Report of Health Behavior Modification Among Latinos Diagnosed With Multiple Cardiovascular Risk Factors.

INTRODUCTION: Hypertension, hypercholesterolemia, and type II diabetes are leading cardiovascular risk factors in the United States, and Latinos are disproportionately burdened by these chronic health conditions. The extent to which Latinos overall and by language spoken at home report health behavior modification following diagnosis is poorly understood. METHODS: Our inclusion criteria included participants sampled in the 2011-2016 waves of the National Health and Nutrition Examination Survey who self-identified as Latinos, were 20 years of age or above, and reported a diagnosis of hypertension, hypercholesterolemia or diabetes (N=2027). We examined associations between the language spoken at home and report of adoption of 3 recommended health behaviors in the past year: weight loss, leisure-time physical activity (LTPA) and smoking cessation. Separate log-binomial models were fit to estimate prevalence ratios (PRs) for each health behavior. RESULTS: Approximately one third (28%) of study participants had been diagnosed with diabetes and more than half reported a diagnosis of hypercholesterolemia (65%) or hypertension (60%). Most Latinos met the highest levels of smoking cessation criteria (82%), whereas less than a third met LTPA recommendations (29%) or attempted weight loss (24%) in the past year. Fully adjusted outcome specific models showed that exclusively speaking English at home was associated with a higher probability of reporting weight loss attempt and LTPA compared with Spanish only speakers, although only LTPA was statistically significant [weight loss PR: 1.23, 95% confidence interval (CI): 0.92, 1.65; LTPA PR: 1.74; 95% CI: 1.37, 2.20; smoking cessation PR: 0.93, 95% CI: 0.86, 1.01]. CONCLUSIONS: Our findings provide new evidence on patterns of behavioral modification in a population-based sample of Latinos diagnosed with chronic health conditions. Findings suggest the need to promote language and culturally relevant initiatives to increase the adoption of health-enhancing behaviors and improve chronic disease management among Spanish-speaking Latinos.

Effectiveness and easiness of adherence to behavioural guidelines for diet and lifestyle changes for cholesterol-lowering: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial.

BACKGROUND: The present study aimed to assess perceived effectiveness and easiness of behavioural diet and lifestyle changes related to dyslipidaemia given by physicians or dieticians as a result of diet and lifestyle modifications being difficult to maintain. METHODS: One-hundred hypercholesterolaemic individuals were enrolled in a parallel, randomised 6-week study. Fifty were advised by dietitians (dietitian group: DG) in six weekly face-to-face behavioural therapy sessions and 50 received standard advice from physicians (physician group: PG). All individuals were followed-up for another 6 weeks under real-life conditions. Questionnaires regarding perceived effectiveness, easiness of adhering, forecasted and actual adherence to specific cholesterol-lowering advice were completed. RESULTS: Scores of perceived effectiveness of advice for sufficient exercise, limiting saturated fat (SFA) intake, eating fish twice a week, consuming plenty of fresh fruit and vegetables, and limiting salt intake different scientifically (all P < 0.05) in PG and DG between study phases. Scores of the individuals' perception of effectiveness at all study phases were higher in the DG compared to PG for sufficient exercise, limiting SFA intake, eating fish twice a week, eating plenty of fruits and vegetables, and limiting salt intake, whereas scores of easiness were significant only for fish consumption (P = 0.008) and using foods with added plant sterols (all P < 0.05). DG and PG significantly differed in forecasted (week 6) versus actual adherence (week 12) to various chances, with DG reporting higher adherence. CONCLUSIONS: Lifestyle and dietary changes related to dyslipidaemia can be achieved with continuous education, monitoring and follow-ups by dieticians, as well as potentially other trained healthcare professionals.

Patients-in-waiting or chronically healthy individuals? People with elevated cholesterol talk about risk.

