1
|
Riaz M, Smith SM, Dietrich EA, Winchester DE, Guo J, Park H. Trends in pharmacotherapy utilization among patients with heart failure with preserved ejection fraction. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100259. [PMID: 38510191 PMCID: PMC10946036 DOI: 10.1016/j.ahjo.2023.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 03/22/2024]
Abstract
Study objective Half of patients with heart failure have preserved ejection fraction (HFpEF). Over the years, guidelines have recommended or advised against various therapies for HFpEF management. However, there is limited evidence on the trends in utilization of the various medications. The aim of this study was to examine the trends in the use of pharmacotherapies among patients with HFpEF from 2008 through 2020. Design Retrospective cohort study of patients with HFpEF used MarketScan® Commercial and Medicare Supplemental Databases (2007-2020). Participants Patients with HFpEF. Outcome measures Utilization rates for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), aldosterone receptor antagonists (ARAs), diuretics, β-blockers, calcium channel blockers (CCBs), phosphodiesterase 5 inhibitors (PDE5Is), nitrates, digoxin, and sodium glucose cotransporter-2 inhibitors (SGLT2i) within 90 days of the first HFpEF diagnosis. Results We identified 156,730 patients with HFpEF (mean [SD] age, 73 [13.4] years; 57 % females). From 2008 to 2020, we found increased utilization rates for ARNIs (0.02 % vs. 0.17 % of all patients, p < 0.01), ARBs (14.3 % vs. 18.6 %, p < 0.01), ARAs (7.0 % vs. 8.4 %, p < 0.01), CCBs (30.6 % vs. 33.4 %, p < 0.01), and SGLT2i (0.001 % vs. 0.021 %, p < 0.01). By contrast, the utilization of ACEIs (30.4 % vs. 20.5 %, p < 0.01), digoxin (9.5 % vs. 2.4 %, p < 0.01), nitrates (10.7 % vs. 4.9 %, p < 0.01), diuretics (54.1 % vs. 50.4 %, p = 0.20), and β-blockers (52.6 % vs. 51.7 %, p < 0.01) decreased, while utilization rates of PDE5Is remained stable (1.5 % vs. 1.1 %, p = 0.90) . Conclusions During the 13-year study period, the utilization of ARNIs, ARBs, ARAs, CCBs, and SGLT2i increased while the utilization of digoxin, nitrates, diuretics, and β-blockers decreased among patients with HFpEF.
Collapse
Affiliation(s)
- Munaza Riaz
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Lahore College for Women University, Lahore, Punjab, Pakistan
| | - Steven M. Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Eric A. Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - David E. Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| |
Collapse
|
2
|
Buková A, Chovanová E, Küchelová Z, Junger J, Horbacz A, Majherová M, Duranková S. Association between Educational Level and Physical Activity in Chronic Disease Patients of Eastern Slovakia. Healthcare (Basel) 2021; 9:healthcare9111447. [PMID: 34828493 PMCID: PMC8619688 DOI: 10.3390/healthcare9111447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 01/05/2023] Open
Abstract
Aims: This study aimed to investigate selected chronic diseases patients with different educational attainment regarding their awareness of and compliance with recommended physical activity. Method: This cross-sectional study was conducted from October 2018 to February 2019 in cooperation with chronic diseases clinics in eastern Slovakia. The study involved 893 patients. Results: People with higher education apparently recognise to a greater extent the importance of nutrition, diet, and the role of physical activity in treating their disease. Moreover, they have knowledge of physical exercises appropriate for their disease. Conversely, a noticeably higher number of less educated patients reported receiving general, respectively detailed information about the importance of physical activity in treating their disease. Differences in awareness of appropriate exercises and their implementation were not statistically significant. Conclusions: The results fail to prove educational attainment being a key determinant of chronic diseases. However, it can be reasonably argued that lower educational attainment may be a reliable risk signal of chronic diseases in later life.
Collapse
Affiliation(s)
- Alena Buková
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia; (Z.K.); (J.J.); (A.H.)
- Correspondence: ; Tel.: +421-552341624
| | - Erika Chovanová
- Faculty of Sport, University of Prešov, 080 01 Prešov, Slovakia;
| | - Zuzana Küchelová
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia; (Z.K.); (J.J.); (A.H.)
| | - Jan Junger
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia; (Z.K.); (J.J.); (A.H.)
| | - Agata Horbacz
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University, 040 11 Košice, Slovakia; (Z.K.); (J.J.); (A.H.)
| | - Mária Majherová
- Faculty of Humanities and Natural Sciences, University of Prešov, 080 01 Prešov, Slovakia; (M.M.); (S.D.)
| | - Silvia Duranková
- Faculty of Humanities and Natural Sciences, University of Prešov, 080 01 Prešov, Slovakia; (M.M.); (S.D.)
