Metabolic Syndrome, Modifiable Lifestyle Factors, and Sleep-Disordered Breathing: The Hispanic Community Health Study.

BACKGROUND: US Hispanics/Latinos are disproportionately susceptible to metabolic syndrome (MetS), attributed in part to systemic inequities related to health and lifestyle factors such as low physical activity (PA) levels, diet quality, alcohol use, tobacco use, and sleep disorder. Gender and heritage group differences are vastly understudied and need to be examined in this heterogeneous population. PURPOSE: To examine the relationships between select health and lifestyle factors and MetS among Hispanic gender and heritage subgroups (Hypothesis 1) and determine whether gender and heritage moderate those relationships (Hypothesis 2). METHODS: Participants included 14,155 Hispanic Americans aged 18-76 (59% female, mean age 45.92 ± 13.97) from seven heritage subgroups. This secondary analysis of cross-sectional data from the observational Hispanic Community Health Study/Study of Latinos (HCHS/SOL) dataset used hierarchical multinomial logistic regression to test Hypothesis 1; the dependent variable, MetS, included three categories delineating absence of MetS and presence of MetS with or without related medication use. Hayes' PROCESS macro tested Hypothesis 2. RESULTS: Low PA and sleep-disordered breathing (SDB) each had significant (p < .001) predictive value of MetS group membership, whereas both low and high alcohol use (p < .001) were associated with decreased MetS risk. Cigarette pack-years were not significantly associated with MetS outcomes. Gender moderated the association between MetS and alcohol use (p < .001), cigarette pack-years (p < .001), and SDB (p < .001) such that the effects on MetS were higher in females than males. The association between MetS and diet quality (p < .001) was stronger among males than in females. CONCLUSIONS: Gender and heritage differences were prominent among study variables.

A Randomized Controlled Trial, Non-Nutrition Based mHealth Program: The Potential Impact on Dietary Intake in College Students.

The aims of this study were to (1) explore this sample's pre- and post-intervention dietary intake, specifically the macro- and micronutrients, and their eating habits related to location of consumption and use of electronic devices, and (2) compare this sample's nutritional measures to the current Dietary Guidelines 2020 to 2025. Twenty-eight participants were included in the secondary data analysis. Participants reported a total of 822 items consumed during this study. Most items were consumed at home (n = 629, 76.5%). We found significant differences in the intake of energy, protein, total fat, carbohydrates, total vegetables, total grains, and total meat in different locations. For most of these measures, consumption at home and/or restaurants resulted in a greater magnitude of consumption than at other locations (e.g., car, daycare). Participants reported consuming most of their energy and nutrients while either using electronic devices alone (n = 365, 44.4%) or using no devices (n = 346, 42.1%). Significant differences were found among three measures including energy, total fat, and total fiber. The majority of the macronutrients (total fiber, fruits, vegetables, meat, and dairy) consumed by our sample were under the threshold recommended in the 2020 to 2025 Dietary Guidelines.

MOBILE Intervention Pilot Study in College Students With Elevated Blood Pressure.

BACKGROUND: Hypertension is typically recognized in middle-aged and older adults but often overlooked in younger populations. OBJECTIVE: We evaluated a mobile intervention for reducing blood pressure (BP) in college-age students for 28 days. METHODS: Students with elevated BP or undiagnosed hypertension were assigned to an intervention or control group. All subjects completed baseline questionnaires and attended an educational session. For 28 days, intervention subjects sent their BP and motivation levels to the research team and completed assigned BP-reducing tasks. After 28 days, all subjects completed an exit interview. RESULTS: We found a statistically significant decrease in BP in the intervention group only ( P = .001) but no statistical difference in sodium intake for either group. Mean hypertension knowledge increased in both groups but was only significant for the control group ( P = .001). CONCLUSIONS: The results provide preliminary data on BP reduction with greater impact on the intervention group.

Mental health is related to metabolic syndrome: The Hispanic community health study/ study of Latinos.

