Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond.

This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals for the organization. The committee was charged with defining a new concept, cardiovascular health, and determining the metrics needed to monitor it over time. Ideal cardiovascular health, a concept well supported in the literature, is defined by the presence of both ideal health behaviors (nonsmoking, body mass index <25 kg/m(2), physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, and fasting blood glucose <100 mg/dL).

Associations between patterns of objectively measured physical activity and risk factors for the metabolic syndrome.

Purpose: To determine whether certain patterns of objectively measured physical activity (PA) are associated with the risk factors for or the diagnosis of the metabolic syndrome (MS).

Design: Latent class analysis, including assessment of the associations between latent PA classes and risk factors for the MS.

Setting: Random sample from throughout the United States using data from the 2003-2004 National Health and Nutrition Examination Survey.

Sugar-sweetened soda consumption, hyperuricemia, and kidney disease.

The metabolism of high-fructose corn syrup used to sweeten soda drinks may lead to elevations in uric acid levels. Here we determined whether soda drinking is associated with hyperuricemia and, as a potential consequence, reduced kidney function. At baseline, 15,745 patients in the Atherosclerosis Risk in Communities Study completed a dietary questionnaire and had measurements of their serum creatinine and uric acid.

Paul Coverdell National Acute Stroke Registry Surveillance - four states, 2005-2007.

Problem/condition: Each year, approximately 795,000 persons in the United States experience a new or recurrent stroke. Data from the prototype phase (2001-2004) of the Paul Coverdell National Acute Stroke Registry (PCNASR) suggested that numerous acute stroke patients did not receive treatment according to established guidelines.

Reporting Period: This report summarizes PCNASR data collected during 2005-2007 from Georgia, Illinois, Massachusetts, and North Carolina, the first states to have PCNASRs implemented in and led by state health departments.

Diabetes and the risk of sudden cardiac death, the Atherosclerosis Risk in Communities study.

Studies suggest that diabetes may specifically elevate the risk of sudden cardiac death in excess of other heart disease outcomes. In this study, we examined the association of type 2 diabetes with the incidence of sudden cardiac death when compared to the incidence of non-sudden cardiac death and non-fatal myocardial infarction (MI). We used data from the Atherosclerosis Risk in Communities (ARIC) study to examine the incidence of sudden and non-sudden cardiac death and non-fatal MI among persons with and without diabetes in follow-up from the baseline data collection (1987-1989) through December 31, 2001.

Neighborhood disparities in incident hospitalized myocardial infarction in four U.S. communities: the ARIC surveillance study.

Purpose: Hospital-based surveillance of myocardial infarction (MI) in the United States (U.S.) typically includes age, gender, and race, but not socioeconomic status (SES).

Association of multiple anthropometrics of overweight and obesity with incident heart failure: the Atherosclerosis Risk in Communities study.

Background: The association of central adiposity with incident heart failure (HF) has yet to be studied in a large population-based study.

Methods And Results: The Atherosclerosis Risk in Communities study is an ongoing biracial population-based cohort of those aged 45 to 64 years from 4 US communities with 16 years' median follow-up for incident, hospitalized, or fatal HF. Waist-hip ratio, waist circumference, and body mass index (BMI) were measured at baseline (1987-1989).

Hemostasis, inflammation, and fatal and nonfatal coronary heart disease: long-term follow-up of the atherosclerosis risk in communities (ARIC) cohort.

Objective: This study examines the hypothesis that chronic inflammation is associated with a higher risk of cardiac death compared to the risk of nonfatal myocardial infarction.

Methods And Results: Cardiac death and nonfatal MI events were identified in the ARIC cohort during follow-up from 1987 through 2001. Markers of inflammation and hemostasis were determined at baseline using standardized procedures.

Association of asymptomatic peripheral arterial disease with vascular events in patients with stroke or transient ischemic attack.

Background And Purpose: Patients with stroke and patients with transient ischemic attack (TIA) are at high risk for vascular events and may not exhibit the signs and symptoms of peripheral arterial disease (PAD). We investigated if asymptomatic PAD detected by ankle brachial index <0.9 is independently associated with recurrent vascular events in patients with stroke or TIA.

A comprehensive review of prehospital and in-hospital delay times in acute stroke care.

The purpose of this study was to systematically review and summarize prehospital and in-hospital stroke evaluation and treatment delay times. We identified 123 unique peer-reviewed studies published from 1981 to 2007 of prehospital and in-hospital delay time for evaluation and treatment of patients with stroke, transient ischemic attack, or stroke-like symptoms. Based on studies of 65 different population groups, the weighted Poisson regression indicated a 6.

Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients.

Background And Purpose: The prognostic value early diffusion-weighted magnetic resonance imaging (DWMRI) adds in the setting of transient ischemic attack (TIA), after risk stratification by a clinical score, is unclear. The purpose of this study is to evaluate, after ABCD2 score risk categorization in admitted TIA patients, whether negative DWMRI performed within 24 hours of symptom onset improves on the identification of patients at low risk for experiencing a disabling stroke within 90 days.

Methods: At 15 North Carolina hospitals, we enrolled a prospective nonconsecutive sample of admitted TIA patients.

A multicenter evaluation of the ABCD2 score's accuracy for predicting early ischemic stroke in admitted patients with transient ischemic attack.