| |
Collapse
|
3
|
Gebremedhin MH, Gebrekirstos LG. Dietary and Behavioral Risk Factors of Ischemic Heart Disease Among Patients of Medical Outpatient Departments in Southern Ethiopia: Unmatched Case-Control Study. Integr Blood Press Control 2021; 14:123-132. [PMID: 34588813 PMCID: PMC8473848 DOI: 10.2147/ibpc.s322663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Worldwide mortality due to cardiovascular disease is the dominant cause of death, and ischemic heart disease is the leading one. Though risk factors for Ischemic heart diseases are modifiable and preventable, it is not well investigated in the local context. Thus, this study aimed to assess the dietary and behavioral risk factors for ischemic heart disease among patients in medical outpatient departments in Southern, Ethiopia. METHODS A facility-based unmatched case-control study was conducted from November 16 to March 20, 2020, among patients with ischemic heart disease and those patients who visited the three hospitals of the Wolaita Zone. A convenient sampling method was used and the data were entered using Epi data version 3.1 and exported to SPSS version 21 for analysis, a p-value <0.05, were considered statistically significant. RESULTS A total of 557 study participants (140 cases and 417 controls) were included in a ratio of 1:3. The adjusted odds ratio for having no formal education (AOR = 3.18; 95% CI: 1.59, 6.34), previous history of hypertension (AOR= 2.84; 95% CI: 1.73, 4.66), physical inactivity (AOR= 2.23; 95% CI: 1.32, 3.76), inadequate intake of fruit and vegetable consumption (AOR= 2.43; 95% CI; 1.40, 4,22), palm oil use for food preparation (AOR= 2.12; 95% CI: 1.23, 3.63) and obesity (AOR= 5.68; 95% CI: 2.63, 12.23) increased the occurrence of the disease. CONCLUSION Although ischemic heart disease is preventable, using relatively simple and inexpensive lifestyle changes, it is projected to cause preventable loss of life. So, expanding health education and healthy life styles including exercise is recommended.
Collapse
Affiliation(s)
- Meron Hadis Gebremedhin
- School of medicine, College of health science and medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Lielt Gebreselassie Gebrekirstos
- Department of maternity and reproductive health, College of health science and medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
4
|
Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, Dhindsa DS, Ghazzal B, Choudhary MK, Sandesara PB, Hayek SS, Topel ML, Alkhoder AA, Martini MA, Sidoti A, Ko Y, Lewis TT, Vaccarino V, Sperling LS, Quyyumi AA. Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease. J Am Heart Assoc 2019; 8:e013165. [PMID: 31476920 PMCID: PMC6755831 DOI: 10.1161/jaha.119.013165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/15/2019] [Indexed: 01/03/2023]
Abstract
Background Educational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied. Methods and Results Patients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all-cause mortality and secondary outcomes were a composite of cardiovascular death/non-fatal myocardial infarction and non-fatal myocardial infarction during follow-up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow-up, there were 1066 all-cause deaths, 812 cardiovascular deaths/non-fatal myocardial infarction, and 276 non-fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality (hazard ratios 1.52 [95% CI 1.11-2.09]; 1.43 [95% CI 1.17-1.73]; and 95% CI 1.26 [1.03-1.53], respectively). Similar findings were observed for secondary outcomes. Conclusions Low educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high-risk patient population need further investigation.
Collapse
Affiliation(s)
- Heval M. Kelli
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman S. Tahhan
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Chang Liu
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Tiffany A. Dong
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of MedicineEmory University School of MedicineAtlantaGA
| | - Devinder S. Dhindsa
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Bahjat Ghazzal
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Muaaz K. Choudhary
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Salim S. Hayek
- Division of CardiologyDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMI
| | - Matthew L. Topel
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman A. Alkhoder
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Mohamed A. Martini
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arianna Sidoti
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Yi‐An Ko
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Tene T. Lewis
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| |
Collapse
|
5
|
Relationship between sensory liking for fat, sweet or salt and cardiometabolic diseases: mediating effects of diet and weight status. Eur J Nutr 2019; 59:249-261. [PMID: 30719567 DOI: 10.1007/s00394-019-01904-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Previous works have been suggested that individual sensory liking is a predictor of dietary intake and weight status, and may consequently influence development of cardiometabolic diseases (CMDs). We investigated the association between sensory liking for fat-and-salt, fat-and-sweet, sweet or salt and the onset of hypertension, diabetes and cardiovascular diseases (CVDs) over 6 years in adults, and the mediating effects of dietary intake and body mass index (BMI). METHODS We examined the CMDs risk among 41,332 (for CVD and diabetes) and 37,936 (for hypertension) French adults (NutriNet-Santé cohort). Liking scores, individual characteristics, diet and anthropometry were assessed at baseline using questionnaires. Health events were collected during 6 years. Associations between sensory liking and CMDs risk, and the mediating effect of diet and BMI, were assessed using Cox proportional hazards models. RESULTS Sensory liking for fat-and-salt was associated with an increased risk of diabetes, hypertension and CVD [hazard ratios (HR) for 1-point increment of the sensory score: HR 1.30 (95% CI 1.18, 1.43), HR 1.08 (1.04, 1.13) and HR 1.10 (1.02, 1.19), respectively]. BMI and dietary intake both explained 93%, 98% and 70%, of the overall variation of liking for fat-and-salt liking in diabetes, hypertension and CVD, respectively. Liking for fat-and-sweet and liking for salt were also associated with an increased risk of diabetes [HR 1.09 (1.01, 1.17) and HR 1.09 (1.01, 1.18), respectively], whereas liking for sweet was associated with a decreased risk [HR 0.76 (0.69, 0.84)]. CONCLUSIONS Higher liking for fat-and-salt is significantly associated with CMDs risk, largely explained by dietary intake and BMI. Our findings may help to guide effective targeted measures in prevention.
