Racial/ethnic heterogeneity in the socioeconomic patterning of CVD risk factors: in the United States: the multi-ethnic study of atherosclerosis

Many studies document racial variation, gender differences, and socioeconomic status (SES) patterning in cardiovascular disease (CVD) risk factors but few studies have investigated heterogeneity in SES differences by race/ethnicity or gender. Using data from the Multi-Ethnic Study of Atherosclerosis (N=6,814) and stratified regression models, we investigated race/ethnic differences in the SES patterning of diabetes, hypertension, smoking, and body mass index (BMI). Inverse socioeconomic gradients in hypertension, diabetes, smoking, and BMI were observed in White and Black women but associations were weaker or absent in Hispanic and Chinese women (except in the case of diabetes for Hispanic women). Even greater heterogeneity in social patterning of risk factors was observed in men. In White men all four risk factors were inversely associated with socioeconomic position, although often associations were only present or were stronger for education than for income. The inverse socioeconomic patterning was much less consistent in men of other races/ethnic groups, and higher SES was associated with higher BMI in non-White men. These findings have implications for understanding the causes of social patterning, for the analysis of SES adjusted race/ethnic differences, and for the targeting of interventions.     

Homocysteine,vitamin B(6), and lipid in cardiovascular disease

OBJECTIVES: Elevated homocysteine (Hcy) is considered an independent risk factor for cardiovascular disease (CVD). An elevated plasma Hcy level may interact with conventional CVD risk factors to further increase vascular disease risk. Therefore, we investigated the plasma levels of Hcy, vitamin B(6) status (pyridoxal phosphate and pyridoxal), and lipid profile in patients with CVD. METHODS: Possible associations between sex, age, body mass index (BMI), and waist-to-hip ratio (WHR) to levels of plasma Hcy and plasma Hcy to vitamin B(6) status and lipid profile were examined. RESULTS: Plasma Hcy level, body mass index, and waist-to-hip ratio were significantly higher in patients with CVD than in controls. Male CVD patients had significantly higher plasma Hcy levels than did female patients. Plasma levels of pyridoxal phosphate and total B(6) aldehyde were significantly higher in male than in female patients. Plasma Hcy levels of patients did not correlate to their plasma vitamin B(6) status or to their lipid profiles. Plasma Hcy level correlated positively with age, body mass index, and waist-to-hip ratio (P < 0.0001). CONCLUSIONS: This suggested that patients with CVD have higher levels of plasma Hcy that are influenced by sex, age, body mass index, and waist-to-hip ratio and not by their plasma vitamin B(6) status and lipid profiles.     

The effect of dental care on cardiovascular disease outcomes: an application of instrumental variables in the presence of heterogeneity and self-selection

Studies show a relationship between oral inflammatory processes and cardiovascular risk factors, suggesting that dental care may reduce the risk of cardiovascular disease (CVD) events. However, due to the differences between men and women in the development and presentation of CVD, such effects may vary by sex. We use a valid set of instrumental variables to evaluate these issues and include a test of essential heterogeneity. CVD events include new occurrences of heart attack (including death from heart attack), stroke (including death from stroke), angina, and congestive heart failure. Controls include age, race, education, marital status, foreign birthplace, and cardiovascular risk factors (health status, body mass index, alcohol use, smoking status, diabetes status, high-blood-pressure status, physical activity, and depression). Our analysis finds no evidence of essential heterogeneity. We find the minimum average treatment effect for women to be -0.01, but find no treatment effect for men. This suggests that women who receive dental care may reduce their risk of future CVD events by at least one-third. The findings may only apply to married middle-aged and older individuals as the data set is only representative for this group.     

Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998

BACKGROUND: This study examined the extent to which areal socio-economic gradients in all-cause and cardiovascular disease (CVD) mortality among US men and women aged 25-64 years increased between 1969 and 1998. METHODS: Using factor analysis 17 census tract variables were used to develop an areal index of socio-economic status that was used to stratify all US counties into five socio-economic categories. By linking the index to county-level mortality data from 1969 to 1998, we calculated annual age-adjusted mortality rates for each area socio-economic group. Poisson regression models were fitted to estimate areal socio-economic gradients in mortality over time. RESULTS: Areal socio-economic gradients in all-cause and cardiovascular mortality have increased substantially over the past three decades. Compared to men in the highest area socio-economic group, rates of all-cause and CVD mortality among men in the lowest area socio-economic group were 42% and 30% greater in 1969-1970 and 73% and 79% greater in 1997-1998, respectively. The gradients in mortality among women were steeper for CVD than for all causes. Compared to women in the highest area socio-economic group, rates of all-cause and CVD mortality among women in the lowest area socio-economic group were 29% and 49% greater in 1969-1970 and 53% and 94% greater in 1997-1998, respectively. CONCLUSIONS: Although US all-cause and cardiovascular mortality declined for all area socio-economic groups during 1969-1998, the gradient increased because of significantly larger mortality declines in the higher socio-economic groups. Increasing areal inequalities in mortality shown here may be related to increasing temporal differences in the material and social living conditions between areas.     

Iron stores and cardiovascular disease risk factors in women of reproductive age in the United States

BACKGROUND: The increasing proportion of iron-replete individuals in industrialized countries and the possible increased risk of cardiovascular disease (CVD) among men with high iron stores raise concerns regarding improved iron status in women of reproductive age. OBJECTIVE: This study examined the association between iron stores and a set of established CVD risk factors among nonpregnant women aged 20-49 y. DESIGN: Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to examine the relation between race-ethnicity-specific quartiles of serum ferritin (SF) and a set of CVD risk factors [body mass index (BMI), total cholesterol, triacylglycerol, HDL cholesterol, plasma glucose, and blood pressure (BP)]. Women with a history of CVD or liver disease were excluded. We controlled for age, session of measurement, prevalent infection, recent blood donation, and treatment with iron for anemia. RESULTS: Mean SF values were 53.22 +/- 2.08 micro g/L (n = 1178), 58.93 +/- 2.39 micro g/L (n = 1093), and 43.33 +/- 1.39 micro g/L (n = 1075) among non-Hispanic white, non-Hispanic black, and Mexican American women, respectively. Iron stores were positively associated with CVD risk factors only among non-Hispanic black and Mexican American women after adjustment for confounding variables. The strongest associations were seen among Mexican American women: compared with the middle 2 quartiles, the lowest and highest quartiles of SF had lower and higher values, respectively, for BMI, total cholesterol, triacylglycerol, glucose, and diastolic BP. CONCLUSION: These findings suggest that CVD risk factors, especially those related to glucose and lipid metabolism, are positively associated with iron status in women.     

Moderate Alcohol Use Is Associated with Reduced Cardiovascular Risk in Middle-Aged Men Independent of Health,Behavior, Psychosocial,and Earlier Life Factors

We examined whether the often-reported protective association of alcohol with cardiovascular disease (CVD) risk could arise from confounding. Our sample comprised 908 men (56–67 years), free of prevalent CVD. Participants were categorized into 6 groups: never drinkers, former drinkers, and very light (1–4 drinks in past 14 days), light (5–14 drinks), moderate (15–28 drinks), and at-risk (>28 drinks) drinkers. Generalized linear mixed effect models examined the associations of alcohol use with three established CVD risk scores: The Framingham Risk Score (FRS); the atherosclerotic CVD (ASCVD) risk score; and the Metabolic Syndrome (MetS) Severity score, adjusting for group differences in demographics, body size, and health-related behaviors. In separate models we additionally adjusted for several groups of potentially explanatory factors including socioeconomic status, social support, physical and mental health status, childhood factors, and prior history of alcohol misuse. Results showed lower CVD risk among light and moderate alcohol drinkers, relative to very light drinkers, for all CVD risk scores, independent of demographics, body size, and health-related behaviors. Alcohol-CVD risk associations were robust to further adjustment for several groups of potential explanatory factors. Study limitations include the all-male sample with limited racial and ethnic diversity, and the inability to adjust for sugar consumption and for patterns of alcohol consumption. Although this observational study does not address causation, results show that middle-aged men who consume alcohol in moderation have lower CVD risk and better cardiometabolic health than men who consume little or no alcohol, independent of a variety of health, behavioral, psychosocial, and earlier life factors.     

