Disparities In Cardiovascular Disease Research Articles

Social and Structural Determinants of Cardiovascular Complications of Diabetes.

Cardiovascular disease (CVD) is the leading cause of mortality in people who have diabetes. Racial and ethnic minorities with diabetes have suboptimal management of cardiovascular risk factors, leading to higher mortality. Social and structural determinants of health are external factors that influence an individual's ability to choose positive health behaviors. In this review, we will discuss cardiovascular complications in people who have diabetes and their relationship to social determinants of health (SDOH). Recent innovations in diabetes treatment, including new devices and medications, have improved care and survival. However, disparities in the availability of these treatments to racial and ethnic minorities may contribute to continued inequities in CVD outcomes. Racial/ethnic disparities in CVD relate to inequities in economic opportunity, education and health literacy, neighborhoods and social cohesion, and health care access and quality driven by structural racism.

A novel antibody that neutralizes corticotropin-releasing factor attenuates the cardiovascular effects of chronic social defeat stress in mice

According to the World Health Organization, cardiovascular disease (CVD) continues to be the leading cause of death worldwide. While a myriad of genetic and environmental factors influence the development of CVD, there are several lines of evidence suggesting that psychological stress contributes to health disparities in CVD observed amongst different populations. Our lab seeks to understand the effects of psychosocial stress on cardiovascular health using a model of chronic social defeat stress (CSDS) in mice. In this paradigm, male C57BL/6 mice undergo brief daily defeat sessions and are housed in the same cage as the larger, more aggressive CD1 defeater mouse, separated by a polycarbonate divider that allows for continuous visual, auditory, and olfactory contact while preventing physical contact. We have previously demonstrated that this paradigm causes robust and persistent elevations in blood pressure, indices of chronic inflammation, elevations in plasma corticosterone and cardiac and adrenal hypertrophy. Social defeat also leads to robust activation of corticotropin releasing factor (CRF) neurons within the paraventricular nucleus of the hypothalamus (PVN). In the present studies, we investigate whether we can alleviate some of the adverse effects of CSDS through targeting the HPA axis using CTRND05, a novel anti-CRF antibody. Adult male C57BL/6 mice were assigned to either CSDS or control (paired) housing. Following 14 days of CSDS or control housing, mice were treated with one injection of CTRND05 (25 mg/kg, i.p.) or vehicle (IgG), followed by 14 more days of CSDS or control housing. A booster administration of CTRND05 (12.5 mg/kg, i.p.) was given 7 days after the initial dose. Adrenal weights were significantly reduced in pair housed mice treated with CTRND05 compared to pair housed mice treated with IgG, and there was a trend towards a reduction in adrenal weight of CSDS mice treated with CTRND05 in comparison with CSDS mice treated with IgG. There was also a trend for reduced basal corticosterone in CSDS mice treated with CTRND05. Importantly, while IgG treatment had no effect on the systolic blood pressure (SBP) of CSDS mice, treatment with CTRND05 significantly lowered the SBP of CSDS mice when compared with pre-treatment. These data suggest that targeting CRF may serve as a therapeutic tactic for treatment of stress-related hypertension. R35HL150750, R01HL136595. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Area deprivation and premature cardiovascular mortality: a nationwide population-based study in South Korea

BackgroundRegional disparities in cardiovascular disease (CVD) burden exist. The effect of area deprivation, one of the possible explanations, still needs to be fully understood. This population-based study investigated the association...

Abstract P377: Association Between Area Deprivation and Premature Cardiovascular Mortality in South Korea

Background: The underlying factors for regional disparities in cardiovascular disease (CVD) have yet to be fully understood. There is limited research on the effect of regional-level socioeconomic conditions on CVD mortality. This ecological study aims to investigate the association between area deprivation and premature death from CVD. Methods: The deprivation index was formulated with 10 socioeconomic indicators across all the 250 municipalities in Korea. Mortality rates from total CVD, ischemic heart disease, and cerebrovascular disease in adults <65 years were directly standardized for sex and age using the total population structure. Municipalities are stratified by urbanicity, and the number of hospitals and the size of an area were adjusted in log-linear regression models. Results: The most deprived municipalities showed 41.6% excess mortality for total CVD, 30.3% for ischemic heart disease, and 36.9% for cerebrovascular disease, compared to the least deprived ones. Even after adjusting for the number of hospitals per unit area, the association of area deprivation was more significant in metropolitan areas than in other provinces. As one increment of the deprivation index increased, the adjusted rate ratios for total CVD were 1.031 (1.020-1.043) in metropolitans and 1.009 (1.000-1.019) in other provinces. Additional multilevel analyses showed consistent findings of higher risks in deprived areas. Conclusions: This study highlights a higher risk of premature cardiovascular death in socioeconomically disadvantaged areas. The CVD prevention strategies should reflect regional characteristics, with a particular focus on reducing the burden in deprived metropolitan areas.

Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH All of Us Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in All of Us . 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.

Abstract P361: Health Behaviors, Healthcare Utilization and Social Determinants of Health Among Afro-Latin and Non-Hispanic Black Men at Risk for Hypertension: The CLIP Study

Background: Non-Hispanic Black (NHB) men experience cardiovascular disparities, including high prevalence of hypertension and high morbidity and mortality due to cardiovascular disease (CVD). Less is known about CVD risk among Afro-Latin (AL) men, who are an understudied population overall. The Hispanic/Latin population is the largest and fastest growing ethnic minority group in the United States, as well as one of the most heterogeneous. However, CVD in this population is often examined in aggregate, or by country of origin, and is most often compared to Non-Hispanic White individuals, not only limiting understanding of CVD risk but also potential avenues for intervention. Objective: To describe CVD risk, healthcare utilization and social determinants of health among a sample of AL and NHB men. Methods and Results: We present preliminary data from the Community-to-Clinic Linkage Program (CLIP) study, a community-based cluster randomized trial testing barbershop facilitation to prevent hypertension in normotensive Black men. The study is set in Staten Island (SI), New York City. Approximately 10% of SI residents identify as Black, of which ~ 90% live in 6 zip codes with the highest prevalence of hypertension in the borough. Within the cohort (N=243), AL men (N=88) and NHB men (N=155) had similar blood pressure, but AL men were younger and had lower BMI compared to NHB men, age mean (SD), 35.1 (11.8) years versus 39.2 (12.1) years, p=0.007, BMI 25.6 (4.2) versus 27.2 (5.2) BMI, p=0.01. While diet was similar, AL men had higher levels of weekly physical activity, 5662 (4927) minutes versus 3461 (2453) minutes among NHB men, p<0.001. Both groups had a similar rate of smoking tobacco and there were no differences related to sleep quality or sleep duration. AL men were more likely to have seen a healthcare provider in the last 5 years compared to NHB men and used the emergency room for care more than NHB men, 70.5% versus 47.6%, p=0.02, and 20.4% versus 9.2%, p=0.02, respectively. More AL men delayed medical care because of costs in the last year than NHB men, 8.2% versus 2.3%, p=0.03. Fewer AL men reported having a primary care provider, 19.4% versus 29.3%, p=0.03 compared to NHB men. Both groups reported similar rates of depressive symptoms and social support, but NHB men had higher perceives stress (PSS-4 scores), 6.0 (2.9) versus 4.4 (3.4), p<0.001 than AL men. More AL men were born abroad, 69.4% versus 96.6%, p<0.001 than NHB men. Education attainment was similar between both groups; AL men were more likely to be employed full-time than NHB men, 57.1% versus 51.7%, p=0.04. Income data was limited as approximately a third of men declined to respond. Conclusion: Understanding CVD risk and patterns of healthcare utilization among Afro-Latin and Non-Hispanic Black men will help inform strategies for intervention to improve cardiovascular health and reduce CVD disparities.

Abstract P519: Sleep as a Cardiometabolic Risk Factor Following Release From Carceral Facilities

