Socio-economic inequalities in high blood pressure and additional risk factors for cardiovascular disease among older individuals in Colombia: Results from a nationally representative study

Objectives. To describe patterns of multimorbidity among fatal cases of COVID-19, and to propose a classification of patients based on age and multimorbidity patterns to begin the construction of etiological models. Methods. Data of Colombian confirmed deaths of COVID-19 until June 11, 2020, were included in this analysis (n=1488 deaths). Relationships between COVID-19, combinations of health conditions and age were explored using locally weighted polynomial regressions. Results. The most frequent health conditions were high blood pressure, respiratory disease, diabetes, cardiovascular disease, and kidney disease. Dyads more frequents were high blood pressure with diabetes, cardiovascular disease or respiratory disease. Some multimorbidity patterns increase probability of death among older individuals, whereas other patterns are not age-related, or decrease the probability of death among older people. Not all multimorbidity increases with age, as is commonly thought. Obesity, alone or with other diseases, was associated with a higher risk of severity among young people, while the risk of the high blood pressure/diabetes dyad tends to have an inverted U distribution in relation with age. Conclusions. Classification of individuals according to multimorbidity in the medical management of COVID-19 patients is important to determine the possible etiological models and to define patient triage for hospitalization. Moreover, identification of non-infected individuals with high-risk ages and multimorbidity patterns serves to define possible interventions of selective confinement or special management.

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Association Between Self-Reported Hypertension and Antihypertensive Medication Use and Cardiovascular Disease–Related Events and Expenditures Among Patients Diagnosed With Hypertension

Public Health Reports ◽

10.1177/0033354919864363 ◽

2019 ◽

Vol 134 (5) ◽

pp. 493-501

Author(s):

Madeleine M. Baker-Goering ◽

David H. Howard ◽

Julie C. Will ◽

Garrett R. Beeler Asay ◽

Kakoli Roy

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

High Blood Pressure ◽

Antihypertensive Medication ◽

Medication Use ◽

Medical Expenditures ◽

Self Report ◽

Related Event ◽

Predicted Probability

Objectives: Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure. Methods: We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures. Results: Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P < .001), had a significantly lower predicted probability of a CVD-related event (0.6%, P < .001), and on average spent significantly less on CVD-related events ($251, P = .01) than patients who did not self-report high blood pressure. Conclusion: This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients’ awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events.

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High Blood Pressure During Pregnancy and Development of Risk Factors for Cardiovascular Disease

Annals of Internal Medicine ◽

10.7326/p18-0008 ◽

2018 ◽

Vol 169 (4) ◽

pp. I-18

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

High Blood Pressure

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Abstract P151: Primary ASCVD Risk Associated With Undiagnosed Conditions Decreased Over NHANES 1999-2014

Circulation ◽

10.1161/circ.137.suppl_1.p151 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

