Self-reported Risk Factors Research Articles

Age- and sex-dependent associations between self-reported physical activity levels and self-reported cardiovascular risk factors: a population-based cross-sectional survey

BackgroundThe amount of regular physical activity (PA) can modulate the prevalence of traditional risk factors for cardiovascular disease (CVD) such as obesity, systemic hypertension, hypercholesterolemia, and type 2 diabetes (T2D). However, how different PA levels either below (< 600 MET min/week), within (600–1200 MET min/week), or above (> 1200 MET min/week) the range of the minimal WHO recommendations impact the age- and sex-dependent prevalence of these risk factors remains to be elucidated.MethodsThis cross-sectional study was performed to evaluate these relationships using population-based self-reported data collected in a central European country (Austria, 2019). The sample included a total of 15,461 persons (7166 males: 16–95 + years, BMI 26.6 ± 4.4; 8295 females: 16–95 + years, BMI 25.1 ± 5.0). Besides various lifestyle factors (e.g., dietary habits, smoking, and alcohol consumption), variables of particular interest were the age- and sex-dependent amount of weekly PA and prevalence of risk factors for CVD. Sex-specific logistic regression analyses were applied to estimate adjusted odds ratios (ORs) for the associations between self-reported PA and risk factor prevalence.ResultsRelatively small beneficial effects were found regarding the prevalence of risk factors for CVD when achieving PA levels corresponding to 600–1200 MET min/week as compared to those who did not meet these recommendations. However, exceeding the WHO recommendations provided much more pronounced benefits, especially in younger and older age groups. Adjusted ORs revealed that high volumes of PA (> 1200 MET min/week) were associated with a 32–43% reduction in the prevalence of obesity and T2D compared to those who did not achieve the WHO recommendations (< 600 MET min/week), as well as with a lower prevalence of systemic hypertension only in women and a lower prevalence of hypercholesterolemia only in men.ConclusionsExceeding minimal WHO recommendations for PA promises large beneficial effects, particularly on the prevalence of obesity and T2D. Demonstrated sex differences in PA levels and their association with cardiovascular risk factors may provide an important basis for preventive health counseling.

The prevalence of patient-reported cognitive complaints and dementia risk factors in the audiology clinic

Background Hearing-dementia research mainly focuses on determining the causal direction of this association. Little is known about the prevalence of cognitive problems in a representative audiology patient population. Aim To examine the occurrence of self-reported cognitive complaints (SCC) and dementia risk factors (RF) in an audiology patient population. Materials and methods Patients visiting audiology clinics (n = 1100, 51% female and avg. age 61yrs) were administered an online intake tool based on the International Classification of Functioning Disability and Health. Domains extracted for analyses were memory and concentration (SCC) and loneliness, depression, sleep and vision (dementia RF) and self-reported hearing problems (SHP). Prevalence rates and associations with demographic variables and SHP were examined. Results SCC were highly prevalent, with over half of the patients reporting memory or concentration problems. Regarding dementia RF, 68% reported sleeping problems and > 50% reported sadness, anxiety or depressed mood. SHP correlated significantly with self-reported memory problems, loneliness, and vision problems. Conclusion This descriptive cohort-study suggests a high risk of cognitive issues within the audiology clinic population, indicated by the high prevalence of SCC and some dementia RF. Our findings underscore the importance of considering closer cooperation between care pathways like audiology and neurology and use of a holistic patient-centered approach.

Effects of Occupational and Leisure-Time Physical Activity on the Risk of Dementia: Results From the Copenhagen City Heart Study.

