Brewer, LaPrincess C.

ABSTRACT Aims Religiosity and spirituality (R/S) are generally associated with a more favourable cardiovascular risk profile, but longitudinal evidence is limited. We examined whether multidimensional R/S predicts its future behavioural and biological components. Methods This prospective cohort study analysed 6,844 adults aged ≥50 (56% women; mean R/S score 2.1; 20% weekly attenders; 81% Christian) from waves 4–7 of the English Longitudinal Study of Ageing (ELSA). Behavioural outcomes included smoking, exercise, alcohol intake, and fruit and vegetable consumption; biological outcomes included blood pressure (BP), haemoglobin A1c (HbA1c), and the inflammatory risk markers C-reactive protein (CRP) and fibrinogen. R/S was assessed with four items from the Santa Clara Strength of Religious Faith Questionnaire. Hierarchical linear and logistic regressions adjusted for age, sex, wealth, education and ethnicity; biomarker models also adjusted for health behaviours and body mass index. Results Greater spirituality ( B =−0.019; 95%CI[−0.036,−0.003]), daily prayer/meditation ( B =−0.017; 95%CI[−0.032,−0.002]), participation in organized religion ( B =−0.017; 95%CI[−0.032,−0.002]), and importance of religious faith ( B =−0.017; 95%CI[−0.033,−0.002]) were independently associated with lower fibrinogen levels. Daily prayer/meditation also independently predicted higher fruit and vegetable intake ( B =0.004; 95%CI[0.000,0.008]). However, frequent attendance (OR=0.846; 95%CI[0.730,0.982]), the significance of faith (OR=0.935; 95%CI[0.879,0.994]), and religious purpose (OR=0.939; 95%CI[0.884,0.997]) independently reduced the odds of meeting exercise recommendations. Similarly, frequent attendance was associated with higher HbA1c ( B =0.002; 95%CI[0.000,0.005]). There were no independent associations with CRP or blood pressure. Conclusion R/S showed mixed prospective associations with the cardiovascular risk profile: favourable for fibrinogen and fruit and vegetable intake, unfavourable for physical activity and HbA1c. LAY SUMMARY We examined whether religious and spiritual involvement was related to later heart-related health behaviours and blood measurements in more than 6,800 English adults aged 50 and over. The associations ran in both directions, and the study cannot show that religion or spirituality causes these changes. Stronger religious and spiritual involvement was associated with lower fibrinogen, a blood protein linked to clotting. Daily prayer or meditation was associated with eating more fruit and vegetables. Regular attendance at religious services was associated with less physical activity and higher blood sugar. GRAPHICAL ABSTRACT

Background Studies have demonstrated neighborhood structural inequities are associated with cardiovascular outcomes among breast cancer survivors. We investigated the associations between bias in mortgage lending practices (contemporary redlining and racial lending bias) and cardiovascular outcomes in women with breast cancer. Methods Using the SEER (Surveillance, Epidemiology, and End Results)–Medicare database, we identified 51 007 Black and White women diagnosed with breast cancer between 2010 and 2014 with follow‐up through 2020. We used Home Mortgage Disclosure Act data to calculate census‐tract contemporary redlining index and racial lending bias index, and assessed indices continuously and categorically (low, moderate, or high). We used Cox proportional hazards regression to estimate multivariable‐adjusted, cause‐specific hazard ratios (HRs) for major adverse cardiovascular events, ischemic heart disease, heart failure, stroke, and cardiovascular death. Results In the overall population, a 10%‐unit increase in redlining was associated with increased risk of major adverse cardiovascular events (HR, 1.04 [95% CI, 1.02–1.06]). Among Black women, those in high redlining neighborhoods had an increased heart failure risk compared with those in low redlining neighborhoods (HR, 1.22 [95% CI, 1.05–1.41]). Similarly, White women in high redlining neighborhoods had an increased risk of ischemic heart disease (HR, 1.23 [95% CI, 1.15–1.30]) and stroke (HR, 1.09 [95% CI, 1.03–1.16]). Black women in high racial lending bias neighborhoods had reduced cardiovascular mortality risk compared with those in low racial lending bias neighborhoods (HR, 0.69 [95% CI, 0.54–0.90]). Conclusions We identified associations between contemporary redlining and cardiovascular outcomes among breast cancer survivors. High racial lending bias was associated with reduced cardiovascular mortality risk among Black women. Bias in mortgage lending practices may serve as a structural driver of cardiovascular disparities.

