Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing ...evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.
Financial strain is a prevalent form of psychosocial stress in the United States; however, information about the relationship between financial strain and cardiovascular health remains sparse, ...particularly in older women.
The cross-sectional association between financial strain and ideal cardiovascular health were examined in the Women's Health Study follow-up cohort (N = 22,048; mean age = 72± 6.0 years).Six self-reported measures of financial strain were summed together to create a financial strain index and categorized into 4 groups: No financial strain, 1 stressor, 2 stressors, and 3+ stressors. Ideal cardiovascular health was based on the American Heart Association strategic 2020 goals metric, including tobacco use, body mass index, physical activity, diet, blood pressure, total cholesterol and diabetes mellitus. Cardiovascular health was examined as continuous and a categorical outcome (ideal, intermediate, and poor). Statistical analyses adjusted for age, race/ethnicity, education and income.
At least one indicator of financial strain was reported by 16% of participants. Number of financial stressors was associated with lower ideal cardiovascular health, and this association persisted after adjustment for potential confounders (1 financial stressor (FS): B = −0.10, 95% Confidence Intervals (CI) = −0.13, −0.07; 2 FS: B = −0.20, 95% CI = −0.26, −0.15; 3+ FS: B = −0.44, 95% CI = −0.50, −0.38).
Financial strain was associated with lower ideal cardiovascular health in middle aged and older female health professional women. The results of this study have implications for the potential cardiovascular health benefit of financial protections for older individuals.
Background. We studied women and their infants to evaluate risk factors for congenital transmission and cardiomyopathy in Trypanosoma cruzi–infected women. Methods. Women provided data and blood for ...serology and quantitative polymerase chain reaction (PCR). Infants of infected women had blood tested at 0 and 1 month by microscopy, PCR and immunoblot, and serology at 6 and 9 months. Women underwent electrocardiography (ECG). Results. Of 1696 women, 456 (26.9%) were infected; 31 (6.8%) transmitted T. cruzi to their infants. Women who transmitted had higher parasite loads than those who did not (median, 62.0 interquartile range {IQR}, 25.8–204.8 vs 0.05 IQR, 0–29.6; P < .0001). Transmission was higher in twin than in singleton births (27.3% vs 6.4%; P = .04). Women who had not lived in infested houses transmitted more frequently (9.7% vs 4.6%; P = .04), were more likely to have positive results by PCR (65.5% vs 33.9%; P < .001), and had higher parasite loads than those who had lived in infested houses (median, 25.8 IQR, 0–64.1 vs 0 IQR, 0–12.3; P < .001). Of 302 infected women, 28 (9.3%) had ECG abnormalities consistent with Chagas cardiomyopathy; risk was higher for older women (odds ratio OR, 1.06 95% confidence interval {CI}, 1.01–1.12 per year) and those with vector exposure (OR, 3.7 95% CI, 1.4–10.2). We observed a strong dose-response relationship between ECG abnormalities and reported years of living in an infested house. Conclusions. We hypothesize that repeated vector-borne infection sustains antigen exposure and the consequent inflammatory response at a higher chronic level, increasing cardiac morbidity, but possibly enabling exposed women to control parasitemia in the face of pregnancy-induced Th2 polarization.
Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to ...determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.
Depressive disorders are a leading cause of disability and are globally pervasive. It is estimated that 80% of depression occurs in low-income and middle-income countries. Depression is associated ...with worse outcomes in patients with cardiac disease including heart failure (HF); however, mechanistic understanding to explain heightened risk in HF remains poorly characterized. We examined the association between depressive symptoms and cardiac structure and function by transthoracic echocardiography. We selected a random sample of adult participants in Puno and Pampas de San Juan de Miraflores, Peru, from the CRONICAS cohort study. Depression symptoms were self-reported and measured with the Center for Epidemiological Studies Depression Scale in 2010. Participants underwent transthoracic echocardiography in 2014. Multivariable linear regression was used to examine the relationship between depressive symptoms and echocardiographic measures of cardiac structure and function and was adjusted for relevant covariates. Three hundred and seventy-three participants (mean age 56.7 years, 57% female) were included in this analysis of which 91 participants (24%) had clinically significant depressive symptoms. After adjustment, clinically significant depressive symptoms were associated with a reduced diastolic relaxation velocity compared to non-depressed subjects (–0.72 cm/s, 95% CI –1.21 to –0.24, p = 0.004). Other differences between depressed and non- depressed participants were less obvious. In conclusion, clinically significant depressive symptoms were associated with a lower septal e’ velocity in the Peruvian population. Depressive symptoms were not obviously associated with other abnormalities in cardiac structure or function.
