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RECOMMENDATIONS RELATED TO PREVENTION

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Prevention of Adverse Lifestyles and Related Risk Factors

  • Advance understanding of key determinants of elevated CVD risk factors, including the rise in risk factor levels with age, to strengthen the ability to influence them.
  • Conduct trials of the effects on blood pressure and lipoprotein profiles of dietary patterns and other lifestyle changes, including smoking and physical activity.
  • Identify optimal strategies for the primary prevention of elevated risk factors.
  • Study interactions between genetic susceptibility and adverse lifestyles.

Institute-initiated and investigator-initiated research programs are testing interventions for preventing adverse lifestyles and preventing development of CVD risk factors. Topics include prevention of obesity, prevention of smoking, improvement in dietary practices, preventing the decline in physical activity, and promoting increases in physical activity. Various settings and population subgroups are being studied, and several studies focus on children. Some studies focus on the role of psychosocial factors, such as hostility, depressive symptoms, and socioeconomic status, on behavioral risk factors such as poor diet, lack of physical activity, and smoking, including how psychosocial risk factors in early life (e.g., harsh family environments, low socioeconomic status, depression, aggression/hostility) may lead to the adoption of behavioral risk factors in adulthood. Gene-intervention interactions are being examined in some studies.

Investigator-Initiated Studies

A prospective study of diet and CVD (Jiang He, PI)
Aerobic exercise and BP, a meta-analysis (George Kelley, PI)
An interactive multimedia HRA for behavior change (A. Blair Irvine, PI)
Behavioral factors in atherosclerosis progression (Thomas Kamarck, PI)
Biobehavioral determinants of obesity in Black women (Robert Klesges, PI)
Caffeine effects on cardiovascular reactivity (James Lane, PI)
Caffeine influences on exercise and psychological stress (William Lovallo, PI)
Characterization of the relationship between sodium intake and BP control (Mark Espeland, PI)
CHD risk, behavioral stress, and reproductive hormones (Karen Matthews, PI)
CV risk factors in minority preschool children (Christine Williams, PI)
CVD risk and health in postmenopausal phytoestrogen users (Donna Kritz-Silverstein, PI)
Dietary etiologies of heart disease and cancer (Walter Willett, PI)
Dietary patterns and risk of CVD (Frank Hu, PI)
Dietary intervention methods for clinical trials (Rena Wing, PI)
Dose response to exercise and cardiovascular health (Michael Perri, PI)
Enhancing cardiovascular health after menopause (Kathleen Light, PI)
Enhancing exercise adherence in college students (Janet Buckworth, PI)
Epidemiology studies of dietary fiber and blood pressure (Jiang He, PI)
Exercise and psychological stress induced ischemia (David Sheps, PI)
Exercise dose for CV health of obese girls (Bernard Gutin, PI)
Exercise level effects on CHD risk factors (Paul Williams, PI)
Increased physical activity in African-American women (Deborah Young, PI)
Increasing physical activity in low-income women (Abby King, PI)
Increasing low-fat school/worksite vending choices (Simone French, PI)
Increasing availability of low-fat foods in high schools (Simone French, PI)
International Population Study on Macronutrients and Blood Pressure (INTERMAP) (Jeremiah Stamler, PI)
Latitude within a NCEP Step 1 diet: an optimal diet (John Farquhar, PI)
Middle school physical activity and nutrition (M-SPAN) (James Sallis, PI)
Midlife women become active and improve health (Michelle Segar, PI)
Physical activity training for children with CD-Interactive (Robert Rager, PI)
Population-wide smoking cessation/prevention program (Robert Klesges, PI)
Prevention of overweight in preschool minority children (Marian Fitzgibbon, PI)
Project Andale: increasing exercise in Hispanic women (Melbourne Hovell, PI)
Project PRIME - applications of lifestyle exercise (Steven Blair, PI)
Promotion of physical activity in high school girls (Russell Pate, PI)
Prospective study of health in runners and walkers (Paul Williams, PI)
Psychophysiologic stress, exercise, and autonomic control (Richard Sloan, PI)
Reducing television viewing to prevent childhood obesity (Thomas Robinson, PI)
School- and family-based obesity prevention for children (Thomas Robinson, PI)
Smoking onset in a biethnic population (Robert Klesges, PI)
Stress and myocardial ischemia: mechanisms and treatment (James Blumenthal, PI)
Stress, estrogen, opioids, and atherogenesis in women (James McCubbin, PI)
Trial of Aspirin and Vitamin E in Women (Julie Buring, PI)

