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Li X, Yang W, Miao Y, Dove A, Wang J, Du T, Fang Z, Xu W, Zhang Q. Relation of Cognitive Reserve Indicator to Heart Disease and Cardiac Structure and Function: A Large Community-Based Longitudinal Study. J Am Heart Assoc 2024; 13:e033249. [PMID: 39190584 DOI: 10.1161/jaha.123.033249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/01/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND High cognitive reserve (CR) has been related to lower dementia risk, but its association with heart disease (HD) is unknown. We aimed to explore the relation of CR to HD and cardiac structure and function. METHODS AND RESULTS Within the UK Biobank, 349 907 HD-free participants were followed up. A composite CR indicator involving education/occupation attainment/television viewing time/confiding frequency/social connection frequency/variety of leisure activities was generated, and further categorized into low/moderate/high levels. Incident HD, including coronary HD, cardiac arrhythmia, and heart failure, was ascertained on the basis of medical records. During the follow-up, a subsample (n=31 182) underwent cardiac magnetic resonance imaging to assess ventricular structure and function. Data were analyzed using Cox regression, Laplace regression, and linear regression. Compared with low CR, the hazard ratio and 95% CI of any HD for high CR was 0.78 (0.75-0.80) (including 0.68 [0.66-0.71] for coronary HD, 0.91 [0.87-0.95] for cardiac arrhythmia, and 0.63 [0.58-0.68] for heart failure). Furthermore, high CR was associated with delayed HD onset by 1.59 (95% CI, 1.37-1.82) years compared with low CR. In cardiac magnetic resonance imaging data analysis, compared with low CR, high CR was associated with larger left ventricular end-diastolic volume (β, 0.13 [95% CI, 0.09-0.17]), left ventricular end-systolic volume (β, 0.05 [95% CI, 0.01-0.10]), left ventricular stroke volume (β, 0.16 [95% CI, 0.12-0.21]), and left ventricular ejection fraction (β, 0.08 [95% CI, 0.03-0.13]). CONCLUSIONS High CR is associated with favorable HD health. Our findings suggest that the beneficial effect of CR is not limited to dementia but also HD.
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Affiliation(s)
- Xuerui Li
- Department of Geriatrics, Tianjin Medical University General Hospital Tianjin Geriatrics Institute Tianjin China
| | - Wenzhe Yang
- School of Public Health Tianjin Medical University Tianjin China
- Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China
| | - Yuyang Miao
- Department of Geriatrics, Tianjin Medical University General Hospital Tianjin Geriatrics Institute Tianjin China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Jiao Wang
- Department of Epidemiology, College of Preventive Medicine Third Military Medical University Chongqing China
| | - Tingting Du
- Department of Geriatrics, Tianjin Medical University General Hospital Tianjin Geriatrics Institute Tianjin China
| | - Zhongze Fang
- Tianjin Key Laboratory of Environment Nutrition and Public Health Tianjin China
- Department of Toxicology and Sanitary Chemistry, School of Public Health Tianjin Medical University Tianjin China
| | - Weili Xu
- Department of Geriatrics, Tianjin Medical University General Hospital Tianjin Geriatrics Institute Tianjin China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society Karolinska Institutet Stockholm Sweden
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital Tianjin Geriatrics Institute Tianjin China
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Wee YMS, Koh YLE, Tan NC. Assessment and stratification of self-care profile of patients with essential hypertension. Singapore Med J 2024; 65:459-465. [PMID: 34717303 PMCID: PMC11382822 DOI: 10.11622/smedj.2021181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 08/30/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Yi-Mei Sabrina Wee
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
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3
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Liu W, Lin Q, Fan Z, Cui J, Wu Y. Education and cardiovascular diseases: a Mendelian randomization study. Front Cardiovasc Med 2024; 11:1320205. [PMID: 38426117 PMCID: PMC10902100 DOI: 10.3389/fcvm.2024.1320205] [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: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Background Observational studies have indicated a potential association between education and cardiovascular diseases (CVDs). However, uncertainties regarding the causal relationship persist. Therefore, this study aimed to investigate whether higher levels of education causally reduce the risks of CVDs. Methods Employing a two-sample Mendelian randomization (MR) design, our study examined the relationship between education and ten different CVDs. Utilizing data from the IEU Open GWAS database, relevant single nucleotide polymorphisms (SNPs) were identified through stringent screening criteria. Causality was assessed using the inverse-variance weighted (IVW), ME-Egger regression, and weighted median methods. Sensitivity analyses, including heterogeneity and pleiotropy tests, were conducted to ensure the robustness of our findings. Results Our study identified a genetic predisposition associated with an additional 3.6 years of education, which significantly reduced the risk of various CVDs. Specifically, this genetic factor was found to lower the risk of type 2 diabetes by 46.5%, coronary heart disease by 37.5%, ischemic stroke by 35.4%, cardiac-related mortality by 28.6%, heart failure by 28.2%, transient ischemic attack by 24%, atrial fibrillation by 15.2%, peripheral artery disease by 0.3%, and hypertension by 0.3%. However, no significant evidence revealed a causal relationship between education and pulmonary embolism. Conclusion Our study provides robust evidence supporting the role of higher educational attainment in reducing the incidence of various cardiovascular diseases, including type 2 diabetes, coronary heart disease, ischemic stroke, cardiac-related mortality, heart failure, transient ischemic attack, atrial fibrillation, peripheral artery disease, and hypertension. However, the impact of education on pulmonary embolism remains inconclusive.
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Affiliation(s)
- Wei Liu
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Quan Lin
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zongjing Fan
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jie Cui
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Wu
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Pakrad F, Shiri R, Mozayani Monfared A, Mohammadi Saleh R, Poorolajal J. Predictors of Premature Mortality Following Coronary Artery Bypass Grafting: An Iranian Single-Centre Study. Healthcare (Basel) 2023; 12:36. [PMID: 38200942 PMCID: PMC10779296 DOI: 10.3390/healthcare12010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Modifiable risk factors play an important role in the premature mortality among patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to examine the factors that influence the early death of patients who had CABG. We conducted a prospective cohort study and followed 2863 patients after their CABG, and collected data on their characteristics and blood tests. We used the Cox proportional hazards regression model in Stata, version 16, to identify the predictors of early mortality. Out of 2863 patients, 162 died during the follow-up period. The survival rate was 99.2% within the first three days after the surgery, 96.2% from the fourth day to the end of the first year, 94.9% at the end of the second year, and 93.6% at the end of the third year. After adjusting for confounding factors, we found that older age (hazard ratio [HR] 1.05, 95% CI 1.02, 1.08 for one year increase in age), obesity (HR 2.16, 95% CI 1.25, 3.72), ejection fraction < 50% (HR 1.61, 95% CI 1.06, 2.44), number of rehospitalizations (HR 2.63, 95% CI 1.35, 5.12 for two or more readmissions), history of stroke (HR 2.91, 95% CI 1.63, 5.21), living in rural areas (HR 1.58, 95% CI 1.06, 2.34), opium use (HR 2.08, 95% CI 1.40, 3.09), and impaired glomerular filtration rate increased the risk of early death after CABG, while taking a beta-blocker (HR 0.59, 95% CI 0.38, 0.91) reduced the risk. We conclude that modifiable risk factors such as excess body mass, high blood glucose, opium use, and kidney dysfunction should be monitored and managed in patients who had CABG to improve their survival outcomes.
