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Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. Detrimental effect of high social risk on the cardiovascular health status of community-dwelling older adults living in rural settings. A population-based, longitudinal prospective study. Int J Cardiol 2023; 375:124-130. [PMID: 36581111 DOI: 10.1016/j.ijcard.2022.12.044] [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: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Information of the effect of social risk on the cardiovascular health (CVH) status among individuals living in rural settings is limited. We aim to assess this effect in participants of the Three Villages Study cohort. METHODS Following a longitudinal prospective design, older adults living in rural Ecuador received baseline social risk determinations by means of social determinants of health components included in the Gijon's Social-Familial Evaluation Scale (SFES) together with clinical interviews and procedures to determine CVH status included in the Life's Simple 7 construct. Those who also received CVH assessment at the end of the study were included. Random-effects generalized least square and mixed logistic regression models were fitted to assess the longitudinal effect of social risk on CVH metrics, after adjusting for relevant covariates. RESULTS The study included 443 community dwellers (mean age: 67 ± 7 years). The Gijon's SFES mean score was 9.8 ± 2.7 points. The mean number of ideal CVH metrics at baseline was 3.1 ± 1.3, which decreased to 2.6 ± 1.2 (β: -0.467; 95% C.I.: -0.588 to -0.346), after a mean of 7.31 ± 3.26 years of follow-up. The total Gijon's SFES score was higher among individuals with a worsening CVH status compared to those who did not (10.4 ± 2.6 versus 9.3 ± 2.6; p < 0.001). The ideal CVH status declined 1.23 (95% C.I.: 1.13-1.34) times per point of change in the total Gijon's SFES score. CONCLUSION Study results indicate a deleterious effect of high social risk on CVH status at follow-up in this underserved population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
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Nasr A, Matthews KA, Brooks MM, Barinas‐Mitchell E, Orchard T, Billheimer J, Wang NC, McConnell D, Rader DJ, El Khoudary SR. Early Midlife Cardiovascular Health Influences Future HDL Metrics in Women: The SWAN HDL Study. J Am Heart Assoc 2022; 11:e026243. [PMID: 36285790 PMCID: PMC9673623 DOI: 10.1161/jaha.122.026243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
Background Utility of high-density lipoprotein cholesterol (HDL-C) in assessing the antiatherogenic properties of HDL may be limited in midlife women. Novel metrics of HDL function, lipid contents, and subclasses may better reflect the atheroprotective capacities of HDL, supporting the need to evaluate how cardiovascular health affects these metrics in women. We assessed the relationship of early midlife Life's Simple 7 (LS7) score and its health behavior components with future HDL function (HDL-cholesterol efflux capacity), HDL-phospholipid, HDL-triglyceride, HDL particles (HDL-P) and size, and the relationship between LS7 score and changes in HDL metrics over time. Methods and Results We analyzed 529 women (baseline age: 46.4 [2.6] years, 57% White) from the SWAN HDL (Study of Women's Health Across the Nation HDL) study who had baseline LS7 followed by future repeated HDL metrics. Multivariable linear mixed models were used. Higher LS7 score was associated with favorable future HDL profile (higher HDL-phospholipid, total HDL-P and large HDL-P, lower HDL-triglyceride, and larger overall HDL size). Ideal body mass index was associated with higher HDL-cholesterol efflux capacity, HDL-phospholipid, and large HDL-P, lower HDL-triglyceride and small HDL-P, and larger overall HDL size. Ideal physical activity was associated with higher HDL-phospholipid, and total, large, and medium HDL-P. Ideal smoking was associated with less HDL-triglycerides. Diet was not related to HDL metrics. Higher LS7 score and ideal body mass index were associated with slower progression of HDL size over time. Conclusions Novel HDL metrics may better reflect the clinical utility of HDL. Improving lifestyle at midlife, particularly maintaining ideal body mass index, is associated with better future HDL phenotype.