OBJECTIVE: Metabolic syndrome (MetS) is associated with common mental health conditions. Using cross-sectional data from the observational Hispanic Community Health Study / Study of Latinos (HCHS/SOL), this study examined the relationship between MetS and depression and anxiety in addition to testing moderating effects of gender and Hispanic heritage subgroups. METHODS: Participants included 13,496 Hispanic Americans aged 18-74 (59% women, mean age 46.59 ± 13.65) from seven heritage subgroups. Depression was measured using the Center for Epidemiologic Studies Depression 10-item scale, and anxiety was assessed using the State-Trait Anxiety Inventory 10-item scale. A 3-level categorical variable was developed to assess the combined influence of depression and anxiety. The dependent variable is dichotomous, delineating the presence or absence of MetS as defined by the National Cholesterol Education Program Third Adult Treatment Panel. Logistic regression and Hayes' PROCESS macro assessed these relationships and the moderating effects of gender-heritage subgroups. RESULTS: Results suggest depression (p < .001) and anxiety (p < .001) were associated with an increased likelihood of MetS. Puerto Ricans had the highest, and South Americans had the lowest, levels of depression and anxiety. Gender moderated the relationship between mental health and MetS, with women having a significant increase in the probability of MetS with depression (p < .001), anxiety (p < .001), or both (p < .001). CONCLUSION: Elevated symptoms of depression and anxiety are associated with the presence of MetS in US Hispanic subgroups. Gender-heritage differences are present among the study variables. Strategies to manage psychological well-being must be employed to optimize cardiometabolic health in US Hispanics.

Electrocardiogram Abnormalities Associated With Metabolic Syndrome: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Metabolic syndrome (MetS) is a prognostic cluster of physiologic risk factors that may develop into cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Electrocardiogram abnormalities (ECGA) can be instrumental in identifying the early stages of disease and may be associated with MetS in Hispanic Americans. OBJECTIVE: To explore the relationships between MetS and major and minor ECGA in the Hispanic population (Hypothesis 1) and determine whether gender-ethnic subgroups moderate these relationships (Hypothesis 2). METHODS: This secondary data analysis was conducted using large-scale data from the cohort study Hispanic Community Health Study/Study of Latinos (N = 13,628; 59% women and 41% men). Major ECGA encompassed 9 abnormalities including pathologic Q waves and left ventricular hypertrophy. Minor ECGA were tested independently of major ECGA. MetS was classified into 4 categories delineating metabolic abnormalities and related medication use. Multinomial logistic regression and Hayes' PROCESS macro were used for statistical analysis. RESULTS: Major ECGA were significantly associated with the presence of MetS and/or related medication use, whereas minor ECGA abnormalities were associated with MetS for participants who also took MetS-related medications only. Gender moderated the association between MetS and minor ECGA such that women with minor ECGA had a higher likelihood of MetS when compared to men. CONCLUSIONS: Findings suggest that early recognition and associated treatment of major and minor ECGA can be important to prevent MetS and further morbidities in the Hispanic population.

Lifestyle Choices and Risk of Developing Cardiovascular Disease in College Students.

The purpose of the study was to examine and evaluate the cardiovascular risk factors in college students including their nutritional and social choices and how those choices related to their cardiovascular health. A descriptive, cross-sectional study of 148 college students, obtaining their blood pressure, body mass index, fasting lipid panel, fasting glucose, hemoglobin A1c, serum cotinine levels, physical activity, alcohol consumption, and dietary habits. A high prevalence of cardiovascular disease risk factors was found: 23.8% were current or past smokers with more male than female smokers (p = .009); 65.5% consumed alcoholic beverages; 13.5% had elevated blood pressure; 25.7% had hypertension stage I; 3.4% had hypertension stage II; 36.5% were overweight while 19.9% were obese; 14.2% had prediabetes and 2% had diabetes; and 40.5% had borderline high cholesterol levels while 3.4% had hyperlipidemia. Elevated blood pressure and hypertension were most prevalent between the ages of 18 and 23 years and among males (p = .001). The top three risk factor co-occurrences were overweight and drinking alcohol (33.78%), followed by family history of heart disease and drinks alcohol (27.70%), and overweight and history of heart disease (25.68%). Of the 148 participants, 108 of them had at least two cardiovascular risk factors. The results of this study indicate that college students participate in risky behaviors that predispose them to develop CVD in the future.

