1
|
Lien I, Moffet H, Liu J, Karter A, Solomon M, Go A, Nasir K, Sidney S, Rana J. Association Between Cardiovascular Health Status and Healthcare Utilization in a Large Integrated Healthcare System. AJPM FOCUS 2024; 3:100213. [PMID: 38590395 PMCID: PMC10999799 DOI: 10.1016/j.focus.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Introduction The American Heart Association Life's Simple 7 schema can be used to categorize patients' cardiovascular health status as poor, intermediate, or ideal on the basis of smoking, BMI, physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between cardiovascular health status and subsequent healthcare utilization. Methods This was an observational cohort study of adults from an integrated healthcare delivery system-Kaiser Permanente Northern California-that had outpatient care between 2013 and 2014. Patients were categorized by American Heart Association cardiovascular health status: poor, intermediate, or ideal. Individual-level healthcare utilization and costs in 2015 were accumulated for each patient and compared across the 3 cardiovascular health categories and stratified by age groups. Results A total of 991,698 patients were included in the study. A total of 194,003 (19.6%) were aged 18-39 years; 554,129 (55.9%) were aged 40-64 years; and 243,566 (24.6%) were aged ≥65 years. A total of 259,931 (26.2%) had ideal cardiovascular health; 521,580 (52.6%) had intermediate cardiovascular health; and 210,187 (21.2%) had poor cardiovascular health. Healthcare utilization measured by average relative cost per patient increased monotonically across age categories (p<0.001). In addition, cardiovascular health category was inversely associated with lower cost in each age group (p<0.001). Conclusions Adults who were younger and had more ideal cardiovascular health had relatively lower healthcare costs across age groups. Interventions to promote better cardiovascular health may improve patient outcomes and reduce overall healthcare expenditures.
Collapse
Affiliation(s)
- Irvin Lien
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Howard Moffet
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Jennifer Liu
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Andrew Karter
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Matthew Solomon
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Alan Go
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Khurram Nasir
- Division of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas
| | - Stephen Sidney
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Jamal Rana
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| |
Collapse
|
2
|
Venkatesh KK, Perak AM, Wu J, Catalano P, Josefon JL, Costantine MM, Landon MB, Lancki N, Scholtens D, Lowe W, Khan SS, Grobman WA. Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence. Am J Obstet Gynecol 2024:S0002-9378(24)00563-5. [PMID: 38703941 DOI: 10.1016/j.ajog.2024.04.037] [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: 02/19/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes, including hypertensive disorders of pregnancy and gestational diabetes mellitus, influence maternal cardiovascular health long after pregnancy, but their relationship to offspring cardiovascular health following in-utero exposure remains uncertain. OBJECTIVE To examine associations of hypertensive disorders of pregnancy or gestational diabetes mellitus with offspring cardiovascular health in early adolescence. STUDY DESIGN This analysis used data from the prospective Hyperglycemia and Adverse Pregnancy Outcome Study from 2000 to 2006 and the Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study from 2013 to 2016. This analysis included 3317 mother-child dyads from 10 field centers, comprising 70.8% of Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. The exposures included having any hypertensive disorders of pregnancy or gestational diabetes mellitus vs not having hypertensive disorders of pregnancy or gestational diabetes mellitus, respectively (reference). The outcome was offspring cardiovascular health when aged 10-14 years, on the basis of 4 metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The primary outcome was defined as having at least 1 cardiovascular health metric that was nonideal vs all ideal (reference), and the second outcome was the number of nonideal cardiovascular health metrics (ie, at least 1 intermediate metric, 1 poor metric, or at least 2 poor metrics vs all ideal [reference]). Modified poisson regression with robust error variance was used and adjusted for covariates at pregnancy enrollment, including field center, parity, age, gestational age, alcohol or tobacco use, child's assigned sex at birth, and child's age at follow-up. RESULTS Among 3317 maternal-child dyads, the median (interquartile) ages were 30.4 (25.6-33.9) years for pregnant individuals and 11.6 (10.9-12.3) years for children. During pregnancy, 10.4% of individuals developed hypertensive disorders of pregnancy, and 14.6% developed gestational diabetes mellitus. At follow-up, 55.5% of offspring had at least 1 nonideal cardiovascular health metric. In adjusted models, having hypertensive disorders of pregnancy (adjusted risk ratio, 1.14 [95% confidence interval, 1.04-1.25]) or having gestational diabetes mellitus (adjusted risk ratio, 1.10 [95% confidence interval, 1.02-1.19]) was associated with a greater risk that offspring developed less-than-ideal cardiovascular health when aged 10-14 years. The above associations strengthened in magnitude as the severity of adverse cardiovascular health metrics increased (ie, with the outcome measured as ≥1 intermediate, 1 poor, and ≥2 poor adverse metrics), albeit the only statistically significant association was with the "1-poor-metric" exposure. CONCLUSION In this multinational prospective cohort, pregnant individuals who experienced either hypertensive disorders of pregnancy or gestational diabetes mellitus were at significantly increased risk of having offspring with worse cardiovascular health in early adolescence. Reducing adverse pregnancy outcomes and increasing surveillance with targeted interventions after an adverse pregnancy outcome should be studied as potential avenues to enhance long-term cardiovascular health in the offspring exposed in utero.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH.