Leisure-time physical activity (LTPA) decreases the risk of dementia, whereas occupational physical activity (OPA) possibly increases the risk. Yet, previous findings are mixed. We therefore aimed to investigate the effect of LTPA and OPA, respectively, on dementia among men and women. In this observational, longitudinal study, we used data from the second wave of a population-based cohort from the municipality of Copenhagen as baseline. Data were collected in 1981-1983, and 10 343 participants were followed until the end of 2016. LTPA and OPA were self-reported, and information on dementia diagnoses and redemption of dementia medication was obtained at an individual level from national health registers. We used Poisson regression to analyze the association between LTPA/OPA and dementia and adjusted for self-reported age, socioeconomic factors, stress, and cardiovascular risk factors (smoking, alcohol, body mass index, and blood pressure). A higher level of LTPA was associated with a lower dementia risk among men, but we found no clear association among women. OPA and dementia were not associated among men, but occupationally active women who reported OPA in terms of walking, lifting, and heavy work had a higher risk of dementia than women with sedentary jobs. This study supported earlier findings of a protective effect of LTPA on dementia among men. Women in physically demanding jobs possibly have a higher risk of dementia, yet this finding warrants further investigation in future studies.

Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity

Sexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults. To examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults. This cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states. Self-reported sexual orientation and gender identity. Outcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome. The study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP). In this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Patterns of Telehealth Visits After the COVID-19 Pandemic Among Individuals With or at Risk for Cardiovascular Disease in the United States.

Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio-only) in people with CVD and CVD risk factors. We also assessed their rationale and satisfaction with telehealth visits. A nationally representative sample of 6252 participants from the 2022 Health Information National Trends Survey 6 was used. We defined the CVD risk categories as having no self-reported CVD (coronary heart disease or heart failure) or CVD risk factors (hypertension, diabetes, obesity, or current smoking), CVD risk factors alone, and CVD. Multivariable logistic regression, adjusting for major sociodemographic factors, assessed the relationship between CVD risk and telehealth uptake. The weighted prevalence of using telehealth was 50% (95% CI, 44%-56%) for individuals with CVD and 40% (95% CI, 37%-43%) for those with CVD risk factors alone. Individuals with CVD had the highest odds of using any telehealth (audio-only or video) (adjusted odds ratio [OR], 2.02 [95% CI, 1.39-2.93]) when compared with those without CVD or CVD risk factors. Notably, 21% (95% CI, 16.3%-25.6%) of patients with CVD used audio-only visits (adjusted OR, 2.38 [95% CI, 1.55-3.64]) compared with patients without CVD or CVD risk factors. In a nationally representative survey, there was high prevalence of any (video or audio-only) telehealth visits in people with CVD, and audio-only visits comprised a significant proportion of telehealth visits in this population.

Association Between Self-Reported Infections and Seropositivity Among Pregnant Women With Gastroschisis: A Case Control Study, With Emphasis on Chlamydia trachomatis.

Gastroschisis is a birth defect with the greatest risk among women <20 years of age. Pregnant women attending the University of Utah's Maternal-Fetal Medicine Diagnostic Center between 2011 and 2017 for either their routine diagnostic ultrasound or referral were recruited (cases: pregnant women with fetal gastroschisis, n = 53 participated/57, 93%; controls: pregnant women without fetal abnormalities, n = 102 participated/120, 85%). A clinic coordinator consented and interviewed women and obtained a blood sample and prenatal medical records. We evaluated self-reported maternal characteristics, risk factors, and infections. To assess pathogen seropositivity we used Serimmune's Serum Epitope Repertoire Analysis validated 35 pathogen panels and Chlamydia trachomatis and compared seropositivity to self-report and prenatal medical record screening to assess sensitivity. Cases were more likely to report a younger age at sexual debut (p = <0.01), more sexual partners (p = 0.02), being unmarried (p < 0.01), changing partners between pregnancies (p = <0.01), smoking cigarettes (<0.01), and a recent sexually transmitted infection (STI) (p = 0.02). No differences were observed for self-report of illicit drug use or periconceptional urinary tract infections. Cases had a higher seropositivity for cytomegalovirus (p = 0.01). No differences were observed for herpes simplex I, II, or Epstein-Barr. Though based on small numbers, C. trachomatis seropositivity was highest in cases (17%) compared to controls (8.8%) with the highest proportion observed in case women <20 years of age (cases 33%; controls 0%). Any STI (self-report or seropositivity) was also highest among cases <20 years of age (cases 47%; controls 0%). Among C. trachomatis seropositive women, self-report and prenatal medical record sensitivity was 27.8% and 3%, respectively. Cases were more likely to engage in behaviors that can increase their risk of exposure to sexually transmitted pathogens. Case women <20 years of age had the highest proportion of C. trachomatis seropositivity and any STI. Prenatal medical records and self-report were inadequate to identify a recent chlamydial infection whereas, the SERA assay is a novel approach for evaluating subclinical infections that may impact the developing embryo.

