In the last decades, the US Hispanic and Latino population has increased dramatically, now comprising the nation's largest minority group.¹ Cardiovascular diseases (CVDs) are leading causes of mortality among Hispanic/Latino individuals in the United States,² and this relatively young ethnic group is at high risk of future CVD morbidity and mortality as it ages. Evidence also suggests that CVD risk factors and disease rates may vary considerably among Hispanic/Latino groups. Risk for CVDs among Hispanic/Latino individuals has been reported to differ by degree of acculturation and duration of residence in the United States.^3-7

Background: Numerous studies have investigated risk factors for Alzheimer disease (AD). However, at a recent National Institutes of Health State-of-the-Science Conference, an independent panel found insufficient evidence to support the association of any modifiable factor with risk of cognitive decline or AD.Objective: To present key findings for selected factors and AD risk that led the panel to their conclusion.Data Sources: An evidence report was commissioned by the Agency for Healthcare Research and Quality. It included English-language publications in MEDLINE and the Cochrane Database of Systematic Reviews from 1984 through October 27, 2009. Expert presentations and public discussions were considered.Study Selection: Study inclusion criteria for the evidence report were participants aged 50 years and older from general populations in developed countries; minimum sample sizes of 300 for cohort studies and 50 for randomized controlled trials; at least 2 years between exposure and outcome assessment; and use of well-accepted diagnostic criteria for AD.Data Extraction: Included studies were evaluated for eligibility and data were abstracted. Quality of overall evidence for each factor was summarized as low, moderate, or high.Data Synthesis: Diabetes mellitus, hyperlipidemia in midlife, and current tobacco use were associated with increased risk of AD, and Mediterranean-type diet, folic acid intake, low or moderate alcohol intake, cognitive activities, and physical activity were associated with decreased risk. The quality of evidence was low for all of these associations.Conclusion: Currently, insufficient evidence exists to draw firm conclusions on the association of any modifiable factors with risk of AD.

Obesity adversely affects a large array of health outcomes, including coronary heart disease (CHD), other cardiovascular disease (CVD), and diabetes mellitus.¹ It is also associated with established cardiovascular risk factors, particularly diabetes and elevated levels of blood pressure and serum cholesterol.¹ However, controversies persist as to whether excess weight has additional impact on CVD outcomes beyond its effects on established risk factors.^2,3 Direct evidence on this issue is scant. Although obesity has been upgraded from a contributing risk factor to a major modifiable risk factor for CHD,⁴ risk assessment tools such as the Framingham Risk Score do not include any measure of obesity.⁵ In clinical settings, patients sometimes ask if they still need to control their weight if their blood pressure and cholesterol levels are not high. Therefore, in light of the worsening obesity epidemic,⁶ further research is warranted to examine whether obesity carries additional risks in the absence or presence of other major risk factors.

Research from JAMA — Favorable Cardiovascular Risk Profile in Young Women and Long-term Risk of Cardiovascular and All-Cause Mortality — ContextFor women, impact of cardiovascular risk factors measured in young adulthood, particularly favorable (low-risk) profile, on mortality has been difficult to assess due to low short-term death rates.ObjectiveTo assess the relationship of baseline coronary risk factor status to mortality from coronary heart disease (CHD), cardiovascular diseases (CVDs), and all causes in young women.DesignProspective cohort study.Setting and ParticipantsA total of 7302 women aged 18 to 39 years without prior CHD or major electrocardiographic abnormalities screened between 1967 and 1973 for the Chicago Heart Association Detection Project in Industry. Risk groups were defined using national guidelines for values of systolic and diastolic blood pressure, serum cholesterol level, body mass index, presence of diabetes, and smoking status. Participants were divided into 4 groups: low risk, 0 risk factors high but 1 or more unfavorable, 1 only risk factor high, and 2 or more risk factors high.Main Outcome MeasuresAll-cause mortality, CHD mortality, and CVD mortality; hazard ratio of outcome measures comparing low-risk group with other groups.ResultsOnly 20% met low-risk criteria; 59% had high levels of 1 or more risk factors. During an average follow-up of 31 years, there were 47 CHD deaths, 94 CVD deaths, and 469 deaths from all causes. The age-adjusted CVD death rate per 10 000 person-years was lowest for low-risk women and increased with the number of risk factors, ie, 1.5, 1.7, 5.0, and 9.1 for low-risk; 0, 1, and 2 or more risk factors high, respectively. Multivariate-adjusted CVD mortality hazard ratio for low-risk women was 0.19 (95% confidence interval, 0.08-0.45) compared with women with 2 or more risk factors high. Similar patterns were observed for CHD and all-cause mortality and for both blacks and whites.ConclusionFor women with favorable levels for all 5 major risk factors at younger ages, CHD and CVD are rare; long-term and all-cause mortality are much lower compared with others.

Research from JAMA — Relation of Body Mass Index in Young Adulthood and Middle Age to Medicare Expenditures in Older Age — ContextIncreasing prevalence of overweight/obesity and rapid aging of the US population have raised concerns of increasing health care costs, with important implications for Medicare. However, little is known about the impact of body mass index (BMI) earlier in life on Medicare expenditures (cardiovascular disease [CVD]–related, diabetes-related, and total) in older age.ObjectiveTo examine relationships of BMI in young adulthood and middle age to subsequent health care expenditures at ages 65 years and older.Design, Setting, and ParticipantsMedicare data (1984-2002) were linked with baseline data from the Chicago Heart Association Detection Project in Industry (CHA) (1967-1973) for 9978 men (mean age, 46.0 years) and 7623 women (mean age, 48.4 years) (baseline overall age range, 33 to 64 years) who were free of coronary heart disease, diabetes, and major electrocardiographic abnormalities, were not underweight (BMI <18.5), and were Medicare-eligible (≥65 years) for at least 2 years during 1984-2002. Participants were classified by their baseline BMI as nonoverweight (BMI, 18.5-24.9), overweight (25.0-29.9), obese (30.0-34.9), and severely obese (≥35.0).Main Outcome MeasuresCardiovascular disease–related, diabetes-related, and total average annual Medicare charges, and cumulative Medicare charges from age 65 years to death or to age 83 years.ResultsIn multivariate analyses, average annual and cumulative Medicare charges (CVD-related, diabetes-related, and total) were significantly higher by higher baseline BMI for both men and women. Thus, with adjustment for baseline age, race, education, and smoking, total average annual charges for nonoverweight, overweight, obese, and severely obese women were, respectively, $6224, $7653, $9612, and $12 342 (P<.001 for trend); corresponding total cumulative charges were $76 866, $100 959, $125 470, and $174 752 (P<.001 for trend). For nonoverweight, overweight, obese, and severely obese men, total average annual charges were, respectively, $7205, $8390, $10 128, and $13 674 (P<.001 for trend). Corresponding total cumulative charges were $100 431, $109 098, $119 318, and $176 947 (P<.001 for trend).ConclusionOverweight/obesity in young adulthood and middle age has long-term adverse consequences for health care costs in older age.