Hernandez Sevillano Joel, Babagoli Masih A, Chen Yitong, Liu Shelley H, Mellacheruvu Pranav, Johnson Janet, Ibanez Borja, Lorenzo Oscar, Mechanick Jeffrey I
Kravis Center for Clinical Cardiovascular Health at the Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Int J Cardiol Cardiovasc Risk Prev. 2024 Aug 19;23:200322. doi: 10.1016/j.ijcrp.2024.200322. eCollection 2024 Dec.
Adiposity, dysglycemia, and hypertension are metabolic drivers that have causal interactions with each other. However, the effect of neighborhood-level disadvantage on the intensity of interactions among these metabolic drivers has not been studied. The objective of this study is to determine whether the strength of the interplay between these drivers is affected by neighborhood-level disadvantage.
This cross-sectional study analyzed patients presenting to a multidisciplinary preventive cardiology center in New York City, from March 2017 to February 2021. Patients' home addresses were mapped to the Area Deprivation Index to determine neighborhood disadvantage. The outcomes of interest were correlation coefficients (range from -1 to +1) among the various stages (0 - normal, 1 - risk, 2 - predisease, 3 - disease, and 4 - complications) of abnormal adiposity, dysglycemia, and hypertension at presentation, stratified by neighborhood disadvantage.
The cohort consisted of 963 patients (age, median [IQR] 63.8 [49.7-72.5] years; 624 [65.1 %] female). The correlation among the various stages of adiposity, dysglycemia, and hypertension was weaker with increasing neighborhood disadvantage (P for trend <0.001). Specifically, the correlation describing adiposity, dysglycemia, and hypertension interaction was weaker in the high neighborhood disadvantage group compared to the intermediate neighborhood disadvantage group (median [IQR]: 0.34 [0.27, 0.44] vs. median [IQR]: 0.39 [0.34, 0.45]; P < 0.001) and compared to the low neighborhood disadvantage group (median [IQR]: 0.34 [0.27, 0.44] vs. median [IQR]: 0.54 [0.52, 0.57]; P < 0.001), as well as weaker in the intermediate neighborhood disadvantage group compared to the low neighborhood disadvantage group (median [IQR]: 0.39 [0.34, 0.45] vs. 0.54 median [IQR]: 0.54 [0.52, 0.57]; P < 0.001).
Interactions among the various stages of abnormal adiposity, dysglycemia, and hypertension with each other are weaker with increasing neighborhood disadvantage. Factors related to neighborhood-level disadvantage, other than abnormal adiposity, might play a crucial role in the development of dysglycemia and hypertension.
肥胖、血糖异常和高血压是相互之间存在因果关系的代谢驱动因素。然而，社区层面的不利因素对这些代谢驱动因素之间相互作用强度的影响尚未得到研究。本研究的目的是确定这些驱动因素之间相互作用的强度是否受到社区层面不利因素的影响。
这项横断面研究分析了2017年3月至2021年2月期间到纽约市一家多学科预防心脏病中心就诊的患者。将患者的家庭住址映射到地区贫困指数，以确定社区的不利程度。感兴趣的结果是就诊时肥胖、血糖异常和高血压各阶段（0 - 正常、1 - 风险、2 - 疾病前期、3 - 疾病、4 - 并发症）之间的相关系数（范围从 -1到 +1），按社区不利程度分层。
该队列由963名患者组成（年龄，中位数[四分位间距]63.8[49.7 - 72.5]岁；624名[65.1%]为女性）。随着社区不利程度的增加，肥胖、血糖异常和高血压各阶段之间的相关性减弱（趋势P<0.001）。具体而言，与中等社区不利程度组相比，高社区不利程度组中描述肥胖、血糖异常和高血压相互作用的相关性较弱（中位数[四分位间距]：0.34[0.27, 0.44]对中位数[四分位间距]：0.39[0.34, 0.45]；P<0.001），与低社区不利程度组相比也较弱（中位数[四分位间距]：0.34[0.27, 0.44]对中位数[四分位间距]：0.54[0.52, 0.57]；P<0.001），并且中等社区不利程度组与低社区不利程度组相比也较弱（中位数[四分位间距]：0.39[0.34, 0.45]对中位数[四分位间距]：0.54[0.52, 0.57]；P<0.001）。
随着社区不利程度的增加，肥胖、血糖异常和高血压各阶段之间的相互作用减弱。除肥胖异常外，与社区层面不利因素相关的因素可能在血糖异常和高血压的发展中起关键作用。