Background: Approximately 2 million people are incarcerated, and 11 million cycle in and out of U.S. jails and prisons annually. Cardiovascular disease (CVD) morbidity and mortality are higher among people with a history of incarceration, especially in the weeks following release from prison. Sleep is an underexplored factor that may contribute to CVD disparities among people with a history of incarceration. Population-specific risk factors in the social and physical environment may contribute to poor sleep and CVD risk during imprisonment and after release from a carceral facility. Methods: The Sleep Justice study, an ancillary study to an ongoing prospective cohort recruiting individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study, aimed to describe sleep and examine the connections between sleep and CVD risk factor control among people released from a carceral facility. Sleep was assessed using subjective and objective measures. The Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control were used, and wrist-worn actigraphy was used to measure sleep objectively in a subsample of 80 participants. We will examine sleep and its association with CVD in this sample of people recently released from a carceral facility. Results: Most participants were male (92%), non-Hispanic Black (51%) or Hispanic (27%), were incarcerated 2-5 times, and were living in transitional housing (78%) at baseline. All participants had a CVD risk factor as a requirement of the study inclusion criteria: hypertension (78%), hyperlipidemia (47%), obesity (59%), diabetes (29%), and history of CVD (19%). Most reported low (24%) or some control (35%) over their sleep. Participants were at increased risk for sleep apnea, with 47% at moderate risk and 23% at high risk. Most participants reported poor sleep quality (65%) on the PSQI. We conducted logistic regression examining the relationship between sleep and CVD risk and found that poor sleep quality was associated with HTN (p=0.02), even after adjusting for age, race and ethnicity, and gender (AOR 2.44, 95% CI 1.14-5.29). Discussion: Given the disproportionate incarceration of racial and ethnic minoritized groups, the impact of incarceration on sleep health and CVD are areas that urgently need to be examined. This study is the first to examine sleep after release from a carceral facility and highlights the need for interventions targeting sleep health and CVD in this population.

Sex Disparities in Cardiovascular Disease.

Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease.

Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.

Racial and ethnic disparities in cardiovascular disease - analysis across major US national databases

BackgroundThere are several studies that have analyzed disparities in cardiovascular disease (CVD) health using a variety of different administrative databases; however, a unified analysis of major databases does not exist. In this analysis of multiple publicly available datasets, we sought to examine racial and ethnic disparities in different aspects of CVD, CVD-related risk factors, CVD-related morbidity and mortality, and CVD trainee representation in the US. MethodsWe used National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, National Inpatient Sample, Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research, United Network for Organ Sharing, and American Commission for Graduate Medical Education data to evaluate CVD-related disparities among Non-Hispanic (NH) White, NH Black and Hispanic populations. ResultsThe prevalence of most CVDs and associated risk factors was higher in NH Black adults compared to NH White adults, except for dyslipidemia and ischemic heart disease (IHD). Statins were underutilized in IHD in NH Black and Hispanic patients. Hospitalizations for HF and stroke were higher among Black patients compared to White patients. All-cause, CVD, heart failure, acute myocardial infarction, IHD, diabetes mellitus, hypertension and cerebrovascular disease related mortality was highest in NH Black or African American individuals. The number of NH Black and Hispanic trainees in adult general CVD fellowship programs was disproportionately lower than NH White trainees. ConclusionRacial disparities are pervasive across the spectrum of CVDs with NH Black adults at a significant disadvantage compared to NH White adults for most CVDs.

Abstract HUP14: Racial And Ethnic Disparities In Neighborhood Socioeconomic Status Associated With Cardiovascular Disease And Stroke: The Women’s Health Initiative

Introduction: The role of socioeconomic status (SES) across cardiovascular diseases (CVD) is well researched at the individual-level but fails to explain the greater CVD rates among Black and American Indian and Alaska Native (AIAN) groups at every level of SES. This research evaluated whether lower Neighborhood SES (NSES), a structural determinant of health, was associated with racial and ethnic disparities in CVD or stroke among aging women. Methods: The data came from the Women’s Health Initiative (WHI) cohort, consisting of 161,808 postmenopausal women with 30 years of data on stroke and CVD incidence. The NSES data were obtained from the US Census based on participant’s census tract of residence. We evaluated racial and ethnic disparities in the exposure and outcome prevalence using ANOVA. Associations between NSES and time to stroke and CVD were evaluated using multivariate adjusted Cox Regression models, and models were stratified by race and ethnicity to evaluate disparities. Results: NSES differed by race and ethnicity. Black, AIAN, and Latina groups were significantly (P<0.01) more likely to live in neighborhoods with NSES Z-scores below the population mean (Z-score=0) compared with White and Asian groups. The mean NSES Z-score among Black participants was -5.21 standard deviations below the population mean. Thirty-year CVD and stroke incidence followed the same trajectory of racial disparities. Preliminary analysis suggests results from Cox regression models will identify lower NSES to be longitudinally associated with greater stroke and CVD incidence overall, and greater effect sizes among groups experiencing structural racism. Conclusion: This research evaluates racial disparities in NSES as a structural determinant of stroke and CVD. These findings provide evidence emphasizing the need for neighborhood-level interventions to improve CVD disparities that coalesce in marginalized communities.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

Zip Code Health Disparities: Mapping Cardiovascular Inequities at the Neighborhood Level.

