scholarly journals Cross-sectional analysis of educational inequalities in primary prevention statin use in UK Biobank

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319238
Author(s):  
Alice Rose Carter ◽  
Dipender Gill ◽  
George Davey Smith ◽  
Amy E Taylor ◽  
Neil M Davies ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Cardiovascular Prevention ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Unit Increase ◽  
Using Data ◽  
Large Prospective Cohort Study ◽  
Statin Use ◽  
Years Of Schooling

ObjectiveIdentify whether participants with lower education are less likely to report taking statins for primary cardiovascular prevention than those with higher education, but an equivalent increase in underlying cardiovascular risk.MethodsUsing data from a large prospective cohort study, UK Biobank, we calculated a QRISK3 cardiovascular risk score for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female participants; mean age 56 years). We used logistic regression to explore the association between (i) QRISK3 score and (ii) educational attainment on self-reported statin use. We then stratified the association between QRISK3 score and statin use, by educational attainment to test for interactions.ResultsThere was evidence of an interaction between QRISK3 score and educational attainment. Per unit increase in QRISK3 score, more educated individuals were more likely to report taking statins. In women with ≤7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (OR 1.07, 95% CI 1.07 to 1.07). In women with ≥20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14 to 1.15). Comparable ORs in men were 1.04 (95% CI 1.04 to 1.05) for ≤7 years of schooling and 1.08 (95% CI 1.08, 1.08) for ≥20 years of schooling.ConclusionPer unit increase in QRISK3 score, individuals with lower educational attainment were less likely to report using statins, likely contributing to health inequalities.

scholarly journals Educational inequalities in statin treatment for preventing cardiovascular disease: cross-sectional analysis of UK Biobank

2020 ◽  
Author(s):  
Alice R Carter ◽  
Dipender Gill ◽  
Richard Morris ◽  
George Davey Smith ◽  
Amy E Taylor ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Prescription Data ◽  
List Type ◽  
Uk Biobank ◽  
Cross Sectional ◽  
Statin Use ◽  
Years Of Schooling

AbstractImportanceThe most socioeconomically deprived individuals remain at the greatest risk of cardiovascular disease. Differences in risk adjusted use of statins between educational groups may contribute to these inequalities.ObjectiveTo identify whether people with lower levels of educational attainment are less likely to take statins for a given level of cardiovascular risk.DesignCross-sectional analysis of a population-based cohort study and linked longitudinal primary care records.SettingUK Biobank data from baseline assessment centres, linked primary care data and hospital episode statisticsParticipantsUK Biobank participants (N = 489 679, mean age = 56, 54% female) with complete data on educational attainment and self-reported medication use. Secondary analyses were carried out on a subsample of participants with linked primary care data (N = 217 675).Main outcome measuresStatin use self-reported to clinic nurses at baseline assessment centres, validated with linked prescription data in a subsample of participants in secondary analyses.ResultsGreater education was associated with lower statin use, whilst higher cardiovascular risk (assessed by QRISK3 score) was associated with higher statin use in both females and males. There was evidence of an interaction between QRISK3 and education, such that for the same QRISK3 score, people with more education were more likely to report taking statins. For example, in women with 7 years of schooling, equivalent to leaving school with no formal qualifications, a one unit increase in QRISK3 score was associated with a 6% higher odds of statin use (odds ratio (OR) 1.06, 95% CI 1.05, 1.06). In contrast, in women with 20 years of schooling, equivalent to obtaining a degree, a one unit increase in QRISK3 score was associated with an 11% higher odds of statin use (OR 1.11, 95% CI 1.10, 1.11). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for men with 7 years of schooling and (95% CI 1.07, 1.07) for men with 20 years of schooling.ConclusionsFor the same level of cardiovascular risk, individuals with lower educational attainment are less likely to receive statins, likely contributing to health inequalities.SummaryWhat is already known on this topic?Despite reductions in the rates of cardiovascular disease in high income countries, individuals who are the most socioeconomically deprived remain at the highest risk.Although intermediate lifestyle and behavioural risk factors explain some of this, much of the effect remains unexplained.What does this study add?For the same increase in QRISK3 score, the likelihood of statin use increased more in individuals with high educational attainment compared with individuals with lower educational attainment.These results were similar when using UK Biobank to derive QRISK3 scores and when using QRISK scores recorded in primary care records, and when using self-reported statin prescription data or prescription data from linked primary care records.The mechanisms leading to these differences are unknown, but both health seeking behaviours and clinical factors may contribute.