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Affiliation(s)
- Fatemeh Pakrad
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan 6517838698, Iran;
| | - Rahman Shiri
- Finnish Institute of Occupational Health, 00032 Helsinki, Finland;
| | - Azadeh Mozayani Monfared
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan 6517838736, Iran;
| | - Ramesh Mohammadi Saleh
- Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan 6517838698, Iran;
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan 6517838687, Iran
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan 6517838687, Iran
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Yuan D, Wang M, Bu S, Mu T, Li Y. Associations of Socioeconomic Factors and Unhealthy Lifestyles with Allostatic Load: A Meta-analysis. Int J Behav Med 2023:10.1007/s12529-023-10235-5. [PMID: 37889389 DOI: 10.1007/s12529-023-10235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Allostatic load (AL) is a biological tool for objectively assessing chronic stress and has been discussed inconsistently for its correlation with socioeconomic factors and unhealthy lifestyles. Therefore, this meta-analysis was performed to explore the impact of socioeconomic factors and unhealthy lifestyles on AL. METHOD Different databases, including Web of Science, PubMed, EBSCOhost, Embase, CNKI, VIP, SinoMed, and Wanfang, were searched from inception to June 6, 2023. A total of 25 studies, reporting the correlations of seven socioeconomic factors and three unhealthy lifestyles with AL, were finally included. The pooled odds ratios (OR) and 95% confidence intervals (CIs) were examined using random-effect and fixed-effect models. Literature quality, heterogeneity, and publication bias were evaluated. RESULTS The meta-analysis showed a significantly increased risk of high AL in the older individuals as compared to the younger ones (OR = 1.05, 95% CI 1.04-1.06), in the individual with low education as compared to those with high education (OR = 1.25, 95% CI 1.05-1.48), and in the individuals with low physical activities as compared to those with high physical activities (OR = 1.44, 95% CI 1.26-1.64). This meta-analysis also showed a significantly decreased risk of high AL in the individuals with high income as compared to those with low income (OR = 0.77, 95% CI 0.71-0.83) and in women as compared to men (OR = 0.80, 95% CI 0.80-0.81). CONCLUSION This meta-analysis showed older people, men, and people having low physical activity, low income, and low education were more likely to have a high AL. TRIAL REGISTRATION This meta-analysis was registered on the PROSPERO database with trial registration number CRD42022326105. Instead of providing information at registration, we added an author (Tingyu Mu), who provided critical revisions to the paper in this meta-analysis.
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Affiliation(s)
- Dehui Yuan
- School of Nursing, Anhui Medical University, Hefei City, Anhui Province, China, 230601
| | - Minghuan Wang
- School of Nursing, Anhui Medical University, Hefei City, Anhui Province, China, 230601
| | - Sisi Bu
- School of Nursing, Anhui Medical University, Hefei City, Anhui Province, China, 230601
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China, 310053
| | - Yuhong Li
- School of Nursing, Anhui Medical University, Hefei City, Anhui Province, China, 230601.
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Chen S, Zhu Y, Jin S, Zhao D, Guo J, Chen L, Huang Y. Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study. BMC Cardiovasc Disord 2023; 23:501. [PMID: 37817110 PMCID: PMC10566157 DOI: 10.1186/s12872-023-03478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Diabetes increases the risk of hypertension morbidity, but whether this association is varied with glycemic control remains unknown. We aimed to examine the association of glycemic control with hypertension among individuals with diabetes. METHODS Data was from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorized as having adequate glycemic control (HbA1c < 7%) and inadequate glycemic uncontrol (HbA1c ≥ 7%) by combining blood glucose tests and physician's diagnoses in 2011. Incident hypertension was ascertained through self-reported physician diagnoses from 2011 to 2018. Cox proportional hazards regression models were used to examine the effect of glycemic control on hypertension. RESULTS Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 were insufficient glycemic control. During 7 years of follow-up, 141 individuals developed hypertension. Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 (95% CI, 1.07-2.21) in the multivariate model. Additionally, the influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms (P for interaction < 0.05). CONCLUSIONS Insufficient glycemic control was associated with a higher risk of hypertension among individuals with diabetes. Notably, the effect of glycemic control on hypertension was more pronounced among those with lower educational attainment and those exhibiting depressive symptoms. These findings underscore the significance of vigilant glycemic monitoring, educational background considerations, and mental health assessments in managing diabetic individuals.
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Affiliation(s)
- Shengliang Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yi Zhu
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Sihui Jin
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Dongbao Zhao
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Jianwei Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Lijin Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yixiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China.
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Oktamianti P, Kusuma D, Amir V, Tjandrarini DH, Paramita A. Does the Disparity Patterning Differ between Diagnosed and Undiagnosed Hypertension among Adults? Evidence from Indonesia. Healthcare (Basel) 2023; 11:healthcare11060816. [PMID: 36981473 PMCID: PMC10048049 DOI: 10.3390/healthcare11060816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Healthcare systems in many low- and middle-income countries (LMICs) are not yet designed to tackle the high and increasing burden of non-communicable diseases (NCDs), including hypertension. As a result, a large proportion of people with disease or risk factors are undiagnosed. Policymakers need to understand the disparity better to act. However, previous analyses on the disparity in undiagnosed hypertension, especially from LMICs, are lacking. Our study assessed the geographic and socioeconomic disparity in undiagnosed hypertension and compared it with diagnosed hypertension. Methods: We used the Basic Health Survey (Riskesdas) 2018 and performed geospatial and quantitative analyses across 514 districts in Indonesia. Dependent variables included diagnosed and undiagnosed hypertension among adults (18+ years) and by gender. Results: A high prevalence of undiagnosed hypertension at 76.3% was found, with different patterns of disparity observed between diagnosed and undiagnosed hypertension. Diagnosed hypertension was 1.87 times higher in females compared with males, while undiagnosed hypertension rates were similar between genders. Urban areas had up to 22.6% higher rates of diagnosed hypertension, while undiagnosed hypertension was 11.4% more prevalent among females in rural areas. Districts with higher education rates had up to 25% higher diagnosed hypertension rates, while districts with lower education rates had 6% higher rates of undiagnosed hypertension among females. The most developed regions had up to 76% and 40% higher prevalence of both diagnosed and undiagnosed hypertension compared with the least developed regions. Conclusion: The disparity patterning differs between diagnosed and undiagnosed hypertension among adults in Indonesia. This highlights the need for effective measures, including healthcare system reforms to tackle NCDs in LMICs.
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Affiliation(s)
- Puput Oktamianti
- Health Administration and Policy Department, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dian Kusuma
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London EC1V 0HB, UK
- Correspondence:
| | - Vilda Amir
- Center for Health Administration and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
| | - Dwi Hapsari Tjandrarini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
| | - Astridya Paramita
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor 16915, Indonesia
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Sun Y, Jin M, Yu T, Zhang J. Cardiovascular risk factors mediating the protective effect of education on cervical spondylosis risk. Sci Rep 2023; 13:936. [PMID: 36650225 PMCID: PMC9845322 DOI: 10.1038/s41598-023-28153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
The causal association between education and cervical spondylosis may be mediated partly through risk factors of cardiovascular disease. The identification of the protective effect of education and the evaluation of risk factors will help to optimize disease prevention at both clinical and public health levels. In this study, we applied several different Mendelian randomization (MR) methods to identify which cardiovascular factors underlie the clustering of cervical spondylosis with cardiovascular disease, and the degree to which these mediate an effect of education. Univariable MR analyses provided evidence supporting a protective effect of genetically predicted education on cervical spondylosis risk, and MVMR further identified the direct effect of education level. Our results also provided evidence supporting the detrimental effects of BMI and smoking on cervical spondylosis risk, with evidence that the effect of education is mediated through BMI and smoking. The proportions of the effect of education mediated through BMI and smoking were 12% and 3%, respectively. These findings highlight education, obesity, and smoking as common mechanisms underlying the clustering of cervical spondylosis with risk factors of cardiovascular disease, which might represent clinical and public health targets for reducing multi-morbidity and the burden of these common conditions.
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Affiliation(s)
- Yang Sun
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China
| | - Manqiu Jin
- Department of Plastic Surgery, The First Hospital of Jilin University, Jilin Changchun, China
| | - Tiecheng Yu
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China
| | - Jiting Zhang
- Department of Orthopedics, The First Hospital of Jilin University, Jilin Changchun, China.
