Abstract MP14: Association Between Housing Insecurity With Reduced Access to Healthcare and Cardiovascular Disease Prevention: The Behavior Risk Factor Surveillance System (BRFSS) Study

Introduction: Risk factors including hypertension and hyperlipidemia increase the risk of cardiovascular disease (CVD). Yet, the significantly increased prevalence of CVD in housing insecure populations cannot be explained by the diagnosed prevalence of these risk factors alone. These populations may face unique barriers to care related to lack of access to screening, prevention, and treatment that complicate heart health.

Hypothesis: Access to quality healthcare and CVD prevention is reduced for the housing insecure population, independent of income and sociodemographic factors, compared to housing secure populations.

Methods: Using data from the 2017 Behavior Risk Factor Surveillance System (BRFSS), housing insecurity was self-reported as not being able to pay mortgage, rent, or utility bills over the past 12 months. Weighted multivariable logistic regressions were used to calculate adjusted odds ratios for the healthcare access variables.

Results: In our study population, 8.79% (51.8% female, 71.7% white) experienced housing insecurity. Compared to housing secure individuals, housing insecure individuals were more likely to not have a primary care doctor (OR 1.25 [1.16-1.35]), be unable to afford doctor visits (3.89 [3.63-4.16]), report pending medical bills (2.62 [2.33-2.93]), have Medicare (1.26 [1.01-1.57]) or Medicaid (1.83 [1.46-2.28]), experience gaps in healthcare coverage (2.94 [2.45-3.53]), delayed medical care (2.38 [2.10-2.70]), and were 4 times more likely to not take medications as prescribed due to cost (4.39 [3.86-4.99]). Among those with known hypertension and hypercholesterolemia, respectively, people experiencing housing insecurity were more likely to not be taking antihypertensive (1.35 [1.20-1.51]) and cholesterol-lowering medications (1.33 [1.18-1.48]).

Conclusion: Housing insecure populations experience significant healthcare access disparities, potentially exacerbating health outcomes through the underdiagnosis, prevention, and treatment of CVD.

Acute exposure of minimally ox-LDL elicits survival responses by downregulating the mediators of NLRP3 inflammasome in cultured RAW 264.7 macrophages

Lipid burden in macrophages driven by oxidized LDL (oxLDL) accelerates the foam cell formation and the activation of sterile inflammatory responses aggravating the atherosclerosis. However, there is limited information on the mediators and the pathways involved in the possible survival responses, especially at the initial phase, by lipid-burden in macrophage cells on encountering oxLDL. The present study was designed to assess the expression status of major mediators involved in the NLRP3 inflammasome pathway of sterile inflammation and the cellular responses in oxLDL-challenged cultured RAW 264.7 macrophage cells. Ox-LDL-treated RAW 264.7 macrophage cells displayed a decreased expression of the key sterile inflammatory mediators, TLR4, TLR2, ASC, NLRP3 and IL-18 at protein and transcript levels; however, displayed increased level of IL-1β, RAGE and TREM1 at protein level. Biological responses including lipid uptake, lipid peroxidation, cellular hypertrophy, mitochondrial density, and mitochondrial membrane potential were significantly increased in oxLDL-treated macrophages. Moreover, superoxide production was significantly decreased in the oxLDL-treated macrophages compared to the control. Overall, the findings revealed the expression status of key sterile mediators and the macrophage response during the initial phase of oxLDL exposure tend toward the prevention of inflammation. Further understanding would open novel translational opportunities in the management of atherosclerosis.