The Tyrolean early vascular ageing-study (EVA-Tyrol): study protocol for a non-randomized controlled trial : Effect of a cardiovascular health promotion program in youth, a prospective cohort study

Benoît Bernar, Nina Gande, Katharina A Stock, Anna Staudt, Raimund Pechlaner, Ralf Geiger, Andrea Griesmacher, Stefan Kiechl, Michael Knoflach, Ursula Kiechl-Kohlendorfer, Early Vascular Aging (EVA) Study Group, Mandy Asare, Manuela Bock-Bartl, Maximilian Bohl, Christina Burger, Gregor Brössner, Tatjana Heisinger, Christoph Hochmayr, Julia Klingenschmid, Martina Kothmayer, Julia Marxer, Raimund Pechlaner, Maximilian Pircher, Carmen Reiter, Sophia J Kiechl, Bernhard Winder, Benoît Bernar, Nina Gande, Katharina A Stock, Anna Staudt, Raimund Pechlaner, Ralf Geiger, Andrea Griesmacher, Stefan Kiechl, Michael Knoflach, Ursula Kiechl-Kohlendorfer, Early Vascular Aging (EVA) Study Group, Mandy Asare, Manuela Bock-Bartl, Maximilian Bohl, Christina Burger, Gregor Brössner, Tatjana Heisinger, Christoph Hochmayr, Julia Klingenschmid, Martina Kothmayer, Julia Marxer, Raimund Pechlaner, Maximilian Pircher, Carmen Reiter, Sophia J Kiechl, Bernhard Winder

Abstract

Background: According to the World Health Organization, cardiovascular diseases (CVDs) are the leading non-communicable cause of death. Awareness of the individual risk profile is crucial to implement a healthy lifestyle and prevent CVDs. Multiple studies demonstrated that atherosclerosis, the main cause of CVDs, begins early in life. Therefore, it may be necessary to start prevention programs already in childhood.

Methods: The EVA-Tyrol study is a population-based non-randomized controlled trial that will prospectively enroll 2000 participants from high schools and training companies in North- and East-Tyrol (Austria) and South-Tyrol (Italy). Participants will be assigned to either an intervention (n = 1500) or a control (n = 500) group. Intervention group participants will be enrolled at the 10th school grade (mean age 15-16 years), undergo two examinations within a two-year interval, with follow-up at the 12th grade (mean ages 17-18 years). Control group participants will be enrolled at the 12th grade (mean age 17-18 years). Medical examination will include anthropometric measurements, comprehensive lifestyle and dietary questionnaires, a fasting blood sample, high-resolution ultrasound of the carotid arteries, and measurement of carotid-femoral pulse wave velocity. Active intervention will consist of (1) enhancing knowledge about CVDs, (2) individual medical counseling based on the results of the baseline examination, (3) an online health promotion tool and (4) involvement of participants in planning and implementation of health promotion projects. Effectiveness of the intervention will be assessed by comparing the proportion subjects with ideal health metrics as defined by the American Heart Association between study groups.

Discussion: This study aims to improve cardiovascular health in Tyrolean adolescents by demonstrating the efficacy of a multi-layer health promotion program and may yield novel insights into the prevalence of vascular risk conditions and mechanisms of early vascular pathologies in adolescents.

Trial registration: EVA-Tyrol has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic illustration of study design
Fig. 2
Fig. 2
SPIRIT diagram: Timeframe of EVA-Tyrol