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Work-Related Stress and Occurrence of Cardiovascular Disease: A 13-Year Prospective Study. J Occup Environ Med 2022; 64:927-933. [PMID: 35902362 DOI: 10.1097/jom.0000000000002645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the influence of work-related psychological and physical stresses on risk of cardiovascular disease (CVD). METHODS A total of 5651 CVD-free participants older than 50 years from the Survey of Health, Ageing and Retirement in Europe were followed up for 13 years to detect incident CVD. Work-related stress was assessed using job strain and job reward questionnaire. Cox regression model was used to estimate the association. RESULTS High physical demands (hazard ratio [HR], 1.30) and low reward (HR, 1.19) compared with their counterparts, as well as active physical jobs (HR, 1.41) and high physical strain (HR, 1.45) in comparison with low physical strain were associated with higher risk of incident CVD after adjusting for confounders. However, combining physically stressful jobs with low reward did not further increase the CVD risk. CONCLUSIONS Avoiding physically stressful jobs or providing appropriate reward may reduce the occurrence of CVD.
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Meng L, Xu J, Li J, Hu J, Xu H, Wu D, Hu X, Zeng X, Zhang Q, Li J, Gong T, Liu D. Self-reported prevalence and potential factors influencing cardio-cerebral vascular disease among the Chinese elderly: A national cross-sectional study. Front Cardiovasc Med 2022; 9:979015. [PMID: 36337863 PMCID: PMC9630358 DOI: 10.3389/fcvm.2022.979015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Aging is an essential national condition throughout China in the 21st century. Cardio-cerebral vascular disease (CCVD) is a common chronic vascular disease in the elderly. Despite aging becoming an increasingly pressing issue, there has been no comprehensive national investigation into the risk factors, prevalence, and management of CCVD among the elderly population in China. MATERIALS AND METHODS Through the 4th Survey of the Aged Population in Urban and Rural China (SSAPUR), a nationally representative sample of 224,142 adults aged more than 60 years was surveyed using a multistage, stratified sampling method. The 4th SSAPUR was used to investigate CCVD in the elderly. Univariate and multivariate logistic proportional regression analyses explored the risk factors. These risk factors were then entered into a multivariate linear regression model to identify independent predictive factors for CCVD. Disease management was assessed from the self-reported history of physician diagnosis, treatments, and hospital visits among individuals with CCVD. RESULTS After excluding samples with missing information, 215,041 individuals were included in the analysis. The overall prevalence of CCVD was 26%. Living in a rural area, being older, being female, having low literacy, smoking, getting little sleep, losing a spouse, being single, not getting enough exercise, having a bad financial situation, and not taking part in public welfare programs were the main risk factors for CCVD among the elderly in China (P < 0.05). In the multivariate linear regression model, holding all other variables at any fixed value, CCVD remained associated with "urban and rural" (β = 0.012, P < 0.001), "age" (β = -0.003, P < 0.001), "sex" (β = -0.022, P < 0.001), "education level" (β = -0.017, P < 0.001), "marriage" (β = 0.004, P = 0.047), "smoking" (β = 0.012, P = 0.003), "drinking" (β = -0.015, P = 0.001), and "sleep" (β = 0.008, P = 0.005). There were no collinearity problems among these factors. CONCLUSION Major risk factors for prevalent CCVD among the elderly in China include the following: rural residence, female, low literacy level, poor sleep quality, bereavement, non-marriage, living alone, lack of exercise, poor financial situation, and non-participation in public welfare activities. Chinese national policies for preventing, controlling, and managing risk factors for CCVD in the elderly must be urgently developed.
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Affiliation(s)
- Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiapei Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, China
| | - Jianyi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dishan Wu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Gomes ATDS, Gabe KT, Jaime PC. Development and validation of an instrument to assess Brazilians' knowledge, perceptions, and behaviors toward salt and sodium. J Clin Hypertens (Greenwich) 2022; 24:555-565. [PMID: 35389562 PMCID: PMC9106076 DOI: 10.1111/jch.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to develop and validate an instrument to assess Brazilian adults' knowledge, perceptions, and behaviors (KPB) toward salt and sodium. Based on a PAHO/WHO questionnaire, a new instrument was developed and evaluated by 11 experts, generating item and scale-level content validity indexes (I-CVI and S-CVI, respectively). Face validity was verified through a focus group with eight participants, followed by an operational test with 36 interviewees. Exploratory factor analysis (EFA) was used to determine the construct validity, and Cronbach's α coefficient was calculated to analyze instrument's reliability, using data collected via telephone from a probabilistic sample of 422 adults. The generated solutions were analyzed from theoretical and statistical significance perspectives, which supported the determination of the best model. Remaining items were scored, with higher scores related to healthier practices. A descriptive analysis was performed considering the data from the 422-adult sample. I-CVIs (0.73-1), S-CVIs (0.93; 0.97) and the interviewees' analysis indicated that items are representative and clear, in addition to being suitable for application to the target audience. Tests confirmed sample adequacy to perform the EFA (KMO = 0.82; Bartlett's sphericity test, p < .001). The final validated model, with 16 items, sufficiently explained the variance and presented good reliability (Cronbach's α = 0.81; 95% CI 0.79 - 0.84). Women, older individuals, and with higher education had significantly higher scores, regardless of chronic diseases diagnosis (p < .001). This instrument is ready to be applied and easily reproduced, contributing to the assessment of KPB toward salt and sodium in Brazil.
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Affiliation(s)
- Alícia Tavares da Silva Gomes
- Programa de Pós‐Graduação em Nutrição em Saúde PúblicaSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
| | - Kamila Tiemann Gabe
- Programa de Pós‐Graduação em Nutrição em Saúde PúblicaSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
| | - Patricia Constante Jaime
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
- Nutrition DepartmentSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
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12
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Wild LE, Walters M, Powell A, James KA, Corlin L, Alderete TL. County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2202. [PMID: 35206386 PMCID: PMC8872484 DOI: 10.3390/ijerph19042202] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023]
Abstract
Cardiometabolic diseases are a group of interrelated diseases that pose greater burden among socially vulnerable communities. The social vulnerability index (SVI) identifies communities vulnerable to emergencies and may also help determine communities at risk of adverse chronic health outcomes. However, no studies have examined the relationship between the SVI and cardiometabolic health outcomes in Colorado or focused on rural settings. The aim of this ecological study was to determine whether the county-level SVI is associated with county-level cardiometabolic health indicators with a particular focus on rurality and racial/ethnic diversity. We obtained 2014 SVI scores from the Centers for Disease Control and Prevention (scored 0-1; higher = more vulnerable) and 2013-2015 cardiometabolic health estimates from the Colorado Department of Public Health and Environment. The distribution of social determinants of health was spatially evaluated. Bivariate relationships between the SVI and cardiometabolic indicators were estimated using simple linear regression models. The highest SVI scores were observed in rural areas, including the San Luis Valley (mean: 0.78, median: 0.91), Southeast (mean: 0.72, median: 0.73), and Northeast (mean: 0.66, median: 0.76) regions. Across Colorado, the SVI accounted for 41% of the variability in overweight and obesity prevalence (p < 0.001), 17% of the variability in diabetes prevalence (p = 0.001), and 58% of the age-adjusted myocardial infarction hospitalization rate (p < 0.001). SVI values may be useful in determining a community's burden of cardiometabolic diseases.
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Affiliation(s)
- Laura E. Wild
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - McKailey Walters
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
| | - Alaina Powell
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
| | - Katherine A. James
- Department Environmental and Occupational Health, University of Colorado Anschutz Medical Campus, Denver, CO 80045, USA;
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, USA; (M.W.); (L.C.)
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA
| | - Tanya L. Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (L.E.W.); (A.P.)
