Estimates of Mortality Benefit From Ideal Cardiovascular Health Metrics: A Dose Response Meta-Analysis

Background Several studies have shown an inverse relationship between ideal cardiovascular health (CVH) and mortality. However, there are no studies that pool these data to show the shape of the relationship and quantify the mortality benefit from ideal CVH. Methods and Results We conducted a systematic internet literature search of multiple databases including MEDLINE, Web of Science, Embase, CINAHL, and Scopus for longitudinal studies assessing the relationship between ideal CVH and mortality in adults, published between January 1, 2010, and May 31, 2017. We included studies that assessed the relationship between ideal CVH and mortality in populations that were initially free of cardiovascular disease. We conducted a dose‐response meta‐analysis generating both study‐specific and pooled trends from the correlated log hazard ratio estimates of mortality across categories of ideal CVH metrics. A total of 6 studies were included in the meta‐analysis. All of the studies indicated a linear decrease in (cardiovascular disease and all‐cause) mortality with increasing ideal CVH metrics. Overall, each unit increase in CVH metrics was associated with a pooled hazard ratio for cardiovascular disease mortality of 0.81 (95% confidence interval, 0.75–0.87), while each unit increase in ideal CVH metrics was associated with a pooled hazard ratio of 0.89 (95% confidence interval, 0.86–0.93) for all‐cause mortality. Conclusions Our meta‐analysis showed a strong inverse linear dose‐response relationship between ideal CVH metrics and both all‐cause and cardiovascular disease–related mortality. This study suggests that even modest improvements in CVH is associated with substantial mortality benefit, thus providing a strong public health message advocating for even the smallest improvements in lifestyle

The relationship of erectile dysfunction and subclinical cardiovascular disease: A systematic review and meta-analysis

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) and CVD mortality. However, the relationship between ED and subclinical CVD is less clear. We synthesized the available data on the association of ED and measures of subclinical CVD. We searched multiple databases for published literature on studies examining the association of ED and measures of subclinical CVD across four domains: endothelial dysfunction measured by flow-mediated dilation (FMD), carotid intima–media thickness (cIMT), coronary artery calcification (CAC), and other measures of vascular function such as the ankle–brachial index, toe–brachial index, and pulse wave velocity. We conducted random effects meta-analysis and meta-regression on studies that examined an ED relationship with FMD (15 studies; 2025 participants) and cIMT (12 studies; 1264 participants). ED was associated with a 2.64 percentage-point reduction in FMD compared to those without ED (95% CI: –3.12, −2.15). Persons with ED also had a 0.09-mm (95% CI: 0.06, 0.12) higher cIMT than those without ED. In subgroup meta-analyses, the mean age of the study population, study quality, ED assessment questionnaire (IIEF-5 or IIEF-15), or the publication date did not significantly affect the relationship between ED and cIMT or between ED and FMD. The results for the association of ED and CAC were inconclusive. In conclusion, this study confirms an association between ED and subclinical CVD and may shed additional light on the shared mechanisms between ED and CVD, underscoring the importance of aggressive CVD risk assessment and management in persons with ED

Lipoprotein sub-fractions by ion-mobility analysis and its association with subclinical coronary atherosclerosis in high-risk individuals

Aims: There is limited knowledge about the association of lipoprotein particles and markers of coronary atherosclerosis such as coronary artery calcification (CAC) in relatively young high-risk persons. This study examines the association of lipoprotein subfractions and CAC in high cardiometabolic risk individuals. Methods: The study presents analysis from baseline data of a randomized trial targeted at high-risk workers. Employees of Baptist Health South Florida with metabolic syndrome or diabetes were recruited. At baseline, all 182 participants had lipoprotein subfraction analysis using the ion mobility technique and participants above 35 years (N =170) had CAC test done. Principal components (PC) were computed for the combination of lipoprotein subclasses. Multiple bootstrapped regression analyses (BSA) were conducted to assess the relationship between lipoprotein subfractions and CAC. Results: The study population (N=170) was largely female (84%) with a mean age of 58 years. Three PCs accounted for 88% variation in the sample. PC2, with main contributions from VLDL particles in the positive direction and large LDL particles in the negative direction was associated with a 22% increase in CAC odds (P value ＜0.05 in 100% of BSA). PC3, with main contributions from HDL lipoprotein particles in the positive direction and small/medium LDL and large IDL particles in the negative direction, was associated with a 9% reduction in CAC odds (P＜0.05 in 88% of BSA). PC1, which had approximately even contributions from HDL, LDL, IDL and VLDL lipoprotein subfractions in the positive direction, was not associated with CAC. Conclusion: In a relatively young but high-risk population, a lipoprotein profile predominated by triglyceride-rich lipoproteins was associated with increased risk of CAC, while one predominated by HDL lipoproteins offered modest protection. Lipoprotein sub-fraction analysis may help to further discriminate patients who require more intensive cardiovascular work-up and treatment

Economic Impact of Moderate‐Vigorous Physical Activity Among Those With and Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey

Background Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate‐vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD. Methods and Results The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two‐part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures per capita. The final study sample included 26 239 surveyed individuals. Overall, 47% engaged in moderate‐vigorous PA ≥30 minutes, ≥5 days/week, translating to 111.5 million adults in the United States stratifying by CVD status; 32% reported moderate‐vigorous PA among those with CVD versus 49% without CVD. Generally, participants reporting moderate‐vigorous PA incurred significantly lower health care expenditures and resource utilization, displaying a step‐wise lower total annual health care expenditure as moving from CVD to non‐CVD (and each CRF category). Conclusions Moderate‐vigorous PA ≥30 minutes, ≥5 days/week is associated with significantly lower health care spending and resource utilization among individuals with and without established CVD

Abstract 102: The Association of Sleep Duration with Healthcare Expenditure Across Cardiovascular Health Profiles: The Baptist Health South Florida Employee Study

Introduction: Despite the substantial evidence of health benefits associated with adequate sleep duration, little is known about the relationship between sleep duration and healthcare expenditure. ..