Circadian Rhythms in Sudden Cardiac Arrest: A Review.

BACKGROUND: Sudden cardiac arrest (SCA) is a serious public health issue caused by the cessation of cardiac electrical and mechanical activity. Despite advances in pedestrian lifesaving technologies like defibrillators, the SCA mortality rate remains high, and survivors are at risk of suffering ischemic injury to various organs. Understanding the contributing factors for SCA is essential for improving morbidity and mortality. One factor capable of influencing SCA incidence and survival is the time of day at which SCA occurs. OBJECTIVES: This review focused on the effect of time of day on SCA incidence, survival rate, and survival to discharge over the past 30 years and the role of age, sex, and SCA location in modulating the timing of SCA. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews criteria guided this review. Four databases (PubMed, Cochrane Libraries, Scopus, and Cumulative Index to Nursing and Allied Health Literature) were queried for research reports or articles addressing time of day and cardiac arrest, which were subsequently screened by the authors for inclusion in this analysis. RESULTS: A total of 48 articles were included in the final analysis. This analysis showed a bimodal SCA distribution with a primary peak in the morning and a secondary peak in the afternoon; these peaks were dependent on age (older persons), sex (more frequent in males), and the location of occurrence (out-of-hospital cardiac arrest vs. in-hospital cardiac rest). Survival following SCA was lowest between midnight and 06:00 a.m. DISCUSSION: The circadian rhythm likely plays an important role in the time-of-day-dependent pattern that is evident in both the incidence of and survival following SCA. There is a renewed call for nursing research to examine or address circadian rhythm as an element in studies involving older adults and activities affecting cardiovascular or respiratory parameters.

Risk factors associated with cardiovascular disease among adult Nevadans.

OBJECTIVE: Cardiovascular disease (CVD) remains the number one cause of death in the US and Nevada is ranked 11th highest for CVD mortality. The study sought to examine the association between self-reported risk factors and CVD presence among adult Nevadans, between years 2011 and 2017. METHODS: This is a cross-sectional, population-based study that utilized the 2011 and 2017 Nevada Behavioral Risk Factor Surveillance System data. Data were analyzed between 2019 and 2020. RESULTS: A total of 5,493 and 3,764 subjects in 2011 and 2017, respectively were included. BMI (overweight/obesity) remained the most prevalent CVD risk factor. The second most common CVD risk factor was high cholesterol, followed by hypertension. Compared to females, males were 1.64 times more likely to have reported CVD in 2011, which increased to 1.92 in 2017. Compared to non-smokers, everyday smokers were 1.96 times more likely in 2011 and 3.62 times more likely in 2017. Individuals with high cholesterol status were 2.67 times more likely to have reported CVD compared to those with normal levels in 2011. In 2011, individuals with hypertension were 3.74 times more likely to have reported CVD compared to those who did not have hypertension. This relationship increased its magnitude of risk to 6.18 times more likely in 2017. In 2011, individuals with diabetes were 2.90 times more likely to have reported CVD compared to those without the condition. CONCLUSIONS: Public health and healthcare providers need to target preventable cardiovascular risk factors and develop recommendations and strategies locally, nationally, and globally.

Perception and Beliefs Regarding Cardiovascular Risk Factors and Lifestyle Modifications Among High-Risk College Students.

BACKGROUND: Studying risk factors and corresponding behavior in young adults is important as atherosclerotic plaque begins to form in early adulthood, resulting in cardiovascular disease (CVD) later in life. The purpose of this study was to explore the perceptions and beliefs regarding cardiovascular risk and lifestyle modification among high-risk college students (based on Framingham 30-year risk score). METHODS: Semistructured qualitative interviews were conducted and analyzed using qualitative content analysis. RESULTS: Risk factors included overweight/obesity, alcohol consumption, elevated blood pressure, family history, and smoking. Qualitative interviews revealed six themes: (a) recognizing risk, (b) lifestyle trajectories, (c) factors influencing lifestyles, (d) ideal healthy lifestyle modifications, (e) perceived benefits of healthy lifestyles, and (f) integrating technology and health apps. Participants demonstrated a lack of understanding of how the various factors contributed to CV risk. Influencing factors to a healthy lifestyle were categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation. CONCLUSIONS: Understanding high-risk college students' beliefs and perceptions regarding CVD risk factors and lifestyle modification is the first step to assessing the problem facilitating early intervention in the young adult population. Clinicians should assess, develop, and implement risk reduction programs that are tailored to individuals who need it the most, those at high risk.

