Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants: A Policy Statement From the American Heart Association.

In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.

Neighborhood segregation and cancer prevention guideline adherence in US Hispanic/Latino adults: Results from the HCHS/SOL.

Background: Adherence to the American Cancer Society (ACS) guidelines for cancer prevention is associated with a lower risk of cancer and mortality. The role of neighborhood segregation on adherence to the guidelines among Hispanic/Latino adults is relatively unexplored. Materials and methods: The Hispanic Community Health Study/Study of Latinos is a community-based prospective cohort of 16,462 Hispanic/Latino adults, ages 18-74 years enrolled in 2008-2011 from the Bronx, Chicago, Miami and San Diego. Dimensions of neighborhood segregation were measured using 2010 United States' census tracts:-evenness (the physical separation of a group), exposure (the propensity for contact between groups), and their joint effect (hypersegregation). ACS guideline adherence levels - low, moderate, high - were created from accelerometry-measured physical activity, dietary intake, alcohol intake, and body mass index. Weighted multinominal logistic regressions estimated relative risk ratios (RRR) and 95% confidence intervals (CI) for guideline adherence levels and its components. Results: Hispanic/Latino adults were classified as low (13.7%), moderate (58.8%) or highly (27.5%) adherent to ACS guidelines. We found no evidence of an association between segregation and overall guideline adherence. Exposure segregation associated with lower likelihood of moderate adherence to alcohol recommendations (RRRmoderate vs. low:0.86, 95%CI:0.75-0.98) but higher likelihood for diet recommendations (RRRmoderate vs. low:1.07, 95%CI:1.01-1.14). Evenness segregation associated with lower likelihood of high adherence to the physical activity recommendations (RRRhigh vs. low:0.73, 95%CI:0.57-0.94). Hypersegregation was associated with individual guideline components. Conclusion: We found evidence of a cross-sectional relationship between neighborhood segregation and ACS cancer prevention guideline components, but not with overall ACS guideline adherence.

DASH diet and prevalent metabolic syndrome in the Hispanic Community Health Study/Study of Latinos.

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure and preventing cardiovascular disease (CVD), but little data exist on these associations in US Hispanics/Latinos. We sought to assess associations between DASH score and prevalence of metabolic syndrome (MetS) and its components in diverse Hispanics/Latinos. We studied 10,741 adults aged 18-74 in the multicenter Hispanic Community Health Study/Study of Latinos. Dietary intake was measured using two 24-hour recalls, and MetS defined per the 2009 harmonized guidelines. We assessed cross-sectional associations of DASH score and MetS (and its dichotomized components) using survey logistic regression, and DASH and MetS continuous components using linear regression. We also stratified these models by Hispanic/Latino heritage group to explore heritage-specific associations. We found no associations between DASH and MetS prevalence. DASH was inversely associated with both measures of blood pressure (p < 0.01 for systolic and p < 0.001 for diastolic) in the overall cohort. DASH was also inversely associated with diastolic blood pressure in the Mexican (p < 0.05), Central American (p < 0.05), and South American (p < 0.01) groups; triglycerides (p < 0.05) in the Central American group; fasting glucose overall (p < 0.01) and in the Mexican group (p < 0.01); and waist circumference overall (p < 0.05) and in the South American group (p < 0.01). DASH was positively associated with HDL-cholesterol (p < 0.01) in the Central American group. DASH may better capture diet-MetS associations in Hispanic/Latino subpopulations such as Central/South Americans; this study also adds evidence that Hispanics/Latinos should be analyzed by heritage. Further research, and/or culturally tailored DASH measures will help further explain between-heritage differences.

Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial.

Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.