Higher Rates Of Cardiovascular Disease Research Articles

Sedentary Behavior Reduction: A Stepwise Approach to Increasing Physical Activity and Reducing Cardiovascular Disease Risk in Endometrial Cancer Survivors.

Endometrial cancer survivors experience high rates of cardiovascular disease (e.g., heart disease, obesity, diabetes). The heightened cardiovascular disease risk may be attributed to cancer treatment coupled with sub-optimal lifestyle behaviors following treatment, including high amounts of sedentary behavior (SB). Public health agencies have graded the association of evidence between SB and cardiovascular disease as strong. However, while clinicians may wish to prescribe SB substitution strategies to reduce SB, guidelines do not currently exist. An additional challenge to behavior change pertains to the unique barriers that endometrial cancer survivors face, including treatment-associated fatigue and limited self-efficacy. Engaging in healthy movement behaviors, including minimizing SB and achieving recommended amounts of physical activity, are critical for health and well-being as well as cardiometabolic disease prevention. The purpose of this perspective paper is to propose an informed approach to physical activity promotion aimed to initiate movement and promote long-term behavior change by starting with an emphasis on reducing SB in endometrial cancer survivors. First, we address why endometrial cancer survivors should be targeted with SB reduction. Then, we suggest a stepwise approach to increasing physical activity by starting with SB reduction, including consideration to behavioral theories. Finally, we provide suggestions for future directions.

Chlorthalidone and Advanced Chronic Kidney Disease.

Chlorthalidone and Advanced Chronic Kidney Disease.

A Review of the Quality of Cardiometabolic Risk Monitoring Amongst Psychiatric Inpatients, and of Interventions to Reduce Their Long-Term Risk of Cardiovascular Disease

AimsIn Britain, individuals with severe mental illness die on average 15–20 years earlier than the general population. Their higher rates of cardiovascular disease contribute significantly to this. This audit reviewed how well cardiometabolic risk factors are screened for during inpatient admissions, and how frequently appropriate interventions are implemented for identified risk factors. It then assessed ways of improving current monitoring and interventions. We prioritised enhanced collaboration between patients and healthcare professionals, combined with formalising and systematising the physical health screening process.MethodsBed coordination provided identification details of all patients admitted to an all-male acute psychiatric ward from 01/05/2019–31/08/2019. Each patient's record was reviewed to ascertain whether risk factors outlined in Lester UK Adaptation: Positive Cardiometabolic Health Resource were screened for. If a risk factor in this resource's “red zone” was identified, the patient's documentation was reviewed to see whether corrective action was attempted. Raw numbers and percentages of patients receiving any given physical health check were reviewed. For abnormal results, how many patients had appropriate action taken was then also checked.Results63 patients were admitted, 50 of whom had a Rethink template completed. All physical health data (except blood results) were collected using the Rethink template.41 patients smoked tobacco: seven accepted cessation support, 19 declined cessation support, and 15 were not offered support. 9 patients had no smoking status documented.26 patients self-reported healthy lifestyles versus 24 who did not. Of these 24, 17 had no lifestyle intervention documented.31 patients had a BMI > 25, of whom two were offered support, and 28 had no documented support.12 patients were hypertensive, of whom three were offered further support, and eight had no further action documented.44 patients were normoglycaemic, fifteen had no blood glucose test, and four had pre-diabetes/diabetes of whom one was offered further support.32 patients had dyslipidaemia: one received further support, four were already on appropriate pharmacotherapy, and 27 had no further intervention documented. 25 had no bloods taken.ConclusionMost patients had identifiable cardiometabolic risk factors: smoking, BMI > 25, poor lifestyle, dyslipidaemia, hypertension, hyperglycaemia (in decreasing order). Where risk factors were identified, intervention to address these risk factors and identification of barriers to supporting patients were lacking. COVID-19 may have changed the nature of admissions and health priorities. Structural changes were implemented, including changes to admission physical health assessments, introduction of well-man clinics, and improved communication between inpatient and community settings on discharge. A re-audit is pending.

Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies: A National Registry Dataset Analysis

BackgroundAlthough a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. ObjectivesWe investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. MethodsThe study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. ResultsAmong the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. ConclusionsThere is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes.