Self-rated cardiovascular risk and 15-year cardiovascular mortality

PURPOSE Many individuals perceive their cardiovascular disease (CVD) risk to be lower than established clinical tools would estimate, yet little is known about the long-term consequences of holding such optimistic beliefs. We evaluated whether lower self-ratings of CVD risk are associated with lower rates of CVD death after addressing potential confounding by an extensive set of social and biologic CVD risk factors.METHODS We conducted a 15-year mortality surveillance study of adults aged 35 to 75 years from southeastern New England (n = 2,816) who had no history of myocardial infarction. Baseline evaluation in 1990–1992 included household interview, anthropomorphic measures, and laboratory analyses. Outcomes were obtained using the National Death Index records through December 2005.RESULTS Rating oneself to be at lower-than-average risk for one’s age and sex was associated with lower rates of CVD mortality among men (hazard ratio [HR]=0.3; 95% confidence interval [CI], 0.2–0.7) but not among women (HR = 0.9; 95% CI, 0.5–1.7). None of the following weakened the findings among men: adjustment for baseline Framingham Risk Score, propensity score adjustment for both social and biologic factors, and censoring the first 2 years of surveillance.CONCLUSIONS Lower self-ratings of CVD risk are independently associated with lower rates of CVD death among men.     

Socioeconomic differences in the progression of carotid atherosclerosis in middle-aged men and women with subclinical atherosclerosis in Sweden

While the persistence of socioeconomic differences in cardiovascular disease (CVD) has been recognized for many years, less is known about whether socioeconomic factors are of importance to CVD before symptoms of the disease appear. In this study the associations among educational level, occupational status and progression of atherosclerosis were investigated in 1016 Swedish middle-aged men and women with signs of subclinical atherosclerosis, i.e., carotid plaque (defined as focal intima-media thickness (IMT) > 1.2 mm). IMT in the common carotid artery (CCA) and in the carotid bifurcation area, as well as carotid plaque score, was determined by B-mode ultrasound. Results showed only weak associations between educational level, occupational status and age-, sex- and baseline IMT-adjusted progression of IMT in the CCA. However, in the age, sex- and baseline IMT-adjusted analyses, those in unskilled manual occupations showed a significantly higher yearly progression of carotid IMT in the bifurcation area compared to those in high- or medium-level non-manual occupations. Those with primary education tended to show a higher yearly progression of carotid IMT in the bifurcation area compared to those with completed secondary education. After adjustment for risk factors, the magnitude of these associations were somewhat attenuated. Similar patterns of associations were seen for the change of carotid plaque score. We conclude that low socioeconomic status (SES) is associated with progression of atherosclerosis in a middle-aged population with signs of subclinical atherosclerosis. Even though socioeconomic differences in cardiovascular risk factor levels could explain part of the found differences in progression rate in women, the mechanisms involved remain to be further established.     

Associations between socioeconomic status and cardiovascular risk factors in an urban population in China

INTRODUCTION: In developed countries socioeconomic status has been proven to be an important factor in the progression of cardiovascular disease. The present article reports the results of a cross-sectional assessment to investigate the association between socioeconomic status and cardiovascular risk factors in a Chinese urban population. METHODS: In 1996, a behavioural risk factor survey was carried out in Tianjin, the third largest city in China. A sample of 4000 people aged 15-69 years, stratified by sex and 10-year age groups, was drawn randomly from urban areas of the city. The present study covers respondents aged 25-69 years (1615 men and 1592 women). Four socioeconomic indicators (education, occupation, income, and marital status), blood pressure, body mass index, and cigarette smoking were determined in the survey. RESULTS: Educational level seemed to be the most important measure of the four socioeconomic indicators in relation to the cardiovascular risk factors in the study population. People with lower socioeconomic status had higher levels of cardiovascular risk factors. The association between socioeconomic status and cardiovascular risk factors was more consistent among women than men. DISCUSSION: Our findings do not seem to differ from those observed in developed countries.     

