The Association of Area-based Deprivation and Cardiovascular Risk among Vietnam-Era Twins Open Access

Ahmed, Annam (Summer 2019)

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Objectives: The aim of this study was to examine the association of area-based deprivation and cardiovascular risk using a controlled twin design.

Background: Existing literature has highlighted the importance of considering both genetic and environmental influences on cardiovascular health. However, there is limited information on the influence of area-based deprivation on cardiovascular risk.

Methods: We conducted a secondary analysis of data from a study of middle-aged male twins recruited from the Vietnam Era Twin Registry. The area-deprivation index (ADI) scores were calculated using the 2013 Neighborhood Atlas developed by the University of Wisconsin, and Framingham risk scores for LDL cholesterol (FRS-LDL) were calculated. Analysis was conducted using linear mixed models.

Results: A total of 502 twins (251 pairs) with a mean age of 55.5 years were included in this study. The mean ADI score was 46 and the mean FRS-LDL score was 5.9. Considering twins as individuals, there was a significant unadjusted association between ADI and FRS-LDL: for each 10 points increment in ADI score, the FRS-LDL increased by 0.1 points. After adjusting for potential confounders (age, years of education, and history of coronary heart disease), the association was slightly weakened. In within twin pair-analyses, there was no association between ADI and FRS-LDL comparing twins discordant for ADI (FRS-LDL: -0.02 per 10-point increment in ADI, 95% CI: -0.14, 0.01). Results remained consistent even when using the dichotomizing ADI score. When examined by zygosity, the within-pair association between ADI and FRS-LDL was larger in dizygotic than monozygotic twin pairs (p=0.05 for interaction).

Conclusions: Among Vietnam-era veterans, genetics and familial factors play a greater role in cardiovascular risk than environmental factors.

Table of Contents

Table of Contents

List of Abbreviations and Acronyms 1

Background 2

Introduction 2

Area-based Deprivation and Cardiovascular Disease 2

Geographic Variation and Cardiovascular Disease 4

Twins and Geographic Variation 6

Twin Studies of Area Deprivation Index 8

Twin Studies of Cardiovascular Disease 9

Framingham Risk Score 11

Conclusion 14

Manuscript 15

Introduction 15

Methods 17

Results 20

Discussion 23

Appendices 26

References 34

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