Research Goes Red: Early Experience With a Participant-Centric Registry.

RATIONALE: Cardiovascular disease remains the leading cause of death in women. To address its determinants including persisting cardiovascular risk factors amplified by sex and race inequities, novel personalized approaches are needed grounded in the engagement of participants in research and prevention. OBJECTIVE: To report on a participant-centric and personalized dynamic registry designed to address persistent gaps in understanding and managing cardiovascular disease in women. METHODS AND RESULTS: The American Heart Association and Verily launched the Research Goes Red registry (RGR) in 2019, as an online research platform available to consenting individuals over the age of 18 years in the United States. RGR aims to bring participants and researchers together to expand knowledge by collecting data and providing an open-source longitudinal dynamic registry for conducting research studies. As of July 2021, 15 350 individuals have engaged with RGR. Mean age of participants was 48.0 48.0±0.2 years with a majority identifying as female and either non-Hispanic White (75.7%) or Black (10.5%). In addition to 6 targeted health surveys, RGR has deployed 2 American Heart Association-sponsored prospective clinical studies based on participants' areas of interest. The first study focuses on perimenopausal weight gain, developed in response to a health concerns survey. The second study is designed to test the use of social media campaigns to increase awareness and participation in cardiovascular disease research among underrepresented millennial women. CONCLUSIONS: RGR is a novel online participant-centric platform that has successfully engaged women and provided critical data on women's heart health to guide research. Priorities for the growth of RGR are centered on increasing reach and diversity of participants, and engaging researchers to work within their communities to leverage the platform to address knowledge gaps and improve women's health.

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study.

OBJECTIVES: This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress. METHODS: Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary. RESULTS: Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (ß -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (ß -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05). CONCLUSIONS: These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

Obesity and Severity of Menopausal Symptoms: a Contemporary Review.

PURPOSE OF REVIEW: Vasomotor symptoms are frequently experienced by women during menopause and have been linked to obesity. Severity of menopausal symptoms is a distinct construct from presence of symptoms, and the relation between severity of symptoms and obesity is less established. The purpose of this brief narrative review was to summarize evidence from recent studies on associations between menopausal symptom severity and measures of obesity. RECENT FINDINGS: Sixteen articles were identified that specifically assessed and reported on the severity of menopausal symptoms in relation to measures of obesity including body mass index (BMI), waist circumference, and waist-to-hip ratio. Most studies to date show that greater BMI, waist size, and waist-to-hip ratio are associated with greater severity of menopausal symptoms. Given the large segment of women who will experience symptoms and that severity of symptoms influences treatment decisions, future studies are needed to determine how weight management efforts may reduce the severity of menopausal symptoms.

Variable Eating Patterns: A Potential Novel Risk Factor for Systemic Inflammation in Women.

BACKGROUND: The timing and regularity of eating patterns could play a role in systemic inflammation, as circadian clocks responsible for daily rhythms of inflammatory signaling are entrained by food intake. PURPOSE: To evaluate associations of intra-weekly and weekday-weekend differences in eating timing patterns with high-sensitivity C-reactive protein (hsCRP). METHODS: A community-based sample of 103 U.S. women from the American Heart Association Go Red for Women Strategically Focused Research Network completed a meal-timing questionnaire and provided a blood sample for measurement of hsCRP. Differences in weekday versus weekend eating start time, eating end time, and nightly fasting duration were calculated as eating jetlag metrics. Intra-weekly variability in eating timing patterns was defined by the standard deviation (SD) of these variables. Multivariable linear regression models were used to evaluate cross-sectional associations of eating timing variability metrics with hsCRP. RESULTS: Each additional 30-min difference in weekday-weekend eating end time was related to 13% higher hsCRP (p = .023). Similarly, every 30-min increase in eating end time SD, reflecting greater variability in timing of last eating occasion, was associated with 29% higher hsCRP. Per 1-hr weekday-weekend difference in nightly fasting duration, there was a 45% elevation in hsCRP (p = .003). Every 30-min increase in nightly fasting duration SD, representing greater variability in span of the daily fasting/eating periods, was associated with 46% higher hsCRP. CONCLUSIONS: Variable eating timing patterns were associated with higher hsCRP. Intervention studies are needed to determine whether stabilizing the timing of eating occasions may represent a novel strategy to reduce chronic inflammation.

