Abstract 17267: Cardiovascular Risk Profile of Appalachians Living in an Austere Environment

Abstract

Background: Austere environments are characterized by persistent poverty, high unemployment, lack of health insurance, low education, poor access to healthcare, and poor access to fresh foods and safe areas for activity. Eastern Kentucky is the most austere of all Appalachia. It has been identified, by self-report from Behavioral Risk Factor Surveillance System, to have among the worst cardiovascular (CV) health in the U.S. Objective data, however, are limited. Objective: To describe the CV risk factor profile of Appalachian Kentucky.

Methods: We enrolled 1146 individuals from Appalachian Kentucky (age 52.8 ± 15, range 19 - 91 years; 74.5% women). We measured (1) body mass index from height assessed with a stadiometer, weight with a professional scale; (2) lipid profile; (3) HgA1c in diabetics; (4) depressive symptoms using the PHQ-9; (5) waist circumference with anthropemtric tapes; (6) blood pressure (BP); and (7) sodium intake using 24-hour urinary sodium excretion.

Results: A total of 29% of participants met WHO criteria for overweight, and 58% for obesity (compared to 35% and 27%, nationally). Sixteen percent were diabetic (compared to 9% nationally); of these 52.5% had HgA1c > 7%. Waist circumference was abnormal at > 40 inches in 61% of men, and > 35 inches in 78% of women. A total of 18% of individuals met criteria for depression (compared to 2-3% nationally). Forty-six percent of participants had hypertension (compared to 25% nationally). Diastolic BP was > 90mmHg in 12% of individuals, and among those prescribed antihypertensive medications was > 90 mmHg in 13%. Systolic BP was > 140mmHg in 50%, and among those prescribed antihypertensive medication was > 140mmHg in 60%. Systolic BP was > 120mmHg in 67.7% of individuals. Low density lipoprotein was > mg/dL in 60.4%; high density lipoprotein was < 40mg/dL in 75.4% of men and < 50mg/dL in 61.6% of women; triglycerides were > 200mg/dL in 40% of individuals. Daily sodium excretion was > 2500mg in 72% of participants.

Conclusions: Compared to published data, the CV risk profile of this sample is markedly worse than that seen in the rest of Appalachia, the state of Kentucky or the United States. Novel interventions are needed to address CV health disparities in Appalachian Kentucky.