Collapse
|
6
|
Torssander J, Moustgaard H, Peltonen R, Kilpi F, Martikainen P. Partner resources and incidence and survival in two major causes of death. SSM Popul Health 2018; 4:271-279. [PMID: 29854911 PMCID: PMC5976827 DOI: 10.1016/j.ssmph.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/10/2017] [Accepted: 03/04/2018] [Indexed: 11/30/2022] Open
Abstract
Because people tend to marry social equals - and possibly also because partners affect each other's health - the social position of one partner is associated with the other partner's health and mortality. Although this link is fairly well established, the underlying mechanisms are not fully identified. Analyzing disease incidence and survival separately may help us to assess when in the course of the disease a partner's resources are of most significance. This article addresses the importance of partner's education, income, employment status, and health for incidence and survival in two major causes of death: cancer and cardiovascular diseases (CVD). Based on a sample of Finnish middle-aged and older couples (around 200,000 individuals) we show that a partner's education is more often connected to incidence than to survival, in particular for CVD. Once ill, any direct effect of partner's education seems to decline: The survival chances after being hospitalized for cancer or CVD are rather associated with partner's employment status and/or income level when other individual and partner factors are adjusted for. In addition, a partner's history of poor health predicted higher CVD incidence and, for women, lower cancer survival. The findings suggest that various partner's characteristics may have different implications for disease and survival, respectively. A wider focus on social determinants of health at the household level, including partner's social resources, is needed.
Collapse
Affiliation(s)
- Jenny Torssander
- Swedish Institute for Social Research, Stockholm University, Sweden
| | - Heta Moustgaard
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Riina Peltonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Fanny Kilpi
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland.,CHESS, University of Stockholm, Stockholm, Sweden.,Max Planck Institute of Demographic Research, Rostock, Germany
| |
Collapse
|
7
|
Socioeconomic Status as a Predictor of Mortality in Patients Admitted With Atrial Fibrillation. Am J Cardiol 2017; 119:1378-1381. [PMID: 28400027 DOI: 10.1016/j.amjcard.2017.01.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
Lower socioeconomic status (SES) is associated with a higher risk of cardiovascular disease. However, the association between SES and mortality in patients with atrial fibrillation (AF) is not clear. We examined whether SES predicts all-cause mortality in patients hospitalized with AF. This is a retrospective study of patients aged >18 years, admitted with a primary diagnosis of AF to Montefiore Medical Center between 2000 and 2010. Multivariable logistic regression models were used to determine predictors of survival adjusted for age, gender, heart failure, diabetes mellitus, chronic kidney disease, previous myocardial infraction, chronic obstructive pulmonary disease, hypertension, peripheral vascular disease, and SES. SES was determined using the New York City Department of Health Standardized Score (a log composite score of household income, value of housing units, net rental income, household occupations, and educational level). The cohort was divided into quartiles based on SES score, with Q4 the highest and Q1 the lowest SES score. There were 4,503 patients identified with a mean follow up of 4.5 years in the following SES quartiles: Q1 (n = 1,132), Q2 (n = 1,119), Q3 (n = 1,126), and Q4 (n = 1,126). The unadjusted mortality varied across quartiles (Q1 to Q4), 54%, 58%, 56%, and 59%, respectively (p = 0.004). After controlling for other variables in the multivariable analysis, patients with the lowest SES (Q1) had a significantly higher mortality than patients in the quartile with the highest (Q4) SES (odds ratio 1.3, CI 1.1 to 1.5). In conclusion, patients admitted to the hospital with AF have varying mortality based on their SES. After controlling for co-morbidities, patients with AF and lower SES scores had higher mortality. Further research studies are warranted to study this risk of increased mortality in AF population.
Collapse
|
8
|
Danková Z, Vorobel'ová L, Čerňanová V, Drozdová D, Grendár M, Baldovič M, Cvíčelová M, Siváková D. Genetic and Environmental Biomarkers Associated with Triglyceride Levels in Two Groups of Slovak Women. Genet Test Mol Biomarkers 2016; 21:46-52. [PMID: 27854512 DOI: 10.1089/gtmb.2016.0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study analyzed the association between the MLXIPL gene polymorphism (rs3812316) and triglyceride (TG) levels and selected environmental biomarkers in Slovak women at risk for cardiovascular disease compared to a reference sample. MATERIALS AND METHODS The studied sample consisted of 200 women at cardiovascular risk (mean age 52.96 ± 6.01 years) and 244 healthy women (mean age 47.52 ± 5.34 years). Participants gave details of their health and lifestyle during their medical examination, and peripheral blood samples were used for biochemical analyses and DNA genotyping. A nested polymerase chain reaction-restriction fragment length polymorphism assay was used to detect the rs 3812316 SNP. RESULTS We determined that there were significantly different genotype distributions in two TG categories: (1) subjects with normal TG values had a significantly higher G allele frequency than those with elevated TG levels (χ2 = 6.1556, df = 2, p = 0.046); and (2) the rare G allele frequency was 0.11 in the cardiovascular risk group and 0.15 in the reference group. Binary regression analysis showed that women with at least one G allele had a significantly lower relative risk of hypertriglyceridemia than women with the CC genotype (OR = 0.399, p = 0.022, 95% CI = 0.182-0.876). CONCLUSION This cross-sectional study suggests that MLXIPL rs3812316 genotypes may be associated with TG levels. However, further analysis is advisable because of study limitations.