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13
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Structural Factors and Quality of Diabetes Health Services in Hail, Saudi Arabia: A Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9121691. [PMID: 34946417 PMCID: PMC8701064 DOI: 10.3390/healthcare9121691] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the Hail region are scarce. Such data are imperative to develop effective strategies to control the epidemic in the region. A cross-sectional study of diabetes patients attending diabetes health care facilities in Hail was conducted using a sample of 392 patients. An interviewer-administered questionnaire was used. A slightly higher proportion of female participants (54.1%) were included in the sample. Most of the participants were from rural areas (73.9%), and 70.9% of the participants were from the middle-age (30–50 years) category. A close proximity to the diabetes clinic (OR = 1.98; 95% CI: 1.08–3.44), good transport facilities (OR = 1.67; 95% CI: 1.11–2.78) and feeling contented with supportive services (OR = 2.03; 95% CI: 1.12–4.04) were associated with patients’ satisfaction with the overall quality of the diabetes clinic services. The presence of good-quality health care professionals working in these treatment centers also seemed to contribute to patients’ satisfaction with the services they received. These structural factors associated with patients’ satisfaction with the services they received from diabetes clinics must be considered in diabetes control programs in the region. The minimization of structural barriers will eventually assist the national strategic plan, Vision 2030, which aims to improve the quality of life of the Saudi people by 2030.
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14
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Ptushkina V, Seidel-Jacobs E, Maier W, Schipf S, Völzke H, Markus MRP, Nauck M, Meisinger C, Peters A, Herder C, Schwettmann L, Dörr M, Felix SB, Roden M, Rathmann W. Educational Level, but Not Income or Area Deprivation, is Related to Macrovascular Disease: Results From Two Population-Based Cohorts in Germany. Int J Public Health 2021; 66:633909. [PMID: 34744587 PMCID: PMC8565278 DOI: 10.3389/ijph.2021.633909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany. Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke). Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models. Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.
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Affiliation(s)
- Violetta Ptushkina
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Esther Seidel-Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Werner Maier
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, München-Neuherberg, Germany.,Chair of Epidemiology, University of Augsburg at University Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), München-Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany.,Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes, Research at Heinrich-Heine-University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
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15
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Lin Y, Zhang S, Wang S, Zhong X, Li Y, Xiong Z, Sun X, Huang Y, Fan Y, Guo Y, Zhou H, Yang D, Liu M, Xu X, Zhuang X, Liao X. Behavioral Factors Mediating the Impact of Educational Attainment on Incident Heart Failure - A Mediation Analysis. Circ J 2021; 85:1545-1552. [PMID: 34135264 DOI: 10.1253/circj.cj-21-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To examine the association of low educational attainment with incident heart failure (HF) and explore potential behavioral mediators of the causal pathway.Methods and Results:A total of 12,109 participants in the Atherosclerosis Risk in Communities Study (ARIC) were included. Educational attainment was measured at baseline, and the risk of HF across educational attainment groups was assessed by Cox proportional hazards models. Using mediation analysis, we evaluated the mediating role of behavioral factors in the causal pathway between educational attainment and HF. During a median follow-up of 25.1 years, 2,407 cases (19.9%) of HF occurred. Educational attainment showed an inverse association with HF risk (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1,26-1.57 for low educational attainment; HR, 1.13; 95% CI, 1.02-1.25 for medium educational attainment). In the mediation analysis, the association between educational attainment and HF was partially mediated by income, waist-to-hip ratio, current smoking, body mass index, current drinking, sports and physical activity, which explained 24.3%, 20.2%, 13.8%, 10.1%, 7.7%, 7.3% and 4.5%, respectively, of the relationship. In total, all mediators contributed 56.3% of the total effect. CONCLUSIONS Low educational attainment was associated with increased risk for HF. Income, obesity and current smoking mediated a great proportion of the total effect of educational attainment on HF. Our results provide underlying insights for the development of targeted public health interventions to reduce educational disparities on HF incidence.
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Affiliation(s)
- Yifen Lin
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Shuyi Wang
- Department of Rheumatology, First Affiliated Hospital of Sun Yat-Sen University
| | - Xiangbin Zhong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yuqi Li
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Zhenyu Xiong
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xiuting Sun
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yiquan Huang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yongqiang Fan
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Huimin Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Menghui Liu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xingfeng Xu
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University.,NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University
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16
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Gill D, Karhunen V, Malik R, Dichgans M, Sofat N. Cardiometabolic traits mediating the effect of education on osteoarthritis risk: a Mendelian randomization study. Osteoarthritis Cartilage 2021; 29:365-371. [PMID: 33422704 PMCID: PMC7955282 DOI: 10.1016/j.joca.2020.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/14/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate which cardiometabolic factors underlie clustering of osteoarthritis (OA) with cardiovascular disease, and the extent to which these mediate an effect of education. DESIGN Genome-wide association study (GWAS) of OA was performed in UK Biobank (60,800 cases and 328,251 controls) to obtain genetic association estimates for OA risk. Genetic instruments and association estimates for body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), smoking and education were obtained from existing GWAS summary data (sample sizes 188,577-866,834 individuals). Two-sample Mendelian randomization (MR) analyses were performed to investigate the effects of exposure traits on OA risk. MR mediation analyses were undertaken to investigate whether the cardiometabolic traits mediate any effect of education on OA risk. RESULTS MR analyses identified protective effects of higher genetically predicted education (main MR analysis odds ratio (OR) per standard deviation increase 0.59, 95% confidence interval (CI) 0.54-0.64) and LDL-C levels (OR 0.94, 95%CI 0.91-0.98) on OA risk, and unfavourable effects of higher genetically predicted BMI (OR 1.82, 95%CI 1.73-1.92) and smoking (OR 2.23, 95%CI 1.85-2.68). There was no strong evidence of an effect of genetically predicted SBP on OA risk (OR 0.98, 95% CI 0.90-1.06). The proportion of the effect of genetically predicted education mediated through genetically predicted BMI and smoking was 35% (95%CI 13-57%). CONCLUSIONS These findings highlight education, obesity and smoking as common mechanisms underlying OA and cardiovascular disease. These risk factors represent clinical and public health targets for reducing multi-morbidity related to the burden these common conditions.
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Affiliation(s)
- D Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Institute for Infection and Immunity, St George's University of London, London, United Kingdom; St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - V Karhunen
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
| | - R Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - M Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany.
| | - N Sofat
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom; St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
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17
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Lidin M, Hellenius ML, Rydell Karlsson M, Ekblom-Bak E. Effects of Structured Lifestyle Education Program for Individuals With Increased Cardiovascular Risk Associated With Educational Level and Socioeconomic Area. Am J Lifestyle Med 2021; 15:28-38. [PMID: 33447169 PMCID: PMC7781060 DOI: 10.1177/1559827620951143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Differences in socioeconomic status contribute to inequalities in lifestyle habits and burden of noncommunicable diseases. We aimed to examine how the effects of a 1-year structured lifestyle education program associate with the participant’s educational level and socioeconomic area (SEA) of residence. Methods. One hundred individuals (64% women) with high cardiovascular risk were included. Education level (nonuniversity vs university degree) was self-reported and SEA (low vs high) defined by living in different SEAs. Lifestyle habits and quality of life were self-reported, cardiovascular risk factors and Framingham 10-year cardiovascular disease risk were measured at baseline and after 1 year. Results. Sedentary behavior decreased in both nonuniversity degree and low SEA group over 1 year, with a significantly greater improvement in daily activity behavior in low- compared with high-SEA group. Abdominal obesity decreased significantly more in the nonuniversity compared with the university degree group. Cardiovascular risk and quality of life improved in all groups, however, with greater discrimination when using educational level as the dichotomization variable. Conclusion. The results are clinically and significantly relevant, suggesting that low socioeconomic status measured both as educational level and SEA are no barriers for changing unhealthy lifestyle habits and decreasing cardiovascular risk after participation in a lifestyle program.