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Patrick Catalano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Jami L Josefon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Mark B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - William Lowe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University, Boston, MA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University, Chicago, IL; Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, IL
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| |
Collapse
|
3
|
Murkey JA, Gaston SA, Alhasan DM, Payne CW, Jackson WB, Jackson CL. Food security status and cardiometabolic health by sex/gender and race/ethnicity among adults in the United States. BMC Public Health 2024; 24:1220. [PMID: 38698385 PMCID: PMC11065684 DOI: 10.1186/s12889-024-18655-y] [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: 10/03/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Minoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are projected to widen due to the worsening climate crisis that is straining the agricultural system including food supplies. Nonetheless, studies have not investigated the relationship between food security status and 'ideal' CVH in a large, nationally-representative and racially/ethnically diverse US sample. METHODS AND RESULTS We investigated household food security status in relation to 'ideal' CVH among US adults (N = 157,001) using 2014-2018/2020 National Health Interview Survey data. Food security status was defined as very low, low, marginal, or high. A summed score of 4 health behaviors and 3 clinical factors totaling 7 different measures was dichotomized (yes/no) to assess modified 'ideal' CVH (mICVH). Using Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% CIs of mICVH by household food security status. We stratified models by sex/gender and race/ethnicity. Very low food security prevalence was higher among non-Hispanic (NH)-Black (8.0%) compared to Hispanic/Latinx (5.1%), NH-White (3.1%) and NH-Asian (1.7%) adults. The association between very low versus high food security and mICVH was stronger among women (PR = 0.23 [95% CI: 0.17-0.31]) than men (PR = 0.48 [95% CI: 0.35-0.66]). Compared to NH-White adults with high food security, racially/ethnically minoritized groups with very low to high food security were generally less likely (range: [PRvery low = 0.25[95% CI: 0.14-0.44] - [PRhigh = 0.88 [95% CI: 0.79-0.97]) to meet mICVH criteria. CONCLUSIONS Food insecurity was associated with lower mICVH prevalence and racially/ethnically minoritized groups were disproportionately burdened.
Collapse
Affiliation(s)
- Jamie A Murkey
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC, 27709, USA
| | - Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC, 27709, USA
| | - Dana M Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC, 27709, USA
| | - Christopher W Payne
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, 27703, USA
| | - W Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, NC, 27703, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC, 27709, USA.
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA.
| |
Collapse
|
4
|
Ware L, Vermeulen B, Maposa I, Flood D, Brant LC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of Cardiovascular Health Profiles Across Population Surveys From 5 High- to Low-Income Countries. CJC Open 2024; 6:582-596. [PMID: 38559335 PMCID: PMC10980894 DOI: 10.1016/j.cjco.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
Background To facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown. Methods Nationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18-69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries. Results Among 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh. Conclusions Our findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible.
Collapse
Affiliation(s)
- Lisa Ware
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African Medical Research Council Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa C.C. Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Public Health (ITR), University of Porto, Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Gastón Perman
- Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B. Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Darwin R. Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
5
|
Hosseinpour‐Niazi S, Afaghi S, Hadaegh P, Mahdavi M, Farhadnejad H, Tohidi M, Mirmiran P, Azizi F, Hadaegh F. The association between metabolic syndrome and insulin resistance with risk of cardiovascular events in different states of cardiovascular health status. J Diabetes Investig 2024; 15:208-218. [PMID: 37873675 PMCID: PMC10804926 DOI: 10.1111/jdi.14101] [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: 06/20/2023] [Revised: 09/19/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
AIMS/INTRODUCTION The aim was to examine the joint effect of metabolic syndrome (MetS) and insulin resistance (IR) with ideal cardiovascular health (iCVH) status on incident cardiovascular diseases (CVDs). MATERIALS AND METHODS The study included 6,240 Iranian adults ≥30 years, free of prior cardiovascular disease. Ideal cardiovascular health was determined based on American Heart Association's Life Simple 7. Metabolic syndrome was defined according to the Joint Interim Statement Criteria, and insulin resistance was defined as HOMA-IR ≥1.85 in women and ≥2.17 in men. Multivariable Cox proportional hazard ratios (HRs) were applied to examine the impact of metabolic syndrome, and insulin resistance at various levels of iCVH status. RESULTS During the median follow-up of 14.0 years, 909 cases of cardiovascular disease occurred. Metabolic syndrome and insulin resistance were significantly associated with incident cardiovascular disease events. In the poor and intermediate status, metabolic syndrome increased cardiovascular disease events with HRs of 1.83 and 1.57, respectively; the corresponding values for insulin resistance in the mentioned categories were 1.91 and 1.25, respectively (P values < 0.05). In the intermediate and poor iCVH status, hypertriglyceridemia was linked to a 40% and 35% higher risk of cardiovascular disease, the corresponding values for low HDL-C was 20% and 60%, respectively (P values < 0.05). Although adding metabolic syndrome, its dyslipidemia and insulin resistance to iCVH status in both poor and intermediate status significantly improve the prediction of cardiovascular disease using net reclassification improvement (P values < 0.05), the value of C-index did not change. CONCLUSIONS Metabolic syndrome and the dyslipidemia component had a negligible but significant improvement in the prediction of cardiovascular disease among individuals with non-optimal iCVH status.
