Abstract 16923: Healthy Lifestyle is Inversely Associated With All-Cause Mortality Irrespective of Medication Burden

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Neil Kelly ◽  
Orysya Soroka ◽  
Chukwuma Onyebeke ◽  
Laura Pinheiro ◽  
Samprit Banerjee ◽  
...  
Keyword(s):  
Racial Differences ◽  
Proportional Hazards ◽  
Sedentary Lifestyle ◽  
Healthy Lifestyle ◽  
Cox Proportional Hazards ◽  
Healthy Behaviors ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality ◽  
High Adherence ◽  
Regards Study

Introduction: The benefits of a healthy lifestyle in the context of a high disease and medication burden are not clear. Hypothesis: Healthy lifestyle is inversely associated with all-cause mortality among adults with high medication burden. Methods: We examined participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Exposure variables were 4 healthy behaviors: adherence to a Mediterranean diet, physical activity, smoking abstinence, and sedentary lifestyle avoidance (low TV time). Each behavior was scored from 0-2, where 0 indicated low adherence and 2 indicated high adherence. We also examined a cumulative Health Behavior Score (HBS) based on the sum of individual behavior scores (range 0-8). The main outcome was all-cause mortality. To examine the association between each behavior and mortality, we estimated Cox proportional hazards models for each medication burden stratum (no polypharmacy: 0-4 medications at baseline; polypharmacy: 5-9; hyperpolypharmacy: ≥ 10), adjusting for socio-demographics, health status, comorbid conditions, and medication adherence. Results: Among 20,417 participants (9.8 ± 3.8 years followup), mean age was 64.8 ± 9.2 years, and 56% were women. At baseline, 44% had no polypharmacy, 39% had polypharmacy, and 17% had hyperpolypharmacy. Mortality increased with increasing medication burden (no polypharmacy: 19.1%; polypharmacy: 29.7%; hyperpolypharmacy: 41.3%). The highest score for each behavior was inversely associated with all-cause mortality in all 3 strata. The highest HBS for each stratum conferred substantial benefit (no polypharmacy: HR 0.52 (95% CI 0.45-0.61); polypharmacy: HR 0.55 (95% CI 0.49-0.63); hyperpolypharmacy HR 0.69 (95% CI 0.58-0.82)) (Table). Conclusions: Healthy lifestyle was inversely associated with all-cause mortality irrespective of medication burden, supporting the value of healthy lifestyle counseling even among adults with high medication burden.

scholarly journals High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

2013 ◽  
Vol 2 ◽  
Author(s):  
Suzanne E. Judd ◽  
Kristal J. Aaron ◽  
Abraham J. Letter ◽  
Paul Muntner ◽  
Nancy S. Jenny ◽  
...  
Keyword(s):  
Racial Differences ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Black And White ◽  
Cox Proportional Hazards Models ◽  
Group Data ◽  
All Cause Mortality ◽  
Regards Study

AbstractIncreased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.

Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Yulia Khodneva ◽  
Daniel Lackland ◽  
Ronald Prineas ◽  
Monika Safford
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Models ◽  
Chd Risk ◽  
Regards Study ◽  
Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

Abstract P316: Multiple Vulnerabilities to Health Disparities and Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Monika M Safford ◽  
Laura Pinheiro ◽  
Madeline Sterling ◽  
Joshua Richman ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Health Disparities ◽  
Racial Differences ◽  
Low Income ◽  
Proportional Hazards ◽  
Health Management ◽  
Cox Proportional Hazards ◽  
Southeastern Us ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Regards Study

Social determinants contribute to disparities in incident CHD but it is not known if they have an additive effect. We hypothesized that having more socially determined vulnerabilities to health disparities is associated with increased risk of incident CHD in the REGARDS study, a large biracial prospective cohort with physiological and survey measures. Experts adjudicated incident fatal and nonfatal CHD over 10 years of follow-up. Vulnerabilities included black race, low education, low income, and Southeastern US residence. The risks for CHD outcomes associated with 1, 2, and 3+ vs 0 vulnerabilities were calculated with Cox proportional hazards models adjusted for medical conditions, functional status, health behaviors, and physiologic variables. Of the 19,645 participants free of CHD at baseline (mean age 64 years, 57% women), 16% had 0 vulnerabilities, 36% had 1, 29% had 2, and 18% had 3+. Increasing numbers of vulnerabilities were associated with higher incidence (Figure) and risk of CHD that attenuated somewhat after multivariable adjustment (Table). These findings may provide a method of risk stratification useful for population health management.