Prevalence of interarm blood pressure difference is notably higher in women; the Viborg population-based screening program (VISP)

BackgroundBilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm.MethodsThis sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results).ResultsWe included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32–1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140–159/90–99 mmHg (OR 1.68, 95% CI 1.44–1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49–2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm.ConclusionFemale sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening.Trial registration for VISPNCT03395509:10/12/2018.

Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation.

Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.

Predicting first time depression onset in pregnancy: applying machine learning methods to patient-reported data.

To develop a machine learning algorithm, using patient-reported data from early pregnancy, to predict later onset of first time moderate-to-severe depression. A sample of 944 U.S. patient participants from a larger longitudinal observational cohortused a prenatal support mobile app from September 2019 to April 2022. Participants self-reported clinical and social risk factors during first trimester initiation of app use and completed voluntary depression screenings in each trimester. Several machine learning algorithms were applied to self-reported data, including a novel algorithm for causal discovery. Training and test datasets were built from a randomized 80/20 data split. Models were evaluated on their predictive accuracy and their simplicity (i.e., fewest variables required for prediction). Among participants, 78% identified as white with an average age of 30 [IQR 26-34]; 61% had income ≥ $50,000; 70% had a college degree or higher; and 49% were nulliparous. All models accurately predicted first time moderate-severe depression using first trimester baseline data (AUC 0.74-0.89, sensitivity 0.35-0.81, specificity 0.78-0.95). Several predictors were common across models, including anxiety history, partnered status, psychosocial factors, and pregnancy-specific stressors. The optimal model used only 14 (26%) of the possible variables and had excellent accuracy (AUC = 0.89, sensitivity = 0.81, specificity = 0.83). When food insecurity reports were included among a subset of participants, demographics, including race and income, dropped out and the model became more accurate (AUC = 0.93) and simpler (9 variables). A relatively small amount of self-report data produced a highly predictive model of first time depression among pregnant individuals.

Self-reported depression and its risk factors among hypertensive patients, Morocco: a cross-sectional study.

Hypertensive patients are at an elevated risk of developing mental diseases such as depression, which can impair their quality of life. The purpose of this study is to measure the prevalence of self-reported depression among hypertensive patients treated at primary health care facilities in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 1053 hypertensive patients attending primary health care facilities in Marrakech was conducted. A face-to-face questionnaire was used to collect socio-demographic, behavioral, and clinical data, as well as hypertension treatment characteristics and the care-patient-physician triad. The Patient Health Questionnaire-9 was used to assess self-reported depression. To identify self-reported depression risk factors, multivariate logistic regression was used. Depressive symptoms were reported by 56.1% of hypertensive patients. The patients' average age was 63.2 ± 9.5years, and 508 (85.9%) were female. Female sex, stress, a low-salt diet, pain and physical discomfort, an urban living environment, a lack of self-monitoring of hypertension, an unsatisfactory relationship with the healthcare system, a family history of hypertension, and the perception of adverse effects of the antihypertensive drug were all associated with self-reported depression. Self-reported depression is prevalent among hypertensive patients in Marrakech. The mental health component should be emphasized while addressing hypertensive patients in primary health care facilities.

Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups.

Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.