Collapse
Affiliation(s)
- Somayeh Hosseinpour‐Niazi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Siamak Afaghi
- Department of Internal Medicine, Shahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Parto Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
6
|
Ware L, Vermeulen B, Maposa I, Floo D, Brant LCC, Khandelwal S, Singh K, Soares S, Jessen N, Perman G, Riaz BK, Sachdev HS, Allen NB, Labarthe DR. Comparison of cardiovascular health profiles across population surveys from five high- to low-income countries. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.26.23293185. [PMID: 37546768 PMCID: PMC10402230 DOI: 10.1101/2023.07.26.23293185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Aims With the greatest burden of cardiovascular disease morbidity and mortality increasingly observed in lower-income countries least prepared for this epidemic, focus is widening from risk factor management alone to primordial prevention to maintain high levels of cardiovascular health (CVH) across the life course. To facilitate this, the American Heart Association (AHA) developed CVH scoring guidelines to evaluate and track CVH. We aimed to compare the prevalence and trajectories of high CVH across the life course using nationally representative adult CVH data from five diverse high- to low-income countries. Methods Surveys with CVH variables (physical activity, cigarette smoking, body mass, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the United States (US). Participants were included if they were 18-69y, not pregnant, and had data for these CVH metrics. Comparable data were harmonized and each of the CVH metrics was scored using AHA guidelines as high (2), moderate (1), or low (0) to create total CVH scores with higher scores representing better CVH. High CVH prevalence by age was compared creating country CVH trajectories. Results The analysis included 28,092 adults (Ethiopia n=7686, 55.2% male; Bangladesh n=6731, 48.4% male; Brazil n=7241, 47.9 % male; England n=2691, 49.5% male, and the US n=3743, 50.3% male). As country income level increased, prevalence of high CVH decreased (>90% in Ethiopia, >68% in Bangladesh and under 65% in the remaining countries). This pattern remained using either five or all six CVH metrics and following exclusion of underweight participants. While a decline in CVH with age was observed for all countries, higher income countries showed lower prevalence of high CVH already by age 18y. Excess body weight appeared the main driver of poor CVH in higher income countries, while current smoking was highest in Bangladesh. Conclusion Harmonization of nationally representative survey data on CVH trajectories with age in 5 highly diverse countries supports our hypothesis that CVH decline with age may be universal. Interventions to promote and preserve high CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where CVH remains relatively high, protection of whole societies from risk factor epidemics may still be feasible.
Collapse
Affiliation(s)
- Lisa Ware
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bridget Vermeulen
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David Floo
- Wuqu’ Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luisa CC Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Brazil
| | | | - Kavita Singh
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Sara Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Portugal
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
- Research Unit of the Department of Medicine, Maputo Central Hospital, Mozambique
| | - Gastón Perman
- Department of Public Health. Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - Baizid Khoorshid Riaz
- National Institute of Preventive & Social Medicine (NIPSOM), Ministry of Health & Family Welfare, Mohakhali, Dhaka, Bangladesh
| | | | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Darwin R Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| |
Collapse
|
7
|
Choi HR, Chang Y, Kim Y, Cho Y, Kwon MJ, Kang J, Kwon R, Lim GY, Kim KH, Kim H, Hong YS, Park J, Zhao D, Cho J, Guallar E, Park HY, Ryu S. Vasomotor and other menopause symptoms and the prevalence of ideal cardiovascular health metrics among premenopausal stage women. Menopause 2023; 30:750-757. [PMID: 37279516 PMCID: PMC10309111 DOI: 10.1097/gme.0000000000002203] [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: 10/27/2022] [Revised: 04/05/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We examined the association between menopause symptoms and the prevalence of ideal cardiovascular health (CVH) metrics among premenopausal women. METHODS This cross-sectional study comprised 4,611 premenopausal women aged 42 to 52 years. Data for CVH metrics were collected during health screening examinations. Menopause symptoms were measured using the Korean version of the Menopause-Specific Quality of Life questionnaire. For vasomotor, psychosocial, physical, and sexual symptoms, participants were divided into absent or symptomatic groups, further divided into tertiles (range, 0-7; 7 being the most bothersome). Ideal CVH metrics were defined according to the American Heart Association Life Simple 7 metrics, except dietary component. Cardiovascular health metrics were scored from 0 (unhealthy) to 6 (healthy) and classified as poor (0-2), intermediate (3-4), and ideal (5-6). Multinomial logistic regression models were used to estimate the prevalence ratios for intermediate and poor CVH metrics using ideal CVH as the reference. RESULTS The overall and 4 menopause-specific quality of life domain scores were significantly associated with poorer CVH metrics scores in a dose-response manner ( P < 0.05). After adjusting for age, parity, education level, anti-Mullerian hormone levels, and alcohol intake, women with the most bothersome degree for vasomotor, psychosocial, physical, and sexual symptoms had significantly higher prevalence of poor CVH metrics, with corresponding prevalence ratios (95% confidence interval) of 2.90 (1.95-4.31), 2.07 (1.36-3.15), 3.01 (1.19-7.65), and 1.66 (1.15-2.39), respectively, compared with those without each vasomotor, psychosocial, physical, and sexual symptom. CONCLUSIONS Premenopausal stage women with either vasomotor or nonvasomotor menopausal symptoms have significantly higher prevalence of poor CVH metrics, compared with those without any menopausal symptoms.
