Eliminating Disparities in Cardiovascular Disease for Black Women: JACC Review Topic of the Week.

Black women are disproportionately affected by cardiovascular disease with an excess burden of cardiovascular morbidity and mortality. In addition, the racialized structure of the United States shapes cardiovascular disease research and health care delivery for Black women. Given the indisputable evidence of the disparities in health care delivery, research, and cardiovascular outcomes, there is an urgent need to develop and implement effective and sustainable solutions to advance cardiovascular health equity for Black women while considering their ethnic diversity, regions of origin, and acculturation. Innovative and culturally tailored strategies that consider the differential impact of social determinants of health and the unique challenges that shape their health-seeking behaviors should be implemented. A patient-centered framework that involves collaboration among clinicians, health care systems, professional societies, and government agencies is required to improve cardiovascular outcomes for Black women. The time is "now" to achieve health equity for all Black women.

Evaluation and management of blood lipids through a woman's life cycle.

There are currently no sex-specific guidelines for evaluation and management of blood lipids. While previous guidelines acknowledge sex-specific risk enhancing factors for lipid management in women for CVD prevention, this review focuses on how lipids are impacted during normal hormonal changes throughout a woman's life cycle- during adolescence, pre-pregnancy, pregnancy, pre- and perimenopause, menopause, and at older ages. In this review, the authors focus on management of primary prevention of CVD by examining sex-specific cardiovascular risk factors at each stage and pay special attention to statin use, statin side effects and non-statin therapies. Women need to understand their personalized cholesterol goals and ally with their clinicians to ensure successful management. Additionally, we highlight the biases that exist when treating dyslipidemia in women and the special care clinicians should take to ensure appropriate and aggressive therapies are made available to female patients. Finally, the authors recommend future research should focus on increasing enrollment of women in lipid trials. This is of paramount importance in discovering sex-specific difference in lipid management.

Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women: JACC Review Topic of the Week.

Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.

Effects of a hypoenergetic diet associated with açaí (Euterpe oleracea Mart.) pulp consumption on antioxidant status, oxidative stress and inflammatory biomarkers in overweight, dyslipidemic individuals.

OBJECTIVE: To evaluate the effects of a hypoenergetic diet (HD)associated with açaí pulp consumption on oxidative stress, antioxidant status and inflammatory biomarkers in overweight, dyslipidemic individuals. RESEARCH METHODS & PROCEDURES: A randomized, double-blind, placebo-controlled clinical trial was conducted for 90 days. The study began with a 30-day run-in period, during which the intervention was exclusively a HD. Following this period, volunteers were randomized into 2 groups, and 200 g of either açaí pulp or placebo were added to the HD for 60 days. Anthropometric measurements, arterial pressure, oxidative stress and antioxidant status biomarkers, inflammatory and biochemical biomarkers were evaluated. RESULTS: Sixty-nine volunteers completed the clinical trial, 30 of which were in the HD + açaí group and 39 in HD + placebo group. Plasma 8-isoprostane concentrations significantly reduced 60 days after the intervention in the açaí group (p = 0.000), and there was a significant difference between the groups (açaí versus placebo; p = 0.037). Regarding inflammatory status parameters, a significant reduction in IL-6 was observed in the HD + açaí group (p = 0.042), and IFN-γ decreased significantly in both groups, HD + açaí (p = 0.001) and HD + placebo (p = 0.008); there were, however, no differences between the groups. Lipid profile parameters and blood glucose levels did not show change, regardless of nutritional intervention. CONCLUSION: The addition of açaí to a HD, for 60 days, reduced oxidative stress and improved inflammation in overweight, dyslipidemic individuals.

Effects of oat bran and nutrition counseling on the lipid and glucose profile and anthropometric parameters of hypercholesterolemia patients

