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Meta-Analysis
. 2021 Aug 11;16(8):e0255959.
doi: 10.1371/journal.pone.0255959. eCollection 2021.

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

Janko Janković  1 , Stefan Mandić-Rajčević  1 , Maša Davidović  1   2 , Slavenka Janković  3
Affiliations
Meta-Analysis

Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis

Janko Janković et al. PLoS One. .

Abstract

Background: In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH.

Methods: A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics.

Results: This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics.

Conclusions: To the best of our knowledge, this is the first systematic review on the relationship between participants' socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
A PRISMA flow diagram that details the inclusion and exclusion of studies considered for this systematic review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig 2
Fig 2. Forest plots showing proportions of ideal cardiovascular health metrics and ideal cardiovascular health.
Ideal smoking (A), Ideal diet (B), Ideal physical activity (C), Ideal body mass index (D), Ideal blood pressure (E), Ideal total cholesterol (F), Ideal fasting blood glucose (G), 5, 6 and 7 ideal CVH metrics (H), Ideal CVH (6 and 7 CVH metrics) (I). CVH, Cardiovascular health; CI, confidence interval.
Fig 3
Fig 3. Forest plots depicting proportions with their confidence intervals of ideal cardiovascular health by age group.
See this image and copyright information in PMC

References

    1. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al.. Defining and setting national goals for cardiovascular health promotion and disease reduction: The american heart association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121: 586–613. doi: 10.1161/CIRCULATIONAHA.109.192703 - DOI - PubMed
    1. Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD. Community prevalence of ideal cardiovascular health, by the american heart association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011;57: 1690–1696. doi: 10.1016/j.jacc.2010.11.041 - DOI - PMC - PubMed
    1. Fang J, Yang Q, Hong Y, Loustalot F. Status of cardiovascular health among adult Americans in the 50 States and the District of Columbia, 2009. J Am Heart Assoc. 2012;1: 1–13. doi: 10.1161/JAHA.111.000638 - DOI - PMC - PubMed
    1. Graciani A, León-Muñoz LM, Guallar-Castillón P, Rodríguez-Artalejo F, Banegas JR. Cardiovascular health in a southern mediterranean european country a nationwide population-based study. Circ Cardiovasc Qual Outcomes. 2013;6: 90–98. doi: 10.1161/CIRCOUTCOMES.112.967893 - DOI - PubMed
    1. Olsen GS, Holm ASS, Jørgensen T, Borglykke A. Distribution of ideal cardiovascular health by educational levels from 1978 to 2006: A time trend study from the capital region of Denmark. Eur J Prev Cardiol. 2014;21: 1145–1152. doi: 10.1177/2047487313485513 - DOI - PubMed

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