Background: Increased arterial stiffness, a marker of cardiovascular disease (CVD), is prevalent among African American (AA) adults and contributes to persistent CVD disparities. The Cardio-Ankle Vascular Index (CAVI) is a validated measure of arterial stiffness and predictor of adverse CVD outcomes. However, its relationship with the novel American Heart Association’s Life’s Essential 8 (LE8) cardiovascular health (CVH) construct has not been examined among AAs. Hypothesis: We hypothesized that increased arterial stiffness would be associated with lower CVH among AA adults. Methods: We analyzed baseline data from AA adults in the Techquity by FAITH! Trial, a 2-arm cluster randomized controlled trial conducted across 18 AA churches in Rochester and Minneapolis–St. Paul, Minnesota. Eligible participants (age ≥18 years with suboptimal diet or physical activity [PA]) completed validated electronic surveys (e.g., PA patterns) and clinical assessments (e.g., blood pressure [BP], lipids). CAVI was summarized as mean and categorized as normal (<8), borderline (8 to <9), or abnormal (≥9). CVH was assessed using the LE8 score (range 0-100 points) and categorized as low (<50), moderate (50-79), or high (≥80). Associations between CAVI and LE8 were assessed using multivariable linear regression adjusted for age, sex, and income (continuous) and Fisher’s exact test (categorical). LE8 components were compared across CAVI categories using Kruskal–Wallis tests. Results: Among 140 participants (mean age 53.0 years [SD 14.6]; 68% female), the mean LE8 score was 62.7 (SD 14.0). Nicotine exposure LE8 score was the highest (84.6 [SD 26.6]) and diet was the lowest (40.7 [SD 13.7]). Mean CAVI was 7.9 (SD 1.5), with 50% of participants classified as normal, 22% borderline, and 28% abnormal. No association between continuous CAVI and LE8 scores was observed after adjustment (unadjusted R 2 = 3.5%). All participants with high LE8 had normal CAVI, while abnormal CAVI was more prevalent among those with low (40%) and moderate (30%) LE8 scores (p<0.001). LE8 scores differed across CAVI categories for BP (median 50 in normal CAVI vs 30 in borderline/abnormal CAVI; p=0.003) and glucose LE8 scores (median 100 vs 60; p=0.014). Conclusions: Greater arterial stiffness was associated with lower CVH categories, with notable component-level differences in BP and glucose. Although not independently associated with overall LE8, integrating CAVI and LE8 categories may improve CVD risk stratification among AAs.

Background: Mindfulness-based interventions may improve cardiovascular health (CVH) by supporting behavioral change across multiple risk factors. This study evaluated the impact of Mindfulness-Based Blood Pressure Reduction (MB-BP), a mindfulness program targeting hypertension-related behaviors ( Image 1 ), on CVH using the American Heart Association’s Life’s Essential 8 framework. Methods: This secondary analysis of parallel-group, phase 2 randomized clinical trial evaluated the effects of MB-BP on CVH in 201 participants with elevated office BP (≥120/80 mmHg). The MB-BP group (n=101) received an 8-week program focused on mindfulness training and education targeting diet, physical activity, medication adherence, alcohol use, and stress, whereas the control group (n=100) received enhanced usual care ( Image 2 ). CVH was assessed using available Life’s Essential 8 components: systolic blood pressure, body mass index (BMI), diet (DASH adherence), physical activity, smoking, and sleep duration. Generalized estimating equations evaluated intervention effects through six months. Results: At six months follow-up, MB-BP participants significantly improved composite CVH scores compared to controls (standardized mean difference: 0.144; 95% CI: 0.023, 0.266) ( Image 3 ). MB-BP influenced most CVH components in healthier directions at trend levels, with the strongest responses for physical activity (47.9 MET min/week; 95% CI: -16.5, 112.3), sleep (0.34 hours/night; 95% CI: -0.10, 0.78), systolic blood pressure (-4.95 mmHg; 95% CI: -10.34, 0.44) and DASH diet score (0.27, 95% CI: -0.15, 0.69). Conclusions: MB-BP led to modest but clinically significant improvements in CVH, driven by multiple Life’s Essential 8 components. These findings suggest that MB-BP may be an effective behavioral intervention to support CVH and reduce risk for cardiovascular disease. ClinicalTrials.gov Preregistration Identifiers: NCT03256890, NCT03859076

BACKGROUND: For reasons not fully understood, Black adults experience more socioeconomic disadvantages (SED) than their White counterparts, as well as earlier onset and greater mortality from heart failure (HF). The John Henryism hypothesis predicts that repeated high-effort coping, that is, John Henryism (JH), with socioeconomic adversity can accelerate cardiovascular aging, thus increasing the risk for HF. METHODS: The analysis sample consisted of participants from the JHS (Jackson Heart Study), a cohort of Black adults from the Jackson, Mississippi Metropolitan area. The analysis sample included participants with no cardiovascular disease at baseline (2000–2004) with complete SED and JH scores. Indicators of SED included low household income, low educational attainment, and low maternal educational attainment scores. JH scores (0–36) were categorized as low (<28), moderate (29–32), and high (>32). Effect moderation of JH in the SED and incident HF association was assessed using interaction terms and stratification. Proportional hazards regression determined the hazard ratio and 95% CI, and models adjusted for age, sex, and established lifestyle risk factors. RESULTS: Among 1704 participants (mean age: 52.15 years, 64.3% female), 100 HF events occurred by 2016 (mean follow-up, 10 years). A statistically significant interaction between income and JH was observed for incident HF ( P =0.04). For every 1-unit increase in income disadvantage score, the risk of HF increased 2-fold among those with high JH (hazard ratio, 2.00 [95% CI, 1.39–2.86]) after full adjustment. Among participants with low JH, the corresponding unadjusted association was hazard ratio, 1.40 [95% CI, 1.04–1.90], but this association attenuated after adjusting for age and sex (hazard ratio, 1.19 [95% CI, 0.87–1.63]). CONCLUSIONS: The association between income disadvantage and HF differed by JH level. Because SED and high JH tend to co-occur, both should be considered in future research aiming to decrease the burden of HF in Black Americans.

