Abstract
BackgroundGeographic variation in traditional cardiovascular disease (CVD) risk factors has been observed among women in the US. It is not known whether state-level variation in cardiovascular inflammation exists or could be explained by traditional clinical risk factors and behavioral lifestyle factors.Methods and ResultsWe used multilevel linear regression to estimate state-level variation in inflammatory biomarker patterns adjusted for clinical and lifestyle characteristics among 26,029 women free of CVD. Participants derived from the Women's Health Study, a national cohort of healthy middle-aged and older women. Inflammatory biomarker patterns (plasma levels of high-sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1), and fibrinogen) were compared to state-level patterns of traditional CVD risk factors and global risk scores. We found that all three inflammatory biomarkers exhibited significant state-level variation including hsCRP (lowest vs. highest state median 1.3 mg/L vs. 2.7 mg/L, unadjusted random effect estimate 1st to 99th percentile range for log hsCRP 0.52, p<.001), sICAM-1 (325 ng/ml vs. 366ng/ml, unadjusted random effect estimate 1st to 99th percentile range 0.44, p<.001), and fibrinogen (322 mg/dL vs. 367 mg/dL, unadjusted random effect estimate 1st to 99th percentile range 0.41, p = .001). Neither demographic, clinical or lifestyle characteristics explained away state-level effects in biomarker patterns. Southern and Appalachian states (Arkansas, West Virginia) had the highest inflammatory biomarker values. Regional geographic patterns of traditional CVD risk factors and risk scores did not completely overlap with biomarkers of inflammation.ConclusionsThere is state-level geographic variation in inflammatory biomarkers among otherwise healthy women that cannot be completely attributed to traditional clinical risk factors or lifestyle characteristics. Future research should aim to identify additional factors that may explain geographic variation in biomarkers of inflammation among healthy women.
Highlights
Inflammation is a major determinant of atherothrombotic cardiovascular disease (CVD) events [1]
There is state-level geographic variation in inflammatory biomarkers among otherwise healthy women that cannot be completely attributed to traditional clinical risk factors or lifestyle characteristics
We evaluated state-level profiles of high sensitivity Creactive protein (hsCRP), soluble intercellular adhesion molecule type 1 (sICAM-1), and fibrinogen in a large-scale cohort of healthy women in the United States, in which the prevalence of traditional CVD risk factors is low
Summary
Inflammation is a major determinant of atherothrombotic cardiovascular disease (CVD) events [1]. In a recent comprehensive meta-analysis of 54 prospective cohort studies, the magnitude of risk associated with a one standard deviation increase in hsCRP was at least as large as that associated with a similar change in blood pressure or cholesterol [9]. Despite these data, factors that contribute to population-level differences in cardiovascular inflammation have not been fully explored. Comparable data evaluating geographic patterns in inflammatory biomarkers have not been reported It is not known whether there is geographic variation in inflammation in relatively lower-risk, healthy populations who have yet to develop CVD. It is not known whether state-level variation in cardiovascular inflammation exists or could be explained by traditional clinical risk factors and behavioral lifestyle factors
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