Self-reported exertional heat illness and risk factors among collegiate marching band artists

Marching band (MB) artists are often part of the general student population and not required to complete a pre-participation health screening to identify predisposing medical conditions or risks for injury/illness. Anecdotally, exertional heat illnesses (EHI) are a concern for MB artists. As more athletic trainers provide MB healthcare, research is needed on EHI occurrence and MB associated EHI risk factors. We utilized an exploratory cross-sectional study design to determine EHI risk factors, including previous EHI occurrence, among collegiate MB artists. MB artists (n ​= ​1 207; age ​= ​[19.6 ​± ​1.3] years) actively participating in their college/university's MB during the 2019 football season completed an online survey to characterize demographics, medical history, medication and supplement use, and nutrition behaviors. Chi-square and binomial logistical regressions assessed associations between categorical variables. Previous EHI was reported by 50.6% of MB artists, with 466 (76.3%) experiencing exertional heat exhaustion and 31 (5.1%) exertional heat stroke. More females reported exertional heat exhaustion overall (68.2%, p ​< ​0.001) and in the previous year (73.3%, p ​< ​0.001). Experiencing a previous EHI was significantly associated with having a mood/neurological condition (63.5%, p ​< ​0.001), diagnosed (74.3%, p ​= ​0.004) or perceived eating disorder (66.7%, p ​< ​0.001), and taking prescription medications (59.4%, p ​< ​0.001), over-the-counter medications (58.9%, p ​= ​0.002), and supplements (55.4%, p ​= ​0.037). Half of collegiate MB artists reported experiencing previous EHIs and engaged in behaviors known to increase EHI risk. MB artists should complete pre-participation examinations to identify pre-existing medical conditions and risks for adverse medical events. Healthcare providers working with MB artists should develop policies and procedures to mitigate EHI risks and occurrence.

Abstract 2205: Modifiable risk factors are associated with clonal hematopoiesis

Abstract Observational studies have implicated modifiable factors like smoking, alcohol intake, physical activity (PA), and sleep to cancer risk. Clonal hematopoiesis (CH), marked by clonal expansions of mutated hematopoietic progenitors with mosaic chromosomal alterations (mCAs) or clonal hematopoiesis of indeterminate potential (CHIP), has been associated with the risk of serval cancers and may shed light the interplay between these factors and early preneoplastic hematopoietic expansion.Leveraging genotyping array and whole-exome sequencing data of leukocyte-derived DNA from 485,028 participants without hematologic malignancies in the UK Biobank (UKBB), we performed genome-wide characterization of two common forms of CH—mCAs and CHIP. To assess associations between social deprivation, self-reported modifiable risk factors, and CH risk, we employed multivariable logistic regression models adjusted for potential confounders including age, sex, smoking history, and genetic ancestry.We identified 11,826 (2.4%) individuals with autosomal mosaic chromosomal alterations (auto mCAs), 15,499 (3.2%) with loss of the X chromosome (mLOX), 43,044 (8.8%) with loss of the Y chromosome (mLOY) and 22,508 (4.6%) with CHIP. Individuals with any CH subtype were on average older than CH-free individuals (p &amp;lt; 9.11 × 10−52). Multivariable models identified a significant negative association between mLOY and social deprivation in England (1 SD change in score: OR = 0.968 [0.956-0.980], p = 4.88 × 10−7), suggesting modifiable risk factors could influence risk of mLOY. We observed a positive association with ever smoking and CH, which decreased with increased years since smoking cessation. Current smokers were at higher risk for auto mCAs (Odds ratio (OR) = 1.23, 95% Confidence Interval (CI):[1.16-1.31], P-value (p) = 2.63 × 10−11), mLOY (OR = 2.25, 95%CI: [2.17-2.33], p &amp;lt; 9.11 × 10−52), and CHIP (OR = 1.40,, 95%CI: [1.34-1.47] p &amp;lt; 9.11 × 10−52); and former smokers also exhibited significant associations for mLOY (OR = 1.16, 95%CI: [1.13-1.19], p = 2.97 × 10−32) and CHIP (OR = 1.11, 95%CI: [1.08-1.15], p = 2.75 × 10−13). Alcohol consumption was associated with a significant increase in the risk of mLOX in heavy drinkers (&amp;gt;2-3 drinks/day) compared to non-drinkers (OR = 1.16, 95%CI: [1.09-1.24], p = 1.21 × 10−5). Moderate and high PA levels (categorized as level 2 and 3 based on total activity), were positively associated with increased mLOY frequency (moderate: OR = 1.05, 95%CI: [1.02-1.08], p = 8.6 × 10−2, high: OR = 1.06, 95%CI: [1.03-1.08], p = 1.6 × 10−3). We observed no evidence for an association between sleep patterns and CH.Our investigation in a large cohort identified associations between CH and social deprivation, smoking, alcohol consumption and PA. As CH is an intermediate marker for hematologic cancer risk, our findings imply that modifiable exposures may contribute to hematologic cancer risk through clonal mechanisms. Citation Format: Corey D. Young, Aubrey K. Hubbard, Pedro Saint-Maurice, Irenaeus Chan, Kelly L. Bolton, Stephen J. Chanock, Charles Matthews, Steven C. Moore, Erikka Loftfield, Yin Cao, Mitchell J. Machiela, Duc Tran. Modifiable risk factors are associated with clonal hematopoiesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2205.

