Lassale Camille, Cené Crystal W, Asselin Anouk, Sims Mario, Jouven Xavier, Gaye Bamba
Cardiovascular Epidemiology and Genetics group, Hospital Del Mar Research Institute (IMIM), Barcelona, Spain; CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA.
Atherosclerosis. 2022 Apr;346:98-108. doi: 10.1016/j.atherosclerosis.2022.01.006. Epub 2022 Jan 22.
Cardiovascular health (CVH), as many other aspects of health, is socially patterned. However, little is known about the socioeconomic determinants of following a more or less favourable pattern of CVH change at midlife.
We used data on 11,049 participants in the Atherosclerosis Risk in Communities (ARIC) study, a prospective, population-based, bi-racial cohort that included participants aged 44-66 years in 1987-1989, who attended a second visit 6 years later. At both visits, CVH was assessed with the American Heart Association's Life's Simple 7 (LS7) score ranging 0-14, based on 7 metrics: cholesterol, blood glucose, blood pressure, smoking, body mass index, physical activity, and diet. An LS7 score ≥8 was considered ideal, <8 was considered poor. Multivariable logistic regression models were used. In a first sample (N = 4416) of participants who started with a poor CVH, we modelled odds of improvement (Poor-Ideal vs. Poor-Poor). In a second sample (N = 6633) with baseline ideal CVH, we modelled odds of deterioration (Ideal-Poor vs. Ideal-Ideal). The determinants considered were baseline age, sex, race, educational level, income and working status.
The majority (8,347, 75.5%) of participants remained in the same CVH category at both waves: 28.7% poor-poor, and 46.8% ideal-ideal. The remaining 24.5% were evenly split between improving (11.2%) and deteriorating (13.2%). Compared to poor-poor CVH, older participants displayed higher odds of improving to ideal CVH (OR < = 1.41; 95% CI:1.17, 1.69), whereas Black race (vs White, OR = 0.68; 0.57, 0.80), low education (vs high, OR = 0.65; 0.53, 0.79) and low income (vs high, OR = 0.71; 0.57, 0.87)) were associated with lower odds of improvement. Compared to ideal-ideal CVH, Black participants (OR = 1.59; 1.33, 1.89), with low education (OR = 1.98; 1.64, 2.39), low income (OR = 1.57; 1.30, 1.88), and non-working (vs currently working, OR = 1.27; 1.06, 1.51) had greater odds of deterioration to poor CVH.
We identified vulnerable groups at higher risk of worsening their CVH over time: Black people, with low income, low education, and who are unemployed. Efforts to reduce income and educational gaps and address structural racism, which shapes the distribution of health-promoting and health-harming resources, are paramount to reduce inequities in CVH.
心血管健康（CVH）与健康的许多其他方面一样，存在社会模式差异。然而，对于中年时期CVH变化模式或多或少有利的社会经济决定因素，我们知之甚少。
我们使用了社区动脉粥样硬化风险（ARIC）研究中11,049名参与者的数据，这是一项基于人群的前瞻性双种族队列研究，纳入了1987 - 1989年年龄在44 - 66岁的参与者，他们在6年后进行了第二次随访。在两次随访中，根据胆固醇、血糖、血压、吸烟、体重指数、身体活动和饮食这7项指标，使用美国心脏协会的生命简单7项（LS7）评分对CVH进行评估，评分范围为0 - 14分。LS7评分≥8分被认为是理想的，<8分被认为是差的。使用多变量逻辑回归模型。在第一个样本（N = 4416）中，参与者起始的CVH较差，我们对改善的几率（差 - 理想对比差 - 差）进行建模。在第二个样本（N = 6633）中，参与者基线CVH理想，我们对恶化的几率（理想 - 差对比理想 - 理想）进行建模。所考虑的决定因素包括基线年龄、性别、种族、教育水平、收入和工作状态。
大多数（8347名，75.5%）参与者在两次随访中CVH类别保持不变：28.7%为差 - 差，46.8%为理想 - 理想。其余24.5%在改善（11.2%）和恶化（13.2%）之间平均分配。与差 - 差的CVH相比，年龄较大的参与者改善到理想CVH的几率更高（OR <= 1.41；95% CI：1.17，1.69），而黑人种族（与白人相比，OR = 0.68；0.57，0.80）、低教育水平（与高教育水平相比，OR = 0.65；0.53，0.79）和低收入（与高收入相比，OR = 0.71；0.57，0.87）与改善几率较低相关。与理想 - 理想的CVH相比，黑人参与者（OR = 1.59；1.33，1.89）、低教育水平（OR = 1.98；1.64，2.39）、低收入（OR = 1.57；1.30，1.88）以及非在职（与当前在职相比，OR = 1.27；1.06，1.51）恶化到差的CVH的几率更高。
我们确定了随着时间推移CVH恶化风险较高的弱势群体：黑人、低收入、低教育水平以及失业者。努力缩小收入和教育差距并解决结构性种族主义问题（结构性种族主义影响促进健康和损害健康资源的分配）对于减少CVH方面的不平等至关重要。
