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Hua J, Shen R, Guo X, Yu L, Qiu M, Ma L, Peng X. The mediating role of depression in the association between socioeconomic status and cardiovascular disease: A nationwide cross-sectional study from NHANES 2005-2018. J Affect Disord 2024; 366:466-473. [PMID: 39187190 DOI: 10.1016/j.jad.2024.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 08/04/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
Disparities in socioeconomic status (SES) are associated with an increased risk of cardiovascular disease (CVD). Depression is a highly prevalent cardiovascular risk factor among individuals with low SES. The present study aimed to gain a better understanding of the association between SES and CVD by examining the mediating effects of depression. 30,127 participants, 50.77 % female, with a mean age of 47.37 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, were included. Weighted multivariable logistic regression analyses estimated the association between SES and CVD. Mediation analyses tested the mediating effects of depression. The multivariable-adjusted odds ratio (OR) of high SES for CVD was 0.42 (95 % confidence interval (CI): 0.36, 0.50; P < 0.001). In parallel, depression was negatively associated with SES, in which the multivariable-adjusted β was -1.42 (95 % CI: -1.62, -1.22; P < 0.001) in high SES compared to low SES. For the association between depression and CVD, the multivariable-adjusted OR per 1-point increase of PHQ-9 score for CVD was 1.08 (95 % CI: 1.07, 1.09; P < 0.001). The mediation models indicated that depression mediated 10.92 % of the total association between SES and CVD when fully adjusted. Identifying individuals with depression for appropriate treatment is promising for reducing the CVD burden among populations with low SES.
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Affiliation(s)
- Jinghai Hua
- Department of Cardiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Ruihuan Shen
- Department of Translational Medicine and Clinical Research, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Xuantong Guo
- State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ling Yu
- Department of Cardiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Minzi Qiu
- Department of Nephrology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Lihong Ma
- State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Xiaoping Peng
- Department of Cardiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi 330006, China.
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Ang SP, Chia JE, Krittanawong C, Vummadi T, Deshmukh A, Usman MH, Lavie CJ, Mukherjee D. Racial disparities in trend, clinical characteristics and outcomes in Takotsubo syndrome. Curr Probl Cardiol 2024; 49:102826. [PMID: 39197600 DOI: 10.1016/j.cpcardiol.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is an acute transient nonischemic cardiomyopathy often characterized by its hallmark feature of left ventricular apical ballooning. The correlation between racial backgrounds and the prognosis of individuals with TTS remains poorly defined. Our study aimed to explore the influence of race on the trends, clinical presentations, and outcomes in patients diagnosed with TTS. METHODS We queried the National Inpatient Sample (NIS) database from 2016 to 2020 and identified hospitalizations with TTS. We compared the clinical features and outcomes across three different races - non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic population. The primary outcome was in-hospital mortality. RESULTS 76,505 weighted hospitalizations for TTS were identified, of which 65,495 (85.6%) were non-Hispanic White, 5,830 (7.6%) were non-Hispanic Black, and 5,180 (6.8%) were Hispanics. After propensity-score matching, NHB patients had higher odds of acute kidney injury (OR: 1.49, 95% CI: 1.21-1.84, p < 0.001) and mechanical ventilation (OR: 1.33, 95% CI: 1.04-1.68, p = 0.02). Hispanic patients had a higher incidence of acute kidney injury requiring dialysis when compared to NHW patients (OR: 2.53, 95% CI: 1.11-5.77, p = 0.027). There was no significant difference in terms of in-hospital mortality between NHB and Hispanic patients when compared to NHW patients. Notably, Hispanic populations experienced a higher mortality rate during the COVID-19 period. CONCLUSION Our study suggested significant differences in the outcomes of TTS across different racial groups. Hispanic populations experienced a higher mortality rate with TTS during the COVID-19 era. Further research should emphasize discovering the factors contributing to the observed disparities.
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Affiliation(s)
- Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
| | | | - Tharangini Vummadi
- Department of Anesthesiology, University of Central Florida, Ocala, FL, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Muhammed Haris Usman
- Department of Cardiovascular Disease, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA.
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA; Department of Cardiovascular Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
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Cabaraux P, Bellante F, Gaspard N, Dusart A. Comparison between "Mothership" and "Drip and Ship" models in the management of acute ischemic strokes eligible for mechanical thrombectomy in the Charleroi area, Belgium. J Stroke Cerebrovasc Dis 2024:108011. [PMID: 39277065 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/04/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND In the management of acute ischemic stroke with large vessel occlusion (LVO-AIS), current data are conflicting as to whether a mothership model of management (MS) is associated with better functional recovery than a drip-and-ship model (DS). METHOD Files from LVO-AIS patients treated with MT at CHU Charleroi were analyzed between 01/01/2017 and 12/31/2022. Consecutive patients with a LVO-AIS of the anterior circulation and a prestroke modified Rankin Scale (mRS) ≤2 were included. The study's primary endpoint was the functional independence, defined as a mRS of 0-2 at 3 months post-stroke. Times metrics of MT and thrombolysis application, safety outcome including symptomatic intracranial hemorrhage and death were recorded. We conducted similar analyses by dividing DS patients, depending of their transfer time (less or more than 20 minutes). Logistic regression was used to assess if differences in baseline characteristics affected the primary outcome. RESULTS 366 patients were included: 229 in the DS group and 137 in the MS group. Demographic data showed a higher rate of tobacco use and lower functional status prestroke in the MS population. The MS group demonstrated better performance in time metrics related to thrombolysis and MT administration. The proportion of patients achieving an mRS of 0-2 at 3 months was similar in the DS and MS groups (50.22% vs. 48.17%, p = 0.706). The same conclusions were drawn from the subgroup analysis. Logistic regression analysis showed no impact of baseline characteristic differences on the primary outcome. CONCLUSION Despite faster access to MT in the MS model, our study did not find any significant differences in functional recovery at three months post-stroke between the MS and DS management models. Our data suggest further that the prestroke health status was an important factor influencing functional outcomes after LVO-AIS.
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Affiliation(s)
- Pierre Cabaraux
- Department of neurology, hôpital universitaire de Bruxelles, HUB, Brussels, Belgium.
| | - Flavio Bellante
- Department of neurology, centre hospitalier universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Gaspard
- Department of neurology, hôpital universitaire de Bruxelles, HUB, Brussels, Belgium
| | - Anne Dusart
- Department of neurology, centre hospitalier universitaire de Charleroi, Charleroi, Belgium
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Ghajar A, Khant KM, Sargeant MM, Bandarupalli T, Philips B, Assis FR, Catanzaro JN, Nekkanti R, Sears SF, Shantha G. All-cause mortality due to conduction abnormalities in the United States: sex, racial, and geographic variations from 1999 to 2022. Heart Rhythm 2024:S1547-5271(24)03299-5. [PMID: 39260663 DOI: 10.1016/j.hrthm.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/20/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Mortality related to conduction abnormalities in the US population is not well-documented. Population-based stratification approaches can improve public health policies and targeted strategies. OBJECTIVE To evaluate all-cause mortality related to conduction abnormalities in the US population METHODS: The CDC WONDER database was utilized to calculate the Age-Adjusted Mortality Rate (AAMR) per 100,000 individuals above 35 years old related to conduction abnormalities between 1999 and 2022. RESULTS A total of 207,861 deaths were attributed to conduction abnormalities throughout the study period with 56,186 of these deaths occurring between 2020 and 2022. All-cause mortality related to conduction abnormalities has increased during the past decade with an exponential growth in 2020-2021 (COVID-19 era; Annual Percent Change (APC) of 16.6% per year). Although the mortality rates decreased in 2022, they remained elevated compared to 2019-2020. Throughout the past two decades, males consistently exhibited higher mortality rates than females, with the rate in 2022 being 1.5 times higher (AAMR 11.4 vs 7.0 per 100,000). Non-Hispanic Black patients experienced a significantly higher mortality rate compared to non-Hispanic White individuals in the study period (AAMR 13.7 vs. 8.6 per 100,000 in 2022). In the past two decades, mortality has been persistently higher in rural and small-medium-sized metro areas than in large metro urban areas. CONCLUSIONS Mortality rates related to conduction abnormalities have increased over the past decade, and persistent disparities have been observed. These data suggest that continued innovative outreach approaches and engagement with under-represented populations remain essential.
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Affiliation(s)
- Alireza Ghajar
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Kyaw M Khant
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Maeve M Sargeant
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Tharun Bandarupalli
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Binu Philips
- Division of Cardiology, Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA, USA
| | - Fabrizio R Assis
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - John N Catanzaro
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Rajasekhar Nekkanti
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Samuel F Sears
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA; Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Ghanshyam Shantha
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA.
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Lee EY, Nguyen VH, Cheung R, Nguyen MH. Trends of chronic liver diseases by income level and socioeconomic factors in the United States: A population-based study. Aliment Pharmacol Ther 2024. [PMID: 39238267 DOI: 10.1111/apt.18242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/29/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND/AIMS With polarizing income disparities, this study investigated the prevalence and trends of liver disease in a U.S. population-based sample based on income-to-poverty ratio (IPR). METHODS This cross-sectional study analysed survey data from the 1999-2018 National Health and Nutrition Examination Survey with highest (HIG), middle-income (MIG), and lowest income (LIG) groups defined as IPR ≤ 1, 1 < IPR <5, and IPR ≥ 5, respectively. RESULTS We analysed 59,204 adult participants with 48.2% male, 39.7% aged 18-39, 36.2% 40-59, and 24.1% ≥60 years. The weighted prevalence of hepatitis C (HCV), B (HBV) infection, non-alcoholic fatty liver disease (NAFLD), alcohol-associated liver disease (ALD), and advanced fibrosis in LIG were 3.9% (n = 276), 7.4% (n = 527), 33.2% (n = 714), 5.2% (n = 401), and 9.0% (n = 694), respectively, compared to lower rates for HIG: 1.0% (n = 82), 3.2% (n = 263), 29.6% (n = 798), 3.9% (n = 354), and 5.0% (n = 638). After adjusting for age, sex, race and ethnicity, education, and birthplace, HIG had the lowest odds of having any liver disease [adjusted odds ratio (aOR) 0.67, p < 0.0001], with similar findings for specific conditions including HCV, HBV, and advanced fibrosis (aOR 0.24, 0.52, and 0.64, all p < 0.0001, respectively). While viraemic HCV prevalence decreased over time for HIG, there were no changes for MIG nor LIG. Similarly, NAFLD prevalence was stable for HIG but increased for MIG and LIG. CONCLUSION LIG and MIG in the United States have higher liver disease burdens than HIG, with increasing NAFLD prevalence and lack of decline in current HCV infection prevalence over time as opposed to declining or stable trend in HIG.