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.

Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.

Evening Chronotype Is Associated with Poorer Habitual Diet in US Women, with Dietary Energy Density Mediating a Relation of Chronotype with Cardiovascular Health.

BACKGROUND: An innate preference for later timing of sleep and activity, termed evening chronotype, is linked to poorer cardiovascular health (CVH). However, associations of chronotype with specific health behaviors in US women are not well characterized. Of particular interest is habitual diet, because <1% of US adults meet recommendations for a healthful diet. OBJECTIVES: We aimed to evaluate cross-sectional and prospective associations of chronotype with diet quantity and quality in US women, and to assess whether dietary energy density (ED), a robust predictor of cardiometabolic outcomes, mediates an established chronotype-CVH relation. METHODS: Data were collected from participants in the AHA Go Red for Women Strategically Focused Research Network cohort (aged 20-76 y; 61% racial/ethnic minority) at baseline (n = 487) and 1-y follow-up (n = 432). Chronotype (evening compared with morning/intermediate) and habitual diet were ascertained from the Morningness-Eveningness Questionnaire and an FFQ, respectively. Multivariable-adjusted linear regression models evaluated cross-sectional and prospective associations of chronotype with diet. Causal mediation analyses assessed whether dietary ED mediated a relation between chronotype and CVH, quantified using AHA Life's Simple 7 score, derived from clinical measurements and validated assessments of CVH components. RESULTS: Evening compared with morning/intermediate chronotype was associated with poorer diet quality, including lower intakes of plant protein (cross-sectional: ß = -0.63 ± 0.24, P < 0.01; prospective: ß = -0.62 ± 0.26, P = 0.01), fiber (cross-sectional: ß = -2.19 ± 0.65, P < 0.001; prospective: ß = -2.39 ± 0.66, P < 0.001), and fruits and vegetables (cross-sectional: ß = -1.24 ± 0.33, P < 0.001; prospective: ß = -1.15 ± 0.36, P = 0.001). Evening chronotype was also associated with higher dietary ED at baseline (ß = 0.20 ± 0.05, P = 0.001) and 1 y (ß = 0.19 ± 0.06, P = 0.001). Dietary ED was a partial mediator of the association between evening chronotype and poorer CVH (24.6 ± 9.1%, P < 0.01). CONCLUSIONS: Evening chronotype could contribute to unhealthful dietary patterns in US women, with higher dietary ED partially mediating the relation between eveningness and poorer CVH. Behavioral interventions to reduce dietary ED might mitigate cardiovascular disease risk in women with evening chronotype.

History of Weight Cycling Is Prospectively Associated With Shorter and Poorer-Quality Sleep and Higher Sleep Apnea Risk in Diverse US Women.

BACKGROUND: Poor sleep and history of weight cycling (HWC) are associated with worse cardiovascular health, yet limited research has evaluated the association between HWC and poor sleep patterns. METHODS: The American Heart Association Go Red for Women Strategically Focused Research Network cohort at Columbia University (n = 506; mean age, 37 ± 15.7 years; 61% racial/ethnic minority) was used to evaluate the cross-sectional associations of HWC and sleep at baseline and the prospective associations of HWC from baseline with sleep at the 1-year visit. History of weight cycling, defined as losing and gaining 10 lb or more at least once (excluding pregnancy), was self-reported. Sleep duration, sleep quality, insomnia severity, and obstructive sleep apnea risk were assessed using the validated Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Berlin questionnaires. Linear and logistic regression models, adjusted for age, race/ethnicity, education, health insurance status, pregnancy history, and menopausal status, were used to evaluate the relation of HWC with sleep. RESULTS: Most women reported 1 or more episodes of weight cycling (72%). In linear models of cross-sectional and prospective data, each additional weight cycling episode was related to shorter sleep duration, poorer sleep quality, longer sleep onset latency, greater insomnia severity, more sleep disturbances, lower sleep efficiency, and higher sleep medication use frequency. In the logistic models, HWC (≥1 vs 0 episodes) was associated with greater odds for short sleep, poor sleep quality, long sleep onset latency (≥26 minutes), high obstructive sleep apnea risk, and sleep efficiency lower than 85%. CONCLUSION: History of weight cycling predicted poor sleep among women, suggesting that weight maintenance may represent an important strategy to promote sleep health. The potential bidirectional relationship between HWC and sleep requires further investigation.

