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. 2021 Jul;96(7):1770-1781.
doi: 10.1016/j.mayocp.2020.12.034. Epub 2021 Mar 26.

Geographic Variation in Cardiovascular Health Among American Adults

Vibhu Parcha  1 , Rajat Kalra  2 , Sarabjeet S Suri  1 , Gargya Malla  3 , Thomas J Wang  4 , Garima Arora  1 , Pankaj Arora  5
Affiliations

Geographic Variation in Cardiovascular Health Among American Adults

Vibhu Parcha et al. Mayo Clin Proc. 2021 Jul.

Abstract

Objective: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.

Methods: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.

Results: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (Ptrend<.001) nationally, with modest improvement across all regions (Ptrend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (Ptrend=.03) and southern regions (Ptrend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons).

Conclusion: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

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Conflict of interest statement

Disclosures: None of the authors had any conflicts of interest or financial disclosures to declare.

Figures

Figure 1.
Figure 1.. Heatmap of Prevalence of Cardiovascular Risk Factors and Diseases: 2017
The figure shows the prevalence of cardiovascular risk factors and diseases in the United States. The darker shades indicate higher prevalence, and a lighter shade indicates a lower prevalence.
Figure 2.
Figure 2.. Geographic Distribution of Cardiovascular Mortality and Relationship with Prevalence of Poor Cardiovascular Health: 2017
Panel A: Geographic Distribution of Cardiovascular Mortality. The heatmap depicts the age-adjusted cardiovascular mortality rate (per 100,000 persons). The darker shades indicate greater mortality, and lighter shade indicates lower mortality. The map shows the quartiles of cardiovascular mortality across the American states. Panel B. Relationship of Cardiovascular Mortality and Prevalence of Poor Cardiovascular Health. The diamonds in blue indicate the states in the southern region. The red diamonds represent the states in the western region. The pink diamonds represent the states from the northeastern region. The green diamonds indicate the midwestern region states.
Figure 2.
Figure 2.. Geographic Distribution of Cardiovascular Mortality and Relationship with Prevalence of Poor Cardiovascular Health: 2017
Panel A: Geographic Distribution of Cardiovascular Mortality. The heatmap depicts the age-adjusted cardiovascular mortality rate (per 100,000 persons). The darker shades indicate greater mortality, and lighter shade indicates lower mortality. The map shows the quartiles of cardiovascular mortality across the American states. Panel B. Relationship of Cardiovascular Mortality and Prevalence of Poor Cardiovascular Health. The diamonds in blue indicate the states in the southern region. The red diamonds represent the states in the western region. The pink diamonds represent the states from the northeastern region. The green diamonds indicate the midwestern region states.
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