Context Recent recommendations from the American Heart Association aim to improve cardiovascular health by encouraging the general population to meet 7 cardiovascular health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet. Objective To examine time trends in cardiovascular health metrics and to estimate joint associations and population-attributable fractions of these metrics in relation to all-cause and cardiovascular disease (CVD) mortality risk.

ObjectiveComparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality.DesignNon-institutionalised population surveys.Setting and participantsEngland (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years.OutcomesStroke and IHD mortality rates were plotted against countries’ specific prevalence data.ResultsMean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality.ConclusionsWhile the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.

The high prevalence of hypovitaminosis D among African American women warrants further examination of vitamin D recommendations for these women. The determinants of hypovitaminosis D among women should be considered when these women are advised on dietary intake and supplement use.

Background: Relatively few studies have focused on who is at risk for weight regain after weight loss and how to prevent it. The objectives of this study were to determine the prevalence and predictors of weight regain in U.S. adults who had experienced substantial weight loss. Methods:Data were analyzed from the 1999 -2002 National Health and Nutrition Examination Survey (NHANES). This study examined U.S. adults aged 20 -84 years who were overweight or obese at their maximum weight (body mass index Ն25) and had experienced substantial weight loss (weighed 10% less than their maximum weight 1 year before they were surveyed) (nϭ1310). Results:Compared to their weight 1 year ago, 7.6% had continued to lose weight (Ͼ5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (Ͼ5%). Factors associated with weight regain (vs weight maintenance or loss) included Mexican American ethnicity (versus non-Hispanic white) (odds ratio [OR]ϭ2.0; 95% confidence interval [CI]ϭ1.3-3.1), losing a greater percentage of maximum weight (Ն20% vs 10% to Ͻ15%) (ORϭ2.8; 95% CIϭ2.0 -4.1), having fewer years since reaching maximum weight (2-5 years vs Ͼ10 years) (ORϭ2.1; 95% CIϭ1.2-3.7), reporting greater daily screen time (Ն4 hours vs 0 -1 hour) (ORϭ2.0; 95% CIϭ1.3-3.2), and attempting to control weight (ORϭ1.8; 95% CIϭ1.1-3.0). Finally, weight regain was higher in those who were sedentary (ORϭ1.8; 95% CIϭ1.0 -3.0) or not meeting public health recommendations for physical activity (ORϭ2.0; 95% CIϭ1.2-3.5).Conclusions: How to achieve the skills necessary for long-term maintenance of weight loss in the context of an obesogenic environment remains a challenge.

Context Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovascular disease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures. Objective To assess the association between consumption of added sugars and blood lipid levels in US adults. Design, Setting, and Participants Cross-sectional study among US adults (n=6113) from the National Health and Nutrition Examination Survey (NHANES) 1999–2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (<5% [reference group], 5%–<10%, 10%–<17.5%, 17.5%–<25%, and ≥25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated. Main Outcome Measures Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (<40 mg/dL for men; <50 mg/dL for women), high triglyceride levels (≥150 mg/dL), high LDL-C levels (≥130 mg/dL), or high ratio of triglycerides to HDL-C (>3.8). Results were weighted to be representative of the US population. Results A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P<.001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P<.001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P=.047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (≥10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (<5% added sugars). Conclusion In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.

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Our findings suggest that a higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality, and higher sodium intake is associated with increased total mortality in the general US population.

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