Abstract 19554: Lipoprotein(a) and Risk of Ischemic Stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristine S Alexander ◽  
Neil A Zakai ◽  
Fred Unverzagt ◽  
Virginia Wadley ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Continuous Variable ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Lipoprotein A ◽  
Cox Proportional Hazards Models ◽  
Regards Study

Background: Increased lipoprotein (a) (Lp(a)) is associated with coronary risk, but links with stroke have been less consistent. Blacks have 2-4-fold higher Lp(a) levels than whites, and have higher stroke incidence than whites, but have been under-represented in studies of Lp(a) and stroke to date. Hypothesis: Lp(a) is a risk factor for ischemic stroke, and this risk differs by race. Methods: REGARDS recruited 30,239 black and white U.S. men and women in 2003-7 to study regional and racial differences in stroke mortality. We measured Lp(a) by immunonepholometric assay in 572 cases of incident ischemic stroke and a 1,104-person cohort random sample. The hazard ratio of stroke by baseline Lp(a) was calculated using Cox proportional hazards models, stratified by race. Lp(a) was modeled both as a continuous variable (per sex- and race-specific SD) and in sex- and race-specific quartiles, given known differences in distributions by race and sex. Results: As shown in the Figure, being in the 4 th vs 1 st Lp(a) quartile was associated with ischemic stroke in black but not white participants, adjusted for age and sex (Model 1). The HRs were essentially unchanged with added adjustment for stroke risk factors (Model 2). There was no significant association between Lp(a) as a continuous variable and stroke, though race-specific patterns were similar. There remained no association between Lp(a) and stroke in whites when we used the sex- and race-specific 90 th percentile as a cut-off (HR: 0.91 95% CI: 0.52, 1.60). Discussion: Lp(a) was associated with ischemic stroke risk in black but not white REGARDS participants, this might partly explain the black/white disparity in stroke. Further studies in racially diverse groups are necessary to confirm these findings. Figure 1. Hazard ratios for Lp(a) and stroke in blacks and whites, per quartile (compared with first quartile) and SD.

Abstract P351: Inflammation and Stroke Risk in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Nancy S Jenny ◽  
Peter Callas ◽  
Neil A Zakai ◽  
Leslie McClure ◽  
Suzanne Judd ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stroke Patients ◽  
Stroke Risk Factors ◽  
Cox Proportional Hazards Models ◽  
Regards Study