Importance The prevalence of cardiovascular disease differs substantially across neighborhoods. However, few studies have examined the contribution of neighborhood-level structural racism to inequities in cardiovascular health. Objective To investigate the association between neighborhood-level manifestations of structural racism and the prevalence of cardiovascular clinical and behavioral risk factors and cardiovascular diseases. Design, Setting, and Participants This cross-sectional study consisted of 71 915 US census tracts. The Structural Racism Effect Index (SREI) was appended to the 2020 Centers for Disease Control and Prevention’s PLACES dataset. Race and ethnicity were self-reported and obtained from the 2019 American Community Survey 5-year estimates. Data analysis was conducted from June 2024 to October 2024. Exposure The SREI is a composite score of census tract measures within 9 domains affected by structural racism (built environment, criminal justice, education, employment, housing, income and poverty, social cohesion, transportation, and wealth). The SREI scores were categorized into distribution-based quintiles, where higher quintiles represented greater neighborhood structural racism. Main Outcomes and Measures Neighborhood-level prevalence of cardiovascular clinical (high blood pressure, high cholesterol, obesity, and diabetes) and behavioral (current cigarette smoking and no leisure-time physical activity) risk factors and cardiovascular disease (coronary heart disease and stroke). Multilevel-linear mixed models, adjusting for confounders, were used to estimate adjusted prevalence rate ratios (aPRR). Results Among 71 915 census tracts, neighborhoods in the highest quintiles of structural racism were more likely than neighborhoods in the lowest quintile to be in the southern region (quintile 1, 19.9% vs quintile 5, 56.8%). The proportion of the population that was Black was largest in neighborhoods in the highest quintile of structural racism (quintile 1, 2.2% vs quintile 5, 23.0%). After adjustment, compared with the lowest quintile of structural racism, the highest quintile had significantly higher prevalence rates of cardiovascular clinical risk factors, including high blood pressure (aPRR, 1.37; 95% CI, 1.37-1.38), obesity (aPRR, 1.40; 95% CI, 1.39-1.40), and diabetes (aPRR, 1.80; 95% CI, 1.79-1.81). Similarly, for cardiovascular behavioral risk factors, the highest quintile of structural racism had significantly higher prevalence rates of current cigarette smoking (aPRR, 1.84; 95% CI, 1.83-1.85) and no leisure-time physical activity (aPRR, 1.88; 95% CI, 1.87-1.89). Additionally, for cardiovascular diseases, the highest quintile of structural racism had higher prevalence rates of coronary heart disease (aPRR, 1.80; 95% CI, 1.79-1.82) and stroke (aPRR, 1.99; 95% CI, 1.98-2.00). Conclusions and Relevance In this cross-sectional study, structural racism was associated with inequities in neighborhood cardiovascular health, highlighting opportunities for place-based prevention efforts.

The COVID-19 pandemic caused unprecedented disruption of social networks and negatively impacted social determinants of health (SDoH, e.g., economic stability, mental health, health care access) among African Americans. The FAITH! (Fostering African-American Improvement in Total Health!) Program, an academic-community partnership with African American churches, pivoted to pandemic-related impacts on health behaviors of African Americans. This exploratory, cross-sectional study examined associations between multilevel factors influencing difficulty maintaining a healthy lifestyle during the early pandemic phase, including mental/emotional health and COVID-19 hardships (e.g., job/food/housing insecurity, paying utilities). An online survey was distributed via FAITH!-affiliated churches and social media. Logistic regression (odds ratios [ORs], adjusted for age/gender) and associated 95% confidence intervals [CIs]) examined associations between difficulty maintaining a healthy lifestyle and multilevel factors. Greater than half of respondents reported difficulty maintaining a healthy lifestyle (N = 169, 54% [91/169]). Adjusted odds of having difficulty maintaining a healthy lifestyle were greater for those reporting mental/emotional health issues (high-stress OR 4.0; 95% CI [1.9,8.9], p < .001); occasional symptoms of depression (OR 3.7; 95% CI [01.9,7.7]; p < .001); anger (OR 2.5; 95% CI [1.2,5.4]; p = .044), and anxiety (OR 2.8; 95% CI [1.4,6.0]; p = .008)). COVID-19 hardships of job insecurity (OR 1.4.; 95% CI [0.7, 2,8]; p = .015), difficulty paying rent (OR 4.4; 95% CI [2.1,9.9]; p < .001) or difficulty paying for food/utilities (OR 5.4; 95% CI [2.6,11.7]; p < .001) were associated with difficulty maintaining a healthy lifestyle. Our study revealed the negative impact of mental/emotional health and COVID-19 hardships on maintaining a healthy lifestyle among African Americans. This could inform SDoH-focused lifestyle interventions during future public health crises.