Collapse
Affiliation(s)
- Zuzana Danková
- 1 Jessenius Faculty of Medicine in Martin (JFM CU), Biomedical Center Martin JFM CU, Comenius University in Bratislava , Martin, Slovakia
| | - Lenka Vorobel'ová
- 2 Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| | - Veronika Čerňanová
- 2 Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| | - Darina Drozdová
- 2 Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| | - Marian Grendár
- 1 Jessenius Faculty of Medicine in Martin (JFM CU), Biomedical Center Martin JFM CU, Comenius University in Bratislava , Martin, Slovakia
| | - Marian Baldovič
- 3 Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| | - Marta Cvíčelová
- 2 Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| | - Daniela Siváková
- 2 Department of Anthropology, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava, Slovakia
| |
Collapse
|
9
|
Eichler S, Salzwedel A, Reibis R, Nothroff J, Harnath A, Schikora M, Butter C, Wegscheider K, Völler H. Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery. Eur J Prev Cardiol 2016; 24:257-264. [DOI: 10.1177/2047487316679527] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Eichler
- Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Annett Salzwedel
- Centre of Rehabilitation Research, University of Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jörg Nothroff
- MediClin Rehabilitation Centre Spreewald, Burg, Germany
| | | | | | | | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Germany
| | - Heinz Völler
- Centre of Rehabilitation Research, University of Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| |
Collapse
|
10
|
Association of adiponectin and socioeconomic status in African American men and women: the Jackson heart study. BMC Public Health 2016; 16:511. [PMID: 27301295 PMCID: PMC4908712 DOI: 10.1186/s12889-016-3167-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Recent emphasis has been placed on elucidating the biologic mechanism linking socioeconomic status (SES) to cardiovascular disease (CVD). Positive associations of inflammatory biomarkers provide evidence suggestive of a biologic pathway by which SES may predispose to CVD. African Americans have disproportionately lower SES and have a higher prevalence of CVD risk factors compared to most ethnic/racial groups. Adiponectin (an anti-inflammatory marker) is also lower. The objective of this study was to assess the association of adiponectin with SES among African American men and women using the Jackson Heart Study. Methods Study sample included 4340 participants. Linear regression was performed separately by SES and stratified by sex. Annual household income and level of education was used as proxies for SES. Crude, age, health behavior and health status adjusted models were analyzed. The main outcome was log-transformed adiponectin. Results Men in the lowest income group had significantly higher adiponectin than those in the highest income group in the fully adjusted model (ß/standard error [se], p value = .16/.08, p = .0008. Men with < high school level of education had significantly higher adiponectin in the crude and age adjusted models than those with ≥ college degree (.25/.05, p < .0001; .14/.05/ p = .005, respectively). Women with some college or vocational training in the crude and age adjusted models had lower adiponectin compared to women with ≥ college degree (−.09/.03, p = .004; −.06/.03, p = .04, respectively). Conclusion Findings suggest a potential inverse biologic pathway between annual household income and adiponectin among African American men. There was no such finding among women. Findings suggest interventions should be targeted for higher SES African American men to improve adiponectin levels.
Collapse
|
11
|
Heo JY, Hong KJ, Shin SD, Song KJ, Ro YS. Association of educational level with delay of prehospital care before reperfusion in STEMI. Am J Emerg Med 2015; 33:1760-9. [DOI: 10.1016/j.ajem.2015.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/18/2015] [Accepted: 08/11/2015] [Indexed: 01/18/2023] Open
|
12
|
Mehta PK, Wei J, Wenger NK. Ischemic heart disease in women: a focus on risk factors. Trends Cardiovasc Med 2015; 25:140-51. [PMID: 25453985 PMCID: PMC4336825 DOI: 10.1016/j.tcm.2014.10.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 02/08/2023]
Abstract
Heart disease remains a major contributor to morbidity and mortality in women in the United States and worldwide. This review highlights known and emerging risk factors for ischemic heart disease (IHD) in women. Traditional Framingham risk factors such as hypertension, hyperlipidemia, diabetes, smoking, as well as lifestyle habits such as unhealthy diet and sedentary lifestyle are all modifiable. Health care providers should be aware of emerging cardiac risk factors in women such as adverse pregnancy outcomes, systemic autoimmune disorders, obstructive sleep apnea, and radiation-induced heart disease; psychosocial factors such as mental stress, depression, anxiety, low socioeconomic status, and work and marital stress play an important role in IHD in women. Appropriate recognition and management of an array of risk factors is imperative given the growing burden of IHD and need to deliver cost-effective, quality care for women.
Collapse
Affiliation(s)
- Puja K Mehta
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048.
| | - Janet Wei
- Barbra Streisand Women׳s Heart Center, Cedars-Sinai Heart Institute, 127S San Vicente Boulevard, A 3212, Los Angeles, CA 90048
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
13
|
Johnson-Lawrence V, Galea S, Kaplan G. Cumulative socioeconomic disadvantage and cardiovascular disease mortality in the Alameda County Study 1965 to 2000. Ann Epidemiol 2014; 25:65-70. [PMID: 25534510 DOI: 10.1016/j.annepidem.2014.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Socioeconomic disadvantage is often evaluated at single points in the adult life course in health research. Social mobility models suggest that socioeconomic patterns may also influence disease risk. This study examines cumulative socioeconomic disadvantage (CSD) in relation to cardiovascular disease mortality (CVDM). METHODS Data were from the Alameda County Study (n = 2530). The CSD indices included father's education, the respondent's education, and either average or latent variable trajectory models of adulthood household income (1965-1994). Proportional hazards models were used to assess the associations between CSD and CVDM. RESULTS The CSD measures were not associated with CVDM in men. Among women, the magnitude of the association between CSD and CVDM was greater for the income trajectory (hazard ratio3 vs 0 = 4.73, 95% confidence interval = 2.20-10.18) compared with the average income (hazard ratio3 vs 0 = 3.78, 95% confidence interval = 1.67-8.53) CSD measure. CONCLUSIONS Measures of CSD that incorporate patterning of resources over the life course were associated with CVDM for women but not men. Patterning of available socioeconomic resources may differentially influence chronic disease risk and mortality by gender, and future work should continue to investigate how greater patterns variability in available resources influences health outcomes.
