Household availability of dietary fats and cardiovascular disease and mortality: prospective evidence from Russia

Background: The aim of this analysis was to examine the prospective association between household availability of lard, butter, margarine and vegetable oil with all-cause mortality and cardiovascular disease (CVD) incidence in a general population sample in Russia. Methods: Data from the Russian Longitudinal Monitoring Survey were used. 6618 adult individuals with no previous CVD who were recruited for the study in 1994 and followed-up in subsequent years were included in the analysis. Household availability of lard, butter, margarine and vegetable oil were assessed at baseline with questions on whether these food items were purchased by the participants’ family. Self-reported information on heart attack or stroke (CVD) and death reported by another household member were used as outcome. Results: Over the median follow-up of 11 years, 1787 participants died or reported incident CVD. In the multivariable adjusted survival models, household availability of lard was significantly associated with the combined outcome of CVD incidence and/or death (OR in the high vs. no availability categories: 1.31; 95% CI: 1.05–1.62). The associations with butter (1.06; 0.93–1.20), margarine (1.18; 0.94–1.47) and vegetable oil (0.92; 0.80–1.06) were not statistically significant. When self-reported CVD and mortality were examined separately, the association regarding lard was particularly strong for CVD (1.52; 1.11–2.09). Conclusion: Our results suggest that lard, a dietary fat of animal origin traditionally used in Eastern European cooking, is of a particular concern regarding CVD risk. Replacing it with plant-based oils in cooking practices is strongly recommended

Dietary factors and all-cause and cardiovascular mortality in Eastern European cohorts

Background. Unhealthy diet, particularly low fruit and vegetable consumption, has been proposed as an important reason for the high cardiovascular disease (CVD) mortality in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). However, individual-level food and nutrient intake data in these regions and direct comparisons with Western European populations are sparse, and estimates of their health effects are not available. Aims. The aim of this thesis was to compare dietary intake habits between adults who live in Eastern and Western European countries, and to assess the relationships between selected dietary habits and all-cause and cause-specific mortality in Eastern Europeans. Methods. Data collected from the Czech, Polish and Russian participants of the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) prospective cohort study (n=28,947) were used. The comparison of food and nutrient intakes with British participants in the UK Whitehall II study was carried out using quantile regression analysis after dietary data harmonization. The associations between dietary habits and mortality outcomes in the Eastern European cohorts were assessed by Cox regression models. Missing data was imputed using multiple random imputation procedures. Results. Compared to the British participants, fruit and vegetable intakes were significantly lower in the pooled Eastern European sample but not in all country cohorts. In the pooled HAPIEE sample, the healthy diet indicator score and the Mediterranean diet score were significantly and inversely associated with CVD mortality even after multivariable adjustments. Regarding fruit and vegetable intake, the inverse association appeared to be the strongest with stroke mortality and especially among smokers. Discussion. The findings of this thesis support the hypothesis that unhealthy diet has played a role in the high CVD mortality in Eastern Europe. Public health interventions which target fruit and vegetable consumption and/or other dietary factors should be considered in this region

Genetics of Cardiovascular Disease: How Far Are We from Personalized CVD Risk Prediction and Management?

Despite the rapid progress in diagnosis and treatment of cardiovascular disease (CVD), this disease remains a major cause of mortality and morbidity. Recent progress over the last two decades in the field of molecular genetics, especially with new tools such as genome-wide association studies, has helped to identify new genes and their variants, which can be used for calculations of risk, prediction of treatment efficacy, or detection of subjects prone to drug side effects. Although the use of genetic risk scores further improves CVD prediction, the significance is not unambiguous, and some subjects at risk remain undetected. Further research directions should focus on the “second level” of genetic information, namely, regulatory molecules (miRNAs) and epigenetic changes, predominantly DNA methylation and gene-environment interactions

Extending Adjuvant Endocrine Therapy for 10 Years: A Mixed-Methods Analysis of Women's Decision Making in an Online Breast Cancer Forum

An additional 5 years of treatment with adjuvant hormonal therapy, to complete 10 years of medication, is recommended to reduce the risk of breast cancer recurrence. Yet professionals and patients should balance this benefit against side effects and toxicities. Little is known about women's decision making regarding persistence with extended endocrine therapy. In this study, we collected data from a UK online breast cancer forum to analyse patterns of persistence and its associated factors. A mixed-methods exploratory sequential design was used, with a qualitative analysis of text (n = 61 individuals) informing the development of a quantitative instrument to statistically analyse the prevalence of the findings (n = 130). Our findings identified three different groups of women who had to make decisions regarding persistence with treatment: those about to complete 5 years of therapy, those who decided to extend treatment, and those who were initially prescribed 10 years. Factors affecting persistence were, lack of self-efficacy in managing side effects, lack of reassurance about individual risk of recurrence, and impact on quality of life. Interventions such as training of healthcare professionals including risk communication, medication reviews by clinical pharmacists, and re-planning of services in follow-up care, should better support women's needs in extended hormonal therapy