Life's Simple 7 and Nonalcoholic Fatty Liver Disease: The Multiethnic Study of Atherosclerosis

BackgroundThe American Heart Association (AHA) has defined Life's Simple 7 (LS7) as a measure of overall cardiovascular health . Nonalcoholic fatty liver disease (NAFLD) has been involved as a risk factor for cardiovascular disease. We evaluated the association between LS7 and NAFLD.MethodsWe evaluated participants form the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cardiovascular health score was calculated from the Life's Simple 7 metrics. A score of 0-8 was considered inadequate, 9-10 average, and 11-14 optimal. NAFLD was defined using noncontrast cardiac computed tomography (CT) and a liver/spleen attenuation ratio (L/S) < 1. Multivariable regression were performed to evaluate the association.ResultsOur cross-sectional analysis of 3901 participants showed 19% (n = 747) had optimal cardiovascular health, 33% (n = 1270) had average, and 48% (n = 1884) had inadequate. White participants were most likely to have an optimal score (51%, n = 378), whereas African American participants had the lowest proportion with optimal scores (16%, n = 120; P < 0.001). The overall prevalence of NAFLD was 18% with a distribution of 7%, 14%, and 25% in the optimal, average, and inadequate score categories, respectively (P < 0.001). Adjusted for risk factors, average and optimal health categories had lower odds of NAFLD compared to those with inadequate scores: odds ratio for average, 0.44 (95% confidence interval 0.36-0.54); optimal, odds ratio 0.19 (95% confidence interval 0.14-0.26). This association was similar across gender, race and age groups.ConclusionA more favorable cardiovascular health score was associated with a lower prevalence of NAFLD. This study may suggest a potential of Life's Simple 7 in the prevention of liver disease.     

新疆地区城市人口理想心血管健康行为和因素分析

[目的]探讨新疆地区城市人口理想心血管健康(ICVH)行为和因素的流行现状。[方法] 2019年7月—2021年9月采用两阶段随机抽样的方法随机选取北疆地区乌鲁木齐市、南疆地区库尔勒市两个固定社区30～74岁的居民,进行问卷调查、生理生化指标检测,排除既往脑卒中和(或)冠心病患者后,分析ICVH指标的流行现状。[结果](1)共10 520例,参与者平均年龄为46.58岁,男性5 367例,女性5 153例,全部参与者中理想空腹血糖占比78.4%(95%CI:77.6%～79.2%),理想吸烟状态占比76.5%(95%CI:75.7%～77.3%),理想总胆固醇占比65.2%(95%CI:64.3%～66.1%)。参与者达到理想体力活动水平占比仅有20.9%(95%CI:20.1%～21.7%),理想BMI水平占比31.4%(95%CI:30.5%～32.3%),理想血压水平占比39.1%(95%CI:38.2%～40.0%),理想膳食水平占比43.0%(95%CI:42.0%～43.9%)。(2)仅有1.5%(95%CI:1.3%～1.7%)的参与者拥有7项ICVH指标。(3)青年组仅...     

Historical redlining and cardiovascular health: The Multi-Ethnic Study of Atherosclerosis

We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments. Data included 4,779 participants (mean age 62 y; SD = 10) from the baseline sample of the Multi-Ethnic Study of Atherosclerosis (MESA; 2000 to 2002). Ideal CVH was a summary measure of ideal levels of seven CVH risk factors based on established criteria (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking). We assigned MESA participants’ neighborhoods to one of four grades (A: best, B: still desirable, C: declining, and D: hazardous) using the 1930s federal Home Owners’ Loan Corporation (HOLC) maps, which guided decisions regarding mortgage financing. Two-level hierarchical linear and logistic models, with a random intercept to account for participants nested within neighborhoods (i.e., census tracts) were used to assess associations within racial/ethnic subgroups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Chinese). We found that Black adults who lived in historically redlined areas had a 0.82 (95% CI −1.54, −0.10) lower CVH score compared to those residing in grade A (best) neighborhoods, in a given neighborhood and adjusting for confounders. We also found that as the current neighborhood social environment improved the association between HOLC score and ideal CVH weakened (P < 0.10). There were no associations between HOLC grade and CVH measures or effect modification by current neighborhood conditions for any other racial/ethnic group. Results suggest that historical redlining has an enduring impact on cardiovascular risk among Black adults in the United States.

