Higher Rates Of Cardiovascular Disease Research Articles

Connection Between HIV and Mitochondria in Cardiovascular Disease and Implications for Treatments.

HIV infection and antiretroviral therapy alter mitochondrial function, which can progressively lead to mitochondrial damage and accelerated aging. The interaction between persistent HIV reservoirs and mitochondria may provide insight into the relatively high rates of cardiovascular disease and mortality in persons living with HIV. In this review, we explore the intricate relationship between HIV and mitochondrial function, highlighting the potential for novel therapeutic strategies in the context of cardiovascular diseases. We reflect on mitochondrial dynamics, mitochondrial DNA, and mitochondrial antiviral signaling protein in the context of HIV. Furthermore, we summarize how toxicities related to early antiretroviral therapy and current highly active antiretroviral therapy can contribute to mitochondrial dysregulation, chronic inflammation, and poor clinical outcomes. There is a need to understand the mechanisms and develop new targeted therapies. We further consider current and potential future therapies for HIV and their interplay with mitochondria. We reflect on the next-generation antiretroviral therapies and HIV cure due to the direct and indirect effects of HIV persistence, associated comorbidities, coinfections, and the advancement of interdisciplinary research fields. This includes exploring novel and creative approaches to target mitochondria for therapeutic intervention.

The association between the triglyceride–glucose index and the risk of cardiovascular disease in US population aged ≤ 65 years with prediabetes or diabetes: a population-based study

BackgroundThe relationship between the triglyceride–glucose (TyG) index and the risk of cardiovascular disease (CVD) in the U.S. population under 65 years of age with diabetes or prediabetes is unknown. The purpose of this study was to investigate the relationship between baseline TyG index and CVD risk in U.S. patients under 65 years of age with diabetes or prediabetes.MethodsWe used data from the 2003–2018 National Health and Nutrition Examination Survey (NHANES). Multivariate regression analysis models were constructed to explore the relationship between baseline TyG index and CVD risk. Nonlinear correlations were explored using restricted cubic splines. Subgroup analysis and interaction tests were also conducted.ResultsThe study enrolled a total of 4340 participants with diabetes or pre-diabetes, with a mean TyG index of 9.02 ± 0.02. The overall average prevalence of CVD was 10.38%. Participants in the higher TyG quartiles showed high rates of CVD (Quartile 1: 7.35%; Quartile 2: 10.04%; Quartile 3: 10.71%; Quartile 4: 13.65%). For CVD, a possible association between the TyG index and the risk of CVD was observed. Our findings suggested a linear association between the TyG index and the risk of CVD. The results revealed a U-shaped relationship between the TyG index and both the risk of CVD (P nonlinear = 0.02583) and CHF (P nonlinear = 0.0208) in individuals with diabetes. Subgroup analysis and the interaction term indicated that there was no significant difference among different stratifications. Our study also revealed a positive association between the TyG index and comorbid MetS in the U.S. population under 65 years of age with prediabetes or diabetes.ConclusionsA higher TyG index was linked to an increased likelihood of CVD in the U.S. population aged ≤ 65 years with prediabetes and diabetes. Besides, TyG index assessment will contribute to more convenient and effective screening of high-risk individuals in patients with MetS. Future studies should explore whether interventions targeting the TyG index may improve clinical outcomes in these patients.

The association between triglyceride-glucose index and the likelihood of cardiovascular disease in the U.S. population of older adults aged ≥ 60 years: a population-based study

BackgroundThe association between the triglyceride-glucose (TyG) index and the likelihood of developing cardiovascular disease (CVD) in the general elderly population in the United States aged 60 and above is not well understood. The objective of our study was to examine the relationship between the TyG index and CVD likelihood in the general elderly population over 60 years of age in the United States.MethodsData for this cross-sectional study were sourced from the 2003–2018 National Health and Nutrition Examination Survey. Weighted multivariable regression analysis and subgroup analysis were conducted to estimate the independent relationship between the TyG index and the likelihood of CVD. Non-linear correlations were explored using restricted cubic splines.ResultsA total of 6502 participants were included, with a mean TyG index of 8.75 ± 0.01. The average prevalence of CVD was 24.31% overall. Participants in the higher TyG quartiles showed high rates of CVD (Quartile 1: 19.91%; Quartile 2: 21.65%; Quartile 3: 23.82%; Quartile 4: 32.43%). For CVD, a possible association between the TyG index and the odds of CVD was observed. Our findings suggest a nonlinear association between the TyG index and the odds of CVD. The threshold of 8.73 for the likelihood of CVD. Interaction terms were employed to assess heterogeneities among each subgroup, revealing a significant difference specifically in alcohol consumption. This suggests that the positive association between the TyG index and the likelihood of CVD is dependent on the drinking status of the participants.ConclusionA higher TyG index is linked to an increased likelihood of CVD in US adults aged ≥ 60 years. TyG index is anticipated to emerge as a more effective metric for identifying populations at early likelihood of CVD.

Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap.

People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease. We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020-2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision-making in real-time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines.

Hypertension Prevalence and Control Among People With and Without HIV - United States, 2022.

People with HIV (PWH) have higher rates of cardiovascular disease than people without HIV. However, limited information exists about hypertension prevalence and associated risk factors in PWH. This cross-sectional study included adult patients in the 2022 IQVIATM Ambulatory Electronic Medical Record - US data. HIV was identified based on ≥2 HIV diagnosis codes or a positive HIV test. Hypertension was identified by diagnosis codes, ≥2 blood pressure (BP) readings ≥130/80 mmHg, or an antihypertensive medication prescription. Among those with hypertension, control was defined as most recent BP <130/80 mmHg. Logistic models using marginal standardization method were used to estimate adjusted prevalence ratios (aPR) of hypertension and hypertension control among all patients and PWH specifically, controlling for covariates. Of 7,533,379 patients, 19,102 (0.3%) had HIV. PWH had higher hypertension prevalence (66% vs 54%, aPR:1.14, 95% CI: 1.13-1.15) compared with people without HIV. Among persons with hypertension, PWH were more likely to have controlled hypertension (aPR: 1.10, 95% CI: 1.07-1.13) compared with people without HIV. Among PWH, those from the South were more likely to have hypertension (aPR: 1.07, 95% CI: 1.02-1.12) than PWH from the Northeast, while Black PWH were less likely to have controlled hypertension (aPR: 0.72, 95% CI: 0.67-0.77) than White PWH. PWH were more likely to have hypertension than people without HIV. Geographic and racial disparities in hypertension prevalence and control were observed among PWH. Optimal care for PWH includes comprehensive strategies to screen for, prevent, and manage hypertension.

Elevated FIB-4 Is Associated with Higher Rates of Cardiovascular Disease and Extrahepatic Cancer History in Patients with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is often complicated by steatotic liver disease, cardiovascular disease (CVD), and extrahepatic cancer. We investigated whether FIB-4, an indicator of liver fibrosis, is associated with a higher risk of CVD and extrahepatic cancer history in T2DM. Two hundred and nine of 244 diabetics admitted to our center in one year were included and retrospectively evaluated. One hundred and fifty-two (72.7%) were males and 57 (27.3%) females. The mean age and FIB-4 were 64.3 ± 11 years, and 1.15 ± 0.5, respectively. One hundred and fifty patients (71.8%) had FIB-4 ≤ 1.3, and 59 (28.2%) had FIB-4 > 1.3. A history of CVD was presented in 76 (36.4%) patients, and of extrahepatic cancer in 39 (18.7%). Patients with CVD were significantly older than those without (68.4 ± 8.5 vs. 63.2 ± 11.5 years; p = 0.002), with significantly higher FIB-4 (1.26 ± 0.5 vs. 1.08 ± 0.5; p = 0.012). Patients with cancer were older, with higher FIB-4 compared to those without (68.2 ± 9.5 vs. 64.4 ± 10.9 years; p = 0.098 and 1.37 ± 0.6 vs. 1.1 ± 0.5; p = 0.004, respectively). FIB-4 > 1.3 was associated with a 2.1-fold probability for CVD (χ2 = 5.810; p = 0.025) and 2.7-fold probability for cancer history (χ2 = 7.603; p = 0.01). FIB-4 ≥ 1.3 is associated with a higher probability of CVD or extrahepatic cancer history. FIB-4 could potentially discriminate patients at risk, justifying stricter surveillance.