scholarly journals 145Educational inequalities in primary prevention statin use in UK Biobank

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Alice Carter ◽  
Dipender Gill ◽  
Richard Morris ◽  
George Davey Smith ◽  
Amy Taylor ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Educational Attainment ◽  
Self Report ◽  
Risk Scores ◽  
Uk Biobank ◽  
Preventive Medication ◽  
Unit Increase ◽  
Statin Use ◽  
Years Of Schooling

Abstract Background Socioeconomic inequalities in cardiovascular disease are well documented, but the association of socioeconomic position with treatment for cardiovascular disease prevention is unclear. Methods Using data from a large prospective cohort study, UK Biobank, we calculated QRISK3 cardiovascular risk scores for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female; mean age, 56). We used logistic regression to explore the association between i) QRISK3 score and ii) educational attainment on self-report statin use. We then stratified the association between QRISK3 score, and statin use by educational attainment to test for interactions. Results For an equivalent QRISK3 score, more educated individuals were more likely to report taking statins. In women with 7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (odds ratio (OR) 1.07, 95% CI 1.07, 1.07). In women with 20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14, 1.15). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for 7 years of schooling and 1.08 (95% CI 1.08, 1.08) for 20 years of schooling. Conclusions Individuals with less education are less likely to access statins conditional on cardiovascular risk factors. Key messages Inequalities in access to cardiovascular preventive medication are likely contributing to cardiovascular inequalities.

scholarly journals Evaluation of LDL goal achievement in statin consumption, south east of Iran

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malihe Aghasizadeh ◽  
Saeede Khosravi Bizhaem ◽  
Mahin Baniasadi ◽  
Mohammad Reza Khazdair ◽  
Toba Kazemi
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Goal Achievement ◽  
Moderate Intensity ◽  
Cvd Risk ◽  
Intensity Pattern ◽  
Cross Sectional ◽  
Low Intensity ◽  
Very High ◽  
Statin Use

AbstractLipid goal achievement and statin consumption were estimated at extreme/very-high/high/moderate and low cardiovascular risk categories. In the cross-sectional study, 585 patients treated with statin therapy referring to the heart clinic of Birjand were recruited. Patients were classified and examined LDL-C values and the proportion reaching targets according to the American Association of Clinical Endocrinologists guideline. Three patterns of statin use (high/moderate/low-intensity statin therapy) in all patients were examined and attainments of LDL-C goal in cardiovascular risk groups have been demonstrated. Over half the populations (57.6%) were in the very-high CVD risk group. The results showed that the proportion of patients meeting total LDL-C goal values according to the guidelines was 43.4%. The frequency of patient had achievement LDL goal lower in high-intensity pattern (N = 13, 2.3%), compared with moderate (N = 496, 86.1%) and low-intensity patterns (N = 67, 11.6%). In general, LDL-C goal achievement was greatest with moderate-intensity statin use. LDL-C reduction after statin consumption was estimated about one-third of the studied population. It seems likely that the achievement of a therapeutic target for serum lipids such as LDL-C improved is far more cost-effective and would be able to reach the target LDL as well changing the type and intensity of statins.

scholarly journals Association of Impaired Vascular Endothelial Function with Increased Cardiovascular Risk in Asymptomatic Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Qiuan Zhong ◽  
Qingjiao Nong ◽  
Baoyu Mao ◽  
Xue Pan ◽  
Liuren Meng
Keyword(s):  
Cardiovascular Risk ◽  
Endothelial Function ◽  
Cardiovascular Prevention ◽  
Prognostic Indicator ◽  
Cross Sectional Study ◽  
Vascular Endothelial ◽  
Inverse Association ◽  
Vascular Endothelial Function ◽  
Cvd Risk ◽  
Cross Sectional