Study Objective: We evaluate, in admitted patients with transient ischemic attack, the accuracy of the ABCD(2) (age [A], blood pressure [B], clinical features [weakness/speech disturbance] [C], transient ischemic attack duration [D], and diabetes history [D]) score in predicting ischemic stroke within 7 days.

Methods: At 16 North Carolina hospitals, we enrolled a prospective, nonconsecutive sample of admitted patients with transient ischemic attack and with no stroke history, presenting within 24 hours of transient ischemic attack symptom onset. We conducted a medical record review to determine ischemic stroke outcomes within 7 days.

Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese.

Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention.

Serum and dietary magnesium and risk of ischemic stroke: the Atherosclerosis Risk in Communities Study.

The authors sought to examine the relation between serum or dietary magnesium and the incidence of ischemic stroke among blacks and whites. Between 1987 and 1989, 14,221 men and women aged 45-64 years took part in the first examination of the Atherosclerosis Risk in Communities Study cohort. The incidence of stroke was ascertained from hospital records.

Genomewide association studies of stroke.

Background: The genes underlying the risk of stroke in the general population remain undetermined.

Methods: We carried out an analysis of genomewide association data generated from four large cohorts composing the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium, including 19,602 white persons (mean [+/-SD] age, 63+/-8 years) in whom 1544 incident strokes (1164 ischemic strokes) developed over an average follow-up of 11 years. We tested the markers most strongly associated with stroke in a replication cohort of 2430 black persons with 215 incident strokes (191 ischemic strokes), another cohort of 574 black persons with 85 incident strokes (68 ischemic strokes), and 652 Dutch persons with ischemic stroke and 3613 unaffected persons.

A genetic variant on chromosome 9p21 and incident heart failure in the ARIC study.

Aims: Recent studies showed that polymorphisms on chromosome 9p21 are associated with coronary heart disease (CHD), but few studies examined the association with heart failure (HF), stroke, or other subclinical atherosclerotic diseases. We tested the association of chromosome 9p21 polymorphisms with non-coronary atherosclerotic diseases.

Methods And Results: We studied 4018 African-American and 11 085 white participants from the Atherosclerosis Risk in Communities Study, aged 45-64 at baseline (1987-89).

Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology.

Summary Background: In a recent case-control study, the odds of metabolic syndrome (MetSyn) among deep vein thrombosis cases were almost twice those among controls. We tested the hypothesis that the incidence of non-cancer-related venous thromboembolism (VTE) is higher among adults with MetSyn and further, that associations are stronger for idiopathic than secondary VTE.

Methods: A total of 20 374 middle-aged and elderly adults were followed for over 12 years for incident VTE in the Longitudinal Investigation of Thromboembolism Etiology (LITE).

Declining severity of myocardial infarction from 1987 to 2002: the Atherosclerosis Risk in Communities (ARIC) Study.

Background: Death rates for coronary heart disease have been declining in the United States, but the reasons for this decline are not clear. One factor that could contribute to this decline is a reduction in the severity of acute myocardial infarction (MI). We hypothesized that for those patients hospitalized in the Atherosclerosis Risk in Communities (ARIC) Study with acute incident MI, there was a decline in MI severity from 1987 to 2002.

Trends from 1987 to 2004 in sudden death due to coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study.

Background: Few data are available on the secular changes in sudden coronary heart disease (CHD) death in US communities.

Methods: We examined trends in sudden CHD death from 1987 to 2004, using data from the Atherosclerosis Risk in Communities (ARIC) study. Sudden CHD deaths in residents of 4 communities aged 35 to 74 years were ascertained using multiple sources such as death certificates, informant and coroner interviews, and physician adjudications.

Incident heart failure is associated with lower whole-grain intake and greater high-fat dairy and egg intake in the Atherosclerosis Risk in Communities (ARIC) study.

Background: Prospective studies evaluating associations between food intake and risk of heart failure (HF) in diverse populations are needed.

Objectives: Relationships between incident HF (death or hospitalization) and intake of seven food categories (whole grains, fruits/vegetables, fish, nuts, high-fat dairy, eggs, red meat) were investigated in an observational cohort of 14,153 African-American and white adults, age 45 to 64 years, sampled from four US communities.

Methods: Between baseline (1987-1989) and Exam 3 (1993-1995), dietary intake was based on responses to a 66-item food frequency questionnaire administered at baseline; thereafter, intake was based on averaged baseline and Exam 3 responses.

HbA 1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.

Aims/hypothesis: Heart failure (HF) incidence in diabetes in both the presence and absence of CHD is rising. Prospective population-based studies can help describe the relationship between HbA(1c), a measure of glycaemia control, and HF risk.

Methods: We studied the incidence of HF hospitalisation or death among 1,827 participants in the Atherosclerosis Risk in Communities (ARIC) study with diabetes and no evidence of HF at baseline.

Neighborhood income, health insurance, and prehospital delay for myocardial infarction: the atherosclerosis risk in communities study.

Background: Outcomes following an acute myocardial infarction (AMI) are generally more favorable if prehospital delay time is minimized.

Methods: We examined the association of neighborhood household income (nINC) and health insurance status with prehospital delay among a weighted sample of 9700 men and women with a validated, definite, or probable AMI in the Atherosclerosis Risk in Communities (ARIC) community surveillance study (1993-2002). Weighted multinomial regression with generalized estimation equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and to account for the clustering of patients within census tracts.