Neighborhood Deprivation Trends in Patients Undergoing Carotid Endarterectomy

Residents of socioeconomically disadvantaged neighborhoods have higher rates of cardiovascular disease, increased healthcare resource usage, and earlier death. The area deprivation index (ADI) is a tool that allows for percentile rankings of neighborhoods by socioeconomic disadvantage and includes factors for income, education, employment, and housing quality, where “neighborhood” is defined as a census block group containing ≤3000 people. The aim of this study was to evaluate the ADI for patients undergoing carotid endarterectomy (CEA) to elucidate its potential impact on postoperative outcomes.

Abstract 198: Cardiovascular Outcomes, Behavioral Risk Factors, And Health Insurance In Transgender Population In The United States Of America: Analysis From The 2020 Behavioral Risk Factor Surveillance Survey

Background: There is paucity of clinical data regarding the health and cardiovascular (CV) outcomes of transgender (TG) population. Our aim was to determine the association of CV outcomes (and behavioral risk factors) with being TG in the USA. Methods: We utilized Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS) 2020 to determine responders who identified as TG. Non-TG (Cis gender) were also identified and used as controls. Behavioral risk factors such as history of smoking, lack of exercise, and heavy alcohol consumption (adult men having >14 drinks/week and adult women having >7 drinks/week) were measured. CV outcomes such as stroke, myocardial infarction (MI) and stable angina (SA) were noted. Lack of health insurance and college education were also analyzed. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05). Results: There were 401,958 individuals in this survey. 1017 (0.25%) and 235887 (58.7%) were TG and cis genders respectively. There was a significant association of being TG and reporting stroke (AOR 1.87, [1.71-1.92], p=0.002) and MI (AOR 1.45, [1.39-1.55], p=0.003) compared to Cis genders. Association of TG population with reporting SA was statistically insignificant (p=0.66). TG group was also more likely to not have exercised in the past 30 days (AOR 2.71, [2.51-2.89], p=0.009). Heavy alcohol consumption in past 30 days was significantly higher in TG group (AOR 1.36, [1.21-1.44], P=0.002) compared to Cis genders. There was no significant association of smoking noted (p=0.5). TG population had higher odds of reporting depression (AOR 1.53, [1.50-1.61], p<0.001) compared to Cis genders. They were also more likely to not have health insurance (AOR 0.44, [0.36-0.71], p<0.002), and lack college education (AOR 0.53, [0.50-0.81], p<0.003). Conclusion: Transgender population reports higher rates of cardiovascular diseases (stroke and MI), depressive disorder and heavy alcohol consumption. They are also more likely to not exercise, lack basic health insurance and college education contributing to worse clinical outcomes.

High cortisol levels are associated with oxidative stress and mortality in maintenance hemodialysis patients

BackgroundChronic stimulation of the mineralocorticoid receptor has been suggested as one of the potential causes of cardiovascular events and death in patients with end-stage renal disease. This observational cohort study was performed to demonstrate that serum cortisol might be a predictive marker for patient mortality and to evaluate its association with oxidized low-density lipoprotein (oxLDL) in hemodialysis (HD) patients.MethodsPatients receiving HD three times a week were screened for enrollment at two institutions. Baseline cortisol levels were measured before each HD session, and the patients were divided into two groups according to the median value of serum cortisol before analysis. The baseline characteristics and laboratory values of the high and low cortisol groups were compared. Serum cortisol, adrenocorticotropic hormone, renin, aldosterone, and oxLDL were measured in 52 patients to evaluate the effect of oxidative stress on serum cortisol levels.ResultsA total of 133 HD patients were enrolled in this cohort study. Compared to the patients with low serum cortisol levels, the patients with high serum cortisol levels (baseline cortisol ≥ 10 μg/dL) showed higher rates of cardiovascular disease (59.7% vs. 39.4%, P=0.019) and left ventricular systolic dysfunction (LVSD) (25.9% vs. 8.0%, P=0.016). The patients in the high cortisol group demonstrated higher all-cause mortality than those in the low cortisol group. The serum cortisol level was an independent risk factor for patient mortality (hazard ratio 1.234, 95% confidence interval 1.022-1.49, P=0.029). Among the 52 patients with oxLDL measurements, oxLDL was an independent risk factor for elevated serum cortisol levels (Exp(B) 1.114, P=0.013) and LVSD (Exp(B) 12.308, P=0.045). However, plasma aldosterone levels did not affect serum cortisol levels.ConclusionsSerum cortisol is a useful predictive marker for all-cause death among patients receiving HD. OxLDL is an independent marker for elevated serum cortisol among HD patients.

