Does education modify the effect of ethnicity in the expression of ideal cardiovascular health? The Baptist Health South Florida Employee Study

Ogunmoroti, Oluseye; Utuama, Ovie; Michos, Erin D.; Okunrintemi, Victor; Taleb, Ziyad Ben; Bahelah, Raed; Das, Sankalp; Rouseff, Maribeth; Parris, Don; Agatston, Arthur S.; Feldman, Theodore; Veledar, Emir; Maziak, Wasim; Nasir, Khurram

doi:10.1002/clc.22757

Cited by 8 publications

(3 citation statements)

References 26 publications

(37 reference statements)

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“…In a study by Matozinhos et al [ 56 ] lower levels of education were associated with a lower prevalence of ideal CVH, regardless of gender, compared to those with a higher level of education. In contrast, Ongunmoroti et al [ 60 ] found that lower education was associated with better CVH, while Benziger et al [ 30 ] and Zhao et al [ 73 ] did not find any statistically significant association between education and ideal CVH ( Table 3 ).…”

Section: Resultsmentioning

confidence: 92%

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

et al. 2021

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Background In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH. Methods A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics. Results This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics. Conclusions To the best of our knowledge, this is the first systematic review on the relationship between participants’ socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.

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Section: Resultsmentioning

confidence: 92%

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

et al. 2021

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“…In that study, there were no statistically significant interactions of education and ethnicity on CVH measures, possibly because of the study being underpowered or enrolling a relatively healthy sample. 22 Others have found that in addition to race, ethnicity and nativity may also factor into the association of education and cardiovascular outcomes among White, Latinx, and Asian Californians. In that study, race‐based differences in CVH were greatest among the least educated.…”

Section: Discussionmentioning

confidence: 99%

Educational Attainment, Race, and Ethnicity as Predictors for Ideal Cardiovascular Health: From the National Health and Nutrition Examination Survey

Johnson

Herbert

Stokes

et al. 2022

JAHA

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Background Educational attainment is protective for cardiovascular health (CVH), but the benefits of education may not persist across racial and ethnic groups. Our objective was to determine whether the association between educational attainment and ideal CVH differs by race and ethnicity in a nationally representative sample. Methods and Results Using the National Health and Nutrition Examination Survey, we determined the distribution of ideal CVH, measured by Life’s Simple 7, across levels of educational attainment. We used multivariable ordinal logistic regression to assess the association between educational attainment (less than high school, high school graduate, some college, college graduate) and Life’s Simple 7 category (ideal, intermediate, poor), by race and ethnicity (Asian, Black, Hispanic, White). Covariates were age, sex, history of cardiovascular disease, health insurance, access to health care, and income–poverty ratio. Of 7771 National Health and Nutrition Examination Survey participants with complete data, as level of educational attainment increased, the criteria for ideal health were more often met for most metrics. After adjustment for covariates, effect of education was attenuated but remained significant ( P <0.01). Those with at least a college degree had 4.12 times the odds of having an ideal Life’s Simple 7 compared with less than high school (95% CI, 2.70–5.08). Among all racial and ethnic groups, as level of educational attainment increased, so did Life’s Simple 7. The magnitude of the association between education and CVH varied by race and ethnicity (interaction P <0.01). Conclusions Our findings demonstrate that educational attainment has distinct associations with ideal CVH that differs by race and ethnicity. This work demonstrates the need to elucidate barriers preventing individuals from racial and ethnic minority groups from achieving equitable CVH.

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“…The points were summed, yielding a total CVH score ranging from 0 to 14 18. As previously reported, total CVH scores of 0–8, 9–10 and 11–14 were considered as inadequate, average and optimal CVH, respectively 19–21…”

Section: Methodsmentioning

confidence: 99%

Sex differences in the association between ideal cardiovascular health and biomarkers of cardiovascular disease among adults in the United States: a cross-sectional analysis from the multiethnic study of atherosclerosis

et al. 2019

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ObjectivesThis study investigated the sex differences in the associations between ideal cardiovascular health (CVH), measured by the American Heart Association’s Life’s Simple 7 metrics, and cardiovascular disease (CVD)-related biomarkers among an ethnically diverse cohort of women and men free of clinical CVD at baseline.SettingWe analysed data from the Multi-Ethnic Study of Atherosclerosis conducted in six centres across the USA (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles, California; New York, New York; and St Paul, Minnesota).ParticipantsThis is a cross-sectional study of 5379 women and men, aged 45–84 years old. Mean age (SD) was 62 (10), 52% were women, 38% White, 11% Chinese American, 28% Black and 23% Hispanic.Primary measuresThe seven metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose) were each scored as 0 points (poor), 1 point (intermediate) or 2 points (ideal). The total CVH score ranged from 0 to 14. The CVD-related biomarkers studied were high-sensitivity C-reactive protein, D-dimer, fibrinogen, homocysteine, high-sensitivity cardiac troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP) and interleukin 6. We examined the association between the CVH score and each biomarker using multivariable linear regression, adjusting for age, race/ethnicity, education, income and health insurance status.ResultsHigher CVH scores were associated with lower concentrations of all biomarkers, except for NT-proBNP where we found a direct association. There were statistically significant interactions by sex for all biomarkers (p<0.001), but results were qualitatively similar between women and men.ConclusionA more favourable CVH score was associated with lower levels of multiple CVD-related biomarkers for women and men, except for NT-proBNP. These data suggest that promotion of ideal CVH would have similarly favourable impact on the reduction of biomarkers of CVD risk for both women and men.

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Does education modify the effect of ethnicity in the expression of ideal cardiovascular health? The Baptist Health South Florida Employee Study

Abstract: Higher educational attainment had variable associations with achieved levels of ideal CVH across race/ethnic groups. Interventions to improve CVH should be tailored to meet the needs of target communities.

Cited by 8 publications

References 26 publications

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

Educational Attainment, Race, and Ethnicity as Predictors for Ideal Cardiovascular Health: From the National Health and Nutrition Examination Survey

Sex differences in the association between ideal cardiovascular health and biomarkers of cardiovascular disease among adults in the United States: a cross-sectional analysis from the multiethnic study of atherosclerosis

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