Self-reported Cardiovascular Disease Risk Factors Research Articles

Impact of stress and stress mindset on prevalence of cardiovascular disease risk factors among first responders

BackgroundPsychological stress is recognized as an important modifiable risk factor for cardiovascular disease (CVD). Despite its potential significance, few to no studies have evaluated the association between stress, stress mindset, and CVD risk factors among rural first responders. The objectives of this study were to identify relationships between general stress, stress mindset, and CVD risk factors.MethodsThe study sample (n = 148) included those 18 years or older and who currently serve as a first responder, defined as either EMS, firefighter, or law enforcement. Questionnaires captured information on demographics, years of work experience as a first responder, multiple first responder occupations, general stress, stress mindset, and self-reported CVD risk factors. Data were analyzed using regression analyses.ResultsFindings suggest that first responders with a stress-is-negative mindset have significantly higher general stress levels (β = 2.20, p = 0.01). Of note, general stress was not a significant predictor of CVD risk factors (AOR = 1.00, 95%CI = 0.93, 1.08) included in our study. However, a negative stress mindset was statistically significant predictor of CVD risk factors (AOR = 2.82, 95%CI = 1.29, 6.41), after adjusting for general stress and other potential confounders.ConclusionsFindings suggest that stress mindset is an independent predictor of stress and CVD risk factors among rural first responders. These results have the potential to inform educational and organization level interventions targeting stress appraisal for this vulnerable sub population of workers.

Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

PurposeExhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality. MethodsThe present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67). ResultsResults indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, body mass index, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals. ConclusionsOur findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.

Abstract P314: Social Determinants of Cardiovascular Risk Factors Among African Immigrants in New York City

Background: African immigrants (AIs) constitute a highly diverse and rapidly growing population in the US, particularly in New York City. Yet, their cardiovascular health remains understudied. We examined the prevalence of cardiovascular disease (CVD) risk factors and identified predictors of increased CVD risk among AIs residing in the five New York City (NYC) boroughs. Objective: To examine the relationship between social determinants (marital status, education, employment, and health insurance) and CVD risk factors among AIs living in NYC. Methods: This cross-sectional study was conducted among AIs ≥30 years residing in NYC. Outcomes of interest were self-reported CVD risk factors assessed individually (hypertension, diabetes, hyperlipidemia, overweight/obesity, and poor sleep). Using logistic regression analyses, we examined the associations between social determinants and individual CVD risk factors, adjusting for age and sex. Results: Of 215 participants, the mean age was 54 (SD: 11.7) years, and 70% were female. The majority (93%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight/obesity was most prevalent (76%); with 42%, and 18% having a prior diagnosis of hypertension and diabetes, respectively. Those who were employed had ≥ bachelor's education were less likely to have hyperlipidemia (adjusted Odds Ratio [aOR]: 0.35, 95%CI: 0.15-0.86, or overweight/obesity (aOR: 0.31, 95%CI: 1.11-0.88); and twice (aOR: 2.14, 95%CI: 1.11-4.15), more likely to report poor sleep. However, being married and having health insurance were associated with a 3-fold (aOR: 3.08, 95%CI: 1.12-8.50) and 4-fold (aOR: 4.07, 95%CI: 1.12-14.73) higher likelihood of being overweight/obese. Conclusions: The prevalence of CVD risk factors among AIs was particularly high. Culturally-appropriate interventions and policies to reduce CVD risk factors are highly recommended for this population.

Cardiovascular disease risk factors in autistic adults: The impact of sleep quality and antipsychotic medication use.