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Affiliation(s)
- Matthias Lidin
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Mai-Lis Hellenius
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Monica Rydell Karlsson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Elin Ekblom-Bak
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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18
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Pugliese NR, Rosada J, Masi S. Train the brain to preserve the heart: the link between education and heart failure. Int J Cardiol 2020; 326:202-205. [PMID: 33130258 DOI: 10.1016/j.ijcard.2020.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | - Javier Rosada
- Fourth Unit of Internal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Masi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy; Centre for Cardiovascular Preventions and Outcomes, Institute of Cardiovascular Science, University College London, UK.
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19
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Liao LZ, Zhuang XD, Zhang SZ, Liao XX, Li WD. Education and heart failure: New insights from the atherosclerosis risk in communities study and mendelian randomization study. Int J Cardiol 2020; 324:115-121. [PMID: 33017630 DOI: 10.1016/j.ijcard.2020.09.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We aim to characterize the nature and magnitude of the prospective association between education and incident heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) Study and investigate any causal relevance to the association between them. METHODS The final sample size was 12,315 in this study. Baseline characteristics between education levels were compared using 1-way ANOVA test, the Kruskal-Wallis test, or the χ2 test. We used the Kaplan-Meier estimate to compute the cumulative incident of HF by education levels and the difference in estimate was compared using the log-rank test. Cox hazard regression models were used to explore the association between education levels and incident HF. Two-sample Mendelian randomization (MR) based on publicly available summary-level data from genome-wide association studies (GWASs) was used to estimate the causal influence of the education and incident HF. RESULTS During a median follow-up of 25.1years, 2453 cases (19.9%) of incident HF occurred. After multiple adjustments in the final model, participants in the intermediate and advanced education levels were still associated with 18% and 21% decreased rate of incident HF separately. In MR analysis, we detected a protective causal association between education and HF (P=0.005). CONCLUSIONS Participants with higher education levels were associated with a decreased rate of incident HF. There was a causal association between education and HF.
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Affiliation(s)
- Li-Zhen Liao
- Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China; Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China
| | - Xiao-Dong Zhuang
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China
| | - Shao-Zhao Zhang
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China
| | - Xin-Xue Liao
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China.
| | - Wei-Dong Li
- Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China; Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China.
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20
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Che B, Shen S, Zhu Z, Wang A, Xu T, Peng Y, Li Q, Ju Z, Geng D, Chen J, He J, Zhang Y, Zhong C. Education Level and Long-term Mortality, Recurrent Stroke, and Cardiovascular Events in Patients With Ischemic Stroke. J Am Heart Assoc 2020; 9:e016671. [PMID: 32779506 PMCID: PMC7660803 DOI: 10.1161/jaha.120.016671] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Epidemiological studies have reported discrepant findings on the relationship between education level and outcomes after stroke. We aimed to prospectively investigate the relationship between education level and mortality, recurrent stroke, and cardiovascular events in Chinese patients with ischemic stroke. Methods and Results We included 3861 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. Education level was categorized as illiteracy, primary school, middle school, and college. Study outcomes were all‐cause mortality, stroke‐specific mortality, recurrent stroke, and cardiovascular events within 2 years after ischemic stroke. A meta‐analysis was conducted to incorporate the results of the current study and previous other studies on the association of education level with outcomes after stroke. Within 2 years after ischemic stroke, there were 327 (8.5%) all‐cause deaths, 264 (6.8%) stroke‐specific deaths, 303 (7.9%) recurrent strokes, and 364 (9.4%) cardiovascular events, respectively. The Kaplan–Meier curves showed that patients with the lowest education level had the highest cumulative incidence rates of all‐cause mortality, stroke‐specific mortality, and cardiovascular events (log‐rank P≤0.01). After adjusted for covariates, hazard ratios and 95% CIs of illiteracy versus college education were 2.79 (1.32–5.87) for all‐cause mortality, 3.68 (1.51–8.98) for stroke‐specific mortality, 2.82 (1.20–6.60) for recurrent stroke, and 3.46 (1.50–7.95) for cardiovascular events. The meta‐analysis confirmed the significant association between education status and mortality after stroke (pooled relative risk for lowest versus highest education level, 1.24 [95% CI, 1.05–1.46]). Conclusions Low education level was significantly associated with increased risk of mortality, recurrent stroke, and cardiovascular events after ischemic stroke, independently of established risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.
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Affiliation(s)
- Bizhong Che
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
| | - Suwen Shen
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China.,Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
| | - Yanbo Peng
- Department of Neurology Affiliated Hospital of North China University of Science and Technology Hebei China
| | - Qunwei Li
- Department of Epidemiology, School of Public Health Taishan Medical College Shandong China
| | - Zhong Ju
- Department of Neurology Kerqin District First People's Hospital of Tongliao City Tongliao Inner Mongolia China
| | - Deqin Geng
- Department of Neurology Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Jing Chen
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Jiang He
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.,Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Medical College of Soochow University Suzhou China
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Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey. Int J Hypertens 2020; 2020:8082341. [PMID: 32550019 PMCID: PMC7281842 DOI: 10.1155/2020/8082341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. Objectives We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. Methods In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). Results Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). Conclusions We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.
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Jones LM, Ginier E, Debbs J, Eaton JL, Renner C, Hawkins J, Rios-Spicer R, Tang E, Schertzing C, Giordani B. Exploring Representation of Diverse Samples in fMRI Studies Conducted in Patients With Cardiac-Related Chronic Illness: A Focused Systematic Review. Front Hum Neurosci 2020; 14:108. [PMID: 32477079 PMCID: PMC7240043 DOI: 10.3389/fnhum.2020.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/11/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction/Purpose: Cardiovascular disease (CVD) is the leading cause of death worldwide, and in the United States alone, CVD causes nearly 840,000 deaths annually. Using functional magnetic resonance imaging (fMRI), a tool to assess brain activity, researchers have identified some brain-behavior connections and predicted several self-management behaviors. The purpose of this study was to examine the sample characteristics of individuals with CVD who participated in fMRI studies. Methods: A literature search was conducted in PubMed, CINAHL, and Scopus. No date or language restrictions were applied and research methodology filters were used. In October 2017, 1659 titles and abstracts were identified. Inclusion criteria were: (1) utilized an empirical study design, (2) used fMRI to assess brain activity, and (3) focused on patients with CVD-related chronic illness. Articles were excluded if they: were theory or opinion articles, focused on mental or neuropathic illness, included non-human samples, or were not written in English. After duplicates were removed (230), 1,429 titles and abstracts were reviewed based on inclusion criteria; 1,243 abstracts were then excluded. A total of 186 studies were reviewed in their entirety; after additional review, 142 were further excluded for not meeting the inclusion criteria. Forty-four articles met criteria and were included in the final review. An evidence table was created to capture the demographics of each study sample. Results: Ninety eight percent of the studies did not report the racial or ethnic composition of their sample. Most studies (66%) contained more men than women. Mean age ranged from 38 to 78 years; 77% reported mean age ≥50 years. The most frequently studied CVD was stroke (86%), while hypertension was studied the least (2%). Conclusion: Understanding brain-behavior relationships can help researchers and practitioners tailor interventions to meet specific patient needs. These findings suggest that additional studies are needed that focus on populations historically underrepresented in fMRI research. Researchers should thoughtfully consider diversity and purposefully sample groups by including individuals that are: women, from diverse backgrounds, younger, and diagnosed with a variety of CVD-related illnesses. Identifying and addressing these gaps by studying more representative samples will help healthcare providers reduce disparities and tailor interventions for all CVD populations.
