Active Community Environments and Health: The Relationship of Walkable and Safe Communities to Individual Health

13 pagesThe literature suggests that individuals will be healthier if they live in Active Community Environments that promote exercise and activity. Two key elements of such environments are walkability and safety. Examining data from the National Health and Nutrition Examination Survey III, 1988–1994 and using a multilevel analysis, we found that individuals who live in counties that are more walkable and have lower crime rates tended to walk more and to have lower body mass indices (BMIs) than people in less walkable and more crime-prone areas, even after controlling for a variety of individual variables related to health. Among lifelong residents of an area, lesser walkability and more crime were also associated with respondents reporting weightrelated chronic illness and lower ratings of their own health. The effect of high crime rates was substantially stronger for women than for men, and taking this interaction into account eliminated gender differences in walking, BMI, weight-related chronic conditions, and self-reported poor health. The results suggest that to promote activity and health, planners should consider community walkability, crime prevention, and safety

Is Sprawl Unhealthy? A Multilevel Analysis of the Relationship of Metropolitan Sprawl to the Health of Individuals

13 pagesThis article addresses the contention that urban sprawl influences general health through physical activity, obesity, and the presence of chronic disease. Data on individual health is obtained from the National Health and Nutrition Examination Survey III study in 29 primary metropolitan statistical areas, and data on sprawl are from Ewing et al. Using hierarchical modeling, the results indicate that even with strong controls for individual variables, residents of areas with more highly accessible and gridded street networks have higher health ratings. At the same time, residents of more densely populated urban areas have lower rated health, net of individual-level measures. Measures of sprawl have no significant relationship to frequency of walking, body mass index, or diagnosis of various chronic diseases. However, among those with chronic conditions, including hypertension, diabetes, and lung disease, those who live in areas with more highly connected street networks have higher rated health

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049