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Affiliation(s)
- Eunice Yewon Lee
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Duke University, Durham, North Carolina, USA
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Palo Alto Veterans Affairs Medical Center, Palo Alto, California, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
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Moncion K, Rodrigues L, De Las Heras B, Noguchi KS, Wiley E, Eng JJ, MacKay-Lyons M, Sweet SN, Thiel A, Fung J, Stratford P, Richardson JA, MacDonald MJ, Roig M, Tang A. Cardiorespiratory Fitness Benefits of High-Intensity Interval Training After Stroke: A Randomized Controlled Trial. Stroke 2024; 55:2202-2211. [PMID: 39113181 DOI: 10.1161/strokeaha.124.046564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Limited evidence supports the effects of short-interval high-intensity interval training (HIIT) for improving cardiorespiratory fitness (V̇O2peak) after stroke. We aimed to compare the effects of 12 weeks of short-interval HIIT versus moderate-intensity continuous training (MICT) on V̇O2peak, cardiovascular risk factors, and mobility outcomes among individuals ≥6 months poststroke. METHODS This study was a multi-site, 12-week randomized controlled trial (NCT03614585) with an 8-week follow-up. Participants were randomized into 3 d/wk of HIIT (10×1 minute 80%-100% heart rate reserve interspersed with 1 minute 30% heart rate reserve [19 minutes]) or MICT (20-30 minutes 40%-60% heart rate reserve). Secondary outcomes of the trial, including V̇O2peak, cardiovascular risk factors (carotid-femoral pulse wave velocity, blood pressure, and waist-hip ratio), and mobility (6-minute walk test, 10 m gait speed), were reported. Linear mixed model analyses with a group×study time point interaction evaluated between-group differences. RESULTS Of the 305 potential participants, 82 consented (mean [SD] age 64.9 [9.3] years, 32 females [39%], 1.8 [1.2] years poststroke) and were randomized to HIIT (n=42, mean [SD] baseline V̇O2peak 17.3 [5.9] mL/kg·min) or MICT (n=40, mean [SD] baseline V̇O2peak 17.2 [6.0] mL/kg·min). Participants attended 82% of visits (n=2417/2952). No adverse events occurred during the study period. A significant group×study time point interaction was found (χ2=8.46; P=0.015) for V̇O2peak at 12 weeks (mean difference, 1.81 [95% CI, 0.58-3.04]; P=0.004) whereby the HIIT group had greater gains in V̇O2peak (∆3.52 mL/kg·min [95% CI, 2.47-4.57]; P<0.001) compared with the MICT group (∆1.71 mL/kg·min [95% CI, 0.55-2.86]; P=0.001). There was no between-group difference in V̇O2peak (mean difference, 1.08 [95% CI, -0.26 to 2.42]; P=0.11) at 8-week follow-up. No group×study time point interactions were found for cardiovascular risk factors or mobility outcomes. CONCLUSIONS Short-interval HIIT may be an effective alternative to MICT for improving V̇O2peak at 12 weeks postintervention. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT03614585.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Bernat De Las Heras
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada (J.J.E.)
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Dalhousie University, Faculty of Health, Halifax, Canada (M.M.K.-L.)
| | - Shane N Sweet
- Department of Kinesiology and Physical Education (S.N.S.), McGill University, Montreal, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University and Jewish General Hospital Montréal, Canada (A. Thiel)
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
| | - Paul Stratford
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Julie A Richardson
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods Evidence and Impact (J.A.R.), Faculty of Science, McMaster University, Hamilton, Canada
| | - Maureen J MacDonald
- Department of Kinesiology (M.J.M.D.), Faculty of Science, McMaster University, Hamilton, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Ada Tang
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
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Huang H, Wei T, Huang Y, Zhang A, Zhang H, Zhang Z, Xu Y, Pan H, Kong L, Li Y, Li F. Association between social determinants of health and survival among the US cancer survivors population. BMC Med 2024; 22:343. [PMID: 39183305 PMCID: PMC11346002 DOI: 10.1186/s12916-024-03563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities. METHODS A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality. RESULTS Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25-1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46-2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97-2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48-4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99-5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51-8.90). A similar trend existed for cancer-specific mortality. CONCLUSIONS In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.
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Affiliation(s)
- Hongbo Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tingting Wei
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ying Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Aijie Zhang
- Health Management Center of University-Town Hospital Affiliated to Chongqing Medical University, Chongqing, 401331, China
| | - Heng Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ze Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yijing Xu
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Haonan Pan
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Lingquan Kong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yunhai Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Fan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Huang JN, Yu H, Xia X, Ming WK, Wu S, Cheng LN, ALice Yu Ying L, Zhang J, Jiang Y, Chen W, Zhao Q, Lyu J, Deng L. High cardiovascular mortality risk among older merkel cell carcinoma patients. BMC Geriatr 2024; 24:670. [PMID: 39123101 PMCID: PMC11312700 DOI: 10.1186/s12877-024-05222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/15/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE Previous research has primarily focused on the incidence and mortality rates of Merkel cell carcinoma (MCC), neglecting the examination of cardiovascular mortality (CVM) risk among survivors, particularly older patients. This study aims to assess the risk of CVM in older individuals diagnosed with MCC. METHODS Data pertaining to older MCC patients were obtained from the Surveillance, Epidemiology, and End Results database (SEER). CVM risk was measured using standardized mortality ratio (SMR) and cumulative mortality. Multivariate Fine-Gray's competing risk model was utilized to evaluate the risk factors contributing to CVM. RESULTS Among the study population of 2,899 MCC patients, 465 (16.0%) experienced CVM during the follow-up period. With the prolongation of the follow-up duration, the cumulative mortality rate for CVM reached 27.36%, indicating that cardiovascular disease (CVD) became the second most common cause of death. MCC patients exhibited a higher CVM risk compared to the general population (SMR: 1.69; 95% CI: 1.54-1.86, p < 0.05). Notably, the SMR for other diseases of arteries, arterioles, and capillaries displayed the most significant elevation (SMR: 2.69; 95% CI: 1.16-5.29, p < 0.05). Furthermore, age at diagnosis and disease stage were identified as primary risk factors for CVM, whereas undergoing chemotherapy or radiation demonstrated a protective effect. CONCLUSION This study emphasizes the significance of CVM as a competing cause of death in older individuals with MCC. MCC patients face a heightened risk of CVM compared to the general population. It is crucial to prioritize cardiovascular health starting from the time of diagnosis and implement personalized CVD monitoring and supportive interventions for MCC patients at high risk. These measures are essential for enhancing survival outcomes.
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Affiliation(s)
- Jia-Nan Huang
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, 517000, China
| | - Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
| | - Xichun Xia
- Institute of Biomedical Transformation, Jinan University, Guangzhou, China
- Department of Dermatology, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Shuai Wu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Meterials Science and Engineering, Jinan University, Guangzhou, China
| | - Leong Nga Cheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
- Department of Dermatology, Kiang wu hospital, Macau, Macau SAR, China
| | - Lee ALice Yu Ying
- Hong Kong Medical and Education Training Limited, Kowloon, Hong Kong SAR, China
| | - Jinrong Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China
| | - Yuzhen Jiang
- Royal Free Hospital & University College London, London, UK
| | - Wenhui Chen
- Shanghai Aige Medical Beauty Clinic Co., Ltd.(Agge), Shanghai, China
| | - Qiqi Zhao
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China.
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, 517000, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Liehua Deng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, China.
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, 517000, China.
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Yang J, Kim SH, Sim JK, Gu S, Seok JW, Bae DH, Cho JY, Lee KM, Choe KH, Lee H, Yang B, Min KH. Tuberculosis survivors and the risk of cardiovascular disease: analysis using a nationwide survey in Korea. Front Cardiovasc Med 2024; 11:1364337. [PMID: 39185138 PMCID: PMC11341360 DOI: 10.3389/fcvm.2024.1364337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024] Open
Abstract
Background Although the association between tuberculosis (TB) and cardiovascular disease (CVD) has been reported in several studies and is explained by mechanisms related to chronic inflammation, few studies have comprehensively evaluated the association between TB and CVD in Korea. Methods Using the Korea National Health and Nutrition Survey, we classified individuals according to the presence or absence of previous pulmonary TB was defined as the formal reading of a chest radiograph or a previous diagnosis of pulmonary TB by a physician. Using multivariable logistic regression analyses, we evaluated the association between the 10-year atherosclerotic cardiovascular disorder (ASCVD) risk and TB exposure, as well as the 10-year ASCVD risk according to epidemiological characteristics. Results Among the 69,331 participants, 4% (n = 3,101) had post-TB survivor group. Comparing the 10-year ASCVD risk between the post-TB survivor and control groups, the post-TB survivor group had an increased 10-year ASCVD risk in the high-risk group (40.46% vs. 24.00%, P < 0.001). Compared to the control group, the intermediate- and high-risk groups had also significantly increased 10-year ASCVD risks (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.23 and OR 1.69, 95% CI 1.59-1.78, respectively) in the post-TB survivor group. In the association of CVD among post-TB survivors according to epidemiologic characteristics, age [adjusted OR (aOR) 1.10, 95% CI 1.07-1.12], current smoking (aOR 2.63, 95% CI 1.34-5.14), a high family income (aOR 2.48, 95% CI 1.33-4.62), diabetes mellitus (aOR 1.97, 95% CI 1.23-3.14), and depression (aOR 2.06, 95% CI 1.03-4.10) were associated with CVD in the post-TB survivor group. Conclusions Our study findings suggest a higher 10-year ASCVD risk among TB survivors than healthy participants. This warrants long-term cardiovascular monitoring and management of the post-TB population.
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Affiliation(s)
- Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sun-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae Kyeom Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, Republic of Korea
| | - Jeong Won Seok
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Dae-Hwan Bae
- Department of Cardiology, Chungbuk National University College of Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Sun SN, Yao MD, Liu X, Li J, Chen XL, Huang WW, Ni SH, Ouyang XL, Yang ZQ, Li Y, Xian SX, Wang LJ, Lu L. Trends in cardiovascular health among US adults by glycemic status based on Life's Essential 8. Prev Med 2024; 185:108042. [PMID: 38878800 DOI: 10.1016/j.ypmed.2024.108042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE We aimed to assess the secular trends in cardiovascular health (CVH) among U.S. adults with different glycemic statuses based on the Life's Essential 8 (LE8). METHODS This cross-sectional study used nationally representative data from 6 cycles of the National Health and Nutrition Examination Surveys between 2007 and 2018. Survey-weighted linear models were used to assess time trends in LE8 scores. Stratified analyses and sensitivity analyses were conducted to validate the stability of the results. RESULTS A total of 23,616 participants were included in this study. From 2007 to 2018, there was no significant improvement in overall CVH and the proportion of ideal CVH among participants with diabetes and prediabetes. We observed an opposite trend between health behavior and health factors in the diabetes group, mainly in increasing physical activity scores and sleep scores (P for trend<0.001), and declining BMI scores [difference, -6.81 (95% CI, -12.82 to -0.80)] and blood glucose scores [difference, -6.41 (95% CI, -9.86 to -2.96)]. Dietary health remained at a consistently low level among participants with different glycemic status. The blood lipid scores in the prediabetes group improved but were still at a lower level than other groups. Education/income differences persist in the CVH of participants with diabetes or prediabetes, especially in health behavior factors. Sensitivity analyses of the absolute difference and change in proportion showed a consistent trend. CONCLUSIONS Trends in CVH among participants with diabetes or prediabetes were suboptimal from 2007 to 2018, with persistent education/income disparities.
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Affiliation(s)
- Shu-Ning Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Mei-Dan Yao
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Xin Liu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Jin Li
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Xing-Ling Chen
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Wei-Wei Huang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Shi-Hao Ni
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Xiao-Lu Ouyang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Zhong-Qi Yang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Yue Li
- Luohu District Traditional Chinese Medicine Hospital, Shenzhen 518001, China..
| | - Shao-Xiang Xian
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.
| | - Ling-Jun Wang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.
| | - Lu Lu
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.; Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.; Key Laboratory of Chronic Heart Failure, Guangzhou University of Chinese Medicine, Guangzhou 510407, China.