References

    1. World Health Organization (WHO) Fact sheet: “Cardiovascular diseases”. 2018.
    1. World Health Organization (WHO) Mainpage: “Cardiovascular diseases (CVDs)”. 2018.
    1. World Health Organization (WHO) Fact sheet: “The top 10 causes of death”. 2018.
    1. Institute of Medicine. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health; chapter 5 reducing the burden of cardiovascular disease: Intervention strategies: The National Academies Press; 2010. 10.17226/12815.
    1. Barker DJ, Osmond C, Law CM. The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis. J Epidemiol Community Health. 1989;43:237–240. doi: 10.1136/jech.43.3.237.
    1. Singhal A, Cole TJ, Fewtrell M, Kennedy K, Stephenson T, Elias-Jones A, Lucas A. Promotion of faster weight gain in infants born small for gestational age: is there an adverse effect on later blood pressure? Circulation. 2007;115(2):213–220. doi: 10.1161/CIRCULATIONAHA.106.617811.
    1. Law CM, Shiell AW, Newsome CA, Syddall HE, Shinebourne EA, Fayers PM, Martyn CN, De Swiet M. Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age. Circulation. 2002;105(9):1088–1092. doi: 10.1161/hc0902.104677.
    1. Posod A, Odri Komazec I, Kager K, Pupp Peglow U, Griesmaier E, Schermer E, Würtinger P, Baumgartner D, Kiechl-Kohlendorfer U. Former very preterm infants show an unfavorable cardiovascular risk profile at a preschool age. PLoS One. 2016;11(12):e0168162. doi: 10.1371/journal.pone.0168162.
    1. Velican D, Velican C. Atherosclerotic involvement of the coronary arteries of adolescents and young adults. Atherosclerosis. 1980;36(4):449–460. doi: 10.1016/0021-9150(80)90238-5.
    1. World Health Organization (WHO) Published by the World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization. In: Mendis S, Puska P, Norrving B, editors. Global Atlas on cardiovascular disease prevention and control. Section A What are cardiovascular diseases (CVDs)? 2018.
    1. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD, American Heart Association Strategic Planning Task Force and Statistics Committee Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation. 2010;121(4):586–613. doi: 10.1161/CIRCULATIONAHA.109.192703.
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, DK MG, Mohler ER, 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee Executive Summary: Heart Disease and Stroke Statistics—2014 Update; A Report from the American Heart Association. Circulation. 2014;129(3):399–410. doi: 10.1161/01.cir.0000442015.53336.12.
    1. Health Behavior in School-aged Children (HBSC) HBSC Physical activity focus group. Factsheet: “Physical activity”. 2019.
    1. Health Behavior in School-aged Children (HBSC) HBSC Risk behaviours focus group. Factsheet: “Tobacco”. 2019.
    1. Health Behavior in School-aged Children (HBSC) HBSC Risk behaviours focus group. Factsheet: “Alcohol”. 2019.
    1. Knoflach M, Kiechl S, Kind M, Said M, Sief R, Gisinger M, van der Zee R, Gaston H, Jarosch E, Willeit J, Wick G. Cardiovascular risk factors and atherosclerosis in young males: ARMY study (atherosclerosis risk-factors in male youngsters) Circulation. 2003;108(9):1064–1069. doi: 10.1161/01.CIR.0000085996.95532.FF.
    1. Knoflach M, Kiechl S, Penz D, Zangerle A, Schmidauer C, Rossmann A, Shingh M, Spallek R, Griesmacher A, Bernhard D, Robatscher P, Buchberger W, Draxl W, Willeit J, Wick G. Cardiovascular risk factors and atherosclerosis in young women: atherosclerosis risk factors in female youngsters (ARFY study) Stroke. 2009;40(4):1063–1069. doi: 10.1161/STROKEAHA.108.525675.
    1. Pahkala K, Hietalampi H, Laitinen TT, Viikari JS, Rönnemaa T, Niinikoski H, Lagström H, Talvia S, Jula A, Heinonen OJ, Juonala M, Simell O, Raitakari OT. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the special Turku coronary risk factor intervention project for children [STRIP] study) Circulation. 2013;127(21):2088–2096. doi: 10.1161/CIRCULATIONAHA.112.000761.
