Kottke, Thomas E.

P39 Background: Risk factor trends in the United States are not favorable. We determined the potential population impact of risk factor trends versus achieving Healthy People 2010 goals. Methods: Four possible risk factor scenarios were defined for the year 2020. Scenarios were based on current and past risk factor levels and current national goals: 1) Current risk factor levels in Olmsted County, MN; 2) Continued rise in diabetes and smoking rates; 3) #2 plus loss of blood pressure and cholesterol control; 4)Population meets Healthy People 2010 goals. Risk factors were assigned stochastically to the year 2000 Olmsted County, MN population, ages 30-83. Framingham-based risk functions were then used to calculate cardiovascular (CVD) event rates under each scenario. Conclusions: If diabetes and smoking continue to rise, and hypertension and cholesterol rise to historically high levels, CVD rates could rise as much as 75%. In contrast, meeting Healthy People 2010 goals would reduce CVD rates by 49%. Table 1.

P90 Background and Methods:While only a minority of the population follows a low fat diet and does daily physical activity, it is unclear how much of the population is trying to improve these lifestyle habits. We carried out a telephone survey of 1232 adults, >20 years of age, from Olmsted County, MN to assess their attempts at improving their dietary and exercise habits to lower their risk of developing heart disease and stroke. Results: Fifty-nine percent of respondents reported making attempts to improve exercise habits, 71% reported attempts to improve their eating habits, and 50% reported trying to improve both habits. In all, 80% reported trying to improve exercise and/or dietary habits. Of those trying to change exercise habits, 69% reported at least some physical activity on a daily basis (Pearson correlation = 0.34). Of those attempting to change dietary habits, 31% reported eating at least five servings of fruits and vegetables each day (Pearson correlation = 0.14). After multivariate adjustment, attempts to change diet or exercise were highest in persons trying to lose or maintain weight, and persons who reported having received previous physician advice to change diet and exercise habits. Conclusions: The majority of people in Olmsted County, MN are attempting to change their exercise and dietary habits to reduce their risk of coronary heart disease and stroke. Still, only a minority are meeting recommended dietary and physical activity goals. Since most people are in the action phase of exercise and dietary behavioral change, health promotion messages should include information on how best to improve and maintain these health habits. Furthermore, since report of receiving physician advice is correlated with attempts to change lifestyle habits and since only 44% of the population reports receiving such advice, there is an opportunity for health care providers to impact their patients lives by advising them on how to make improvements in their dietary and exercise habits.

Background Elevated lipoprotein(a) [Lp(a)] levels have been associated with the presence of atherosclerotic disease. However, the results of prospective studies of Lp(a) and cardiovascular disease have been contradictory. Methods and Results From 1968 through 1982, lipoprotein analysis was performed in 11 335 Olmsted County residents. Quantitative cholesterol and triglycerides were obtained along with semiquantitative Lp(a) levels based on electrophoretic pattern. Lp(a) bands were scored from 0 (absent) to 3 (increased). A cohort of 4967 men and 4968 women with no prior history of atherosclerotic disease who had baseline Lp(a) determinations were followed up for 14 years for development of coronary artery disease (CAD) and cerebrovascular disease (CVD). During 131 330 person-years of follow-up, there were 1848 CAD events and 841 CVD events. Age, diabetes, hypertension, cholesterol, and triglycerides were significantly and independently associated with an increased risk of CAD and CVD in men and women. There was a significant increase in the adjusted hazards ratio for CAD with increasing Lp(a) levels for men and women. For Lp(a) level 3, the hazard ratio was 1.9 (range, 1.3 to 2.9) in women and 1.6 (range, 1.0 to 2.5) in men. The adjusted hazard ratio for CVD showed an irregular association with Lp(a) levels in men and no association in women. Conclusions In this cohort of 9936 men and women initially free of cardiovascular disease who were followed up for 14 years, Lp(a) was a significant predictor of risk of future CAD. Lp(a) was a weak risk factor for CVD in men and was not a significant predictor of CVD risk in women.