scholarly journals Patterns of Circadian Variation in 24-Hour Ambulatory Blood Pressure, Heart Rate, and Sympathetic Tone Correlate with Cardiovascular Disease Risk: A Cluster Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Myung Han Hyun ◽  
Jun Hyuk Kang ◽  
Sunghwan Kim ◽  
Jin Oh. Na ◽  
Cheol Ung Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Time Series ◽  
Circadian Variation ◽  
Sympathetic Tone ◽  
Atherosclerotic Cardiovascular Disease ◽  
Metabolic Factors ◽  
Multiple Variables ◽  
Ascvd Risk

To investigate whether specific time series patterns for blood pressure (BP), heart rate (HR), and sympathetic tone are associated with metabolic factors and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). A total of 989 patients who underwent simultaneous 24-hour ambulatory BP and Holter electrocardiogram monitoring were enrolled. The patients were categorized into sixteen groups according to their circadian patterns using the consensus clustering analysis method. Metabolic factors, including cholesterol profiles and apolipoprotein, were compared. The 10-year ASCVD risk was estimated based on the Framingham risk model. Overall, 16 significant associations were found between the clinical variables and cluster groups. Age was commonly associated with all clusters in systolic BP (SBP), diastolic BP (DBP), HR, and sympathetic tone. Metabolic indicators, including diabetes, body mass index, total cholesterol, high-density lipoprotein, and apolipoprotein, were associated with the four sympathetic tone clusters. In the crude analysis, the ASCVD risk increased incrementally from clusters 1 to 4 across SBP, DBP, HR, and sympathetic tone. After adjustment for multiple variables, however, only sympathetic tone clusters 3 and 4 showed a significantly high proportion of patients at high risk (≥7.5%) of 10-year ASCVD (odds ratio OR=5.90, 95% confidential interval CI=1.27–27.46, and P value = 0.024 and OR=15.28, 95% CI=3.59–65.11, and P value < 0.001, respectively). Time series patterns of BP, HR, and sympathetic tone can serve as an indicator of aging. Circadian variations in sympathetic tone can provide prognostic information about patient metabolic profiles and indicate future ASCVD risk.

scholarly journals The association of six-minutes walking test (6MWT) with cardiovascular disease risk among older women with type 2 diabetes mellitus in a rural primary health care: a pilot observational study

2020 ◽  
Vol 3 (1) ◽  
pp. 34
Author(s):  
Rakhmat Ari Wibowo ◽  
Arum Tri Wahyuningsih ◽  
Rio Jati Kusuma ◽  
Wahyu Pamungkasih ◽  
Denny Agustiningsih
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Older Women ◽  
Walking Test ◽  
Primary Health ◽  
Ascvd Risk

The recent systematic review found that cardiovascular events contributed to approximately half of all deaths among patients with type 2 diabetes mellitus (T2DM). Several studies suggested that the six-minutes walking test (6MWT) could be a valuable prognostic tool for predicting cardiovascular disease (CVD) events in particular diseases. However, less is known concerning the role of 6MWT in predicting CVD events among patients with T2DM. Thus, this pilot observational study aimed to test the feasibility of conducting the 6MWT and to examine the association of measures collected during 6MWT with ASCVD risk estimator parameters for predicting CVD events among T2DM patients. Fourteen older women with T2DM in a rural primary health care were enrolled in this cross-sectional study. Blood pressure measurement, heart rate measurement, and blood sampling for HDL, LDL, and total cholesterol measurements were carried out during rest. Both heart rate and distance were measured at the end of the following 6MWT. Feasibility data were collected. Recruitment rate and measurement completion rate were 85.7% and 40% respectively. No adverse events during the 6MWT were reported. Patient’s heart rate at the end of 6MWT was correlated with diastolic blood pressure (r=0.5 p=0.48). Multivariate analyses suggested that every one-meter increase in distance of 6MWT, there is a decrease in diastolic blood pressure of -0.9 mmHg (p=0.01; 95% CI= -1.6 to -0.2). In conclusion, 6MWT is a feasible simple test which could provide a valuable prediction of ASCVD risk among older women with T2DM. Thus, this test should be considered to be conducted as a part of routine examination. Cohort study with a larger sample could be suggested to establish the usefulness of the 6MWT in predicting CVD risk.