Institute-Initiated Studies and Research Programs

Activity Counseling Trials (ACT)
Children and Adolescent Trial of Cardiovascular Health (CATCH)
CVD Nutrition Education for Low-Literacy Skills
Diet and Cardiovascular Disease Risk in Children and Adolescents
Dietary Approaches to Stop Hypertension (DASH) and DASH-Sodium
Girls health Enrichment Multi-Site Studies (GEMS)
Innovative Approaches to Prevention of Obesity
Innovative Approaches to Disease Prevention through Behavior Change
Pathways
Physical Activity and Cardiopulmonary Health
Premier: Lifestyle Interventions for Blood Pressure Control
Smoking Cessation Strategies for Minorities
Trial of Activity in Adolescent Girls (TAAG)
Trials of Hypertension Prevention II (TOHP II)

Workshops and Special Emphasis Panels

Special Emphasis Panel on Intervention Studies in Children and Adolescents to Prevent CVD
Workshop on Maintenance of Behavior Change in Cardiovascular Risk Reduction
Workshop on Assessing Risk for Coronary Heart Disease
Workshop on Sodium and Blood Pressure
National Conference on Cardiovascular Disease Prevention
Working Group on Adherence to Medical and Lifestyle Interventions

Control of High Blood Pressure and Other Established CVD Risk Factors

  • Develop and evaluate improved prevention measures, for individuals and populations, for control of high blood pressure, adverse blood lipids/lipoprotein patterns, and smoking.
  • Conduct trials to determine optimal initial and long-term combinations of lifestyle and drug therapy to reduce high blood pressure, modify lipoprotein patterns, and prevent CVD complications.
  • Conduct trials among segments of the population with lower levels of elevated blood pressure ("high normal"), moderately high (borderline) total cholesterol levels, or low HDL levels.

Institute-initiated and investigator-initiated research programs are testing interventions for controlling CVD risk factors in various population groups and settings. Topics include weight reduction in obesity, effects of dietary patterns on blood pressure, effects of dietary interventions on elevated LDL-cholesterol, the role of physical activity in reducing elevated blood pressure, methods for smoking cessation, effects of differing antihypertensive and blood lipid treatments on CVD mortality, weight reduction to prevent CVD in diabetes patients, and medical treatments to prevent CVD in diabetes patients. Some studies are in participants with "high normal" or "higher than optimal" blood pressure levels or are examining subgroups defined by risk factor level.