Collapse
Affiliation(s)
- Vicki Johnson-Lawrence
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, MI.
| | - Sandro Galea
- Department of Epidemiology, Columbia University, New York, NY
| | - George Kaplan
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
14
|
|
15
|
Johnson-Lawrence V, Kaplan G, Galea S. Socioeconomic mobility in adulthood and cardiovascular disease mortality. Ann Epidemiol 2013; 23:167-71. [PMID: 23453385 DOI: 10.1016/j.annepidem.2013.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/15/2013] [Accepted: 02/09/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Life course models suggest that socioeconomic mobility is associated with decreased cardiovascular disease (CVD) mortality risk. We examined adult socioeconomic mobility measured by household income in relation to CVD mortality risk among older adults. METHODS Data from 2691 (n(men) = 1157; n(women) = 1534) Alameda County Study respondents in 1994 were used in these analyses. Latent growth curve models were used to identify income patterns from 1965 to 1994. RESULTS Income patterns were categorized as consistently low, moderately low, increasing, and high. Bivariate models showed that membership in the increasing compared with high pattern was associated with decreased hazards of CVD mortality (hazard ratio, 0.15; 95% confidence interval [CI], 0.04-0.53). Controlling for age, race/ethnicity, marital status, and gender, respondents in the consistently low (HR, 2.1; 95% CI, 1.5-3.1) and high pattern (HR, 2.2; 95% CI, 1.1-4.2) had increased hazards of CVD mortality than those in the moderately low income group. CONCLUSIONS Patterns of association were consistent with social mobility models of socioeconomic position, indicating lower CVD mortality risk for those with increasing or higher incomes. Future work should continue to investigate measures that capture the variation in social mobility over the life course, and how these patterns shape chronic disease risk in later life.
Collapse
|
16
|
Christensen S, Mogelvang R, Heitmann M, Prescott E. Level of education and risk of heart failure: a prospective cohort study with echocardiography evaluation. Eur Heart J 2010; 32:450-8. [PMID: 21147865 DOI: 10.1093/eurheartj/ehq435] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS With increasing socioeconomic disparity in cardiovascular risk factors, there is a need to assess the role of socioeconomic factors in chronic heart failure (CHF) and to what extent this is caused by modifiable risk factors. METHODS AND RESULTS In a prospective cohort of 18 616 men and women without known myocardial infarction or CHF examined in 1976-78, 1981-83, 1991-94, and 2001-03 in the Copenhagen City Heart Study, we studied the effect of education on CHF incidence. During a median follow-up of 21 years (range 0-31), 2190 participants were admitted to hospital for CHF. Age-adjusted hazard ratio (HR) for intermediary (8-10 years) and high level of education (>10 years) with low (< 8 years) as reference was 0.69 (0.62-0.78) and 0.52 (0.43-0.63), respectively, with similar associations in men and women. After adjusting for updated cardiovascular risk factors, corresponding HRs were 0.75 (0.67-0.85) and 0.61 (0.50-0.73). In a random subset of the population examined with echocardiography in 2001-03 (n = 3589), education was associated with left ventricular (LV) hypertrophy, LV dilatation, reduced LV ejection fraction, and severe diastolic dysfunction (P for trend, all <0.05), whereas no association was found for mild diastolic dysfunction (P for trend, 0.61). With the exception of LV hypertrophy, significant associations persisted after adjustment for potential mediating factors. CONCLUSION In this cohort study, the level of education was associated with cardiac dysfunction and predicted future hospital admission for CHF. Only a minor part of the excess risk was mediated through traditional cardiovascular risk factors. Strategies to reduce this inequality should be strengthened.
Collapse
Affiliation(s)
- Stefan Christensen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg, Copenhagen, Denmark
| | | | | | | |
Collapse
|
17
|
Smeulders ESTF, van Haastregt JCM, Ambergen T, Stoffers HEJH, Janssen-Boyne JJJ, Uszko-Lencer NHKM, Gorgels APM, Lodewijks-van der Bolt CLB, van Eijk JTM, Kempen GIJM. Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme. PATIENT EDUCATION AND COUNSELING 2010; 81:214-221. [PMID: 20153132 DOI: 10.1016/j.pec.2010.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/30/2009] [Accepted: 01/09/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. METHODS Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. RESULTS In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up. CONCLUSION Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme. PRACTICE IMPLICATIONS These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
Collapse
Affiliation(s)
- Esther S T F Smeulders
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
McKenzie C, Skelly AH. Perceptions of coronary heart disease risk in African American women with type 2 diabetes: a qualitative study. DIABETES EDUCATOR 2010; 36:766-73. [PMID: 20573999 DOI: 10.1177/0145721710374652] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to explore the perceptions of coronary heart disease (CHD) risk in a group of southern African American women with type 2 diabetes (T2DM). METHODS Semistructured interviews were conducted in participants' homes or setting of choice. The interviews were conducted with 6 participants from a larger study of 48 women who were stratified into levels of low, medium, and high perception of CHD risk, with 2 participants in each group. The interviews were analyzed using NVivo software; both investigators recoded and analyzed the data. RESULTS African American women with T2DM do not believe they are at risk for CHD unless they are told specifically by their primary health care provider that they have heart disease. The African American women in the study expressed that managing their diabetes to prevent heart disease can be overwhelming. Participants identified faith beliefs called not claiming the illness as a reason they did not perceive themselves at risk for CHD. CONCLUSIONS Not claiming an illness may influence health and preventive behaviors. Many African American women with T2DM may not claim their illness. Diabetes educators should acknowledge and address women's beliefs to create an appropriate plan of care.