Abstract 17098: Liver Fibrosis and Associated Cardiovascular Disease Risk and Its Predictors Among US Adults With and Without Diabetes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nathan D Wong ◽  
Matthew Bang ◽  
WENJUN FAN ◽  
Aprille Espinueva
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Liver Fibrosis ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Female Sex ◽  
Ascvd Risk

Background: Liver fibrosis is a complication of non-alcoholic fatty liver disease (NAFLD) and is associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether this risk may be enhanced in persons with pre-diabetes (pre-DM) or diabetes (DM), however, is not established. We examined the association of liver fibrosis with estimated ASCVD risk and its predictors according to DM status. Methods: We studied 30,895 adults (3,983 or 12.9% with DM) from the National Health and Nutrition Examination Surveys 1999-2014 with liver function measures to calculate FIB-4 scores; values of 1.3-2.67 and >2.67 indicated a moderate and high probability of advanced fibrosis, respectively. We studied the prevalence high FIB-4 scores in those with and without pre-DM and DM and the 10-year ASCVD risk based on the ACC/AHA Pooled Cohort Risk Calculator in persons without known ASCVD. In addition, multiple logistic regression examined predictors of high FIB-4 scores. Results: The prevalence of FIB-4 scores of 1.3-2.67 and >2.67 ranged from 17.8% and 1.5% in those without pre-DM/DM, 29.9% and 2.5% in those with pre-DM, and 35.3% and 3.5% in those with DM, respectively (p<0.0001). The figure shows the 10-year ASCVD risk by FIB-4 scores and presence of pre-DM and DM. Multivariable indicators of a FIB-4 score >2,67 were age (odds ratio [OR]=3.0 / 10 years), female sex (OR=0.53), non-Hispanic Black ethnicity (OR=2.0), waist circumference (OR=0.76/SD), alcohol use (OR=1.5), and NALFD (OR=3.3) in those without DM, and age (OR=2.2/10 years), female sex (OR=0.48), systolic blood pressure (1.4/SD), diastolic blood pressure (0.76/SD), and current smoking (OR=2.2) in those with DM (all p<0.05 to p<0.0001). Conclusions: Advanced fibrosis is more prevalent in those with vs. without DM. The presence of DM with higher FIB-4 scores is associated with especially high estimated ASCVD risks warranting increased efforts to address prevention and treatment of liver fibrosis.

scholarly journals Using Predicted Atherosclerotic Cardiovascular Disease Risk for Discrimination of Awake or Nocturnal Hypertension

2020 ◽  
Vol 33 (11) ◽  
pp. 1011-1020
Author(s):  
Swati Sakhuja ◽  
John N Booth ◽  
David E Anstey ◽  
Byron C Jaeger ◽  
Cora E Lewis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Blood Pressure Monitoring ◽  
Cardiovascular Disease Risk ◽  
Atherosclerotic Cardiovascular Disease ◽  
Nocturnal Hypertension ◽  
Ascvd Risk ◽  
Using Data ◽  
Atherosclerotic Cardiovascular Disease Risk

Abstract BACKGROUND Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. METHODS We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40–79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015–2016 (n = 716) and the baseline Jackson Heart Study exam in 2000–2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. RESULTS Among participants with a 10-year predicted ASCVD risk &lt;5%, 5% to &lt;7.5%, 7.5% to &lt;10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP &lt;130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. CONCLUSIONS Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

scholarly journals Predicting the risk of atherosclerotic cardiovascular disease among adults living with HIV/AIDS in Addis Ababa, Ethiopia: A hospital-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260109
Author(s):  
Minyahil Woldu ◽  
Omary Minzi ◽  
Workineh Shibeshi ◽  
Aster Shewaamare ◽  
Ephrem Engidawork
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Male Gender ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lower Systolic Blood Pressure ◽  
Younger Age ◽  
Increased Risk ◽  
Ascvd Risk ◽  
Living With Hiv