David R Nelson ◽

Jessica A Davis

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Heart Disease ◽

High Blood Pressure ◽

The United States ◽

High Cholesterol ◽

Diabetes Status ◽

Ascvd Risk ◽

Over Time

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a general term for a group of diseases characterized by atherosclerosis that affect the heart and blood vessels. ASCVD is the leading cause of death in the United States contributing to at least 200,000 preventable deaths from heart disease and stroke each year. Cardiovascular disease, heart disease, and stroke mortality has declined since the year 2000, due to broader use of evidence-based therapies and changes to risk factors and lifestyle modifications, but the decline began to slow after 2011. Two main risk factors contributing to ASCVD are high blood pressure and high cholesterol. Efforts have been made to increase control of these factors at the population-level, however, only those who are diagnosed can be treated. While awareness has increased over time, there is still a significant contribution to ASCVD events from those who were undiagnosed but have high blood pressure, high cholesterol, and/or diabetes. Hypothesis: To assess how much of the total U.S. population ASCVD risk is undiagnosed from 1999-2014. Methods: The Pooled Cohort Equations assessed 10-year ASCVD risk, based on age, sex, race, total cholesterol, HDL level, systolic blood pressure, use of blood pressure medication, smoking status, and diabetes status. The undiagnosed risk of the primary risk population (age 40-79 years, without missing values for necessary cholesterol, blood pressure, and glucose measures) from 1999-2014 Continuous National Health and Nutrition Examination Survey (NHANES) was calculated based on self-report questions and clinical measures, after age, sex, race, smoking, and diagnosed risks were accounted for. Linear regression for complex survey data tested whether undiagnosed risk was changing over time. Results: Applying the ASCVD risk equation to the NHANES subset (n=8,763; weighted n=104,421,757), undiagnosed conditions were associated with 10% of the projected ASCVD events. That is, per 100,000 Americans in this subset, 7,747 ASCVD events were estimated over 10-years, and 800 were based on risk from undiagnosed diabetes, hypercholesterolemia, or hypertension. However, ASCVD risk associated with undiagnosed conditions over time decreased (p<0.001), from 1,169 per 100,000 in 1999-2000, to 642 per 100,000 in 2013-2014. Conclusions: NHANES creates a unique opportunity to quantify undiagnosed ASCVD risk in a nationally representative sample. Since 1999, a sizeable portion of the US primary ASCVD risk was based on undiagnosed conditions, however, this proportion of undiagnosed risk decreased over time.

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Abstract 17345: Particulate Matter and Risk of Incident Cardiovascular Disease in a Nationwide Cohort of Men

Circulation ◽

10.1161/circ.132.suppl_3.17345 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jaime E Hart ◽

Jarvis T Chen ◽

Robin C Puett ◽

Jeff D Yanosky ◽

Eric B Rimm ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Particulate Matter ◽

High Blood Pressure ◽

Smoking Status ◽

Sensitivity Analyses ◽

Cvd Risk ◽

Ambient Exposure ◽

The Impact

Introduction: Chronic exposures to particulate matter (PM) have been associated with cardiovascular disease (CVD) morbidity and mortality. We examined the impact of long-term exposures to PM on the risk of incident coronary heart disease (CHD) and stroke among members of the nationwide all-male Health Professionals Follow-Up Study (HPFS) prospective cohort. Methods: HPFS members were followed biennially between 1986-2006 to obtain information on incident disease and to update information on CVD risk factors. Time-varying ambient PM 10 , PM 2.5-10 , and PM 2.5 for the previous 12 months were calculated from monthly predictions at the address level. Multivariate adjusted Cox proportional hazards models were used to estimate [HR (95%CI)] for the association between each fraction of PM and each outcome among 43,371 CVD-free members of the HPFS, adjusting for risk factors and other potential confounders. We also assessed effect modification by region of the country, BMI, smoking status, and comorbidities (hypercholesterolemia, high blood pressure, and diabetes). Sensitivity analyses were conducted restricting the population to men who provided residential (N=15,395), as opposed to work, addresses. Results: The mean (SD) levels of 12-month average PM 10 , PM 2.5-10 , and PM 2.5 were 20.7 (6.2), 8.4 (4.7) and 12.3 (3.4) μg/m 3 . In the full population, there was only modest evidence of increased risks of incident CHD or stroke with increasing PM exposures. Associations with stroke were modified by region, hypercholesterolemia, high blood pressure, and diabetes, with larger effects among those with comorbid conditions and in the Northeast and South. CHD, but not stroke, dose-responses were stronger among those who provided residential as opposed to work addresses; each 10 μg/m 3 increase, was associated with increases in overall CHD [1.10 (95%CI: 1.01-1.20), 1.09 (0.97-1.23), and 1.14 (0.98-1.32) for PM 10 , PM 2.5-10 , and PM 2.5 , respectively]. Conclusions: In this cohort of US men, PM exposures were only modestly associated with elevated risks of CHD and stroke. Comorbidities and region modified the associations with stroke, and residential ambient exposures were more associated with CHD than work ambient exposure.