Risk adopts an ambiguous position between health and illness/disease and is culturally salient in various health-related everyday practices. Previous research on risk experience has mostly focused on the illness/disease side of this risk ambiguity. Persons at risk have typically been defined as patients (of some kind) and their condition as a form of proto-illness. To allow for the cultural proliferation of health risk and to account for the health side of risk ambiguity, I chose to focus on elevated cholesterol, a condition both intensely medicalised and connected to the everyday practice of eating, among participants (n = 14) recruited from a consumer panel and approached not as patients, but as individuals concerned about their cholesterol. Utilising the biographical disruption framework developed by Bury, I show how the risk experience of my participants differed from the chronic illness experience. Instead of patients-in-waiting suffering from a proto-illness, they presented themselves as 'chronically healthy individuals' (Varul 2010), actively trying to avoid becoming patients through a responsible regimen of personal health care. The results call for a more nuanced approach to the risk experience, which accounts for both sides of the risk ambiguity.

Educational diagnosis of self-management behaviours in patients with diabetes mellitus, hypertension and hypercholesterolaemia based on the PRECEDE model: Qualitative study.

AIMS AND OBJECTIVES: To identify the key factors of adopting self-care behaviours in the treatment of diabetes mellitus II, hypertension and hypercholesterolaemia when the three conditions appear simultaneously. BACKGROUND: Diabetes, hypertension and hypercholesterolaemia are chronic health problems which often appear together. The correct monitoring of these pathologies when they concur simultaneously requires specific health management behaviours, to which a significant part of the population is unable of adhering, despite recommendations from professional healthcare workers. DESIGN: A qualitative study using focus groups techniques was carried out. The elements related to the content were drafted following the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ checklist). METHODS: Patients with simultaneous diabetes, hypertension and hypercholesterolaemia, as well as nursing professionals and family doctors who have treated patients at primary care centres, were the key sources of information. The methodology used to analyse the information was content analysis. RESULTS: There were factors which can positively or negatively determine the adoption of the self-management recommendations that healthcare professionals make to patients who simultaneously have diabetes, hypertension and hypercholesterolaemia. These factors were not only associated with the patient, but also with the health carers themselves and the healthcare system and policies in force. CONCLUSIONS: When health professionals provide recommendations for self-care to people diagnosed with diabetes, hypertension and hypercholesterolaemia simultaneously, they should bear in mind not only the determinants of behaviour associated with the patient, but also those that are related to the health professionals themselves and with the healthcare system. The PRECEDE model could be a good tool to identify and design health education programs. RELEVANCE TO CLINICAL PRACTICE: The knowledge of the determinants of health behaviour of patients with chronic diseases could improve adherence patients to health recommendations, avoid associated complications and increase their quality of life.

Psychometric Evaluation of a Treatment Acceptance Measure for Use in Patients Receiving Treatment via Subcutaneous Injection.

BACKGROUND: Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, significantly reduces low-density lipoprotein cholesterol, but requires subcutaneous injections rather than oral pills. To measure patients' acceptance of this treatment modality, a new patient-reported outcome, the Injection-Treatment Acceptance Questionnaire (I-TAQ), was developed. OBJECTIVES: To psychometrically evaluate the I-TAQ with patients at high risk of cardiovascular events receiving alirocumab. METHODS: The 22-item, 5-domain I-TAQ was administered cross-sectionally to 151 patients enrolled in alirocumab clinical trials. Item response distributions, factor and multitrait analyses, interitem correlations, correlations with an existing measure of acceptance (convergent validity), and comparison of known-groups were performed to assess the I-TAQ's psychometric properties. RESULTS: Completion rates were high, with no patients missing more than two items and 91.4% missing no data. All items displayed high ceiling effects (>30%) because of high treatment acceptance. Factor analysis supported the a priori hypothesized item-domain structure with good fit indices (root mean square error approximation = 0.070; comparative fit index = 0.988) and high factor loadings. All items demonstrated item convergent validity (item-scale correlation ≥0.40), except for the side effects domain, which was limited by small numbers (n = 46). Almost all items correlated most highly with the domain to which they were assigned (item discriminant validity). Internal reliability was acceptable for all domains (Cronbach α range 0.72-0.88) and convergent validity was supported by a logical pattern of correlations with the Chronic Treatment Acceptance Questionnaire. CONCLUSIONS: These findings provide initial evidence of validity and reliability for the I-TAQ in patients treated with subcutaneous alirocumab. The I-TAQ could prove to be a valuable patient-reported outcome for therapies requiring subcutaneous injection.

