatory medication use, and alcohol consumption. Other covariates considered included sleep continuity and depressive symptoms. Results: A total of 44.8% of the sample experienced at least one type of childhood abuse/neglect. Women with a history of emotional abuse had higher IL-6 levels than women without this history in multivariate models (β = 0.077, standard error = 0.032, p = 0.017). Results were not accounted for by covariates and persisted additionally controlling for depressive symptoms and sleep. Childhood abuse/neglect was not related to hsCRP. Conclusions: Childhood emotional abuse was associated with higher levels of IL-6 in midlife women. Assessing childhood trauma exposure along with inflammatory markers may be important for the development of prevention strategies at midlife to prevent chronic diseases later in life.
| S-EPMC7757571 | biostudies-literature
Project description:ImportanceEducational attainment is an underrecognized factor associated with racial disparities in cardiovascular disease (CVD) risk. Early childhood programs providing comprehensive family services can promote educational and socioeconomic success, but few, if any, studies of large-scale programs have assessed their associations with midlife CVD risk and mediating factors.ObjectiveTo examine the association between an early childhood program providing multisystemic services from ages 3 to 9 years with midlife CVD risk and whether years of education mediate these associations.Design, setting, and participantsUsing a matched-group, quasi-experimental design, a cohort of Black and Hispanic children in the Chicago Longitudinal Study enrolled in an established early childhood program from 1983 to 1989 or the usual services were followed up for 30 years after the end of the intervention. A midlife survey on well-being was administered when the participants were aged 37 years. Analyses were conducted from September 1, 2020, to October 15, 2020.InterventionThe Child-Parent Center (CPC) Education Program provides school-based educational enrichment and comprehensive family services for 6 years, from ages 3 to 9 years (preschool to third grade [P-3]).Main outcomes and measuresGeneral and hard Framingham Risk Scores (FRSs) were calculated from self-reported physical health and behavior profiles in the midlife Chicago Longitudinal Study survey. Years of education completed at age 34 years were measured primarily from administrative records.ResultsThere were 1539 participants in the original sample (1430 Black participants [92.9%]; 108 Hispanic participants [7.0%]; 1 White participant [0.1%]); 1104 of 1401 participants (78.8%) in the tracked sample completed a midlife survey on well-being by age 37 years, and 1060 participants had data available for analysis (mean [SD] age, 34.9 [1.4] years; 565 women [53.3%]), including 523 participants who grew up in high-poverty contexts. After adjusting for 17 baseline attributes and differential attrition via propensity score weighting, CPC preschool was associated with significantly lower general FRS (marginal coefficient, -2.2 percentage points [% hereafter]; 95% CI -0.7% to -3.6%; P = .004) and hard FRS (marginal coefficient, -1.6%; 95% CI -0.5% to -2.6%; P = .004), for a 20% reduction in cardiovascular disease risk. The program group was also less likely to have high-risk FRS status, including being in the top quartile of hard FRS (marginal coefficient, -7.2%; 95% CI, -0.3% to -11.6%; P = .02). Those who participated for 4 to 6 years (CPC P-3) had lower general FRS than those who participated for fewer years, but the difference was not significant (marginal coefficient, -1.2%; 95% CI, -2.5% to 0.2%; P = .09); longer participation was associated with placement in the median or higher risk category for general FRS (marginal coefficient, -7.9%; 95% CI -0.7% to -12.4%; P = .007) and hard FRS (marginal coefficient, -9.0%; 95% CI -0.6% to -11.4%; P = .02). Years of education completed by age 34 years accounted for up to 23% of the observed group differences for FRSs, including CPC preschool (general FRS, from -2.16% to -1.66%; difference = -0.5%) and P-3 (general FRS, from -1.16% to -0.71%; difference = -0.45%).Conclusions and relevanceIn this quasi-experimental design study, a comprehensive early childhood program for a community cohort at high risk of disparities was associated with lower CVD risk later in life. Corroborating previous research, years of education through college matriculation accounted for a sizable percentage of this association. Early childhood enrichment may contribute to CVD prevention.
