Heart Niagara Inc.

Niagara Falls, Canada

Heart Niagara Inc.

Niagara Falls, Canada
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McCrindle B.W.,University of Toronto | Manlhiot C.,University of Toronto | Millar K.,University of Toronto | Gibson D.,Heart Niagara Inc. | And 6 more authors.
Journal of Pediatrics | Year: 2010

Objective: To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents. Study design: Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada. Results: A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk. Conclusions: A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008. © 2010 Mosby Inc. All rights reserved.


Narang I.,University of Toronto | Manlhiot C.,University of Toronto | Davies-Shaw J.,University of Toronto | Gibson D.,Heart Niagara Inc. | And 5 more authors.
CMAJ | Year: 2012

Background: Evidence suggests that inadequate or disturbed sleep is associated with increased cardiovascular risk in adults. There are limited data on sleep quality and associated cardiovascular risk in children. Methods: We obtained data on adolescents from the 2009/10 cycle of the Healthy Heart Schools' Program, a population-based cross-sectional study in the Niagara region of Ontario. Participants underwent measurements of cardiometabolic risk factors, including body mass index (BMI), lipid profile and blood pressure, and they completed questionnaires measuring sleeping habits and nutritional status. We assessed sleep disturbance using the sleep disturbance score derived from the Pittsburgh Sleep Quality Index. We explored associations between sleeping habits and cardiovascular risk factors. Results: Among 4104 adolescents (51% male), the mean hours of sleep per night (± standard deviation) were 7.9 ± 1.1 on weeknights and 9.4 ± 1.6 on weekends. In total, 19% of participants reported their sleep quality as fairly bad or very bad on weeknights and 10% reported it as fairly bad or very bad on weekends. In the multivariable regression models, a higher sleep disturbance score was associated with increased odds of being at high cardiovascular risk (highest v. lowest tertile odds ratio [OR] 1.43 [95% confidence interval (CI) 1.16-1.77], p < 0.001), increased odds of hypertension (highest v. lowest tertile OR 1.44 [95% CI 1.02-2.05], p = 0.05) and increased odds of elevated non-high density lipoprotein cholesterol (highest v. lowest tertile OR 1.28 [95% CI 1.00-1.64], p = 0.05). The mean duration of sleep was not associated with these outcomes. Interpretation: In healthy adolescents, sleep disturbance is associated with cardiovascular risk factor abnormalities. Intervention strategies to optimize sleep hygiene early in life may be important for the prevention of cardiovascular disease. © 2012 Canadian Medical Association or its licensors.


Khoury M.,University of Toronto | Manlhiot C.,University of Toronto | Dobbin S.,Heart Niagara Inc. | Gibson D.,Heart Niagara Inc. | And 6 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2012

Objective: To determine if the interaction of waist circumference percentile and waist to height ratio (WHtR) with body mass index (BMI) may serve to provide further risk specification in the lipid and blood pressure assessment of adolescents beyond BMI classification. Design: Population-based, cross-sectional study. Data collected during the 2009-2010 academic school year. Setting: Geographically and administratively defined Niagara Region, Ontario, Canada. Data collected in school, during subjects' mandatory physical education class. Part of the Heart Niagara Inc Healthy Heart Schools' Program. Participants: Entire population of grade 9 (14- and 15-year-old) students in the Niagara Region, Ontario. Four thousand eight hundred eighty-four students enrolled in grade 9 during the study period, of which 4104 participated (51% male) and 3248 (79%) had complete data. Main Outcome Measures: Nonfasting lipid values and blood pressure categories in subjects categorized based on BMI/waist circumference percentile and BMI/WHtR. Results: The associations between blood pressure, lipid profile, and measures of adiposity (BMI alone, BMI/waist circumference percentile, and BMI/WHtR) were statistically significant but had a limited strength and were not statistically significant from each other. For overweight and obese subjects, increased WHtR categories were associated with worsened lipid profile and increased odds of hypertension both relative to subjects with both normal BMI and normal WHtR and subjects with normal WHtR within each BMI category. Conclusion: Waist measures should be included in the screening and assessment of overweight and obese adolescents. ©2012 American Medical Association. All rights reserved.