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High Blood Pressure as a Risk Factor for Cardiovascular Disease, and Risk Factors for Hypertension

Acta Medica Scandinavica ◽

10.1111/j.0954-6820.1977.tb07637.x ◽

2009 ◽

Vol 201 (S602) ◽

pp. 25-28

Author(s):

Leif Hagerup ◽

Marianne Schroll ◽

Hans Ibsen

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Factor ◽

High Blood Pressure

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Comparison of cardiovascular disease risk factors, assessment and management in men and women, including consideration of absolute risk: a nationally representative cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-038761 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038761

Author(s):

Emily Banks ◽

Jennifer Welsh ◽

Grace Joshy ◽

Melonie Martin ◽

Ellie Paige ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Factor ◽

Absolute Risk ◽

Density Lipoprotein ◽

Cvd Risk ◽

Cross Sectional ◽

Recommended Treatment ◽

Nationally Representative

ObjectivesCardiovascular disease (CVD) is highly preventable and optimal treatments based on absolute risk can halve risk of future events. Compared with women, men have higher risks of developing CVD. However, women can experience suboptimal treatment. We aimed to quantify sex differences in CVD risk, assessment and treatment in Australian adults.Design, participants, settingCross-sectional analysis of nationally representative data from interview, physical measures, medication review and blood and urine samples, from 2011 to 2012 Australian Health Survey participants aged 45–74 (n=11 518).Outcome measuresCVD risk factors, absolute 5-year risk of a primary CVD event, blood pressure and cholesterol assessment in the previous 2 and 5 years and use of recommended CVD preventive medications were compared using Poisson regression to estimate age-adjusted male versus female prevalence ratios (PRs).ResultsWomen had a generally more favourable CVD risk factor profile than men, including lower: current smoking prevalence (women=14.5%; men=18.4%, PR=0.78, 95% CI=0.70 to 0.88); body mass index (women (mean)=28.3 kg/m2; men (mean)=28.8 kg/m2, p<0.01); systolic and diastolic blood pressure (systolic: women (mean)=127.1 mm Hg; men (mean)=130.5 mm Hg, p<0.001); blood glucose (women (mean)=5.2 mmol/L; men (mean)=5.5 mmol/L); diabetes prevalence (women=6.8%; men=12.5%, PR=0.55, 95% CI=0.44 to 0.67); prior CVD (women=7.9%; men=11.3%) and absolute primary CVD risk (absolute 5-year CVD risk >15%: women=6.6%, 95% CI=5.4 to 7.8; men=15.4%, 95% CI=13.9% to 16.9%). Compared with men, women had higher low-density lipoprotein, high-density lipoprotein and total cholesterol and sedentary behaviour and lower physical activity. Blood pressure and cholesterol assessment were common in both sexes. Among those at high absolute risk, age-adjusted proportions receiving recommended CVD medications were low, without sex differences (women=21.3%; men=23.8%, PR=0.93, 95% CI=0.49 to 1.78). Fewer women than men with prior atherosclerotic CVD were receiving recommended treatment (women=21.8%, men=41.4%, PR=0.55, 95% CI=0.31 to 0.96).ConclusionWomen have a more favourable CVD risk factor profile than men. Preventive treatment is uncommon and women with prior atherosclerotic CVD are around half as likely as men to be receiving recommended treatment.

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The Effects of a Digital Mental Health Intervention in Adults with Cardiovascular Disease Risk Factors: An Analysis of Real-World User Data (Preprint)

10.2196/preprints.32351 ◽

2021 ◽

Author(s):

Robert M Montgomery ◽

Eliane M Boucher ◽

Ryan D Honomichl ◽

Tyler A Powell ◽

Sharelle L Guyton ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

High Blood Pressure ◽

Real World ◽

Well Being ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Over Time

BACKGROUND The American Heart Association has identified poor mental health in particular as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention, and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and amidst users with chronic conditions. OBJECTIVE The objective of this analysis of real-world user data was to examine changes in both subjective well-being and anxiety over time in Happify users with self-reported cardiovascular disease risk factors, including high blood pressure and cholesterol, diabetes, and heart disease. METHODS Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate our first hypothesis, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For the second hypothesis, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. RESULTS Users completed an average of 2.9 activities per week, and 35% (636/1803) met criteria for the recommended use. For both the Happify scale and the GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, supporting the first hypothesis. The addition of the interaction term between time and recommended use, was significant as well for both outcomes, supporting the second hypothesis. CONCLUSIONS This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time, and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who used less. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing cardiovascular disease.

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