Geographic and Individual Correlates of Subclinical Atherosclerosis in an Asymptomatic Rural Appalachian Population

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Abstract

Background:

This study aimed to examine the association between subclinical atherosclerosis (ascertained as coronary artery calcium [CAC]) in asymptomatic individuals in the Central Appalachian region of the United States and individual- and geographic-level factors.

Materials and Methods:

Data were obtained from participants in CAC screening between 2012 and 2016. CAC score was assessed as CAC = 0 (no plaque), 1 ≤ CAC ≤ 99 (mild plaque), 100 ≤ CAC ≤ 399 (moderate plaque) and CAC ≥ 400 (severe plaque). Additionally, data on demographics (age, sex and race), medical conditions, lifestyle factors and family history of coronary artery disease were obtained. Further, zip codes of place of residence for participants were used to generate geographic-level data. Descriptive statistics were used to estimate the prevalence of CAC, and multinomial logistic regression models were used to delineate significant factors.

Results:

Of 1,512 participants, 57.6% had CAC > 0. The prevalence of mild, moderate and severe plaques was 31.6%, 16.3% and 9.7%, respectively. Demographics (age and sex), medical conditions, lifestyle factors and family history of coronary artery disease were associated with increased risk for subclinical atherosclerosis. Further, the proportion of minority residents significantly increased the risk for severe plaque (relative risk ratio = 1.06, P = 0.04) and the proportion of residents on government assistance significantly decreased the risk for mild plaque (relative risk ratio = 0.93, P = 0.03).

Conclusions:

The results imply that the proportion of minority residents in a geographic area is associated with increased relative risk for subclinical atherosclerosis, while the proportion of residents on government assistance decreased such risk. However, future geographic or neighborhood-level studies with a larger sample size are needed to delineate further the consistency of these results in the Central Appalachian population.

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