Preventing sudden death with n-3 (omega-3) fatty acids and defibrillators.

BACKGROUND: Because interventions that prevent and treat events due to cardiovascular disease are applied to different, but overlapping, segments of the population, it can be difficult to estimate their effectiveness if formal calculations are not available. METHODS: Markov chain analysis, including sensitivity analysis, was used with a hypothetical population resembling that of Olmsted County, MN, aged 30 to 84 in the year 2000 to compare the estimated impact of three interventions to prevent sudden death: (1) raising blood levels of n-3 (omega-3) fatty acids, (2) distributing automated external defibrillators (AEDs), and (3) implanting cardioverter defibrillators (ICDs) in appropriate candidates. The analysis was performed in 2004, 2005, and 2006. RESULTS: Raising median n-3 fatty acid levels would be expected to lower total mortality by 6.4% (range from sensitivity analysis = 1.6% to 10.3%). Distributing AEDs would be expected to lower total mortality by 0.8% (0.2% to 1.3%), and implanting ICDs would be expected to lower total mortality by 3.3% (0.6% to 8.7%). Three fourths of the reduction in total mortality due to n-3 fatty acid augmentation would accrue from raising n-3 fatty acid levels in the healthy population. CONCLUSIONS: Based on central values of candidacy and efficacy, raising n-3 fatty acid levels would have about eight times the impact of distributing AEDs and two times the impact of implanting ICDs. Raising n-3 fatty acid levels would also reduce rates of sudden death among the subpopulation that does not qualify for ICDs.

CardioVision 2020: program acceptance and progress after 4 years.

OBJECTIVE: To report program acceptance and progress after 4 years of a heart disease prevention program. SUBJECTS: All Olmsted County, Minnesota residents aged >/=20 years. METHODS: The analysis is based on independent population-based interview samples from 1999, 2000, 2001, and 2003; a dietary questionnaire mailed to interviewees; and blood pressure and cholesterol data from medical records of consenting Olmsted County residents. National, Minnesota, and Olmsted County Behavioral Risk Factor Surveillance System trends for fruit and vegetable consumption, body mass index, participation in physical activity, and smoking are compared. The data were analyzed in 2005. RESULTS: More than 90% of the population considers CardioVision 2020 to be a good, very good, or excellent idea. The program is associated with a 25% reduction in the number of people exposed to environmental tobacco smoke and small but significant increases in consumption of fruits and daily physical activity. The population meeting the serum cholesterol goal increased from 52.0% in 1999 to 57.5% in 2003, and the population meeting the blood pressure goal increased from 53.7% in 1999 to 59.9% in 2003. However, attempts to quit smoking and the amount of time spent in physical activity did not increase. By 2003, nearly 9% of the population reported making a behavior change because of CardioVision 2020. Compared to Minnesota and national trends, fruit and vegetable consumption increased significantly in Olmsted County. CONCLUSIONS: The population of Olmsted County views CardioVision 2020 in a positive light. Positive changes in several personal behaviors and risk factor levels have occurred.

Design and development of a coronary heart disease decision support tool.

We are developing a decision support tool to help clinicians and policy makers estimate the impact of various coronary heart disease (CHD) treatments on disease outcomes for populations. We have created seven modules that correspond to states commonly encountered with CHD, that is, congestive heart failure, tachyarrhythmia, stable angina pectoris, acute coronary syndrome, bradycardia, postmyocardial infarction, and postcoronary artery bypass grafting, and a healthy individual module. Within each module, we created event-decision- intervention-outcome flow pathways to simulate risk of a clinical event and the expected outcome as the result of a particular intervention. We will combine disease state probability estimates based on the experience of the Olmsted County, Minnesota, population and estimates of intervention efficacy based on clinical trial data to estimate the impact of interventions on a population. We plan to make this tool available to the public through the internet.

Dietary intake of fruits, vegetables, and fat in Olmsted County, Minnesota.