Background: Levels of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 and the anti-inflammatory cytokine IL-10 are altered in acute stroke patients compared to controls. However, results for IL-10 are inconsistent (higher in stroke patients compared to controls in some studies and decreased in others) and very few studies have examined associations of these biomarkers with risk of incident stroke. Methods: We examined associations of baseline levels of IL-6, IL-8 and IL-10 with stroke risk factors and risk of incident stroke in 1,572 white and black men and women from the REGARDS Study; an observational cohort of 30,239 adults followed for 5 years. Among those without prebaseline stroke, stroke cases (n=592, 53% men, 59% white, mean age 70 years) were compared to a cohort random sample (n=980, 44% men, 58% white, mean age 65 years). We used Cox proportional hazards models to examine associations of biomarkers with incident stroke. Hazard ratios (HR; 95% confidence intervals) for highest compared to lowest quartile for each biomarker are presented. Results: Baseline IL-6 was significantly higher in incident stroke cases compared to the cohort sample (p<0.001) while IL-8 and IL-10 levels did not vary significantly (p>0.05 for both). Adjusting for age, sex and race, IL-6 was higher in blacks compared to whites and higher in current smokers compared to never/former smokers (all p≤0.01). IL-6 was inversely associated with physical activity, alcohol use and education (all p≤0.01). IL-8 and IL-10 did not vary significantly with the risk factors examined. Adjusting for age, sex and race, the HR for risk of incident stroke in those in the highest compared to lowest quartile of IL-6 was 2.4 (1.6-3.4). HRs for IL-8 and IL-10 were 1.5 (1.0-2.1) and 1.4 (1.0-1.9), respectively. Adjusting for Framingham stroke risk factors and history of coronary heart disease, only IL-6 remained significantly associated with stroke risk (HR 2.0; 1.3-3.2). HRs for IL-8 and IL-10 were 1.1 (0.7-1.6) and 1.2 (0.8-1.8), respectively. IL-6 remained significantly associated with stroke risk when C-reactive protein was added to the model (HR 1.7; 1.1-2.7). Associations did not differ by race. Conclusions: In this population-based sample of US black and white adults, IL-6, but not IL-8 or IL-10, was associated with stroke risk factors and risk of incident stroke. Further study is needed on the clinical utility of IL-6 measurement in stroke risk assessment.

Abstract MP02: Quantifying The Impact Of Maintenance And Changes Of Lifestyles On Risk Of Cardiovascular Disease And All-cause Mortality - The Doetinchem Cohort Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Gerben Hulsegge ◽  
Martha L Daviglus ◽  
Yvonne T van der Schouw ◽  
Henriëtte A Smit ◽  
W M Verschuren
Keyword(s):  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Healthy Lifestyle ◽  
Single Point ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Physically Active ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality ◽  
The Impact

Background: It is not fully understood to what extent changes in lifestyle over time influence the risk of cardiovascular disease (CVD) and death among healthy adults, since most studies assessed lifestyle at a single point in time. Objective: To investigate the association of maintenance and changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality. Methods: Healthy lifestyle factors (HLF), i.e., healthy diet, physically active, not smoking, moderate alcohol consumption, sufficient sleep duration, and normal weight were assessed among 5,290 CVD- and cancer-free adults aged 25-65 years in 1993-1997 (baseline examination). Participants were categorized as having unhealthy (0-2 HLF), moderately healthy (3-4 HLF), or healthy (5-6 HLF) lifestyles. They were subdivided as maintained, improved, or deteriorated HLF 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CI) for combined fatal and non-fatal CVD and all-cause mortality following the risk-change period were estimated using Cox proportional hazards models. Results: Individuals who maintained their HLF had 62% lower risk of CVD (HR: 0.38, 95%CI: 0.23-0.64) (Figure 1) and 54% for all-cause mortality (HR: 0.46, 95%CI: 0.27-0.77) than those who maintained unhealthy lifestyles. In general, compared to maintenance of HLF, improvement and deterioration of HLF were associated with better or worse HRs than their baseline risks for CVD and all-cause mortality, respectively. Conclusion: Maintenance of a healthy lifestyle is associated with significant and independent low risk of CVD and all-cause mortality. Effort is needed to improve the adoption and maintenance of a healthy lifestyle.

scholarly journals Joint Association of Modifiable Lifestyle and Metabolic Health Status with Incidence of Cardiovascular Diabetes and All-Cause mortality: A Perspective Cohort Study

2020 ◽  
Author(s):  
Yingting Zuo ◽  
Haibin Li ◽  
Shuohua Chen ◽  
Xue Tian ◽  
Dapeng Mo ◽  
...  
Keyword(s):  
Health Status ◽  
Proportional Hazards ◽  
Healthy Lifestyle ◽  
Cox Proportional Hazards ◽  
Metabolic Health ◽  
Metabolic Risk ◽  
Cvd Risk ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality ◽  
Joint Associations