Mild sleep restriction increases 24-hour ambulatory blood pressure in premenopausal women with no indication of mediation by psychological effects.

BACKGROUND: Studies assessing the impact of sleep restriction (SR) on blood pressure (BP) are limited by short study length, extreme SR (<4 hours a night), and lack of attention to psychological distress as a possible mediator. METHODS: A community-based cohort was assembled with 237 women (age 34.1 ±â€¯13.5 years; body mass index 25.4 ±â€¯5.4 kg/m2), and a randomized, crossover, intervention study was conducted in 41 women (24 completed: age 30.2 ±â€¯6.5 years; body mass index 24.3 ±â€¯2.8 kg/m2) to determine the causal effect of SR on BP. Sleep was maintained as usual (HS) or reduced by 1.5 hours a night (SR) for 6 weeks. In the cohort, associations between sleep and psychosocial factors were evaluated using multivariable models adjusted for demographic and clinical confounders. In the intervention study, in-office BP was measured weekly; ambulatory BP was measured at end point. Psychological factors were assessed at baseline and end point. Mixed-model analyses with total sleep time (TST, main predictor), week and fraction of time spent in physical activity (covariates), and subject (random effect) were performed. RESULTS: Among the community cohort, higher perceived stress, stressful events and distress, and lower resilience were associated with shorter sleep, worse sleep quality, and greater insomnia symptoms (P < .05). In the intervention, systolic BP increased as TST decreased (TST × week interaction, [coefficient ±â€¯standard error] -0.0097 ±â€¯0.0046, P = .036). Wake ambulatory diastolic blood pressure (-0.059 ±â€¯0.022, P = .021) and mean arterial pressure (-0.067 ±â€¯0.023, P = .018) were higher after SR versus HS. Psychological distress variables were not affected by TST and did not mediate the effects of SR on BP. CONCLUSIONS: These results suggest that SR influences CVD risk in women via mechanisms independent of psychological stressors.

Sleep Regularity and Cardiometabolic Heath: Is Variability in Sleep Patterns a Risk Factor for Excess Adiposity and Glycemic Dysregulation?

PURPOSE OF REVIEW: Night-to-night variability in sleep patterns leads to circadian disruption and, consequently, could increase cardiometabolic risk. The purpose of this review is to summarize findings from studies published between 2015 and 2020 examining various measures of night-to-night variability in sleep in relation to metabolic syndrome (MetS), type 2 diabetes (T2D), and their risk factors. We illustrate a potential causal pathway between irregular sleep patterns and T2D, highlighting knowledge gaps along the way. RECENT FINDINGS: Across different measures of sleep variability, irregular sleep patterns were associated with poorer cardiometabolic outcomes. Higher standard deviations (SD) across nights of sleep duration and onset or midpoint of sleep were associated with increased odds of having MetS and clusters of metabolic abnormalities as well as greater adiposity and poorer glycemic control. Conversely, greater regularity of rest-activity patterns related to lower risk for T2D. Social jetlag was associated with glycemic dysregulation, adiposity, T2D, and MetS. These associations are often observed in both metabolically healthy and unhealthy individuals; both higher SD of sleep duration and social jetlag relate to poorer glucose regulation in individuals with diabetes. There is consistent evidence of associations of sleep variability with increased risk for adiposity, glucose dysregulation, T2D, and MetS. Although experimental evidence is needed to determine causation, there is support to recommend stabilizing sleep patterns for cardiometabolic risk prevention.

Variability in Sleep Patterns: an Emerging Risk Factor for Hypertension.

PURPOSE OF REVIEW: In this review, we summarize recent epidemiological data (2014-2019) that examine the association of sleep variability with blood pressure (BP), discuss potential underlying mechanisms, and highlight future research directions. RECENT FINDINGS: Higher standard deviations of sleep duration and sleep-onset timing were not related to BP. However, a higher Sleep Regularity Index score was associated with lower odds of hypertension. Studies on social jetlag, a prevalent form of sleep variability, reported null associations. In contrast, lower interdaily stability in circadian rest-activity rhythms, a measure of invariability in sleep-wake cycles between days and synchronization to light and dark cycles, was associated with higher BP and greater hypertension odds, particularly among non-shift workers. Sleep variability is consistently associated with risk factors for hypertension. Evidence on sleep variability and BP is limited and varies depending on the measure used to characterize day-to-day variability in sleep. Studies that identify and utilize a standard definition of sleep variability, incorporate a 24-h ambulatory BP monitoring, and ensure coinciding timing of sleep and BP measurements are necessary to disentangle these relationships.

