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The impact of modifiable lifestyle factors among individuals at high risk for cardiovascular disease due to prediabetes, the metabolic syndrome, or type 1 diabetes

Devaraj, Susan (2020) The impact of modifiable lifestyle factors among individuals at high risk for cardiovascular disease due to prediabetes, the metabolic syndrome, or type 1 diabetes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Individuals with prediabetes, metabolic syndrome, or type 1 diabetes (T1D) are at increased cardiovascular disease risk. The American Heart Association’s (AHA) cardiovascular health metrics framework offers an appealing approach to health promotion to minimize cardiovascular disease risk. This framework defines and quantifies cardiovascular health using seven metrics (total cholesterol, blood pressure, blood glucose, BMI, smoking, physical activity, diet), promoting progress toward ideal ranges of each. This dissertation expanded the application of these metrics by 1) measuring their improvement during the course of a behavioral lifestyle intervention among individuals with prediabetes and/or metabolic syndrome, and 2&3) among adults with T1D, establishing the predictive value of the AHA metrics scores for incident coronary artery disease (CAD) and exploring potential associations between TID-specific patterns of nutrient intake and CAD.
Cohorts from two Diabetes Prevention Program community-based behavioral lifestyle intervention studies (n=305) were used to address aim 1. Measures of cardiovascular health metrics across the 12-month intervention were evaluated and found to significantly improve. Not only was there a beneficial shift toward the ideal range in several of the metrics, but significant improvement was also seen in composite metric scores.
The Pittsburgh Epidemiology of Diabetes Complications cohort of individuals with childhood onset T1D was used to address aims 2 and 3. Among young adults (n=435), higher composite cardiovascular health metrics scores were associated with lower CAD risk over 25 years of follow-up. Focusing on diet, (n=465), data derived patterns of nutrient intake were not significantly associated with CAD development over 30 years after adjusting for diabetes duration.
This effort demonstrated the value of the AHA cardiovascular health metrics in capturing improvement in risk factors among individuals with prediabetes and/or metabolic syndrome during the course of an effective and widely available behavioral lifestyle intervention. These metrics also provided support for developing cardiovascular risk factor targets for CAD prevention among young adults with T1D with additional research needed to understand the role of diet in this population. Overall, this body of work documents the public health relevance of the AHA cardiovascular health metrics in guiding health promotion for cardiovascular disease risk reduction in these high-risk populations.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Devaraj, Susansud34@pitt.edusud340000-0002-3702-2874
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairKriska, Andreaaky@Pitt.edu0000-0002-3522-0869
Committee CoChairCostacou, Tinacostacout@edc.pitt.edu0000-0001-9303-3810
Committee MemberRockette-Wagner, Bonnybjr26@pitt.edu0000-0002-4096-917X
Committee MemberMiller, Rachelmillerr@edc.pitt.edu0000-0003-1845-8477
Committee MemberOrchard, Trevortjo@pitt.edu0000-0001-9552-3215
Committee MemberGary-Webb, Tiffanytgary@pitt.edu0000-0001-9843-1084
Date: 2 December 2020
Defense Date: 13 November 2020
Approval Date: 19 January 2021
Submission Date: 4 December 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 192
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cardiovascular health, nutrition, type 1 diabetes, prediabetes, metabolic syndrome, cardiovascular disease
Date Deposited: 19 Jan 2021 20:55
Last Modified: 19 Jan 2021 20:55
URI: http://d-scholarship.pitt.edu/id/eprint/40031

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