Approximately 40% of American adults are affected by cardiovascular disease (CVD) risk factors (e.g., high blood pressure, high cholesterol, diabetes, and overweight or obesity), and risk among autistic adults may be even higher. Mechanisms underlying the high prevalence of CVD risk factors in autistic people may include known correlates of CVD risk factors in other groups, including high levels of perceived stress, poor sleep quality, and antipsychotic medication use. A sample of 545 autistic adults without intellectual disability aged 18+ were recruited through the Simons Foundation Powering Autism Research, Research Match. Multiple linear regression models examined the association between key independent variables (self-reported perceived stress, sleep quality, and antipsychotic medication use) and CVD risk factors, controlling for demographic variables (age, sex assigned at birth, race, low-income status, autistic traits). Overall, 73.2% of autistic adults in our sample had an overweight/obesity classification, 45.3% had high cholesterol, 39.4% had high blood pressure, and 10.3% had diabetes. Older age, male sex assigned at birth, and poorer sleep quality were associated with a higher number of CVD risk factors. Using antipsychotic medications was associated with an increased likelihood of having diabetes. Poorer sleep quality was associated with an increased likelihood of having an overweight/obesity classification. Self-reported CVD risk factors are highly prevalent among autistic adults. Both improving sleep quality and closely monitoring CVD risk factors among autistic adults who use antipsychotic medications have the potential to reduce risk for CVD.

Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study.

BackgroundAdults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations.ObjectiveWe conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment.MethodsWe recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function.ResultsCVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance.ConclusionsSelf-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation.

The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data.

BackgroundThe American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions.ObjectiveThe objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2).MethodsData were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time.ResultsBoth hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well.ConclusionsThis analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD.

Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States

ObjectiveThe Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. Methods: Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. Results: Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. Conclusion: We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.

Risk factor control across the spectrum of cardiovascular risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BackgroundPresence of cardiovascular disease (CVD) risk factors (RFs) should prompt patients and their providers to work aggressively towards controlling those that are modifiable. The extent to which a greater CVD RF burden is related to CVD RF control in a contemporary and diverse Hispanic/Latino population is not well-understood. MethodsUsing multicenter community-based data from the Hispanic Community Health Study/Study of Latinos, we assessed the self-reported prevalence of hypertension, hypercholesterolemia, diabetes, and prevalent CVD (ischemic heart disease or stroke). We used contemporaneous guidelines to define RF control. Multivariable logistic regression for complex survey sampling was used to examine whether having more CVD RFs was associated with CVD RF control (adjusting for age, sex, Hispanic background group, education, and health insurance). ResultsOur sample included 8521 participants with at least one CVD RF or prevalent CVD. The mean age in HCHS/SOL target population was 49 (SE 0.3) years and 56% were women. Frequency of one, two, or three self-reported CVD RFs was 57%, 26%, 8%, respectively, and overall 9% of participants had prevalent CVD. After adjusting for sociodemographic factors, compared to those reporting one CVD RF, individuals with three CVD RFs were the least likely to have blood pressure, cholesterol, and glucose optimally controlled (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.40–0.80). However, those with prevalent CVD were more likely to have all three risk factors controlled, (OR: 1.43; 95% CI: 1.01–2.01). ConclusionHispanic/Latino adults with three major CVD RFs represent a group with poor overall CVD RF control. Secondary CVD prevention fares better. The potential contributors to inadequate CVD RF control in this highly vulnerable group warrants further investigation.

Abstract 20: Neighborhood Social Cohesion and Cvd Risk Factors in Lesbian, Gay, and Bisexual Adults