Cardiovascular disease (CVD) remains the leading cause of death and a significant source of racial/ethnic health disparities in the United States (1–3). As a result, the American Heart Association developed its 2020 Strategic Impact Goals to reduce CVD mortality by 20% and improve cardiovascular health (CVH) by 20% for all Americans (4–6). Currently, less than 5% of US adolescents and adults have ideal CVH (1), which underscores the importance of targeted efforts to improve primordial prevention of CVD. Improving neighborhood environments may be essential to these efforts since a strong body of literature has shown that neighborhood built, social, and socioeconomic environments (e.g., healthy food and physical activity resources and safety) are associated with CVD risk factors and mortality (7, 8). Focusing on modern-day neighborhood environments without acknowledging the historical context that shapes these environments ignores the reality of structural racism and its consequences for the CVH of racially and ethnically minoritized populations. Structural racism, which refers to “the totality of ways in which societies foster racial discrimination, through mutually reinforcing inequitable systems (e.g. housing, education, employment, health care, criminal justice), that in turn reinforce discriminatory beliefs, values, and distribution of resources,” (9) is a major driver of racial/ethnic inequities. However, examinations of the role that structural racism plays in shaping the distribution of resources and opportunities across neighborhoods—which has been demonstrated to significantly impact health—are largely missing from the current literature.One way to capture structural racism is to examine historical discriminatory policies that negatively impacted Black neighborhoods, given the robust evidence that neighborhood context matters for health. Redlining, a practice that became institutionalized through the federal Home Owners’ Loan Corporation (HOLC) security maps created in the 1930s, is one significant policy that influenced current neighborhood conditions (10, 11). The name “redlining” refers to the process of color-coding areas red if they included high concentrations of Black, immigrant, and working-class residents, deeming these areas hazardous and excessively risky for investment (12). HOLC grades prevented residents in these “undesirable” neighborhoods, especially Black residents, from accessing mortgage financing and home ownership. This led to the systematic disinvestment in redlined neighborhoods for decades, contributing to stark inequities in the quality of the physical and social environments in which historically marginalized populations reside in greater proportions (12). Along with other discriminatory housing policies such as deed restrictions and racial covenants, redlining made predominantly Black neighborhoods more susceptible to the negative impacts of subsequent policies and programs, including urban renewal, planned shrinkage, deindustrialization, and White flight (13). Thus, previously redlined areas have been cumulatively affected by a low prevalence of home ownership, uneven economic development, displacement of residents, community disintegration (13), and lack of access to education and economic opportunities (12).The potential links between historical redlining and cardiovascular outcomes are supported by strong theoretical frameworks and empirical evidence. Ecosocial theory, which posits that social and material contexts affect health through pathways of embodiment, provides a framework for understanding how redlining may impact CVH (14, 15). These pathways become biologically embedded through physiological disruption that may alter multiple systems including metabolic and cardiovascular systems. Moreover, studies have shown that HOLC risk grades are associated with present-day patterns of racial residential segregation, persistent poverty, and income inequality, all of which have been linked to cardiovascular risk factors and outcomes (10, 16–18). Studies have also begun to link historical redlining to select physical health outcomes (preterm birth, asthma hospitalizations, and self-rated health) (19–22); however, no study to date has examined redlining in relation to cardiovascular risk.Thus, using data from a multiethnic sample of middle-aged adults, we examined associations between historical redlining and ideal CVH. We examined these associations within racial/ethnic subsamples, given that redlining was a racist discriminatory policy that unfairly targeted and disproportionately impacted racial/ethnic minoritized neighborhoods and individuals, especially Black Americans. Due to the historical and upstream nature of our exposure, we also assessed whether associations were modified by present-day indicators of neighborhood physical and social environment, which are features that can be intervened upon to improve CVH. We hypothesized that racially/ethnically minoritized participants residing in historically redlined areas would have lower ideal CVH scores independent of confounders, and that associations would be most pronounced in neighborhoods with poorer physical and social environments.     