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11
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Westrick AC, Zhu P, Friese CR, Langa KM, Kobayashi LC. The association of pre-cancer diagnosis cardiovascular risk factors with memory aging after a cancer diagnosis, overall and by race/ethnicity. J Cancer Surviv 2024; 18:1144-1153. [PMID: 38647590 DOI: 10.1007/s11764-024-01593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Cardiovascular risk factors (CVRFs) are associated with increased risk for cognitive impairment and decline in the general population, but less is known about how CVRFs might influence cognitive aging among older cancer survivors. We aimed to determine how CVRFs prior to a cancer diagnosis affect post-cancer diagnosis memory aging, compared to cancer-free adults, and by race/ethnicity. METHODS Incident cancer diagnoses and memory (immediate and delayed recall) were assessed biennially in the US Health and Retirement Study (N = 5,736, 1998-2018). CVRFs measured at the wave prior to a cancer diagnosis included self-reported cigarette smoking, obesity, diabetes, heart disease, hypertension, and stroke. Multivariable-adjusted linear mixed-effects models evaluated the rate of change in standardized memory score (SD/decade) post-cancer diagnosis for those with no, medium, and high CVRFs, compared to matched cancer-free adults, overall and stratified by sex and race/ethnicity. RESULTS Higher number of CVRFs was associated with worse baseline memory for both men and women, regardless of cancer status. Cancer survivors with medium CVRFs had slightly slower rates of memory decline over time relative to cancer-free participants (0.04 SD units/decade [95% CI: 0.001, 0.08]). Non-Hispanic Black (NHB) and Hispanic cancer-free participants and cancer survivors had worse baseline memory than their Non-Hispanic White (NHW) counterparts. CONCLUSIONS CVRFs were associated with worse baseline memory function, but not decline, for cancer-free adults and cancer survivors. Racial disparities were largely similar between cancer survivors and cancer-free adults. IMPLICATIONS FOR CANCER SURVIVORS These findings may inform hypotheses about pre-diagnosis multimorbidity and cognitive aging of cancer survivors from diverse groups.
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Affiliation(s)
- Ashly C Westrick
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Peiyao Zhu
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Christopher R Friese
- Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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12
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Blazel MM, Perzynski AT, Gunsalus PR, Mourany L, Gunzler DD, Jones RW, Pfoh ER, Dalton JE. Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults. JAMA Netw Open 2024; 7:e2429764. [PMID: 39177999 PMCID: PMC11344236 DOI: 10.1001/jamanetworkopen.2024.29764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/27/2024] [Indexed: 08/24/2024] Open
Abstract
Importance Hypertension in middle-aged adults (35-50 years) is associated with poorer health outcomes in late life. Understanding how hypertension varies by race and ethnicity across levels of neighborhood disadvantage may allow for better characterization of persistent disparities. Objective To evaluate spatial patterns of hypertension diagnosis and treatment by neighborhood socioeconomic position and racial and ethnic composition. Design, Setting, and Participants In this cross-sectional study of middle-aged adults in Cuyahoga County, Ohio, who encountered primary care in 2019, geocoded electronic health record data were linked to the area deprivation index (ADI), a neighborhood disadvantage measure, at the US Census Block Group level (ie, neighborhood). Neighborhoods were stratified by ADI quintiles, with the highest quintile indicating the most disadvantage. Data were analyzed between August 7, 2023, and June 1, 2024. Exposure Essential hypertension. Main Outcomes and Measures The primary outcome was a clinician diagnosis of essential hypertension. Spatial analysis was used to characterize neighborhood-level patterns of hypertension prevalence and treatment. Interaction analysis was used to compare hypertension prevalence by racial and ethnic group within similar ADI quintiles. Results A total of 56 387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) across 1157 neighborhoods, which comprised 3.4% Asian, 31.1% Black, 5.5% Hispanic, and 60.0% White patients, were analyzed. A gradient of hypertension prevalence across ADI quintiles was observed, with the highest vs lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%). Of the 315 neighborhoods with predominantly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; only 31 of 263 neighborhoods (11.8%) comprising 5% or less Black patient populations met this same criterion. Compared with a spatial model without covariates, inclusion of ADI and percentage of Black patients accounted for 91% of variation in hypertension diagnosis prevalence among men and 98% among women. Men had a higher prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively). Conclusions and Relevance These findings show an association between neighborhood deprivation and hypertension prevalence, with disparities observed particularly among Black patients, emphasizing a need for structural interventions to improve community health.
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Affiliation(s)
- Madeleine M. Blazel
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Adam T. Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio
| | - Paul R. Gunsalus
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lyla Mourany
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas D. Gunzler
- Center for Healthcare Research and Policy, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio
| | - Robert W. Jones
- Cleveland Clinic Value-Based Operations, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth R. Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | - Jarrod E. Dalton
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Metlock FE, Hinneh T, Benjasirisan C, Alharthi A, Ogungbe O, Turkson-Ocran RAN, Himmelfarb CR, Commodore-Mensah Y. Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review. Hypertension 2024; 81:1675-1700. [PMID: 38887955 DOI: 10.1161/hypertensionaha.123.22571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.
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Affiliation(s)
- Faith E Metlock
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | - Thomas Hinneh
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
| | | | | | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Research Section, Beth Israel Deaconess Medical Center, Boston, MA (R.-A.N.T.-O.)
- Harvard School of Medicine, Boston, MA (R.-A.N.T.-O.)
| | - Cheryl R Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins School of Medicine, Baltimore, MD (C.R.H.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD (F.E.M., T.H., C.B., O.O., C.R.H., Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (C.R.H., O.O., Y.C.-M.)
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14
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Moran AE, Goldman L. Predicting the Future Prevalence of Cardiovascular Disease: The Good, the Bad, the Known, and the Unknown. Circulation 2024; 150:253-254. [PMID: 38832514 DOI: 10.1161/circulationaha.124.070265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Andrew E Moran
- Vagelos College of Physicians and Surgeons (A.E.M., L.G.), Columbia University, New York, NY
- Department of Medicine (A.E.M.), Columbia University, New York, NY
| | - Lee Goldman
- Vagelos College of Physicians and Surgeons (A.E.M., L.G.), Columbia University, New York, NY
- Division of Cardiology (L.G.), Columbia University, New York, NY
- Irving Medical Center, Department of Epidemiology, Mailman School of Public Health (L.G.), Columbia University, New York, NY
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15
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Joseph NT, Peterson LM. The social status adversity and health in daily life moments study: ecological momentary assessment and ambulatory health assessments to examine meaning and mechanisms. BMC Psychol 2024; 12:402. [PMID: 39030651 PMCID: PMC11264941 DOI: 10.1186/s40359-024-01903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND African Americans and those of lower socioeconomic status (SES) are at disproportionate risk for hypertension- and cardiovascular-disease-related mortality relative to their counterparts. Progress in reducing these disparities is slowed by the facts that these disparities are difficult to mitigate in older adults and early origins of these disparities are poorly understood. The Social Status Adversity and Health in Daily Life Moments Study aims to precisely understand the proximal cognitive-emotional mechanisms by which unique social exposures disproportionately impacting these populations influence blood pressure (BP) parameters early in the lifespan and determine which individuals are more at risk. METHODS The study uses ecological momentary assessment (EMA) and ambulatory blood pressure (ABP) monitoring to assess race- and SES-based factors as they manifest in daily life moments alongside simultaneously manifesting cognitive-emotional states and ABP. A sample of 270 healthy African Americans between the ages of 18 and 30 is being recruited to complete two periods of 2-day, 2-night hourly ABP monitoring alongside hourly EMA assessments of socioeconomic strain, unfair treatment, and neighborhood strain during the waking hours. ABP data will be used to calculate ecologically valid measures of BP reactivity, variability, and nocturnal dipping. Other measures include actigraphy equipment worn during the monitoring period and comprehensive assessment of behavioral and psychosocial risk and resilience factors. Multilevel and multiple linear regression analyses will examine which momentary social adversity exposures and cognitive-emotional reactions to these exposures are associated with worse BP parameters and for whom. DISCUSSION This is the first time that this research question is approached in this manner. The Social Status Adversity and Health in Daily Life Moments Study will identify the cognitive-emotional mechanisms by which the most impactful race- and SES-based exposures influence multiple BP parameters in African American emerging adults. Further, it will identify those most at risk for the health impacts of these exposures. Achievement of these aims will shape the field's ability to develop novel interventions targeting reduction of these exposures and modification of reactions to these exposures as well as attend to those subpopulations most needing intervention within the African American emerging adult population.
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Affiliation(s)
- Nataria T Joseph
- Department of Psychology, Pepperdine University, 24255 Pacific Coast Hwy, Malibu, CA, 90263, USA.
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16
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Murphy BS, Nam Y, McClelland RL, Acquah I, Cainzos‐Achirica M, Nasir K, Post WS, Aldrich MC, DeFilippis AP. Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e033651. [PMID: 38979824 PMCID: PMC11292754 DOI: 10.1161/jaha.123.033651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Social determinants of health (SDoH) are associated with cardiovascular risk factors and outcomes; however, they are absent from risk prediction models. We aimed to assess if the addition of SDoH improves the predictive ability of the MESA (Multi-Ethnic Study of Atherosclerosis) Risk Score. METHODS AND RESULTS This was a community-based prospective population cohort study that enrolled 6286 men and women, ages 45-84 years, who were free of clinical coronary heart disease (CHD) at baseline. Data from 10-year follow-up were examined for CHD events, defined as myocardial infarction, fatal CHD, resuscitated cardiac arrest, and revascularization in cases of anginal symptoms. Participants included 53% women with average age of 62 years. When adjusting for traditional cardiovascular risk factors, SDoH, and coronary artery calcium, economic strain, specifically low family income, was associated with a greater risk of CHD events (hazard ratio [HR], 1.42 [95% CI, 1.17-1.71], P value<0.001). Area under the curve of risk prediction with SDoH was 0.822, compared with 0.816 without SDoH. The calibration slope was 0.860 with SDoH and 0.878 in the original model. CONCLUSIONS Significant associations were found between economic/financial SDoH and CHD risk factors and outcomes. Incorporation of SDoH into the MESA Risk Score did not improve predictive ability of the model. Our findings do not support the incorporation of SDoH into current risk prediction algorithms.
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Affiliation(s)
| | - Yunbi Nam
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | | | - Isaac Acquah
- Department of MedicineMedStar Union Memorial HospitalBaltimoreMDUSA
| | | | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTXUSA
| | - Wendy S. Post
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Melinda C. Aldrich
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Andrew P. DeFilippis
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTNUSA
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Bai B, Liu Q, Liu Y, Liu F, Wang Y, Chen Y, Liang Y, Wang H, Wu C, Guo L, Ma H, Geng Q. Long-term trends in lifestyle factors among respondents with dyslipidemia in the United States. Am J Med Sci 2024:S0002-9629(24)01327-2. [PMID: 38972378 DOI: 10.1016/j.amjms.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 05/15/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To explore the long-term trends in unhealthy lifestyle factors and the risk sociodemographic subgroups among people with dyslipidemia. METHODS Data extracted from the 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Lifestyle factors were smoking status, alcohol drinking, obesity, dietary quality, depression, physical activity, and sedentary behavior. A Joinpoint regression model was used to estimate trends in the log-transformed age-standardized prevalence. Multinomial logistic regression models adjusted for age, sex, and race/ethnicity were used to analyze subgroups by sociodemographic factors. RESULTS Data for 33,680 respondents were extracted between 1999 and 2018. The prevalence of smoking and poor-quality diet decreased from 1999 to 2018 (P<0.001), while obesity significantly increased (P<0.001). The prevalence of depression marginally increased from 2005 to 2018 (P=0.074). We observed that non-Hispanic Black individuals, Hispanics, males, as well as those with lower family income-to-poverty ratios and education levels, unemployed individuals, or those lacking a spouse/live-in partner, were at elevated risk of unhealthy lifestyle factors when compared to the reference groups. CONCLUSIONS Among NHANES respondents from 1999 to 2018 with dyslipidemia, significant reductions in the prevalence of current smoking and poor diet were observed, while the prevalence of obesity was markedly increased. There were sociodemographic differences in the management of lifestyle factors. Further initiatives to encourage people with dyslipidemia are required to reduce potential adverse outcomes.