Collapse
Affiliation(s)
- Hye Rin Choi
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yoosoo Chang
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yejin Kim
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosun Cho
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Jung Kwon
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeonggyu Kang
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ria Kwon
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Ga-Young Lim
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Institute of Medical Research, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Kye-Hyun Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Soo Hong
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jihwan Park
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Juhee Cho
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Hyun-Young Park
- Department of Precision Medicine, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seungho Ryu
- From the Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| |
Collapse
|
8
|
Radovanovic M, Jankovic J, Mandic-Rajcevic S, Dumic I, Hanna RD, Nordstrom CW. Ideal Cardiovascular Health and Risk of Cardiovascular Events or Mortality: A Systematic Review and Meta-Analysis of Prospective Studies. J Clin Med 2023; 12:4417. [PMID: 37445451 DOI: 10.3390/jcm12134417] [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: 06/09/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, hence significant efforts have been made to establish behavior and risk factors associated with CVD. The American Heart Association proposed a 7-metric tool to promote ideal cardiovascular health (CVH). Recent data demonstrated that a higher number of ideal CVH metrics was associated with a lower risk of CVD, stroke, and mortality. Our study aimed to perform a systematic review and meta-analysis of prospective studies investigating the association of ideal CVH metrics and CVD, stroke, and cardiovascular mortality (CVM) in the general population. Medline and Scopus databases were searched from January 2010 to June 2022 for prospective studies reporting CVH metrics and outcomes on composite-CVD, coronary heart disease, myocardial infarction, stroke, and CVM. Each CVH metrics group was compared to another. Twenty-two studies totaling 3,240,660 adults (57.8% men) were analyzed. The follow-up duration was 12.0 ± 7.2 years. Our analysis confirmed that a higher number of ideal CVH metrics led to lower risk for CVD and CVM (statistically significant for composite-CVD, stroke, and CVM; p < 0.05). Conclusion: Even modest improvements in CVH are associated with CV-morbidity and mortality benefits, providing a strong public health message about the importance of a healthier lifestyle.
Collapse
Affiliation(s)
- Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Janko Jankovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Stefan Mandic-Rajcevic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Centre-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Richard D Hanna
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Cardiology, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Charles W Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| |
Collapse
|
9
|
Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
Collapse
Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
| |
Collapse
|
10
|
Broni EK, Ogunmoroti O, Osibogun O, Echouffo-Tcheugui JB, Chevli PA, Shapiro MD, Ndumele CE, Michos ED. Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis. Endocr Pract 2023; 29:456-464. [PMID: 37028649 PMCID: PMC10330128 DOI: 10.1016/j.eprac.2023.03.276] [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: 02/22/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate the association between ideal cardiovascular health (CVH) and adipokine levels. Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal CVH was introduced to promote 7 key health factors and behaviors in the general population. Previous studies have found strong associations between obesity and ideal CVH. However, existing literature on the link between CVH and adipokines is scarce. METHODS We studied 1842 Multi-Ethnic Study of Atherosclerosis participants free of cardiovascular disease who had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting blood glucose) measured at baseline and serum adipokine levels measured at a median of 2.4 years later. Each CVH metric was assigned a score of 0 (poor), 1 (intermediate), or 2 (ideal), and all scores were summed for a total CVH score (0-14). The total CVH scores of 0 to 8, 9 to 10, and 11 to 14 were considered inadequate, average, and optimal, respectively. We used multivariable linear regression models to assess the nonconcurrent associations between the CVH score and log-transformed adipokine levels. RESULTS The mean age was 62.1 ± 9.8 years; 50.2% of participants were men. After adjusting for sociodemographic factors, a 1-unit higher CVH score was significantly associated with 4% higher adiponectin and 15% and 1% lower leptin and resistin levels. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels than those with inadequate CVH scores. Similar trends were observed for those with average versus inadequate CVH scores. CONCLUSION In a multi-ethnic cohort free of cardiovascular disease at baseline, individuals with average and optimal CVH scores had a more favorable adipokine profile than those with inadequate CVH scores.