Impaired vascular endothelial function has attracted attention as a prognostic indicator of cardiovascular prevention. The association between impaired endothelial function and cardiovascular risk in the asymptomatic population, however, has been poorly explored. We evaluated the association of brachial artery flow-mediated dilation (FMD) with Framingham-estimated 10-year cardiovascular disease (CVD) risk in subjects free of CVD, especially by cardiovascular risk profiles. In total, 680 adults aged 30-74 years were enrolled from Rongan and Rongshui of Liuzhou, Guangxi, China, through a cross-sectional study in 2015. In the full-adjusted model, the odds ratio for the estimated 10-year CVD risk comparing the low FMD (<6%) with the high FMD (≥10%) was 2.81 (95% confidence interval [CI]: 1.21, 6.53;Pfor trend = 0.03). In subgroup analyses, inverse associations between FMD and the estimated 10-year CVD risk were found in participants with specific characteristics. The adjusted odds ratios, comparing the 25th and the 75th percentiles of FMD, were 2.77 (95% CI: 1.54, 5.00) for aged ≥60 years, 1.77 (95% CI: 1.16, 2.70) for female, 1.59 (95% CI: 1.08, 2.35) for nonsmokers, 1.74 (95% CI: 1.02, 2.97) for hypertension, 1.59 (95% CI: 1.04, 2.44) for normal glycaemia, 2.03 (95% CI: 1.19, 3.48) for C-reactive protein ≥10 mg/L, and 1.85 (95% CI: 1.12, 3.06) for eGFR <106 mL/minute per 1.73 m2. Therefore, impaired endothelial function is associated with increased CVD risk in asymptomatic adults. This inverse association is more likely to exist in subjects with higher cardiovascular risk.

Abstract P071: Association Between Polyunsaturated Fat Consumption and Hypertension among Statin Users and Non-users

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
James N Kiage ◽  
Uchechukwu K Sampson ◽  
Loren Lipworth ◽  
Sergio Fazio ◽  
Qilu Yu ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Inverse Association ◽  
Cardiovascular Risk Reduction ◽  
Cross Sectional ◽  
Pufa Intake ◽  
Black And White ◽  
Beneficial Effects ◽  
Fat Consumption ◽  
Statin Use

Background: Numerous prospective studies suggest inverse associations between intake of polyunsaturated fatty acids (PUFA) and cardiovascular outcomes. However, recent randomized studies have failed to demonstrate these benefits. One of the prevailing hypotheses is that the beneficial effects of PUFA may now be masked by the widespread use of statins, which lower lipids and blood pressure and are potent modulators of cardiovascular risk. Hypothesis: We tested the hypothesis that the association between PUFA and hypertension varies by statin use. Methods and Results: We conducted a cross-sectional analysis based on 74,658 black and white men and women in the Southern Community Cohort Study. Intake of PUFA was assessed by a food-frequency questionnaire, while history of diagnosed hypertension and statin use were self-reported. The mean±SD age was 52±9 years, body mass index was 30±8 kg/m 2 , and energy intake from PUFA was 8.0±1.8%. Sixty percent of the participants were women and 68% were African Americans. Hypertension (55%), statin use (16%), smoking (40%) and alcohol use (55%) were common in this cohort. In an adjusted logistic model with hypertension as the dependent variable, there was no interaction between PUFA intake and statin therapy ( P =0.13), whereas a significant inverse association was evident between PUFA intake and hypertension among non-statin users ( P for trend = 0.03) but not among statin users ( P for trend = 0.36) ( Table ). Conclusion: In conclusion, these results support a beneficial effect of PUFA consumption on hypertension, which is only apparent in the absence of statin therapy. These findings underscore the need to stratify by statin therapy when randomizing participants to cardiovascular interventions and support the notion that PUFA may be important in cardiovascular risk reduction in patients where statin therapy is not an option.

scholarly journals Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study (Preprint)

2021 ◽  
Author(s):  
Atsushi Miyawaki ◽  
Takahiro Tabuchi ◽  
Michael K Ong ◽  
Yusuke Tsugawa
Keyword(s):  
Educational Attainment ◽  
Rural Areas ◽  
Urban Areas ◽  
Income Level ◽  
Cross Sectional Study ◽  
Internet Survey ◽  
Older Individuals ◽  
Cross Sectional ◽  
Using Data ◽  
University Degree

BACKGROUND The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. OBJECTIVE We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. METHODS Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. RESULTS Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; <i>P</i>&lt;.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; <i>P</i>&lt;.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; <i>P</i>&lt;.001). Disparities in telemedicine use by income level were not observed in either time period. CONCLUSIONS In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic.

scholarly journals To what extent is the altitude at which we live associated with 10-year cardiovascular risk?