Lifetime overweight status in relation to serial changes in body composition and risk factors for cardiovascular disease: The Fels Longitudinal Study

OBJECTIVE: The aims were to determine if 1) individuals who became and maintained overweight during their entire lifetime differ from those who were never-overweight in terms of annual changes in adiposity and concurrent changes in cardiovascular disease (CVD) risk factors; 2) the changes and their relationships to each other varied between these groups or by sex within the groups; and 3) alcohol usage, smoking habits, and level of physical activity differed between groups. RESEARCH METHODS AND PROCEDURES: Data from 16,315 examinations of 414 individuals were utilized to assess lifetime overweight (body mass index [BMI] > 25 kg/m2) status. A regressive analytic approach was used to determine the average annual changes for each individual over an adult serial interval ranging from 4 to 20 years. RESULTS: Men and women who have become and maintained overweight have higher blood pressure and a poorer lipid/lipoprotein risk profile than those who have never been overweight. There is an accelerated deterioration in the atherogenic profile of overweight men and women as indicated by annual changes in CVD risk factors about double that of their never-overweight counterparts. In women, increased risk is derived from increasing systolic and diastolic blood pressure, whereas in men the increased risk comes not only from increasing diastolic blood pressure but also cholesterol, triglycerides, and low-density lipoprotein cholesterol levels and, to a lesser extent, decreasing high-density lipoprotein cholesterol. DISCUSSION: The reduced physical activity observed in the overweight adults may be related to their accumulation of adipose tissue at a rate about double their never-overweight counterparts, and this may be driving the higher rate of increase of CVD risk factors in the overweight groups.     

Socio-economic position and cardiovascular risk factorsin an Italian rural population

Cardiovascular disease (CVD) is the leading industrial world cause of mortality. Lower social class groups have higher incidence of CVD and also display less favourable risk factor profiles. To investigate the association and gradient between major cardiovascular risk factors (smoking habit, serum lipid profile, blood pressure, relative body weight) and socio-economic position (proxy measures selected: education and occupation) data on 2592 men and 2866 women were analysed. The effect of potential confounding factors and effect modifiers was estimated. Linear and logistic regression modelling was performed for continuous and dichotomous outcomes respectively. The lower the grade of employment or the level of education, the higher was the prevalence of obesity in the study population. The association was stronger in women than in men. Higher education was associated with a lower prevalence of smoking among men and a higher prevalence among women. Systolic blood pressure was negatively related to socio-economic position in both men and women in the age-adjusted models. Attention should be concentrated on socio-economic differences in obesity and blood pressure in this population.     

Marital status and cardiovascular risk factors among middle-aged Japanese male workers: the High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study

Marital status is related to cardiovascular disease (CVD) risk factors in Western countries. However, few studies have addressed the relationship between marital status and CVD risk factors in other populations. We investigated lifestyle and CVD risk factors relative to marital status among middle-aged Japanese men. We analyzed baseline data of 40-59-yr-old male workers who participated in the high-risk and population strategy for occupational health promotion (HIPOP-OHP) study. We compared lifestyle and CVD risk factors between men who were married (Group M; n=1,419, mean age 47.9 +/- 5.1 yr) and those who had never married (Group N; n=163, mean age 46.7 +/- 4.3 yr). Men in Group N were more likely to skip breakfast, work more shifts and exercise less. Current smoking rates, as well as average values of diastolic blood pressure (DBP), serum total cholesterol and fasting plasma glucose were also higher in Group N than in Group M. The proportion of participants with three or more CVD risk factors, namely smoking, hypertension, hypercholesterolemia and hyperglycemia was higher in Group N, than in Group M (12.9% vs. 5.0%, p<0.01). The difference between Groups M and N was more evident in the subgroup of living with others, than in the subgroup of living alone. Since men who have never married might be at higher risk for CVD, effort should be made to educate this population about decreasing lifestyle-related risk factors.     

When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood

STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.     

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

Objective: This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).

Design: This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N?=?12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) – the co-occurrence of physical and psychiatric health problems – are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.

Results: Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to ‘Psychiatric Only’ health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.

Conclusion: These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.     