Abstract Background We investigated the joint associations of modifiable lifestyle and metabolic factors with incident cardiovascular disease (CVD) and all-cause mortality.MethodsThis study included 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of CVD at baseline from Kailuan study during 2006 to 2007 and followed them until new-onset CVD event, death or December 31, 2017. Baseline metabolic health status was assessed by Adult Treatment Panel-III (ATP-III) criteria and five lifestyle factors was collected using a self-reported questionnaire. We performed Cox proportional hazards models to evaluate the joint associations.Results During a median follow-up of 11.03 years, we observed 6,590 CVD events and 9,218 all-cause mortality. Participants within more metabolic risk components and least healthy lifestyle had the highest CVD risk (hazard ratio [HR] 2.06 [95% CI 1.77-2.39]) and mortality risk (HR 1.53 [95% CI 1.31-1.78]), as compared with the less metabolic risk components and most healthy lifestyle group. Compared with the most healthy lifestyle, the HR of CVD for participants with least healthy lifestyle was 1.26 (95% CI 1.17–1.37) in the category with low metabolic risk, 1.16 (95% CI 1.03–1.31) and 1.07 (95% CI 0.90–1.27) for those with medium and high metabolic risk, respectively.ConclusionsWe showed that healthy lifestyle and metabolic health were associated with a lower risk of CVD and all-cause mortality. The association between metabolic risk and the risk of CVD was not modified by healthy lifestyle. Our results indicated that healthy lifestyle should be promoted even for people with high metabolic risk.

Abstract 187: Electrocardiographic Heart Rate-corrected Qt Interval And Risk Of Stroke In The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Elsayed Z Soliman ◽  
George Howard ◽  
George Howard ◽  
Mary Cushman ◽  
Brett Kissela ◽  
...  
Keyword(s):  
Heart Rate ◽  
Racial Differences ◽  
Qt Interval ◽  
Proportional Hazards ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Corrected Qt Interval ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Regards Study

Background: Prolongation of heart rate-corrected QT interval (QTc) is a well established predictor of cardiovascular morbidity and mortality. Little is known, however, about the relationship between this simple electrocardiographic (ECG) marker and risk of stroke. Methods: A total of 27,411 participants aged > 45 years without prior stroke from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. QTc was calculated using Framingham formula (QTcFram). Stroke cases were identified and adjudicated during an up to 7 years of follow-up (median 2.7 years). Cox proportional hazards analysis was used to estimate the hazard ratios for incident stroke associated with prolonged QTcFram interval (vs. normal) and per 1 standard deviation (SD) increase, separately, in a series of incremental models. Results: The risk of incident stroke in the study participants with baseline prolonged QTcFram was almost 3 times the risk in those with normal QTcFram [HR (95% CI): 2.88 (2.12, 3.92), p<0.0001]. After adjustment for age, race, sex, antihypertensive medication use, systolic blood pressure, current smoking, diabetes, left ventricular hypertrophy, atrial fibrillation, prior cardiovascular disease, QRS duration, warfarin use, and QT-prolonging drugs (full model), the risk of stroke remained significantly high [HR (95% CI): 1.67 (1.16, 2.41), p=0.0060)], and was consistent across several subgroups of REGARDS participants. When the risk of stroke was estimated per 1 SD increase in QTcFram, a 24% increased risk was observed [HR (95% CI): 1.24 (1.16, 1.33), p<0.0001)]. This risk remained significant in the fully adjusted model [HR (95% CI): 1.12 (1.03, 1.21), p=0.0055]. Similar results were obtained when other QTc correction formulas including Hodge’s, Bazett’s and Fridericia’s were used. Conclusions: QTc prolongation is associated with a significantly increased risk of incident stroke independently from known stroke risk factors. In light of our results, examining the risk of stroke associated with QT-prolonging drugs may be warranted.

