The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III)

Abstract

Objective ─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods ─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results ─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ​≥ ​3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions ─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.

Family income and cardiovascular disease risk in American adults

“…Income disparity has been studied as a component of SES among NHANES participants in two recent studies. Zhang and colleagues studied NHANES III participants recruited in 1988–1994 and created a cumulative social risk score comprising of PIR < 1, minority race, education < 12th grade, and living single 12 . They observed that a higher cumulative social risk score was independently associated with 19% to 52% higher risk of CVD death 12 .…”

“…Zhang and colleagues studied NHANES III participants recruited in 1988–1994 and created a cumulative social risk score comprising of PIR < 1, minority race, education < 12th grade, and living single 12 . They observed that a higher cumulative social risk score was independently associated with 19% to 52% higher risk of CVD death 12 . Zhang et al subsequently studied NHANES participants recruited in 1988–1994 (NHANES III) and 1999–2014 (continuous cycles) 13 .…”

Inflammasomes as potential mediators of adverse cardiovascular events in diabetes and lupus: more questions than answers

“…37,38 In summary, despite the many contrasting features between T2DM and SLE, both these clinical entities share a similar increased risk for developing CVD. [2][3][4][5] A search for a common denominator has left us with the prospect of NLRP3 inflammasomes as a potential suitable and quite appealing candidate that might explain the particularly aggressive nature of vascular disease and atherosclerosis progression found in T2DM and SLE patients.…”

“…A series of well described risk factors have been traditionally linked to the development of ASCVD 2 . One of these risk factors is diabetes mellitus.…”

“…1 A series of well described risk factors have been traditionally linked to the development of ASCVD. 2 One of these risk factors is diabetes mellitus. Specifically, type 2 diabetes mellitus (T2DM) not only has been shown to accelerate atherothrombosis, leading to CAD, 3 but also T2DM is a well recognized cause of peripheral vascular disease and stroke.…”