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Guo Z, Yuan Y, Fu Y, Cui N, Yu Q, Guo E, Ding C, Zhang Y, Jin J. Cardiovascular disease risk perception among community adults in South China: a latent profile analysis. Front Public Health 2023; 11:1073121. [PMID: 37228713 PMCID: PMC10203385 DOI: 10.3389/fpubh.2023.1073121] [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: 10/18/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Risk perception, a critical psychological construct, influences health behavior modification and maintenance of individuals with cardiovascular disease (CVD) risk. Little is known about CVD risk perception among Chinese adults. This research examined the profiles of CVD risk perception of community adults in South China, and explored the characteristics and factors that influence their perception of CVD risk. Method This cross-sectional study was conducted in Hangzhou, Zhejiang Province, in South China from March to July 2022 and included 692 participants. Risk perception was assessed using the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaire. Latent profile analysis (LPA) was performed to extract latent classes of CVD risk perception. These classes of CVD risk perception were compared with 10-year CVD risk categories to define correctness of estimation. Chi-square tests and multinomial regression analyses were used to identify differences between these categories. Results Three CVD risk perception classes were identified by LPA: low risk perception (14.2% of participants), moderate risk perception (46.8%), high risk perception (39.0%). Individuals who were aged with 40-60 year (OR = 6.94, 95% CI = 1.86-25.84), diabetes (OR = 6.26, 95% CI = 1.34-29.17), married (OR = 4.52, 95% CI = 2.30-8.90), better subjective health status (OR = 3.23, 95% CI = 1.15-9.10) and perceived benefits and intention to change physical activity (OR = 1.16, 95% CI = 1.05-1.27) were more likely to be in the high-risk perception class. Compared to absolute 10-year CVD risk based on China-PAR, a third of participants (30.1%) correctly estimated their CVD risk, 63.3% overestimated it and 6.6% underestimated it. CVD risk underestimation was associated with hypertension (OR = 3.91, 95% CI = 1.79-8.54), drinking (OR = 3.05, 95% CI = 1.22-7.64), better subjective health status (OR = 2.67, 95% CI = 1.18-6.03). Conclusions Most adults in South China possess a moderate level of CVD risk perception. Advanced age, higher monthly income, diabetes and better health status were significantly related to higher perceived CVD risk. Individuals with hypertension, drinking and better subjective health status were associated with CVD risk underestimation. Healthcare professionals should pay attention to the indicators for different classes and identify underestimation group as early as possible.
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Affiliation(s)
- Zhiting Guo
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yong Yuan
- China Mobile (Hangzhou) Information Technology Co., Ltd., Hangzhou, Zhejiang, China
| | - Yujia Fu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Nianqi Cui
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qunfei Yu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Erling Guo
- School of Public Health, Hebei Medical University, Shijiangzhuang, Hebei, China
| | - Chuanqi Ding
- Emergency Department, Changxing County People's Hospital, Huzhou, Zhejiang, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, Zhejiang, China
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Brewer L, Jones C, Slusser J, Pasha M, Lalika M, Chacon M, Takawira P, Shanedling S, Erickson P, Woods C, Krogman A, Ferdinand D, Underwood P, Cooper L, Patten C, Hayes S. Mobile Health Intervention to Promote Hypertension Self-Management among African Americans Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App. JMIR Form Res 2023. [PMID: 37115658 DOI: 10.2196/45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND African Americans (AAs) are at a higher risk of premature death from cardiovascular diseases compared to White Americans, with disproportionate attributable risk from uncontrolled hypertension. These health disparities are rooted in structural racism with resultant adverse social determinants of health (SDOH) including limited access to quality healthcare. Given their high usage among AAs, mobile technologies, including smartphones, show promise in increasing access to reliable health information. Thus, culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. OBJECTIVE This formative study assessed the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among AAs. METHODS A mixed methods study of AA patients with uncontrolled hypertension was implemented over two consecutive phases. In Phase 1, patients and clinicians from two federally qualified health centers (FQHCs) in the Minneapolis-St. Paul, Minnesota metropolitan area provided input through a focus group series to refine an existing culturally tailored mHealth app (FAITH! [Fostering African-American Improvement in Total Health!] App) to promote hypertension self-management among AA patients with uncontrolled hypertension. Phase 2 was a single-arm pre-post intervention pilot study to assess feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention utilizing the refined FAITH! Hypertension App synchronized with a wireless BP monitor and support from a community health worker (CHW) to address SDOH-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication/BP self-monitoring and social networking. Primary outcomes were feasibility (app engagement/satisfaction) and preliminary efficacy (change in BP) at immediate post-intervention. RESULTS In Phase 1, 13 AA patients (69% age ≥50, 77% female) and 16 clinicians (69% age ≥50, 88% female, 63% AA) participated in focus groups. Based on their feedback, app modifications included addition of: BP/medications-tracking, BP self-care task reminders, and culturally sensitive contexts. In Phase 2, 16 AA patients were enrolled (mean age 52.6 years [SD 12.3], 75% female). Of the 16, 38% completed at least half of 10 education modules. Seven of the 16 completed the post-intervention assessment. These patients rated the intervention a 9 (out of 10) as helpful in hypertension self-management. Qualitative data revealed that these patients viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. Of the 7 patients, mean systolic and diastolic BPs decreased by 6.4 mmHg (p=.15) and 2.8 mmHg (p=.78) at immediate post-intervention, respectively. CONCLUSIONS A culturally tailored mHealth app, with reinforcement by CHW support, may improve hypertension self-management among under-resourced AAs receiving care at FQHCs. A future randomized efficacy trial of the intervention is warranted. CLINICALTRIAL Registration: ClinicalTrials.gov Identifier: NCT03777709.