Influence of Baseline Psychological Health on Muscle Pain During Atorvastatin Treatment.

BACKGROUND: 3-hydroxy-3-methylglutaryl coenzyme A reductase reductase inhibitors (statins) are generally well tolerated, with statin-associated muscle symptoms (SAMS) the most common side effect (~10%) seen in statin users. However, studies and clinical observations indicate that many of the self-reported SAMS appear to be nonspecific (ie, potentially not attributable to statins). OBJECTIVE: Mental health and well-being influence self-perception of pain, so we sought to assess the effect of baseline well-being and depression on the development of muscle pain with 6 months of atorvastatin 80 mg/d (ATORVA) or placebo in healthy, statin-naive adults. METHODS: The Psychological General Well-being Index (n = 83) and Beck Depression Inventory (n = 55) questionnaires were administered at baseline in participants (aged 59.5 ± 1.2 years) from the effect of Statins on Skeletal Muscle Function and Performance (STOMP) trial (NCT00609063). Muscle pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), pain that interferes with daily life (Brief Pain Inventory [BPI]), and pain severity (BPI) were then measured before, throughout, and after treatment. RESULTS: At baseline, there were no differences in well-being (Psychological General Well-being Index), depression (Beck Depression Inventory), or pain measures (SF-MPQ and BPI) (P values ≥ .05) between the placebo and ATORVA groups. Baseline well-being correlated negatively with baseline BPI pain severity (r = -0.290, P = .008). Baseline depression correlated with baseline pain (SF-MPQ; r = 0.314, P = .020). Baseline well-being and depression did not predict the change in pain severity or interference after 6 months among the total sample or between groups (P values ≥ .05). CONCLUSION: Baseline well-being and depression were not significant predictors of pain after 6 months of ATORVA (P values ≥ .05). Thus, they do not appear to increase the risk of SAMS in otherwise healthy adults.

Emotional eating as a mediator between anxiety and cholesterol in population with overweight and hypertension.

Although the relationship between cholesterol and mood states (especially anxiety) has been well studied, few researches have included the role of eating styles in this relationship. This study explored the associations among eating styles, negative emotional symptoms, and levels of cholesterol (and other medical variables) in a population with hypertension and overweight or obesity, analyzing the possible mediation mechanisms involved. A cross-sectional study was conducted in 68 adults with hypertension and overweight/obesity, and stepwise multiple regression analysis and mediation analyses were carried out to test the hypothesis that eating styles mediate the relationship between negative emotional symptoms and cholesterol. Several significant correlations among age, anthropometric, medical, and psychological variables (eating styles and negative emotional symptoms) were found. There was a significant indirect effect of anxiety on total cholesterol and LDL cholesterol through emotional eating. Results suggest that emotional eating has a relevant role in the rise in total and LDL cholesterol, acting as a mediator in the relationship between anxiety and cholesterol. This finding could have important implications, since it introduces a new variable in the relationship between emotions and cholesterol and, therefore, changes the way of understanding this relationship, and of treating high cholesterol in a hypertensive sample.

Factors Affecting Adherence to Statins in Hypercholesterolemic Kuwaiti Patients: A Cross-Sectional Study.