Abstract P513: Coronary Artery Calcium Burden in Rural Alabama: Initial Findings From the Risk Underlying Rural Areas Longitudinal Cohort Study

Introduction: Individuals living in rural areas have a disproportionately high rate of cardiovascular disease (CVD) mortality. Coronary artery calcium (CAC) scanning may inform CVD risk stratification. However, the prevalence of CAC in rural areas is unknown. Research Question: What is the prevalence of CAC according to age, sex, and self-reported race (Black, White) in two rural counties in Alabama? Aims: To determine the prevalence of a CAC score &gt;0, a CAC score ≥100, and premature CAC among rural persons without clinical CVD and the extent to which they differ by demographic group. Methods: We studied 789 participants between the age of 25 and 64 years in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study sample in Alabama who underwent CAC scoring on non-contrast cardiac computed tomography. Premature CAC was defined as CAC &gt;0 for men &lt;45 years old, and women &lt;55 years old. Multivariable logistic regression (including age, sex, race) estimated adjusted odds ratios (aOR) for CAC &gt;0 and CAC ≥100. Results: The median age was 51 years, 70% were women, and 80% were Black. Among the were 37% with CAC &gt;0 the median CAC score was 64, while 14% had CAC ≥100 and 12% had premature CAC. Significant differences in all three CAC categories were consistently observed across age and sex, but not race ( Figure ). After adjusting for age and race, women had an approximate 70% lower odds of CAC &gt;0 (aOR=0.29, 95% CI: 0.19-0.44) and CAC ≥100 (aOR=0.28, 95% CI: 0.18-0.43) compared to men. There were no significant differences in CAC &gt;0 (aOR=0.70, 95% CI: 0.43-1.12) or CAC ≥100 (aOR=0.76, 95% CI: 0.46-1.25) for Black versus White persons independent of age and sex. Conclusion(s): In a Southern rural cohort of young and middle-aged persons, approximately one in three had prevalent CAC and one in eight had premature CAC. In contrast to previously published urban cohorts, rural Black adults had a similar CAC burden to their White counterparts. There is a need to explore the factors implicated in the high CAC burden within Southern rural communities.

Lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients in non-metropolitan areas of Brandenburg, Germany.

In the non-metropolitan region of Brandenburg (Germany), which is characterized by high rates of cardiovascular diseases and underserved medical care, there is a lack of awareness regarding lipoprotein(a) [Lp(a)] as a risk factor. In addition, data from patients with atherosclerotic cardiovascular disease (ASCVD) in diverse regional backgrounds, including the understudied Brandenburg cohort, and various healthcare statuses remain insufficient. In this WalkByLab study, Lp(a) levels were monitored in a non-metropolitan cohort (n = 850) in Brandenburg, Germany, comprising 533 patients at high cardiovascular risk and 317 healthy controls. Patients underwent a comprehensive angiological screening, which included blood serum analysis, assessment of medical and family history, cardiovascular risk, and disease status, and evaluation of lifestyle and quality of life. All parameters were evaluated with regard to two groups based on Lp(a) levels: low (<50 mg/dl) and high (≥50 mg/dl). Brandenburg patients with cardiovascular diseases showed higher Lp(a) levels than healthy controls (24.2% vs. 14.8%, p = 0.001). Logistic regression analysis with different characteristics revealed that Lp(a) was an independent risk factor significantly associated with ASCVD (OR 2.26, 95% CI 1.32-3.95, p = 0.003). The high-Lp(a) group showed a higher proportion of patients with coronary artery disease, peripheral artery disease, or cerebrovascular disease compared to the low-Lp(a) group (50% vs. 36.8%; 57.7% vs. 45.8%; 17.6% vs. 9.2%; p = 0.004); also, a higher percentage of patients in the high-Lp(a) group had heart failure (72.8% vs. 53.2%, p = 0.014) and myocardial infarction (24.7% vs. 13.9%, p = 0.001). The high-Lp(a) group exhibited higher rates of statins (63.1% vs. 50.4%, p = 0.003), ezetimibe (14.8% vs. 5.5.%, p = 0.001), and beta-blockers (55.7% vs. 40.7%, p = 0.001) use. Lp(a) levels were found to be independent of physical activity or smoking behavior and did not change over time (12 months). Our study highlights the significance of elevated Lp(a) levels in Brandenburg cardiovascular patients and identifies them as an independent risk factor for ASCVD, which has implications for addressing cardiovascular health of non-metropolitan populations.