Introduction: Greater perceived neighborhood social cohesion (degree of connectedness among neighbors) has been associated with lower rates of cardiovascular disease (CVD) risk factors and incident CVD. Although sexual minorities (e.g., gay, lesbian, and bisexual) report lower neighborhood social cohesion and higher CVD risk than their heterosexual peers, there is limited population-based evidence regarding the association of neighborhood factors with CVD risk in sexual minorities. Hypothesis: Better neighborhood social cohesion would be associated with lower odds of CVD risk factors in sexual minorities. Methods: We used data from the National Health Interview Survey (2013-2018), a nationally representative sample of U.S. adults. To assess neighborhood social cohesion participants rated the degree to which they agreed with 4 statements (on a 4-point Likert scale). Responses were summed and reverse-coded so that higher scores indicated greater neighborhood social cohesion (range = 4-16). We assessed six self-reported CVD risk factors: current tobacco use, physical inactivity, short sleep duration (≤ 6 h), obesity (BMI ≥ 30kg/m2), and diagnosis of hypertension and/or diabetes. Sex- and sexual identity-stratified logistic regression models were used to examine the association of neighborhood social cohesion and CVD risk factors. Models were adjusted for demographic characteristics and length of time living in neighborhood. Results: The sample consisted of 166,588 participants (97% heterosexual, 2% gay/lesbian, 1% bisexual). Gay (M = 11.9, p <0.001) and bisexual men (M = 11.5, p <0.001) had lower mean social cohesion scores than heterosexual men (M = 12.5). Similarly, lesbian (M = 11.9, p <0.01) and bisexual women (M = 11.1, p <0.001) had lower mean social cohesion scores than heterosexual women (M = 12.4). Among heterosexual participants higher neighborhood social cohesion scores were associated with lower odds of reporting all CVD risk factors. Greater neighborhood social cohesion was associated with lower odds of physical inactivity in lesbian women (AOR 0.95, 95% CI [0.90-0.99]) and lower odds of short sleep duration in lesbian (AOR 0.88, 95% CI [0.84-0.93]) and bisexual women (AOR 0.93, 95% [0.89-0.98]). Greater neighborhood social cohesion was associated with lower odds of obesity in bisexual men (AOR 0.90, 95% CI [0.82-0.99]). Conclusions: Findings suggest that neighborhood social cohesion may be a determinant of CV health in sexual minorities, particularly those that identify as female. Longitudinal studies to examine how neighborhood social cohesion and other neighborhood factors (e.g., violence, safety, and walking environment) influence CVD risk over time in this population are needed.

Abstract 08: Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among Whites, African Americans, African Immigrants and Afro-Caribbeans: Insights From the 2010-2018 National Health Interview Survey

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the U.S. Blacks are disproportionately affected by CVD risk factors, compared to whites. However, Blacks are not monolithic and include the following ethnic groups; African Americans (AAs), African Immigrants (AIs), and Afro-Caribbeans (ACs). It is unclear how AIs and ACs compare to their AA counterparts and Whites with respect to CVD risk factors. Objective: To examine trends in CVD risk factors among three Black ethnic groups in comparison to whites between 2010-2018. Methods: A comparative analysis of the National Health Interview Survey was conducted among N=452,997 participants, examining sociodemographic data and trends in self-reported CVD risk factors (hypertension, diabetes, overweight/obesity, and smoking). Generalized linear models with a Poisson distribution were used to obtain the respective predictive probabilities of CVD risk factors. Results: The sample included 82,835 Blacks (89% AAs, 5% AIs and 6% ACs) and 370,362 whites. AIs were the youngest with mean age of 40.8 years and were less likely to be insured (76%) compared to whites (91%) and AAs (83%) ( p =<0.001). ACs (23%) were more likely be college-educated than AAs (17%) but not AIs (36%) or whites (32%), (p=<0.001). AIs had the lowest age- and sex-adjusted prevalence of all four CVD risk factors. There were disparities (among AAs) and advantages (among AIs and ACs) in CVD risk factors. ( Figure) . Overweight/obesity and diabetes prevalence was increasing in AAs and whites ( p -values for trend<0.001). Smoking prevalence was highest in whites and AAs compared to AIs and ACs but the prevalence decreased significantly between 2010-2018 ( p -values for trend<0.001). Conclusion: Our results have shown significant heterogeneity in CVD risk factors among three Black ethnic groups compared to whites. These findings suggest that race alone does not account for health disparities in CVD risk factors. Environmental, psychological, and social factors may play a larger role in CVD risk.

Prevalence of cardiovascular risk factors across six African Immigrant Groups in Minnesota.