This review examines the multifaceted impact of neighborhood-level social determinants of health (SDOH) on cardiovascular disease (CVD) and outlines strategic interventions for mitigating cardiovascular health inequities. Research highlights that environmental and socioeconomic factors within a neighborhood-including education, unemployment, healthcare access, racial segregation, systemic inequities, air quality, housing quality, and other SDOH-influence CVD outcomes. Addressing CVD disparities necessitates a comprehensive strategy that integrates policy reform, enhanced community infrastructure, improved healthcare access, and community empowerment and leverages innovative technology to create equitable health outcomes across diverse populations.

PHYSICAL SYMPTOMS REACTIVITY TO DAILY STRESSORS AND CARDIOVASCULAR DISEASE: A COMPARISON OF BLACK AND WHITE ADULTS

Abstract Black adults have higher risk for cardiovascular disease (CVD) compared to their White counterparts. Biopsychosocial frameworks suggest that this racial difference may not only be due to higher stressor exposure (e.g., discrimination) but also to stressor reactivity (i.e., heightened automatic reactions to stressors). This study examined if racial disparities in CVD is explained by elevated physical symptoms in response to daily stressors (“physical symptom reactivity to stressors”). Data came from 1,727 adults (non-Hispanic Black=38%, non-Hispanic White=62%) who participated in the Midlife in the United States Study at Time-1 (T1: 2004-2009). A subset (n=1,482) was reassessed at Time-2 (T2: 2013-2019). Race, daily physical symptoms, and daily stressors were measured at T1. Physical symptom reactivity to stressors (i.e., individual slope of physical symptoms as a function of daily stressor severity) was calculated using 8-day diary data. Physician-diagnosed CVD was captured at T1 and T2. Indirect pathways (A path: race->stressor physical reactivity, B path: race->CVD) were tested, adjusting for health and sociodemographic covariates. At T1, Black adults exhibited a higher risk of CVD compared to White individuals through higher physical symptom reactivity to stressors (A path: B=0.004, SE=0.0006, p<.001; B path: B=-3.56, SE=1.32, p=.007; indirect effect=0.12, SE=0.03, 95% CI=[0.06, 0.18]). These indirect pathways were also supported when predicting the risk of CVD at T2 after controlling for T1 CVD (B path: B=-3.23, SE=1.56, p=.038; indirect effect=0.07, SE=0.04, 95% CI=[0.02, 0.16]). Findings newly suggest that racial differences in physical manifestations of stress may contribute to disproportionate development of CVD, the deadliest disease in America.

Global Cardiovascular Research: Gaps and Opportunities.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. CVDs contribute to a large health and economic burden on a global scale. We aim to describe the current landscape of global cardiovascular research, highlight significant findings, and identify potential opportunities for further studies. There has been remarkable research output regarding cardiovascular health in recent decades. Large-scale collaborative studies have made impactful strides in identifying modifiable risk factors and forming evidence-based guidelines to facilitate improved cardiovascular care and outcomes. However, there are significant CVD disparities between high- and low- income countries which require interventions to mitigate these inequalities. Encouraging collaborative partnerships, strengthening research capacity in low-resource settings, and promoting equity in research are fundamental strategic approaches to help improve global cardiovascular research.