Intake of Blueberries, Anthocyanins, and Risk of Eye Disease in Women

BackgroundBlueberries and anthocyanins, their key bioactive component, may improve eye health. However, few long-term studies have examined blueberries and anthocyanins with cataract and age-related macular degeneration (AMD). ObjectivesTo investigate the prospective association between blueberry and anthocyanin intake with incident cataract, total AMD, and visually significant AMD among middle-aged and older women. MethodsA total of 36,653 and 35,402 women initially free of AMD and cataract, respectively, aged ≥45 y from the Women’s Health Study provided semiquantitative food frequency questionnaire data on blueberry intake categorized as none, 1–3 servings/mo, 1 serving/wk, or ≥2 servings/wk, plus a combined category of ≥1 serving/wk. Total anthocyanin intake and major subclasses were energy-adjusted and categorized into quintiles. Self-reported risk factors of eye disease were adjusted in multivariable hazard ratios (HRs) (95% confidence intervals [CIs]) of confirmed cataract, AMD, and visually significant AMD with mean follow-up of 11 y. ResultsAmong the participants, 10.5% consumed ≥1 serving/wk of blueberries, with mean total anthocyanin intake of 11.2 mg/d. Compared to no blueberry intake, women consuming 1–3 servings/mo, 1 serving/wk, and ≥2 servings/wk had corresponding multivariable HRs of total AMD of 0.90 (95% CI: 0.73, 1.11), 0.71 (95% CI: 0.50, 1.00), and 0.36 (95% CI: 0.14, 0.93) (Ptrend = 0.011); those consuming ≥1 servings/wk had an HR of 0.68 (95% CI: 0.47, 0.98). A similar magnitude of HRs were found for visually significant AMD (Ptrend = 0.012) but not for cataract. There were no significant associations between increasing total anthocyanin quintiles and total and visually significant AMD, but there was a modest inverse association with cataract (Ptrend = 0.022), driven by a 10% reduction in cataract in the upper 2 quintiles. ConclusionsGreater blueberry intake significantly reduced total AMD, but not visually significant AMD or cataract. However, the magnitude of effect for visually significant AMD was similar to total AMD. There was a modest but significant inverse association between dietary anthocyanin intake with cataract but not AMD.

Intersectional analysis of social disparities in type 2 diabetes risk among adults in Germany: results from a nationwide population-based survey