The interplay of socioeconomic status and ethnicity on Hispanic and white men's cardiovascular disease risk and health communication patterns

In this article, we seek to confirm past studies that document increased levels of cardiovascular disease (CVD) risk factors among White men with lower educational attainment. Second, we include a population of Hispanic men (89% Mexican American) to examine the separate and interactive effects of ethnicity and education (our measure of socioeconomic status) on CVD risk factors. Third, we examine how education and ethnicity are related to receiving health messages from print media and interpersonal channels, with the hypothesis that less educated, higher CVD risk Hispanic and White men receive fewer messages than more educated men. Finally, we examine other psychosocial variables (e.g. knowledge, self-efficacy and motivation) that may help explain observed differences in CVD risk and health communication. The study sample included 2029 men, 25-64 years of age, from three population-based, cross-sectional surveys conducted from 1979 to 1990 as part of the Stanford Five-City Project. Hispanic and White men with lower educational attainment had higher levels of CVD risk factors, and received less health information from print media and interpersonal channels than Hispanic and White men with higher educational attainment. Furthermore, less educated men from both ethnic groups reported less CVD knowledge, lower self-efficacy and lower motivation to reduce CVD risk factors than higher educated men. These results highlight the need for effective intervention programs that target low educated Hispanic and White men to decrease their disproportionate risk of CVD.     

Associations between coffee consumption and inflammatory markers in healthy persons: the ATTICA study

BACKGROUND: The effect of coffee consumption on the cardiovascular system is conflicting. Inflammation is important to the development of cardiovascular disease (CVD), and several dietary factors are thought to exert significant effects on inflammation and thus on the risk of CVD. OBJECTIVE: We aimed to investigate the associations between coffee consumption and inflammatory markers. DESIGN: The cross-sectional survey enrolled 1514 men (x +/- SD age: 46 +/- 13 y; range: 18-87 y) and 1528 women (aged 45 +/- 13 y; range: 18-89 y). Five percent of men and 3% of women were excluded for history of CVD. Fasting blood samples were collected. Dietary habits (including consumption of various types of coffee) were evaluated by using a validated food-frequency questionnaire. RESULTS: Compared with coffee nondrinkers, men who consumed >200 mL coffee/d had 50% higher interleukin 6 (IL-6), 30% higher C-reactive protein (CRP), 12% higher serum amyloid-A (SAA), and 28% higher tumor necrosis factor alpha (TNF-alpha) concentrations and 3% higher white blood cell (WBC) counts (all: P < 0.05). Women who consumed >200 mL coffee/d had 54% higher IL-6, 38% higher CRP, 28% higher SAA, and 28% higher TNF-alpha concentrations and 4% higher WBC counts (all: P < 0.05) than did coffee nondrinkers. The findings were significant even after control for the interactions between coffee consumption and age, sex, smoking, body mass index, physical activity status, and other covariates. CONCLUSIONS: A relation exists between moderate-to-high coffee consumption and increased inflammation process. This relation could explain, in part, the effect of increased coffee intake on the cardiovascular system.     

Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans

PurposeHigher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established.MethodsAcculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II. We conducted a cross-sectional analysis of the association of acculturation with prevalence of CV risk factors among 1789 elderly men and women from the Sacramento Area Latino Study on Aging using multivariate linear and logistic regression. We tested for the interaction of acculturation with risk factors by nativity status.ResultsMedian age was 69.8 years. Higher acculturation was associated with lower systolic blood pressure, lower low-density lipoprotein, higher high-density lipoprotein, and lower prevalence of CV disease after age and sex adjustment. Higher acculturation remained associated with lower level of low-density lipoprotein and higher level of high-density lipoprotein after full adjustment. Nativity status did not affect these results.ConclusionsContrary to other reports in middle-aged persons, higher levels of acculturation were associated with better lipid profiles and no significant differences in other CV risk factors by acculturation level in elderly Latinos.     