OBJECTIVE: This study examined statin adherence amongst Kuwaiti hypercholesterolemic patients in order to identify factors associated with poor adherence and to determine whether or not an association exists between statin adherence and the risk profile of coronary heart disease (CHD). SUBJECTS AND METHODS: Two hundred hypercholesterolemic patients (30-69 years of age) were recruited from Kuwaiti primary healthcare clinics and interviewed about demographic characteristics, pre-existing self-reported medical conditions and prescribed medications. The Morisky Medication Adherence Scale was used to assess statin adherence (a self-reported, medication-adherence questionnaire divided into 3 levels, with a score of 8 denoting high adherence, 6 to <8 denoting medium adherence and <6 denoting low adherence). Data regarding anthropometric, psychological and serum risk factors were collected using 2 additional questionnaires, laboratory tests and bioelectrical impedance scales. Binary logistic regression was used to determine predictors of adherence and general linear modelling was used to test relationships between continuous outcomes and statin adherence. RESULTS: Of the 200 participants, 117 (58.5%) reported low adherence, 83 (41.5%) reported medium adherence and no patients (0%) scored high adherence. Younger patients (aged 30-50 years) had lower adherence than older patients (>50 years) [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01-1.09] for every extra year; p < 0.01). Those without diabetes, i.e. 113 (56.5%), were less likely to report medium adherence than those with diabetes (OR 0.42; 95% CI 0.23-0.75; p < 0.01). Low statin adherence was associated with higher levels of plasma cholesterol (p < 0.001) and low-density lipoprotein (p < 0.01). CONCLUSION: In this study, there was a high prevalence of low statin adherence, especially among younger patients with fewer concomitant diseases. The results indicated an inverse relationship between statin adherence and CHD risk profile.

Sustained multiplicity in everyday cholesterol reduction: repertoires and practices in talk about 'healthy living'.

This article is concerned with talk about and the practices of healthy living in relation to cholesterol reduction. It draws on qualitative interviews with 89 people who are current or former users of either cholesterol-lowering functional foods or statins for cardiovascular risk reduction. Focusing on data about everyday activities including food preparation, shopping and exercise, we illustrate four repertoires that feature in talk about cholesterol reduction (health, pleasure, sociality and pragmatism). Using Gilbert and Mulkay's notion of a 'reconciliation device', we suggest ways in which apparently contradictory repertoires are combined (for example, through talk about moderation) or kept apart. We suggest that, in contrast to the interactiveness of the repertoires of health and pleasure, a pragmatic repertoire concerning food provisioning, storage and cooking as well as the realities of exercise, appears distinct from talk about health and is relatively inert. Finally we consider the implications of these discursive patterns for daily practices. Our data suggest there is little emphasis on coherence in people's practices and illustrate the significance of temporal, spatial and social distribution in allowing people to pursue different priorities in their everyday lives. Rather than the calculated trade-offs of earlier medical sociology we draw on Mol to foreground the possibility of sustained multiplicity in daily practices.

Evaluation of the association of physical activity levels with self-perceived health, depression, and anxiety in Spanish individuals with high cholesterol levels: a retrospective cross-sectional study.

Background: Hypercholesterolemia is the most common form of dyslipidaemia in the world leading to negative health effects, both physical and mental. Physical activity (PA) can reduce total cholesterol and has positive effects on mental health. This retrospective cross-sectional study analyses the relationships between physical activity level (PAL), self-perceived health (SPH) and mental health. Methods: This study was based on data from the Spanish National Health Survey 2017 (SNHS 2017), with 3,176 Spanish adults with high cholesterol as participants. Non-parametric tests were used as the data did not follow normality. Results: Dependent relationships were found between PAL and SPH, depression and anxiety. Women had higher depression and anxiety prevalences than men, while men were more likely to report being very active, although the proportion of walkers was higher in women. The physically inactive population presented higher negative SPH, depression and anxiety proportions and psychological distress than physically active people. Conclusion: The physically inactive people had a higher risk of negative SPH, depression and anxiety. Regular PA may improve SPH and mental health in people with high cholesterol, but more studies are needed to establish causal relationships, mechanisms, and optimal doses.

Longitudinal relationship of depressive and anxiety symptoms with dyslipidemia and abdominal obesity.

