Evaluating cardiovascular disease risk among African Americans in the Fruit and Veggies for Health Study

Purpose: Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Elevated blood pressure, blood glucose, cholesterol, and low high-density lipoprotein (HDL) are well-accepted markers of CVD risk. The prevalence of CVD in the US is expected to rise 10% by 2030 attributed to a dramatic rise in obesity, blood pressure, and diabetes. African Americans are at a greater risk for CVD incidence and progression. Fruit and vegetable (F&V) consumption is considered to be protective against CVD. The Fruit and Veggies for Health study conducted at Baylor Scott & White Health and Wellness Center, Dallas, was a randomized trial that prospectively compared changes in markers of chronic kidney disease (CKD) in African Americans randomized to either receiving a weekly supply of F&V or to a cooking class plus a weekly supply of F&V. This project aims to evaluate the effect of the intervention on the secondary outcomes of the study related to CVD namely blood pressure, blood glucose, and cholesterol. In addition, differential rates of change across intervention groups may be explored. Methods: African American adults identified to have an increased risk of CKD by urine dipstick (n=142) were randomized to either receiving weekly F&V for 6 weeks with cooking class (n=70) or weekly F&V only (n=72). Both groups received 18 weeks of farm stand vouchers to continue getting F&V after the 6 weeks of prepackaged F&V. Blood pressure, fasting blood glucose, HbA1c, cholesterol (total, HDL, LDL, TRG), and body-mass-index were measured at baseline, 6-weeks, and 6-months. Descriptive statistics for demographic variables and metabolic markers at baseline were performed using chi-square tests and t-tests. Changes in secondary outcome measures between two measurement times, overall and by group, were analyzed using paired t-tests. Mixed-effects models, adjusted for age, gender, education, and income were conducted with a per-protocol analysis to evaluate the changes in each outcome over the three measurement times. Multiple imputation methods were used to avoid bias due to list-wise deletion. All analyses were performed using SAS version 9.4 with a 0.05 level of significance. Results: Participants' mean age was 57 years (SD=11.8); (22.5% Male, 77.5% Female). The distribution of age, gender, marital status, and income was similar across both groups. Mean HbA1c among all participants decreased significantly by 0.2% (SD=0.5, p-value< 0.0001) from baseline to 6-weeks, and by 0.2% (SD=0.6, p-value< 0.0001) from baseline to 6-months. Mean HDL increased significantly by 2.2 mg/dL (SD=9.3, p-value=0.005) from baseline to 6-months and by 3.9 mg/dL (SD=10, p-value< 0.0001) from 6-weeks to 6-months among all participants. The analysis is ongoing and complete results by intervention group will be ready for the presentation. Conclusion: Interventions that provide access to F&V and assist in skills to increase F&V intake by African Americans are needed, and may significantly help in lowering markers of CVD risk. Intervening in early stages might help reduce CVD incidence, its progression to advanced stages, and associated mortality.