Collapse
Affiliation(s)
- Carolyn McKenzie
- The Adult Geriatric Health Division, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr McKenzie)
| | - Anne H Skelly
- The Family Health Division, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina (Dr Skelly)
| |
Collapse
|
19
|
The impact of income and education on dietary habits in stone formers. Urology 2010; 76:307-13. [PMID: 20138338 DOI: 10.1016/j.urology.2009.11.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 10/16/2009] [Accepted: 11/07/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the impact of socioeconomic status (SES) on dietary habits in stones formers (SF) as there is an obvious association between dietary habits and risks of urolithiasis. METHODS SF were selected to complete the Diet History Questionnaire (DHQ) and an SES questionnaire. Meaningful dietary constituents were generated from DHQ raw data. SF were considered of lower SES if they had less than 12 years of education and lived below the poverty level. RESULTS Ninety-nine SF completed the DHQ and SES questionnaires. Thirty-seven SF had low education, whereas 62 high education levels. Significant mean dietary constituents by education level (lower vs higher) were calcium (1058.4 vs 705.0 mg/d), carbohydrate (394.9 vs 253.4 g/d), cholesterol (398.7 vs 253.4 mg/d), dietary fiber (24.6 vs 17.9 g/d), food energy (3307.9 vs 2051.5 kcal/d), phosphorus (1903.9 vs 1220.1 mg/d), potassium (4195.6 vs 2861.5 mg/d), and sodium (5136.8 vs 3050.5 mg/d) (P <.05). Thirty-four SF were below the poverty level and 60 above it. Significant mean dietary constituents by annual income (below vs above poverty level) were carbohydrate (397.6 vs 259.3 g/d), dietary fiber (26.1 vs 17.8 g/d), magnesium (481.8 vs 316.7 mg/d), and potassium (4141.9 vs 3031.6 mg/d), (P <.05). CONCLUSIONS SES impacts dietary habits and this may strongly influence stone formation and recurrence. Therefore, dietary counseling and modification as prevention for further stone formation should be more emphasized in SF of lower SES.
Collapse
|
20
|
Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Neighborhood socioeconomic context and long-term survival after myocardial infarction. Circulation 2010; 121:375-83. [PMID: 20065165 DOI: 10.1161/circulationaha.109.882555] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neighborhood of residence has been suggested to affect cardiovascular risk above and beyond personal socioeconomic status (SES). However, such data are currently lacking for patients with myocardial infarction (MI). We examined all-cause and cardiac mortality according to neighborhood SES in a cohort of MI patients. METHODS AND RESULTS Consecutive patients < or =65 years of age discharged from 8 hospitals in central Israel after incident MI in 1992 to 1993 were followed up through 2005. Individual data were obtained at study entry, including education, income, and employment. Neighborhood SES was estimated through a composite census-derived index developed by the Israel Central Bureau of Statistics. During follow-up, 326 deaths occurred in 1179 patients. Patients residing in disadvantaged neighborhoods had higher mortality rates, with 13-year survival estimates of 61%, 74%, and 82% in increasing tertiles (P(trend)<0.001). After adjustment for sociodemographic variables, traditional risk factors, MI severity indexes, and individual SES measures, the hazard ratios for death associated with neighborhood SES were 1.47 (95% confidence interval, 1.05 to 2.06) in the lower and 1.19 (95% confidence interval, 0.86 to 1.63) in the middle tertiles compared with the upper tertile (P(trend)=0.02). The respective hazard ratios were even stronger for cardiac death (1.63; 95% confidence interval, 1.09 to 2.25; and 1.41; 95% confidence interval, 0.96 to 2.07). In the final models, neighborhood context and several individual SES measures were concurrently associated with all-cause and cardiac mortality. CONCLUSIONS Neighborhood SES is strongly associated with long-term survival after MI. The association is partly, but not entirely, attributable to individual SES and clinical characteristics. These data support a multidimensional relationship between SES and MI outcome.
Collapse
Affiliation(s)
- Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel.
