Ideal Cardiovascular Health Among American Adults After the Economic Recession of 2008-2009: Insights from NHANES

Patel, Nirav; Kalra, Rajat; Bhargava, Anirudh; Arora, Garima; Arora, Pankaj

doi:10.1016/j.amjmed.2019.06.004

Cited by 27 publications

(12 citation statements)

References 36 publications

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“…The high proportions of people with favorable smoking status in this study (71%) could be a reflection of comprehensive tobacco control policies and a significant decrease of smoking worldwide [ 74 ]. The prevalence of ideal fasting blood glucose metric (68%) like in reviews by Younus et al [ 15 ] and Peng et al [ 19 ] was also high but trend results suggest its decline [ 62 , 74 ]. This high optimal prevalence of fasting blood glucose may partly be explained by the slight improvement of physical activity and dietary pattern [ 74 – 76 ], which were found to be risk factors for elevated fasting blood glucose and diabetes [ 77 ].…”

Section: Discussionmentioning

confidence: 99%

“…We are aware that the CVH status has changed during the observed period and several cohort studies assessing trends in ideal CVH and CVH metrics documented that finding. Patel et al [62] examined the trends in ideal CVH during economic recession (2007-2010) and subsequent economic recovery (2011)(2012)(2013)(2014)(2015)(2016) among American adults and noted a decline in ideal CVH score that was primarily driven by the increased prevalence of obesity and poor fasting glucose. A Danish study [5], using data from six cross-sectional studies conducted in an adult population aged 30-64 years in Denmark from 1978 to 2006, reported an increasing trend in ideal CVH.…”

Section: Plos Onementioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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

et al. 2021

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“…The relaxation of social distancing may critically affect racial minorities who are already at a higher risk for adverse outcomes because of a large comorbidity burden, unemployment, food insecurity, and limited access to health care. Such conditions may perpetuate the deeply entrenched racial disparities in health outcomes 48,49 and make the mitigation of these disparities even more challenging.…”

Section: Discussionmentioning

confidence: 99%

Geographic Variation in Racial Disparities in Health and Coronavirus Disease-2019 (COVID-19) Mortality

Parcha

Malla

Suri

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease-2019 (COVID-19) cumulative incidence and mortality in the United States. Patients and Methods Age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, obesity), preexisting medical conditions (pulmonary disease, heart disease, stroke, kidney disease, malignancy), poor health behaviors (smoking, alcohol abuse, physical inactivity), and adverse socioeconomic factors (education, household income, health insurance) was computed in 435,139 American adult participants from 2017 Behavioral Risk Factor Surveillance System survey (BRFSS). Correlation was assessed between health determinants and the race-stratified COVID-19 crude mortality and infection-fatality-ratio computed from respective state public health departments in 47 states. Results Blacks had a higher prevalence of comorbidities (63.3% [95%CI:62.4-64.2%] vs. 55.1% [95%CI:54.7-55.5]) and adverse socioeconomic factors (47.0% [95%CI:46.0-47.9%] vs. 30.9% [95%CI:30.6-31.3]) than Whites. The prevalence of preexisting medical conditions was similar among Blacks (30.4% [95%CI:28.8-32.1%]) and Whites (30.8% [95%CI:30.2-31.4%]). The prevalence of poor health behaviors was higher in Whites (57.2% [95%CI:56.3-58.0%]) than Blacks (50.2% [95%CI:46.2-54.2%]). The comorbidities and adverse socioeconomic factors were highest in the Southern region, and poor health behaviors were highest in the Western region. Cumulative incidence rate (per 100,000 persons) was three-fold higher in Blacks (1546.4) compared withwith Whites (540.4). The crude mortality (per 100,000 persons) was two-fold higher in Blacks (83.2) than Whites (33.2). However, the infection-fatality-ratio (per 100-cases) was similar between Whites (6.2) and Blacks (5.4). Within racial groups, the geographic distribution of health determinants did not correlate with state-level COVID-19 mortality and infection-fatality ratio (p>0.05 for all). Conclusions Racial disparities in COVID-19 are largely driven by the higher cumulative incidence of infection in Blacks. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health determinants.

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“…Moreover, increased time spent in intermediate or ideal CVH during midlife has been related to a lower risk of cardio-metabolic morbidity and mortality in later life [ 12 ]. Despite national efforts to improve CVH, achievement of ideal status on all seven CVH metrics remains low nationally, and may even be declining [ 13 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study

et al. 2022

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Importance Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with poor CVH profiles escape CVD development. Objective To describe the prevalence of paradoxical relations among CVH, SubDz, and CVD. Design Cohort study, Framingham Study data collected prospectively (1995–2016). Setting Population-based. Participants 7,627 participants (mean age 49 years, 53% women) attending Offspring examinations 6/7 and Third Generation examinations 1/2. Exposures CVH score (range 0–14) constructed from poor, intermediate, or ideal status for each metric (smoking, diet, physical activity, blood pressure, body mass index, fasting glucose, total cholesterol); and prevalent SubDz (≥1 of: increased carotid intimal media thickness, CIMT; left ventricular hypertrophy, LVH; microalbuminuria, MA; elevated ankle brachial index, ABI; coronary artery calcium score ≥100,CAC). Main outcome(s) and measure(s) Ideal CVH (scores 12–14), intermediate CVH (scores 8–11), and poor CVH (0–7). We described three distinct paradoxical phenomena, involving combinations of CVH, SubDz, and CVD, and generated CVD incidence rates and predicted CVD probabilities for all combinations. Results We observed 842 CVD events (median follow-up 13.7 years); 1,663 participants had SubDz. Most individuals with poor CVH (78%) or SubDz (57% for CIMT to 77% for LVH) did not develop CVD on follow-up. Among participants with incident CVD, the majority had intermediate or ideal CVH (68%) or absent SubDz (46% for CAC to 96% for ABI) at baseline. We observed similar paradoxical results in relations between CVH and prevalent SubDz. Poor CVH and prevalent SubDz were each associated with higher CVD incidence rates compared to intermediate or ideal CVH and absent SubDz, respectively. The predicted CVD probability was nearly three-times greater among participants with poor (22%) versus intermediate or ideal CVH (8%). Mean CVD predicted probabilities were nearly three (26% vs. 10% for MA) to six-times (29% vs. 5% for CAC) greater among participants with SubDz versus without SubDz. Findings were consistent within age and sex strata. Conclusions and relevance Although poor CVH and SubDz presence are associated with CVD incidence, paradoxical phenomena involving CVH, SubDz, and CVD are frequently prevalent in the community. Further studies to elucidate biological mechanisms underlying these phenomena are warranted.

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Ideal Cardiovascular Health Among American Adults After the Economic Recession of 2008-2009: Insights from NHANES

Cited by 27 publications

References 36 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

Geographic Variation in Racial Disparities in Health and Coronavirus Disease-2019 (COVID-19) Mortality

Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study

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