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Affiliation(s)
- Bingqing Bai
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, PR China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Quanjun Liu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yuting Liu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Yu Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yilin Chen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanting Liang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Haochen Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chao Wu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Lan Guo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Huan Ma
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China.
| | - Qingshan Geng
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China.
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 PMCID: PMC11389897 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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19
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López-Bueno R, Calatayud J, Del Pozo Cruz J, Yang L, Del Pozo Cruz B. Dose-response associations of the American Heart Association's new "Life's essential 8" metrics with all-cause and cardiovascular mortality in a nationally representative sample from the United States. Prog Cardiovasc Dis 2024; 85:31-37. [PMID: 38925257 DOI: 10.1016/j.pcad.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Our aim was to examine the prospective dose-response associations of American Heart Association's (AHA) LIFE's Essential 8 (LE8) score and number of cardiovascular health (CVH) factors with high score with all-cause and cardiovascular disease (CVD) related mortality. METHODS We pooled 6 consecutive waves of the National Health and Nutrition Examination Survey (NHANES) comprising rounds between 2007 and 2008 and 2017-2018. We calculated hazard ratios (HRs) and conducted restricted cubic splines models to assess the dose-response association of LE8 score and CVH factors with all-cause and CVD mortality. RESULTS Analyses included 23,531 adults aged 18 years and over (mean [SD] age, 43.6 [16.7] years; 11,979 [51%] female; 8960 [38.1%] non-Hispanic white individuals) with a median follow-up of 7.3 years (IQR 4.3-10.1), corresponding to 168,033 person-years. The dose-response analyses showed a significant inverse curvilinear trend for the association between LE8 score with all-cause and CVD mortality. The optimal risk reduction for all-cause mortality was found at 100 points of the LE8 Score (HR, 0.50; 95% CI, 0.27-0.93) compared to the reference (median LE8 score [62.5 points]). Moreover, the dose-response association between LE8 and CVD mortality also exhibited a significant inverse curvilinear association up to 90 points (HR, 0.41; 95% CI, 0.17-0.99). Optimal levels of LE8 score may be able to avert around 40% of the annual all-cause and CVD deaths among the US adult population. CONCLUSIONS Best-case scenario of CVH may reduce around 40% of the all-cause and CVD annual mortality among adults in the United States.
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Affiliation(s)
- Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark.
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jesús Del Pozo Cruz
- Physical Education and Sports Department, Faculty of Education, University of Seville, Seville, Spain; Epidemiology of Physical Activity and Fitness Across the Lifespan Research Group (EPAFit), University of Seville, Seville, Spain
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Borja Del Pozo Cruz
- Faculty of Education, University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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20
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Yang H, Wang J, Li Y, Zhao M, Magnussen CG, Xi B. Trends in Cardiovascular Health Among US Adolescents Aged 12-19 Years Using the New "Life's Essential 8" Metrics, 2007-2018. J Adolesc Health 2024; 75:94-106. [PMID: 38739053 DOI: 10.1016/j.jadohealth.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The American Heart Association recently issued a substantial update to the definition and scoring of cardiovascular health (CVH), now called "Life's Essential 8" (LE8). We aimed to assess the trends in overall and individual LE8 CVH metrics among adolescents in the United States. METHODS A total of 6,999 United States adolescents aged 12-19 years from six cycles of the National Health and Nutrition Examination Survey from 2007-2008 to 2017-2018 were included in this study. The individual LE8 metrics included diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP). A higher CVH score indicates better CVH health. RESULTS The mean score of overall CVH significantly increased from 72.8 (95% confidence interval: 71.2-74.3) in 2007-2008 to 77.3 (76.1-78.5) in 2017-2018 in US adolescents (p-trend < .001). From 2007-2008 to 2017-2018, the mean scores increased from 75.5 (72.0-79.1) to 90.0 (88.0-91.9) for nicotine exposure, from 65.2 (61.6-68.8) to 73.3 (69.9-76.8) for sleep health, from 69.9 (67.1-72.8) to 73.0 (69.1-76.9) for blood lipids, and from 94.4 (93.0-95.9) to 96.2 (95.2-97.3) for BP (all p-trend < .05). However, the mean scores for diet, physical activity, and blood glucose did not significantly change (all p-trend > .05), whereas the mean score decreased from 81.4 (78.9-84.0) to 78.6 (76.4-80.8) for BMI (p-trend = .023). DISCUSSION In United States adolescents, the overall CVH and four components (nicotine exposure, sleep health, blood lipids, and BP) significantly improved over time, diet, physical activity, and blood glucose remained unchanged, whereas BMI worsened.
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Affiliation(s)
- Hui Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiaxiang Wang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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21
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Liu J, Mozaffarian D. Trends in Diet Quality Among U.S. Adults From 1999 to 2020 by Race, Ethnicity, and Socioeconomic Disadvantage. Ann Intern Med 2024; 177:841-850. [PMID: 38885507 DOI: 10.7326/m24-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Few data have assessed trends in diet quality among U.S. adults. OBJECTIVE To evaluate trends in diet quality by race, ethnicity, and socioeconomic disadvantage. DESIGN Repeated cross-sectional study. SETTING United States. PARTICIPANTS Noninstitutionalized adults aged 20 years or older who responded to the 1999-2020 National Health and Nutrition Examination Survey (NHANES). MEASUREMENTS The proportion of participants meeting the targets of the validated American Heart Association (AHA) 2020 continuous diet score (based on higher intake of fruits, vegetables, whole grains, fish and shellfish, and nuts, seeds, and legumes and lower intake of sugar-sweetened beverages, processed meat, saturated fat, and sodium) and the Healthy Eating Index (HEI)-2015, and energy-adjusted consumption of their components and other individual food groups and nutrients. Poor diet was defined as less than 40% adherence to the AHA score, intermediate as 40% to 79.9% adherence, and ideal as at least 80% adherence. RESULTS A total of 51 703 adults were included. From 1999 to 2020, the proportion of U.S. adults with poor diet quality decreased from 48.8% to 37.4% (difference, -11.4 percentage points [95% CI, -16.8 to -5.96 percentage points]), the proportion with intermediate quality increased from 50.6% to 61.1% (difference, 10.5 percentage points [CI, 5.20 to 16.1 percentage points]), and the proportion with ideal quality increased from 0.66% to 1.58% (difference, 0.93 percentage points [CI, 0.35 to 1.51 percentage points]) (P for trend < 0.001 for each). Persistent or worsening disparities in diet quality were observed by age, sex, race and ethnicity, education, income, food security, Supplemental Nutrition Assistance Program participation, and health insurance coverage. For example, the proportion of adults with poor diet quality decreased from 47.9% to 33.0% among those with food security (P for trend < 0.001) but did not change (51.3% to 48.2%) among those experiencing food insecurity (P for trend = 0.140) (P for interaction = 0.001). Findings were similar for HEI-2015. LIMITATIONS Self-reported diet; cross-sectional study design. CONCLUSION Diet quality among U.S. adults improved modestly between 1999 and 2020, but the proportion with poor diet quality remains high, and dietary disparities persist or are worsening. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York (J.L.)
| | - Dariush Mozaffarian
- Food Is Medicine Institute Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts (D.M.)
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22
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Søndergaard MM, Freeman P, Kristensen AMD, Chang SM, Nassir K, Mortensen MB, Nørgaard BL, Maeng M, Andersen MP, Søgaard P, Tayal B, Pareek M, Johnsen SP, Køber L, Gislason G, Torp-Pedersen C, Kragholm KH. Education level and the use of coronary computed tomography, functional testing, coronary angiography, revascularization, and outcomes-a 10-year Danish, nationwide, registry-based follow-up study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:294-304. [PMID: 37740574 DOI: 10.1093/ehjqcco/qcad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Coronary computed tomography angiography (CCTA) can guide downstream preventive treatment and improve patient prognosis, but its use in relation to education level remains unexplored. METHODS This nationwide register-based cohort study assessed all residents in Denmark between 2008 and 2018 without coronary artery disease (CAD) and 50-80 years of age (n = 1 469 724). Residents were divided according to four levels of education: low, lower-mid, higher-mid, and high. Outcomes were CCTA, functional testing, invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Individuals with the lowest education level underwent CCTA (absolute risk [AR] 3.95% individuals aged ≥50-59, AR 3.62% individuals aged ≥60-69, and AR 2.19% individuals aged ≥70-80) less often than individuals of lower-mid (AR 4.16%, AR 3.90%, and AR 2.41%), higher-mid (AR 4.38%, AR 4.30%, and AR 2.45%) and highest education level (AR 3.98%, AR 4.37%, and AR 2.30%). Similar differences were observed for functional testing. Conversely, use of ICA, and risks of revascularization and MACCE were more common among individuals of lowest education level. Among patients examined with CCTA (n = 50 234), patients of lowest education level less often underwent functional testing and more likely initiated preventive medication, underwent ICA, revascularization, and experienced MACCE. CONCLUSION Despite tax-financed healthcare in Denmark, individuals of lowest education level were less likely to undergo CCTA and functional testing than persons of higher education level. Invasive coronary angiography utilization, revascularization, and MACCE risks were higher for individuals of lowest education level. Among CCTA-examined patients, patients of lowest education level were more likely to initiate preventive medication and had the highest risks of revascularization and MACCE when compared to higher education level groups. These findings suggest that the preventive potential of CCTA is underutilized in individuals of lower education level, a proxy for socioeconomic status. Socioeconomic differences in CAD assessment, care, and outcomes are likely even larger without tax-financed healthcare.
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Affiliation(s)
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Su Min Chang
- Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, 77030 Houston, TX, USA
| | - Khurram Nassir
- Houston Methodist DeBakey Heart and Vascular Center, Preventive Cardiology, 77030 Houston, TX, USA
| | | | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Houston Methodist Hospital, 77030 Houston, TX, USA
| | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, 2100, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, 2100, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, 3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, 1353, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, 77030 Houston, TX, USA
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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23
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Michas G, Alexanian I, Ntali G, Tzanela M, Trikas A. Establishing a cardiometabolic outpatient department in Greece: a roadmap for multidisciplinary care. Hellenic J Cardiol 2024:S1109-9666(24)00123-4. [PMID: 38851429 DOI: 10.1016/j.hjc.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Affiliation(s)
- George Michas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Ioannis Alexanian
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Georgia Ntali
- Department of Endocrinology "D. IKKOS", Diabetes Center, Center of Excellence for Rare Endocrine Diseases, Evangelismos General Hospital of Athens, Athens, Greece
| | - Marinella Tzanela
- Department of Endocrinology "D. IKKOS", Diabetes Center, Center of Excellence for Rare Endocrine Diseases, Evangelismos General Hospital of Athens, Athens, Greece
| | - Athanasios Trikas
- Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
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24
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Aggarwal R, Ostrominski JW, Vaduganathan M. Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2011-2020. JAMA 2024; 331:1858-1860. [PMID: 38717747 PMCID: PMC11079779 DOI: 10.1001/jama.2024.6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024]
Abstract
This cross-sectional study assesses the prevalence and temporal evolution of cardiovascular-kidney-metabolic syndrome stages.