Healthcare-seeking behaviours in college students and young adults: a review.

BACKGROUND/AIMS: To review the literature on college students' healthcare-seeking behaviours to uncover the current evidence and promote better healthcare-seeking behaviours and essentially better health outcomes in young adults. METHODS: The researchers conducted an extensive literature review using CINAHL, Cochrane, PubMed, EBSCOhost and Google Scholar in the years 2018 and 2019. The search was limited to the past 18 years (2000-2018) and to studies reported in the English language focused on the general healthcare-seeking behaviour of college students. The search was also extended to young adults (aged 18-39 years). RESULTS: A total of 56 articles were identified for abstract review and only 28 articles met the inclusion criteria for the final review. The following themes emerged to organise our findings: healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviours and barriers to accessing care among college students. CONCLUSIONS: This review summarises the current body of knowledge related to healthcare-seeking behaviour among college students, health information resource utilisation and its influence on healthcare-seeking behaviour and barriers to accessing care among this population. Important measures further to address the health needs and interventions for addressing these needs among the college student population are discussed.

Review of the Scientific Literature on Young Adults Related to Cardiovascular Disease Intervention.

Many young adults are at risk for cardiovascular disease related to their behavioral choices. Irresponsible alcohol consumption, tobacco smoking, sedentary lifestyle, poor dietary habits, and excessive weight gain are some of the behaviors that put young adults at risk. The Centers for Disease Control and Prevention identified that 15% of young adults are diagnosed with chronic illnesses related to their behavioral choices. The purpose of this review is to identify, in the literature, interventions that are currently available to young adults and evaluate the adequacy and effectiveness of those interventions. An extensive electronic search was conducted using CINAHL, EBSCOhost, Cochrane, PubMed, and Google Scholar. A total of 130 articles were identified and 28 articles met the inclusion criteria. Three main interventions were identified for young adults: personalized interventions, technology-based interventions, and educational/behavioral interventions. The interventions were all effective to different degrees and interventions were most effective when they were combined. This review impacts in what manner nurses and health care providers deliver health promotion, prevention, and management of cardiovascular risk factors in young adults; in particular, nurses play a key role in lifestyle modifications including diet and exercise.

Differences in Cardiovascular Risk Factors in College Students: Midwest Versus Southwest.

PURPOSE: This study was designed to identify underlying cardiovascular risk factors among college students including lifestyle characteristics, health behaviors and knowledge, and perception of the risk factors. METHOD: College students (N = 293), aged 19-36 years, enrolled at either a Midwestern or a Southwestern University in the United States, responded to three questionnaires: sociodemographic, knowledge of cardiovascular risk factors, and perception of cardiovascular risk factors. Anthropometric measures collected included blood pressure (BP), glucose, lipid panel, height, weight, and body mass index (BMI). RESULTS: There were significant regional and gender differences in cardiovascular disease (CVD) risk among Southwestern and Midwestern college students. Students from the Southwest had a higher risk of developing CVD in 30 years compared to those in the Midwest; they also had a higher perceived risk. Males were more at risk of developing CVD than females but had a lower perceived risk than females. Dietary habits were similar between the two populations, and we found no significant differences in BMI. The two regions varied in BP levels, but the Midwestern students had significantly higher prevalence of elevated BP and Stage 2 hypertension. CONCLUSION: Our data suggest that college students are a high-risk population and tend to underestimate and misperceive their risk for developing CVD.

College Students' Perception of Current and Projected 30-Year Cardiovascular Disease Risk Using Cluster Analysis with Internal Validation.

