We observed a gap between patients receiving and absorbing or retaining information on self-care for congestive heart failure supplied by health care providers. Self-care education needs to be directed to outpatients in addition to inpatients.

Estimates of CAM use in this nationally representative sample were considerably lower than have been reported in previous surveys. Most CAM therapies are used by US adults in conjunction with conventional medical services.

: Neighborhood walkability, food availability, safety, and social cohesion may be mechanisms that link neighborhoods to hypertension.

Background Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding trends in coronary heart disease (CHD) mortality rates. Methods and Results We estimated race and gender specific trends in the incidence of hospitalized MI, case-fatality and CHD mortality from community-wide surveillance and validation of hospital discharges and of in- and out-of-hospital deaths among 35 to 74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) Study. Biomarker adjustment accounted for change from reliance on cardiac enzymes to widespread use of troponin measurements overtime. Between 1987 and 2008, a total of 30,985 fatal or non-fatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7 percent per year among men and 4.3 percent per year among women. Rates of both in- and out-of-hospital CHD death declined significantly throughout the period. Age- and biomarker adjusted average annual rate of incident MI decreased 4.3 percent among white men, 3.8 percent among white women, 2.9 percent among black women, and 1.5 percent among black men. Declines in CHD mortality and MI incidence were greater in the second decade (1997–2008). Failure to account for biomarker shift would have masked declines in incidence, particularly among blacks. Age-adjusted 28-day case-fatality after hospitalized MI declined 4.2 percent per year among white men and 3.6 percent per year among black men, 2.6 percent per year among white women, and 2.4 percent per year among black women. Conclusions Although these findings from 4 communities may not directly generalize to blacks and whites in the entire US, we observed significant declines in MI incidence, primarily due to downward trends in rates between 1997 and 2008.

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OBJECTIVE —The prevalence of type 2 diabetes among Hispanic and Asian Americans is increasing. These groups are largely comprised of immigrants who may be undergoing behavioral and lifestyle changes associated with development of diabetes. We studied the association between acculturation and diabetes in a population sample of 708 Mexican-origin Hispanics, 547 non–Mexican-origin Hispanics, and 737 Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA). RESEARCH DESIGN AND METHODS —Diabetes was defined as fasting glucose ≥126 mg/dl and/or use of antidiabetic medications. An acculturation score was calculated for all participants using nativity, years living in the U.S., and language spoken at home. The score ranged from 0 to 5 (0 = least acculturated and 5 = most acculturated). Relative risk regression was used to estimate the association between acculturation and diabetes. RESULTS —For non–Mexican-origin Hispanics, the prevalence of diabetes was positively associated with acculturation score, after adjustment for sociodemographics. The prevalence of diabetes was significantly higher among the most acculturated versus the least acculturated non–Mexican-origin Hispanics (prevalence ratio 2.49 [95% CI 1.14−5.44]); the higher the acculturation score is, the higher the prevalence of diabetes ( P for trend 0.059). This relationship between acculturation and diabetes was partly attenuated after adjustment for BMI or diet. Diabetes prevalence was not related to acculturation among Chinese or Mexican-origin Hispanics. CONCLUSIONS —Among non–Mexican-origin Hispanics in MESA, greater acculturation is associated with higher diabetes prevalence. The relation is at least partly mediated by BMI and diet. Acculturation is a factor that should be considered when predictors of diabetes in racial/ethnic groups are examined.

OBJECTIVE —We characterized dietary patterns and their relation to incident type 2 diabetes in 5,011 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). RESEARCH DESIGN AND METHODS —White, black, Hispanic, and Chinese adults, aged 45–84 years and free of cardiovascular disease and diabetes, completed food frequency questionnaires at baseline (2000–2002). Incident type 2 diabetes was defined at three follow-up exams (2002–2003, 2004–2005, and 2005–2007) as fasting glucose >126 mg/dl, self-reported type 2 diabetes, or use of diabetes medication. Two types of dietary patterns were studied: four empirically derived (principal components analysis) and one author-defined (low-risk food pattern) as the weighted sum of whole grains, vegetables, nuts/seeds, low-fat dairy, coffee (positively weighted), red meat, processed meat, high-fat dairy, and soda (negatively weighted). RESULTS —The empirically derived dietary pattern characterized by high intake of tomatoes, beans, refined grains, high-fat dairy, and red meat was associated with an 18% greater risk (hazard ratio per 1-score SD 1.18 [95% CI 1.06–1.32]; P trend = 0.004), whereas the empirically derived dietary pattern characterized by high intake of whole grains, fruit, nuts/seeds, green leafy vegetables, and low-fat dairy was associated with a 15% lower diabetes risk (0.85 [0.76–0.95]; P trend = 0.005). The low-risk food pattern was also inversely associated with diabetes risk (0.87 [0.81–0.99]; P trend = 0.04). Individual component food groups were not independently associated with diabetes risk. Associations were not modified by sex or race/ethnicity. CONCLUSIONS —Multiple food groups collectively influence type 2 diabetes risk beyond that of the individual food groups themselves.

Background A simple and effective Heart Failure (HF) risk score would facilitate the primary prevention and early diagnosis of HF in general practice. We examined the external validity of existing HF risk scores, optimized a 10-year HF risk function, and examined the incremental value of several biomarkers, including NT-proBNP. Methods and Results During 15.5 years (210,102 person-years of follow-up), 1487 HF events were recorded among 13,555 members of the bi-ethnic Atherosclerosis Risk in Communities (ARIC) Study cohort. The area under curve (AUC) from the Framingham-published, Framingham-recalibrated, Health ABC HF recalibrated, and ARIC risk scores were 0.610, 0.762, 0.783, and 0.797, respectively. Upon addition of NT-pro-BNP, the optimism corrected AUC of the ARIC HF risk score increased from 0.773 (95% CI: 0.753 – 0.787) to 0.805 (95% CI: 0.792 – 0.820). Inclusion of NT-proBNP improved the overall classification of re-calibrated Framingham, re-calibrated Health ABC, and ARIC risk scores by 18%, 12%, and 13%, respectively. In contrast, Cystatin C or hs-CRP did not add towards incremental risk prediction. Conclusions The ARIC HF risk score is more parsimonious yet performs slightly better than the extant risk scores in predicting 10-year risk of incident HF. The inclusion of NT-proBNP markedly improves HF risk prediction. A simplified risk score restricted to a patient’s age, race, gender, and NT-proBNP performs comparably to the full score (AUC = 0.745), and is suitable for automated reporting from laboratory panels and electronic medical records.