Sex differences in outcomes among patients hospitalized with pulmonary embolism: insights from National Inpatient Sample 2002-2020

Abstract Background Pulmonary embolism is one of the leading causes of cardiovascular mortality and morbidity. It is estimated that it contributes to 100,000 death per year. Gender disparities in cardiovascular diseases have been described before with some conflicting results regarding gender disparities in outcomes of pulmonary embolism. We sought to evaluate sex differences in the baseline characteristics and in-hospital outcomes among patients hospitalized for pulmonary embolism. Methods Data were extracted from the National Inpatient Sample database. International Classification of Diseases, 9th and 10th Revision codes were used to identify patients with PE during the years 2002–2020. Patients were stratified based gender into 2 groups. Results A total of 1192030 patients with PE were identified, of whom 564666 (47.4%) were males. Males are more likely to be younger with mean age (61.7 ± 16.3 years vs 63.7 ± 18.1 years, p<0.001) compared to females. Baseline comorbidities such as diabetes mellitus (3.9% vs 3.8%, p<0.001), coronary artery disease (CAD) (20.1% vs. 13.1%, p< 0.001), atrial fibrillation (15.5 vs 13.3%, p<0.001), chronic kidney disease (12.5% vs 10.5%, p<0.001) and pulmonary hypertension (39.5% vs 38.4%, p<0.001) were more prevalent in males while hypertension (54.9% vs 53.7%, p<0.001) and heart failure (18.6% vs 18.5%, p<0.46) were more prevalent in females. Mean length of stay was higher among males compared to females (8.1 ± 10.6 days vs 7.7 ± 9.5 days, P=0.001). With regard outcomes, the likelihood of cardiogenic shock (1.3% vs 1.1%, p<0.001), use of vasopressors (1.2% vs 1%, P<0.001), and use of mechanical ventilation (MV) (10.1% vs 8.1%, p<0.001), were higher among males compared to females, moreover mortality was higher among males (7.4% vs 7%, P<0.001). Utilization of pharmacologic and interventional therapies was more prevalent among males including systemic thrombolytics (2.2% vs 2%, P<0.001), catheter directed thrombolytics (0.5% vs 0.4%, P<0.001), and embolectomy (0.2% vs 0.2%, P<0.001) compared to females. Adjusted hospitalization cost was higher among males ($21493.9 ± 38795.7 vs $18658.1 ± 31667.7, p<0.001) compared to females. Conclusion We report higher rates of cardiogenic shock, use of vasopressors and mechanical ventilation among males compared to females leading to higher utilization of pharmacologic and interventional therapies. We additionally report higher mortality among males. Further clinical investigations are warranted to explore the risk among males.

Abstract 15494: Racial and Ethnic Differences in Cardiovascular Health Among US Adults With a History of Cancer

Introduction: Evidence reports co-occurring risk factors between cardiovascular disease (CVD) and cancer and treatment-resultant cardiotoxicities amplifying CVD risks. Hypothesis: Given demographic disparities in CVD and cancer outcomes, we illustrated race and ethnicity-specific distributions of cardiovascular health (CVH) and quantified the contributions of socioeconomic factors to racial disparities in CVH among those with prior cancer. Methods: In the National Health Examination and Nutrition Survey 2011-2020, we identified 2628 adults aged ≥18 years with prior cancer. CVH was assessed based on the American Heart Association’s Life’s Essential 8 metrics. The Kitagawa-Blinder-Oaxaca decomposition quantified the magnitude of individual socioeconomic factors contributing to racial differences in CVH. Results: Of the 2628 US adults with prior cancer (mean[SD] age, 63.4[13.8] years; 57% women), 6.0% identified as Hispanic or Latino, 1.6% as non-Hispanic (NH) Asian, 5.2% as NH Black or African American, 84.1% as NH White, and 3.1% as uncategorized or multiple categories. NH Asian had the highest Life’s Essential 8 score (out of 100, women: 66.0; male: 69.2) in contrast to the poorest CVH in NH Black women (59.0) and Hispanic men (57.7). Overall, diet, physical activity, and body mass index were suboptimal. Across race, NH Black had the poorest blood pressure (women: 52.6, men: 41.8) and sleep (women: 74.3, men: 70.2), whereas uncategorized or multiracial group had high tobacco exposure (women: 43.6; men: 53.2). NH White women had the worst lipids (62.4), whereas NH Asian women (65.2) and Hispanic men (69.0) had the lowest glycemic score. Differences were partly explained by deprivation and low education contributing to poorer CVH among Hispanic and NH Black, whereas lower US nativity contributed to better CVH in NH Asian. Conclusions: CVH in US adults with prior cancer was suboptimal with significant racial disparities explained by socioeconomic factors.