Investigator-Initiated Studies

Aerobic exercise and BP, a meta-analysis (George Kelley, PI)
Assessing the value of cigarette smoking (Suzanne Mitchell, PI)
Bingeing and weight gain upon smoking cessation (Cynthia Pomerleau, PI)
Blood pressure control: racial and psychosocial influences (Kathleen Light, PI)
Characterization of the relationship between sodium intake and BP control (Mark Espeland, PI)
Cholesterol reduction effects on behavior (Matthew Muldoon, PI)
Combining scheduled reduction with weight control (William Riley, PI)
CVD risk and health in postmenopausal phytoestrogen users (Donna Kritz-Silverstein, PI)
CVD trends 1980-1991: a gender specific perspective (Carol Derby, PI)
Diet adherence intervention for dyslipidemia (DietAid) (Robert Friedman, PI)
Dietary fat, plasma lipids and other CHD risk factors (Alice Lichtenstein, PI)
Dietary patterns and risk of CVD (Frank Hu, PI)
Dietary intervention methods for clinical trials (obesity treatment) (Robert Jeffery, PI)
Dose response to exercise and cardiovascular health (Michael Perri, PI)
Epidemiology studies of dietary fiber and blood pressure (Jiang He, PI)
Exercise training in older hypertensive men and women (Kerry Stewart, PI)
Exercise adherence in a behavioral weight loss program (John Jakicic, PI)
Fat reduction intervention trial in African-Americans (Theresa Prewitt, PI)
Fluoxetine as a quit smoking aid for depression-prone (Bonnie Spring, PI)
Genetic epidemiology of responses to antihypertensives (Stephen Turner, PI)
Improving participation in worksite smoking programs (Robert Jeffery, PI)
Individualized smoking cessation via the Internet (Russ Reynolds, PI)
Interactive multimedia intervention to reduce CHD (A. Blair Irvine, PI)
Latitude within a NCEP Step 1 diet: an optimal diet (John Farquhar, PI)
Matching antidepressant treatment for smoking cessation (Raymond Niaura, PI)
Meta-analysis of post-smoking cessation weight gain (Leslie Robinson, PI)
Models of demonstration and evaluation of weight loss study (Judith Wylie-Rosett, PI)
Pediatric smoking cessation study (Susan Curry, PI)
Personalized self-help smoking cessation (Peter Berger, PI)
Population-wide smoking cessation/prevention program (Robert Klesges, PI)
Prevention and management of CHD in women: A CD-ROM (John McKinlay, PI)
Promoting smoking cessation in hospital patients (Harry Lando, PI)
Promoting long-term dietary change to reduce CVD risk (Michaela Kiernan, PI)
Promoting smoking cessation and reducing weight gain (Bonnie Spring, PI)
Smoking, estrogen and cardiovascular health in women (Susan Girdler, PI)
Smoking as a vital sign - impact on practice and cessation (Michael Fiore, PI)
Smoking cessation/reduction in pregnancy trial (SCRIPT) (Richard Windsor, PI)
Smoking cessation program for low-income pregnant women (Thomas Lasater, PI)
Smoking cessation in the elderly (Robert Klesges, PI)
Stress reduction and hypertensive heart disease (Robert Schneider, PI)
Stress and anger management for those with hypertension (Charles Lollis, PI)
Systems to enhance provider counseling in hyperlipidemia (Ira Ockene, PI)
The effect of heart disease education on older women (Noreen Clark, PI)
Treatment of hypertension with two exercise intensities (Joel Posner, PI)
Trial of Nonpharmacologic Interventions in the Elderly (Paul Whelton and John Kostis, PIs)
Women's Initiative on No smoking - WINS randomized trial (Erica Froelicher, PI)
Women's Antioxidant and Cardiovascular Study (WACS) (Joann Manson, PI)

Institute-Initiated Studies and Research Programs

Activity Counseling Trial (ACT)
Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack (ALLHAT)
Dietary Approaches to Stop Hypertension (DASH) and DASH-Sodium
Dietary Intervention Study in Children (DISC)
Improving Hypertensive Care for Inner City Minorities
Prevention and Treatment of Hypertension Study (PATHS)
Physical Activity and Cardiopulmonary Health
Premier: Lifestyle Interventions for Blood Pressure Control
Prevention and Treatment of Hypertension Study (PATHS)
Prevention of Cardiovascular Disease in Diabetes Mellitus
Smoking Cessation Strategies for Minorities
Study of Health Outcomes of Weight Loss (SHOW)
Trials of Hypertension Prevention II (TOHP II)

Workshops and Special Emphasis Panels

Special Emphasis Panel on Macrovascular Disease in Diabetes Mellitus
Special Emphasis Panel on Intervention Studies in Children and Adolescents to Prevent CVD
Workshop on Maintenance of Behavior Change in Cardiovascular Risk Reduction
Workshop on Sodium and Blood Pressure
National Conference on Cardiovascular Disease Prevention
Working Group on Adherence to Medical and Lifestyle Interventions

Reduction of CVD Events, Disability, and Death Associated With Socioeconomic Differences (and ethnicity)

  • Clarify roles of adverse lifestyles, elevated risk factors, and diminished access to health care in causing higher CVD rates and less favorable trends among more vulnerable segments of the population.
  • Conduct trials and demonstration research projects to determine effective interventions for preventing CVD risk in families and communities in all population strata.

