Impacts of mid- to later childhood body build, social circumstance and blood pressure on early-adult arterial stiffness in different ethnic groups

OBJECTIVE: Arterial stiffness, measured as aortic pulse wave velocity [PWV], is a powerful prognostic indicator for cardiovascular events, displacing blood pressure (BP). Little is known of its determinants. We tested how factors measured twice previously in childhood in the MRC ‘DASH’ study, particularly body mass (BMI) components and BP, affected PWV in young adults. DESIGN AND METHODS: Of 6643 London children, aged 11-13y, from 51 schools in samples of about 1000 in 6 ethnic groups, 4785 (72% of the cohort), were seen again at 14-16y. In 2013, 666 (97% of invited) took part in a young-adult pilot (21-23y). With psychosocial, anthropometric and BP measures, PWV was recorded via an upper arm cuff on the calibrated Arteriograph device. RESULTS: PWV reproducibility was excellent, with mean differences across 3 x 6-8 cardiac cycles each of -0.06, 0.03 and 0.06 m/sec. Unadjusted PWVs in Caribbean-origin and White UK young men were similar (mean+SD 7.9+0.3 vs 7.6 +0.4 m/sec) and lower in other groups at similar SBPs (120mmHg), BMIs (24.6kg/m2) and waists (84.3cm). In full regression models, while Caribbean (higher BMIs and waists), African and Indian young women had lower PWV (by 0.5-0.8, 95%CI 0.1-1.1,m/sec) than did white UK women (6.9+0.2), values were still increased by age, BP, a powerful impact from waist/height, with a racism effect (+0.4m/sec) in women. Childhood effects of waist/hip were also detectable. CONCLUSION: Even by young adulthood, increased waist/height ratios, BP and psychosocial variables such as perceived racism were independent determinants of arterial stiffness, likely to increase with age.

Correlates of vigorous physical activity in adolescents in five secondary schools in Trinidad

OBJECTIVE: To determine the correlates of vigorous physical activity in adolescents in Trinidad. DESIGN AND METHODS: Adolescents (n = 344) between 11-15 years from five secondary schools in North-central Trinidad were cross-sectionally surveyed. Behavioural risk factors: alcohol and smoking use, physical activity and diet were obtained by a pilot tested interviewer administered questionnaire. In addition, anthropometric measures were obtained on site at school. Multivariate logistical regression was used to analyze correlates of vigorous physical activity by sex. RESULTS: Fruit and vegetable intake (p < 0.001) and religion (p = 0.034) were correlated with vigorous physical activity in females. Lower waist circumference (p = 0.014), age (p = 0.046) and diastolic blood pressure (p < 0.01) were correlated with vigorous physical activity in males. Body mass index (BMI) for age data indicated that 41.3% of the children were overweight or obese. However, vigorous physical activity did not correlate with BMI for age in either sex. In the final logistic regression models, higher vigorous physical activity was associated with lower diastolic blood pressure in males (p < 0.05) and an increased daily intake of fruit and vegetables in females (p < 0.001). CONCLUSION: Increased dietary intake of fruits and vegetables in females and lower diastolic blood pressure in males were associated with higher vigorous physical activity. Prospective studies are required to determine and clarify the relative importance of diet and physical activity in overweight adolescents and their risk of chronic metabolic disease.

The association between indices of obesity and common clinical measures in adults with and without type 2 diabetes

OBJECTIVE: To determine if there are any differences in anthropometric measurements, lipid profile, blood pressure and body shape between diabetics and non-diabetics. DESIGN AND METHODS: This cross-sectional study comprised 309 subjects with 91 males and 218 females; there were 217 diabetics and 92 non-diabetics. The sample was taken from three hospitals in Trinidad. Lipid profile and blood pressure were taken from each facility’s physicians’ notes while anthropometric measurements were taken from the patients themselves. RESULTS: The diabetic group had elevated body mass index, and waist to hip ratios were significantly higher (p<0.05) when compared to non-diabetics. There was no significant difference in lipid profile and blood pressure between diabetics and non-diabetics. As age increased, the prevalence of type 2 diabetes mellitus was higher. Of the 217 diabetics, 173 were of East Indian descent. With regards to gender, more males were found to be diabetics resulting from having an android body shape as compared to females (gynoid body shape). It was deduced that waist to hip ratio was the best indicator of type 2 diabetes mellitus based on the area under the curve analysis. CONCLUSION: Of all the anthropometric measurements used, waist to hip ratio was found to be the most effective indicator of type 2 diabetes mellitus in Trinidadians, while body mass index was found to be the least.