BackgroundDifferences in type 2 diabetes risk have been reported for several sociodemographic determinants including sex/gender or socioeconomic status. From an intersectional perspective, it is important to not only consider the role of social dimensions individually, but also their intersections. This allows for a deeper understanding of diabetes risk and preventive needs among diverse population groups.MethodsAs an intersectionality-informed approach, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was used in a population-based sample of adults without known diabetes in Germany from the cross-sectional survey “Disease knowledge and information needs– Diabetes mellitus (2017)”. Diabetes risk was assessed by the German Diabetes Risk Score (GDRS, range 0-122 points), estimating the individual risk of developing type 2 diabetes within the next 5 years based on established self-reported risk factors. Nesting individuals in 12 intersectional strata defined by combining sex/gender, educational level, and history of migration, we calculated measures to quantify the extent to which individual differences in diabetes risk were explained at strata level, and how much this was due to additive or multiplicative intersectional effects of social determinants.ResultsDrawing on data of 2,253 participants, we found good discriminatory accuracy of intersectional strata (variance partition coefficient = 14.00% in the simple intersectional model). Model-predicted GDRS means varied between 29.97 (corresponding to a “low risk” of < 2%) in women with high educational level and a history of migration, and 52.73 (“still low risk” of 2–5%) in men with low educational level without a history of migration. Variance in GDRS between strata was mainly explained by additive effects of social determinants (proportional change in variance to intersectional interaction model = 77.95%) with being male and having low educational level being associated with higher GDRS. There was no evidence of multiplicative effects in individual strata.ConclusionsType 2 diabetes risk differed between intersectional strata and can to some extent be explained at strata level. The role of intersectional effects was minor and needs to be further investigated. Findings suggest a need for specific preventive measures targeted at large groups with increased diabetes risk, such as men and persons with low educational level.

Stability and change in self-reported risk and resilience factors associated with mental health of siblings of individuals with and without neurodevelopmental conditions over 15 months

Stability and change in self-reported risk and resilience factors associated with mental health of siblings of individuals with and without neurodevelopmental conditions over 15 months

Self-reported cardiovascular disease risk factor screening among people living with HIV vs. members of the general population in Botswana: a community-based study.

Morbidity and mortality due to cardiovascular diseases (CVDs) are high and increasing in low- and middle-income countries. People living with HIV (PLWH) are more likely to experience CVD than members of the general population. Therefore, we aimed to assess whether PLWH were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana from February to August 2017 as part of a larger community-based cluster randomized HIV treatment-as-prevention trial. Participants were asked if they had been screened for and counselled on cardiovascular disease risk factors (history of hypertension or blood pressure check, blood glucose and cholesterol measurements, weight check and weight control, tobacco smoking and cessation, alcohol use and physical activity) in the preceding 3 years. HIV testing was offered to those with an unknown HIV status. Multiple logistic regression analysis controlling for age and sex was used to assess the relationship between CVDRF screening and HIV status. Of the 3981 participants enrolled, 2547 (64%) were female, and 1196 (30%) were PLWH (93% already on antiretroviral therapy [ART]). PLWH were more likely to report previous screening for diabetes (25% vs. 19%, p < 0.001), elevated cholesterol (17% vs. 12%, p < 0.001) and to have had their weight checked (76% vs. 55%, p < 0.001) than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake (42% vs. 33%, p < 0.001), smoking cessation (66% vs. 46%, p < 0.001), weight control (38% vs. 29%, p < 0.001), physical activity (46% vs. 34%, p < 0.001) and alcohol consumption (35% vs. 23%, p < 0.001) than their HIV-uninfected counterparts. Overall, PLWH were more likely to have received screening for and/or counselling on CVDRFs (adjusted odds ratio 1.84, 95% CI: 1.46-2.32, p < 0.001). PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.

Effectiveness of a culturally tailored text messaging program for promoting cervical cancer screening in accra, Ghana: a quasi-experimental trial