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Affiliation(s)
- Rahul Aggarwal
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - John W. Ostrominski
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
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25
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Shi S, Zhao Q, Wu G, Yan H, Yu B, Zheng Q, Li Y, Zheng L, Yuan Y, Zhong J, Xu J, Wu Y, Xu J, Chen L, Li S, Jiang J, Wang J, Fan J, Chen M, Tang B, Li W, Wu Q, Shi B, Zhou S, Zhao X, Yin Y, Zhang Z, Zhong G, Han X, Liu F, Wu M, Gao L, Yang B, Tang Y, Huang H, Huang C. Variation and disparity in awareness of atrial fibrillation in China: A national cross-sectional study. Int J Cardiol 2024; 404:131957. [PMID: 38471651 DOI: 10.1016/j.ijcard.2024.131957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The latest information regarding the awareness of atrial fibrillation (AF) remains limited in China. OBJECTIVES The present study aimed to understand the variation and disparity in awareness of AF in China. METHODS The cross-sectional study used data from the 2020 nationwide epidemiology survey on AF among adults aged 18 years or older in mainland China to assess the prevalence of AF awareness. The awareness of AF diagnostic methods and outcomes was also assessed using an interviewer-administered questionnaire. RESULTS Of the 114,039 adults responding to the survey, 1463 (age-standardized prevalence, 55.3% (95% confidence interval [CI], 47.7-62.9%) and 10,202 (8.2%, 95%CI 5.4-10.9%) were aware of AF in participants with and without AF, respectively. Of these, 36.4% (95%CI 30.0-42.9%) and 6.3% (95%CI 3.6-9.1%) considered electrocardiogram as a method of diagnosing AF, and 30.0% (95% CI 3.2-8.2%) and 5.2% (95%CI 2.7-7.6%) considered stroke as an outcome of AF. The proportion of participants who being aware of AF varied significantly across sociodemographic and cardiovascular disease subgroups, and was almost consistently lower in rural areas than those in urban areas. Overall, lack of AF awareness was associated with rural areas, geographical region, lower education levels, and without history and had no risk factors of cardiovascular disease. CONCLUSIONS Nearly half of adults with AF, and >90% non-AF population are unaware of AF in China, with significant variation and disparity. Focused public health initiatives are needed to improve awareness and knowledge of AF among high-risk populations.
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Affiliation(s)
- Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Gang Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Hong Yan
- School of Public Health, Wuhan University, Wuhan 430060, China
| | - Bin Yu
- School of Public Health, Wuhan University, Wuhan 430060, China
| | - Qiangsun Zheng
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yigang Li
- Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Liangrong Zheng
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yiqiang Yuan
- Henan Provincial Chest Hospital, Zhengzhou 450008, China
| | - Jingquan Zhong
- Qilu Hospital of Shandong University, Jinan 250063, China
| | - Jian Xu
- Anhui Provincial Hospital, Hefei 230001, China
| | - Yanqing Wu
- The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jing Xu
- Tianjin Chest Hospital, Tianjin 300222, China
| | - Lin Chen
- Fujian Provincial Hospital, Fuzhou 350013, China
| | - Shufeng Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jian Jiang
- West China Hospital of Sichuan University, Chengdu 610044, China
| | - Jingfeng Wang
- Sun Yat-sen Memorial Hospital, Guangzhou 510120, China
| | - Jie Fan
- The First People's Hospital of Yunnan Province, Kunming 650034, China
| | | | - Baopeng Tang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Wei Li
- The Affiliated Hospital of Guizhou Medical University, Guizhou 550004, China
| | - Qiang Wu
- Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Bei Shi
- Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China
| | - Shenghua Zhou
- The Second Xiangya Hospital of Central South University, Changsha 430062, China
| | - Xingsheng Zhao
- Inner Mongolia Autonomous Region People's Hospital, Huhehot 010020, China
| | - Yuehui Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Zheng Zhang
- The First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Guoqiang Zhong
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xuebin Han
- Shanxi Cardiovascular Hospital, Taiyuan 030024, China
| | - Fan Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - Ming Wu
- Hainan General Hospital, Haikou 570311, China
| | - Lianjun Gao
- The First Affiliated Hospital of Dalian Medical University, Dalian 116051, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China.
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China.
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China; Hubei Key Laboratory of Cardiology, Wuhan 430060, China.
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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Lababidi H, Lababidi G, Rifai MA, Nasir K, Al-Kindi S. Cardiovascular disease in Arab Americans: A literature review of prevalence, risk factors, and directions for future research. Am J Prev Cardiol 2024; 18:100665. [PMID: 38634110 PMCID: PMC11021916 DOI: 10.1016/j.ajpc.2024.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Recent evidence suggests Arab Americans, individuals with ancestry from Arabic-speaking countries, have an elevated risk for CVD compared to other ethnicities in the US. However, research focusing specifically on CVD in this population is limited. This literature review synthesizes studies investigating CVD prevalence, risk factors, and outcomes in Arab Americans. Multiple studies found higher rates of coronary heart disease, cerebrovascular disease, and hypertension compared to non-Hispanic White participants. The prevalence of type 2 diabetes, a major CVD risk factor, was also markedly higher, ranging from 16 % to 41 % in Arab Americans based on objective measures. Possible explanations include high rates of vitamin D deficiency, genetic factors, and poor diabetes control. Other metabolic factors like dyslipidemia and obesity did not consistently differ from general population estimates. Psychosocial factors may further increase CVD risk, including acculturative stress, discrimination, low health literacy, and barriers to healthcare access. Smoking, especially waterpipe use, was more prevalent in Arab American men. Though heterogenous, Arab Americans overall appear to have elevated CVD risk, warranting tailored screening and management. Culturally appropriate educational initiatives on CVD prevention are greatly needed. Future directions include better characterizing CVD prevalence across Arab American subgroups, delineating genetic and environmental factors underlying increased diabetes susceptibility, and testing culturally tailored interventions to mitigate CVD risks. In summary, this review highlights concerning CVD disparities in Arab Americans and underscores the need for group-specific research and preventive strategies.
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Affiliation(s)
- Hossam Lababidi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Ghena Lababidi
- Medical program, American University of Beirut, United States
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
| | - Sadeer Al-Kindi
- Houston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, United States
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Loeb TB, Albarran GI, Lee E, McEwan JA, Dyer KE, Cooley-Strickland M, Norwood-Scott E, Ramm K, Kesblyan D, Barnes A, Novacek D, Chin D. Identifying social determinants of health in populations exposed to structural inequities: a qualitative study of the COVID-19 pandemic experiences of Black and Latinx people living with HIV and cardiovascular risks. Front Public Health 2024; 12:1336184. [PMID: 38873288 PMCID: PMC11169879 DOI: 10.3389/fpubh.2024.1336184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities. Methods Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains. Results Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines. Discussion This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.
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Affiliation(s)
- Tamra Burns Loeb
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Graciela I. Albarran
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ethan Lee
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jenna Alarcon McEwan
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen E. Dyer
- Independent Researcher, Los Angeles, CA, United States
| | - Michele Cooley-Strickland
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Enricka Norwood-Scott
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kate Ramm
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
| | - David Kesblyan
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aleeja Barnes
- Independent Volunteer, Los Angeles, CA, United States
| | - Derek Novacek
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Dorothy Chin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Yi H, Li M, Dong Y, Gan Z, He L, Li X, Tao Y, Xia Z, Xia Z, Xue Y, Zhai Z. Nonlinear associations between the ratio of family income to poverty and all-cause mortality among adults in NHANES study. Sci Rep 2024; 14:12018. [PMID: 38797742 PMCID: PMC11128441 DOI: 10.1038/s41598-024-63058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
Socioeconomic status (SES) has been linked to mortality rates, with family income being a quantifiable marker of SES. However, the precise association between the family income-to-poverty ratio (PIR) and all-cause mortality in adults aged 40 and older remains unclear. A cross-sectional study was conducted using data from NHANES III, including 20,497 individuals. The PIR was used to assess financial status, and various demographic, lifestyle, and clinical factors were considered. Mortality data were collected from the NHANES III linked mortality file. The study revealed a non-linear association between PIR and all-cause mortality. The piecewise Cox proportional hazards regression model showed an inflection point at PIR 3.5. Below this threshold, the hazard ratio (HR) for all-cause mortality was 0.85 (95% CI 0.79-0.91), while above 3.5, the HR decreased to 0.66 (95% CI 0.57-0.76). Participants with lower income had a higher probability of all-cause mortality, with middle-income and high-income groups showing lower multivariate-adjusted HRs compared to the low-income group. This study provides evidence of a non-linear association between PIR and all-cause mortality in adults aged 40 and older, with an inflection point at PIR 3.5. These findings emphasize the importance of considering the non-linear relationship between family income and mortality when addressing socioeconomic health disparities.
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Affiliation(s)
- Hong Yi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minghui Li
- Department of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Youzheng Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zumao Gan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Lei He
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xiaozhong Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yu Tao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zirong Xia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhen Xia
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhenyu Zhai
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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An D, Xu Y. Environmental risk factors provoke new thinking for prevention and treatment of dementia with Lewy bodies. Heliyon 2024; 10:e30175. [PMID: 38707435 PMCID: PMC11068646 DOI: 10.1016/j.heliyon.2024.e30175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
In recent years, environmental factors have received attention in the pathogenesis of neurodegenerative diseases. Other than genetic factors, the identification of environmental factors and modifiable risk factors may create opportunities to delay the onset or slow the progression of Lewy body disease. Researchers have made significant progress in understanding environmental and modifiable risk factors over the past 30 years. To date, despite the increasing number of articles assessing risk factors for Lewy body disease, few reviews have focused on their role in its onset. In this review, we reviewed the literature investigating the relationship between Lewy body disease and several environmental and other modifiable factors. We found that some air pollutants, exposure to some metals, and infection with some microorganisms may increase the risk of Lewy body disease. Coffee intake and the Mediterranean diet are protective factors. However, it is puzzling that low educational levels and smoking may have some protective effects. In addition, we proposed specific protocols for subsequent research directions on risk factors for neurodegenerative diseases and improved methods. By conducting additional case-control studies, we could explore the role of these factors in the etiopathogenesis of Lewy body disease, establishing a foundation for strategies aimed at preventing and reducing the onset and burden of the disease.
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Affiliation(s)
- Dinghao An
- Department of Neurology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- State Key Laboratory of Pharmaceutical Biotechnology and Institute of Translational Medicine for Brain Critical Diseases, Nanjing University, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, Nanjing, China
- Nanjing Neurology Clinical Medical Center, Nanjing, China
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Li J, Zhang J, Somers VK, Covassin N, Zhang L, Xu H. Trends and Disparities in Treatment and Control of Atherosclerotic Cardiovascular Disease in US Adults, 1999 to 2018. J Am Heart Assoc 2024; 13:e032527. [PMID: 38639366 PMCID: PMC11179884 DOI: 10.1161/jaha.123.032527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Although cardiovascular mortality continued declining from 2000 to 2019, the rate of this decrease decelerated. We aimed to assess the trends and disparities in risk factor control and treatment among US adults with atherosclerotic cardiovascular disease to find potential causes of the deceleration. METHODS AND RESULTS A total of 55 ,021 participants, aged ≥20 years, from the 1999 to 2018 National Health and Nutrition Examination Survey were included, of which 5717 were with atherosclerotic cardiovascular disease. Risk factor control was defined as hemoglobin A1c <7%, blood pressure <140/90 mm Hg, and non-high-density lipoprotein cholesterol <100 mg/dL. The prevalence of atherosclerotic cardiovascular disease oscillated between 7.3% and 8.9% from 1999 to 2018. A significant increasing trend was observed in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension within the population with atherosclerotic cardiovascular disease (Ptrend≤0.001). Non-high-density lipoprotein cholesterol <100 mg/dL increased from 7.1% in 1999 to 2002 to 15.7% in 2003 to 2006, before plateauing. Blood pressure control (<140/90 mm Hg) increased until 2011 to 2014, but declined to 70.1% in 2015 to 2018 (Ptrend<0.001, Pjoinpoint=0.14). Similarly, the proportion of participants achieving hemoglobin A1c control began to decrease after 2006 (Pjoinpoint=0.05, Ptrend=0.001). The percentage of participants achieving all 3 targets increased significantly from 4.5% to 18.6% across 1999 to 2018 (Ptrend=0.02), but the increasing trend decelerated after 2005 to 2006 (Pjoinpoint<0.001). Striking disparities in risk factor control and medication use persisted between sexes, and between different racial and ethnic populations. CONCLUSIONS Worsened control of glycemia, blood pressure, obesity, and alcohol consumption, leveled lipid control, and persistent socioeconomic disparities may be contributing factors to the observed deceleration in decreasing cardiovascular mortality trends.