Abstract 109: Differences in Cardiovascular Health: Why Hispanic Women Fare Better Then Non Hispanic Women: The Baptist Health South Florida Employee Study

Background: In the United States, Hispanic females have the highest life expectancy, 87 years compared to 81years for white females, 78 years for African-American females and 81 years for Hispanic males. Other ethnic and gender discrepancies are a well addressed issue in cardiac outcomes, but almost nothing is known about the potential cofounders of this striking difference. In this study, we shed light on the variables that potentially relate to the underlying differences in cardiovascular health (CVH) using data from female employees of Baptist Health South Florida, a large nonprofit health care organization. Methods: Female employees (7683) with complete data from an annual health fair and health risk assessment (HRA) for 2014 were included in this study. Mean age was 43 ±12 years. We compared results for 4235 Hispanic females (55.1%) to non-Hispanic females (44.9%) for 21 cardiovascular health (CVH) related characteristics, grouped into biometric measurements (12), knowledge (4) and attitudes (5). All variables were dichotomized and Fisher exact test was used to test for differences. Odds ratios are used to express importance of differences and spread of data. Results: Hispanic females demonstrated significant advantage over non-Hispanic females in 10 of 12 CVH related measurements grouped into disease conditions and risk factors. Of note, Hispanic women were 62% more likely to have 5 or more CVH metrics. There was no difference in any of the 4 knowledge questions however, Hispanic females had healthier attitudes. They were significantly less inclined to want to increase their time of exercise, and they were also less likely to worry about their weight. In summary, Hispanic females had better CVH related biometric and behavioral profiles in 15 of 21 variables compared to non-Hispanic females. Conclusion: In this presumably healthy working population with equal access to health care and benefits, Hispanic females showed much better values of cardiac risk factors, accompanied with positive attitude toward life. Our findings point to potential pathways of longevity and improved CVH among Hispanic females. ![][1] [1]: /embed/graphic-1.gi

Gaps in provider lifestyle counseling and its adherence among obese adults with prediabetes and diabetes in the United States

Obesity is an epidemic affecting about 40% of the US adult population. Tracking with the obesity epidemic is an increase in the prevalence of diabetes and pre-diabetes. Both pre-diabetes and diabetes are often coexistent with obesity and contribute to an increased total and cardiovascular disease related morbidity and mortality. Lifestyle modification is usually the first step in management among individuals with obesity and/or pre-diabetes or diabetes, but remains an unfulfilled potential by healthcare providers to promote healthier lifestyles in obese patients. We aimed to describe the current patterns of lifestyle counseling (diet, physical activity, and weight loss) and their adherence by patients with obesity in the US using the National Health Interview Survey, 2016-2017. We analyzed these patterns among individuals with pre-diabetes and diabetes. We found that, regardless of pre-diabetes or diabetes status, almost 1 in 3 individuals with mild obesity (BMI ≥ 30 & \u3c 35) and 1 in 4 with severe obesity (BMI ≥ 35) reported lack of lifestyle counseling from healthcare providers regarding diet or physical activity, and 2 in 3 individuals with any level of obesity reported lack of referral/counsel concerning weight loss programs. Lifestyle counseling and its compliance among obese adults from a contemporary dataset in the US is still suboptimal. This study highlights the gaps in the implementation of the AHA/ACC 2013 guidelines on management of obesity among adults particularly among those with metabolic disease, who would derive the greatest benefit

Habitual sleep duration and its relationship with cardiovascular health, healthcare costs, and resource utilization in a working population

Objective: Little is known about the relationship between habitual sleep duration, cardiovascular health (CVH) and their impact on healthcare costs and resource utilization. We describe the relationship between sleep duration and ideal CVH, and the associated burden of healthcare expenditure and utilization in a large South Florida employee population free from known cardiovascular disease. Methods: The study used data obtained from a 2014 voluntary Health Risk Assessment among 8629 adult employees of Baptist Health South Florida. Health expenditures and resource utilization information were obtained through medical claims data. Frequencies of the individual and cumulative CVH metrics across sleep duration were computed. Mean and marginal per-capita healthcare expenditures were estimated. Results: The mean age was 43 years, 57% were of Hispanic ethnicity. Persons with 6-8.9hours and ≥9 hours of sleep were significantly more likely to report optimal goals for diet, physical activity, body mass index, and blood pressure when compared to those who slept less than 6 hours. Compared to those who slept less than 6 hours, those sleeping 6-8.9hours and ≥9hours had approximately 2- (odds ratio 2.1, 95% confidence interval: 1.9-3.0) and 3-times (odds ratio 3.0, 95% confidence interval: 1.6-5.6) higher odds of optimal CVH. Both groups with 6 or more hours of sleep had lower total per-capita expenditure (approximately $2000 and$2700 respectively), lower odds of visiting an emergency room, or being hospitalized compared to those who slept \u3c 6 hours. Conclusion: Sleeping 6 or more hours was associated with better CVH, lower healthcare expenditures, and reduced healthcare resource utilization