Greater acculturation is associated with poorer cardiovascular health in the multi-ethnic study of atherosclerosis

BACKGROUND: Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association’s 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi-ethnic cohort of US adults free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: This was a cross-sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/eth-nicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign-born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non-Hispanic White-, 26% non-Hispanic Black-, 12% Chinese-and 22% Hispanic-Americans. US-born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50– 0.79], P\u3c0.001) compared with foreign-born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08– 3.36], P=0.03; and 1.65 [1.04– 2.63], P=0.03, respectively). Foreign-born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43– 0.91], P=0.02). CONCLUSIONS: Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH

Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND: Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi‐ethnic cohort of US adults free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: This was a cross‐sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign‐born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non‐Hispanic White‐, 26% non‐Hispanic Black‐, 12% Chinese‐ and 22% Hispanic‐Americans. US‐born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50–0.79], P<0.001) compared with foreign‐born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08–3.36], P=0.03; and 1.65 [1.04–2.63], P=0.03, respectively). Foreign‐born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43–0.91], P=0.02). CONCLUSIONS: Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH

National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers

Importance: Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates. Objectives: To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States. Design, Setting, and Participants: This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year’s National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures. Main Outcomes and Measures: Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures. Results: The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2% (95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost,$46 million) in 2006 to 2007 to $73 million (out-of-pocket cost,$9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications. Conclusions and Relevance: The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines

Relation of Serum Vitamin D to Risk of Mitral Annular and Aortic Valve Calcium (from the Multi-Ethnic Study of Atherosclerosis)

Serum 25-hydroxyvitamin D [25(OH)D] concentration has been identified as a possible modifiable risk factor for cardiovascular disease (CVD). We hypothesized that serum 25(OH)D concentration would be associated with calcifications of the left-sided heart valves, which are markers of CVD risk. Aortic valve calcium (AVC) and mitral annular calcium (MAC) were quantified from cardiac computed tomography scans performed on 5,530 Multi-Ethnic Study of Atherosclerosis participants at the baseline examination (2000 to 2002) and at a follow-up visit at either Examination 2 (2002 to 2004) or Examination 3 (2004 to 2005). 25(OH)D was measured from serum samples collected at the baseline examination. Using relative risk regression, we evaluated the multivariable-adjusted risk of prevalent and incident AVC and MAC in this ethnically diverse population free of clinical CVD at baseline. The mean age of participants was 62 ± 10 years; 53% were women, 40% white, 26% black, 21% Hispanic, and 12% Chinese. Prevalent AVC and MAC were observed in 12% and 9% of study sample, respectively. There were no significant associations between 25(OH)D and prevalent AVC or MAC. Over a mean follow-up of 2.5 years, 4% developed incident AVC and 5% developed incident MAC. After adjusting for demographic variables, each 10 ng/ml higher serum 25(OH)D was associated with a 15% (relative risk 0.85, 95% confidence interval 0.74 to 0.98) lower risk of incident MAC but not AVC. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors. Results suggest a possible link between serum 25(OH)D and the risk for incident MAC, but future studies with longer follow-up are needed to further test this association

Trends and Costs Associated With Suboptimal Physical Activity Among US Women With Cardiovascular Disease

IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of death and disability amongwomen. Achievement of recommended physical activity (PA) levels is an essential component ofCVD management.OBJECTIVE: To describe trends, sociodemographic factors, and health care expenditures associatedwith suboptimal PA among a nationally representative sample of US women with CVD.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used serial data from theMedical Expenditure Panel Survey from 2006 through 2015. The analyses were conducted in August2018. Women who had self-reported and/or International Classification of Diseases, Ninth Revision,diagnosis of CVD were included.MAIN OUTCOMES AND MEASURES: Recommended PA was defined as 30 minutes or more ofmoderate- to vigorous-intensity exercise, 5 or more days per week. Weighted logistic regression wasused to examine the associations of various sociodemographic factors with suboptimal PA, adjustedfor comorbidities. A 2-part econometric model was used to assess health care expenditures.RESULTS: A total of 18 027 women were included in this study. The results were weighted to provideestimates for approximately 19.5 million adult women in the United States with CVD (mean [SD] age,60.4 [16.9] years). More than half of the women with CVD reported suboptimal PA, a trend thatincreased during the 10-year period, with 58.2% (95% CI, 55.9%-60.5%) of participants reportingsuboptimal PA in 2006-2007 vs 61.9% (95% CI, 59.7%-64.2%) in 2014-2015 (P = .004). Theproportion of women with suboptimal PA differed by sociodemographic factors. In adjusted models,compared with non-Hispanic white women, African American women (odds ratio, 1.22; 95% CI,1.08-1.38) and Hispanic women (odds ratio, 1.33; 95% CI, 1.13-1.58) were more likely to havesuboptimal PA. Women from low- or very low-income strata (compared with high-income strata),enrolled in public insurance (compared with private insurance), and with less than high schooleducation (compared with at least some college education) were more likely to have suboptimal PA.Health care costs among women with CVD with suboptimal PA were higher compared with thoseamong women who met the recommended PA, and this increased through time, from a mean totalhealth care expenditure of $12 724 (95$11 627-$13 821) in 2006-2007 to$14 820 (95% CI,$13 521-$16 119) in 2014-2015.CONCLUSIONS AND RELEVANCE: The proportion of women with CVD not meeting recommendedPA is high and increasing, particularly among certain racial/ethnic and socioeconomic groups, and isassociated with significant health care costs. More must be done to improve PA for secondaryprevention and reduction of expenditures among women with CVD

Nondietary cardiovascular health metrics with patient experience and loss of productivity among US adults without cardiovascular disease: The medical expenditure panel survey 2006 to 2015

Background: The American Heart Association 2020 Impact Goals aimed to promote population health through emphasis on cardiovascular health (CVH). We examined the association between nondietary CVH metrics and patient-reported outcomes among a nationally representative sample of US adults without cardiovascular disease.Methods and Results: We included adults aged ≥18 years who participated in the Medical Expenditure Panel Survey between 2006 and 2015. CVH metrics were scored 1 point for each of the following: not smoking, being physically active, normal body mass index, no hypertension, no diabetes mellitus, and no dyslipidemia, or 0 points if otherwise. Diet was not assessed in Medical Expenditure Panel Survey. Patient-reported outcomes were obtained by telephone survey and included questions pertaining to patient experience and health-related quality of life. Regression models were used to compare patient-reported outcomes based on CVH, adjusting for sociodemographic factors and comorbidities. There were 177 421 Medical Expenditure Panel Survey participants (mean age, 45 [17] years) representing ~187 million US adults without cardiovascular disease. About 12% (~21 million US adults) had poor CVH. Compared with individuals with optimal CVH, those with poor CVH had higher odds of reporting poor patient-provider communication (odds ratio, 1.14; 95% CI, 1.05-1.24), poor healthcare satisfaction (odds ratio, 1.15; 95% CI, 1.08-1.22), poor perception of health (odds ratio, 5.89; 95% CI, 5.35-6.49), at least 2 disability days off work (odds ratio, 1.39; 95% CI, 1.30-1.48), and lower health-related quality of life scores.Conclusions: Among US adults without cardiovascular disease, meeting a lower number of ideal CVH metrics is associated with poor patient-reported healthcare experience, poor perception of health, and lower health-related quality of life. Preventive measures aimed at optimizing ideal CVH metrics may improve patient-reported outcomes among this population