Introduction Transgender women have been reported to have a high burden of cardiovascular disease (CVD) and risk factors based largely on surveys. Our aim was to describe the prevalence of CVD and associated comorbidities among a cohort of older transgender women referred to cardiology as part of their gender-affirming care. Methods This was a retrospective, cross-sectional study of transgender women at a single institution from 2017 to 2019. Results Fifty-two consecutive patients were included. The most common reasons for referral were cardiac risk factor management (45%) and pre-operative cardiac risk stratification prior to gender-affirming surgery (35%). The mean age was 57 ± 10 years, 87% were white, and 92% had insurance coverage. Forty-eight patients (92%) were taking gender-affirming hormone therapy; 5 had undergone breast augmentation, 4 had undergone orchiectomy, and 2 had undergone vaginoplasty. The most common comorbidities were depression and/or anxiety (63%), obesity (58%), and hyperlipidemia (54%). Excluding aldosterone antagonists, 46% were on cardiac medications; changes were recommended for 25% of patients: new prescriptions in 9, dose adjustments in 5, and discontinuations in 4. According to the pooled cohort equation, the 10-year risk of atherosclerotic CVD was 9.4 ± 7.7% when the study population was calculated as male and 5.2 ± 5.1% when calculated as female ( p <0.001). For patients who completed exercise testing, the functional aerobic capacity was fair (77.6 ± 21.4%) when calculated as male and average (99.5 ± 27.5%) as female ( p < .0001); there was inconsistency in sex used for calculating the result on the formal report. Conclusions Older transgender women may have an underestimated prevalence of CVD and its risk factors. More research is needed to identify cardiovascular health profiles, improve practice consistency, and establish normative values for transgender patients.
Background There is a scarcity of validated rapid dietary screening tools for patient use in the clinical setting to improve health and reduce cardiovascular risk. The Healthy Eating Index (HEI) 2015 measures compliance with the 2015 to 2020 Dietary Guidelines for Americans but requires completion of an extensive diet assessment to compute, which is time consuming and impractical. The authors hypothesize that a 19‐item dietary survey assessing consumption of common food groups known to affect health will be correlated with the HEI‐2015 assessed by a validated food frequency questionnaire and can be further reduced without affecting validity. Methods and Results A 19‐item Eating Assessment Tool (EAT) of common food groups was created through literature review and expert consensus. A cross‐sectional survey was then conducted in adult participants from a preventive cardiology clinic or cardiac rehabilitation and in healthy volunteers (n=661, mean age, 36 years; 76% women). Participants completed an online 156‐item food frequency questionnaire, which was used to calculate the HEI score using standard methods. The association between each EAT question and HEI group was analyzed by Kruskal‐Wallis test. Linear regression models were subsequently used to identify univariable and multivariable predictors for HEI score for further reduction in the number of items. The final 9‐item model of Mini‐EAT was validated by 5‐fold cross validation. The 19‐item EAT had a strong correlation with the HEI score ( r =0.73) and was subsequently reduced to the 9 items independently predictive of the HEI score: fruits, vegetables, whole grains, refined grains, fish or seafood, legumes/nuts/seeds, low‐fat dairy, high‐fat dairy, and sweets consumption, without affecting the predictive ability of the tool ( r =0.71). Conclusions Mini‐EAT is a 9‐item validated brief dietary screener that correlates well with a comprehensive food frequency questionnaire. Future studies to test the Mini‐EAT's validity in diverse populations and for development of clinical decision support systems to capture changes over time are needed.
A Review of Nutrition in Cardiac Rehabilitation 383N utrition is a central component of lifestyle intervention for the secondary prevention of cardiovascular disease (CVD). 1,2 However, despite the evidence of cardioprotective diets as a major modifiable risk factor in reversing and slowing the progression of CVD, 3,4 patient adherence and maintenance of a heart healthy diet remain low and provider-mediated nutritional intervention is underutilized in clinical practice. [5][6][7][8] Cardiac rehabilitation (CR), prescribed to patients with a history of a recent myocardial infarction, chronic stable angina, heart failure with reduced ejection fraction, cardiovascular surgery, and other CVD, is a comprehensive multidisciplinary approach composed of supervised exercise and counseling, with nutrition counseling and education serving as a core component. 1,4,9 Although there is consensus that the quality of nutrition mitigates CVD [10][11][12][13][14] and CR reduces CVD mortality and improves quality of life, 15 best practice methodologies for nutrition intervention in CR are lacking and the barriers to implementation of successful nutrition interventions in CR and sustained healthy dietary behaviors are complex.The aim of this review is to briefly summarize the evidence-based cardioprotective diets and explore the fundamental role of registered dietary nutritionists (RDN) in CR, the current evidence behind nutrition interventions in CR, and behavior change techniques (BCT) integral to nutrition intervention in CR. We provide recommendations for best practices in CR nutrition intervention and propose future innovative strategies of nutrition research and its potential role in supporting long-term change in CR. METHODOLOGYA literature search was conducted in Google, PubMed, Elsevier, the Evidence Analysis Library of the Academy of Nutrition and Dietetics, and the Journal of Cardiopulmonary Rehabilitation and Prevention to identify human studies of original investigations, systematic reviews, and national guidelines published from 1980 to 2021. The following keywords or phrases were involved: CR dietary assessment, intervention in CR, dietary counseling in CR, dietary and nutritional recommendations in CR, CR RDN, current nutrition practice in CR programs, CR nutrition guidelines, CR dietitian resources, CR behavior change, motivational interviewing in CR nutrition, effectiveness of eHealth CR on health outcomes, and barriers and long-term outcomes following CR nutrition.Peer-reviewed original investigations and systematic reviews of adults ≥18 yr participating in CR were included if there was adequate mention of nutritional or dietary assessment and/or intervention. For brevity, cardioprotective diets were included only if described and highlighted by the American Heart Association and American College of Cardiology due to the diversity of dietary patterns in the literature. Only validated dietary questionnaires utilized in CR were included. Exclusion criteria included non-English articles and non-peer-reviewed studies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.