Cardiovascular disease is the leading cause of death in the United States. The American Heart Association set national goals for cardiovascular health, including 7 metrics for ideal cardiovascular health. Research has shown that social factors, such as socioeconomic position (i.e., income, education), are important influences on cardiovascular health. Specifically, disparities in cardiovascular health exist between higher and lower socioeconomic positions.
We assessed the hypothesis that higher socioeconomic position would be associated with improved cardiovascular health, measured as 4 cardiovascular health factors as outlined by the American Heart Association Life’s Simple 7, following an exercise intervention.
This study used data from the Examination of Mechanisms (E-Mechanic) of Exercise-Induced Weight Compensation randomized control trial. Cardiovascular health factors included 1) BMI, 2) cholesterol, 3) glucose, and 4) systolic blood pressure, which were used to create composite cardiovascular health scores based upon ideal (2 points), intermediate (1 point), and poor (0 points) health for each factor for a possible range of 0 points (worst CVH) to 8 points (best CVH). These scores were calculated pre- and post-intervention. The primary covariate, socioeconomic position, was created using principal components analysis with income and educational attainment to produce a single socioeconomic factor that was dichotomized to indicate high socioeconomic position (=1). We also included covariates for age, sex, race, and marital status.
Among the 114 participants (21-65 years old; 72% female; 30% black) who received the E-MECHANIC exercise intervention, the mean cardiovascular health factor score pre-intervention was 5.1 points (SD=1.2 points) and post-intervention 5.4 (SD=1.2 points). Regression analysis revealed that the exercise intervention increased cardiovascular health overall (p=0.03). However, participants with higher socioeconomic position had significantly (p=0.002) greater improvement in cardiovascular health factor scores. At baseline participants with higher socioeconomic position had better cardiovascular health, but not significantly better (LS-means difference = 0.38; p=0.35). Yet, after the intervention the difference in cardiovascular health between high and low socioeconomic position participants had increased (LS-means difference = 0.71; p=0.01).
Although cardiovascular health improved for all intervention participants, those with higher socioeconomic position demonstrated better improvement in cardiovascular health thusly increasing socioeconomic health disparities. This provides further evidence that in order for interventions to be equally effective among participants consideration should be given to socioeconomic influences and interventions may need to be customized for different populations.
Cardiovascular Health Research in the Workplace: A Workshop Report