Challenges, needs, and experiences of recently hospitalized cardiac patients and their informal caregivers.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States. Unpaid family caregivers of patients who experienced a cardiac event may occupy a key position in disseminating continuous health messages to these patients, yet more information is needed to guide the development of educational and behavioral interventions targeting caregivers. OBJECTIVE: The purpose of this qualitative study was to assess the challenges, needs, and personal experiences of cardiac patients and their informal caregivers to explore the types of programs and services that would be most beneficial in promoting adherence to national CVD guidelines among cardiac patients and their caregivers. METHODS: Patients who had been admitted to the cardiovascular service line of a large urban academic medical center and their informal caregivers (N = 38, 63% women, 74% white) participated in semistructured interviews and focus groups. Participants were asked to speak about 4 major categories of their personal experiences: support, challenges, coping, and program delivery, to determine their needs, the kind of educational interventions that would be most helpful to them, and how they would prefer this information/education to be delivered. RESULTS: Both patients and caregivers ranked diet as the most pressing challenge (91% and 78%, respectively). The Internet, television, and social media were the preferred methods of delivery of such programs. Challenges most commonly cited by caregivers and patients included issues related to taking/administering prescribed medications and medication side effects, and mental stress. Caregivers expressed that not knowing what to expect after the patient's discharge from the hospital was a major stressor. CONCLUSION: These findings may inform the development of educational interventions targeted to cardiac caregivers so that they may be more effective in assisting the patients in their care to adhere to national CVD prevention guidelines.

Caregiver status: a simple marker to identify cardiac surgery patients at risk for longer postoperative length of stay, rehospitalization, or death.

BACKGROUND: Patients who have undergone cardiac surgery, especially those with greater comorbidities, may be cared for by family members or paid aides. OBJECTIVE: The purpose of this study was to evaluate the association between having a caregiver among patients who underwent cardiac surgery and clinical outcomes at 1 year. We hypothesized that patients with a caregiver would have longer lengths of stay and higher rehospitalization or death rates 1 year after surgery. METHODS: We studied 665 patients consecutively admitted for cardiac surgery as part of the Family Cardiac Caregiver Investigation To Evaluate Outcomes sponsored by the National Heart, Lung, and Blood Institute. The participants (mean age, 65 years; women, 35%; racial/ethnic minorities, 21%) completed an interviewer-assisted questionnaire to determine caregiver status. Outcomes were documented by a hospital-based information system; demographics/comorbidities, by electronic records. Associations between having a caregiver and outcomes were evaluated by logistic regression, adjusted for demographic and comorbid conditions. RESULTS: At baseline, 28% of the patients (n = 183) had a caregiver (8%, paid; 20%, informal only). Having a caregiver was associated with longer (>7 days) postoperative length of stay in univariate analysis among the patients with paid (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.57-5.74) or informal (OR, 1.55; 95% CI, 1.04-2.31) caregivers versus none; the association remained significant for the patients with paid (OR, 2.13; 95% CI, 1.00-4.55) but not with informal (OR, 1.12; 95% CI, 0.70-1.80) caregivers after adjustment. Having a paid caregiver was significantly associated with rehospitalization/death at 1 year in univariate analysis (OR, 2.09; 95% CI, 1.18-3.69); having an informal caregiver was not (OR, 1.39; 95% CI, 0.94-2.06). Increased odds of rehospitalization/death associated with having a paid caregiver attenuated after adjustment (OR, 1.39; 95% CI, 0.74-2.62). CONCLUSIONS: The patients who underwent cardiac surgery who had a paid caregiver had a significantly longer length of stay independent of comorbidity. The increased risk of rehospitalization/death associated with having a paid caregiver was explained by demographics and comorbidity. These data suggest that caregiver status assessment may be a simple method to identify cardiac surgery patients at increased risk for adverse clinical outcomes.

The role of social support in the relation between chronotype and mental health in a cohort of women from the American Heart Association Go Red for Women Strategically Focused Research Network.