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Affiliation(s)
- LaPrincess Brewer
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, 200 1st St S.W., Rochester, US
| | | | - Joshua Slusser
- Mayo Clinic, Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Rochester, US
| | | | - Mathias Lalika
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, US
| | - Megan Chacon
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Patricia Takawira
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Stanton Shanedling
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Paul Erickson
- NorthPoint Health and Wellness Center, Minneapolis, US
| | | | - Ashton Krogman
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, US
| | | | - Lisa Cooper
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, US
| | - Christi Patten
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, Rochester, US
| | - Sharonne Hayes
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
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Hao X, Li Y, Huang G, Zeng Y. Role of the N6-methyladenosine regulatory factor in reducing the risk of cardiovascular disease: subtype diagnosis following aerobic exercise-assisted weight loss. Am J Transl Res 2022; 14:5363-5378. [PMID: 36105062 PMCID: PMC9452351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to construct a model based on different N6-methyladenosine (m6A) regulatory factors involved in reducing the risk of the development of cardiovascular diseases under conditions of aerobic exercise. METHODS We screened for significantly different expressions of m6A regulators from the GSE66175 dataset. Five candidate m6A regulators were identified using the random forest model to predict aerobic exercise-mediated fat loss and reduction of the risk of cardiovascular disease. A nomogram model was established for analysis, and the consensus clustering method was used to distinguish between the two m6A clusters (clusters A and B). The single-sample gene set-enrichment analysis method was used to assess the abundance of immune cells in the samples related to cardiovascular anomalies. We determined the relationship between the functions of 29 immune cells and m6A clusters. RESULTS Twelve significantly and differentially expressed m6A regulators in the control and aerobic exercise groups were screened out, and it was observed that METTL13 correlated positively with the expression levels of the YTH domain containing 1 (YTHDC1), YTH N (6)-methyl adenosine RNA binding protein 1, and leucine-rich pentatricopeptide repeat-containing. The fat mass and obesity-associated gene negatively correlated with YTHDC1 and the fragile X mental retardation 1 protein. The random forest and support vector machine models were used to screen the ELAV-like RNA binding protein 1 (ELAVL1), RNA binding motif protein 15B (RBM15B), insulin-like growth factor binding protein 1 (IGFBP1), Wilms tumor 1-associated protein (WTAP), and zinc finger CCCH-type containing 13 (ZC3H13) genes. Analysis of the line graph model and the results obtained using decision curve analysis revealed the efficiency of the model. Gene ontology enrichment analysis was used to analyze the m6A regulatory gene model, and the results suggested that it was associated with RNA splicing. The results obtained using the Kyoto Encyclopedia of Genes and Genomes enrichment analysis method suggests that the genes were associated with Alzheimer's disease and neurodegeneration pathways associated with multiple diseases. The m6A regulatory gene model was associated with most of the immune cells infiltrating tumors and was also closely related to genes associated with lipid metabolism. CONCLUSIONS The m6A regulatory factor plays an important role in reducing the risk of cardiovascular disease under conditions of aerobic exercise-assisted weight loss. It is also associated with the metabolic pathways of low-density lipoprotein, high-density lipoprotein, and triglyceride.