Alcohol, wine, and cardiovascular health

Studies evaluating the health benefits of alcohol and wine have demonstrated that moderate consumption is associated with a decrease in all-cause and cardiovascular mortality. Various populations and alcoholic beverages exhibit this effect to different degrees. Alcoholic beverages exhibit multiple mechanisms that may favorably influence cardiac risk potential actions on platelets, antioxidants, fibrinolysis, and lipids. However, other data suggest that the perceived benefit of alcoholic beverages in general, and wine in particular, are the result of socioeconomic confounders. In the absence of more rigorous evidence, it is not currently possible to define the role of wine in human health.     

Ideal cardiovascular health behaviors and factors prevent the development of hypertension in prehypertensive subjects

Abstract

Background: Seven ideal health metrics were defined by AHA to monitor cardiovascular health. This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects. Methods: Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke, myocardial infarction or malignancy. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the development of hypertension. Results: During a follow-up of 52.2 months, 15?500 prehypertensive participants developed hypertension. The cumulative incidence of hypertension decreased with the number of ideal health metrics increased. It was 78.61%, 71.08%, 63.15%, 56.07% and 61.62% in prehypertensive individuals carrying ≤1, 2, 3, 4 and ≥5 ideal health behaviors or factors, respectively. After adjustment for age, gender, family history of hypertension, alcohol consumption, resting heart rate, plasma triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein, the risk ratios of incident hypertension in the subjects who carried 2, 3, 4, and ≥5 ideal health metrics were 0.833 (95%CI: 0.789–0.880), 0.710 (95%CI: 0.672–0.749), 0.604 (95%CI: 0.568–0.642), and 0.581 (95%CI: 0.524–0.643), respectively, in comparison to those with ≤1 ideal health metric. A similar trend was also observed in male and female populations. Poor health metrics, including body mass index, diet (salt intake), physical activity, total cholesterol, and smoking, were predictors for the development of hypertension in prehypertensive individuals. Conclusion: Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension.     

Optimal lifestyle behaviors and 10‐year progression of arterial stiffness: The Multi‐Ethnic Study of Atherosclerosis

Majority of previous studies showed no association between a single health behavior and arterial stiffness, but the benefit of simultaneously having multiple healthy behaviors (optimal lifestyle) on the progression of arterial stiffness is unknown. Among 2810 individuals (age 60.0 ± 9.4, 46.5% male), optimal lifestyle marker (yes/no) on four health behaviors (ie, BMI < 25 kg/m², never or former smoker, never or moderate drinker, exercised > 500 METS min/week) across four visits (≈ 5 years) were summed to create an optimal lifestyle score. Carotid arterial stiffness was measured using distensibility coefficient (DC) and Young''s elastic modulus (YEM) at visit 1 and after a mean of 9.5 years (visit 5). The association of optimal lifestyle with 10‐year percent change in DC and YEM was assessed using multiple linear regression. DC decreased by 5.3% and YEM increased by 24.4% over 10 years. Mean optimal lifestyle score was 9.4 ± 3.1 (range: 0–16). Individuals in quintiles 2–5 of optimal lifestyle score compared to quintile 1 (with the least optimal lifestyle score) did not show slower deceleration of DC [Q2, −0.3% (95% CI: −6.0, 5.4); Q3, −0.01% (−4.5, 4.5); Q4, −0.6% (−5.2, 3.9); Q5, −0.4% (−5.3, 4.4)], trend p‐value = .82] or slower progression of YEM [Q2, 0.1% (−7.1, 7.3); Q3, −0.8% (−8.0, 6.5); Q4, 4.5% (−2.3, 11.3); Q5, −0.2% (−8.3, 7.9)], trend p‐value = .49] after adjusting for risk factors. The association remained non‐significant when stratified by categories of age, sex, race, BP control, and diabetes. Our findings indicate that optimal score on multiple health behaviors may not independently slow arterial stiffness progression.     