Abstract A022: Detecting cardiovascular disease risk in early-stage endometrial cancer survivors: preliminary evidence of pulse wave velocity and social vulnerability index

Abstract BACKGROUND: Endometrial cancer survivors (ECS) experience high rates of cardiovascular disease (CVD) likely due to lifestyle and social-environmental factors, including high obesity rates up to 60%. Early detection of CVD is crucial in order to intervene; however, strategies to identify ECS most at risk for CVD are currently lacking. The gold-standard methodology to non-invasively measure CVD is pulse wave velocity (PWV), and one way to identify social-environmental susceptibility is the Centers for Disease Control social vulnerability index (SVI). PURPOSE: Therefore, the purpose of this study is to investigate (1) CVD risk in stage 1 ECS using PWV and (2) the social-environmental influence on CVD risk using SVI. METHODS: Stage 1 ECS who were 1-12 months post-treatment, with a BMI ≥ 25.0 kg/m2, age 50-80 years, and English speaking were recruited in the gynecology-oncology clinic. Oscillometric PWV was measured in a supine position via Mobil-O-Graph. Body composition [body fat percentage (%)] was measured via Bioelectrical Impedance Analysis. Participant zip code was used to determine SVI of their county of residence. SVI is defined as low-medium (0.00-0.49), medium-high (0.50-0.69), and high (0.70-1.00). Linear regression was used to compare PWV and SVI. RESULTS: Seventeen ECS (65% White, 25% Black, 5% Asian, 5% American Indian, 64 ± 7 years old, 6 ± 4 months post-treatment, 44 ± 6% body fat) participated in the study. Participants resided in counties with low-medium (18%), medium-high (24%), and high (58%) SVI and PWV was measured as 8.2 ± 0.8 m/s, 9.1 ± 0.8 m/s, and 9.7 ± 1.0 m/s respectively. The overall regression was not statistically significant (R=0.38, R2=0.14, F=1.15, p=0.34). DISCUSSION: Overall, PWV was elevated in ECS residing in counties with medium-high and high SVI categories compared to normative data. PWV can be used to non-invasively measure CVD risk in clinic in early-stage ECS. Despite failing to reach statistical significance, a 1.0 m/s change is considered to be a clinically meaningful difference in PWV. Therefore, ECS residing in counties with high SVI may be at greater CVD risk compared to those living in less vulnerable communities. Further research is needed, including a larger sample size, to identify successful interventions to reduce CVD in ECS most at risk. Citation Format: Lauren C. Bates-Fraser, Victoria Bae-Jump, Lee Stoner, Erik D. Hanson. Detecting cardiovascular disease risk in early-stage endometrial cancer survivors: preliminary evidence of pulse wave velocity and social vulnerability index [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A022.

Building Statewide Quality Improvement Capacity to Improve Cardiovascular Care and Health Equity: Lessons from the Tennessee Heart Health Network

Many states with high rates of cardiovascular disease (CVD) lack statewide quality improvement (QI) infrastructure (for example, resources, leadership, community) to address relevant health needs of the population. Academic health centers are well positioned to play a central role in addressing this deficiency. This article describes early experience and lessons learned in building statewide QI infrastructure through the Tennessee Heart Health Network (Network). A statewide, multistakeholder network composed of primary care practices (PCPs), health systems, health plans, QI organizations, patients, and academic institutions was led by the University of Tennessee Health Science Center (UTHSC), an academic health center, to improve cardiovascular health by supporting dissemination and implementation of patient-centered outcomes research (PCOR) evidence-based interventions in primary care. PCPs were required to select and implement at least one of three interventions (health coaching, tailored health-related text messaging, and pharmacist-physician collaboration). Thirty statewide organizational partners joined the Network in year one, including 18 health systems representing 77 PCPs (30.0% of 257 potentially eligible PCPs identified) with approximately 300,000 patients. The organizational partners share EHRs for the ongoing tracking and reporting of key health metrics, including hypertension control and delivery of tobacco cessation counseling. Of the 77 PCPs, 62 continue participation after year two (80.5% retention). Main barriers to participation and reasons for discontinuing participation included reluctance to share data and changes in leadership at the health system level. These 62 PCPs selected the following interventions to implement: health coaching (41.9%), tailored health-related text messages (48.4%), and pharmacist-physician collaboration (40.3%). Academic health centers have broad reach and high acceptability by diverse stakeholders. Tennessee's experience illustrates how academic health centers can serve as platforms for building a statewide infrastructure for disseminating, implementing, and sustaining QI interventions at the practice level. Assessment of Network impact is ongoing.