OBJECTIVE: Previous research indicates that patients with severe symptoms of depression or anxiety are prone toward the development of dyslipidemia and abdominal obesity. We sought to study these associations longitudinally. METHODS: Among 2126 Netherlands Study of Depression and Anxiety participants, we studied whether severity of depressive (Inventory of Depressive Symptoms) or anxiety (Beck Anxiety Inventory) symptoms at baseline was associated with changes in lipids (i.e., total, high-density lipoprotein [HDL] or low-density lipoprotein cholesterol, and triglycerides) or waist circumference during a 2-year follow-up period. We also examined whether changes in severity of symptoms were associated with changes in lipid or waist circumference levels over these 2 years. Multivariate linear regression analyses were adjusted for age, sex, education, and tobacco consumption. RESULTS: Baseline symptoms of depression or anxiety predicted a decrease in HDL cholesterol (adjusted ß = -.062 [p = .003] and ß = -.050 [p = .02], respectively) and an increase in waist circumference (adjusted ß = .060 [p = .01] and ß = .053 [p = .02], respectively) for 2 years. Reduction of symptoms of depression or anxiety over time did not coincide with an amelioration of lipid or waist circumference values. CONCLUSIONS: People with initially severe symptoms of depression or anxiety showed a subsequent decrease in HDL cholesterol levels and an increase in abdominal obesity over time, independent of a potential reduction in symptom severity in this period. Therefore, such people are at elongated and increasing risk for dyslipidemia and obesity, predisposing them to cardiovascular disease.

Direct-to-consumer television advertising exposure, diagnosis with high cholesterol, and statin use.

BACKGROUND: While statin drugs are recommended for secondary prevention of coronary heart disease (CHD), there is no medical consensus on whether or not a statin should be added to lifestyle change efforts for primary prevention of CHD. Previous research suggests that exposure to direct-to-consumer advertising (DTCA) increases drug demand among those at comparatively low risk. Research has yet to examine whether individual-level DTCA exposure may influence statin use among men and women at high, moderate, or low risk for future cardiac events. OBJECTIVE: To determine the relationship between estimated exposure to DTCA for statin drugs and two clinical variables: diagnosis with high cholesterol and statin use. DESIGN: We used logistic regression to analyze repeated cross-sectional surveys of the United States population, merged with data on the frequency of DTCA appearances on national, cable, and local television, between 2001 and 2007. PARTICIPANTS: American adults (n=106,685) aged 18 and older. MAIN MEASURES: Levels of exposure to statin DTCA, based on ad appearances and TV viewing patterns; self-reports of whether or not a respondent has been diagnosed with high cholesterol, and whether or not a respondent took a statin in the past year. KEY RESULTS: Adjusting for potential confounders, we estimate that exposure to statin ads increased the odds of being diagnosed with high cholesterol by 16 to 20 %, and increased statin use by 16 to 22 %, among both men and women (p<0.05). These associations were driven almost exclusively by men and women at low risk for future cardiac events. There was also evidence of a negative association between DTCA exposure and statin use among high-risk women (p<0.05) CONCLUSIONS: This study provides new evidence that DTCA may promote over-diagnosis of high cholesterol and over-treatment for populations where risks of statin use may outweigh potential benefits.

Cardiovascular risk factors and cognitive decline in adults aged 50 and over: a population-based cohort study.

OBJECTIVES: the objective of the present study was to explore the association between cardiovascular risk and cognitive decline in adults aged 50 and over. METHODS: participants were older adults who participated in the English Longitudinal Study of Ageing. Outcome measures included standardised z-scores for global cognition, memory and executive functioning. Associations between cardiovascular risk factors and 10-year Framingham risk scores with cognitive outcomes at 4-year and 8-year follow-ups were estimated. RESULTS: the mean age of participants (n = 8,780) at 2004-05 survey was 66.93 and 55% were females. Participants in the highest quartile of Framingham stroke risk score (FSR) had lower global cognition (b = -0.73,CI: -1.37, -0.10), memory (b = -0.56, CI: -0.99, -0.12) and executive (b = -0.37, CI: -0.74, -0.01) scores at 4-year follow-up compared with those in the lower quartile. Systolic blood pressure ≥160 mmHg at 1998-2001 survey was associated with lower global cognitive (b = -1.26, CI: -2.52, -0.01) and specific memory (b = -1.16, CI: -1.94, -0.37) scores at 8-year follow-up. Smoking was consistently associated with lower performance on all three cognitive outcomes. CONCLUSION: elevated cardiovascular risk may be associated with accelerated decline in cognitive functioning in the elderly. Future intervention studies may be better focused on overall risk rather than individual risk factor levels.