BackgroundAlthough African immigrants represent a large and growing segment of the U.S. population, there are little or no data available on the prevalence of cardiovascular disease (CVD) risk factors among this diverse population. This study compared the prevalence of self-reported CVD risk factors and health behaviors and examined the associations between immigration related characteristics and CVD risk factors and health behaviors across six African immigrants groups.MethodsData were from 996 African immigrants in the U.S., (37.9% Somalis; 26.8% Ethiopians; 14% Liberians; 8.5% Sudanese; 5.1% Kenyans and 7.8% others group) from a cross-sectional survey conducted in the Twin cities of Minnesota. Logistic regression models estimated the associations of demographic characteristics, and immigration-related factors (length of stay in the United states, English proficiency, income and health insurance) with prevalence of CVD risk factors (overweight/obese; hypertension and diabetes mellitus) and self-reported health behaviors (cigarette smoking, physical inactivity, conscious effort to exercise and eating a healthy diet).ResultsWe found a relatively low self-reported prevalence of diabetes, hypertension, and smoking. However, significant differences were noted by country of origin. Using Somalis as our referent country of origin group, we found that Liberians and Kenyans were more likely to report having diabetes or hypertension. On all measures of health behaviors, Liberians were more likely to engage in more health protective behaviors than other individuals.ConclusionsAlthough African immigrants have different prevalence rates for CVD risk factors and health behaviors, there is a need to further explore the differences observed by country of emigration.

HIV Provider–Patient Communication Regarding Cardiovascular Risk

Few global studies have assessed HIV clinician-patient communication regarding cardiovascular disease (CVD) risks. We conducted a multicountry, comparative, cross-sectional survey of HIV-infected individuals in 12 countries on 5 continents in 2010, with 100 to 200 enrollees per country. HIV-infected adults >17 years and on antiretroviral therapy were recruited in clinics and community organizations and surveyed via direct interview, telephone encounter, or online. Chi-square analyses were performed with an 80% power to detect a difference of >20%. Of 2035 participants, 37% were women. Prevalence of self-reported CVD risk factors was 28% overall, and greater CVD risk was present in 55% of patients in North America, 12% in Africa, and 26% to 28% on other continents. Only 19% of patients ever discussed CVD with their physician, and 31% had ever discussed hypertension, hypercholesterolemia, family history of CVD, or smoking; these findings were true for HIV clinicians in all regions of the world. Forty-four percent of smokers reported never discussing smoking with their HIV clinician. We found that HIV clinicians worldwide are not sufficiently addressing CVD risk factors with their patients. Expanded training and education for HIV clinicians should include effective approaches to the mitigation of CV risk factors.

Abstract P373: A Comparison of Examination-Based and Self-Reported Cardiovascular Health Indicators Using Mississippi Delta Cardiovascular Health Examination Survey Preliminary Data and the Mississippi Behavioral Risk Factor Surveillance System