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Affiliation(s)
- Jingen Li
- Department of Cardiovascular MedicineDongzhimen Hospital, Beijing University of Chinese MedicineBeijingChina
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Cardiovascular Diseases CenterXiyuan Hospital, China Academy of Chinese Medical Sciences, National Clinical Research Center for Chinese Medicine CardiologyBeijingChina
| | - Jie Zhang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China‐Japan Friendship HospitalBeijingChina
| | | | - Naima Covassin
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Lijing Zhang
- Department of Cardiovascular MedicineDongzhimen Hospital, Beijing University of Chinese MedicineBeijingChina
| | - Hao Xu
- Cardiovascular Diseases CenterXiyuan Hospital, China Academy of Chinese Medical Sciences, National Clinical Research Center for Chinese Medicine CardiologyBeijingChina
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Brownell NK, Ziaeian B, Jackson NJ, Richards AK. Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018. Circ Cardiovasc Qual Outcomes 2024; 17:e010111. [PMID: 38567505 PMCID: PMC11104495 DOI: 10.1161/circoutcomes.123.010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. METHODS The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. RESULTS A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P<0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%-5.1%, P<0.05; PIR 3-4.99: 7.6%-6.1%, P<0.05). The 10-year PCE risk for the lowest income category (PIR <1) did not significantly change (8.1%-8.7%). In 1988-1994, the 10-year PCE risk for PIR <1 was 6% higher than PIR 5; by 2015-2018, this relative inequity increased to 70% (P<0.05). When using metrics that account for all income categories, the achievement index improved (8.0%-7.1%, P<0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health. CONCLUSIONS In this serial cross-sectional survey of US adults spanning 30 years, the population's mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.
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Affiliation(s)
| | - Boback Ziaeian
- Division of Cardiology (B.Z.), University of California, Los Angeles
| | - Nicholas J. Jackson
- Division of General Internal Medicine and Health Services Research (N.J.J.), University of California, Los Angeles
| | - Adam K. Richards
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington (A.K.R.)
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Firkins SA, Chittajallu V, Flora B, Yoo H, Simons-Linares R. Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database. Obes Surg 2024; 34:1415-1424. [PMID: 38512645 DOI: 10.1007/s11695-024-07181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery. MATERIALS AND METHODS We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations. RESULTS A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35-39 years for topiramate, 40-44 years for phentermine/topiramate and naltrexone/bupropion, 45-49 years for semaglutide, and 65-69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use. CONCLUSION Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.
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Affiliation(s)
- Stephen A Firkins
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Vibhu Chittajallu
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - Bailey Flora
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Heesoo Yoo
- Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Pan D, Xu L, Zhang LX, Shi DZ, Guo M. Associations between remnant cholesterol levels and mortality in patients with diabetes. World J Diabetes 2024; 15:712-723. [PMID: 38680693 PMCID: PMC11045415 DOI: 10.4239/wjd.v15.i4.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Dyslipidemia is frequently present in patients with diabetes. The associations of remnant cholesterol and mortality remains unclear in patients with diabetes. AIM To explore the associations of remnant cholesterol with all-cause and cardiovascular mortality in patients with diabetes. METHODS This prospective cohort study included 4740 patients with diabetes who participated in the National Health and Nutrition Examination Survey from 1999 through 2018. Remnant cholesterol was used as the exposure variable, and all-cause and cardiovascular mortality were considered outcome events. Outcome data were obtained from the National Death Index, and all participants were followed from the interview date until death or December 31, 2019. Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes, in which remnant cholesterol was modeled as both a categorical and a continuous variable. Restricted cubic splines (RCSs) were calculated to assess the nonlinearity of associations. Subgroup (stratified by sex, age, body mass index, and duration of diabetes) and a series of sensitivity analyses were performed to evaluate the robustness of the associations. RESULTS During a median follow-up duration of 83 months, 1370 all-cause deaths and 389 cardiovascular deaths were documented. Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality [hazard ratio (HR) 95% confidence interval (CI): 0.66 (0.52-0.85)]; however, when remnant cholesterol was modeled as a continuous variable, it was associated with increased risks of all-cause [HR (95%CI): 1.12 (1.02-1.21) per SD] and cardiovascular [HR (95%CI): 1.16 (1.01-1.32), per SD] mortality. The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality. Subgroup and sensitivity analyses did not reveal significant differences from the above results. CONCLUSION In patients with diabetes, higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality, and diabetes patients with slightly higher remnant cholesterol (0.68-1.04 mmol/L) had a lower risk of all-cause mortality.
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Affiliation(s)
- Deng Pan
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Graduate School, Beijing University of Chinese Medicine, Beijing 100020, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Lin Xu
- Gynecological Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing 100020, China
| | - Li-Xiao Zhang
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Da-Zhuo Shi
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Ming Guo
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
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Meaney E, Pérez-Robles E, Ortiz-Flores M, Perez-Ishiwara G, Meaney A, Munguía L, Roman G, Nájera N, Ceballos G. Overweight, Obesity, and Age Are the Main Determinants of Cardiovascular Risk Aggregation in the Current Mexican Population: The FRIMEX III Study. J Clin Med 2024; 13:2248. [PMID: 38673521 PMCID: PMC11051286 DOI: 10.3390/jcm13082248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The Mexican population exhibits several cardiovascular risk factors (CVRF) including high blood pressure (HBP), dysglycemia, dyslipidemia, overweight, and obesity. This study is an extensive observation of the most important CVFRs in six of the most populated cities in Mexico. Methods: In a cohort of 297,370 participants (54% female, mean age 43 ± 12.6 years), anthropometric (body mass index (BMI)), metabolic (glycemia and total cholesterol (TC)), and blood pressure (BP) data were obtained. Results: From age 40, 40% and 30% of the cohort's participants were overweight or obese, respectively. HBP was found in 27% of participants. However, only 8% of all hypertensive patients were controlled. Fifty percent of the subjects 50 years and older were hypercholesterolemic. Glycemia had a constant linear relation with age. BMI had a linear correlation with SBP, glycemia, and TC, with elevated coefficients in all cases and genders. The β1 coefficient for BMI was more significant in all equations than the other β, indicating that it greatly influences the other CVRFs. Conclusions: TC, glycemia, and SBP, the most critical atherogenic factors, are directly related to BMI.
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Affiliation(s)
- Eduardo Meaney
- Laboratorio de Investigación Cardiometabólica Integral, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (E.P.-R.); (M.O.-F.)
| | - Enrique Pérez-Robles
- Laboratorio de Investigación Cardiometabólica Integral, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (E.P.-R.); (M.O.-F.)
| | - Miguel Ortiz-Flores
- Laboratorio de Investigación Cardiometabólica Integral, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (E.P.-R.); (M.O.-F.)
| | - Guillermo Perez-Ishiwara
- Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Mexico City 07320, Mexico;
| | - Alejandra Meaney
- Cardiovascular Unit, Hospital Regional “1° de Octubre”, Instituto de Seguridad Social y Servicios para los Trabajadores del Estado, Mexico City 07760, Mexico
| | - Levy Munguía
- Dirección Normativa de Salud, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 06030, Mexico
| | - Gisele Roman
- Coalición por el Corazón de México, Mexico City 01090, Mexico
| | - Nayelli Nájera
- Laboratorio de Investigación Cardiometabólica Integral, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (E.P.-R.); (M.O.-F.)
| | - Guillermo Ceballos
- Laboratorio de Investigación Cardiometabólica Integral, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (E.P.-R.); (M.O.-F.)
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Gallucci G, Turazza FM, Inno A, Canale ML, Silvestris N, Farì R, Navazio A, Pinto C, Tarantini L. Atherosclerosis and the Bidirectional Relationship between Cancer and Cardiovascular Disease: From Bench to Bedside-Part 1. Int J Mol Sci 2024; 25:4232. [PMID: 38673815 PMCID: PMC11049833 DOI: 10.3390/ijms25084232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Atherosclerosis, a complex metabolic-immune disease characterized by chronic inflammation driven by the buildup of lipid-rich plaques within arterial walls, has emerged as a pivotal factor in the intricate interplay between cancer and cardiovascular disease. This bidirectional relationship, marked by shared risk factors and pathophysiological mechanisms, underscores the need for a comprehensive understanding of how these two formidable health challenges intersect and influence each other. Cancer and its treatments can contribute to the progression of atherosclerosis, while atherosclerosis, with its inflammatory microenvironment, can exert profound effects on cancer development and outcomes. Both cancer and cardiovascular disease involve intricate interactions between general and personal exposomes. In this review, we aim to summarize the state of the art of translational data and try to show how oncologic studies on cardiotoxicity can broaden our knowledge of crucial pathways in cardiovascular biology and exert a positive impact on precision cardiology and cardio-oncology.
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Affiliation(s)
| | - Fabio Maria Turazza
- Struttura Complessa di Cardiologia, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy;
| | - Alessandro Inno
- Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy;
| | - Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, 55041 Lido di Camaiore, Italy;
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98100 Messina, Italy;
| | - Roberto Farì
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Alessandro Navazio
- Cardiologia Ospedaliera, Department of Specialized Medicine, AUSL—IRCCS in Tecnologie Avanzate e Modelli Assistenziali in Oncologia, 42100 Reggio Emilia, Italy;
| | - Carmine Pinto
- Provincial Medical Oncology, Department of Oncology and Advanced Technologies, AUSL—IRCCS in Tecnologie Avanzate e Modelli Assistenziali in Oncologia, 42100 Reggio Emilia, Italy;
| | - Luigi Tarantini
- Cardiologia Ospedaliera, Department of Specialized Medicine, AUSL—IRCCS in Tecnologie Avanzate e Modelli Assistenziali in Oncologia, 42100 Reggio Emilia, Italy;
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Tajdini M, Behnoush AH, Pashang M, Jameie M, Khalaji A, Sadeghian S, Vasheghani-Farahani A, Poorhosseini H, Masoudkabir F, Hosseini K, Davoodi S, Sahebjam M, Barkhordari K, Ashraf H, Shafiei A, Karimi A. Heart surgery over two decades: what we have learned about results and changing risks. BMC Cardiovasc Disord 2024; 24:195. [PMID: 38580959 PMCID: PMC10996112 DOI: 10.1186/s12872-024-03860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVES Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. METHODS This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). RESULTS A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. CONCLUSIONS Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings.