Khoury M.,University of Toronto | Manlhiot C.,University of Toronto | Gibson D.,Heart Niagara Inc. | Chahal N.,University of Toronto | And 3 more authors.
BMC Pediatrics | Year: 2016

Background: Universal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Given the clustering of cardiovascular risk factors within families, one benefit of screening adolescents may be to identify "at-risk" families in which adult members might also be at elevated risk and potentially benefit from medical evaluation. Methods: Cross-sectional study of grade 9 students evaluating adiposity, lipids and blood pressure. Data collected by Heart Niagara Inc. through the Healthy Heart Schools' Program. Parents completed questionnaires, evaluating family history of dyslipidemia, hypertension, diabetes and early cardiovascular disease events in parents and siblings (first-degree relatives), and grandparents (second-degree relatives). Associations between positive risk factor findings in adolescents and presence of a positive family history were assessed in logistic regression models. Results: N = 4014 adolescents ages 14-15 years were screened; 3467 (86 %) provided family medical history. Amongst adolescents, 4.7 % had dyslipidemia, 9.5 % had obesity, and 3.5 % had elevated blood pressure. Central adiposity (waist-to-height ratio ≥0.5) in the adolescent was associated with increased odds of diabetes in first- (OR:2.0 (1.6-2.6), p < 0.001) and second-degree relatives (OR:1.3 (1.1-1.6), p = 0.002). Dyslipidemia was associated with increased odds of diabetes (OR:1.6 (1.1-2.3), p < 0.001), hypertension (OR:2.2 (1.5-3.2), p < 0.001) and dyslipidemia (OR:2.2 (1.5-3.2),p < 0.001) in first degree relatives. Elevated blood pressure did not identify increased odds of a positive family history. Conclusions: Presence of obesity and/or dyslipidemia in adolescents identified through a universal school-based screening program is associated with risk factor clustering within families. Universal pediatric cardiometabolic screening may be an effective entry into reverse cascade screening. © 2016 Khoury et al.


Banks L.,Hospital for Sick Children | Manlhiot C.,Hospital for Sick Children | Dobbin S.W.,Heart Niagara Inc. | Gibson D.,Heart Niagara Inc. | And 5 more authors.
Pediatric Exercise Science | Year: 2012

Background: Moderate-to-vigorous physical activity (MVPA) has been negatively associated with cardiometabolic risk. We sought to determine if MVPA interacts with body-mass index (BMI) and waist circumference (WC) in determining cardiometabolic risk in adolescents. Methods: This crosssectional study included cardiometabolic risk (blood pressure [BP], nonfasting lipids) screening and a 7-day recall physical activity questionnaire in 4,104 adolescents (51% male; mean age: 14.6 ± 0.5 years old). WC- and BMI- percentiles were used to define anthropometric categories (including obese adolescents: 90th WC, 85th BMI). Results: Obesity in adolescents was associated with lower levels of high-density lipoprotein (HDL cholesterol (Estimate [EST]: -0.28(0.07) mmol/L, p < .001) and higher non-HDL cholesterol (EST: +0.38(0.14) mmol/L, p = .008). Each additional day with 320 min of MVPA was associated with lower non-HDL cholesterol (EST: -0.014(0.005) mmol/L/days/ week, p = .003), independent of anthropometric category. Each additional day with 320 min of MVPA was associated with an increased odds ratio (OR) for higher BP category in obese adolescents (OR: 1.055, 95% CI: 1.028-1.084, p < .001) and a lower odds ratio for higher BP category in presumably-muscular adolescents (OR: 0.968, 95% CI: 0.934-0.989, p = .005). Conclusions:An increase in MVPA was associated with an increased likelihood for higher BP category in obese adolescents. The dose-response relationship between physical activity and cardiometabolic risk needs to be evaluated in adolescents of varying anthropometry categories. © 2012 Human Kinetics, Inc.


Khoury M.,University of Toronto | Manlhiot C.,University of Toronto | Fan C.-P.S.,University of Toronto | Gibson D.,Heart Niagara Inc. | And 4 more authors.
CMAJ | Year: 2016