Women are disproportionally affected by psychological distress and lack of social support and are more vulnerable to the negative impact of chronotype on mental health. This study evaluates cross-sectional associations between chronotype and mental health, while assessing the mediating role of social support among women from diverse racial/ethnic backgrounds. Women from the American Heart Association Go Red for Women Research Network were included (N = 506, mean age = 37 ± 15.7, 61% racial/ethnic minority). Chronotype, depression, perceived stress, health-related quality of life, and social support were assessed at baseline using validated self-reported questionnaires. Linear regression and causal mediation analyses were performed. Depression and negative emotionality were higher among women with evening vs. morning/intermediate chronotypes (all p < 0.05). Multivariable analyses adjusted for sociodemographic and clinical confounders showed associations between evening chronotype and higher depression (p = 0.004) and negative emotionality (p = 0.010). However, these associations were no longer significant after adjusting for social support (depression: p = 0.12; negative emotionality: p = 0.18). Social support significantly mediated 44.6% and 45.8% of the total effect of chronotype on depression and negative emotionality, respectively. Social support represents a potential mechanism underlying the associations between eveningness and poor mental health. Chronotype and social support should be considered in interventions for the promotion of mental health in women.

The effects of sustained mild sleep restriction on stress and distress among healthy adults: Findings from two randomized crossover studies.

OBJECTIVE/BACKGROUND: Experimental studies suggest that sleep loss affects psychological outcomes. However, most studies focus on acute severe in-laboratory sleep restriction, with limited ecological validity. This study examines the impact of sustained mild sleep restriction (SR) on stress and distress among healthy adults in a naturalistic home environment. PATIENTS/METHODS: We analyzed data from two randomized crossover studies. Individuals who regularly slept 7-9 h/night completed two 6-wk intervention phases separated by a 6-wk washout: habitual sleep (HS: maintenance of habitual bed and wake times) and SR (delayed bedtime by 1.5 h/night and maintenance of habitual wake time). Adherence to sleep duration requirements was verified with wrist actigraphy and daily sleep diaries during each intervention phase. Measures of perceived stress, subjective anxiety, subjective depression, rumination, and cortisol were collected at baseline and endpoint of each intervention phase. RESULTS: Sixty-two participants (age 36.4 ± 14.0 y, 85.5 % women, 63.3 % racial/ethnic minority) were included in our analyses. Mean total sleep time was 7.4 ± 0.4 h/night during HS and 6.2 ± 0.4 h/night during SR (p < 0.001). Higher perceived stress (3.6 ± 1.0, p = 0.0007) and subjective anxiety (1.1 ± 0.5, p = 0.039) were observed after SR compared to HS. No effect of sleep condition was observed on subjective depression, rumination, and cortisol. CONCLUSIONS: Our findings suggest that prolonged mildly insufficient sleep, similar to what commonly experienced in the real world, can lead to increased perceived stress and subjective anxiety in healthy adults. Addressing sleep loss, even if mild, should be a key component of interventions aimed at promoting mental health in the general population.

Psychosocial factors are associated with sleep disturbances and evening chronotype among women: A brief report from the American Heart Association Go Red for Women Strategically Focused Research Network.

OBJECTIVES: To evaluate associations between psychosocial factors and sleep characteristics commonly linked to cardiovascular disease risk among racially/ethnically diverse women. METHODS: Women from the AHA Go Red for Women cohort (N = 506, 61% racial/ethnic minority, 37 ± 16years) were assessed using self-reported questionnaires. Logistic regression models were adjusted for age, race, ethnicity, education, and insurance. RESULTS: Women with depression had ∼3-fold higher odds of short sleep (95%CI=1.69-4.61), 2-fold higher odds of poor sleep quality and obstructive sleep apnea risk (95%CI=1.42-3.70 and 1.34-4.24), 4-fold higher odds of insomnia (95%CI=2.42-6.59), and greater likelihood of having an evening chronotype (OR:2.62, 95%CI=1.41-4.89). Low social support was associated with insomnia (OR:1.79, 95%CI=1.18-2.71) and evening chronotype (OR:2.38, 95%CI=1.35-4.19). Caregiving was associated with short sleep (OR:1.73, 95%CI=1.08-2.77) and obstructive sleep apnea risk (OR:2.46, 95%CI=1.43-4.22). CONCLUSIONS: Depression, caregiver strain, and low social support are significantly associated with poor sleep and evening chronotype, highlighting a potential mechanism linking these psychosocial factors to cardiovascular disease risk.