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Affiliation(s)
- Alexis Nasr
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Karen A. Matthews
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Maria M. Brooks
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Emma Barinas‐Mitchell
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Trevor Orchard
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
| | - Jeff Billheimer
- Departments of Medicine and GeneticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Norman C. Wang
- Division of Cardiology, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Dan McConnell
- Department of EpidemiologyUniversity of MichiganAnn ArborMI
| | - Daniel J. Rader
- Departments of Medicine and GeneticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Samar R. El Khoudary
- Department of EpidemiologyUniversity of Pittsburgh, School of Public HealthPittsburghPA
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Chang SW, Zitko P, Passi-Solar Á, Danaei G, Margozzini P. Changes in cardiovascular mortality in Chile during the COVID-19 pandemic. Heart 2022; 108:1716-1721. [PMID: 35105666 PMCID: PMC8822542 DOI: 10.1136/heartjnl-2021-320082] [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] [Received: 08/03/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has impacted regular cardiovascular healthcare access and delivery. Service utilisation has declined, and excess cardiovascular mortality has been reported in several countries. We aim to estimate excess cardiovascular deaths in Chile during 2020. METHODS We collected mortality data from the Chilean Department of Statistics and Health Information and refined them using the maps of Global Burden of Disease Studies in 2017 and 2010. We conducted a time series analysis using quasi-Poisson distribution to predict cardiovascular mortality in 2020 and compared it with observed numbers and calculated attributable fractions (AFs) with 95% uncertainty intervals, as a whole and by sex, age group and type of cardiovascular disease. RESULTS During 2015-2020, 173 283 cardiovascular deaths were recorded, with 28 141 deaths in 2020. The observation in 2020 was lower than our projection in the overall data (-4.0% (-5.0% to -2.8%)) and in male (-11.7% (-13% to -10.3%)). However, positive AFs were noted among female (5.0% (3.2% to 6.8%)), people in age group 80-89 years (11.0% (8.6% to 13.5%)) and people who died from hypertensive heart diseases (18.9% (14.7% to 23.5%)). CONCLUSIONS Less overall cardiovascular deaths were observed in 2020 compared with our projection, possibly associated with competing risks from COVID-19 infection in men. Nonetheless, excess cardiovascular deaths were observed among women, people in the age group 80-89 years and people who died from hypertensive heart diseases suggesting possible negative cardiovascular impacts brought by the pandemic on these vulnerable groups.
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Affiliation(s)
- Sheng-Wei Chang
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Pedro Zitko
- Department of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Álvaro Passi-Solar
- Department of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Goodarz Danaei
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Paula Margozzini
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Department of Public Health, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Patil SJ, Golzy M, Johnson A, Wang Y, Parker JC, Saper RB, Haire-Joshu D, Mehr DR, Foraker RE, Kruse RL. Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis. J Clin Med 2022; 11:2897. [PMID: 35629024 PMCID: PMC9145991 DOI: 10.3390/jcm11102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying individual and neighborhood-level factors associated with worsening cardiometabolic risks despite clinic-based care coordination may help identify candidates for supplementary team-based care. Methods: Secondary data analysis of data from a two-year nurse-led care coordination program cohort of Medicare, Medicaid, dual-eligible adults, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2), from ten Midwestern primary care clinics in the U.S. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed individual and neighborhood-level factors associated with changes in outcome measures from before to after completion of the LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure. In adjusted models, higher pre-intervention cardiometabolic measures were associated with worsening of all cardiometabolic measures. Women had worsening LDL-cholesterol compared with men. Women with pre-intervention HbA1c > 6.8% and systolic blood pressure > 131 mm of Hg had worse post-intervention HbA1c and systolic blood pressure compared with men. Adding individual’s neighborhood-level risks did not change effect sizes significantly. Conclusions: Increased cardiometabolic risks and gender were associated with worsening cardiometabolic outcomes. Understanding unresolved gender-specific needs and preferences of patients with increased cardiometabolic risks may aid in tailoring clinic-community-linked care planning.
