Male sex, less education, physical inactivity, cigarette smoking, overweight, diabetes, hypertension, valvular heart disease, and coronary heart disease are all independent risk factors for CHF. More than 60% of the CHF that occurs in the US general population might be attributable to coronary heart disease.

We showed an inverse association of fruit and vegetable intake with the risk of cardiovascular disease and all-cause mortality in the general US population.

Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons.

Energy intake and the prevalence of obesity have increased dramatically. Dietary interventions should focus on decreasing energy intake and potentially by substituting protein for fat or carbohydrates.

Background-Circulating adiponectin levels are lower in men than in women and lower in advanced coronary artery disease, obesity, and type 2 but not type 1 diabetes. However, it is not known whether low adiponectin levels predict development of atherosclerosis independently of other cardiovascular risk factors. Methods and Results-Progression of coronary artery calcification (CAC) over an average of 2.6 years (range, 1.6 to 3.3)was assessed in a cohort of patients with type 1 diabetes and nondiabetic subjects 19 to 59 years of age. In this nested case-control substudy, plasma adiponectin levels were measured in 101 cases with significant CAC progression and in 205 controls. Controls were oversampled on the basis of age, gender, diabetes status, and presence of baseline CAC. In conditional logistic regression adjusted for baseline CAC volume and other significant predictors of CAC progression, adiponectin levels were inversely related to progression of CAC in diabetic (OR, 0.47; 95% CI, 0.24 to 0.94) and nondiabetic (OR, 0.15; 95% CI, 0.05 to 0.40 for a doubling in adiponectin levels) subjects. Adjustment for additional cardiovascular risk factors did not change this association. In conditional logistic regression models by quartiles of plasma adiponectin levels, the probability value for trend was statistically significant for all participants (PϽ0.001) and nondiabetic participants (PϽ0.001) and was borderline for type 1 diabetics (Pϭ0.08). Conclusions-Low

Abstract-Alcohol drinking has been associated with increased blood pressure in epidemiological studies. We conducted a meta-analysis of randomized controlled trials to assess the effects of alcohol reduction on blood pressure. We included 15 randomized control trials (total of 2234 participants) published before June 1999 in which alcohol reduction was the only intervention difference between active and control treatment groups. Using a standard protocol, information on sample size, participant characteristics, study design, intervention methods, duration, and treatment results was abstracted independently by 3 investigators. By means of a fixed-effects model, findings from individual trials were pooled after results for each trial were weighted by the inverse of its variance. Overall, alcohol reduction was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic blood pressures of Ϫ3. A large number of cross-sectional and prospective epidemiological studies have repeatedly demonstrated that alcohol consumption is 1 of the most important modifiable risk factors for hypertension among populations from a variety of geographic regions, including North America, Europe, and Asia. [1][2][3] The positive association between alcohol intake and blood pressure (BP) generally persists after adjustment for important confounders such as age, body mass, smoking, exercise, and sodium and potassium intake. A number of clinical trials have been conducted to examine the effects of a reduction in alcohol consumption on BP. 4 -18 In general, these studies have had a small sample size and have reported inconsistent findings. 4 -18 A recently published large-scale, long-term clinical trial failed to show a significant reduction in BP associated with an alcohol treatment program. 18 We conducted a meta-analysis of randomized controlled trials to examine the effects of alcohol reduction on BP. By pooling information from individual trials, we were able to obtain more stable statistical estimates of intervention effect and to explore the basis for heterogeneity in the study outcomes. Methods Selection of StudiesA comprehensive literature search was performed with the MED-LINE computerized database (for studies from 1966 through June 1999) with medical subject headings "alcohols," "alcohol drinking," and "blood pressure," as well as text words "alcohol reduction" and "alcohol restriction." Only full-length original journal articles were considered; no attempt was made to include abstracts or unpublished studies. The search was restricted to studies conducted in humans and classified as clinical trials in the MEDLINE database. Medical librarians were consulted during the literature search. A manual search was also conducted by using reference lists from original and review articles. The contents of 24 articles identified during the literature search were reviewed to determine whether they met the prestated criteria for inclusion in our meta-analysis. The literature search and the article review wer...

OBJECTIVE -The purpose of this study was to compare the lipid profile and the prevalence of lipid abnormalities in youth with and without type 1 diabetes and explore the role of glycemic control on the hypothesized altered lipid profile in youth with type 1 diabetes.RESEARCH DESIGN AND METHODS -We conducted a cross-sectional analysis of 512 youth with type 1 diabetes (mean duration 4.22 years) and 188 healthy control subjects aged 10 -22 years in Colorado and South Carolina. SEARCH for Diabetes in Youth (SEARCH) participants with type 1 diabetes and healthy control subjects recruited from primary care offices in the same geographic regions were invited to attend a research visit. Fasting lipid profiles were compared between youth with type 1 diabetes (stratified according to categories of optimal [A1C Ͻ7.5%] and suboptimal [A1C Ն7.5%] glycemic control) and healthy nondiabetic youth, using multiple linear and logistic regression.RESULTS -Youth with type 1 diabetes and optimal A1C had lipid concentrations that were similar (total cholesterol, LDL cholesterol, and LDL particle size) or even less atherogenic (HDL cholesterol, non-HDL cholesterol, triglyceride, and triglyceride-to-HDL cholesterol ratio) than those observed in nondiabetic youth, whereas youth with suboptimal glycemic control had elevated standard lipid levels (total cholesterol, LDL cholesterol, and non-HDL cholesterol). Youth with type 1 diabetes also had significantly elevated apolipoprotein B levels and more small, dense LDL particles than nondiabetic youth, regardless of glycemic control.CONCLUSIONS -Youth with type 1 diabetes have abnormal lipid levels and atherogenic changes in lipoprotein composition, even after a relatively short disease duration. As in adults, glycemic control is an important mediator of these abnormalities.

Aims/hypothesis To evaluate whether exposure to maternal gestational diabetes (GDM) is associated with adiposity and fat distribution in a multiethnic population of children. Methods Retrospective cohort study of 82 children exposed to maternal GDM and 379 unexposed youths 6-13 years of age with measured BMI, waist circumference, skinfold thickness, and visceral and subcutaneous abdominal fat. Results Exposure to maternal GDM was associated with higher BMI (p=0.02), larger waist circumference (p=0.004), more subcutaneous abdominal fat (p=0.01) and increased subscapular to triceps skinfold thickness ratio (p=0.01) in models adjusted for age, sex, race/ethnicity and Tanner stage. Adjustment for socioeconomic factors, birthweight and gestational age, maternal smoking during pregnancy and current diet and physical activity did not influence associations; however, adjustment for maternal pre-pregnancy BMI attenuated all associations. Conclusions/interpretation Exposure to maternal GDM is associated with increased overall and abdominal adiposity, and a more central fat distribution pattern in 6-to 13-yearold youths from a multi-ethnic population, providing further support for the fetal overnutrition hypothesis.