Global incidence of adverse clinical events in non-alcoholic fatty liver disease: A systematic review and meta-analysis.

Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events. We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events. 19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05). People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.

A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

In the USA, structural racism contributes to higher rates of cardiovascular disease (CVD) including hypertension, heart disease, and stroke among African American persons. Evidence-based interventions (EBIs), which include programs, policies, and practices, can help mitigate health inequities, but have historically been underutilized or misapplied among communities experiencing discrimination and exclusion. This commentary on the special issue of Prevention Science, “Advancing the Adaptability of Chronic Disease Prevention and Management Through Implementation Science,” describes the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention’s (DHDSP’s) efforts to support implementation practice and highlights several studies in the issue that align with DHDSP’s methods and mission. This work includes EBI identification, scale, and spread as well as health services and policy research. We conclude that implementation practice to enhance CVD health equity will require greater coordination with diverse implementation science partners as well as continued innovation and capacity building to ensure meaningful community engagement throughout EBI development, translation, dissemination, and implementation.

EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland.

Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality. In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.

A community health promotion project: Amazing Race for Heart Health.

American Indians have higher rates of cardiovascular disease (CVD), likely due to disproportionate burden of diabetes and limited access to widespread CVD prevention programs such as Honoring the Gift of Heart Health (HGHH), a 10-week CVD risk factor awareness curriculum. Due to its length, HGHH may be difficult to complete; therefore, we aimed to evaluate a shortened CVD risk factor awareness program based on the HGHH educational materials for American Indians residing in southwest Oklahoma, entitled "The Amazing Race for Heart Health." We conducted an interventional study where each participant served as their own control (n = 61), with pre- and post-intervention measurements. We included American Indians from seven tribal nations in southwest Oklahoma. At two interventional meetings we used educational materials and activities from HGHH focusing on nutrition, cholesterol, diabetes, hypertension, physical activity, and heart attack warning signs. McNemar's test was used to determine the effectiveness of the intervention on raising CVD risk factor awareness. When comparing the pre- and post-survey responses, the percentage of correct responses either stayed the same or increased. Knowledge improved in 11/25 (44%, p < 0.05) domains including the difference between good and bad cholesterol and types of physical activity that can prevent CVD. When considering diabetes, knowledge increased regarding the interaction between diabetes and cholesterol in the association with CVD. These results demonstrate that the "Amazing Race for Heart Health," a shortened CVD risk factor educational program based on the HGHH educational materials, was effective at increasing awareness regarding CVD risk factors.

Trends in the prevalence of dementia in LMIC: findings from 10/66 studies in Latin America and the Caribbean.

AbstractBackgroundPopulation ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggest a decline in dementia incidence in High Income Countries due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle‐income countries (LMICs), there are no recent estimates of dementia prevalence and incidence in LMICs. The present study aimed to examine new trends on dementia prevalence and incidence in Latin‐America and associations of socioeconomic determinants and cardiovascular risk factors.MethodSample size included older adults from Latin America (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Mexico) drawn from the 10/66 Dementia Research Group study. We compare wave 1 (2003‐2006) with wave 3 (2016‐2019) of 10/66 studies. The main outcome was dementia prevalence relative to previous waves. Dementia diagnosis was determined according to 10/66 dementia criteria. All the 10/66 waves used the same standardized assessments and protocols.ResultDementia prevalence is stable Cuba, standardized dementia prevalence rates was 12.4% in wave I and 10.1% in wave III. Relative to wave I, Dominican Republic (wave I 11.5% vs wave II 13.6%), Peru (wave I 9.2% vs wave II 16.8%) and Mexico (wave 1 8.3% vs wave 2 17.1%) experience a significant increase in dementia prevalence. Despite, improvements in levels of education, increases in dementia prevalence were associated with higher rates of cardiovascular disease and cardiovascular risk factors, including diabetes, hypertension, obesity and heart disease in the later‐born cohorts. Self‐reported stroke is also rising.ConclusionThe prevalence of dementia in the older Latin American and Caribbean population is high and increasing relative to the previous decade. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries

Abstract 14103: Neighborhood Environmental Burden and Cardiovascular Health in the United States

Introduction: Little is known about the association between cumulative environmental burden and cardiovascular health. Methods: This national study of 71,659 US census tracts linked the CDC environmental burden index and social vulnerability index (SVI) to 2020 PLACES. Mixed-effects linear regression models were used to determine associations between cumulative environmental burden (air pollution, hazardous/toxic sites, built environment, transportation infrastructure, water pollution) and cardiovascular risk factors (hypertension, diabetes, obesity) and diseases (coronary heart disease, stroke) after adjustment for age, sex, SVI, rurality, region, and health care access. Results: Neighborhoods with the highest environmental burden (quartile 4), compared to those with the lowest burden (quartile 1), had greater SVI scores (0.64 vs 0.42) and a higher proportion of racial/ethnic minorities (34% vs 12%). After adjustment, quartile 4 neighborhoods had significantly higher rates of cardiovascular risk factors than quartile 1 neighborhoods, including hypertension (32.8% vs 32.1%, adjusted difference: 0.84% [95% CI: 0.71-0.98]), diabetes (12.2% vs 10.7%, 0.62% [0.53-0.70]), and obesity (33.6% vs 30.9%, 0.77% [0.60-0.94]). Similarly, quartile 4 neighborhoods had higher rates of cardiovascular diseases (Figure) . Results were consistent after geospatial- and covariate-based matching of quartile 4 and 1 neighborhoods. Associations between increasing environmental burden quartiles and cardiovascular risk factors and diseases were significantly more pronounced in most versus least socially vulnerable neighborhoods. Conclusion: Across US neighborhoods, cumulative environmental burden was dose-dependently associated with higher rates of cardiovascular risk factors and diseases, particularly in socially vulnerable communities. Efforts addressing poor environmental conditions may improve cardiovascular health and reduce inequities.

Perspectives Regarding Engagement in Physical Activity in Women: Traditional Gender Role-Based Themes.

There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors. The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources. This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity. Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support. The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.

The sleep justice study - a prospective cohort study assessing sleep as a cardiometabolic risk factor after incarceration: a protocol paper

BackgroundAn estimated 11 million individuals are released from U.S. jails and prisons each year. Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) events and mortality compared to the general population, especially in the weeks following release from carceral facilities. Healthy sleep, associated with cardiovascular health, is an underexplored factor in the epidemiology of CVD in this population. Incarcerated people may have unique individual, environmental, and institutional policy-level reasons for being sleep deficient. The social and physical environment within carceral facilities and post-release housing may synergistically affect sleep, creating disparities in sleep and cardiovascular health. Since carceral facilities disproportionately house poor and minoritized groups, population-specific risk factors that impact sleep may also contribute to inequities in cardiovascular outcomes.MethodsThis study is ancillary to an ongoing prospective cohort recruiting 500 individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study. The Sleep Justice study will measure sleep health among participants at baseline and six months using three validated surveys: the Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control. In a subsample of 100 individuals, we will assess sleep over the course of one week using wrist actigraphy, a validated objective measure of sleep that collects data on rest-activity patterns, sleep, and ambient light levels. Using this data, we will estimate and compare sleep health and its association with CVD risk factor control in individuals recently released from carceral facilities.DiscussionThe incarceration of millions of poor and minoritized groups presents an urgent need to understand how incarceration affects CVD epidemiology. This study will improve our understanding of sleep health among people released from carceral facilities and its potential relationship to CVD risk factor control. Using subjective and objective measures of sleep will allow us to identify unique targets to improve sleep health and mitigate cardiovascular risk in an otherwise understudied population.

Ethnic disparities of vascular complications in pre-diabetes, undiagnosed diabetes, and newly diagnosed diabetes

In the U.S., ethnic minorities with pre-diabetes, undiagnosed type 2 diabetes (T2D), and newly diagnosed T2D had a higher prevalence of microvascular complications than non-Hispanic Whites and exhibited distinct risk factors, whereas Whites had a higher rate of cardiovascular disease.

Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey.

This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population. This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population. Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population. Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.