Mediation effect of arterial stiffness on ideal cardiovascular health and stroke

Background and aimsIdeal cardiovascular health (CVH) metrics was associated with stroke, but the causal pathway was poorly investigated. Arterial stiffness was a major factor associated with both ideal CVH metrics and stroke. This study aimed to investigate whether the effect of ideal CVH metrics on stroke was mediated and enhanced by arterial stiffness.Methods and resultsA total of 15,297 participants were included in current study. Arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV). Causal mediation analyses were used to separate the overall effects of ideal CVH metrics on stroke into indirect effects (mediated by arterial stiffness) and direct effects (mediated through pathways other than arterial stiffness). After a median follow-up of 5.88 years, 324 total stroke events (292 ischemic stroke and 31 hemorrhagic stroke) occurred. Mediation analysis showed 23.94% of the relation between ideal CVH and total stroke was mediated by baPWV (95% confidence interval [CI] of the indirect effect: 0.93–0.95). Further analysis showed the ideal CVH < median combined with baPWV ≥1400 cm/s was associated with the highest risk of total stroke (hazard ratio: 5.62; 95% CI, 3.53–8.96), compared with CVH ≥ median combined with baPWV < 1400 cm/s. Similar results were observed for ischemic stroke, but not for hemorrhagic stroke.ConclusionsArterial stiffness played a mediating role in the associations between ideal CVH metrics and risk of total and ischemic stroke. Combined ideal CVH metrics and baPWV is a reasonable and useful tool for the assessment and prevention of stroke.     

Correlates of ideal cardiovascular health in European adolescents: The HELENA study

Background and aims

The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents.

理想心血管健康行为和因素对新发缺血性脑卒中的影响

目的探讨理想心血管健康行为和因素对新发缺血性脑卒中的影响。方法采用前瞻性队列研究方法,以参加2006-07-2007-10开滦集团健康查体的职工为研究对象,排除既往患脑梗死、心肌梗死及与该研究有关的数据和资料不全者,最终91698名职工进入观察队列,观察随访该队列发生新发缺血性脑卒中的情况;依据美国心脏协会定义的理想心血管健康行为和因素,用K-M法计算不同理想心血管健康行为和因素组的缺血性脑卒中累积发病率,并经Log-rank检验;采用Cox比例风险模型分缺血性脑卒中的影响因素。结果具备5～7项理想心血管健康行为和因素的个体只占研究人群的9.1%,其中具备所有7项的只有93例,占研究人群的0.1%,不足4项者占69.4%。具有0～1、2、3、4、5～7项理想心血管健康行为和因素的人群缺血性脑卒中的累积发病率逐渐降低(P<0.01);Cox比例风险模型表明,校正性别、年龄、收入水平、受教育水平后,具备1～6项理想心血管健康行为和因素的人群发生缺血性脑卒中的风险为无健康行为和因素人群的0.99、0.71、0.51、0.35、0.24、0.28倍。结论理想心血管健康行为和因素对脑血管具有保护作用,随着理想心血管健康行为和因素的个数增多,缺血性脑卒中的累积发病率呈下降趋势。     

C‐Reactive Protein Level and the Incidence of Eligibility for Statin Therapy: The Multi‐Ethnic Study of Atherosclerosis

Background:

Given the results of the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial, statin initiation may be considered for individuals with elevated high‐sensitivity C‐reactive protein (hsCRP). However, if followed prospectively, many individuals with elevated CRP may become statin eligible, limiting the impact of elevated CRP as a treatment indication. This analysis estimates the proportion of people with elevated CRP that become statin eligible over time.

Hypothesis:

Most people with elevated CRP become statin eligible over a short period of time.