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Affiliation(s)
- Xiaoya Hao
- College of Physical Education, University of South ChinaHengyang, Hunan, China
| | - Yukun Li
- Hunan Province Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South ChinaHengyang, Hunan, China
| | - Guo Huang
- Hunan Province Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South ChinaHengyang, Hunan, China
| | - Ying Zeng
- Hunan Province Key Laboratory of Cancer Cellular and Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South ChinaHengyang, Hunan, China
- School of Nursing, Hengyang Medical School, University of South ChinaHengyang, Hunan, China
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Kyalwazi AN, Loccoh EC, Brewer LC, Ofili EO, Xu J, Song Y, Joynt Maddox KE, Yeh RW, Wadhera RK. Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019. Circulation 2022; 146:211-228. [PMID: 35861764 DOI: 10.1161/circulationaha.122.060199] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. METHODS We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. RESULTS From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. CONCLUSIONS During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.
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Affiliation(s)
- Ashley N Kyalwazi
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.).,Harvard Medical School, Boston, MA (A.N.K.)
| | - Eméfah C Loccoh
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.C.L.)
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN (L.C.B.)
| | - Elizabeth O Ofili
- Division of Cardiology and the Clinical Research Center, Morehouse School of Medicine, Atlanta, GA (E.O.O.)
| | - Jiaman Xu
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Yang Song
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Karen E Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St Louis, MO (K.E.J.M.)
| | - Robert W Yeh
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
| | - Rishi K Wadhera
- Richard A. and Susan F. Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.N.K., J.X., Y.S., R.W.Y., R.K.W.)
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Brewer LC, Jenkins S, Hayes SN, Kumbamu A, Jones C, Burke LE, Cooper LA, Patten CA. Community-Based, Cluster-Randomized Pilot Trial of a Cardiovascular Mobile Health Intervention: Preliminary Findings of the FAITH! Trial. Circulation 2022; 146:175-190. [PMID: 35861762 PMCID: PMC9287100 DOI: 10.1161/circulationaha.122.059046] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African Americans continue to have suboptimal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7), 7 health-promoting behaviors and biological risk factors (eg, physical activity, blood pressure). Innovative, community-level interventions in partnership with trusted institutions such as African American churches are potential means to improve CVH in this population. METHODS Using a community-based participatory research approach, the FAITH! Trial (Fostering African American Improvement in Total Health) rigorously assessed the feasibility and preliminary efficacy of a refined, community-informed, mobile health intervention (FAITH! App) for promoting CVH among African Americans in faith communities using a cluster randomized controlled trial. Participants from 16 churches in Rochester and Minneapolis-St Paul, MN, were randomized to receive the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. The 10-week intervention core features included culturally relevant and LS7-focused education modules, diet/physical activity self-monitoring, and a group sharing board. Data were collected via electronic surveys and health assessments. Primary outcomes were average change in mean LS7 score (continuous measure of CVH ranging from poor to ideal [0-14 points]) from baseline to 6 months post-intervention (using generalized estimating equations) and app engagement/usability (by the Health Information Technology Usability Evaluation Scale; range, 0-5). RESULTS Of 85 enrolled participants (randomized to immediate [N=41] and delayed [control] intervention [N=44] groups), 76 and 68 completed surveys/health assessments at baseline and 6 months post-intervention, respectively (80% retention rate with assessments at both baseline and 6-month time points); immediate intervention [N=30] and control [N=38] groups). At baseline, the majority of participants (mean age [SD], 54.2 [12.3] years, 71% female) had <4-year college education level (39/66, 59%) and poor CVH (44% in poor category; mean LS7 score [SD], 6.8 [1.9]). The mean LS7 score of the intervention group increased by 1.9 (SD 1.9) points compared with 0.7 (SD 1.7) point in the control group (both P<0.0001) at 6 months. The estimated difference of this increase between the groups was 1.1 (95% CI, 0.6-1.7; P<0.0001). App engagement/usability was overall high (100% connection to app; >75% completed weekly diet/physical activity tracking; Health Information Technology Usability Evaluation Scale, mean [SD], 4.2 [0.7]). CONCLUSIONS On the basis of preliminary findings, the refined FAITH! App appears to be an efficacious mobile health tool to promote ideal CVH among African Americans. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03777709.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
- Center for Health Equity and Community Engagement Research (L.C.B.), Mayo Clinic, Rochester, MN
| | - Sarah Jenkins
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences (S.J.), Mayo Clinic, Rochester, MN
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (A.K.), Mayo Clinic, Rochester, MN
| | | | - Lora E. Burke
- School of Nursing, Department of Health and Community Systems, University of Pittsburgh, PA (L.E.B.)
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.A.C.)
| | - Christi A. Patten
- Department of Psychiatry and Psychology (C.A.P.), Mayo Clinic College of Medicine, Rochester, MN
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Ferdinand KC. Cardiovascular Disparities Up South: The Intersection of Geography, Social Determinants, and Race. Mayo Clin Proc 2022; 97:7-9. [PMID: 34996568 DOI: 10.1016/j.mayocp.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Keith C Ferdinand
- Tulane University School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA.
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