BACKGROUND: In order to prevent chronic, non communicable disease, it is essential that lifestyle is modified to include a diet high in fiber. AIM: To assess the effect oat bran (OB) in conjunction with nutrition counseling (NC) have on lipid and glucose profile, anthropometric parameters,quality of diet, and ingestion of ultraprocessed foods (UPF) and additives in hypercholesterolemia sufferers. METHOD: This was a 90-day, double-blind, placebo-controlled, block-randomized trial undertaken on 132 men and women with LDL-c ≥ 130 mg/ dL. The participants were sorted into two groups: OB Group (OBG) and Placebo Group (PLG), and were given NC and 40g of either OB or rice flour, respectively. Lipid and glucose profile were assessed, as were the anthropometric data, quality of diet (Diet Quality Index revised for the Brazilian population - DQI-R) and whether or not UPF or additives were consumed. RESULTS: Both groups showed a significant decrease in anthropometric parameters and blood pressure, as well as a significant reduction in total and LDL cholesterol. There was also an improvement in DQI-R in both groups and a decrease in consumption of UPF. Blood sugar, HOMA-IR and QUICKI values were found to be significantly lower only in the OBG. CONCLUSION: Our findings in lipid profile and anthropometric parameters signify that NC has a beneficial effect, which is attributable to the improved quality of diet and reduced consumption of UPF. Daily consumption of 40 g of OB was found to be of additional benefit, in decreasing insulin-resistance parameters.

EFFECT OF HYPOENERGETIC DIET COMBINED WITH CONSUMPTION OF COCONUT FLOUR IN OVERWEIGHT WOMEN.

INTRODUCTION: the prevalence of obesity has increased, especially among women. AIM: the aim of this study was to assess the effect of a hypoenergetic diet combined with coconut flour on anthropometric and biochemical data and the quality of the diet. METHODS: we carried out a crossover clinical trial involving a step with hypoenergetic diet only and another with the diet associated with coconut flour consumption (26 g) over the course of nine months. The volunteers were recruited from the São Gonçalo city of Rio de Janeiro. Anthropometric, biochemical and dietary data were collected monthly. The diet quality index revised for the Brazilian population (DQI-R) and the consumption of ultra-processed foods and additives were assessed. The Wilcoxon and Mann-Whitney tests were performed, with p < 0.05 considered statistically significant. RESULTS: forty-two women of an average 47.5 ± 9.5 years of age participated. The hypoenergetic diet promoted a decrease in body fat, body mass index, waist circumference, waist-to-height ratio, visceral adiposity index, diastolic blood pressure, triglycerides and VLDL. The consumption of coconut flour promoted a drop in glucose and total cholesterol levels when supplementing the hypoenergetic diet. The improvement to diet quality can be noted in the decrease in consumption of ultra-processed foods like vegetable oil, chocolate and soft drinks. CONCLUSION: the hypoenergetic diet promoted a decrease in the anthropometric parameters, blood pressure and triglycerides. The consumption of coconut flour promoted a decrease in glucose and total cholesterol levels when supplementing the hypoenergetic diet. The improved diet quality can be seen in the decrease in consumption of ultra- processed foods.

Introducción: la prevalencia de la obesidad ha aumentado, sobre todo entre las mujeres. Objetivo: el objetivo de este estudio fue evaluar el efecto de una dieta hipoenergética combinada con harina de coco en los datos antropométricos y bioquímicos y, así como la calidad de la dieta. Métodos: se realizó un ensayo clínico cruzado que incluyó un paso solo con dieta hipoenergética y otro con la dieta asociada con el consumo de harina de coco (26 g) a lo largo de nueve meses. Los voluntarios fueron reclutados de la ciudad de São Gonçalo de Río de Janeiro. Antropométrica, datos bioquímicos y dietéticos fueron recolectados mensualmente. Fueron evaluados el índice de calidad de la dieta revisado para la población brasileña (ICD-R) y el consumo de alimentos y aditivos ultraprocesados. Se realizaron las pruebas de Wilcoxon y Mann-Whitney, con p < 0,05, considerado estadísticamente significativo. Resultados: participaron cuarenta y dos mujeres con un promedio de 47,5 ± 9,5 años de edad. La dieta hipoenergética promovió una disminución de la grasa corporal, el índice de masa corporal, la circunferencia de la cintura, la relación cintura-talla, el índice de adiposidad visceral, la presión arterial diastólica, los triglicéridos y VLDL. El consumo de harina de coco promovió una caída en los niveles de colesterol y glucosa totales al complementar la dieta hipoenergética. La mejora de la calidad de la dieta puede observarse en la disminución del consumo de alimentos ultraprocesados como el aceite vegetal, el chocolate y los refrescos. Conclusión: la dieta hipoenergética promovió una disminución en los parámetros antropométricos, la presión arterial y los triglicéridos. El consumo de harina de coco favoreció una disminución de los niveles de colesterol y de glucosa totales cuando se complementa la dieta hipoenergética. La calidad de la dieta mejorada se puede ver en la disminución del consumo de alimentos ultraprocesados.