Tuskegee University College of Veterinary Medicine, Nursing and Allied Health 6th Annual Biomedical

1
Tuskegee UniversityCollege of Veterinary
Medicine, Nursing and Allied Health6th Annual
Biomedical Research SymposiumBiomarkers for
Cardiovascular Disease Risk in an
African-American Rural Populationby R. Pace,
Ph. D., L.D.,R.D.B. Wang, Ph.D. J.Qian,M.S.and
N. Dawkins, Ph.D. September 30, 2005
2
Cardiovascular Diseases Classification

• Taken from 9th revision of International
  Classification of Diseases
• Ischemic (Coronary) Heart Disease
• Hypertensive Disease
• Rheumatic Fever/Rheumatic Heart Disease
• Cerebrovascular Disease (stroke)
• (Amer. Heart Assoc. 2001 Stat Rep 9th Rev of
  Intl Class of Diseases, Adapted)

3
Coronary Heart Disease

• Coronary Heart Disease --- involves the network
  of blood vessels surrounding and serving the
  heart manifested in clinical end points of
  myocardial infarction and sudden death. CHD is
  the most prominent form of cardiovascular
  disease.
• Atheroschlerosis---a form of coronary heart
  disease a complex process of thickening and
  narrowing of the arterial walls caused by the
  accumulation of lipids, primarily oxidized
  cholesterol, in the intimal or inner layer in
  combination with connective tissue and
  calcification.

4
Natural progression of atherosclerosis
(From Harkreader H. Fundamentals. Philadelphia
W.B. Saunders, 2000)
5
Process of atherogenesis

• Primarily based on two hypothesis
• Response to injury---inflammation theory
  (Ross,1999)
• C-reactive protein
• Lipid oxidation theory---(Steinbrecher et al.,
  1990)
• GPx Activity

6
Traditional risk factors for CVD

• Age, gender, low socioeconomic status, family
  history
• Smoking
• Low density lipoprotein (LDL) cholesterol
• High density lipoprotein (HDL) cholesterol
• Hypertension
• Obesity
• Diabetes mellitus
• Physical inactivity

7
New and emerging risk factors for CVD

• C-reactive protein
• Homocysteine
• Oxidative stress markers
• Lipoprotein(a)
• (Maas and Boger, 2003)

8

• Southern states with the highest burden of
  coronary heart disease
• Mississippi South Carolina
• Louisiana Tennessee
• West Virginia Georgia
• Oklahoma ALABAMA (ranks 8th)
• Kentucky Arkansas

9

• Cardiovascular Disease is the No. 1 killer of
  African Americans
• Claims 37 of nearly 288,000 African-Americans
  annually
• Heart disease ranks as the number one cause of
  deaths in the Alabama and Macon County
• Alabama and Macon County rates exceeds the
  national average
• (from AHA Heart Disease and Stroke Statistics,
  2004 update)

10

• Research at TU
• evaluated cholesterol levels in 200 subjects in
  Macon, Bullock and Barbour counties
• 24 male and 76 female
• 54 had cholesterol levels that fell into the
  borderline high (200-239 mg/dl) and high risk
  (240 mg/dl) classifications.

11
The Tuskegee University Nutrition Outreach
Program (TUNOP)

• Evaluated the effectiveness of a twelve-week
  nutrition education intervention
• Physical markers used associated with CVD risks
• Anthropometry-body weight, body mass index, waist
  circumstance, hip circumstance and waist to hip
  ratio, and
• Plasma biomarkers as lipid profiles
  (triglycerides, LDL cholesterol, HDL cholesterol,
  total cholesterol), high-sensitivity C-reactive
  protein (hs-CRP), and glutathione peroxidase
  (GPx) activity in plasma.

12
Objectives

• 1. To determine physical markers and lipid
  profiles biomarkers before and after nutrition
  education intervention
• 2. To quantitate plasma hs-CRP concentrations and
  GPx activity before and after the intervention
• 3. To investigate the distributions of hs-CRP and
  plasma GPx activity and the correlation of each
  respectively to other selected biomarkers in this
  African-American population

13
Methodology

• Subject Recruitment in Macon County
• 120 subjects---89 retained-74
• Characteristics
• African-American Male/Female-35 to 75
• Generally Healthy High blood pressure
• High Blood Chol Non-smokers
• Non-alcoholic

14
Nutrition Education Intervention

• Based on identified individual risk factor
• Nutrition lessons conducted 3 hours weekly at two
  local area community churches
• PowerPoint lectures, videos, games and role-play
  scripts were designed for trainers to use
  during the education program.