Collapse
Affiliation(s)
- Eric K Broni
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Parag A Chevli
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
11
|
Douglas PS, McCallum S, Lu MT, Umbleja T, Fitch KV, Foldyna B, Zanni MV, Fulda ES, Bloomfield GS, Fichtenbaum CJ, Overton ET, Aberg JA, Malvestutto CD, Burdo TH, Arduino RC, Ho KS, Yin MT, Ribaudo HJ, Grinspoon SK. Ideal cardiovascular health, biomarkers, and coronary artery disease in persons with HIV. AIDS 2023; 37:423-434. [PMID: 36525544 PMCID: PMC9877147 DOI: 10.1097/qad.0000000000003418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate relationships between Life's Simple 7 (LS7), an assessment of cardiovascular health (CVH), and coronary plaque among people with HIV (PWH). DESIGN Cross-sectional. METHODS Coronary computed tomography angiography, immune/inflammatory biomarkers, and characterization of LS7 were collected among a subset of ART-treated PWH enrolled in REPRIEVE, a primary prevention trial. Analyses adjusted for cardiovascular disease risk (ASCVD score). RESULTS Median age of the 735 participants was 51(±6) years, 16% female, and median (Q1-Q3) CVD risk was 4.5% (2.6-6.9). Forty percent had poor (≤2 ideal components), 51% had intermediate (three or four ideal components), and only 9% had ideal CVH (≥5). Coronary plaque was present in 357 (49%); 167 (23%) had one or more vulnerable plaque features, 293 (40%) had noncalcified plaque, and 242 (35%) had a coronary artery calcium score >0. All three phenotypes were increasingly more prevalent with poorer CVH and these relationships remained after adjusting for ASCVD risk. Poor CVH was associated with higher high-sensitivity C-reactive protein, oxidized low-density cholesterol, and interleukin-6. The relationship of LS7 to plaque remained after adjusting for these biomarkers. CONCLUSIONS Among PWH, poor CVH as measured by LS7 was associated with coronary plaque presence, vulnerable features, and calcification. LS7 was also associated with selected biomarkers; adjustment for these and ASCVD score reduced but did not eliminate LS7's association with plaque, suggesting the possibility of additional protective mechanisms against atherogenesis and plaque remodeling. Clinical use of LS7 and further exploration of its relationships with coronary artery disease may enhance efforts to reduce cardiovascular morbidity and mortality in PWH. CLINICAL TRIALS REGISTRATION NCT02344290.
Collapse
Affiliation(s)
- Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sara McCallum
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School
| | - Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School
| | - Evelynne S. Fulda
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School
| | - Gerald S. Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Judith A. Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carlos D. Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio
| | - Tricia H. Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Roberto C. Arduino
- Division of Infectious Diseases, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas
| | - Ken S. Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael T. Yin
- Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Heather J. Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | |
Collapse
|
12
|
Effects of lifestyle risk behaviour clustering on cardiovascular disease among UK adults: latent class analysis with distal outcomes. Sci Rep 2022; 12:17349. [PMID: 36253519 PMCID: PMC9576714 DOI: 10.1038/s41598-022-22469-6] [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: 06/15/2022] [Accepted: 10/14/2022] [Indexed: 01/10/2023] Open
Abstract
Lifestyle risk behaviours such as smoking, physical inactivity, and unhealthy diet account for a considerable disease burden globally. These risk behaviours tend to cluster within an individual, which could have detrimental health effects. In this study, we aimed to examine the clustering effect of lifestyle risk behaviours on cardiovascular disease (CVD) and CVD risk among adults in the United Kingdom (UK). We performed a latent class (LC) analysis with distal outcomes using the UK Biobank baseline (2006-2010) data. First, we estimated LC measurement models, followed by an auxiliary model conditional on LC variables. We reported continuous (mean difference-MD) and binary (odds ratio-OR) outcomes with 95% confidence intervals. We included 283,172 and 174,030 UK adults who had data on CVD and CVD risk, respectively. Multiple lifestyle risk behaviour clustering (physically inactive, poor fruit & vegetable intake, high alcohol intake, and prolonged sitting) had a 3.29 mean increase in CVD risk compared to high alcohol intake. In addition, adults with three risk behaviours (physically inactive, poor fruit & vegetable intake, and high alcohol intake) had 25.18 higher odds of having CVD than those with two risk behaviours (physically inactive, and poor fruit and vegetable intake). Social deprivation, gender and age were also associated with CVD. Individuals' LC membership with two or more lifestyle risk behaviours negatively affects CVD. Interventions targeting multiple lifestyle behaviours and social circumstances should be prioritized to reduce the CVD burden.