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Affiliation(s)
- Lenette M. Jones
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Emily Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Debbs
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jarrod L. Eaton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Renner
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | | | - Emily Tang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Bruno Giordani
- Psychiatry, Neurology, Psychology, and Nursing, University of Michigan, Ann Arbor, MI, United States
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FAKA A, CHALKIAS C, MAGRIPLIS E, GEORGOUSOPOULOU E, TRIPITSIDIS A, PITSAVOS C, PANAGIOTAKOS D. The influence of socio-environmental determinants on hypertension. A spatial analysis in Athens metropolitan area, Greece. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E76-E84. [PMID: 32490272 PMCID: PMC7225657 DOI: 10.15167/2421-4248/jpmh2020.61.1.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION While epidemiological and pathophysiological aspects of hypertension are still being investigated, there is an increased global interest between hypertension and social health determinants and environmental factors that this study aims to examine. METHODS The sample size used in this work included 2,445 individuals, from Athens metropolitan area, who were randomly enrolled in ATTICA study, during 2001 to 2002. Principal component analysis (PCA), Poisson regression modeling and geographical analysis, based on Geographic Information Systems (GIS) technology, were applied. RESULTS Geographical analysis and thematic mapping revealed that the West municipalities of Athens had the lowest socio-environmental status. Three components were derived from PCA: high, low and mixed socio-environmental status. Poisson regression analysis showed that high socio-environmental status, educational and economic level were negatively correlated with hypertension in some sectors of Athens (p < 0.05, for all). CONCLUSIONS Through the use of geospatial surveillance the underlying epidemiology of hypertension, and those at greater risk, can be more precisely determined. This study underlines the need to account for environmental factors when developing public health policies and programs for effective hypertension prevention or reduction.
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Affiliation(s)
- A. FAKA
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | - C. CHALKIAS
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | - E. MAGRIPLIS
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - E.N. GEORGOUSOPOULOU
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
| | - A. TRIPITSIDIS
- Department of Geography, School of Environment, Geography and Applied Economics, Harokopio University, Athens, Greece
| | - C. PITSAVOS
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - D.B. PANAGIOTAKOS
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Faculty of Health, University of Canberra, Canberra, Australia
- Correspondence: Demosthenes B. Panagiotakos, Harokopio University, 70 El. Venizelou St., 176 71 Athens, Greece - Tel. +30 210-9549332 - E-mail:
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Chang M, Lee HY, Seo SM, Koh YS, Park HJ, Kim PJ, Seung KB. The impact of educational attainment on cardiorespiratory fitness and metabolic syndrome in Korean adults. Medicine (Baltimore) 2020; 99:e19865. [PMID: 32332649 PMCID: PMC7440071 DOI: 10.1097/md.0000000000019865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the relationship between educational attainment and cardiorespiratory fitness (CRF) as a predictor of metabolic syndrome in a Korean population.In this single-center, retrospective cross-sectional study, 988 healthy adults (601 men and 387 women) who underwent regular health check-up in Seoul St. Mary's Hospital were analyzed. Educational attainment was categorized into 3 groups according to their final grade of educational course: middle or high school (≤12 years of education), college or university (12-16 years of education), and postgraduate (≥16 years of education). CRF was assessed by cardiopulmonary exercise testing, biceps strength, hand grip strength, bioelectrical impedance analysis, and echocardiography. Metabolic syndrome was diagnosed according to the 3rd report of the National Cholesterol Education Program.Among the subjects, 357 (36.1%) had metabolic syndrome. The postgraduate group had significantly higher peak oxygen consumption (VO2), biceps strength, hand grip strength, and peak expiratory flow than other groups (all P < .001). This group showed better left ventricular diastolic function, in terms of deceleration time of mitral inflow, maximal tricuspid valve regurgitation velocity, and left atrial volume index than other groups. Peak VO2 (%) was significantly correlated with all the parameters of metabolic syndrome, including insulin resistance (r = -0.106, P = .002), waist circumference (r = -0.387, P < .001), triglyceride (r = -0.109, P = .001), high density lipoprotein-cholesterol (r = 0.219, P < .001), systolic blood pressure (r = -0.143, P < .001), and diastolic blood pressure (r = -0.177, P < .001). And Peak VO2 (%) was found to be a predictor of metabolic syndrome (adjusted β = .988, P < .001). However, the level of education was not able to predict metabolic syndrome (postgraduate group; β = .955, P = .801).Although the postgraduate group had better CRF than other groups, the educational attainment could not exclusively predict metabolic syndrome in this study. Further research is needed to reveal the socioeconomic mechanism of developing metabolic syndrome.
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Affiliation(s)
- Mineok Chang
- Division of Cardiology, Seoul National University Hospital
| | - Hea-Yeon Lee
- Health promotion center, Seoul St. Mary's Hospital
| | - Suk Min Seo
- Division of Cardiology, Eunpyeong St. Mary's Hospital
| | - Yoon-Seok Koh
- Division of Cardiology, Uijeongbu St. Mary's Hospital
| | - Hun-Jun Park
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Pum-Joon Kim
- Division of Cardiology, Eunpyeong St. Mary's Hospital
| | - Ki-Bae Seung
- Division of Cardiology, Seoul St. Mary's Hospital, Seoul, Republic of Korea
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Yuan Y, Zhou B, Wang S, Ma J, Dong F, Yang M, Zhang Z, Niu W. Adult Body Height and Cardiometabolic Disease Risk: The China National Health Survey in Shaanxi. Front Endocrinol (Lausanne) 2020; 11:587616. [PMID: 33408690 PMCID: PMC7780292 DOI: 10.3389/fendo.2020.587616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Based on data from the China National Health Survey, we aimed to examine the association between body height and cardiometabolic disease (CMD) in a large adult population from Shaanxi province, and further to test whether this association was hinged upon other population characteristics. METHODS This population-based study was conducted in 2014 in Shaanxi Province, China. Utilizing a multi-stage stratified cluster sampling method, total 5,905 adults with complete data were eligible for analysis, and 1,151 (19.5%) of them had CMD. Of 1,151 CMD patients, 895 (15.1%) had one disorder and 256 (4.4%) had ≥2 disorders. RESULTS Using the bi-directional stepwise method and all-subsets regression, five factors-age, body mass index, family histories of CMD, exercise, and height-constituted the optimal model when predicting CMD risk. Restricted cubic spline regression showed a reduced tendency towards CMD with the increase of body height, with per 10 cm increment in body height corresponding to 14% reduced risk. Ordinal Logistic regression supported the contribution of body height on both continuous and categorical scales to CMD risk before and after adjustment, yet this contribution was significantly confounded by exercise and education, especially by exercise, which can explain 65.4% of total impact. For example, short stature was associated with an increased risk of CMD after multivariable adjustment not including exercise and education (odds ratio, 95% confidence interval, P: 1.42, 1.21 to 1.66, <0.001), and tall stature was associated with a reduced risk (0.77, 0.64 to 0.92, 0.003). CONCLUSIONS Our findings indicate short stature was a risk factor, yet tall stature was a protective factor for CMD in Chinese. Notably, the prediction of short and tall stature for CMD may be mediate in part by exercise.
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Affiliation(s)
- Yuan Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Shunan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Jia Ma
- Department of Pediatrics, Oriental Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Fen Dong
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Min Yang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- International Medical Services, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Wenquan Niu, ; Zhixin Zhang,
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Wenquan Niu, ; Zhixin Zhang,
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Carter AR, Gill D, Davies NM, Taylor AE, Tillmann T, Vaucher J, Wootton RE, Munafò MR, Hemani G, Malik R, Seshadri S, Woo D, Burgess S, Davey Smith G, Holmes MV, Tzoulaki I, Howe LD, Dehghan A. Understanding the consequences of education inequality on cardiovascular disease: mendelian randomisation study. BMJ 2019; 365:l1855. [PMID: 31122926 PMCID: PMC6529852 DOI: 10.1136/bmj.l1855] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovascular disease outcomes. DESIGN Mendelian randomisation study. SETTING UK Biobank and international genome-wide association study data. PARTICIPANTS Predominantly participants of European ancestry. EXPOSURE Educational attainment, BMI, systolic blood pressure, and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation. MAIN OUTCOMES MEASURE The risk of coronary heart disease, stroke, myocardial infarction, and cardiovascular disease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively. RESULTS Each additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart disease (odds ratio 0.86, 95% confidence interval 0.84 to 0.89) in observational analysis and a 37% lower risk (0.63, 0.60 to 0.67) in mendelian randomisation analysis. As a proportion of the total risk reduction, BMI was estimated to mediate 15% (95% confidence interval 13% to 17%) and 18% (14% to 23%) in the observational and mendelian randomisation estimates, respectively. Corresponding estimates were 11% (9% to 13%) and 21% (15% to 27%) for systolic blood pressure and 19% (15% to 22%) and 34% (17% to 50%) for smoking behaviour. All three risk factors combined were estimated to mediate 42% (36% to 48%) and 36% (5% to 68%) of the effect of education on coronary heart disease in observational and mendelian randomisation analyses, respectively. Similar results were obtained when investigating the risk of stroke, myocardial infarction, and cardiovascular disease. CONCLUSIONS BMI, systolic blood pressure, and smoking behaviour mediate a substantial proportion of the protective effect of education on the risk of cardiovascular outcomes and intervening on these would lead to reductions in cases of cardiovascular disease attributable to lower levels of education. However, more than half of the protective effect of education remains unexplained and requires further investigation.