| | | | | | | | | |
Collapse
|
21
|
Chan RHM, Gordon NF, Chong A, Alter DA. Influence of socioeconomic status on lifestyle behavior modifications among survivors of acute myocardial infarction. Am J Cardiol 2008; 102:1583-8. [PMID: 19064009 DOI: 10.1016/j.amjcard.2008.08.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/02/2008] [Accepted: 08/02/2008] [Indexed: 11/17/2022]
Abstract
The impact of secondary prevention initiatives on survival in higher-risk socioeconomically disadvantaged patients after acute myocardial infarction (AMI) may depend on behavioral adaptive responsiveness, uptake, and adherence to healthier lifestyles. From December 1999 to February 2003, 1,801 patients in Ontario, Canada were interviewed regarding their lifestyle behaviors at 30 days after their index AMI hospitalization. Data were obtained using self-reported surveys, medical chart abstraction, and administrative data linkage. Multivariate analyses were adjusted for baseline sociodemographic, cardiac risk severity, and co-morbid conditions. Socioeconomically disadvantaged patients had greater cardiac risk severity at baseline than did their wealthier better-educated counterparts. Compared with lower-income patients, patients with higher incomes were less likely to smoke (adjusted odds ratio [OR] for highest vs lowest income tertiles 0.36, 95% confidence interval [CI] 0.21 to 0.63, p <0.001), more likely to participate in exercise (adjusted OR 1.40, 95% CI 1.07 to 1.85, p = 0.02), and more likely to decrease or discontinue alcohol use (adjusted OR 1.64, 95% CI 1.16 to 2.34, p = 0.06). The relation between education and lifestyle behaviors was less pronounced for education than for income. After adjustment for baseline factors, patients who acknowledged participation in regular physical exercise at 1 month had a significantly lower long-term mortality than those who did not. In conclusion, socioeconomically disadvantaged patients were sicker at baseline and less behaviorally responsive to embarking on healthy lifestyle changes after AMI than were those of higher socioeconomic status.
Collapse
Affiliation(s)
- Raymond H M Chan
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
22
|
Interaction between income and education in predicting long-term survival after acute myocardial infarction. ACTA ACUST UNITED AC 2008; 15:526-32. [DOI: 10.1097/hjr.0b013e328304feac] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background Population-based data on the impact of socioeconomic status (SES) on long-term survival after myocardial infarction (Ml) are lacking. We evaluated the association of income and education with all-cause mortality and cardiac mortality post-MI and assessed income-by-education interaction. Design Prospective cohort study. Methods Between February 1992 and February 1993, 1521 consecutive patients aged 65 years or less (19% women) discharged from all hospitals in central Israel after incident acute MI were enrolled and followed up through December 2005. Data on SES indicators, cardiovascular risk factors, MI characteristics and severity, comorbidities, and acute treatment were assessed at baseline. Results Low SES, as defined by income and education, was associated with older age, female sex, and higher prevalence of risk factors and comorbidities. Further, low SES patients presented with more severe disease and received fewer cardiac procedures and medications. During follow-up, 427 patients died. Income and education strongly interacted ( P = 0.003). The hazard ratio for death associated with income (below average vs. average/above average) was considerably higher for less educated (≤12 years) patients [2.64, 95% confidence interval (CI): 1.92–3.63] than for more educated (≥12 years) patients (1.53, 95% CI: 1.02–2.29). Adjustment for various prognostic indicators attenuated these estimates, yet excess risk persisted for the less educated group (hazard ratio = 1.58, 95% CI: 1.13–2.21). Similar patterns were noted for cardiac mortality. Conclusion Among patients with incident MI, low SES is related to higher risk profile and poorer treatment. Low income is associated with a large increase in mortality risk when accompanied by low education, suggesting a double jeopardy phenomenon.
Collapse
|
23
|
Georgiades A, Janszky I, Blom M, László KD, Ahnve S. Financial strain predicts recurrent events among women with coronary artery disease. Int J Cardiol 2008; 135:175-83. [PMID: 18619689 DOI: 10.1016/j.ijcard.2008.03.093] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 12/14/2007] [Accepted: 03/29/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although a number of epidemiological studies have found an association between socioeconomic status (SES) indices such as income and education and coronary morbidity and mortality, few have looked at health consequences arising from actually experiencing financial shortcomings. The objective of the present study was to examine whether financial strain predicts recurrent coronary artery disease (CAD) events among women with established CAD. METHODS Two hundred two women (mean age 62+/-9 years) hospitalized for an acute coronary event were followed over a period of 3.5 years. Demographic, socioeconomic, lifestyle-related, psychosocial and biological characteristics were obtained by means of questionnaires and clinical examination. Data on recurrent cardiac events were collected from the Swedish discharge and death registers. RESULTS Women experiencing financial strain over the past year had an increased risk for recurrent events, i.e. the combination of all-cause mortality, new acute myocardial infarction and unstable angina pectoris during the follow-up with an unadjusted hazard ratio (HR) of 3.2 (95% CI 1.6-6.6), and a HR of 2.76 (95% CI 1.02-7.50) after controlling for education, household income, age, cohabiting status, inclusion diagnosis and rehabilitation therapy. Adjustment for potential mediators, i.e. psychosocial factors, lipids, diabetes mellitus, smoking, body-mass index, blood pressure, physical activity, alcohol consumption, participation in other cardiac rehabilitation programs did not alter the results significantly. CONCLUSIONS Financial strain was a predictor for recurrent events among women with CAD, independently of commonly used SES indicators such as education and household income. Future studies will have to explore the mechanism behind this association.