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Affiliation(s)
- Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Davoodi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Barkhordari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiei
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Karimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Zhang X, Wei R, Wang X, Zhang W, Li M, Ni T, Weng W, Li Q. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension. Cardiovasc Diabetol 2024; 23:117. [PMID: 38566082 PMCID: PMC10985955 DOI: 10.1186/s12933-024-02191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Identifying reliable prognostic markers is crucial for the effective management of hypertension. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker linked to cardiovascular outcomes. This study aims to investigate the association of NLR with all-cause and cardiovascular mortality among patients with hypertension. METHODS This study analyzed data from 3067 hypertensive adults in the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2014. Mortality details were obtained from the National Death Index (NDI). Restricted cubic spline (RCS) was deployed to visualize the association of the NLR with mortality risk. Weighted Cox proportional hazards models were employed to assess the independent association of NLR with mortality risk. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to access the predictive ability of NLR for survival. Mediation analysis was used to explore the indirect impact of NLR on mortality mediated through eGFR. RESULTS Over a median 92.0-months follow-up, 538 deaths occurred, including 114 cardiovascular deaths. RCS analysis revealed a positive association between NLR and both all-cause and cardiovascular mortality. Participants were stratified into higher (> 3.5) and lower (≤ 3.5) NLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher NLR had a significantly increased risk of all-cause (HR 1.96, 95% confidence interval (CI) 1.52-2.52, p < 0.0001) and cardiovascular mortality (HR 2.33, 95% CI 1.54-3.51, p < 0.0001). Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between NLR and both all-cause and cardiovascular mortality by a 5.4% and 4.7% proportion, respectively. Additionally, the areas under the curve (AUC) of the 3-, 5- and 10- year survival was 0.68, 0.65 and 0.64 for all-cause mortality and 0.68, 0.70 and 0.69 for cardiovascular mortality, respectively. CONCLUSION Elevated NLR independently confers an increased risk for both all-cause and cardiovascular mortality in individuals with hypertension.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Wantong Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mengxuan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Tian Ni
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiliang Weng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- Department of General Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
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Sterpetti AV, Gabriele R, Iannone I, Campagnol M, Borrelli V, Sapienza P, Dimarzo L. Trends towards increase of Cardiovascular diseases mortality in USA: A comparison with Europe and the importance of preventive care. Curr Probl Cardiol 2024; 49:102459. [PMID: 38346607 DOI: 10.1016/j.cpcardiol.2024.102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.
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Affiliation(s)
| | | | | | | | | | | | - Luca Dimarzo
- Department Of Vascular Surgery, Sapienza University Rome Italy
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Longtine AG, Greenberg NT, Bernaldo de Quirós Y, Brunt VE. The gut microbiome as a modulator of arterial function and age-related arterial dysfunction. Am J Physiol Heart Circ Physiol 2024; 326:H986-H1005. [PMID: 38363212 PMCID: PMC11279790 DOI: 10.1152/ajpheart.00764.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
The arterial system is integral to the proper function of all other organs and tissues. Arterial function is impaired with aging, and arterial dysfunction contributes to the development of numerous age-related diseases, including cardiovascular diseases. The gut microbiome has emerged as an important regulator of both normal host physiological function and impairments in function with aging. The purpose of this review is to summarize more recently published literature demonstrating the role of the gut microbiome in supporting normal arterial development and function and in modulating arterial dysfunction with aging in the absence of overt disease. The gut microbiome can be altered due to a variety of exposures, including physiological aging processes. We explore mechanisms by which the gut microbiome may contribute to age-related arterial dysfunction, with a focus on changes in various gut microbiome-related compounds in circulation. In addition, we discuss how modulating circulating levels of these compounds may be a viable therapeutic approach for improving artery function with aging. Finally, we identify and discuss various experimental considerations and research gaps/areas of future research.
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Affiliation(s)
- Abigail G Longtine
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Nathan T Greenberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Yara Bernaldo de Quirós
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
- Instituto Universitario de Sanidad Animal y Seguridad Alimentaria, Universidad de las Palmas de Gran Canaria, Las Palmas, Spain
| | - Vienna E Brunt
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Wadhera RK, Secemsky EA, Xu J, Yeh RW, Song Y, Goldhaber SZ. Community Socioeconomic Status, Acute Cardiovascular Hospitalizations, and Mortality in Medicare, 2003 to 2019. Circ Cardiovasc Qual Outcomes 2024; 17:e010090. [PMID: 38597091 DOI: 10.1161/circoutcomes.123.010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Socioeconomically disadvantaged communities in the United States disproportionately experience poor cardiovascular outcomes. Little is known about how hospitalizations and mortality for acute cardiovascular conditions have changed among Medicare beneficiaries in socioeconomically disadvantaged and nondisadvantaged communities over the past 2 decades. METHODS Medicare files were linked with the Centers for Disease Control and Prevention's social vulnerability index to examine age-sex standardized hospitalizations for myocardial infarction, heart failure, ischemic stroke, and pulmonary embolism among Medicare fee-for-service beneficiaries ≥65 years of age residing in socioeconomically disadvantaged communities (highest social vulnerability index quintile nationally) and nondisadvantaged communities (all other quintiles) from 2003 to 2019, as well as risk-adjusted 30-day mortality among hospitalized beneficiaries. RESULTS A total of 10 942 483 Medicare beneficiaries ≥65 years of age were hospitalized for myocardial infarction, heart failure, stroke, or pulmonary embolism (mean age, 79.2 [SD, 8.7] years; 53.9% female). Although age-sex standardized myocardial infarction hospitalizations declined in socioeconomically disadvantaged (990-650 per 100 000) and nondisadvantaged communities (950-570 per 100 000) from 2003 to 2019, the gap in hospitalizations between these groups significantly widened (adjusted odds ratio 2003, 1.03 [95% CI, 1.02-1.04]; adjusted odds ratio 2019, 1.14 [95% CI, 1.13-1.16]). There was a similar decline in hospitalizations for heart failure in socioeconomically disadvantaged (2063-1559 per 100 000) and nondisadvantaged communities (1767-1385 per 100 000), as well as for ischemic stroke, but the relative gap did not change for both conditions. In contrast, pulmonary embolism hospitalizations increased in both disadvantaged (146-184 per 100 000) and nondisadvantaged communities (153-184 per 100 000). By 2019, risk-adjusted 30-day mortality was similar between hospitalized beneficiaries from socioeconomically disadvantaged and nondisadvantaged communities for myocardial infarction, heart failure, and ischemic stroke but was higher for pulmonary embolism (odds ratio, 1.10 [95% CI, 1.01-1.20]). CONCLUSIONS Over the past 2 decades, hospitalizations for most acute cardiovascular conditions decreased in both socioeconomically disadvantaged and nondisadvantaged communities, although significant disparities remain, while 30-day mortality is now similar across most conditions.
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Affiliation(s)
- Rishi K Wadhera
- Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., E.A.S., J.X., R.W.Y., Y.S.)
| | - Eric A Secemsky
- Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., E.A.S., J.X., R.W.Y., Y.S.)
| | - Jiaman Xu
- Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., E.A.S., J.X., R.W.Y., Y.S.)
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., E.A.S., J.X., R.W.Y., Y.S.)
| | - Yang Song
- Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., E.A.S., J.X., R.W.Y., Y.S.)
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.Z.G.)
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Peng W, Bai X, Wu C, Zhang H, Li X, Lu J. Sociodemographic Factors, Leisure-Time Physical Activity and Mortality. Am J Prev Med 2024; 66:598-608. [PMID: 37972796 DOI: 10.1016/j.amepre.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Exploring sociodemographic effect modification is important to provide evidence for developing targeted recommendations and reducing health inequalities. This study evaluated how sociodemographic factors including age, sex, race/ethnicity and socioeconomic status (SES) modify the association between leisure-time physical activity (LTPA) and all-cause and major cause-specific mortality. METHODS The study sample included 471,992 people from the 1997-2018 National Health Interview Survey (NHIS) and 41,830 people from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in December 2022. Mortality data from the National Death Index were available to December 31, 2019. Sufficient LTPA was defined as at least 150 minutes of moderate and/or vigorous intensity per week. RESULTS There were 46,289 deaths in NHIS participants and 4,617 deaths in NHANES participants during a mean follow-up of 10 years. Individuals with sufficient LTPA had lower risk of all-cause (NHIS: hazard ratio, 0.74, 95% CI: [0.74-0.74]; NHANES: 0.73 [0.68-0.79]) and cardiovascular mortality (NHIS: 0.75 [0.75-0.75]; NHANES: 0.80 [0.69-0.93]) compared with inactive participants. The subgroup analysis showed significant interactions between LTPA and all sociodemographic factors. Associations between LTPA and mortality were weaker among younger individuals, males, Hispanic adults or those of low SES, respectively. CONCLUSIONS Sociodemographic factors significantly modified the associations between LTPA and mortality. The health benefits of sufficient LTPA were smaller in younger individuals, males, Hispanic adults or those of low SES. These findings can help identify target populations for promotion of physical activity to reduce health inequalities and the development of physical activity guidelines.
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Affiliation(s)
- Wenyao Peng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueke Bai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaoqun Wu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China; Central China Sub-Center of the National Center for Cardiovascular Diseases, Zhengzhou, China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Everett BM. The Confusing Landscape of Cardiovascular Health Assessment, Promotion, and Prediction. Circulation 2024; 149:914-916. [PMID: 38498613 DOI: 10.1161/circulationaha.123.067982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Mo P, Tian CW, Li Q, Teng M, Fang L, Xiong Y, Liu B. Decreased plasma miR-140-3p is associated with coronary artery disease. Heliyon 2024; 10:e26960. [PMID: 38444486 PMCID: PMC10912453 DOI: 10.1016/j.heliyon.2024.e26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Background Although many circulating miRNAs (c-miRNAs) are associated with coronary artery disease (CAD), they are far from being the biomarker for CAD diagnosis or risk prediction. Therefore, novel c-miRNAs discovery and validation are still required, especially evaluating their prediction capacity. Objectives Identify novel CAD-related c-miRNAs and evaluate its risk prediction capacity for CAD. Methods: miRNAs associated with CAD were preliminarily investigated in three paired samples representing pre-CAD stage and CAD stage of three female individuals using the Applied Biosystems miRNA TaqMan® Low-Density Array (TLDA). Then, the candidate miRNAs were further verified in an independent case-control study including 129 CAD patients and 76 controls, and their potential practical value in prediction for CAD was evaluated using a machine learning (ML) algorithm. The accuracy of classification and prediction was assessed with the area under the receiver operating characteristic curve (AUC). Results TLDA analysis shows that miR-140-3p decreased significantly in CAD-stage (FC = -3.01, P = 0.007). Further study shows that miR-140-3p was significantly lower in CAD group [1.26 (0.68, 2.01)] than in control group [2.07 (1.19, 3.21)] (P < 0.001) and independently associated with CAD (P < 0.001). The addition of miR-140-3p to the variables including smoking history, HDL-c, and APOA1 improved the accuracy of classification by logistic regression and of prediction for CAD by ML models. The ML models built with miR-140-3p and HDL-c, respectively, had a similar prediction accuracy. The feature importance of miR-140-3p and HDL-c in the ML models was also similar. Decision curve analysis showed that miR-140-3p and HDL-c had almost identical net benefits. Conclusion Reduced levels of miR-140-3p is linked to CAD, and it is possible to use the plasma level of miR-140-3p as a means of evaluating the risk of CAD.