Abstract 16375: Cardiovascular Risk Factors and Timing of Diagnosis Among Caregivers in the United States

Introduction: The burden of family caregiving has been increasing in the US. However, caregiver burden may be associated with a higher risk of cardiovascular disease (CVD) among adults. Hypothesis: A higher caregiver burden is associated with an increased risk of CVD. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and March 2020, we conducted a cross-sectional analysis of US adults. We evaluated the prevalence of CVD, age at diagnosis, and treatment rates of caregivers and non-caregivers. The term "caregivers" refers to adults who reported that they had to stay at home to take care of their families. Outcomes included the average age at first diagnosis, rates of treatment, and average levels of hemoglobin A1c, cholesterol, and triglycerides. Descriptive and analytical statistics were generated using STATA. Results: Among the 15,560 US adults, 488 were identified as caregivers. Compared to non-caregivers, caregivers were, on average, older (43 vs. 33 years), more likely to be female (93% vs. 49%), Hispanic (34% vs. 22%), born outside the US (51% vs. 18%), and married (79% vs. 56%) (all p<0.001). While there was no difference in hemoglobin A1c, triglyceride, and LDL-cholesterol levels, caregivers were more likely to self-report CVD risk factors at a younger age: diabetes mellitus (44 vs. 49 years), hypertension (42 vs. 47 years), heart failure (37 vs. 57 years), and stroke (42 vs. 57 years) (all p<0.05). Caregivers were less likely to follow lifestyle modifications such as weight loss or taking cholesterol medications. Caregivers had greater odds of being diagnosed with CAD (3.9 [CI 1.7-8.8]), angina (4.4 [CI 1.4-13]), heart attack (4.8 [CI 2.0-12]), and stroke (2.0 [CI 1.2-3.6]). But this association was not significant after adjusting for age, gender, race, and college education. Conclusion: In this nationally representative sample study, 93% of caregivers were female and had CVD risk factors, such as diabetes and hypertension, detected at younger ages than non-caregivers. A high caregiver burden exposes patients to early CVD risk. As caregiver burden increases, early detection and treatment in this largely female patient population is crucial to reduce sex-related CVD disparities.

Abstract 14305: Experiences of Racism and Risk of Preeclampsia: Results From the Black Women’s Health Study

Introduction: In the United States (US) Black women have higher rates of preeclampsia than White women, which contributes to cardiovascular disease disparities. Differences in traditional cardiometabolic risk factors do not fully explain this disparity, and there is growing consensus that experiences of racism may be a root cause. Few studies have evaluated associations between racism and preeclampsia, and none have done so among a cohort of exclusively Black women. Research Question: Are daily and institutional racism associated with preeclampsia among Black women? Methods: We analyzed data from the Black Women’s Health Study, a follow-up study of approximately 59,000 US Black women beginning in 1995. We included 5,315 women who were nulliparous at baseline and had their first pregnancy between 1995 and 2009. Racism was measured as a total daily racism score (reported as daily exposure to interpersonal racism) and an institutional racism score (reported as ever treated unfairly due to race with respect to police, housing, or job). We used unadjusted and adjusted (age at first birth, total gravidity, baseline education attainment, health insurance, smoking, alcohol use, and Body Mass Index) logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for preeclampsia in quartiles of daily racism and domains of institutional racism. A sensitivity analysis examined associations for women with only one birth. Results: Among 5,315 participants, 9.2% had preeclampsia. [BK1] Compared to women in the lowest quartile of exposure to daily racism, those in the highest quartile had 53% increased odds of preeclampsia (adjusted OR 1.53; 95% CI 1.14, 2.05). Compared to women with no history of institutional racism, the ORs for preeclampsia in women who experienced institutional racism in two or three domains were 1.37 (95% CI 1.04, 1.80) and 1.27 (95% CI 0.085,1.86), respectively. Results were similar among women with only one birth: compared to the lowest quartile, women in the highest quartile of daily racism had an 89% higher risk (adjusted OR 1.89; 95% CI 1.31, 2.75). Conclusion: Racism is associated with an increased risk of preeclampsia in US Black women and may contribute to their disproportionately high prevalence of preeclampsia.

Influence of Socioeconomic Gender Inequality on Sex Disparities in Prevention and Outcome of Cardiovascular Disease: Data From a Nationwide Population Cohort in China.

Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage ofangiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or β blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, r=-0.57, P=0.0013), hypertension control (r=-0.62, P=0.0007), and CVD mortality (r=0.45, P=0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.