Abstract Background The complex interaction between pulmonary function, cardiac function and adverse cardiovascular events has only been partially described. We sought to describe the association ...between pulmonary function with left heart structure and function, all-cause mortality and incident cardiovascular hospitalization. Methods This study is a retrospective analysis of patients evaluated in a single tertiary care medical center. We used multivariable linear regression analyses to examine the relationship between FVC and FEV1 with left ventricular ejection fraction (LVEF), left ventricular internal dimension in systole and diastole (LVIDS, LVIDD) and left atrial diameter, adjusting for baseline characteristics, right ventricular function and lung hyperinflation. We also used Cox proportional hazards models to examine the relationship between FVC and FEV1 with all-cause mortality and cardiac hospitalization. Results A total of 1807 patients were included in this analysis with a median age of 61 years and 50% were female. Decreased FVC and FEV1 were both associated with decreased LVEF. In individuals with FVC less than 2.75 liters, decreased FVC was associated with increased all-cause mortality after adjusting for left and right heart echocardiographic variables (hazard ratio HR 0.49, 95% CI 0.29, 0.82, respectively). Decreased FVC was associated with increased cardiac hospitalization after adjusting for left heart size (HR 0.80, 95% CI 0.67, 0.96), even in patients with normal LVEF (HR 0.75, 95% CI 0.57, 0.97). Conclusion In a tertiary care center reduced pulmonary function was associated with adverse cardiovascular events, a relationship that is not fully explained by left heart remodeling or right heart dysfunction.
ObjectiveTo compare all-cause and cause-specific mortality among 3 distinct groups: within-country, rural-to-urban migrants, and rural and urban dwellers in a longitudinal cohort in Peru.MethodsThe ...PERU MIGRANT Study, a longitudinal cohort study, used an age-stratified and sex-stratified random sample of urban dwellers in a shanty town community in the capital city of Peru, rural dwellers in the Andes, and migrants from the Andes to the shanty town community. Participants underwent a questionnaire and anthropomorphic measurements at a baseline evaluation in 2007–2008 and at a follow-up visit in 2012–2013. Mortality was determined by death certificate or family interview.ResultsOf the 989 participants evaluated at baseline, 928 (94%) were evaluated at follow-up (mean age 48 years; 53% female). The mean follow-up time was 5.1 years, totalling 4732.8 person-years. In a multivariable survival model, and relative to urban dwellers, migrant participants had lower all cause mortality (HR=0.30; 95% CI 0.12−0.78), and both the migrant (HR=0.07; 95% CI 0.01−0.41) and rural (HR=0.06; 95% CI 0.01−0.62) groups had lower cardiovascular mortality.ConclusionsCardiovascular mortality of migrants remains similar to that of the rural group, suggesting that rural-to-urban migrants do not appear to catch up with urban mortality in spite of having a more urban cardiovascular risk factor profile.
Survey multivariable linear regression analyses using sampling weights were used to model the relationship of each self-reported occupational exposure with echocardiographic measures of cardiac ...structure and function, adjusting for age, sex, study site, body mass index, tobacco use, alcohol use, physical activity, and years of education. When the analysis was restricted to exposure at the longest held job (N= 504), occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL 1.6, p<0.0001), decreased LV EF (-2.7% 0.6, p<0.0001), worse LV global longitudinal strain (GLS) (1.0% 0.3, p=0.0009), and decreased right ventricular (RV) fractional area change (-0.02 cm2 0.004, p<0.001).
Background Our objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults. Methods and Results Employed participants were included ...(n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest-held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self-reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (-3.1%; standard error SE, 1.0
=0.002). When the analysis was restricted to exposure at the longest-held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6
<0.0001), decreased LV ejection fraction (-2.7%; SE, 0.6
<0.0001), worse LV global longitudinal strain (1.0%; SE, 0.3
=0.0009), and decreased right ventricular fractional area change (-0.02; SE, 0.004
<0.001). Exposure to pesticides was associated with worse average global longitudinal strain (0.8%; SE, 0.2
<0.0001). Exposure to metals was associated with worse global longitudinal strain in the 2-chamber view (1.0%; SE, 0.5
=0.04), increased stroke volume (3.6 mL; SE, 1.6
=0.03), and increased LV mass indexed to BSA (9.2 g/m
; SE, 3.8
=0.01) or height (4.4 g/m
; SE, 1.9
=0.02). Conclusions Occupational exposures to burning wood, vehicle exhaust, pesticides, and metals were associated with abnormal parameters of LV and right ventricular systolic function. Reducing exposures to toxic chemicals and particulates in the workplace is a potential opportunity to prevent cardiovascular disease in populations at risk.
PDF