Chronic Insufficient Sleep in Women Impairs Insulin Sensitivity Independent of Adiposity Changes: Results of a Randomized Trial.

OBJECTIVE: Insufficient sleep is associated with type 2 diabetes, yet the causal impact of chronic insufficient sleep on glucose metabolism in women is unknown. We investigated whether prolonged mild sleep restriction (SR), resembling real-world short sleep, impairs glucose metabolism in women. RESEARCH DESIGN AND METHODS: Women (aged 20-75 years) without cardiometabolic diseases and with actigraphy-confirmed habitual total sleep time (TST) of 7-9 h/night were recruited to participate in this randomized, crossover study with two 6-week phases: maintenance of adequate sleep (AS) and 1.5 h/night SR. Outcomes included plasma glucose and insulin levels, HOMA of insulin resistance (HOMA-IR) values based on fasting blood samples, as well as total area under the curve for glucose and insulin, the Matsuda index, and the disposition index from an oral glucose tolerance test. RESULTS: Our sample included 38 women (n = 11 postmenopausal women). Values are reported with ±SEM. Linear models adjusted for baseline outcome values demonstrated that TST was reduced by 1.34 ± 0.04 h/night with SR versus AS (P < 0.0001). Fasting insulin (ß = 6.8 ± 2.8 pmol/L; P = 0.016) and HOMA-IR (ß = 0.30 ± 0.12; P = 0.016) values were increased with SR versus AS, with effects on HOMA-IR more pronounced in postmenopausal women compared with premenopausal women (ß = 0.45 ± 0.25 vs. ß = 0.27 ± 0.13, respectively; P for interaction = 0.042). Change in adiposity did not mediate the effects of SR on glucose metabolism or change results in the full sample when included as a covariate. CONCLUSIONS: Curtailing sleep duration to 6.2 h/night, reflecting the median sleep duration of U.S. adults with short sleep, for 6 weeks impairs insulin sensitivity, independent of adiposity. Findings highlight insufficient sleep as a modifiable risk factor for insulin resistance in women to be targeted in diabetes prevention efforts.

Medication adherence is associated with having a caregiver among cardiac patients.

BACKGROUND: Medication non-adherence is a significant contributor to suboptimal control of blood pressure and lipids. PURPOSE: This study determined if having a paid and/or family caregiver was associated with medication adherence in patients hospitalized for cardiovascular disease. METHODS: Consecutive patients admitted to the cardiovascular service at a university medical center who completed a standardized questionnaire about medication adherence and caregiving (paid/professional or family member/friend) were included in this analysis (N = 1,432; 63 % white; 63%male). RESULTS: Among cardiac patients, 39 % reported being prescribed ≥ 7 different medications, and one in four reported being non-adherent to their medication(s). Participants who reported having/planning to have a paid caregiver were 40 % less likely to be non-adherent to their medications compared to their counterparts. The association remained significant after adjustment for demographic confounders and comorbid conditions (OR = 0.49; 95 %CI = 0.29-0.82). CONCLUSION: Cardiac patients with a paid caregiver were half as likely to be non-adherent to medications as those without caregivers.

The association between neighborhood socioeconomic status and clinical outcomes among patients 1 year after hospitalization for cardiovascular disease.

Residing in lower socioeconomic status (SES) neighborhoods is associated with increased risk of morbidity and mortality. Few studies have examined this association for cardiovascular disease (CVD) outcomes in a treated population in New York City (NYC). The purpose of this study was to determine the relationship between neighborhood level poverty and 1-year clinical outcomes (rehospitalization and/or death) among hospitalized patients with CVD. Data on rehospitalization and/or death at 1-year were collected from consecutive patients admitted at a university medical center in NYC from November 2009 to September 2010. NYC residents totaled 2,198. U.S. Census 2000 zip code data was used to quantify neighborhood SES into quintiles of poverty (Q1 = lowest poverty to Q5 = highest poverty). Univariate analyses were used to determine associations between neighborhood poverty and baseline characteristics and comorbidities. A logistic regression analysis was used to calculate odds ratios for the association between quintiles of poverty and rehospitalization/death at 1 year. Fifty-five percent of participants experienced adverse outcomes. Participants in Q5 (9 %) were more likely to be female [odds ratio (OR) = 0.49, 95 % confidence interval (CI) 0.33-0.73], younger (OR = 0.50, 95 % CI 0.34-0.74), of minority race/ethnicity (OR = 18.24, 95 % CI 11.12-29.23), and have no health insurance (OR = 4.79, 95 % CI 2.92-7.50). Living in Q5 was significantly associated with increased comorbidities, including diabetes mellitus and hypertension, but was not a significant predictor of rehospitalization/death at 1 year. Among patients hospitalized with CVD, higher poverty neighborhood residence was significantly associated with a greater prevalence of comorbidities, but not of rehospitalization and/or death. Affordable, accessible resources targeted at reducing the risk of developing CVD and these comorbidities should be available in these communities.