Several intervention trials are examining approaches to health behavior intervention in minority or low SES population groups. In addition, studies are refining measurement of SES and examining the impact of rural and urban environments, interactions between race and SES, the impact of early experience and ethnicity on the emergence of adverse psychosocial risk profiles, SES and precursors of adult lifestyles and behaviors from childhood, the association between psychosocial risk factors and biological mediators, stress management interventions, and neurobiological bases of clustering of risk factors. A small-grants program encourages the analysis of existing data sets from large-scale trials and epidemiologic studies, and the goal of several of the supported projects is to determine the influence of SES on health. Multi-center Institute-initiated studies are examining the effects of the interventions in subgroups defined by SES and ethnicity, or are focusing specifically on minority groups (e.g., Pathways, a study of obesity prevention in Native American schoolchildren, and GEMS, a study of obesity prevention in African-American adolescent girls).

Investigator-Initiated Studies

Antecedents of Type A behavior pattern (Karen Matthews, PI)
Antecedents of hypertension: role of race and stress (Frank Treiber, PI)
Behavioral Factors in Coronary Heart Disease (S.L. Syme, PI)
Behavioral factors in coronary heart disease (S.L. Syme, PI)
Biobehavioral determinants of obesity in Black women (Robert Klesges, PI)
Blood pressure control: racial and psychosocial influences (Kathleen Light, PI)
Community-site coronary risk control in Black families (Diane Becker, PI)
CV risk factors in minority preschool children (Christine Williams, PI)
CVD knowledge/morbidity - SES cohort studies (Sharon Davis, PI)
Diet and activity in Mexican-American and Anglo children (Philip Nader, PI)
Do hostility and stress predict CV mortality in MRFIT (Karen Matthews, PI)
Early experience, serotonin, and adult function (Redford Williams, PI)
Fat reduction intervention trial in African-Americans (Theresa Prewitt, PI)
Hostility, depression, social environment and CHD risk (John Barefoot, PI)
Increased physical activity in African-American women (Deborah Young, PI)
Increasing physical activity in low-income women (Abby King, PI)
Lay-led smoking cessation approach for SE Asian men (Moon Cheng, PI)
Mechanisms underlying psychosocial association with ischemic heart disease (George Kaplan, PI)
Neighborhood environments and cardiovascular disease (Anna Diez-Roux, PI)
Neighborhood environments and cardiovascular disease (Anna Diez-Roux, PI)
Overweight adults: ethnic SES and behavioral influences (Marilyn Winkleby, PI)
Pediatric smoking cessation study (Susan Curry, PI)
Project Andale: increasing exercise in Hispanic women (Melbourne Hovell, PI)
Smoking cessation program for low income pregnant women (Thomas Lasater, PI)
Smoking cessation in an urban African-American community (Diane Becker, PI)
Social and occupational influences on health and illness (Michael Marmot, PI)
Sociodemographic regulation of CV function and structure (Frank Treiber, PI)
Stress reduction and hypertensive heart disease (Robert Schneider, PI)
Stress reduction and CVD morbidity and mortality in Blacks (Robert Schneider, PI)
Stress reduction and prevention of hypertension in Blacks (Robert Schneider, PI)
The Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) (George Kaplan, PI)
The Whitehall II Study (Michael Marmot, PI)

Institute-Initiated Studies and Research Programs

Dietary Approaches to Stop Hypertension (DASH) and DASH-Sodium
Pathways
Rapid Early Action for Coronary Treatment (REACT)
Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD)
Premier: Lifestyle Interventions for Blood Pressure Control
Girls health Enrichment Multi-Site Studies (GEMS)
Smoking Cessation Strategies for Minorities
Improving Hypertensive Care for Inner City Minorities
CVD Nutrition Education for Low-Literacy Skills
Physical Activity and Cardiopulmonary Health
Diet and Cardiovascular Disease Risk in Children and Adolescents
Methodology and Measurement in the Behavioral and Social Sciences
Socioeconomic Status and Health Across the Life Course
Innovative Approaches to Disease Prevention through Behavior Change
Innovative Approaches to Prevention of Obesity

Workshops and Special Emphasis Panels

Conference on Socioeconomic Status and Cardiovascular Health and Disease

Prevention of Hypertension, Dyslipidemia, Smoking, and Atherosclerosis Beginning in Youth

  • Conduct trials and demonstration research projects focused on the prevention of risky behaviors and elevated risk in individuals, families, and populations.