Cardiovascular risk: gender differences in lifestyle behaviors and coping strategies.

BACKGROUND: Although cardiovascular disease (CVD) does not occur until mid to late life for most adults, the presence of risk factors, such as high blood pressure (BP) and cholesterol, has increased dramatically in young adults. PURPOSE: The present study examined the relationships between gender and coping strategies, lifestyle behaviors, and cardiovascular risks. METHOD: The sample consisted of 297 (71% female) university students. Participants completed a survey to assess demographics, lifestyle behaviors, and coping strategies, and a physiological assessment including lipid and blood pressure (BP) measurements. Data collection occurred from January 2007 to May 2008. RESULTS: Analyses revealed that age, ethnicity, greater body mass index (BMI), greater use of social support, and less frequent exercise were associated with higher cholesterol, while gender, age, greater BMI, and less frequent exercise were associated with higher systolic BP. There were two significant interactions: one between gender and avoidant coping and the other between gender and exercise on systolic BP, such that for men greater use of avoidant coping or exercise was associated with lower systolic BP. CONCLUSION: Understanding how young adults manage their demands and cope with stress sets the stage for understanding the developmental process of CVD. Both coping strategies and lifestyle behaviors must be considered in appraising gender-related cardiovascular risk at an early age before the disease process has begun.

Risk of cardiovascular disease? A qualitative study of risk interpretation among patients with high cholesterol.

BACKGROUND: Previous studies have shown the importance of paying attention to lay peoples' interpretations of risk of disease, in order to explain health-related behavior. However, risk interpretations interplay with social context in complex ways. The objective was to explore how asymptomatic patients with high cholesterol interpret risk of cardiovascular disease. METHODS: Fourteen patients with high cholesterol and risk of cardiovascular disease were interviewed, and patterns across patient accounts were identified and analysed from an ethnographic approach. RESULTS: Information from the general practitioner about high cholesterol and risk of cardiovascular disease was reinterpreted in everyday social life. The risk associated with fatty foods was weighed against the pleasures of social and cultural events in which this type of food was common and cherished.A positive mindset was applied as a strategy to lower the risk of having high cholesterol, but knowledge about risk was viewed as a cause of anxiety and self-absorption, and this anxiety made the body susceptible to disease, hampering the chances for healthy life. CONCLUSION: Interpretations of high cholesterol and risk of cardiovascular disease are embedded in social relations and everyday life concerns. This should be addressed in general practice in preference-sensitive cases about risk-reducing medication. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01187056.

A cross-sectional study assessing Australian general practice patients' intention, reasons and preferences for assistance with losing weight.

BACKGROUND: The high prevalence of overweight and obesity in the population is concerning, as these conditions increase an individual's risk of various chronic diseases. General practice is an ideal setting to target the reduction of overweight or obesity. Examining general practice patients' intentions to lose weight and preferences for assistance with managing their weight is likely to be useful in informing weight management care provided in this setting. Thus, this study aimed to: 1) identify the proportion and characteristics of patients intending to change weight in the next six months; 2) reasons for intending to change weight and preferences for different modes of weight management assistance in overweight and obese patients. METHODS: A cross-sectional study was conducted with 1,306 Australian adult general practice patients. Consenting patients reported via a touchscreen computer questionnaire their demographic characteristics, intention to lose weight in the next six months, reasons for wanting to lose weight, preferred personnel to assist with weight loss and willingness to accept support delivered via telephone, mobile and internet. RESULTS: Fifty six percent (n = 731) of patients intended to lose weight in the next six months. Females, younger patients, those with a level of education of trade certificate and above or those with high cholesterol had significantly higher odds of intending to lose weight. "Health" was the top reason for wanting to lose weight in normal weight (38%), overweight (57%) and obese (72%) patients. More than half of overweight (61%) or obese (74%) patients reported that they would like help to lose weight from one of the listed personnel, with the dietitian and general practitioner (GP) being the most frequently endorsed person to help patients with losing weight. Almost 90% of overweight or obese participants indicated being willing to accept support with managing their weight delivered via the telephone. CONCLUSIONS: Most overweight or obese general practice patients intended to lose their weight in the next six months for health reasons. Younger females, with higher level of education or had high cholesterol had significantly higher odds of reporting intending to lose weight in the next six months. An opportunity exists for GPs to engage patients in weight loss discussions in the context of improving health. Interventions involving GP and dietitians with weight management support delivered via telephone, should be explored in future studies in this setting.