Intuitive and mindful eating to improve physiological health parameters: a short narrative review of intervention studies.

OBJECTIVES: This brief narrative review aims to give an up-to-date overview of intuitive and mindful eating (I/ME) interventions with specific focus on cardiometabolic risk factors, including glucose, lipid profile, blood pressure and inflammatory markers. CONTENT: I/ME intervention studies in adults which measured at least one physiological parameter other than weight were identified from PubMed. The clinical trial/randomized controlled trial filters and publication dates 2001 through April 2021 with variations of the following keywords were applied: intuitive eating, mindful eating, weight neutral. Ten articles were identified. SUMMARY AND OUTLOOK: Of the 10 studies, seven showed I/ME interventions were more effective than control in at least one cardiometabolic outcome, two showed significant I/ME within-group improvements but no between-group differences, and one showed neither within-group nor between-group differences. Specifically, I/ME improved glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with overweight or obesity, blood pressure among participants with overweight and inflammatory markers among post-menopausal women with obesity. However, the positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies: of the six studies that examined glucose regulation, two demonstrated positive outcomes for I/ME group, whereas four found no effect compared to control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements and one of two showed improvements in inflammatory markers. Given these mixed results, more research is needed to understand the possible effectiveness of I/ME to improve cardiometabolic health.

Paradoxical Effects of Prolonged Insufficient Sleep on Lipid Profile: A Pooled Analysis of 2 Randomized Trials.

Background Insufficient sleep is associated with increased cardiovascular disease risk, but causality is unclear. We investigated the impact of prolonged mild sleep restriction (SR) on lipid and inflammatory profiles. Methods and Results Seventy-eight participants (56 women [12 postmenopausal]; age, 34.3±12.5 years; body mass index, 25.8±3.5 kg/m2) with habitual sleep duration 7 to 9 h/night (adequate sleep [AS]) underwent two 6-week conditions in a randomized crossover design: AS versus SR (AS-1.5 h/night). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, and inflammatory markers (CRP [C-reactive protein], interleukin 6, and tumor necrosis factor-α) were assessed. Linear models tested effects of SR on outcomes in the full sample and by sex+menopausal status (premenopausal versus postmenopausal women+men). In the full sample, SR increased high-density lipoprotein cholesterol compared with AS (ß=1.2±0.5 mg/dL; P=0.03). Sex+menopausal status influenced the effects of SR on change in total cholesterol (P-interaction=0.04), LDL-C (P-interaction=0.03), and interleukin 6 (P-interaction=0.07). Total cholesterol and LDL-C decreased in SR versus AS in premenopausal women (total cholesterol: ß=-4.2±1.9 mg/dL; P=0.03; LDL-C: ß=-6.3±2.0 mg/dL; P=0.002). Given paradoxical effects of SR on cholesterol concentrations, we explored associations between changes in inflammation and end point lipids under each condition. Increases in interleukin 6 and tumor necrosis factor-α during SR tended to relate to lower LDL-C in premenopausal women (interleukin 6: ß=-5.3±2.6 mg/dL; P=0.051; tumor necrosis factor-α: ß=-32.8±14.2 mg/dL; P=0.027). Conclusions Among healthy adults, prolonged insufficient sleep does not increase atherogenic lipids. However, increased inflammation in SR tends to predict lower LDL-C in premenopausal women, resembling the "lipid paradox" in which low cholesterol associates with increased cardiovascular disease risk in proinflammatory conditions. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02835261, NCT02960776.