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Special Issue "Cardiovascular Diseases and Public Health"

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2009)

Special Issue Editor

Guest Editor
Dr. Kathryn M. Rose (Website)

Cardiovascular Disease Program, Department of Epidemiology, University of North Carolina at Chapel Hill, 137 E Franklin Street, Suite 306, Chapel Hill, NC 27514, USA
Fax: +1 919 966 9800
Interests: cardiovascular disease epidemiology; socioeconomic and geographic health disparities; population-based cardiovascular disease surveillance

Special Issue Information

Dear Colleagues,

Despite decades of steady declines in coronary heart disease (CHD) and stroke mortality in many western countries, cardiovascular disease (CVD) is the leading cause of death worldwide. With the aging of populations, higher rates of risk factors (e.g., smoking, physical inactivity), emerging epidemics (e.g., obesity, diabetes, heart failure) and increased economic costs associated with CHD survival, the burden of CVD is projected to steadily increase in coming decades, with less affluent individuals and countries being disproportionately impacted.
This special issue focuses on the contribution of socio-environmental characteristics to disparities in CVD within and across populations. Review papers that critically evaluate the current literature and incorporate suggestions for overcoming shortcomings in future research are encouraged, as are original research papers.

Kathryn Rose, Ph. D.
Guest Editor

Keywords

  • cardiovascular disease
  • stroke
  • coronary heart disease
  • heart failure
  • socioeconomic disparities
  • global burden of cardiovascular disease
  • social environment
  • socio-environmental characteristics
  • socio-economic characteristics

Published Papers (6 papers)

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Research

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Open AccessArticle Estimating Prevalence of Coronary Heart Disease for Small Areas Using Collateral Indicators of Morbidity
Int. J. Environ. Res. Public Health 2010, 7(1), 164-177; doi:10.3390/ijerph7010164
Received: 20 November 2009 / Accepted: 14 January 2010 / Published: 18 January 2010
Cited by 5 | PDF Full-text (1328 KB) | HTML Full-text | XML Full-text
Abstract
Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, [...] Read more.
Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, deaths may be recorded for small areas, but disease prevalence only at a considerably higher spatial scale. Nevertheless prevalence estimates at small area level are important for assessing health need. An instance is provided by England where deaths and hospital admissions for coronary heart disease are available for small areas known as wards, but prevalence is only available for relatively large health authority areas. To estimate CHD prevalence at small area level in such a situation, a shared random effect method is proposed that pools information regarding spatial morbidity contrasts over different indicators (deaths, hospitalizations, prevalence). The shared random effect approach also incorporates differences between small areas in known risk factors (e.g., income, ethnic structure). A Poisson-multinomial equivalence may be used to ensure small area prevalence estimates sum to the known higher area total. An illustration is provided by data for London using hospital admissions and CHD deaths at ward level, together with CHD prevalence totals for considerably larger local health authority areas. The shared random effect involved a spatially correlated common factor, that accounts for clustering in latent risk factors, and also provides a summary measure of small area CHD morbidity. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
Open AccessArticle Associations between Area-Level Unemployment, Body Mass Index, and Risk Factors for Cardiovascular Disease in an Urban Area
Int. J. Environ. Res. Public Health 2009, 6(12), 3082-3096; doi:10.3390/ijerph6123082
Received: 26 October 2009 / Accepted: 1 December 2009 / Published: 4 December 2009
Cited by 14 | PDF Full-text (225 KB) | HTML Full-text | XML Full-text
Abstract
Introduction: Cardiovascular Disease (CVD) has been linked to \"neighbourhood\" socioeconomic status (nSES), often operationalized as a composite index of aggregate income, occupation and education within predefined administrative boundaries. The role of specific, non-composite socioeconomic markers has not been clearly explained. It is [...] Read more.
Introduction: Cardiovascular Disease (CVD) has been linked to \"neighbourhood\" socioeconomic status (nSES), often operationalized as a composite index of aggregate income, occupation and education within predefined administrative boundaries. The role of specific, non-composite socioeconomic markers has not been clearly explained. It is also unclear whether the relationship between nSES and CVD varies according to sex. We sought to determine whether area-level unemployment (ALU) was associated with CVD risk, and whether this association differed by sex. Methods: 342 individuals from the Montreal Neighbourhood Survey of Lifestyle and Health provided self-reported behavioural and socioeconomic information. A nurse collected biochemical and anthropometric data. ALU, a weighted average of the proportion of persons 15-years and older available for but without work, was measured using a Geographic Information System for a 250 m buffer centred on individual residence. Generalized Estimating Equations were used to estimate the associations between ALU, body mass index (BMI) and a cumulative score for total cardiometabolic risk (TCR). Results: After confounder adjustments, the mean 4th minus 1st quartile difference in BMI was 3.19 kg/m2 (95% CI: 2.39, 3.99), while the prevalence ratio for the 4th relative to 1st quartile for TCR was 2.20 (95 % CI: 1.53, 3.17). Sex interacted with ALU; women relative to men had greater mean 3.97 kg/m2 (95% CI: 2.08, 5.85) BMI and greater mean TCR 1.51 (95% CI: 0.78, 2.90), contrasted at mean ALU. Conclusions: Area-level unemployment is associated with greater CVD risk, and this association is stronger for women. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
Open AccessArticle Agreement between the SCORE and D’Agostino Scales for the Classification of High Cardiovascular Risk in Sedentary Spanish Patients
Int. J. Environ. Res. Public Health 2009, 6(11), 2800-2811; doi:10.3390/ijerph6112800
Received: 12 August 2009 / Accepted: 6 November 2009 / Published: 11 November 2009
Cited by 1 | PDF Full-text (465 KB) | HTML Full-text | XML Full-text
Abstract
Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken [...] Read more.
Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40–65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (≥20% according to the Framingham-D’Agostino scale, and ≥5% according to SCORE). Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. Results: The mean risk in males (35%) was 19.5% ± 13% with D’Agostino scale, and 3.2% ± 3.3% with SCORE. Among females, they were 8.1% ± 6.8% and 1.2% ± 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857–0.889) and 0.818 in females (95% CI: 0.800–0.834), while the kappa index was 0.50 in males (95% CI: 0.44%–0.56%) and 0.61 in females (95% CI: 0.52%–0.71%). The most frequent disagreement, characterized by high risk according to D’Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. Conclusions: The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
Open AccessArticle Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study
Int. J. Environ. Res. Public Health 2009, 6(9), 2481-2499; doi:10.3390/ijerph6092481
Received: 14 August 2009 / Accepted: 14 September 2009 / Published: 17 September 2009
Cited by 5 | PDF Full-text (693 KB) | HTML Full-text | XML Full-text
Abstract
Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who [...] Read more.
Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people‟s efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, “fast” food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
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Review