Abstract P030: Variations in Cardiovascular Risk Among Different Clinical Presentations of Metabolic Syndrome in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Todd M Brown ◽  
Joshua Richman ◽  
Vera Bittner ◽  
Cora E Lewis ◽  
Jenifer Voeks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Racial Differences ◽  
Central Obesity ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Next Of Kin ◽  
Cox Proportional Hazards Models ◽  
Chd Risk ◽  
The Individual

Background: Some individuals classified as having metabolic syndrome (MetSyn) are centrally obese while others are not with unclear implications for cardiovascular (CV) risk. Methods: REGARDS is following 30,239 individuals ≥45 years of age living in 48 states recruited from 2003-7. MetSyn risk factors were defined using the AHA/NHLBI/IDF harmonized criteria with central obesity being defined as ≥88 cm in women and ≥102 cm in men. Participants with and without central obesity were stratified by whether they met >2 or ≤2 of the other 4 MetSyn criteria, resulting in the creation of 4 groups. To ascertain CV events, participants are telephoned every 6 months with expert adjudication of potential events following national consensus recommendations and based on medical records, death certificates, and interviews with next-of-kin or proxies. Acute coronary heart disease (CHD) was defined as definite or probable myocardial infarction or acute CHD death. To determine the association between these 4 groups and incident acute CHD, we constructed Cox proportional hazards models in those free of CHD at baseline by race/gender group, adjusting for sociodemographic variables. Results: A total of 20,018 individuals with complete data on MetSyn components were free of baseline CHD. Mean age was 64+/−9 years, 58% were women, and 42% were African American. Over a mean follow-up of 3.4 (maximum 5.9) years, there were 442 acute CHD events. In the non-centrally obese with>2 other risk factors, risk for CHD was higher for all but AA men, though significant only for white men. In contrast, in the centrally obese with >2 other risk factors, risk was doubled for women, but only non-significantly and modestly increased for men. Only AA women with central obesity and ≤2 other risk factors had increased CHD risk (Table). Conclusion: The CHD risk associated with the MetSyn varies by the presence of central obesity as well as the race and gender of the individual.

Abstract MP50: Neighborhood Social And Economic Environment And Heart Failure Risk Among Adults With & Without Diabetes: The Reasons For Geographic And Racial Differences In Stroke (regards) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Gargya Malla ◽  
Andrea Cherrington ◽  
Monika M Safford ◽  
Parag Goyal ◽  
Doyle M Cummings ◽  
...  
Keyword(s):  
Heart Failure ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Economic Environment ◽  
Individual Level ◽  
Black And White ◽  
Regards Study ◽  
Year 2000

Background: Heart failure (HF) mortality rates have been increasing since 2011. Individual-level education and occupation have been inversely associated with HF mortality among those with diabetes mellitus (DM) but not among those without DM. However, less is known about the association between neighborhood social and economic environment (NSEE) and HF risk and whether this association varies by DM status. Methods: This study included 21,244 Black and White adults age >=45 years at baseline (2003-07) from the REGARDS Study. NSEE quartiles were created using z-scores based on 6 census tract variables from year 2000 (% <high school education, % unemployed, % household with <$30,000, % living in poverty, % on public assistance, % without car). Incident HF events (fatal or non-fatal) were adjudicated based on hospitalization with HF signs and symptoms, supportive imaging or biomarkers. Diabetes was defined as fasting glucose >=126 mg/dL or random glucose >=200 mg/dL or use of diabetes medications. Cox proportional hazards regression was used to obtain hazard ratios (95% CI) with HF follow-up through 2016. Results: Mean age was 65 years, 54% were women, 61% were White and 18% had prevalent DM at baseline. During a median 10.1 years, 829 incident HF events occurred. Among adults with DM, neighborhood disadvantage was associated with an increased HF risk , but this association was not statistically significant (Table). Among adults without DM, the risk of HF was higher for participants living in any neighborhood that was not the most advantaged, and the magnitude of association was smiliar across NSEE quartiles. Conclusion: Adults living in disadvantaged neighborhoods had a higher risk of HF, particularly among those without DM. Addressing neighborhood social and economic conditions may be important for HF prevention.

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