Depression,anxiety, antidepressant use,and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/Study of Latinos

PurposeTo describe prevalence and relationships to cardiovascular morbidity of depression, anxiety, and medication use among Hispanic/Latinos of different ethnic backgrounds.MethodsCross-sectional analysis of 15,864 men and women aged 18 to 74 years in the population-based Hispanic Community Health Study/Study of Latinos. Depressive and anxiety symptoms were assessed with shortened Center for Epidemiological Studies Depression Scale and Spielberger Trait Anxiety Scale.ResultsPrevalence of high depressive symptoms ranged from low of 22.3% (95% confidence interval [CI], 20.4–24.3) to high of 38.0% (95% CI, 35.2–41.0) among those of Mexican or Puerto Rican background, respectively. Adjusted odds ratios for depression rose monotonically with number of cardiovascular disease (CVD) risk factor from 1.46 (95% CI, 1.18–1.75) for those with one risk factors to 4.36 (95% CI, 2.47–7.70) for those with five risk factors. Antidepressant medication was used by 5% with striking differences between those with and without history of CVD (15.4% and 4.6%, respectively) and between insured (8.2%) and uninsured (1.8%).ConclusionsAmong US Hispanics/Latinos, high depression and anxiety symptoms varied nearly twofold by Hispanic background and sex, history of CVD, and increasing number of CVD risk factors. Antidepressant medication use was lower than in the general population, suggesting under treatment especially among those who had no health insurance.     

Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites

OBJECTIVE: BMI (kilograms per meters squared) and waist circumference (WC) (measured in centimeters) are each associated with the risk of developing cardiovascular disease (CVD). Therefore, a combination of the two may be more effective in identifying subjects at risk than either alone. The present study sought to identify the combination of BMI and WC that has the strongest association with CVD risk factors in whites. RESEARCH METHODS AND PROCEDURES: Subjects were 8712 white men and women from the Third National Health and Nutrition Examination Survey. The optimal combination of BMI and WC was developed using logistic regression models with BMI and WC as predictors and CVD risk factors as outcomes. The combined measure of BMI and WC using current cut-off points was also examined. Sensitivity, specificity, and receiver operating characteristics curves were compared between the combined measures and BMI alone. RESULTS: For white men, the optimal combination of BMI and WC for identifying CVD risk factors was 0.68 x BMI + 0.32 x WC. This combination generated a score that better estimated the odds of having CVD risk factors than either alone. For white women, WC alone largely determined the likelihood of having CVD risks. The combination of BMI and WC using current cut-off points may provide an improved measure of CVD risk. Combined measures showed a higher sensitivity or a shorter distance in receiver operating characteristic curves in the identification of CVD risk factors. DISCUSSION: Combined measures of BMI and WC may provide a higher overall test performance for CVD risk factors and may be useful in some ethnic groups as an improved means of screening subjects for further evaluation in the clinical setting.     

Self-reported diabetes mellitus and risk of mortality from all causes, cardiovascular disease, and cancer in Takayama: a population-based prospective cohort study in Japan

Background

Diabetes mellitus has been reported to be a major risk factor for cardiovascular disease (CVD), and higher risk of CVD among women than that among men has been observed in many studies. Further, the association of diabetes with increasing risk of cancer has also been reported. Well-designed studies conducted among men and women in the general Japanese population remain scarce.

Methods

Our cohort consisted of 13355 men and 15724 women residing in Takayama, Japan, in 1992. At the baseline, the subjects reported diabetes in a questionnaire. Any deaths occurring in the cohort until 1999 were noted by using data from the Office of the National Vital Statistics. The risk of mortality was separately assessed for men and women by using a Cox proportional hazard model after adjusting for age; smoking status; body mass index (BMI); physical activity; years of education; history of hypertension; and intake of total energy, vegetables, fat, and alcohol.

Results

Diabetes significantly increased the risk of mortality from all causes [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.11-1.64] and from coronary heart disease (CHD) (HR: 2.96, 95% CI: 1.59-5.50) among men, and that from all causes (HR: 1.74, 95% CI: 1.34-2.26) and cancer (HR: 1.88, 95% CI: 1.16-3.05) among women. Diabetes was not significantly associated with mortality from CHD among women.

Conclusion

The findings suggest that diabetes increases the risk of mortality from CVD among men and that from cancer among women. The absence of increased risk of mortality from CHD among women may suggest a particular pattern in the Japanese population.Key words: Diabetes mellitus, Mortality, Cardiovascular disease, Cancer, Cohort study