Adherence to Mediterranean Diet Is Associated With Better Glycemic Control in Children With Type 1 Diabetes: A Cross-Sectional Study.

Type 1 diabetes (T1D) is a chronic condition, with increased morbidity and mortality, due to a higher rate of cardiovascular disease among other factors. Cardiovascular risk increases with the worse glycemic profile. Nutrition has a deep impact on diabetes control. Adherence to the Mediterranean diet (MD) has been shown to decrease cardiovascular risk in children and adults with obesity and adults with type 2 diabetes, but its impact on T1D children has been scarcely analyzed. We hypothesized that the degree of adherence to MD could relate to the increased time in range in children with T1D.Patients and MethodsCross-sectional analysis involving two university hospitals. We measured the adherence to MD with the Mediterranean Diet Quality Index for children and teenagers (KIDMED) questionnaire, which is a validated tool for this purpose. A score of <5 indicates poor adherence to MD, while a good adherence is indicated by a score of >7. Demographic and clinical data were registered on the same day that the questionnaire was taken, with informed consent. Additionally, the patients' ambulatory glucose profiles (AGPs), were registered from the participants' glucose monitors (continuous or flash devices), and daily insulin needs were recorded from patients' insulin pumps (n=28). Other cardiovascular risk factors such as lipid profile, vitamin D levels, and other biochemical parameters were registered from a blood test, performed 2 weeks before recruitment, as part of the patients' annual screening.ResultsNinety-seven patients (44 girls), with an average age of 11.4 years (± 3.01), were included. Seventy-one of them were on multiple daily injection regimens, and all had either continuous or flash glucose monitoring. Fifty-three had HbA1c levels of <7.5%, while only 21 had a time in range (TIR) of >70%. Contingency analysis showed that the odds of having HbA1c <7.5% increase in children with KIDMED score of >7 (O.R. 2.38; ICR 1.05–5.41; p = 0.036). Moreover, the KIDMED score and the HbA1c levels were negatively correlated (R: −0.245; p-value: 0.001), while the KIDMED score and TIR showed a positive correlation (R: 0.200; p-value: 0.009).ConclusionsOur data suggest that adherence to MD may contribute to better glycemic control in children. This should be taken into account at the time of nutritional education on T1D patients and their families.

Behavioral Interventions to Reduce Cardiovascular Risk Among People with Severe Mental Disorder.

Cardiovascular disease (CVD) is the leading cause of death among people with severe mental disorder (SMD). CVD risk factors occur at the individual, health system, and socio-environmental levels and contribute not only to high rates of CVD but also to worsening mental health. While acknowledging this wider context, this review focuses on behavioral interventions for seven CVD risk behaviors-smoking, physical inactivity, excessive alcohol consumption, low fruit and vegetable intake, inadequate sleep, poor social participation, and poor medication adherence-that are common among people with SMD. We survey recent meta-reviews of the literature and then review additional key studies to provide clinical recommendations for behavioral interventions to reduce CVD risk among people with SMD. A transdiagnostic psychological approach from the start of mental health treatment, drawing upon multidisciplinary expertise to address multiple risk behaviors, is recommended.

Cohort Profile: The Center for cArdiometabolic Risk Reduction in South Asia (CARRS).

... Emerging data, largely from the diaspora and largely cross-sectional, indicate that South Asians exhibit high rates of cardiovascular disease (CVD), diabetes, atypical dyslipidaemia profiles, and hepatic steatosis1–7 at lower body weight and younger ages relative to populations with European and other ancestries.8–10 It is hypothesized that these differences are rooted in some combination of distinctive pathophysiology, risk factor, phenotypic and socioeconomic characteristics.11–13 In addition, South Asia exhibits differences in health service use, health care costs and quality of care compared with high-income countries (HICs).14 Well-characterized prospective epidemiological cohorts help study the natural history of diseases and the evolution of care in the region. This can advance the knowledge and science of cardiometabolic diseases and provide the infrastructure for interdisciplinary and dynamic scientific explorations.15 The Center for cArdiometabolic Risk Reduction in South Asia (CARRS) is a population-based representative sociodemographically diverse cohort of 30 874 adults with prospective follow-up in three major cities in South Asia—Chennai and Delhi in India and Karachi in Pakistan.16

Scaling Evidence-Based Interventions to Improve the Cardiovascular Health of People With Serious Mental Illness.

