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Environmental and Neighborhood Influences on Health at #AHA19

Where we live and work shapes us in many ways. Whether growing up in an urban, suburban, or rural community, our neighborhoods can have an outsized impact our hobbies, lifestyle, and health. It was inspiring to see so many investigators presenting findings on this topic today at the American Heart Association (AHA) 2019 Scientific Sessions during the “Environmental and Neighborhood Influences on Health” poster session.

W. Wyatt Wilson and colleagues at the University of Chicago presented “Spatiotemporal Association Between Violent Crime And Ambulatory Elevations In Systolic Blood Pressure”, an innovative analysis of 133,024 geo-coded violent crimes reported by the City of Chicago and home addresses of patients with blood pressure readings from 232,488 unique outpatient appointments. They found that longer duration of exposure to violent crime within 500 meters of patients’ home addresses was associated with increased systolic blood pressure (approximately 0.27 mmHg per crime) [Figure 1]1. These results echo findings from the Jackson Heart Study published earlier this year by Tanya M. Spruill and colleagues on chronic stress and incident hypertension among black adults2. This analysis followed 1,829 adults without hypertension over a median of 7 years and recorded their blood pressure and self-reported stress. After multi-variable adjustment, they found moderate or high perceived stress was associated with higher risk of developing hypertension. The chronic health effects of stress resulting from living in a neighborhood with violent crime is a newly identified and very significant externality of these crimes.

Figure 1:

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Daniel W. Riggs and colleagues at the University of Louisville presented findings on the interaction between neighborhood greenness, air pollution, and arterial stiffness3. This cross-sectional study of 63 adults measured: neighborhood greenness (satellite-derived normalized difference vegetation [NDVI] index), air pollution (particulate matter [PM] 2.5 levels and ozone levels), and arterial stiffness (augmentation pressure, pulse pressure, and aortic systolic pressure in mmHg). They found among participants living in low greenness areas that air pollution was positively correlated with arterial stiffness. Further, Zachary Rhinehart and colleagues at the University of Pittsburgh presented their poster “Association of Particulate Matter and Incident Stroke in Atrial Fibrillation” which was a retrospective study of 31,414 patients at their academic medical center4. They found that among patients diagnosed with atrial fibrillation, living in neighborhoods with high levels of air pollution (highest quartile compared to lowest quartile) was associated with an increased risk of stroke (HR 1.50; CI 1.30 – 1.72) [Figure 2]. Given such consistent findings between air pollution and cardiovascular disease, I wonder if built environment interventions such as increased vegetation might help mediate neighborhood factors that contribute to cardiovascular disease long-term.

Figure 2:

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Attending scientific sessions this year was a phenomenal experience. I came away with new insights for clinic from the late breaking trial sessions, met some incredibly smart and gifted people, and as evidenced by this specific session came away with a renewed enthusiasm to research some questions I was left with. Looking forward to #AHA20!

 

References:

  1. W. Wilson et. al. Spatiotemporal Association Between Violent Crime And Ambulatory Elevations In Systolic Blood Pressure. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 18, 2019 https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.17139
  2. J Am Heart Assoc. 2019;8:e012139. DOI: 10.1161/JAHA.119.012139.
  3. W. Riggs et. al. Effect Modification of Neighborhood Greenness on the Relationship Between Ambient Air Pollution and Arterial Stiffness. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 18, 2019 https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.15881
  4. Rhinehart et. al. Association of Particulate Matter and Incident Stroke in Atrial Fibrillation. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 18, 2019 https://www.ahajournals.org/doi/10.1161/circ.140.suppl_1.16440

 

 

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.

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Psychological and Social Influences on Cardiovascular Disease at #AHA19

Better understanding how depression, social isolation, and other psychosocial determinates of health interact with cardiovascular disease is a rapidly growing field of research. Unpacking the relationship between brain function, cardiovascular physiology, and health outcomes is no simple feat. A number of new studies presented on Saturday, November 16th at the “Depression and Psychosocial Influences on Cardiovascular Disease” poster session during this year’s American Heart Association Scientific Sessions shed new light on this topic.

Crystal Cene and her team at the University of North Carolina presented findings from the Womens Health Initiative Study (WHI) showing a correlation between social isolation and heart failure. In their analysis, they found that socially isolated woman had a 19% higher risk (HR of 1.19; CI 1.03 – 1.39) of developing heart failure over a median follow-up of 15 years1. These findings complement work published earlier this year by Anne Vingaard Christensen and colleagues at Copenhagen University Hospital2. Among 13,442 patients with ischemic heart disease, arrhythmia, valvular disease, or heart failure, loneliness predicated all-cause mortality in men (HR 2.14; CI 1.43 – 3.22) and women (HR2.92, CI 1.55 – 5.49). Given that we now have evidence that loneliness or social isolation puts patients at risk for heart failure and puts patients with heart failure at risk of all-cause mortality, there is all the more need to better understand this relationship.

simple 7Two other groups of researchers presented similar findings with depression and heart failure. An analysis of The Atherosclerosis Risk in Communities Study (ARIC) presented by Katja Vu from Brigham and Women’s Hospital found a relationship between depression and incidence of heart failure with preserved ejection fraction (HR 1.07; CI 1.02 – 1.13) among older adults (mean age 75 years) of both sexes3. However, there was no such relationship with incidence of heart failure with reduced ejection fraction [Figure 1]. Yosef Khan from the American Heart Association presented National Health and Nutritional Examination Survey (NHANES) data suggesting that depression increases risk of heart failure, coronary disease, or cerebrovascular disease even after adjusting for Life’s Simple 7: physical exercise, heart healthy diet, weight, blood pressure, cholesterol, blood sugar, and tobacco use4.

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These provocative findings leave us with many questions: What mechanisms are responsible for poor outcomes among patients with social isolation or depression? Does access to care or medication adherence mediate these effects? Would interventions to reduce social isolation or depression improve cardiovascular outcomes in the long-run? There is a lot left to discover in this bio-psychosocial model, but I for one am looking forward to future work in the field.

 

References:

  1. CW Cene et. al. Social Isolation Independently Predicts Incident Heart Failure Among Older Women: Findings From the Womens Health Initiative Study. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 16-18, 2019 (https://www.abstractsonline.com/pp8/#!/7891/presentation/29740)
  2. Christensen AV, et al. Heart 2019;0:1–7. doi:10.1136/heartjnl-2019-315460
  3. K Vu et. al. Depressive Symptoms, Cardiac Function, and Risk of Heart Failure With Preserved or Reduced Ejection Fraction in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 16-18, 2019 (https://www.abstractsonline.com/pp8/#!/7891/presentation/29738)
  4. Y Khan et. al. Depression and Non Fatal Cardiovascular Diseases Among Adults in the United States. Poster Presentation, American Heart Association 2019 Scientific Sessions, Philadelphia, PA, November 16-18, 2019 (https://www.abstractsonline.com/pp8/#!/7891/presentation/29739)

 

The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.