IntroductionDespite breakthroughs in cervical cancer detection, resource-constrained countries continue to have a disproportionately high incidence and death rate. Mhealth has been identified as an important tool for increasing cervical cancer screening rates in Sub-Saharan Africa. We determined whether sending Ghanaian women culturally tailored one-way mobile phone SMS text messages about cervical cancer would encourage the uptake of the human papillomavirus (HPV) test.MethodsFrom August to November 2016, 88 women aged 18 to 39 living or working in an urban community (Accra, Ghana) participated in a quasi-experimental study. For 8 weeks, 32 SMS messages regarding cervical cancer were developed and sent to the personal phones of intervention arm participants (n = 42). Women in the control group (n = 46) received SMS texts with general health and lifestyle advice. Fischer’s exact tests were performed to assess cervical cancer screening uptake and associated reasons for non-uptake between the intervention and control groups (p < 0.05).ResultsAt the baseline, women differed in terms of ethnicity and wealth. After the intervention, participants’ self-reported risk factors for cervical cancer, such as early menarche, usual source of medical treatment, family history of cancer, smoking, and alcohol history, changed. None of the women in the intervention group sought cervical cancer screening after the intervention, but only one (2.2%) of the control arm participants did. Almost all the women (> 95%) agreed that an HPV test was essential and that regular healthcare check-ups could help prevent cervical cancer. Some women believed that avoiding particular foods could help prevent cervical cancer (23.8% intervention vs. 58.7% control, p < 0.001). Time constraints and out-of-pocket expenses were significant barriers to cervical cancer screening. Conclusion: A one-way SMS delivered to urban women did not increase cervical cancer screening attendance. The time spent in screening facilities and the lack of coverage by the National Health Insurance Scheme limited screening uptake. We urge for the establishment of screening centers in all healthcare facilities, as well as the inclusion of cervical cancer screening in healthcare programs through cost-sharing.

Getting to the heart of Lewy body disease.

Early identification of neurodegenerative diseases before extensive neuronal loss or disabling symptoms have occurred is imperative for effective use of disease-modifying therapies. Emerging data indicate that central Lewy body diseases - Parkinson disease and dementia with Lewy bodies - can begin in the peripheral nervous system, opening up a therapeutic window before central involvement. In this issue of the JCI, Goldstein et al. report that cardiac 18F-dopamine positron emission tomography reveals lower activity selectively in individuals with several self-reported Parkinson disease risk factors who later develop Parkinson disease or dementia with Lewy bodies. Accurately identifying which at-risk individuals will develop central Lewy body disease will optimize early patient selection for disease-modifying therapies.

Cardiac noradrenergic deficiency revealed by 18F-dopamine positron emission tomography identifies preclinical central Lewy body diseases.

In Lewy body diseases (LBDs) Parkinson disease (PD), and dementia with Lewy bodies (DLB), by the time parkinsonism or cognitive dysfunction manifests clinically, substantial neurodegeneration has already occurred. Biomarkers are needed to identify central LBDs in a preclinical phase, when neurorescue strategies might forestall symptomatic disease. This phase may involve catecholamine deficiency in the autonomic nervous system. We analyzed data from the prospective, observational, long-term PDRisk study to assess the predictive value of low versus normal cardiac 18F-dopamine positron emission tomography (PET), an index of myocardial content of the sympathetic neurotransmitter norepinephrine, in at-risk individuals. Participants self-reported risk factor information (genetics, olfactory dysfunction, dream enactment behavior, and orthostatic intolerance or hypotension) at a protocol-specific website. Thirty-four with 3 or more confirmed risk factors underwent serial cardiac 18F-dopamine PET at 1.5-year intervals for up to 7.5 years or until PD was diagnosed. Nine participants had low initial myocardial 18F-dopamine-derived radioactivity (<6,000 nCi-kg/cc-mCi) and 25 had normal radioactivity. At 7 years of follow-up, 8 of 9 with low initial radioactivity and 1 of 11 with normal radioactivity were diagnosed with a central LBD (LBD+) (P = 0.0009 by Fisher's exact test). Conversely, all 9 LBD+ participants had low 18F-dopamine-derived radioactivity before or at the time of diagnosis of a central LBD, whereas among 25 participants without a central LBD only 1 (4%) had persistently low radioactivity (P < 0.0001 by Fisher's exact test). Cardiac 18F-dopamine PET highly efficiently distinguishes at-risk individuals who are diagnosed subsequently with a central LBD from those who are not. gov NCT00775853. Division of Intramural Research, NIH, NINDS.