People with serious mental illnesses (SMIs) experience excess mortality, driven in large part by high rates of cardiovascular disease (CVD), with all cardiovascular disease risk factors elevated. Interventions designed to improve the cardiovascular health of people with SMI have been shown to lead to clinically significant improvements in clinical trials; however, the uptake of these interventions into real-life clinical settings remains limited. Implementation strategies, which constitute the “how to” component of changing healthcare practice, are critical to supporting the scale-up of evidence-based interventions that can improve the cardiovascular health of people with SMI. And yet, implementation strategies are often poorly described and rarely justified theoretically in the literature, limiting the ability of researchers and practitioners to tease apart why, what, how, and when implementation strategies lead to improvement. In this Perspective, we describe the implementation strategies that the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness is using to scale-up three evidenced-based interventions related to: (1) weight loss; (2) tobacco smoking cessation treatment; and (3) hypertension, dyslipidemia, and diabetes care for people with SMI. Building on concepts from the literature on complex health interventions, we focus on considerations related to the core function of an intervention (i.e., or basic purposes of the change process that the health intervention seeks to facilitate) vs. the form (i.e., implementation strategies or specific activities taken to carry out core functions that are customized to local contexts). By clearly delineating how implementation strategies are operationalized to support the interventions' core functions across these three studies, we aim to build and improve the future evidence base of how to adapt, implement, and evaluate interventions to improve the cardiovascular health of people with SMI.

Ketogenic diet, African American women, and cardiovascular health: A systematic review.

Cardiovascular disease (CVD) is the number one cause of death in the United States of America and across the world. The high prevalence of obesity (56.9%) in African American women contributes to high rates of CVD. Ketogenic nutritional therapy has been shown to be a safe and effective therapy for weight loss and reduction in other CVD risk factors (e.g., HgbA1C and blood pressure). However, the evidence investigating ketogenic nutritional therapy among African American women to improve CVD risk factors has not yet been synthesized. To conduct a systematic review of the evidence on CVD risk reduction and ketogenic nutrition therapy among African American women. CINAHL Plus, Cochrane, EMBASE, MEDLINE/PubMed, SCOPUS, and Web of Science were searched for quantitative studies focused on ketogenic nutritional therapy and CVD risk factors among African American women. Included studies measured beta-hydroxybutyrate as an indicator of dietary adherence. Of 4,799 articles identified, six articles representing five studies were included in this review. The majority of participants were female, with very few identified as African American women. Primary outcomes included weight, body mass index (BMI), blood pressure, and lipids. Dietary adherence was difficult to assess. Significant reductions in weight and BMI were noted. Heterogeneity in study design, intervention length, and measurement of dietary adherence made generalizations difficult. Few studies continually monitored dietary adherence using beta-hydroxybutyrate levels, thus threatening the internal validity of the studies. A gap in our understanding remains concerning CVD risk and ketogenic nutritional therapy among African American women specifically. Ketogenic nutritional therapy is effective in women to reduce weight and BMI. Ketogenic nutritional therapy may be beneficial in reducing CVD risk factors. Monitoring dietary adherence using beta-hydroxybutyrate levels with commercially available monitors is key to intervention success.

Describing Transfers Originating Out-of-Facility for Nursing Home Residents.

Potentially avoidable hospitalizations are harmful to nursing home residents. Despite extensive care transitions research, no studies have described transfers originating outside the nursing home (eg, visiting family members or at a dialysis center). This article describes 82 out-of-facility (community) transfers and compares them to transfers originating within the nursing home (direct transfers). Secondary data analysis with multivariable model for community transfer risk factors. Eighty-two community transfers and 1362 transfers originating in the nursing home, involving 870 residents enrolled in the OPTIMISTIC demonstration project between January 1, 2015, and June 30,2016. Transfers were compared using data from the Minimum Data Set and root cause analyses performed at time of transfer. Multivariable associations were assessed at the transfer level to define risk factors for community transfers. Project nurses collected data on community transfers to inform a root cause analysis. Residents with community transfers were younger (74.4years vs 78.2years), with lower prevalence of cognitive impairment (44.8% vs 70.3%) and higher rates of heart failure (38.7% vs 23.3%) than residents with direct transfers. Community transfers were more likely due to cardiovascular illness (31.2% vs 8.7%), whereas less likely to be for cognitive, behavioral, and psychiatric concerns (11.7% vs 22.7%). Nearly half (46%) of community transfers originated at dialysis centers. Residents transferred outside the nursing home were less likely to have documented limitations to care such as a do not resuscitate code status. Communication during community transfers was identified on root cause analyses as a potential area for improvement. Community transfers were more likely to occur in younger residents with higher rates of cardiovascular disease and lower rates of cognitive impairment. Improved communication between nursing home staff and outside providers as well as more extensive advance care planning for residents with cardiovascular disease may reduce community transfers.