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Affiliation(s)
- Pei Mo
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Chao-Wei Tian
- Department of General Practice, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Qiqi Li
- Department of Medical Imaging, Second Clinical College, Guangzhou Medical University, Guangzhou, 510260, China
| | - Mo Teng
- Department of Obstetrics, The Second Affiliated Hospital, Guangzhou Medical University. Guangzhou, 510260, China
| | - Lei Fang
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Yujuan Xiong
- Department of Laboratory Medicine, Panyu Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 511400, China
| | - Benrong Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
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Shah NS, Huang X, Petito LC, Bancks MP, Kanaya AM, Talegawkar S, Farhan S, Carnethon MR, Lloyd-Jones DM, Allen NB, Kandula NR, Khan SS. Social and psychosocial determinants of racial and ethnic differences in cardiovascular health: The MASALA and MESA studies. Am J Prev Cardiol 2024; 17:100636. [PMID: 38322182 PMCID: PMC10844663 DOI: 10.1016/j.ajpc.2024.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/08/2024] Open
Abstract
Background Social and psychosocial determinants are associated with cardiovascular health (CVH). Objectives To quantify the contributions of social and psychosocial factors to racial/ethnic differences in CVH. Methods In the Multi-Ethnic Study of Atherosclerosis and Mediators of Atherosclerosis in South Asians Living in America cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results Among 7,978 adults (mean age 61 [SD 10] years, 52 % female), there were 1,892 Black (mean CVH score for decomposition analysis 7.96 [SD 2.1]), 804 Chinese (CVH 9.69 [1.8]), 1,496 Hispanic (CVH 8.00 [2.1]), 1,164 South Asian (CVH 9.16 [2.0]), and 2,622 White (CVH 8.91 [2.1]) participants. The factors that were associated with the largest magnitude of explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equal to White participants, Black participants' mean CVH score would be 0.14 [SE 0.05] points higher); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants' mean CVH score would be 0.22 [0.10] points lower); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants' mean CVH score would be 0.55 [0.11] points higher and 0.37 [0.11] points lower, respectively). Conclusions In these multiethnic US cohorts, social and psychosocial factors were associated with racial/ethnic differences in CVH.
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Affiliation(s)
- Nilay S. Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Xiaoning Huang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michael P. Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Alka M. Kanaya
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sameera Talegawkar
- George Washington University School of Public Health, Washington, DC, United States
| | - Saaniya Farhan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Donald M. Lloyd-Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Namratha R. Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Diego VP, Manusov EG, Mao X, Almeida M, Peralta JM, Curran JE, Mahaney MC, Göring H, Blangero J, Williams-Blangero S. Metabolic syndrome traits exhibit genotype-by-environment interaction in relation to socioeconomic status in the Mexican American family heart study. Front Genet 2024; 15:1240462. [PMID: 38495670 PMCID: PMC10940335 DOI: 10.3389/fgene.2024.1240462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Socioeconomic Status (SES) is a potent environmental determinant of health. To our knowledge, no assessment of genotype-environment interaction has been conducted to consider the joint effects of socioeconomic status and genetics on risk for metabolic disease. We analyzed data from the Mexican American Family Studies (MAFS) to evaluate the hypothesis that genotype-by-environment interaction (GxE) is an essential determinant of variation in risk factors for metabolic syndrome (MS). Methods: We employed a maximum likelihood estimation of the decomposition of variance components to detect GxE interaction. After excluding individuals with diabetes and individuals on medication for diabetes, hypertension, or dyslipidemia, we analyzed 12 MS risk factors: fasting glucose (FG), fasting insulin (FI), 2-h glucose (2G), 2-h insulin (2I), body mass index (BMI), waist circumference (WC), leptin (LP), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), total serum cholesterol (TSC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Our SES variable used a combined score of Duncan's socioeconomic index and education years. Heterogeneity in the additive genetic variance across the SES continuum and a departure from unity in the genetic correlation coefficient were taken as evidence of GxE interaction. Hypothesis tests were conducted using standard likelihood ratio tests. Results: We found evidence of GxE for fasting glucose, 2-h glucose, 2-h insulin, BMI, and triglycerides. The genetic effects underlying the insulin/glucose metabolism component of MS are upregulated at the lower end of the SES spectrum. We also determined that the household variance for systolic blood pressure decreased with increasing SES. Conclusion: These results show a significant change in the GxE interaction underlying the major components of MS in response to changes in socioeconomic status. Further mRNA sequencing studies will identify genes and canonical gene pathways to support our molecular-level hypotheses.
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Affiliation(s)
- Vincent P. Diego
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Eron G. Manusov
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Xi Mao
- Department of Economics, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Marcio Almeida
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Juan M. Peralta
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Joanne E. Curran
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Michael C. Mahaney
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Harald Göring
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Sarah Williams-Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
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Harville EW, Hakala JO, Rovio SP, Pahkala K, Raitakari O, Lehtimäki T. Trajectories of cardiovascular risk predict pregnancy outcomes: The Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Paediatr Perinat Epidemiol 2024; 38:168-179. [PMID: 37432549 PMCID: PMC10782826 DOI: 10.1111/ppe.12995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Life course patterns of change in risk-trajectories-affect health. OBJECTIVES To examine how trajectories of cardiovascular risk factors are associated with pregnancy and birth outcomes. METHODS Data from two cohort studies participating in the International Childhood Cardiovascular Consortium-The Bogalusa Heart Study (BHS; started in 1973, N = 903 for this analysis) and the Cardiovascular Risk in Young Finns Study (YFS; started in 1980, N = 499) were used. Both followed children into adulthood and measured cardiovascular risk factors, including body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP), total, lipoprotein (LDL)- and high density lipoprotein (HDL)-cholesterol and serum triglycerides. Discrete mixture modelling was used to divide each cohort into distinct trajectories according to these risk factors from childhood to early adulthood, and these groups were then used to predict pregnancy outcomes including small for gestational age (SGA; <10th study-specific percentile of gestational age by sex), preterm birth (PTB; <37 weeks' gestation), hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), with control for age at baseline and at first birth, parity, socioeconomic status, BMI and smoking. RESULTS The models created more trajectories for BMI, SBP and HDL-cholesterol in the YFS than in BHS, for which three classes generally seemed to be sufficient to represent the groups in the population across risk factors. In BHS, the association between the higher and flatter DBP trajectory and PTB was aRR 1.77, 95% confidence interval [CI] 1.06, 2.96. In BHS the association between consistent total cholesterol and PTB was aRR 2.16, 95% CI 1.22, 3.85 and in YFS the association between elevated high trajectory and PTB was aRR 3.35, 95% CI 1.28, 8.79. Elevated-increasing SBP was associated with a higher risk of GH in BHS and increasing or persistent-obese BMI trajectories were associated with GDM in both cohorts (BHS: aRR 3.51, 95% CI 1.95, 6.30; YFS: aRR 2.61, 95% CI 0.96, 7.08). CONCLUSIONS Trajectories of cardiovascular risk, particularly those that represent a consistent or more rapid worsening of cardiovascular health, are associated with a higher risk of pregnancy complications.
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Affiliation(s)
- Emily W. Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Juuso O. Hakala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Suvi P. Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520 Finland
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Zheng D, Cao L. Association Between Myocardial Infarction and Triglyceride-Glucose Index: A Study Based on NHANES Database. Glob Heart 2024; 19:23. [PMID: 38404616 PMCID: PMC10885828 DOI: 10.5334/gh.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To investigate differences in levels of the triglyceride-glucose (TyG) index between individuals with myocardial infarction (MI) and those without MI, as well as the association between TyG index and risk of MI. Methods Data from the National Health and Nutrition Examination Survey (NHANES) for US adults from 2013 to 2018 were included in this study. Using MI as an outcome variable and TyG index as an exposure variable, logistic regression models were employed to analyze relationship between MI and TyG index. Results The study included 6,695 participants. Compared to the non-MI group, patients with MI had significantly higher TyG index (8.89 vs. 8.63, P = 0.003). Higher TyG index was significantly associated with an increased risk of MI in US adults (OR: 1.69, 95% CI: 1.26-2.26, P < 0.001). Race, smoking status, and history of chronic obstructive pulmonary disease (COPD) had significant impacts on the association between TyG index and risk of MI (P for interaction < 0.05). Subgroup analysis demonstrated a significant positive correlation between TyG index and MI risk in non-Hispanic Black individuals, non-smokers, and individuals without COPD across multiple models (OR > 1.0, P < 0.05). Conclusion US adults with higher TyG index were more susceptible to MI, and TyG index may be used to identify individuals at high risk of MI in the US population.
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Affiliation(s)
- Dandan Zheng
- The Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang City, Hubei Province, China
| | - Ligong Cao
- The Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang City, Hubei Province, China
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Zhang D, Lee JS, Pollack LM, Dong X, Taliano JM, Rajan A, Therrien NL, Jackson SL, Popoola A, Luo F. Association of Economic Policies With Hypertension Management and Control: A Systematic Review. JAMA HEALTH FORUM 2024; 5:e235231. [PMID: 38334993 PMCID: PMC10858400 DOI: 10.1001/jamahealthforum.2023.5231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024] Open
Abstract
Importance Economic policies have the potential to impact management and control of hypertension. Objectives To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. Evidence Review A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than 140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. Findings In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. Conclusions and Relevance The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.
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Affiliation(s)
- Donglan Zhang
- Center for Population Health and Health Services Research, Department of Foundations of Medicine, New York University Grossman Long Island School of Medicine, Mineola
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaobei Dong
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee
| | - Joanna M. Taliano
- Office of Science Quality and Library Services, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anand Rajan
- Center for Population Health and Health Services Research, Department of Foundations of Medicine, New York University Grossman Long Island School of Medicine, Mineola
| | - Nicole L. Therrien
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adebola Popoola
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Structural determinants and cardiometabolic typologies related to frailty in community-dwelling older adults. Arch Gerontol Geriatr 2024; 117:105171. [PMID: 37688920 DOI: 10.1016/j.archger.2023.105171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/11/2023]
Abstract
Frailty is a geriatric syndrome linked to adverse outcomes. Co-occurring cardiometabolic factors increase frailty risk; however, their distinct combinations (typologies) associated with frailty are unclear. We aimed to identify subgroups of older adults with distinct cardiometabolic typologies and characterize their relationship with structural determinants and frailty to inform tailored approaches to prevent and delay frailty. This study was cross-sectional design and included 7984 community-dwelling older adults (65+ years) enrolled in the Health and Retirement Study (2006 and 2008). Latent class analysis was performed using seven cardiometabolic indicators (abdominal obesity, obesity, low high-density lipoprotein; and elevated blood pressure, blood sugar, total cholesterol, C-reactive protein). Frailty was indicated by ≥3 features (weakness, slowness, fatigue, low physical activity, unintentional weight loss). Logistic regression was used to examine the relationship between structural determinants (gender, race/ethnicity, and education), cardiometabolic typologies, and frailty. Three cardiometabolic subgroups were identified: insulin-resistant (n = 3547), hypertensive dyslipidemia (n = 1246), and hypertensive (n = 3191). Insulin-resistant subgroup members were more likely to be female, non-Hispanic Black, and college non-graduates; hypertensive dyslipidemia subgroup members were more likely to be non-Hispanic Others and report high school education; and hypertensive subgroup members were more likely to be male and college educated (p≤.05). Frailty risk was higher for females, Hispanic or Non-Hispanic Black older adults, and those with lower education (p≤.001). Frailty risk was greater in the insulin-resistant compared to the other subgroups (both aOR=2.0, both p<.001). Findings highlight a need to design tailored interventions targeting cardiometabolic typologies to prevent and delay frailty.
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Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
| | - Susan G Silva
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
| | - Eleanor S McConnell
- Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Durham, NC, United States
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, United States
| | - Michael P Cary
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States
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