Status of cardiovascular health among adults in a rural area of Northwest China: Results from a cross-sectional study

The social determinants of ideal cardiovascular health: A global systematic review

This systematic review synthesizes research published from January 2010-July 2022 on the social determinants of ideal cardiovascular health (CVH) carried out around the world and compares trends in high-income countries (HICs) to those in low- and middle-income countries (LMICs). 41 studies met inclusion criteria (n = 28 HICs, n = 13 LMICs). Most were from the United States (n = 22) and cross-sectional (n = 33), and nearly all evaluated associations among adults. Among studies conducted in LMICs, nearly all were from middle-income countries and only one was carried out in low-income country. Education (n = 24) and income/wealth (n = 17) were the most frequently examined social determinants in both HICs and LMICs. Although most studies assessed ideal CVH using reliable and valid methods (n = 24), only 7 used criteria pre-defined by the American Heart Association to characterize ideal levels of each CVH metric. Despite heterogeneity in how outcome measures were derived and analyzed, consistent associations were evident between multiple markers of higher social status (i.e. greater education, income/wealth, socioeconomic status, racial/ethnic majority status) and greater levels of ideal CVH across both country contexts. Gaps in the literature include evidence from LMICs and HICs other than the United States, longitudinal research, and investigations of a wider array of social determinants beyond education and income/wealth.

National trends in ideal cardiovascular health among adults in Bhutan from three cross-sectional surveys in 2007, 2014, and 2019

The study aimed to estimate the prevalence, distribution, and correlates of ideal cardiovascular health (CVH) among individuals (20–69 years) across three cross-sectional surveys in 2007, 2014 and 2019 in Bhutan. Cross-sectional data were analysed from 9712 individuals (20–69 years, mean age = 37.6 years) who participated in the 2007, 2014 or 2019 Bhutan STEPS surveys, had complete measurement of CVH metrics, and had no history of a cardiovascular disease in 2014 and 2019. Ideal CVH measures included non-smoking, healthy diet, physical activity, body mass index (< 23 kg/m²), blood pressure < 120/ < 80 mmHg, total cholesterol < 200 mg/dL, and fasting blood glucose < 100 mg/dL). The prevalence of five to seven ideal CVH metrics increased from 11.6% in 2007 to 37.9% in 2019. Trend analyses showed that ideal physical activity, ideal total cholesterol, ideal blood pressure, and ideal fasting glucose increased from 2007 to 2019, while ideal fruit and vegetable intake, ideal smoking, and ideal body mass index decreased from 2007 to 2019. Five to seven ideal CVH metrics, 0–7 ideal CVH metrics, and 0–14 poor, intermediate, and ideal CVH metrics increased from 2007 to 2019. In the adjusted logistic regression analysis, older age decreased the odds of having 5–7 ideal CVH metrics in all three study years. Male sex increased the odds, and employment decreased the odds of 5–7 ideal CVH metrics in 2007, and urban residence increased the odds of 5–7 ideal CVH metrics in 2014 and decreased the odds in 2019. The proportion of meeting 5–7 ideal CVH metrics increased in Bhutan. Primary and secondary prevention programmes must be strengthened to improve CVH in Bhutan, considering identified associated factors.

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

Background

In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH.

Methods

A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I² statistics.

Results

This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics.

Conclusions

To the best of our knowledge, this is the first systematic review on the relationship between participants’ socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.

Ideal Cardiovascular Health in a Nationally Representative Population-Based Sample of Adults in Malawi

Background:

Ideal cardiovascular health (ICH) measures four ideal health behaviours (non-smoking, body mass index <25 kg/m², healthy diet, and physical activity) and three health factors (total cholesterol <200 mg/dL, blood pressure <120/<80 mmHg, and fasting blood glucose <100 mg/dL).

Objective:

This study aimed to determine the prevalence, distribution, and correlates of ICH among adults in Malawi.

Methods:

National cross-sectional survey data of 3,441 persons aged 18–69 years with complete ICH measurements in Malawi in 2017 were analysed.

Results:

Almost one in ten (7.4%) of respondents had 0–2 ICH metric), 21.2% 3–4 ICH metrics, and 71.5% 5–7 ICH metrics). Only 3.3% had all seven ICH metrics, 15.3% had intermediate ICH (≥1 metric in the intermediate category and none in the poor category), and 81.5% poor ICH (≥1 metric in poor category). In adjusted logistic regression analysis, older age (50–69 years) (Adjusted Odds Ratio-AOR: 0.25, 95% Confidence Interval-CI: 0.17–0.36) and urban residence (AOR: 0.56, 95% CI: 0.40–0.78) were negatively associated with meeting 5–7 ICH metrics. In addition, in unadjusted analysis, higher education was positively associated with meeting 5–7 ICH metrics.