Utility of Myocardial Work in Predicting Cardiovascular Outcomes in a Diabetic Population

Diabetes mellitus is a prevalent cardiovascular risk factor and is associated with higher rates of cardiovascular disease and mortality. Myocardial work (MW) is a novel echocardiographic measure of left ventricular (LV) function which allows for characterisation of cardiac energy expenditure and utilisation based on pressure-strain measurement. We sought to evaluate the prognostic utility of MW in patients with diabetes mellitus without established cardiovascular disease. Diabetic patients without established cardiovascular disease referred to our institution for stress echocardiography from Jan 2016 to Dec 2019 were prospectively recruited. Patients underwent a clinical assessment, resting and exercise stress echocardiography. Included patients were followed for up to five years for the composite endpoints of cardiovascular death and major adverse cardiovascular events (MACE). 85 diabetic patients (66.22±12.67yrs; 55% male) were recruited. 94% had hypertension and 55% had hypercholesterolaemia. Over the mean follow-up period of 36.88±22.28months, 10 patients developed the composite endpoint. These patients had lower left ventricular (LV) global longitudinal strain, higher global wasted work (GWW, p<0.01) and lower global work efficiency (GWE, p<0.01). Unadjusted Cox-regression showed GWW (p<0.01) and GWE (p<0.01) to be associated with adverse cardiovascular outcomes. Other factors associated with the composite outcome included LV indexed mass (p=0.02) and resting systolic blood pressure (p=0.03). In diabetic patients without established cardiovascular disease, increased GWW and reduced GWE were associated with poor cardiovascular outcomes. MW indices may help identify diabetic patients at risk of adverse cardiovascular events.

Affective Neuroscience of Loneliness: Potential Mechanisms underlying the Association between Perceived Social Isolation, Health, and Well-Being.

Loneliness, or the subjective feeling of social isolation, is an important social determinant of health. Loneliness is associated with poor physical health, including higher rates of cardiovascular disease and dementia, faster cognitive decline, and increased risk of mortality, as well as disruptions in mental health, including higher levels of depression, anxiety, and negative affect. Theoretical accounts suggest loneliness is a complex cognitive and emotional state characterized by increased levels of inflammation and affective disruptions. This review examines affective neuroscience research on social isolation in animals and loneliness in humans to better understand the relationship between perceptions of social isolation and the brain. Loneliness associated increases in inflammation and neural changes consistent with increased sensitivity to social threat and disrupted emotion regulation suggest interventions targeting maladaptive social cognitions may be especially effective. Work in animal models suggests the neural changes associated with social isolation may be reversible. Therefore, ameliorating loneliness may be an actionable social determinant of health target. However, more research is needed to understand how loneliness impacts healthy aging, explore the role of inflammation as a potential mechanism in humans, and determine the best time to deliver interventions to improve physical health, mental health, and well-being across a diverse array of populations.

The Relationship Between Knee Pain and Heart Failure in Older Black and Latino Women

Background: Knee pain is the second-most prevalent and disabling common pain condition globally, having deleterious effects on daily function including mobility and exercise capacity; chronic knee pain is especially prevalent in older adults. There is substantial evidence to indicate that physically inactive individuals have higher rates of cardiovascular disease. Nonetheless, studies investigating cardiovascular risks with osteoarthritis have had mixed results. Objective: This study explores the relationship between knee pain and heart failure especially examining the factors of age, gender, race in U.S. older adults. Methods: Retrospective secondary analysis of Medicare claims data for 1.478 million adults over age 65. The standard analytical file for 2017 was segmented according to the presence of any of several ICD-10 codes for heart failure (HF). Medicare beneficiaries with and without HF diagnoses were evaluated for knee pain and other common pain-associated conditions; pain condition data was stratified by age, gender and race codes. Results: Knee pain was markedly increased in women with HF in the 65-70- and 70–75-year-old age-cohorts and relatively less increased in older age-cohorts and males. Knee pain in women was especially elevated in those with Medicare race codes indicating Black and Hispanic status. Conclusion: in a large cohort of Medicare beneficiaries, knee pain was noted to be markedly increased in younger cohorts of older women with HF, and more prevalent in Black and Hispanic women. Further studies should evaluate lifestyle, biomechanics, and inflammatory factors that may be contributing to this relationship.