Background: Cardiovascular disease (CVD) surveillance at the regional or local level is limited. The Behavioral Risk Factor Surveillance System (BRFSS) frequently provides the primary source of information on CVD and its risk factors at the population level. However, BRFSS data may be limited due to reliability of self-reported information, a lack of serologic and other objective measurements, and non-local level sampling frames. The Mississippi Delta Cardiovascular Health Examination Survey (CHES) is an ongoing CVD surveillance system in the 18-county Mississippi Delta, a predominately rural, disadvantaged region with some of the highest rates of CVD in the nation. Our objective was to compare prevalence estimates of self-reported CVD risk factors from the Mississippi BRFSS with examination-based measures of these risk factors from Delta CHES. Methods: Delta CHES uses an in-home data collection model to collect survey data, anthropometric measures and fasting blood specimens on a representative sample of adults ≥ 18 years of age living in the Mississippi Delta region. Preliminary examination data, collected between October 2012 and October 2013, from 484 Delta CHES participants were compared to weighted 2011 Mississippi BRFSS self-reported data from 1,187 respondents living in the Mississippi Delta region. Prevalence estimates and 95% confidence intervals (CI) were calculated for measures related to obesity, hypertension, dyslipidemia, diabetes, and smoking. In Delta CHES, dyslipidemia was defined as abnormal values for any cholesterol component or for triglycerides; hypertension was defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg; obesity was defined as body mass index of ≥ 30.0 kg/m 2 ; current smoking was defined as serum cotinine level > 10.0 ng/mL; and diabetes was defined as plasma glucose ≥ 126 mg/dl or hemoglobin A1c ≥ 6.5%. For prevalence estimates, non-overlapping 95% CIs indicate statistical significance (at α=0.05). Results: Delta CHES provided a significantly greater prevalence estimate of obesity [53.5% (95% CI 48.9-58.1%) vs. 42.9% (95% CI 39.0-46.9%)], diabetes [24.4% (95% CI 20.3-28.5%) vs. 16.3% (95% CI 13.7-18.9%)] and smoking [30.4% (95% CI 26.0-34.9%) vs. 20.2% (95% CI 16.7-23.6%)] compared to BRFSS. Conversely, the prevalence of hypertension was significantly lower in Delta CHES compared to BRFSS [14.4% (95% CI 11.2-17.6%) vs. 51.8% (95% CI 47.9-55.8%)]. Conclusion: Objectively measured estimates from Delta CHES and self-reported measures from the Mississippi BRFSS differed for key CVD risk factors. These preliminary findings suggest self-reporting may have distorted past estimates of CVD risk factor rates in the Mississippi Delta region. Population-based CVD surveillance systems using examination-based measurements can provide perspective on routinely collected self-reports.

Characteristics of hypertensive patients and their management in rural Australia

There is now overwhelming evidence that modern antihypertensive management reduces death, stroke and cardiovascular disease (CVD) events.1 However, this can only occur if management is instituted and blood pressure targets achieved. Recent data from AusDiab, showed a high prevalence of untreated hypertension and modifiable CVD risk factors across Australia.2 Rural Australia experiences substantially higher hospital separations for stroke and CVD and death rates from CVD when compared with metropolitan cities.3, 4 The reasons for this are unclear. Self-reported CVD risk factors such as diabetes, hypertension, hypercholesterolaemia and obesity are patchily higher,3 but very little detailed data exist investigating the quality of risk factor management. We have therefore investigated the management of a major CVD risk factor, hypertension, in three randomly selected general practices in rural Victoria.

Computer-assisted telephone interview (CATI) in primary care.

We aimed to study the prevalence of cardiovascular disease (CVD) risk factors among 11,000 inhabitants in Northern Helsinki, and to identify high-risk individuals in the area and direct them to the local primary-health-care-centred CVD-risk-factor prevention programme. We conducted a computer-assisted telephone interview (CATI), a descriptive survey and primary care unit searching for CVD risk factors within the population under its responsibility. Six hundred and sixty-seven individuals aged 18-65 years out of 1000 randomly chosen inhabitants were interviewed using CATI. We measured the prevalence of self-reported CVD risk factors: smoking, blood pressure, last measured total serum cholesterol, body mass index (BMI), alcohol consumption, diabetes, physical exercise habits, positive family history of CVD/diabetes and personal history of CVD. Sixty-seven per cent of the sample was interviewed. Nineteen per cent did not have a telephone and 3% refused to be interviewed. Eleven per cent did not respond. Persons with high cardiovascular risk scores were observed mainly in the oldest age group. In the total sample, 23% of women and 28% of men were estimated to be at high risk of coronary artery disease. Gender differences were seen only in one age-group: 45-54-year-old men reporting higher risk-factor scores. The results were analysed using the Statistical Analysis System (SAS). The CATI-method is a useful tool in screening of high-CVD-risk patients and in guiding them to local CVD primary prevention programmes.