15
Nutrition education focus

• Promotion of decreased saturated fat and
  cholesterol,
• Increased variety and intake of fruits and
  vegetables,
• Increased dietary fiber consumption,
• Promotion of limited salt and alcohol intake, and
• Maintainance of moderate physical activity.

16
Physiological and Biological Measurements

• Anthropometry-body weight, body mass index, waist
  circumstance, hip circumstance and waist to hip
  ratio, and
• Plasma biomarkers as lipid profiles
  (triglycerides, LDL cholesterol, HDL cholesterol,
  total cholesterol), high-sensitivity C-reactive
  protein (hs-CRP), and glutathione peroxidase
  (GPx) activity in plasma (12 hour fasting
  levels).
• Collections Before Nutrition education and
  12-weeks subsequently

17
Anthropometric characteristics
18
Anthropometric characteristics
19
Lipid Profiles

• Significant decreases, P triglycerides, from 89.1 to 81.0 mg/dL
• Highly significant increases for HDL-cholesterol,
  from 54.4 to 57.5 mg/dL

20
 
Figure 10. Changes in plasma hs-CRP
concentrations before and after the
intervention for men and women participating in
the TUNOP. P 21
Figure 12. Changes in plasma glutathione
peroxidase activities before and after the
intervention for participants in the TUNOP. 
22
Anthropometry and CVD Intervention

• Overweight and particularly visceral obesity
  increases an individual risk of CVD.
• Obesity and abdolminal obesity were twice as
  common in African American women as white women
  (NCEP ATPIII, 2004 update).
• The weight loss was one of many major markers
  that successfully evaluated this intervention
  program.

23
Lipids and CVD Intervention

• Overall levels were lower the adult panel
  recommends, but because this African American
  population is more at risk, stringent control is
  recommended.
• Triglycerides and HDL cholesterol are inversely
  related

24
hs-CRP and Intervention

• Saturated fat and dietary fiber had negative
  associations with hs-CRP (King et al. 2003).
• Western diets high in red meat, high-fat dairy
  products and refined grains was positively
  correlated with higher CRP values (Fung et al.,
  2001).
• Therefore, because TUNOP was successful in
  getting participants to change their dietary
  intakes of increasing their fruit and vegetable
  intake, participants reduced their hs-CRP levels
  and their risk for CVD.

25
GPx Activity and CVD Intervention

• Gender related differences were measured in GPx
  with women having significant higher levels than
  men, P (Anderson, et al. l997).
• In this study triglycerides appeared to be
  inversely associated with GPx activity and HDL
  cholesterol positively associate.

26
Conclusion

• The findings of this TUNOP study suggested that
  this nutrition education outreach program can
  play a key role in heightening awareness for
  building healthy dietary habits and lifestyle
  changes.

27
Literature Cited

• American Heart Association 2001 Statistical
  Report Ninth Revision of International
  Classification of Diseases, Adapted.
• American Heart Association. Heart Disease and
  Stroke Statistics 2005 Update. Dallas, Texas.
  American Heart Association 2005.
•  
•  Fung, T. T., Rimm, E. B., Spiegelman, D., et al.
  2001. Association between dietary patterns and
  plasma biomarkers of obesity and cardiovascular
  disease risk. Am J Clin Nutr. 7361-67.
• King, D. E., Egan, B. M. and Geesey, M. E. 2003.
  Relation of dietary fat and fiber to elevation of
  C-reactive protein. Am J Cardiol. 921335-1339.
• Maas, R. and Boger, R. H. 2003. Old and new
  cardiovascular risk factors from unresolved
  issues to new opportunities. Atherosclerosis
  Suppl. 4(4)5-17.

28

• National Cholesterol Education Program (NCEP)
  Expert Panel on Detection, Evaluation, and
  Treatment of High Blood Cholesterol in Adults
  (Adult Treatment Panel III). 2002. Third report
  of the National Cholesterol Education Program
  (NCEP) Expert Panel on Detection, Evaluation, and
  Treatment of High Blood Cholesterol in Adults
  (Adult Treatment Panel III) final report.
  Circulation.10631433421.
•  
• Ross, R. 1999. Atherosclerosisan inflammatory
  disease. N Engl J Med. 340 115-126.
• Steinbrecher, U. P., Zhang H. and Lougheed, M.
  1990. Role of oxidatively modified LDL in
  arthrosclerosis. Free Radic Biol Med. 9
  155-168.
•  

29
Acknowledgements

• FNS Faculty
• B. Phillips, A. Benjamin, E. Bromfield
• J. Oh, B. Wang, K. Willian R. Corley---Co-Is
• Graduate Students
• Alexandria Gray, Jing Qian
• College of Agricultural, Environmental and
  Natural Sciences
• George Washington Carver Experiment Station
• NIH/EXPORT Grant P20MD001 195 03