Association between birth in the stroke belt and late‐life cognition with assessment of socioeconomic and cardiovascular risk factors: The Study of Healthy Aging in African Americans (STAR)

AbstractBackgroundThe Southeastern U.S. (“Stroke Belt”) is known for high rates of cardiovascular diseases and cognitive impairment. Due to the high proportion of Black Americans born in the Stroke Belt and their elevated risk of cognitive impairment, we examined the relationship of birth in a Stroke Belt state with late‐life cognition in The Study of Healthy Aging in African Americans (STAR).MethodSTAR evaluated cognition in African Americans (N=764) ages 50+ who were long‐term Kaiser Permanente Northern California members. Participants completed Multiphasic Health Check‐ups (1964‐1985) at which early adulthood cardiovascular risk factors (CVRF) of body mass index, blood pressure, glucose, and total cholesterol were measured. At STAR wave 1 (2018), participants self‐reported birth state (all participants resided in northern California by the 1980s), childhood and young adulthood socioeconomic status (SES), and completed cognitive assessments using the Spanish and English Neuropsychological Assessment Scales (SENAS). We used linear regression to estimate the association between Stroke Belt birth state with cognition adjusting for birth year, gender, and parental education and evaluating SES and CVRF as potential mediators.ResultAfter exclusions for missing data, 27% (n=197) of 728 participants were born in a Stroke Belt state and mean age at cognitive assessment was 69 years (SD=9). Birth in a Stroke Belt state was associated with worse late‐life executive function (β(95% CI): ‐0.18(‐0.33, ‐0.02)) and semantic memory (β(95% CI): ‐0.37(‐0.53, ‐0.21)), but not verbal episodic memory, compared to individuals born elsewhere. Having 2+ SES risk factors (β(95% CI): ‐0.77(‐0.97, ‐0.56)) or 2+ CVRF (β(95% CI): ‐0.20(‐0.37, ‐0.03)) was associated with significantly worse executive function compared to having no SES or cardiovascular risk factors, respectively. Additionally, having 2+ SES risk factors (β(95% CI): ‐0.64(‐0.85, ‐0.43)) was associated with worse semantic memory. Associations of birth in a Stroke Belt state with executive function (β(95% CI): ‐0.07(‐0.23, 0.08)) and semantic memory (β(95% CI): ‐0.30(‐0.47, ‐0.14)) were attenuated after adjusting for SES and cardiovascular risk factors simultaneously (as well as individually).ConclusionBirth in a Stroke Belt state has lasting influence on cognitive function that is only partially mediated by childhood and early adulthood SES and cardiovascular risk factors.

The roles atherosclerotic cardiovascular disease risk and depression on cognitive outcomes in Mexican Americans and non‐Hispanic whites

AbstractBackgroundMexican Americans (MA) experience cognitive decline at younger ages and have higher rates of cardiovascular disease (CVD) than Non‐Hispanic whites (NHW). Persons who are depressed are more likely to have one or more risk factors for cardiovascular disease. The purpose of this study was to examine the impact of depression and Atherosclerotic Cardiovascular Disease (ASCVD) on cognitive function in MA and NHW.MethodData was collected from the Health and Aging Brain Study: Health Disparities (HABS‐HD) study. A total of 1094 participants who were classified as normal controls were stratified into 4 groups: no depression and low risk ASCVD (N= 684), no depression and high risk ASCVD (N= 222), depression and low risk ASCVD (N=140), and depression and high risk ASCVD (N=48). Depressive symptoms were assessed via Geriatric Depression Scale (GDS). ASCVD risk was calculated using a risk calculator. One‐way ANOVAs were conducted to examine differences in cognitive performance based on ASCVD risk and depression.ResultThe results showed that depressed NHW and MA males with a low ASCVD risk had significantly lower mean scores on Trail Making Test A than the non‐depressed with low ASCVD risk group (p &lt; 0.006), (p &lt; 0.017). Depressed MA males with high ASCVD risk had significantly lower mean scores on the MMSE than the non‐depressed low ASCVD risk group (p &lt; 0.00). Depressed NHW females with low ASCVD risk had significantly lower mean scores on delayed memory than the non‐depressed low ASCVD risk group (p &lt; 0.008). Depressed MA females with a high ASCVD risk demonstrated significantly lower mean scores on the COWA and SEVLT Trials 1‐5 and the non‐depressed low ASCVD risk group (p &lt; 0.002), (p &lt; 0.046).ConclusionThe results of this study indicated that depression and risk of ASCVD can impact cognitive functioning in different ways. In men depression impacted scores on Trails A. In MA women comorbid depression and high risk for ASCVD affect scores on the COWA and SEVLT. These findings support that medical comorbidities influence cognitive function. Future research directions include exploring the relationships between other CVD risk factors and depression.