Cardiovascular risk factors in young adults at a national level are less than ideal specifically for hypercholesterolemia, hypertension, and diabetes. Explore college students' perception of their 30-year cardiovascular disease (CVD) risk using cluster analysis technique with internal validation. This is a descriptive and cross-sectional study. A total of 133 college students, aged 20-36 with no known history of CVD, were recruited and used to perform cluster analysis with internal validation. The mean age of the sample was 24.85 and predominately female (59.5%). The mean score for perception of cardiovascular risk factors was 21.20 ranging from 12 to 34 points on a Likert scale. The mean score for the 30-year CVD risk assessment was 5.23 ranging from 1 to 22%. Five clusters emerged from the cluster analysis. However, two of the clusters, the highest risk with moderate perception and low risk and lowest perception, were identified as areas for potential intervention as there were discrepancies between subjects' perceived risk and their actual 30-year risk. The national data and literature has indicated a lack of awareness of CVD risk among this population which our study also concurred. Identifying the discrepancies between the perceived and projected CVD risk are useful for researchers and clinicians such as nurses to take the initiative to focus on and begin to intervene in this population to reduce potential adverse events of CVD.

Using Cluster Analysis to Identify Subgroups of College Students at Increased Risk for Cardiovascular Disease.

BACKGROUND AND PURPOSE:  To examine the co-occurrence of cardiovascular risk factors and cluster subgroups of college students for cardiovascular risks. METHODS: A cross sectional descriptive study was conducted using co-occurrence patterns and hierarchical clustering analysis in 158 college students. RESULTS: The top co-occurring cardiovascular risk factors were overweight/obese and hypertension (10.8%, n = 17). Of the total 34 risk factors that co-occurred, 30 of them involved being overweight/obese. A six-cluster-solution was obtained, two clusters displayed elevated levels of lifetime and 30-year cardiovascular disease risks. CONCLUSIONS: The hierarchical cluster analysis identified that single White males with a family history of heart disease, overweight/obese, hypertensive or diabetes, and occasionally (weekly) consumed red meat, take antihypertensive medication, and hyperlipidemia were considered the higher risk group compared to other subgroups.

Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment.

OBJECTIVE: To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks. PARTICIPANTS: The final sample that responded to recruitment consisted of 158 college students from a midwestern university. METHODS: A cross-sectional, descriptive study was performed using convenience sampling. RESULTS: College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors. CONCLUSIONS: High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.

Validation of the Knowledge and Perception of Cardiovascular Risk Factors Questionnaires for College Students.

BACKGROUND AND PURPOSE: To test the psychometric properties of two measures of knowledge and perception of cardiovascular risk factors (CRFs). METHODS: A methodological study using a modified version of the Heart Disease Fact Questionnaire (HDFQ) and the Health Beliefs Related to Cardiovascular Disease (HBCVD) questionnaires was administered to 100 college-aged students. RESULTS: The HDFQ Kuder-Richardson-20 reliability estimate was .73. The HBCVD Cronbach's alpha was .70. Principal component analysis demonstrated the HBCVD questions load onto components representing the perceived susceptibility and severity of CRFs. There was an inverse relationship between knowledge and perception of CRFs (ρ = -.26, p = .009), as knowledge increased, perception of risk decreased. CONCLUSIONS: The HDFQ and HBCVD questionnaires had adequate internal consistency reliability and documented construct validity for use in college students.

Cardiovascular risk factors in young adults: a literature review.

This extensive literature review focuses on cardiovascular risk factors in young adults, with an emphasis on hyperlipidemia and hypertension. Multiple studies have confirmed that hyperlipidemia and hypertension during young adulthood are associated with coronary heart disease (CHD) in later decades, and CHD is one type of cardiovascular disease. The primary risk factors identified in the literature that are predictive of CHD are age; gender; race/ethnicity; smoking status; high blood pressure; and elevated lipid levels, especially low-density lipoprotein cholesterol. The current guidelines are insufficient to address screening and treatment in young adults with cardiovascular risk factors. Future studies are warranted to confirm the extent of cardiovascular risks in young adults, which can then be targeted to this population for prevention and intervention strategies.