| S-EPMC8379657 | biostudies-literature
Project description:UnlabelledWe studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling.Trial registrationClinical Trials NCT00893646.
| S-EPMC4995529 | biostudies-literature
Project description:ImportanceThe increasing prevalence of cognitive decline, impairment, and dementia spurs intense interest in cognitive preservation strategies.ObjectiveTo explore the longitudinal association between physical activity (PA) and cognitive performance among women at midlife.Design, setting, and participantsThis cohort study is an analysis from the Study of Women's Health Across the Nation. Enrollment occurred from 1996 through 1997, and follow-up extended into 2017. Included individuals were those who had undergone cognitive measures during the first 3 cognitive test visits and had at least 1 additional cognitive measurement. Stroke prior to baseline was an exclusion, and observations were censored for subsequent stroke. Data were analyzed from June 2018 through August 2019.ExposuresEngaging in sport or exercise PA (self-reported).Main outcomes and measuresThe Symbol Digit Modalities Test (SDMT) was used to assess cognitive processing speed. The East Boston Memory Test-Delayed (EBMT-D) was used to measure verbal episodic memory. The digit span backwards (DSB) test was used to evaluate working memory.ResultsAmong 1718 women with a median (range) observation time of 11.9 (0.60-13.5) years, the mean (SD) baseline age was 45.7 (2.5) years. From baseline through age 61 years, mean change in SDMT score was -0.20 annually (95% CI, -0.26 to -0.15; P < .001). After age 61 years, the mean change in SDMT was -0.51 yearly (95% CI, -0.54 to -0.41; P < .001). Beginning at age 58 years of the mean change in EBMT was -0.03 yearly (95% CI, -0.04 to -0.02; P < .001). Starting at age 61 years, mean (SD) change in DSB was -0.03 annually (95% CI, -0.04 to -0.01; P = .001). When adjusted for attrition and practice effect, PA was associated with higher concurrent SDMT and EBMT scores and a smaller decrease in SDMT score. For each unit increment in PA, there was a 0.36 increment in concurrent SDMT score (95% CI, 0.14 to 0.59; P = .002) and a 0.10 increment in concurrent EBMT score (95% CI, 0.05 to 0.15; P < .001). Greater PA was associated with a smaller annual mean decrease in SDMT score (0.06 yearly; 95% CI, 0.02 to 0.09; P = .001). After additional adjustment for demographic characteristics, menopause symptoms, hormone therapy use, and the presence of diabetes and hypertension, PA was not associated with trajectories (ie, levels or slopes) of any cognitive outcome.Conclusions and relevanceThis cohort study found no association between greater PA levels and cognitive outcomes among women in midlife, unlike cohort studies that begin observations at later ages, which may be associated with confounding by reverse causation (ie, cognitive decline associated with an outcome of lower PA levels).
| S-EPMC8013795 | biostudies-literature
Project description:ObjectivesLife-course models have been infrequently applied to physical function. We sought to examine the effects of the cumulative burden of cardiovascular risk factors (CVRFs) from childhood on physical function in midlife.MethodsThis longitudinal study consisted of 718 participants (aged 37 to 56 years at follow-up) who were examined for CVRFs at least four times during childhood and at least twice in adulthood, with 39 years of follow-up. We assessed physical function in 2013-2016 with the Short Physical Performance Battery (SPPB), 6-minute walking test (6MWT), and handgrip strength. The area under the growth curve (AUC) was used as a measure of cumulative exposure to CVRFs during childhood.ResultsAUC of HDL-cholesterol levels in childhood were positively associated with SPPB score. AUC levels of body mass index (BMI) and triglycerides (TG) were inversely associated with 6MWT. Higher AUC levels of systolic/diastolic blood pressure (BP) predicted poorer hand grip strength. The number of childhood CVRFs in the top quartile, including AUC levels of BMI and TG, were inversely associated with 6MWT and remained significant after adjustment for the adulthood CVRFs.ConclusionCumulative burden of CVRFs from childhood were associated with worse physical function in midlife independent of adulthood CVRFs.
| S-EPMC7513196 | biostudies-literature