    1. Laitinen TT, Pahkala K, Magnussen CG, Viikari JS, Oikonen M, Taittonen L, Mikkilä V, Jokinen E, Hutri-Kähönen N, Laitinen T, Kähönen M, Lehtimäki T, Raitakari OT, Juonala M. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the cardiovascular risk in young Finns study. Circulation. 2012;125(16):1971–1978. doi: 10.1161/CIRCULATIONAHA.111.073585.
    1. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, Sun C, Cheung M, Viikari JS, Dwyer T, Raitakari OT. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365(20):1876–1885. doi: 10.1056/NEJMoa1010112.
    1. Simell O, Niinikoski H, Rönnemaa T, Raitakari OT, Lagström H, Laurinen M, Aromaa M, Hakala P, Jula A, Jokinen E, Välimäki I, Viikari J, STRIP Study Group Cohort profile: the STRIP study (special Turku coronary risk factor intervention project), an infancy-onset dietary and life-style intervention trial. Int J Epidemiol. 2009;38(3):650–655. doi: 10.1093/ije/dyn072.
    1. Health Behavior in School-aged Children (HBSC). WHO Library Cataloguing in Publication Data. International Report from the 2001/2002 survey, Young people’s health in context. Edited by Candace Currie et al. ISBN 92 890 1372 9. (Last 07.01.2019). URL:
    1. Johnson F, Wardle J, Griffith J. The adolescent food habits checklist: reliability and validity of a measure of healthy eating behaviour in adolescents. Eur J Clin Nutr. 2002;56(7):644–649. doi: 10.1038/sj.ejcn.1601371.
    1. Turconi G, Celsa M, Rezzani C, Biino G, Sartirana MA, Roggi C. Reliability of a dietary questionnaire on food habits, eating behaviour and nutritional knowledge of adolescents. Section E, G and H. Eur J Clin Nutr. 2003;57(6):753–763. doi: 10.1038/sj.ejcn.1601607.
    1. Baecke JA, Burema J, Frijters ER. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936–942. doi: 10.1093/ajcn/36.5.936.
    1. Annesi-Maesano I, Didier A, Klossek M, Chanal I, Moreau D, Bousquet J. The score for allergic rhinitis (SFAR) a simple and valid assessment method in population studies. Allergy. 2002;57(2):107–114. doi: 10.1034/j.1398-9995.2002.1o3170.x.
    1. Kiechl S, Pechlaner R, Willeit P, Notdurfter M, Paulweber B, Willeit K, Werner P, Ruckenstuhl C, Iglseder B, Weger S, Mairhofer B, Gartner M, Kedenko L, Chmelikova M, Stekovic S, Stuppner H, Oberhollenzer F, Kroemer G, Mayr M, Eisenberg T, Tilg H, Madeo F, Willeit J. Higher spermidine intake is linked to lower mortality: a prospective population-based study. Am J Clin Nutr. 2018;108(2):371–380. doi: 10.1093/ajcn/nqy102.
    1. Daniels SR, Pratt CA, Hayman LL. Reduction of risk for cardiovascular disease in children and adolescents. Circulation. 2011;124(15):1673–1686. doi: 10.1161/CIRCULATIONAHA.110.016170.
    1. Willeit J, Kiechl S, Oberhollenzer F, Rungger G, Egger G, Bonora E, Mitterer M, Muggeo M. Distinct risk profiles of early and advanced atherosclerosis: prospective results from the Bruneck study. Arterioscler Thromb Vasc Biol. 2000;20(2):529–537. doi: 10.1161/01.ATV.20.2.529.
    1. International Headache Society The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi: 10.1177/0333102417738202.
    1. Bundes Ministerium für Gesundheit und Familie, Österreich . Mutter-Kind-Pass. 2019.
    1. Lubans DR, Lubans DR, Morgan PJ, Okely AD, Dewar D, Collins CE, Batterham M, Callister R, Plotnikoff RC. Preventing obesity among adolescent girls: one-year outcomes of the nutrition and enjoyable activity for teen girls (NEAT girls) cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2012;166(9):821–827. doi: 10.1001/archpediatrics.2012.41.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Lawrence Erlbaum; 1988. pp. 978–0805802832.
    1. Obarzanek E, Kimm SY, Barton BA, Van Horn LL, Kwiterovich PO, Jr, Simons-Morton DG, Hunsberger SA, Lasser NL, Robson AM, Franklin FA, Jr, Lauer RM, Stevens VJ, Friedman LA, Dorgan JF, Greenlick MR, DISC Collaborative research group Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC) Pediatrics. 2001;107(2):256–264. doi: 10.1542/peds.107.2.256.
    1. Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54) BMJ. 2012;345:e5888. doi: 10.1136/bmj.e5888.

Source: PubMed

3
订阅