Institute-initiated research programs and several investigator-initiated studies are examining determinants of the early development of CVD risk factors or testing interventions to improve lifestyle behaviors and prevent risk factor development.

Investigator-Initiated Studies

Antecedents of the Type A behavior pattern (Karen Matthews, PI)
Antecedents of hypertension: role of race and stress (Frank Treiber, PI)
Behavioral factors in coronary heart disease (S.L. Syme, PI)
CV risk factors in minority preschool children (Christine Williams, PI)
Enhancing exercise adherence in college students (Janet Buckworth, PI)
Exercise dose for CV health of obese girls (Bernard Gutin, PI)
Hemodynamics of cardiovascular reactivity in youth (Bruce Alpert, PI)
Increasing low-fat school/worksite vending choices (Simone French, PI)
Middle school physical activity and nutrition (M-SPAN) (James Sallis, PI)
Physical activity training for children with CD-Interactive (Robert Rager, PI)
Prevention of overweight in preschool minority children (Marian Fitzgibbon, PI)
Promotion of physical activity in high school girls (Russell Pate, PI)
Psychophysiology of cardiovascular reactivity (Neil Schneiderman, PI)
Reducing television viewing to prevent childhood obesity (Thomas Robinson, PI)
School- and family-based obesity prevention for children (Thomas Robinson, PI)
Smoking onset in a biethnic population (Robert Klesges, PI)

Institute-Initiated Studies and Research Programs

Children and Adolescent Trial of Cardiovascular Health (CATCH)
Diet and Cardiovascular Disease Risk in Children and Adolescents
Girls health Enrichment Multi-Site Studies (GEMS)
Pathways
Studies of Children's Activity and Nutrition (SCAN)
Trial of Activity in Adolescent Girls (TAAG)

Workshops and Special Emphasis Panels

Special Emphasis Panel on Intervention Studies in Children and Adolescents to Prevent CVD
Workshop on Assessing Risk for Coronary Heart Disease
Workshop on Sodium and Blood Pressure
National Conference on Cardiovascular Disease Prevention

Improvement of Population-Wide Prevention Strategies

  • Conduct public health trials and research demonstrations to identify more effective strategies for community organization, health communication, and health promotion, including educational, economic, and regulatory approaches to improving population behaviors and CVD risk status.

Several Institute- and investigator-initiated research programs are testing interventions aimed at modifying the environment, which can influence health behaviors and CVD risk factors. Studies are being conducted in families, schools, worksites, and communities.

Investigator-Initiated Studies

CV risk factors in minority preschool children (Christine Williams, PI)
Enhancing exercise adherence in college students (Janet Buckworth, PI)
Improving participation in worksite smoking programs (Robert Jeffery, PI)
Increasing low-fat school/worksite vending choices (Simone French, PI)
Increasing availability of low-fat foods in high schools (Simone French, PI)
Middle school physical activity and nutrition (M-SPAN) (James Sallis, PI)
Population-wide smoking cessation/prevention program (Robert Klesges, PI)
Prevention of overweight in preschool minority children (Marian Fitzgibbon, PI)
Promotion of physical activity in high school girls (Russell Pate, PI)
School- and family-based obesity prevention for children (Thomas Robinson, PI)

Institute-Initiated Studies and Research Programs

Children and Adolescent Trial of Cardiovascular Health (CATCH)
Pathways
Rapid Early Action for Coronary Treatment (REACT)
Trial of Activity in Adolescent Girls (TAAG)
Workshops and Special Emphasis Panels

Workshop on Community Studies

Special Emphasis Panel on Intervention Studies in Children and Adolescents to Prevent CVD
Workshop on Maintenance of Behavior Change in Cardiovascular Risk Reduction
National Conference on Cardiovascular Disease Prevention

Clarification of the Insulin-Glucose-Atherosclerosis Association

  • Conduct trials to determine effective ways of modifying the sequence of adverse metabolic events through changes in caloric balance, body weight, fat distribution, dietary composition, and physical activity.