2021 ◽  
Author(s):  
Andrea Cevallos Guerrero ◽  
Heidi Angela Fernández ◽  
Ángela León-Cáceres ◽  
Luciana Armijos-Acurio ◽  
Carlos Erazo ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Health ◽  
Cross Sectional Study ◽  
National Health Survey ◽  
Incidence Rates ◽  
Income Quintile ◽  
Public Health Perspective ◽  
Cross Sectional ◽  
Using Data ◽  
Laboratory Biomarkers

AbstractIntroductionThere is evidence that demonstrates lower incidence rates of cardiometabolic factors at the highlands. There are no studies which correlate the altitude with formally calculated cardiovascular risk by a meter-by-meter approach. Under the hypothesis that cardiovascular risk is inversely associated with altitude, this study was aimed to assess such association.Materials and methodsCross sectional study using data from the Ecuadorian National Health Survey of 2012. We analyzed available information of adults of ≥ 40 to 60 years old who have sociodemographic, anthropometric, cardiovascular risk factors, and laboratory biomarkers that were included in the survey. We assessed the independent association between altitude of the housing in which survey participants lived at, on a meter-by-meter approach, and cardiovascular health risk at ten years, formally calculated by Framingham equations.ResultsLinear regression model showed that participants had 0.0005 % less probability of developing cardiovascular disease at 10 years per each increase in a meter in the altitude that participants live at (p<0.001), adjusted for sex, age, ethnicity, educational level, availability of social security, immigrants in family, area, income quintile, overcrowding (≥ 7 inhabitants in the house), any alcohol consumption, history of hypertension, body mass index, hematocrit, and triglycerides.ConclusionFrom a public health perspective, altitude at which individuals live is an important health determinant of cardiovascular risk. Specifically, per each increase of 1000 m in the altitude that people live at, there is a reduction of almost half a percentual point in the cardiovascular risk at 10 years.

scholarly journals Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRÉ Investigation

2008 ◽  
Vol 68 (9) ◽  
pp. 1395-1400 ◽  
Author(s):  
V P van Halm ◽  
M J L Peters ◽  
A E Voskuyl ◽  
M Boers ◽  
W F Lems ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Prevention ◽  
Arterial Disease ◽  
Population Based ◽  
Cross Sectional Study ◽  
Prevalence Odds Ratio ◽  
Cross Sectional

Objectives:Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk, but the magnitude of this risk is not known precisely. A study was undertaken to investigate the associations between RA and type 2 diabetes (DM2), a well-established cardiovascular risk factor, on the one hand, and cardiovascular disease (CVD) on the other.Methods:The prevalence of CVD (coronary, cerebral and peripheral arterial disease) was determined in 353 randomly selected outpatients with RA (diagnosed between 1989 and 2001, aged 50–75 years; the CARRÉ study) and in participants of a population-based cohort study on diabetes and CVD (the Hoorn study). Patients with RA with normal fasting glucose levels from the CARRÉ study (RA, n = 294) were compared with individuals from the Hoorn study with normal glucose metabolism (non-diabetic, n = 258) and individuals with DM2 (DM2, n = 194).Results:The prevalence of CVD was 5.0% (95% CI 2.3% to 7.7%) in the non-diabetic group, 12.4% (95% CI 7.5% to 17.3%) in the DM2 group and 12.9% (95% CI 8.8% to 17.0%) in those with RA. With non-diabetic individuals as the reference category, the age- and gender-adjusted prevalence odds ratio (OR) for CVD was 2.3 (95% CI 1.1 to 4.7) for individuals with DM2 and 3.1 (95% CI 1.6 to 6.1) for those with RA. There was an attenuation of the prevalences after adjustment for conventional cardiovascular risk factors (OR 2.0 (95% CI 0.9 to 4.5) and 2.7 (95% CI 1.2 to 5.9), respectively).Conclusions:The prevalence of CVD in RA is increased to an extent that is at least comparable to that of DM2. This should have implications for primary cardiovascular prevention strategies in RA.

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