Background: Use of electronic cigarettes (e-cigarettes) among adolescents has not been fully described, in particular their motivations for using them and factors associated with use. We sought to evaluate the frequency, motivations and associated factors for e-cigarette use among adolescents in Ontario. Methods: We conducted a cross-sectional study in the Niagara region of Ontario, Canada, involving universal screening of students enrolled in grade 9 in co-operation with the Heart Niagara Inc. Healthy Heart Schools' Program (for the 2013-2014 school year). We used a questionnaire to assess cigarette, e-cigarette and other tobacco use, and self-rated health and stress. We assessed household income using 2011 Canadian census data by matching postal codes to census code. Results: Of 3312 respondents, 2367 answered at least 1 question in the smoking section of the questionnaire (1274 of the 2367 respondents [53.8%] were male, with a mean [SD] age of 14.6 [0.5] yr) and 2292 answered the question about use of e-cigarettes. Most respondents to the questions about use of e-cigarettes (n = 1599, 69.8%) had heard of e-cigarettes, and 380 (23.8%) of these respondents had learned about them from a store sign or display. Use of e-cigarettes was reported by 238 (10.4%) students. Most of the respondents who reported using e-cigarettes (171, 71.9%) tried them because it was "cool/fun/new," whereas 14 (5.8%) reported using them for smoking reduction or cessation. Male sex, recent cigarette or other tobacco use, family members who smoke and friends who smoke were strongly associated with reported e-cigarette use. Reported use of e-cigarettes was associated with self-identified fair/poor health rating (odds ratio [OR] 1.9 (95% confidence interval [CI] 1.2-3.0), p < 0.001), high stress level (OR 1.7 (95% CI 1.1-2.7), p < 0.001) and lower mean (33.4 [8.4] × $1000 v. 36.1 [10.7] × $1000, p = 0.001) and median [interquartile range] (26.2 [5.6] × $1000 v. 28.1 [5.7] × $1000) household incomes. Interpretation: Use of e-cigarettes is common among adolescents in the Niagara region and is associated with sociodemographic features. Engaging in seemingly exciting new behaviours appears to be a key motivating factor rather than smoking cessation. © 2016 Joule Inc. or its licensors.


Lord S.,University of Toronto | Manlhiot C.,University of Toronto | Tyrrell P.N.,University of Toronto | Dobbin S.,Heart Niagara Inc. | And 5 more authors.
BMJ Open | Year: 2015

Objective: Understanding obesity and its modifiable risk factors in youth is key to addressing the burden of cardiovascular disease later in life. Our aim was to examine the associations among adiposity, negative health behaviours and socioeconomic status in youth from the Niagara Region. Design, setting and participants: Cross-sectional observational study of 3467 grade 9 students during their mandatory health and physical education class to investigate the association between socioeconomic status ( postal code), self-reported health behaviour and adiposity in the Niagara Region, Ontario, Canada. Results: Median household income was $63 696 and overall percentage below the after-tax low-income cutoff was 4.2%. Negative health behaviours (especially skipped meals, lower fruit and vegetable consumption, higher screen time) were associated with lower income neighbourhoods, however, the absolute effect was small. Those participants in the lowest income quintile had a significantly greater body mass index z-score than those in the highest (0.72±1.19 vs 0.53±1.12), but the overall trend across quintiles was not statistically significant. A similar trend was noted for waist-to-height ratio. The lowest income neighbourhoods according to after-tax low-income cut-off had small but statistically significant associations with higher adiposity compared with the middle or highest income neighbourhoods. Conclusions: Obesity prevention efforts should target modifiable behaviours, with particular attention to adolescents from lower income families and neighbourhoods. © 2015, BMJ Publishing Group. All rights reserved.


PubMed | University of Toronto and Heart Niagara Inc.
Type: | Journal: BMC pediatrics | Year: 2016

Universal screening of children for dyslipidemia and other cardiovascular risk factors has been recommended. Given the clustering of cardiovascular risk factors within families, one benefit of screening adolescents may be to identify at-risk families in which adult members might also be at elevated risk and potentially benefit from medical evaluation.Cross-sectional study of grade 9 students evaluating adiposity, lipids and blood pressure. Data collected by Heart Niagara Inc. through the Healthy Heart Schools Program. Parents completed questionnaires, evaluating family history of dyslipidemia, hypertension, diabetes and early cardiovascular disease events in parents and siblings (first-degree relatives), and grandparents (second-degree relatives). Associations between positive risk factor findings in adolescents and presence of a positive family history were assessed in logistic regression models.N=4014 adolescents ages 14-15 years were screened; 3467 (86%) provided family medical history. Amongst adolescents, 4.7% had dyslipidemia, 9.5% had obesity, and 3.5% had elevated blood pressure. Central adiposity (waist-to-height ratio 0.5) in the adolescent was associated with increased odds of diabetes in first- (OR:2.0 (1.6-2.6), p<0.001) and second-degree relatives (OR:1.3 (1.1-1.6), p=0.002). Dyslipidemia was associated with increased odds of diabetes (OR:1.6 (1.1-2.3), p<0.001), hypertension (OR:2.2 (1.5-3.2), p<0.001) and dyslipidemia (OR:2.2 (1.5-3.2),p<0.001) in first degree relatives. Elevated blood pressure did not identify increased odds of a positive family history.Presence of obesity and/or dyslipidemia in adolescents identified through a universal school-based screening program is associated with risk factor clustering within families. Universal pediatric cardiometabolic screening may be an effective entry into reverse cascade screening.

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