Conclusion:

The proportion of meeting 5–7 ICH metrics was high in Malawian adults. Both high-risk and population-wide intervention programmes targeting older adults and urban residents should be implemented in aiding to improve cardiovascular health in Malawi.

Highlights

The Prevalence of Smartphones and WeChat Use Among Older Adults With Chronic Disease in a Western China

Telemedicine is a promising way to deliver patient education and health services, but access to information technology among potential patients is a prerequisite. This study surveyed the prevalence of smartphone use and the use of the Chinese social networking platform WeChat and Wi-Fi access in the homes of older adults in a western area of China. A convenience sample of 225 older adults with chronic diseases in two tertiary hospitals was interviewed regarding smartphone ownership, WeChat use, and access to Wi-Fi at home. Participant ability in performing the activities of daily living was also assessed. Logistic regressions were used to analyze the independently associated factors of smartphone ownership, WeChat use, and Wi-Fi access at home. The results show that the prevalence of smartphone use was 19.6%, only 8.9% of those surveyed used WeChat, but 39.6% had access to Wi-Fi at home. Education level was the only factor significantly associated with the three dependent variables. Ability in performing activities of daily living was positively correlated with access to Wi-Fi at home (odds ratio, 2.549; P = .011). It will be difficult to implement telemedicine through smartphones in such relatively poor areas of China. Better-educated older adults who are less dependent in performing activities of daily living are potential users of telemedicine.

An Epidemiological Study on the Assessment of Cardiovascular Health Status among Adults in an Urban Area of Teliamura Municipality Area, Khowai, Tripura

Background:

In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population.

Objective:

The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it.

Methodology:

In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association.

Results:

The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried.

Conclusion:

Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.

Low levels of ideal cardiovascular health in a semi-urban population of Western Nepal: a population-based, cross-sectional study

Background

The aim of this study was to assess the status of cardiovascular health among a semi-urban population of Nepal, and determine factors associated with ideal cardiovascular health.

Methods

A population-based, cross-sectional study using a systematic random sample was conducted among 2310 adults aged ≥ 25 years in a semi-urban area of the Pokhara Metropolitan City previously named Lekthnath in Nepal. The ideal, intermediate and poor cardiovascular health were defined as the presence of 6-7, 4-5 or 1-3 health metrics, among a list of 7 health behaviours and healthfactors, namely smoking, body mass index, physical activity, fruits and vegetables intakes, harmful alcohol consumption, blood pressure, and fasting blood glucose. We used univariate and multivariate Poisson regression models adjusting for sex, age groups, ethnicity, educational level and socioeconomic status, and calculated the prevalence ratios with 95% CIs.

Results

Only 14.3 % of the participants had ideal cardiovascular health, whereas 67.0% and 18.7% of the participants had intermediate and poor cardiovascular health, respectively. Age groups 45-54 years (prevalence ratio 0.88, 95% CI: 0.83 to 0.94, p<0.001) and 55-64 years (prevalence ratio 0.84, 95% CI: 0.79 to 0.90, p<0.001) were significantly associated with low prevalence of ideal cardiovascular health compared with the age group 35-44 years. Ethnic groups, including Janajati (prevalence ratio 0.89, 95% CI: 0.85 to 0.93, p<0.001) and Dalit (prevalence ratio 0.9, 95% CI: 0.84 to 0.95, p=0.001), were significantly associated with low prevalence of ideal cardiovascular health.

Conclusions

Prevalence of ideal cardiovascular health is low in the semi-urban population in Nepal. Concerted efforts are needed to develop a population-based intervention to improve cardiovascular health in Nepal.

Prevalence of the cardiovascular health status in adults: A systematic review and meta-analysis

BACKGROUND AND AIMS

The American Heart Association has outlined seven cardiovascular health (CVH) metrics, including smoking, body mass index, physical activity, dietary pattern, total cholesterol, and fasting plasma glucose, to define and monitor CVH status. Our study was to evaluate the global CVH in adults.

METHODS AND RESULTS

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles for studies published between 1 January 2010 and 30 June 2018. Included studies should report the proportions of ideal status for the seven CVH metrics and/or provide the prevalence of overall poor (having 0-2 ideal metrics) or ideal (having 5-7 ideal metrics) CVH status in adults. 88 articles were identified: 75 for the prevalence of ideal CVH metrics, 58 for the proportion of overall poor CVH status, and 55 for the proportion of overall ideal CVH status. Smoking had the highest prevalence of ideal status (69.1%) while dietary pattern has the lowest (12.1%). 32.2% and 19.6% of participants had overall poor and ideal CVH, respectively. Females and young adults had better CVH status when compared to males and older adults. There existed regional variations in ideal CVH metrics and overall CVH status. The overall CVH status had improved over study time.