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Open AccessReview A Systematic Review of Occupational Exposure to Particulate Matter and Cardiovascular Disease
Int. J. Environ. Res. Public Health 2010, 7(4), 1773-1806; doi:10.3390/ijerph7041773
Received: 4 March 2010 / Revised: 31 March 2010 / Accepted: 16 April 2010 / Published: 19 April 2010
Cited by 42 | PDF Full-text (405 KB) | HTML Full-text | XML Full-text
Abstract
Exposure to ambient particulate air pollution is a recognized risk factor for cardiovascular disease; however the link between occupational particulate exposures and adverse cardiovascular events is less clear. We conducted a systematic review, including meta-analysis where appropriate, of the epidemiologic association between [...] Read more.
Exposure to ambient particulate air pollution is a recognized risk factor for cardiovascular disease; however the link between occupational particulate exposures and adverse cardiovascular events is less clear. We conducted a systematic review, including meta-analysis where appropriate, of the epidemiologic association between occupational exposure to particulate matter and cardiovascular disease. Out of 697 articles meeting our initial criteria, 37 articles published from January 1990 to April 2009 (12 mortality; 5 morbidity; and 20 intermediate cardiovascular endpoints) were included. Results suggest a possible association between occupational particulate exposures and ischemic heart disease (IHD) mortality as well as non-fatal myocardial infarction (MI), and stronger evidence of associations with heart rate variability and systemic inflammation, potential intermediates between occupational PM exposure and IHD. In meta-analysis of mortality studies, a significant increase in IHD was observed (meta-IRR = 1.16; 95% CI: 1.06–1.26), however these data were limited by lack of adequate control for smoking and other potential confounders. Further research is needed to better clarify the magnitude of the potential risk of the development and aggravation of IHD associated with short and long-term occupational particulate exposures and to clarify the clinical significance of acute and chronic changes in intermediate cardiovascular outcomes. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
Open AccessReview Preventing and Managing Cardiometabolic Risk: The Logic for Intervention
Int. J. Environ. Res. Public Health 2009, 6(10), 2568-2584; doi:10.3390/ijerph6102568
Received: 10 August 2009 / Accepted: 29 September 2009 / Published: 30 September 2009
Cited by 14 | PDF Full-text (532 KB) | HTML Full-text | XML Full-text
Abstract
Cardiometabolic risk (CMR), also known as metabolic syndrome or insulin resistance syndrome, comprises obesity (particularly central or abdominal obesity), high triglycerides, low HDL, elevated blood pressure, and elevated plasma glucose. Leading to death from diabetes, heart disease, and stroke, the root cause [...] Read more.
Cardiometabolic risk (CMR), also known as metabolic syndrome or insulin resistance syndrome, comprises obesity (particularly central or abdominal obesity), high triglycerides, low HDL, elevated blood pressure, and elevated plasma glucose. Leading to death from diabetes, heart disease, and stroke, the root cause of CMR is inadequate physical activity, a Western diet identified primarily by low intake of fruits, vegetables, and whole grains, and high in saturated fat, as well as a number of yet-to-be-identified genetic factors. While the pathophysiological pathways related to CMR are complex, the universal need for adequate physical activity and a diet that emphasizes fruits and vegetables and whole grains, while minimizing food high in added sugars and saturated fat suggests that these behaviors are the appropriate focus of intervention. Full article
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)

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