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Affiliation(s)
- Alice R Carter
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Amy E Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Taavi Tillmann
- Institute for Global Health, University College London, London, UK
| | - Julien Vaucher
- Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital of Ludwig-Maximilians University, Munich, Germany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Centre, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen Burgess
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Michael V Holmes
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- MRC Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Ioanna Tzoulaki
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Abbas Dehghan
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK
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Mendez RDR, Santos MAD, Wysocki AD, Ribeiro BDB, Stauffer LF, Duarte SJH. Cardiovascular risk stratification among hypertensive patients: the influence of risk factors. Rev Bras Enferm 2018; 71:1985-1991. [PMID: 30156687 DOI: 10.1590/0034-7167-2017-0528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to assess the cardiovascular risk in hypertensive patients and the influence of risk factors on the stratification scores. METHODS this is a cross-sectional study with hypertensive patients undergoing outpatient follow-up from November 2014 to February 2015. The Global Risk Score was used to assess cardiovascular risk. To assess the influence of the risk factors with the stratification of the cardiovascular risk score, the main components analysis was used. RESULTS 57 patients participated in the study, and the majority (93.1%) was considered to be at high cardiovascular risk; the analysis of the main components identified five components that explain 85.2% of the total variation. CONCLUSION the cardiovascular risk assessment demonstrated the importance of the identification of risk factors and, consequently, the need to implement actions aimed at controlling these factors, which constitutes a challenge in the adequate management of arterial hypertension.
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Nadrowski P, Podolecka E, Pajak A, Dorynska A, Drygas W, Bielecki W, Kwasniewska M, Tykarski A, Niklas A, Zdrojewski T, Skrzypek M, Wojakowski W, Kozakiewicz K. How does the risk of cardiovascular death and cardiovascular risk factor profiles differ between socioeconomic classes in Poland: A country in transition. Cardiol J 2018; 26:493-502. [PMID: 29570212 DOI: 10.5603/cj.a2018.0003] [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: 09/13/2017] [Revised: 01/25/2018] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is an important factor for cardiovascular diseases (CVD) development. A decline in death rate from CVD among subjects with high SES is observed in developed countries. The aim of this study was to assess differences in cardiovascular risk (CV) between socioeconomic classes in Poland, a country currently in transition. METHODS A sample of 15,200 people was drawn. A three stage selection was performed. Eventually, 6170 patients were examined (2013/2014). Data was collected using a questionnaire in face-to-face interviews, anthropometric data and blood tests were also obtained. Education was categorized as incomplete secondary, secondary and higher than secondary school. Monthly income per person was categorized as low (≤ 1000 PLN), medium (1001-2000 PLN) and high (≥ 2001 PLN). Education and income groups were analyzed by prevalence of CVD risk factors and high CVD risk (SCORE ≥ 5%). RESULTS Higher education was associated with lower prevalence of all analyzed CVD risk factors (p < 0.001), having the highest income with lower prevalence of hypertension, currently smoking, obesity and lower high density lipoprotein cholesterol. Multivariable analysis showed that frequency of high CVD risk decreased with increasing education level (OR 0.61; 95% CI 0.49-0.76; p < 0.01), a similar favorable impact of higher income on high CVD risk was demonstrated in the whole group (OR 0.81; 95% CI 0.67-0.99; p = 0.04). CONCLUSIONS Socioeconomic status is an independent predictor of high CV risk of death. A favorable impact on the prevalence of high CV risk was demonstrated for education and partly for income in the whole group. It may reflect a transition being undergone in Poland, moreover, it predicts how socioeconomic factors may generate health inequalities in other transitioning countries.
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Affiliation(s)
- Pawel Nadrowski
- Division of Cardiology and Structural Heart Diseases, Medical Univer sity of Silesia, Katowice, Poland.
| | - Ewa Podolecka
- Division of Cardiology and Structural Heart Diseases, Medical Univer sity of Silesia, Katowice, Poland
| | - Andrzej Pajak
- Epidemiology and Population Studies Department, Jagiellonian University Medical College, Institute of Public Health, Krakow, Poland
| | - Agnieszka Dorynska
- Epidemiology and Population Studies Department, Jagiellonian University Medical College, Institute of Public Health, Krakow, Poland
| | - Wojciech Drygas
- Department of Epidemiology, Institute of Cardiology, Cardiovascular Disease Prevention and Health Promotion, Warsaw, Poland.,Department of Social and Preventive Medicine, Medical University of Lodz, Poland
| | - Wojciech Bielecki
- Department of Social and Preventive Medicine, Medical University of Lodz, Poland
| | | | - Andrzej Tykarski
- Poznan University of Medical Sciences, Department of Hypertension, Angiology and Internal Medicine, Poznan, Poland
| | - Arkadiusz Niklas
- Poznan University of Medical Sciences, Department of Hypertension, Angiology and Internal Medicine, Poznan, Poland
| | - Tomasz Zdrojewski
- Medical University of Gdansk, Department of Arterial Hypertension and Diabetology, Gdansk, Poland
| | - Michal Skrzypek
- Medical University of Silesia, Department of Biostatistics, School of Public Health, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical Univer sity of Silesia, Katowice, Poland
| | - Krystyna Kozakiewicz
- Division of Cardiology and Structural Heart Diseases, Medical Univer sity of Silesia, Katowice, Poland
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Valero-Elizondo J, Hong JC, Spatz ES, Salami JA, Desai NR, Rana JS, Khera R, Virani SS, Blankstein R, Blaha MJ, Nasir K. Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002–2013. Atherosclerosis 2018; 269:301-305. [DOI: 10.1016/j.atherosclerosis.2017.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/23/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
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30
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Tchicaya A, Lorentz N, Demarest S, Beissel J. Persistence of socioeconomic inequalities in the knowledge of cardiovascular risk factors five years after coronary angiography. Eur J Cardiovasc Nurs 2018; 17:136-147. [PMID: 28696137 PMCID: PMC5802545 DOI: 10.1177/1474515117720789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular diseases are important causes of death, morbidity, and years of potential life lost in most developed countries. AIMS The purpose of this study was to assess trends in knowledge of cardiovascular risk factors among patients five years after coronary angiography and to investigate the impact of educational level on knowledge level. METHODS The study included 1289 of 4391 patients admitted for cardiac events in 2008/2009 at the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg. A follow-up study was conducted by post five years later (2013/2014). Data were obtained from 1837 of the contacted patients (with 548 reported deaths) (response rate=42%). Logistic regression models were used to evaluate the association between educational level and knowledge of cardiovascular risk factors. Educational level was used as a surrogate for socioeconomic status. RESULTS In total, 39.9% of patients could list at least three risk factors in 2013/2014, a much higher percentage than the 8.5% observed during the initial survey. In both sexes, knowledge of cardiovascular risk factors increased between 2008/2009 and 2013/2014. Patients with higher educational levels were more likely (odds ratio=2.33, 95% confidence interval: 1.63-3.34) to cite at least three risk factors than patients with lower education levels. CONCLUSION Knowledge level was associated with educational level, and improved for all educational groups five years after coronary angiography. Educational differences in knowledge persisted, but the gaps decreased. Improving knowledge of cardiovascular risk factors among patients with cardiovascular disease will help increase awareness and promote lifestyle changes.