Methods:

We followed 2153 Multi‐Ethnic Study of Atherosclerosis (MESA) participants free of cardiovascular disease and diabetes with low‐density lipoprotein cholesterol <130 mg/dL at baseline to determine the proportion who become eligible for statins over 4.5 years. The proportion eligible for statin therapy, defined by the National Cholesterol Education Program (NCEP) 2004 updated guidelines, was calculated at baseline and during follow‐up stratified by baseline CRP level (≥2 mg/L).

Results:

At baseline, 47% of the 2153 participants had elevated CRP. Among participants with elevated CRP, 29% met NCEP criteria for statins, compared with 28% without elevated CRP at baseline. By 1.5 years later, 26% and 22% (P = 0.09) of those with and without elevated CRP at baseline reached NCEP low‐density lipoprotein cholesterol criteria and/or had started statins, respectively. These increased to 42% and 39% (P = 0.24) at 3 years and 59% and 52% (P = 0.01) at 4.5 years following baseline.

Conclusions:

A substantial proportion of those with elevated CRP did not achieve NCEP‐based statin eligibility over 4.5 years of follow‐up. These findings suggest that many patients with elevated CRP may not receive the benefits of statins if CRP is not incorporated into the NCEP screening strategy. Additional Supporting Information may be found in the online version of this article. The Multi‐Ethnic Study of Atherosclerosis (MESA) was supported by contracts NO1‐HC‐95159 through NO1‐HC‐95165 and NO1‐HC‐95169 from the National Heart, Lung, and Blood Institute. This research was also supported by grant 1K23DK081665, a Patient‐Oriented Mentored Scientist Award through the National Institute of Diabetes, Digestive, and Kidney Diseases (to DMM). The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

辽宁农村中老年人群理想心血管健康现状及其与脉压的关系

目的 探讨辽宁农村中老年人群理想心血管健康评分(ICHS)和脉压(PP)之间的关系,并对PP的影响因素加以研究,为动脉硬化的防治提供证据。方法 选取2019年10月—2020年12月辽宁省锦州市北镇市农村年龄在50～80岁之间的当地居民共952例为研究对象进行描述性研究。采用标准化调查问卷采集受试者的人口统计学特征、生活方式、既往疾病史、用药史等资料。对受试者的身高、体质量和血压等进行测量,检测总胆固醇、空腹血糖(FBG)等生物化学指标。并对所有受试者进行ICHS评分。将研究对象按照PP高低分为PP正常组(n=521)和PP升高组(n=431),统计分析各变量在两组之间的差异;再对样本进行倾向性评分匹配,使两组受试者具有可比性,分析两组间各变量的差异及PP的影响因素。结果 与PP正常组相比,PP升高组的ICHS较低,心血管健康水平较差,差异有统计学意义(P=0.005);血压(P<0.001)和FBG(P=0.033)也与PP密切相关。多因素Logistic回归分析结果表明ICHS为PP的独立影响因素,理想的ICHS是PP的保护因素(OR=0.55,95%CI:0.37～0.82...     

The positive and negative health effects of alcohol‐ and the public health implications

In this paper, the negative and the positive effects of alcohol on health are reviewed. It is first of all established facts that a high alcohol intake implies an increased risk of a large number of health outcomes, such as dementia, breast cancer, colorectal cancer, cirrhosis, upper digestive tract cancer and alcohol dependency. Second, it is justified that alcohol has beneficial effects for some individuals, especially with regard to prevention of thrombosis of the heart. The public health relevance of these results is considered. The sensible drinking limits, used in both the UK and Denmark, of a maximum of 21 drinks per week for men and 14 drinks per week for women seem valid. A broader public health message of the beneficial effects of alcohol does not seem to be of interest in Western societies, where only a very small fraction of the population are non drinkers and may have very good reasons therefore.     

A systematic review of strategies to increase drinking‐water access and consumption among 0‐ to 5‐year‐olds

The objective of this study is to identify promising strategies for improving drinking‐water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer‐reviewed, full‐text studies from high‐income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty‐five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non‐randomized studies. To date, few high‐quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.