Collapse
|
13
|
Birulina JG, Ivanov VV, Buyko EE, Bykov VV, Dzyuman AN, Nosarev АV, Grigoreva AV, Gusakova SV. Morphological changes in the heart and aorta of rats with diet-induced metabolic syndrome. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-13-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim. To identify early morphological changes in the heart and aorta of rats with experimental metabolic syndrome induced by a high-fat and high-carbohydrate diet (HFHCD).Materials and methods. The study was carried out on male Wistar rats. The animals were divided into two groups: a control group (n = 10) and an experimental group (n = 10). The rats from the control group were fed with a standard laboratory diet. The rats from the experimental group received HFHCD for 12 weeks. Body weight, blood pressure (BP), and individual parameters of carbohydrate and lipid metabolism were assessed in the rats. A histologic examination of the heart and aorta in the animals was performed.Results. Feeding rats with HFHCD led to an increase in body weight, elevation of BP, obesity, hyperglycemia, and triglyceridemia. The histologic examination of the heart in the rats of the experimental group showed signs of vascular disease, lipomatosis, and focal myocardial degeneration. Lipid accumulation in the cells of the media, hyperplasia of adipocytes in the adventitia, and depletion and fragmentation of the elastic lamina were revealed in the aortic wall of the rats receiving HFHCD.Conclusion. The study indicated that HFHCD is an effective way to model metabolic syndrome. Structural disorders in the heart and aorta may be the mainstay for the development of cardiomyopathy and arterial hypertension in diet-induced metabolic syndrome.
Collapse
|
14
|
Addison S, Yang Y, Metlock F, King M, McKoy A, Williams A, Gregory J, Gray DM, Joseph JJ, Nolan TS. The Role of Social Support in Cardiovascular Clinical Trial Participation among Black Men: Black Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12041. [PMID: 36231354 PMCID: PMC9566142 DOI: 10.3390/ijerph191912041] [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: 08/10/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Attainment of the American Heart Association's Life's Simple 7 (LS7) metrics reduces cardiovascular disease (CVD) risk; yet, Black Americans have the lowest LS7 attainment among all communities, the highest rate of CVD mortality, and low clinical trial participation. Social support is positively correlated with chronic disease self-management. Here, we describe the role of social support in a single-arm pilot clinical trial of a community-based lifestyle intervention among Black American men. METHODS The 24-week intervention featured weekly team-based physical activity and LS7-themed education. Seventy-four Black men participated in the intervention; twenty agreed to participate in exit surveys via one of three semi-structured focus groups. Data were transcribed verbatim and analyzed using content analysis framed by House's social support framework. RESULTS Participants reported support from both peers and health coaches. The sub-themes of social support among peers were: (1) acknowledgement, understanding, and validation, (2) inspiration, (3) sense of community, (4) fear of disappointing fellow participants, and (5) group synergy. The sub-themes of social support from the health coaches and study team staff included: (1) contemplation of current health status, (2) racial concordance of health coaches and study team staff, (3) investment of the research team, (4) incentives, (5) access to healthcare providers, and (6) the COVID-19 pandemic. Emotional support was the most frequently discussed theme. CONCLUSIONS Social support, especially emotional support, from peers and health coaches was a driver of clinical trial participation among participants. The intervention created a positive social environment and decreased medical mistrust. This intervention may provide a framework by which to facilitate clinical trial participation among Black men.