"When diet and exercise are not enough": an examination of lifestyle change inefficacy claims in direct-to-consumer advertising.

Previous research suggests that direct-to-consumer (DTC) advertisements for pharmaceutical drugs have the potential to influence consumers' perceptions of whether symptoms should be treated medically and/or through behavior change. However, the relative frequency of messages emphasizing these approaches in pharmaceutical advertising remains largely unknown. A content analysis of print and television advertisements for cholesterol management medication between 1994 and 2005 (for print) and between 1999 and 2007 (for television) was conducted. First, the extent to which established theoretical constructs drawn from health communication scholarship are depicted in the content of DTC cholesterol advertisements is quantified. Second, specific claims about behavior change inefficacy when a pharmaceutical alternative is available are identified. Findings indicate that DTC ads offer many mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease. Theoretical and practical implications of this work are discussed.

Effects of statins and cholesterol on memory functions in mice.

Studies on influence of lipid lowering therapies have generated wide controversial results on the role of cholesterol on memory function. However recent studies revealed that cholesterol lowering treatment substantially reduce the risk of dementia. The objectives of this study were to analyze the effect of statins on memory function and to establish the relationship between increase/decrease in cholesterol synthesis, total cholesterol level and memory function in animals. We examined the relationship between biosynthesis of cholesterol and memory function using two statins (lipophilic simvastatin and hydrophilic pravastatin) and high cholesterol diet in mice for 15 days and 4 months. Memory performance was evaluated with two different behavioral tests and various biochemical parameters such as serum cholesterol, whole brain cholesterol, brain 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) activity and brain acetylcholine esterase (AChE) activity. We found that statin treatment for 4 months, but not for 15 days, showed significant improvement in memory function whereas high cholesterol diet showed significant impairment of memory. However long-term statin treatment showed significant decrease in serum cholesterol level as well as brain AChE level. Moreover high cholesterol diet showed significant decrease in memory function with an increase in serum cholesterol level as well as brain AChE level. There is no direct correlation between brain cholesterol level, as well as HMG-CoA activity with memory function regulation. However there is definite link between plasma cholesterol level and AChE level. A long-standing plasma cholesterol alteration may be essential to regulate memory function which in turn might be mediated through AChE modulated pathway.

Adherence with statins in a real-life setting is better when associated cardiovascular risk factors increase: a cohort study.

BACKGROUND: While the factors for poor adherence for treatment with statins have been highlighted, the impact of their combination on adherence is not clear. AIMS: To estimate adherence for statins and whether it differs according to the number of cardiovascular risk factors. METHODS: A cohort study was conducted using data from the main French national health insurance system reimbursement database. Newly treated patients with statins between September 1 and December 31, 2004 were included. Patients were followed up 15 months. The cohort was split into three groups according to their number of additional cardiovascular risk factors that included age and gender, diabetes mellitus and cardiovascular disease (using co-medications as a proxy). Adherence was assessed for each group by using four parameters: (i) proportion of days covered by statins, (ii) regularity of the treatment over time, (iii) persistence, and (iv) the refill delay. RESULTS: 16,397 newly treated patients were identified. Of these statin users, 21.7% did not have additional cardiovascular risk factors. Thirty-one percent had two cardiovascular risk factors and 47% had at least three risk factors. All the parameters showed a sub-optimal adherence whatever the group: days covered ranged from 56% to 72%, regularity ranged from 23% to 33% and persistence ranged from 44% to 59%, but adherence was better for those with a higher number of cardiovascular risk factors. CONCLUSIONS: The results confirm that long-term drug treatments are a difficult challenge, particularly in patients at lower risk and invite to the development of therapeutic education.