Cardiorespiratory fitness, all-cause mortality, and risk of cardiovascular disease in Trinidadian men--the St James survey

BACKGROUND: This study examined whether cardiorespiratory fitness is a risk factor for cardiovascular disease, myocardial infarction, and all-cause mortality in a low- to middle-income Trinidadian community of African, South Asian Indian, and European origin. Those of Indian descent have a distinctively high rate of myocardial infarction. METHODS: The St James Study is a prospective total community survey located in Port-of-Spain, Trinidad, West Indies. A random sample of 626 men aged 35-69 years, without angina of effort, previous myocardial infarction, partial or complete atrio-ventricular conduction defect, complete heart block, or exercise-induced asthma, was used for the assessment of cardiorespiratory fitness by cycle ergometry. Surveillance for morbidity and mortality was maintained for an average of 7.3 years. RESULTS: When the subjects were grouped into those with an age- and fat-free mass-adjusted peak oxygen uptake above and below the mean of 60.4 mmol/min (1.34 l/min), the hazard ratios (below/above) (95% confidence interval) for all-cause mortality, cardiovascular disease incidence, and incidence of myocardial infarction, after allowance for conventional cardiovascular risk factors, were 2.08 (1.23-3.52), 2.13 (1.22-3.69), and 2.36 (0.84-6.67), respectively. For those unable to achieve a level of work requiring an oxygen uptake of 67 mmol/min (1.5 l/min) during progressive exercise, the respective hazard ratios were 3.49 (1.57-7.76), 2.29 (1.21-4.33), and 5.45 (1.22-24.34). Indian ethnicity remained a predictor of myocardial infarction after allowance for cardiorespiratory performance. CONCLUSION: Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality in the low- to middle-income developing community of Trinidad.

The clinician's guide to the cardiovascular examination

A detailed examination of the cardiovascular system is indispensable to the full appreciation of the cardiac status. Yet, because this fundamental aspect of cardiology is so inadequately presented by many of the major texts, students often fail to grasp the essentials. The author not only brings a rich knowledge of the subject to his task, but also a wide experience of teaching and a firm conviction that the prime purpose of the undergraduate pre-clinical curriculum is to provide information on which the student may build. The student who masters this information will be well prepared for the clinical years and suitably equipped for more advanced studies

A standard method for measuring blood pressure in the Americas

Hypertension, or high blood pressure, is a silent but dangerous disease affecting an estimated 140 million men and women of all ethnic backgrounds in the Americas. This condition results in disability and millions of premature deaths each year from stroke and heart disease, heart failure, and kidney failure. It is estimated that strokes, heart attacks, and kidney failures resulting from hypertension comprise more than half the mortality in the Americas. These diseases cause untold suffering and lead to major social impacts, economic losses, and reduced productivity in every nation in the Western Hemisphere (AU)

A rational approach to severe or resistant hypertension

Severe or resistant hypertension is fortunately not very common in the general population. When discovered, the practitioner must be alert to the fact that alcohol excess and commonly available over-the-counter drugs could be contribution factors. An adequate history would eliminate the need for unnecessary investigations and treatment. Physical examination should be focused upon target organ damage, which if identified should lead to prompt refferal to a specialist centre for treatment. Treatment should be aggressive yet controlled (AU)

Controlling hypertension in diabetes

High blood pressure (hypertension) takes a toll on the heart and blood vessels. So does diabetes mellitus. When both are present in the same individual, it stands to reason that there must be an increase in the risk of cardiovascular problems. The management of a chronic condition such as hypertension in the presence of another chronic condition, requires the development of a close inter-relationship between the patient and the healthcare team. The education of the patient about conditions and their potential sequelae, and the empowerment of the patient - ensuring not only his/her acquisition of knowledge but access to 'tools' for monitoring - are important requirements in the overall management of this 'double whammy'! This education and awareness process must not be restricted to patients, healthcare givers, family and support groups. It must also embrace the wider public and decision makers at the political level, in order to ensure that the best quality of life is afforded these patients within their community and country (AU)

Social factors mediating social class differences in blood pressure in a Jamaican community

Research on the factors mediating social class differences in blood pressure was carried out in a Jamaican community. It was found in a previous report that higher social class is related to lower blood pressure for females, while for males higher social class is related to higher blood pressure. These differences are examined in greater detail here, especially in terms of the historical context of the specific community studied, which is on the fringe of Kingston urban area, and in terms of the continuing importance of a social class system established under colonial rule. In the current study it is shown that class differences in blood pressure for males are mediated by perceptions of social support. Social class differences in blood pressure for females are mediated by perceptions of economic stress. It is suggested that specific patterns of the growth of the city, and the historically-based social class system, have resulted in the juxtaposition of lower and middle class Jamaicans within this community, who in turn are influenced by different factors affecting blood pressure(AU)

Blood pressure and social class in a Jamaican community

A study of social factors and blood pressure was conducted in a Jamaican community among a sample of 199 persons ages 30 to 50. After controlling for obesity, age, and respondent tension(and other covariates), interaction effects of social class and sex for systolic and diastolic blood pressure were found. Blood pressure increased with increasing social class for males and decreased with increasing class for females(AU)