Collapse
Affiliation(s)
- Sarah Addison
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Yesol Yang
- Comprehensive Cancer Center, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
| | - Faith Metlock
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Mikayla King
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Alicia McKoy
- Center for Cancer Health Equity, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
| | - Amaris Williams
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - John Gregory
- National Center for Urban Solutions, The African American Male Wellness Agency, 2780 Airport Drive, Suite 333, Columbus, OH 43230, USA
| | - Darrell M. Gray
- Anthem, Inc. (Formerly The Ohio State University College of Medicine), 1310 G Street, Washington, DC 20005, USA
| | - Joshua J. Joseph
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Timiya S. Nolan
- Comprehensive Cancer Center, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| |
Collapse
|
15
|
Abstract
BACKGROUND Cardiovascular health (CVH) was defined by the American Heart Association as an integrative idealness of seven clinical or lifestyle factors. Based on populations of European ancestry, recent studies have shown that ideal CVH is associated with a slower aging rate. The aging rate is measured by levels of epigenetic age acceleration (EAA), usually obtained from the residuals of regressing DNA methylation (DNAm) age on chronological age. However, little has been known about the association of CVH with biological aging in Asian populations. METHODS AND RESULTS We here analyzed blood DNAm data and clinical/lifestyle factors of 2474 Taiwan Biobank (TWB) participants, to investigate the association of CVH with EAA. CVH was assessed by seven components: smoking status, physical activity, dietary habits, body mass index, total cholesterol, fasting glucose, and blood pressure levels. Four measures of EAA were applied, among which two were based on the first-generation DNAm clocks (HannumEAA and IEAA) and two were based on the second-generation clocks (PhenoEAA and GrimEAA). After excluding 276 individuals with cardiovascular diseases, we regressed EAA on the CVH score (ranging from 0 to 7, integrating the abovementioned seven components) while adjusting for sex, drinking status, and educational attainment. Our results showed that a decrease in one point in the CVH score was associated with a 0.350-year PhenoEAA (p = 4.5E-4) and a 0.499-year GrimEAA (p = 4.2E-15). By contrast, HannumEAA and IEAA were not significantly associated with the CVH score. We have obtained consistent results within each generation of epigenetic clocks. CONCLUSIONS This is one of the first studies to comprehensively investigate the associations of CVH with four epigenetic clocks. Our TWB data showed that ideal CVH is associated with lower levels of EAA calculated according to the second-generation epigenetic clocks (PhenoEAA and GrimEAA). Having an ideal CVH status can lower EAA and reduce the risk of aging-related disorders.
Collapse
|
16
|
Ma Y, Floyd JS, Austin TR, Chen LY, Horwich T, Post WS, Michos ED, Heckbert SR. Life's Simple 7 Cardiovascular Health Score in Relation to Arrhythmias on Extended Ambulatory Electrocardiographic Monitoring (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2022; 170:63-70. [PMID: 35193768 PMCID: PMC9007848 DOI: 10.1016/j.amjcard.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
The Life's Simple 7 (LS7) metric consists of 7 modifiable health behaviors and measures that are known health factors for cardiovascular wellness. Relatively little is known about the association of LS7 score with cardiac arrhythmias. In the setting of the Multi-Ethnic Study of Atherosclerosis, we studied the LS7 score (range 0 to 14), assessed at the 2010 to 2102 study visit, in relation to cardiac arrhythmias assessed by Zio Patch ambulatory electrocardiographic monitoring in 2016 to 2018. In participants free of clinically recognized cardiovascular disease and atrial fibrillation, we used logistic and linear regression to examine the association of total LS7 score with atrial fibrillation, supraventricular ectopy, and ventricular ectopy. In 1,329 participants in the analysis, the mean (SD) age was 67 (8) years and 48% were men. A more favorable total LS7 score was associated with fewer premature ventricular contractions (PVCs) per hour (ratio of geometric means for optimal [11 to 14] versus inadequate [0 to 7] score 0.52 [95% confidence interval 0.34 to 0.81]). After adjustment for sociodemographic characteristics, the association was attenuated (0.66 [0.43 to 1.01]). =Among the LS7 components, a more favorable body mass index was associated with less ventricular ectopy. We did not detect associations of total LS7 score with atrial arrhythmias. In conclusion, in this longitudinal study of older participants free of clinically recognized cardiovascular disease, there was little evidence of association of the LS7 cardiovascular health score with subclinical cardiac arrhythmias. However, there was a suggestion that a more favorable LS7 score was associated with fewer PVCs and specifically, that a more favorable body mass index was associated with fewer PVCs.
Collapse
Affiliation(s)
- Yuyang Ma
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - James S Floyd
- Department of Epidemiology, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas R Austin
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Lin Yee Chen
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota
| | - Tamara Horwich
- Division of Cardiology, Department of Medicine, University of California, Los Angeles
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington.
