A long-standing association exists between elevated triglyceride levels and cardiovascular disease* (CVD).1,2 However, the extent to which triglycerides directly promote CVD or represent a biomarker of risk has been debated for 3 decades.3 To this end, 2 National Institutes of Health consensus conferences evaluated the evidentiary role of triglycerides in cardiovascular risk assessment and provided therapeutic recommendations for hypertriglyceridemic states.4,5 Since 1993, additional insights have been made vis-a-vis the atherogenicity of triglyceride-rich lipoproteins (TRLs; ie, chylomicrons and very low-density lipoproteins), genetic and metabolic regulators of triglyceride metabolism, and classification and treatment of hypertriglyceridemia. It is especially disconcerting that in the United States, mean triglyceride levels have risen since 1976, in concert with the growing epidemic of obesity, insulin resistance (IR), and type 2 diabetes mellitus (T2DM).6,7 In contrast, mean low-density lipoprotein cholesterol (LDL-C) levels have receded.7 Therefore, the purpose of this scientific statement is to update clinicians on the increasingly crucial role of triglycerides in the evaluation and management of CVD risk and highlight approaches aimed at minimizing the adverse public health–related consequences associated with hypertriglyceridemic states. This statement will complement recent American Heart Association scientific statements on childhood and adolescent obesity8 and dietary sugar intake9 by emphasizing effective lifestyle strategies designed to lower triglyceride levels and improve overall cardiometabolic health. It is not intended to serve as a specific guideline but will be of value to the Adult Treatment Panel IV (ATP IV) of the National Cholesterol Education Program, from which evidence-based guidelines will ensue. Topics to be addressed include epidemiology and CVD risk, ethnic and racial differences, metabolic determinants, genetic and family determinants, risk factor correlates, and effects related to nutrition, physical activity, and lipid medications.

In the United States, the National Health and …

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0b013e3182160726

Triglycerides and Cardiovascular Disease A Scientific Statement From the American Heart Association

An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.”

Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3

There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted.

The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

/pdf/social-determinants-of-risk-and-outcomes-for-cardiovascular-32xag7l2hs.pdf

Social Determinants of Risk and Outcomes for Cardiovascular Disease A Scientific Statement From the American Heart Association

/pdf/triglycerides-and-cardiovascular-disease-a-scientific-25jmfgszcb.pdf

Triglycerides and Cardiovascular Disease : A Scientific Statement From the

Outcomes research examines the effects of medical care interventions and policies on the health outcomes of individuals and society.1 Investigators conducting outcomes research seek to inform the development of clinical practice guidelines, to evaluate the quality of medical care, and to foster effective interventions to improve the quality of care.2 Outcomes research has traditionally used quantitative sciences to examine the utilization, cost, and clinical effectiveness of medical care through randomized and nonrandomized experimental designs. Quantitative methods are not as well suited to measure other complex aspects of the healthcare delivery system, such as organizational change, clinical leadership in implementing evidence-based guidelines, and patient perceptions of quality of care, which are also critical issues in outcomes research.3–7 These more nuanced aspects of healthcare delivery may be most appropriately examined with qualitative research methods.8–10

Qualitative approaches are becoming more common in clinical medicine and health services research.5,11–15 Federal encouragement of qualitative research is regularly reflected in funding program announcements issued by the National Institutes of Health.16 For more than a decade, federal agencies and foundations such as the National Science Foundation have demonstrated a commitment to supporting qualitative research through funding scientific conferences, workshops, and monographs on this field of inquiry.17–20 Despite this steady growth in qualitative research, outcomes investigators in cardiology have relatively little guidance on when and how best to implement these methods in their investigations.

The purpose of the present report is to introduce qualitative methods as providing unique and critical contributions to outcomes research. This report will describe the situations in which qualitative approaches are most helpful; summarize the primary principles and practices in study design, sampling, data collection, and data analysis for qualitative studies; present representative examples of cardiovascular outcomes research that uses qualitative methods; and synthesize current standards for …

Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research

Drawing on relevant literature and a study carried out by the author and colleagues, this article reviews the evidence about children’s expressed views on methods used by adults to obtain chil dren’s views. It identifies key considerations deployed by children to account for those prefer ences. Children are normally passive with respect to method choice, but they negotiate differing degrees of engagement related to considerations such as time control, comfort with the research medium, rewardingness and privacy. Their views about methods of research and consultation are sharply affected by notions of inclusiveness and fairness.

/pdf/children-s-voices-on-ways-of-having-a-voice-children-s-and-2ucsi36eov.pdf

CHILDREN'S VOICES ON WAYS OF HAVING A VOICE Children's and young people's perspectives on methods used in research and consultation

In 1990, heart disease and stroke emerged as the leading causes of death worldwide and remain the first and third leading causes of death in the United States, respectively.1,2 Cardiovascular disease (CVD) in the United States is responsible for &40% of all deaths, more than the next 5 leading causes of death combined. CVD death rates have declined significantly over the past several decades as a result of decreased incidence of myocardial infarction and increased survival.3,4 Coronary heart disease is also a leading cause of premature and permanent disability in the US labor force.2 In addition, the economic consequences are grave. In 2004, total CVD costs in the United States were estimated to be $368.4 billion2; these costs are expected to increase 40% to 50% by the year 2010.5 Blacks, the poor, and residents of particular regions in the United States are examples of groups that shoulder a disproportionate burden of CVD.6

US health objectives, as presented in Healthy People 2010, have placed a national emphasis on the prevention of CVD and its risk factors.7 The Secretary of Health and Human Services recently released the Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan) to further the “Healthy People 2010 goal of improving cardiovascular health through the prevention, detection, and treatment of risk factors; early identification and treatment of heart attacks and strokes; and prevention of recurrent cardiovascular events.”8 A recent American Heart Association publication focused on the optimal community approach to the prevention of CVD and its complications.9 This report, from the AHA Expert Panel on Population and Prevention Science, is entitled The American Heart Association Guide for Improving Cardiovascular Health at the Community Level: A Statement for Public Health Practitioners, Healthcare Providers, and Health Policy …

http://www.sisalombardia.it/pdfs/circ_2005_112_2538.pdf

Taking the initiative: implementing the American Heart Association Guide for Improving Cardiovascular Health at the Community Level: Healthy People 2010 Heart Disease and Stroke Partnership Community Guideline Implementation and Best Practices Workgroup.

Taking the initiative Implementing the American Heart Association Guide for improving cardiovascular health at the community level

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Taking the initiative: implementing the American Heart Association Guide for Improving Cardiovascular Health at the Community Level: Healthy People 2010 Heart Disease and Stroke Partnership Community Guideline Implementation and Best Practices Workgroup.

Taking the initiative Implementing the American Heart Association Guide for improving cardiovascular health at the community level