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Affiliation(s)
- Sonal J. Patil
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA;
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA; (Y.W.); (D.R.M.); (R.L.K.)
| | - Mojgan Golzy
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO 65211, USA;
| | - Angela Johnson
- Center for Applied Research and Engagement Systems (CARES), University of Missouri, Columbia, MO 65211, USA;
| | - Yan Wang
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA; (Y.W.); (D.R.M.); (R.L.K.)
| | - Jerry C. Parker
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO 65211, USA;
| | - Robert B. Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA;
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - David R. Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA; (Y.W.); (D.R.M.); (R.L.K.)
| | - Randi E. Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Robin L. Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA; (Y.W.); (D.R.M.); (R.L.K.)
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Abbott LS, Killian MO, Graven LJ, Williams KJ. Latent profile analysis of stress and resilience among rural women: A cross-sectional study. Public Health Nurs 2021; 39:536-544. [PMID: 34750856 DOI: 10.1111/phn.13005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 01/14/2023]
Abstract
Stress is a cardiovascular disease risk factor, and resilience may serve as a buffer for stress. Little is known about stress and resilience among rural women. OBJECTIVE The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience. DESIGN AND SAMPLE A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n = 354). MEASURES Data were collected to measure perceived stress, social support, chronic stress, and resilience. RESULTS A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales. CONCLUSION The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations.
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Affiliation(s)
- Laurie S Abbott
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Michael O Killian
- Florida State University College of Social Work, Tallahassee, Florida, USA
| | - Lucinda J Graven
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Krystal J Williams
- Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences, Tallahassee, Florida, USA
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Michos ED, Khan SS. Further understanding of ideal cardiovascular health score metrics and cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:607-617. [PMID: 34053373 DOI: 10.1080/14779072.2021.1937127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The American Heart Association (AHA) introduced the construct of 'cardiovascular health (CVH)', to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor. AREAS COVERED In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends. EXPERT OPINION Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.
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Affiliation(s)
- Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Stewart AL, Magnani JW, Barinas-Mitchell E, Matthews KA, El Khoudary SR, Jackson EA, Brooks MM. Social Role Stress, Reward, and the American Heart Association Life's Simple 7 in Midlife Women: The Study of Women's Health Across the Nation. J Am Heart Assoc 2020; 9:e017489. [PMID: 33302752 PMCID: PMC7955397 DOI: 10.1161/jaha.120.017489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 Most women occupy multiple social roles during midlife. Perceived stress and rewards from these roles may influence health behaviors and risk factors. This study examined whether social role stress and reward were associated with the American Heart Association Life's Simple 7 in a cohort of midlife women in the United States. Methods and Results Women (n=2764) rated how stressful and rewarding they perceived their social roles during cohort follow-up (age range, 42-61 years). Body mass index, blood pressure, glucose, cholesterol, physical activity, diet, and smoking were assessed multiple times. All components were collected at the fifth study visit for 1694 women (mean age, 51 years). Adjusted linear and logistic regression models were used in analyses of the number of ideal components and the odds of achieving the ideal level of each component, respectively. Longitudinal analyses using all available data from follow-up visits were conducted. At the fifth visit, more stressful and less rewarding social roles were associated with fewer ideal cardiovascular factors. Higher average stress was associated with lower odds of any component of a healthy diet and an ideal blood pressure. Higher rewards were associated with greater odds of ideal physical activity and nonsmoking. Longitudinal analyses produced consistent results; moreover, there was a significant relationship between greater stress and lower odds of ideal glucose and body mass index. Conclusions Perceived stress and rewards from social roles may influence cardiovascular risk factors in midlife women. Considering social role qualities may be important for improving health behaviors and risk factors in midlife women.
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Affiliation(s)
- Andrea L Stewart
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Jared W Magnani
- Department of Medicine University of Pittsburgh Pittsburgh PA
| | - Emma Barinas-Mitchell
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Karen A Matthews
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA.,Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh PA
| | - Samar R El Khoudary
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Elizabeth A Jackson
- Division of Cardiovascular Medicine University of Alabama Birmingham Birmingham AL
| | - Maria M Brooks
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
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