Reliability and changes in validity of self-reported cardiovascular disease risk factors using dual response: The behavioral risk factor survey

The authors previously studied the validity of self-reported cardiovascular disease (CVD) risk factors assessed by telephone surveys, and found the validity low, especially for self-reported hypertension and hypercholesterolemia. One way to improve validity is to combine repeated measurements (dual response) into a single measure. The authors explored this and the reliability of self-reported CVD data collected by the Behavioral Risk Factor Survey in three New York counties from January 1989 to May 1990. Nine hundred and eleven subjects were interviewed by telephone to collect CVD risk factor and health behavior information. Interviewees were offered physical examination and laboratory testing to verify self-reported CVD risk factors; 628 participated. Subjects were also reinterviewed to assess the test-retest reliability of the survey, and to study how validity of self-reported CVD data changes by dual response. Reliability coefficients for CVD risk factors, preventive health practices, and knowledge of risk factor levels ranged from 0.42 to 0.99. Minimal improvement in sensitivity of self-reported risk factors was found using dual response, and it did not improve specificity. Also, for prevalence of risk factors, dual response minimally improved self-reported rates compared to objective estimates. Combining self-reported measurements causes minimal changes in the validity of these variables. Physiological assessment for hypertension and hypercholesterolemia, or correction for misclassification, is needed for valid individual measurement and for community prevalence estimates from telephone surveys. Self-reported cigarette smoking, obesity, and diabetes mellitus have better validity, but physiological assessment or correction for misclassification may supplement these self-reported risk factors.

Validity of cardiovascular disease risk factors assessed by telephone survey: The behavioral risk factor survey

The Behavioral Risk Factor Surveillance System (BRFSS) collects telephone interview data on behaviors for the leading causes of premature death and disability. Its validity has never been adequately studied. The authors replicated BRFSS methodology to validate self-reported cardiovascular disease (CVD) risk factors. Nine-hundred and eleven subjects from three upstate New York counties were interviewed between 1 89 and 5 90 . Interviewees were offered physical examinations and laboratory testing for CVD risk factors; 282 men and 344 women participated. The authors studied validity by comparing objectively measured to self-reported CVD risk factors. Sensitivities for self-reported hypertension, hypercholesterolemia, obesity, smoking, and diabetes were: 43, 44, 74, 82 and 75%, respectively. Only smoking sensitivity differed by gender: men, 77%; women, 86%. Specificity was >85% for all risk factors, except hypercholesterolemia in men (75%). Prevalence was underreported for hypertension, hypercholesterolemia, obesity, and smoking by 43, 50, 25 and 17%, respectively. Results suggest telephone survey research includes physiologic measurements for blood pressure, cholesterol, height, weight, and smoking to validate self-reported CVD risk factors. When this is impossible, results such as these can be used, in similar samples, to correct risk factor prevalence rates from telephone surveys for misclassifications.

Cardiovascular health knowledge in the United States: Findings from the National Health Interview Survey, 1985

Knowledge of the risk precursors to cardiovascular disease is thought to be a key component of health decision making. Many intervention programs have been aimed at increasing the nation's general knowledge of risk factors for cardiovascular disease, although the determinants of the level of cardiovascular disease knowledge are not thoroughly understood. We examined cardiovascular knowledge in a nationally representative sample of the United States population with data from the 1985 Health Promotion and Disease Prevention supplement of the National Health Interview Survey. Interviews with 12,551 white women, 770 Hispanic women, 2,547 black women, 9,832 white men, 576 Hispanic men, and 1,440 black men were used in this analysis. We constructed a seven-item index for cardiovascular disease knowledge. After adjustment for age and education, white men and women scored higher on the cardiovascular disease knowledge index than either their Hispanic or black counterparts. We also examined the relationships of age, education, income, marital status, access to medical care, geographic region, and seven self-reported cardiovascular disease risk factors to the levels of cardiovascular disease knowledge. Education was the strongest predictor of cardiovascular disease knowledge. The variables examined accounted for a small portion of the variance in knowledge. Levels of cardiovascular disease knowledge were lower among respondents with less education and income, those who were not married, those with less access to medical care, and those who were smokers or physically inactive. Therefore, efforts to improve levels of cardiovascular disease knowledge should be directed toward subgroups.