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Affiliation(s)
- Anastase Tchicaya
- Living Conditions Department/Health Research Team, Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg
| | - Nathalie Lorentz
- Living Conditions Department/Health Research Team, Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg
| | | | - Jean Beissel
- National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg
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Ramezankhani A, Azizi F, Hadaegh F, Eskandari F. Sex-specific clustering of metabolic risk factors and their association with incident cardiovascular diseases: A population-based prospective study. Atherosclerosis 2017; 263:249-256. [PMID: 28683364 DOI: 10.1016/j.atherosclerosis.2017.06.921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS We identified distinct patterns of metabolic risk factors (MRF), and examined their association with subsequent cardiovascular disease (CVD) risk. METHODS The study sample included 8113 participants (45% men) aged ≥30 years. Self-organizing map (SOM) was applied to clustering of five dichotomized MRF in men and women. MRF were included: low estimated glomerular filtration rate (eGFR), high fasting plasma glucose (FPG), high total cholesterol (TC), high systolic blood pressure (SBP) and high body mass index (BMI). The association between clusters membership and age, education, smoking status, physical activity level and family history (FH) of premature CVD was estimated using multinomial logistic regression. Cox regression was used to estimate the relation of each cluster with CVD events. RESULTS SOM identified seven distinct clusters of MRF in both men and women. About 35 and 44% of men and women, respectively, had ≥3 MRF. Among men, MRF were clustered in those with older age, low physical activity, lower education and FH of premature CVD; while, among women, clustering was observed in past smoker, those with older age and positive FH of premature CVD. In the male population, a cluster with 100% high SBP and high FPG, had the highest risk for CVD events. However, among women, two clusters, each with 100% high FPG, yielded the highest and similar risk for CVD. CONCLUSIONS SOM identified multiple patterns of MRF in the Iranian population. The results may be useful for targeting efforts to promote strategies to reduce the risk of CVD in the Iranian population.
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Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Eskandari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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van Doorn D, Richardson N, Osborne A. Farmers Have Hearts: The Prevalence of Risk Factors for Cardiovascular Disease Among a Subgroup of Irish Livestock Farmers. J Agromedicine 2017; 22:264-274. [DOI: 10.1080/1059924x.2017.1318728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Diana van Doorn
- Department of Science and Health, National Centre for Men’s Health, Institute of Technology Carlow, Carlow, Ireland
| | - Noel Richardson
- Department of Science and Health, National Centre for Men’s Health, Institute of Technology Carlow, Carlow, Ireland
| | - Aoife Osborne
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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Tchicaya A, Lorentz N. Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography. Health Qual Life Outcomes 2016; 14:165. [PMID: 27912774 PMCID: PMC5135793 DOI: 10.1186/s12955-016-0570-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study is to measure gender differences in health-related quality of life (HRQOL) among men and women patients with cardiovascular diseases (CVD), and to assess the impact of socioeconomic factors on HRQOL between men and women, 5 years after a coronary angiography. Methods The study included 1,289 out of 4,391 patients who had undergone an angiography in the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg in 2008/2009. Four indicators of the WHOQOL-BREF questionnaire (Self-rated health, Quality of life, Physical health, and Psychological health) were used in this study as interest variables. To assess the socioeconomic inequalities in HRQOL between men and women, general linear models were constructed for every indicator, with educational level and living conditions as predictors, and demographic variables, cardiovascular risk factors, and cardiovascular events as covariates. Results Women were older than men (71.5 versus 68.1, p <0.0001) and less likely to be married. HRQOL was significantly different between men and women despite the fact they had the same socioeconomic status. The average score for overall health was 3.7/5 for men versus 3.5/5 for women; similarly, the life quality score was 3.8/5 for men versus 3.6/5 for women. Education level and living conditions were associated with lower HRQOL scores in men and women. Conclusion The findings showed that women have lower HRQOL than men regarding self-rated health, quality of life, and the WHOQOL-BREF physical and psychological domains 5 years after a coronary angiography. Socioeconomic inequalities affect HRQOL, and their influence was similar in both men and women. Socioeconomic inequalities in HRQOL in women and men with CVD are strong 5 years after a coronary angiography. Taking into account differences in gender and socioeconomic status in intervention strategies to substantially reduce the differences observed between women and men could help improve the effectiveness of secondary prevention.
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Affiliation(s)
- Anastase Tchicaya
- LISER- Luxembourg Institute of Socio-Economic Research, LISER, 11 Porte des Sciences, L4366, Esch-Sur-Alzette, Luxembourg.
| | - Nathalie Lorentz
- LISER- Luxembourg Institute of Socio-Economic Research, LISER, 11 Porte des Sciences, L4366, Esch-Sur-Alzette, Luxembourg
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Prevalence of prehypertension and associated risk factors among Chinese adults from a large-scale multi-ethnic population survey. BMC Public Health 2016; 16:775. [PMID: 27515034 PMCID: PMC4982422 DOI: 10.1186/s12889-016-3411-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022] Open
Abstract
Background Up to date, most of previous studies about Chinese prehypertension were conducted based on a small sample or in only one province, which could not represent the general population in China. Furthermore, no information on the ethnic difference in prevalence of prehypertension has been reported in China. The aim of this study is to examine the sex-specific, age-specific and ethnic-specific prevalence of prehypertension and associated risk factors in a large-scale multi-ethnic Chinese adult population. Methods The subjects came from a large-scale population survey about Chinese physiological constants and health conditions conducted in six provinces. 47, 495 adults completed blood pressure measurement. Prehypertension was defined as not being on antihypertensive medications and having SBP of 120–139 mmHg and/or DBP of 80–89 mmHg. Odds ratio (OR) and its 95 % confidence interval (CI) from logistic models were used to reflect the prevalence of prehypertension. Results The mean age of all subjects was 43.9 ± 16.8 years. The prevalence of hypertension and prehypertension for all them was 29.5 and 36.4 %, respectively. The prevalence of hypertension and prehypertension for males (33.2 and 41.1 %, respectively) was higher than that for females (27.0 and 33.2 %, respectively), and P < 0.001. The mean age of the subjects was 54.8 ± 14.0 years for hypertensive, 44.0 ± 16.0 years for prehypertensive and 35.3 ± 14.5 years for normotensive. With aging, subjects had more odds of getting prehypertension. Multivariate logistic model indicated that males (OR = 2.076, 95 % CI: 1.952–2.208), laborers with mental work (OR = 1.084, 95 % CI: 1.020–1.152), Yi (OR = 1.347, 95 %CI: 1.210–1.500) and Hui subjects (OR = 1.133, 95 % CI: 1.024–1.253), alcohol drinkers (OR = 1.147, 95 % CI: 1.072–1.228), the generally obese (OR = 2.460, 95 % CI: 2.190–2.763), the overweight (OR = 1.667, 95 % CI: 1.563–1.788), the abdominally obese (OR = 1.371, 95 % CI: 1.280–1.467) and subjects with family history of cardiovascular diseases (OR = 1.132, 95 % CI: 1.045–1.226) had higher prevalence of prehypertension. Subjects with higher educational level (OR = 0.687, 95 % CI: 0.627–0.752 for university) and Miao (OR = 0.753, 95 % CI: 0.623–0.910), Tibetan (OR = 0.521, 95 % CI: 0.442–0.613), Tujia (OR = 0.779, 95 % CI: 0.677–0.898) subjects had lower prevalence. Conclusion High prevalence rate of prehypertension was general in Chinese adults. Many sociodemographic characteristics were significantly associated with prehypertension. There were important clinical significance and public health significance about age-specific, gender-specific and ethnic-specific Chinese prehypertension conditions studies.
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