Most investigator-initiated studies have not focused on this topic, but two major Institute-initiated studies are testing approaches to preventing CVD in patients with diabetes, one via weight loss and the other via control of glycemia, blood pressure, and dyslipidemia. In addition, many of the studies of overweight and physical activity (listed previously) are pursuing this area as secondary objectives.

Investigator-Initiated Studies

Psychophysiology of Cardiovascular Reactivity (Neil Schneiderman, PI) (Program Project)

Institute-Initiated Studies

Prevention of Cardiovascular Disease in Diabetes Mellitus
Study of Health Outcomes of Weight Loss (SHOW)
Workshops and Special Emphasis Panels
Special Emphasis Panel on Macrovascular Disease in Diabetes Mellitus

Development of Technical Resources and Improved Measurement Techniques

  • Conduct further research on methods to characterize and quantify lifestyles, genetic susceptibility, risk factors, and stages of CVD.
  • Foster collaborative research involving epidemiologists, population geneticists, laboratory scientists, molecular geneticists, and clinical investigators to elucidate relationships between genetic susceptibility and behavioral and environmental determinants of CVD.

A variety of investigator-initiated studies has been funded to develop and adapt new research techniques for epidemiologic and behavioral research. Topics include procedures for mental stress testing, cardiovascular reactivity, collecting biological samples in the field, development of psychological test instruments (including a variety of specialized tests for assessing health quality of life), and measurement of body composition.

Investigator-Initiated Studies

An interactive multimedia HRA for behavior change (A. Blair Irvine, PI)
Behavioral treatment of Raynaud's phenomenon (Robert Freedman, PI)
Dynamic autonomic assessment in diabetic neuropathy (Barry Hurwitz, PI)
Energy balance in young black and white NGHS women (Sue Kimm, PI)
Mental Stress, autonomic function, and heart disease (Andrew Taylor, PI)
Multifrequency impedance and body composition (William Chumlea, PI)

Institute-Initiated Studies and Research Programs

Evaluation of Adherence Interventions in Clinical Trials
Methodology and Measurement in the Behavioral and Social Sciences

Expansion of Research Training Programs in Disciplines Relevant to CVD Prevention and Epidemiology

  • Expand programs for training new investigators in epidemiology and in approaches to individual and population-wide prevention and their evaluation.
  • Develop epidemiological and prevention skills in clinical training programs at all levels.

An RFA was released for the Nutrition Academic Award (NAA) training program, which was initiated to fund medical schools to develop, implement, and evaluate curricula and other training opportunities for medical students, residents, and ancillary medical personnel to learn nutrition principles and clinical practice skills, with an emphasis on preventing cardiovascular disease.

An RFA was released for a Clinical Research Curriculum Award (K30) to award institutions to address, in part, the NIH's initiative to improve the quality of training in clinical research. The purpose of the award is to support the development of new didactic programs in clinical research at institutions that do not currently offer such programs, or to support or expand programs in institutions with existing didactic programs. Clinical research includes patient-oriented research, epidemiologic and behavioral studies, and outcomes of health services research. At this time there are 35 such awards funded.

Awards are also available to support the career development of investigators who have made a commitment to focus their research endeavors on patient-oriented research through the Mentored Patient-Oriented Research Career Development Award. This mechanism provides support for a period of supervised study and research for clinically trained professionals who have the potential to develop into productive, clinical investigators focusing on patient-oriented research. Patient-oriented research is defined as research conducted with human subjects, including: 1) mechanisms of human disease; 2) therapeutic interventions; 3) clinical trials, and; 4) the development of new technologies.

Institute-Initiated Training Programs

Nutrition Academic Award
Clinical Research Curriculum Award (K30) (1998)
Mentored Patient-Oriented Research Career Development Award (K23) (1998)


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Last Updated February 2000




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