OBJECTIVE: To assess self-reported dietary intake in the adult population of Olmsted County, Minnesota. SUBJECTS AND METHODS: We conducted a random-digit-dial telephone survey between March 1 and April 21, 1999, of 1232 adults residing in Olmsted County, Minnesota. We then mailed a structured questionnaire to the survey respondents and achieved a response rate of 732 individuals. Percentages of individuals and predictors of those who meet recommendations for intake of fruits and vegetables and for dietary fats were determined by using chi2 tests of general association and multivariate logistic regression. RESULTS: Only 16% of the population of Olmsted County reported meeting standard dietary recommendations for consuming both 5 or more servings of fruits and/or vegetables per day and no more than 30% of calories from fat. Fifty-one percent of the population was meeting neither recommendation. Women were more likely than men to report meeting both goals (22% vs 8%, P<.001), but still more women were meeting neither goal than were meeting both goals (40% vs 22%, P<.001). Multivariate logistic regression revealed the following factors to predict adherence to both goals: female sex, lower body mass index, nonsmoker, history of high cholesterol, and daily physical activity. CONCLUSION: Few individuals in Olmsted County are meeting national recommendations for intake of fruits, vegetables, and dietary fat. More effective interventions are needed to improve dietary habits in all subgroups of this community.

Opportunities to prevent sudden out-of-hospital death due to coronary heart disease in a community.

BACKGROUND: Intervening successfully to reduce the burden of sudden out-of-hospital death due to coronary heart disease (OHCD) requires knowledge of where these deaths occur and whether they are observed by bystanders. METHODS: To establish the proportion of OHCDs that were witnessed and where they occurred, we reviewed the coroner's notes and medical records of a previously-described sample of OHCD cases among residents of Olmsted County, Minnesota. This cohort (n=113) consisted of a 10% random sample of all Olmsted County residents who died out-of-hospital between 1981 and 1994 and whose deaths were attributed to coronary heart disease. RESULTS: Excluding deaths in nursing homes (n=27), 71 (83%) of the deaths occurred in private homes and 15 (17%) occurred in public places. The event was not witnessed in 59% of deaths occurring in private homes and in 20% of deaths occurring in public places. The presence or absence of a bystander could not be established for 10% of deaths in private homes and 7% of deaths in public areas. CONCLUSIONS: A significant proportion of OHCDs occur in private homes and are not witnessed. Prevention of unwitnessed deaths will require programs that result in primary prevention and/or calls to first responders at the time of impending cardiac arrest.

Attempts at changing dietary and exercise habits to reduce risk of cardiovascular disease: who's doing what in the community?

The objective of this study was to characterize adults in Olmsted County, MN who were attempting to change both their dietary and physical activity habits. A random digit-dial telephone survey was taken of 1232 adults, with questions about lifestyle, medical conditions, demographics, and receipt of previous lifestyle advice from a health care professional. Respondents were grouped in four categories: 1) changing neither diet nor exercise habits (22%); 2) changing diet habits only (20%); 3) changing exercise habits only (9%); and 4) changing both diet and exercise habits (49%). Along with several demographic and behavioral factors, receipt of physician advice to change exercise and dietary habits was a strong predictor of attempts to change both lifestyle habits. Only a minority of the population (23%), however, reported having received such advice. These results support the positive impact of health professional advice on dietary and exercise change in the population. Public health campaigns should be aimed at increasing the provision of such advice.

Self-reported weight, weight goals, and weight control strategies of a midwestern population.

OBJECTIVE: To elicit from individuals in a population their current weight and height, weight goals, and weight control strategies to aid in design of effective interventions to prevent and treat obesity. SUBJECTS AND METHODS: By random digit dial telephone survey, 1224 adult residents of Olmsted County, Minnesota, were contacted between February 28 and May 5, 2000. They self-reported weights and weight goals and described physical characteristics associated with their desire to lose weight. RESULTS: Among the 1224 respondents, 65.6% of men and 47.9% of women reported that they were overweight (body mass index [BMI], 25.0-29.9 kg/m2) or obese (BMI, > or =30.0 kg/m2). Only 0.4% of men and 3.7% of women reported that they were underweight (BMI, <18.5 kg/m2). Of the respondents 72.6% of men and 85.1% of women reported that they were either trying to lose or not gain weight. The average weight loss goal for individuals trying to lose weight was 23.4 pounds for men and 28.0 pounds for women. Only one third of individuals trying to lose weight and one fifth of individuals trying not to gain weight reported using the recommended approach of combining energy restriction with at least 150 minutes of exercise per week. CONCLUSIONS: The prevalence of overweight and obesity in the population and the underutilization of combining both restricting energy intake and exercising at least 150 minutes per week for weight control is high. Like the majority of people in the United States, the majority of people in Olmsted County desire to control their weight. The community has responded with plans to help residents meet their goals, although efficacy and outcomes remain to be determined.