CONCLUSION

The prevalence of ideal status was low for some metrics, such as dietary pattern, and the overall CVH status was still unsatisfactory. We should continue to measure the CVH status and carry out lifestyle interventions to improve the CVH status in the whole population.

Prevalence and clustering of cardiovascular disease risk factors in rural Nepalese population aged 40-80 years

Background

Cardiovascular diseases (CVD) are the main cause of mortality in low- and middle-income countries like Nepal. Different risk factors usually cluster and interact multiplicatively to increase the risk of developing acute cardiovascular events; however, information related to clustering of CVD risk factors is scarce in Nepal. Therefore, we aimed to determine the prevalence of CVD risk factors with a focus on their clustering pattern in a rural Nepalese population.

Methods

A community-based cross-sectional study was conducted among residents aged 40 to 80 years in Lamjung District of Nepal in 2014. A clustered sampling technique was used in steps. At first, four out of 18 wards were chosen at random. Then, one person per household was selected randomly (n = 388). WHO STEPS questionnaires (version 2.2) were used to collect data. Chi-square and independent t-test were used to test significance at the level of p < 0.05.

Results

A total 345 samples with complete data were analyzed. Smoking [24.1% (95% CI: 19.5–28.6)], harmful use of alcohol [10.7% (7.4–13.9)], insufficient intake of fruit and vegetable [72% (67.1–76.6)], low physical activity [10.1% (6.9–13.2)], overweight and obesity [59.4% (54.2–64.5)], hypertension [42.9% (37.6–48.1)], diabetes [16.2% (14.0–18.3)], and dyslipidemia [56.0% (53.0–58.7)] were common risk factors among the study population. Overall, 98.2% had at least one risk factor, while 2.0% exhibited six risk factors. Overall, more than a half (63.4%) of participants had at least three risk factors (male: 69.4%, female: 58.5%). Age [OR: 2.3 (95% CI: 1.13–4.72)] and caste/ethnicity [2.0 (95% CI: 1.28–3.43)] were significantly associated with clustering of at least three risk factors.

Conclusions

Cardiovascular risk factors and their clustering were common in the rural population of Nepal. Therefore, comprehensive interventions against all risk factors should be immediately planned and implemented to reduce the future burden of CVD in the rural population of Nepal.

Prevalence of Multiple Coronary Artery Disease Risk Factors in Kerman: A Population-Based Study in Southeast Iran

BACKGROUND

The risk of disease with 1 risk factor is increased by the presence of additional risk factors. The goal of this study was to assess the prevalence of multiple coronary artery disease (CAD) risk factors among adults in Kerman, Iran, to identify the population groups most at risk.

METHODS

The present study included 5900 adults aged between 15 and 75 years in 2011 in Kerman, Iran. They were selected by 1-stage cluster sampling. Blood pressure, fasting blood glucose, lipids, and 6 CAD risk factors were assessed in the study population. Standardized prevalence rates were compared between the genders and age groups using the χ² test. A P<0.05 was considered statistically significant. All the analyses were performed using Stata, version 14.1.

RESULTS

Overall 93.1%, 57.8%, and 26.2% of the patients had at least 1, 2, and 3 risk factors, respectively. The most frequent combinations of risk factors were dyslipidemia plus low physical activity (37.9%), metabolic syndrome (27.7%), dyslipidemia plus abdominal obesity (14.1%), dyslipidemia plus hypertension (HTN) (10%), dyslipidemia plus smoking (8.6%), and HTN plus abdominal obesity (6.3%). The rate of diabetes mellitus plus HTN plus dyslipidemia was 2.8%. Both prevalence and multiplicity of the risk factors increased by age, and they were mostly higher in the women.

CONCLUSION

Almost 60% of the patients had at least 2 CAD risk factors and only 7% were risk-factor-free. Given that the population is ageing, community health authorities should seek to lessen the burden of these risk factors, almost all of which are preventable.

Cardiovascular health status among Australian adults

Background

The American Heart Association (AHA) committee recently set a guideline to define and monitor the cardiovascular health status. This study aimed to estimate cardiovascular health status among Australian adults using the guideline.

Methods

We used data from a nationally representative sample of 7499 adults (age ≥18 years) from 2011 to 2012 Australian Health Survey. We applied the modified AHA’s definition to estimate the ideal proportions of the seven metrics and the overall cardiovascular health status.

Results

Ideal status was most prevalent for fasting plasma glucose (83.6%) and least observed for dietary pattern (4.8%). The estimated percentage of ideal cardiovascular health was 0.15% in Australian adults. An estimated 0.52% of Australian adults had all four ideal cardiovascular health factors, and 16.38% had all four ideal cardiovascular health behaviors. There exist some age and sex variations for the ideal status of individual metric and the overall cardiovascular health.

Conclusion

The percentage of ideal cardiovascular health in Australian adults is extremely low. Public health policies should be implemented to improve the population-wide cardiovascular health status in Australia.