Abstract 11518: Association of Individual- and Neighborhood-Level Determinants Across Young Adulthood with Racial Disparity in Premature Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults Study

Introduction: Black adults experience higher rates of cardiovascular disease (CVD) compared with White adults, particularly across young adulthood. To identify intervention targets to reduce disparities, we quantified the contribution of individual- and neighborhood-level determinants across young adulthood to Black-White differences in incidence of premature CVD. Methods: In Black and White adults (baseline age 18-30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, the associations of clinical, lifestyle, psychosocial, socioeconomic, and neighborhood determinants with racial disparities in incident CVD were evaluated with sex-stratified Cox proportional hazards models adjusted for time-updated risk factors. Percent reduction in the ß estimate (log-hazard ratio [HR]) for race quantified the contribution of each risk factor group, individually and combined, to incident CVD racial disparities. Results: In 1707 Black and 2001 White young adults followed for median 33.9 (IQR 33.7-34.0) years, Black adults had higher risk of incident CVD than White adults (Figure). The fully adjusted model yielded significant attenuation of the disparity: HR 1.22 (0.68-2.21) for Black vs. White women, HR 1.42 (0.91-2.23) for Black vs. White men. In women, clinical risk factors were associated with the largest percent reduction in the ß estimate (83%) for race. In men, socioeconomic, lifestyle and clinical risk factors were each associated with significant percent reductions in ß estimates (45%, 37%, and 28%, respectively). Conclusions: In CARDIA, risk for premature CVD was no longer significantly higher in Black vs. White adults after adjustment for upstream determinants across multiple domains. The largest contribution to racial disparities was from clinical factors in women and socioeconomic factors in men. These findings may inform earlier-life interventions to reduce disparities in premature CVD.

Abstract 13165: Increasing Incidence Rates and High Case Fatality Rates for Acute Myocardial Infarction in the Caribbean Island of Barbados

Introduction: The Caribbean sub-region has the highest rates of cardiovascular disease in the Region of the Americas. We present data from one of the few population-based registries in the region - the Barbados National Registry for NCDs (BNR). We describe trends in incidence and case fatality rates for acute myocardial infarction(MI) in the high income small island developing state of Barbados. Hypothesis: Myocardial infarction age-standardized incidence rates (ASIRs) are increasing. Methods: Data from the BNR were collected prospectively from charts of patients diagnosed with acute myocardial infarction from all private and public hospitals for the period 2010-2019. Out-of-hospital deaths and in-hospital deaths within 24 hours, were identified through the national vital registration department. Cases are defined in accordance with the Universal Definition of Myocardial Infarctions published by the American Heart Association. Population estimates were obtained from the United Nation World Population Prospects. We calculated incidence rates by sex, age-standardized to the World Health Organization 2000 population and assessed trends in case fatality rates for those admitted to hospital. Results: For the period 2010-2019, 4065 cases of as myocardial infarction (MI) were registered by BNR. Numbers of cases ranged from 294 in 2011 to 547 in 2019. The 3-year average for 2014 - 2016 is 391 cases versus 499 cases for 2017 - 2019 - a 28% increase in new cases. ASIRs increased from 67 per 100,000 (95%UI 59 to 75) in 2011 to 123 per 100,000 (95%UI 113 to 135) in 2019. ASIRs were consistently higher in men ranging from 83 per 100,00 (95% UI 71 - 98) to 120 (95% UI 106 to 136) while rates in women ranged from 43 per 100,000 95% CI (35 - 53) to 83 per 100,000 (73 - 95). The in-hospital case fatality rate (CFR) was 25% in 2019, ranging from 15% in 2011 to 31% in 2014. Overall, CFR was higher in women (24%) versus men (19%) and this was true in 9/10 years. Conclusions: Despite its status as a high income country, ASIRs for MIs in Barbados are increasing while case fatality rates are more than twice as high as rates found in developed countries.