| |
Collapse
|
17
|
Ogunmoroti O, Osibogun O, Mathews L, Esuruoso OA, Ndumele CE, Okunrintemi V, Burke GL, Blumenthal RS, Budoff MJ, Michos ED. Favorable Cardiovascular Health Is Associated With Lower Prevalence, Incidence, Extent, and Progression of Extracoronary Calcification: MESA. Circ Cardiovasc Imaging 2022; 15:e013762. [PMID: 35290079 PMCID: PMC9179934 DOI: 10.1161/circimaging.121.013762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease. Extracoronary calcification (ECC)-measured at the aortic valve, mitral annulus, ascending thoracic aorta, and descending thoracic aorta-is an indicator of systemic atherosclerosis. This study examined whether favorable CVH was associated with a lower risk of ECC. METHODS We analyzed data from MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years without cardiovascular disease at baseline. ECC was measured by noncontrast cardiac computed tomography scan at baseline and after an average of 2.4 years. Prevalent ECC was defined as an Agatston score >0 at the baseline scan. Incident ECC was defined as Agatston score >0 at the follow-up scan among participants with Agatston score of 0 at the baseline scan. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose) was scored 0 to 2 points, with 2 indicating ideal; 1, intermediate; and 0, poor. The aggregated CVH score was 0 to 14 points (0-8, inadequate; 9-10, average; 11-14, optimal). We used Poisson and linear mixed-effects regression models to examine the association between CVH and ECC adjusted for sociodemographic factors. RESULTS Of 6504 participants, 53% were women with a mean age (SD) of 62 (10) years. Optimal and average CVH scores were associated with lower ECC prevalence, incidence, and extent. For example, optimal CVH scores were associated with 57%, 56%, 70%, and 54% lower risk of incident aortic valve calcification, mitral annulus calcification, ascending thoracic aorta calcification, and descending thoracic aorta calcification, respectively. In addition, optimal and average CVH scores were associated with lower ECC progression at 2 years, although these associations were only significant for mitral annulus calcification and descending thoracic aorta calcification. CONCLUSIONS In this multiethnic cohort, favorable CVH was associated with a lower risk of extracoronary atherosclerosis. These findings emphasize the importance of primordial prevention as an intervention to reduce the burden of cardiovascular disease.
Collapse
Affiliation(s)
- Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Olatokunbo Osibogun
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami' FL (O. Osibogun)
| | - Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Olumuyiwa A Esuruoso
- Division of General Internal Medicine, Meharry Medical College, Nashville, TN (O.A.E.)
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Victor Okunrintemi
- Division of Cardiovascular Disease, Houston Methodist Hospital, TX (V.O.)
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (G.L.B.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA (M.J.B.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.).,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (O. Ogunmoroti, L.M., C.E.N., R.S.B., E.D.M.)
| |
Collapse
|
18
|
Brandão MP, Sa-Couto P, Gomes G, Beça P, Reis J. Factors Associated with Cardiovascular Disease Risk among Employees at a Portuguese Higher Education Institution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:848. [PMID: 35055670 PMCID: PMC8775385 DOI: 10.3390/ijerph19020848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/15/2023]
Abstract
This study aimed to estimate the prevalence of risk factors for cardiovascular disease (CVD) and to assess the CVD risk (CVDRisk) in a sample of workers at a specific workplace: a higher education institution in Portugal. Data were collected using a questionnaire (e.cuidHaMUs.QueST®) with 345 HEI workers from June 2017-June 2018 with a high response rate (93.3%). Two constructs of risks for CVD were considered: (i) metabolic risk and hypertension (CVDRisk1); and (ii) modifiable behavioural risk (CVDRisk2). Logistic regression analyses were used to establish a relationship between risk indexes/constructs (CVDRisk1 and CVDRisk2) and groups of selected variables. The most prevalent CVD risk factor was hypercholesterolaemia (43.2%). Sixty-eight percent of participants were in the construct CVDRisk1 while almost half of the respondents were in CVDRisk2 (45.2%). The consumption of soft drinks twice a week or more contributed to a significantly increased risk of CVD in CVDRisk1. Lack of regular exercise and lack of daily fruit consumption significantly increased the risk of CVD in CVDRisk2. The challenge to decision makers and the occupational medical community is to incorporate this information into the daily practices of health surveillance with an urgent need for health promotional education campaigns in the workplace.
Collapse
Affiliation(s)
- Maria Piedade Brandão
- School of Health [ESSUA], Agras do Crasto-Campus Universitário de Santiago, University of Aveiro, Edifício 30, 3810-193 Aveiro, Portugal
- Center for Health Technology and Services Research [CINTESIS], Campus Universitário de Santiago, University of Aveiro, 3800-193 Aveiro, Portugal
| | - Pedro Sa-Couto
- Department of Mathematics [DMAT], University of Aveiro, 3810-193 Aveiro, Portugal; (P.S.-C.); (J.R.)
- Center for Research and Development in Mathematics and Applications [CIDMA], University of Aveiro, 3810-193 Aveiro, Portugal
| | - Gonçalo Gomes
- Department of Communication and Art [DECA], University of Aveiro, 3810-193 Aveiro, Portugal; (G.G.); (P.B.)
- Research Institute for Design, Media and Culture [ID+], University of Aveiro, 3810-193 Aveiro, Portugal
| | - Pedro Beça
- Department of Communication and Art [DECA], University of Aveiro, 3810-193 Aveiro, Portugal; (G.G.); (P.B.)
- Digital Media and Interaction [DigiMedia], University of Aveiro, 3810-193 Aveiro, Portugal
| | - Juliana Reis
- Department of Mathematics [DMAT], University of Aveiro, 3810-193 Aveiro, Portugal; (P.S.-C.); (J.R.)
| |
Collapse
|