Development of a health-related lifestyle self-management intervention for patients with coronary heart disease.
Heart Lung. 2009 Nov-Dec;38(6):491-8
Authors: Fernandez RS, Davidson P, Griffiths R, Juergens C, Salamonson Y
Risk-factor modification after an acute coronary event is imperative, and intervention strategies are continuously being developed to assist patients with behavioral change and, consequently, decreasing the risk of further coronary episodes. This article describes the development of the health-related lifestyle self-management (HeLM) intervention, which is a brief structured intervention embedded within the transtheoretical model of behavioral change. The HeLM intervention was developed by undertaking three discrete yet interrelated studies and consisted of the following components: goal-setting, the HeLM booklet, feedback regarding personal risk, team-building and communication with the patient’s family physician, three supportive telephone calls, trained interviewers, a refrigerator magnet, and a health diary for self-monitoring. The HeLM intervention has been successfully implemented in 50 patients with acute coronary syndrome after discharge from hospital and has been demonstrated to be feasible and practical and could easily be delivered by health care professionals.
PMID: 19944873 [PubMed - indexed for MEDLINE]
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Carotid intima-media thickness: knowledge and application to everyday practice.
Postgrad Med. 2010 Jan;122(1):10-8
Authors: Cobble M, Bale B
Heart disease is the primary cause of death in the United States. Fortunately, intervention measures can reduce the risk of cardiovascular disease (CVD) after a patient has been accurately assessed. Atherosclerotic disease, one of the driving forces behind CVD, is not always detected by traditional risk assessment. Carotid intima-media thickness (CIMT), as measured by B-mode ultrasound, is a surrogate marker for atherosclerosis and can be used to detect an accelerated disease process and subclinical disease. Advantages of CIMT are that it is noninvasive, relatively inexpensive, and can be repeatedly performed with no adverse effects on the patient. Carotid intima-media thickness is associated with CVD and is an independent predictor of stroke and myocardial infarction. Therefore, CIMT is valuable for clarifying CVD risk, particularly for patients with intermediate risk by conventional risk assessment. Screening for subclinical disease even in low-risk patients may have benefit, especially for those with a family history of premature CVD or those with any of the National Cholesterol Education Program risk factors. The detection of subclinical atherosclerosis allows the physician to implement prevention efforts prior to a devastating CVD event and to investigate possible reasons for increased arterial thickening, such as an occult underlying insulin-resistant condition or residual lipid risk markers. Treatment with several types of drugs has been demonstrated to halt the progression or even reduce CIMT. Carotid intima-media thickness is currently limited by the lack of standardized protocols that may affect reproducibility from measure to measure. Efforts to draft a standardized protocol are underway by the Society of Atherosclerosis Imaging and Prevention that will address this issue. Carotid intima-media thickness provides a valuable tool for physicians to clarify the CVD risk of their patients. Practical implications of CIMT for everyday clinical practice are addressed.
PMID: 20107284 [PubMed - in process]
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A prospective study of abdominal obesity and coronary artery calcium progression in older adults.
J Clin Endocrinol Metab. 2009 Dec;94(12):5039-44
Authors: Kramer CK, von Mühlen D, Gross JL, Barrett-Connor E
OBJECTIVE: Little is known about obesity measurements and coronary artery calcium (CAC) progression in older adults. We examined the sex-specific association between measures of body size and fat distribution with CAC progression. SUBJECTS AND METHODS: Participants were 156 men and 182 women (mean age 67 yr) without known heart disease who had electron-beam computed tomography for CAC at baseline and again 4.5 yr later. Obesity assessments were weight, height, body mass index, waist and hip circumference, waist to hip ratio, waist to height ratio, sc and visceral adipose tissue (SAT, VAT), and SAT to VAT ratio based on abdominal electron-beam computed tomography. CAC progression was defined as categorical (square root increased on total CAC volume score > or = 2.5 mm(3)) and continuous variables. RESULTS: During the follow-up, 55% of men and 38.5% of women had CAC progression. Increased waist to hip ratio (> or = 0.9 for men, > or = 0.85 for women) and waist to height ratio (> or = 0.55 for men, > or = 0.54 for women) were positively and independently associated with CAC progression [median (interquartile range)] [60.8 (145) vs. 10.8 (56) mm(3), P = 0.002 and 50 (153) vs. 22(84) mm(3), P = 0.03, respectively]. In women but not men, an increased waist circumference (> 88 cm) independently predicted CAC progression (odds ratio 3.0 95% confidence interval 1.03-8.0, P = 0.04), whereas VAT to SAT ratio predicted CAC progression in men but not women (odds ratio 2.8 95% confidence interval 1.01-7.8, P = 0.04). CONCLUSION: In this study of older adults without known heart disease, abdominal obesity was an independent predictor of CAC progression. These results point to the importance of using clinical measurements of abdominal obesity to identify individuals at increased risk for atherosclerosis.
PMID: 19846732 [PubMed - indexed for MEDLINE]
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