Collapse
Affiliation(s)
- Anastasia Georgiades
- Preventive Medicine, Department of Public Health Sciences, Karolinska Institutet and Center of Public Health, Stockholm County Council, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
24
|
Gerber Y, Weston SA, Killian JM, Therneau TM, Jacobsen SJ, Roger VL. Neighborhood income and individual education: effect on survival after myocardial infarction. Mayo Clin Proc 2008; 83:663-9. [PMID: 18533083 PMCID: PMC2650487 DOI: 10.4065/83.6.663] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the association of neighborhood-level income and individual-level education with post-myocardial infarction (MI) mortality in community patients. PARTICIPANTS AND METHODS From November 1, 2002, through May 31, 2006, 705 (mean+/-SD age, 69+/-15 years; 44% women) residents of Olmsted County, MN, who experienced an MI meeting standardized criteria were prospectively enrolled and followed up. The neighborhood's median household income was estimated by census tract data; education was self-reported. Demographic and clinical variables were obtained from the medical records. RESULTS Living in a less affluent neighborhood and having a low educational level were both associated with older age and more comorbidity. During follow-up (median, 13 months), 155 patients died. Neighborhood income (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.42-3.12; for lowest [median, $34,205] vs highest [median, $60,652] tertile) and individual education (HR, 2.21; 95% CI, 1.47-3.32; for <12 vs >12 years) were independently associated with mortality risk. Adjustment for demographics and various post-MI prognostic indicators attenuated these estimates, yet excess risk persisted for low neighborhood income (HR, 1.62; 95% CI, 1.08-2.45). Modeled as a continuous variable, each $10,000 increase in annual income was associated with a 10% reduction in mortality risk (adjusted HR, 0.90; 95% CI, 0.82-0.99). CONCLUSION In this geographically defined cohort of patients with MI, low individual education and poor neighborhood income were associated with a worse clinical presentation. Poor neighborhood income was a powerful predictor of mortality even after controlling for a variety of potential confounding factors. These data confirm the socioeconomic disparities in health after MI.
Collapse
Affiliation(s)
- Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | | | | | | | | |
Collapse
|
25
|
Sui X, Gheorghiade M, Zannad F, Young JB, Ahmed A. A propensity matched study of the association of education and outcomes in chronic heart failure. Int J Cardiol 2007; 129:93-9. [PMID: 17643517 PMCID: PMC2657036 DOI: 10.1016/j.ijcard.2007.05.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 04/30/2007] [Accepted: 05/19/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heart failure (HF) patients' knowledge about their disease may improve short-term outcomes and may be related to their level of education. However, the effects of patients and spousal education on long-term outcomes in ambulatory chronic HF are unknown. METHODS Of the 571 patients enrolled in the quality of life sub-study of the Digitalis Investigation Group trial, 159 patients or their spouses reported having higher (>12 years) education. Propensity score for higher education, calculated for each patient using a logistic regression model, was used to match 112 (70% of 159) higher education patients with 215 patients with high school (<or=12 years) education. Matched Cox regression analyses were used to estimate associations of high school education with mortality and hospitalizations. RESULTS All-cause hospitalizations occurred in 56% (rate, 3233/10,000 person-years) of higher education and 65% (rate, 4558/10,000 person-years) of high school education patients (hazard ratio {HR} for high school, compared with higher education=1.52; 95% confidence interval {CI}=1.06-2.16; p=0.022). Hospitalizations due to cardiovascular causes occurred in 42% (rate, 2067/10,000 person-years) of higher education and 50% (rate, 4558/10,000 person-years) of high school education patients (HR=1.55; 95% CI, 1.05-2.30; p=0.029). All-cause mortality occurred in 20% (rate, 746/10,000 person-years) of higher education and 30% (rate, 1204/10,000 person-years) of high school education patients (HR=1.52; 95% CI=0.89-2.58; p=0.124). CONCLUSIONS Compared with >12 years of education, lower education was associated with increased hospitalizations among ambulatory chronic HF patients. Patient and spousal education levels may be used to risk stratify HF patients at high risk for hospitalizations.
Collapse
Affiliation(s)
- Xuemei Sui
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL, USA
- VA Medical Center, Birmingham, AL, USA
| |
Collapse
|
26
|
Reynolds B. The Experiential Discounting Task is sensitive to cigarette-smoking status and correlates with a measure of delay discounting. Behav Pharmacol 2006; 17:133-42. [PMID: 16495721 DOI: 10.1097/01.fbp.0000190684.77360.c0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This research compared three different measures of discounting in adult cigarette smokers (n=15; consumed >or=20 cigarettes per day) and nonsmokers (n=15; self-reported never smokers). Participants completed the Experiential Discounting Task (EDT) and question-based measures of delay and probability discounting. The Experiential Discounting Task is a new real-time choice procedure purported to assess delay discounting. The Experiential Discounting Task provides choice consequences (i.e. delays, probabilities, and monetary rewards delivered from a coin dispenser) during choice sessions, whereas the question-based measures are hypothetical (i.e. delays, probabilities, and rewards are not directly experienced). Smokers discounted more than nonsmokers on all three measures. Additionally, the Experiential Discounting Task was significantly correlated with the question-based measure of delay discounting but not probability discounting. These results suggest all three discounting procedures are sensitive to cigarette-smoking status among adult smokers and nonsmokers and that the Experiential Discounting Task may be more comparable to measures of delay discounting than probability discounting.
Collapse
Affiliation(s)
- Brady Reynolds
- Department of Pediatrics, Columbus Children's Research Institute, The Ohio State University, Columbus, Ohio 43205, USA.
| |
Collapse
|
27
|
Lallukka T, Martikainen P, Reunanen A, Roos E, Sarlio-Lähteenkorva S, Lahelma E. Associations between working conditions and angina pectoris symptoms among employed women. Psychosom Med 2006; 68:348-54. [PMID: 16554403 DOI: 10.1097/01.psy.0000204653.92047.0e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women. METHODS Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek's job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work-home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded. RESULTS AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause. CONCLUSIONS Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women.
Collapse
Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|