Background Atherosclerotic Cardiovascular Disease (ASCVD) is an emerging problem among People living with HIV/AIDS (PLWHA). The current study aimed at determining the risk of ASCVD among PLWHA using the Pooled Cohort Equation (PCE) and the Framingham Risk score (FRS). Methods A hospital-based study was carried out from January 2019 to February 2020 in PLWHA. The prevalence of ASCVD risk was determined in individuals aged between 20 to 79 and 40 to 79 years using the FRS and PCE as appropriate. Chi-square, univariate and multivariate logistic regressions were employed for analysis. Results The prevalence of high-risk ASCVD for subjects aged 20 and above using both tools was 11.5 %. For those aged 40 to 79 years, PCE yielded an increased risk (28%) than FRS (17.7%). Using both tools; advanced age, male gender, smoking, and increased systolic blood pressure were associated with an increased risk of ASCVD. Younger age (adjusted odds ratio, AOR) 0.20, 95%CI: 0.004, 0.091; P< 0.001), lower systolic blood pressure (AOR 0.221, 95%CI: 0.074, 0.605 P< 0.004), and lower total cholesterol (AOR 0.270, 95%CI: 0.073, 0.997; p<0.049) were found to be independent predictors of reduced risk of ASCVD. Likewise, younger age (40 to 64 years), female gender, and lower systolic blood pressure were significantly associated with lower risk of ASCVD among patients aged 40 to 79 years using both PCE and FRS. Conclusions A considerable number of PLWHA have been identified to be at risk for ASCVD. ASCVD risk was significantly associated with advanced age, male gender, higher blood pressure, and smoking using both FRS and PCE. These factors should therefore be taken into account for designing management strategies.

Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction

2021 ◽  
pp. 089719002199979
Author(s):  
Roshni P. Emmons ◽  
Nicholas V. Hastain ◽  
Todd A. Miano ◽  
Jason J. Schafer
Keyword(s):  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Blood Cholesterol ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Living With Hiv ◽  
To Receive

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

Arterial calcification in the prediction of atherosclerotic cardiovascular disease among women and men

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.E Van Der Toorn ◽  
D Bos ◽  
B Arshi ◽  
M.K Ikram ◽  
M.W Vernooij ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
The Netherlands ◽  
Arterial Calcification ◽  
Funding Source ◽  
Atherosclerotic Cardiovascular Disease ◽  
Intermediate Risk ◽  
C Statistic ◽  
Ascvd Risk ◽  
Risk Categories

Abstract Background The Coronary Artery Calcium (CAC) Score has emerged as a valuable tool in atherosclerotic cardiovascular disease (ASCVD) risk stratification. However, data on the relevance of arterial calcification in different vascular territories for ASCVD risk prediction is lacking. Purpose First, to assess the sex-specific distribution of arterial calcification in different vessel beds across ASCVD risk categories. Second, to determine the added value of arterial calcification in different vascular territories for ASCVD risk prediction. Methods From a large population-based study, 2,139 participants (mean age 69 years, 55% women) underwent non-contrast computed tomography to quantify CAC, aortic arch calcification (AAC), extracranial- (ECAC) and intracranial carotid artery calcification (ICAC), and vertebrobasilar artery calcification (VBAC). The outcome measure, incident ASCVD, composed of fatal and nonfatal myocardial infarction (MI), other coronary heart disease (CHD) mortality, and stroke. We fitted sex-specific prediction models according to the Pooled Cohort Equations (PCE), and categorized participants into low- (&lt;5%), borderline- (5% to 7.5%), intermediate- (7.5% to 20%), and high ASCVD risk (≥20%), based on the American College of Cardiology (ACC) and American Heart Association (AHA) guideline. Subsequently, we determined the distribution of calcifications in different vascular territories across the risk categories. Next, we extended the PCE prediction model with calcification volumes and calculated the c-statistic and the net reclassification improvement for events (NRIe) and non-events (NRIne). Results The median follow-up for ASCVD was 9.3 years. Among women, 38% was classified as low-risk, 19% as borderline risk, 31% as intermediate risk, and 12% as high risk. Among men, 2% was classified as low-risk, 10% as borderline risk, 60% as intermediate risk, and 28% as high risk. With increasing risk of ASCVD, a larger burden of calcification was observed. In women, simultaneously adding calcification volumes in all vessel beds led to the largest increase in c statistic (from 0.71 to 0.75) for the prediction of ASCVD and the most beneficial reclassification (NRIe: 11%, NRIne: 2%). Among men, the addition of CAC alone most substantially improved the prediction of ASCVD (c statistic improved from 0.65 to 0.68, NRIe and NRIne were 4% and 14%, respectively). Conclusions Our findings suggest a potential role for comprehensive assessment of calcification in different vessel beds for ASCVD risk stratification in particular among women. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Rotterdam Study is supported by Erasmus MC and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Netherlands Genomics Initiative; the Ministry of Education, Culture, and Science; the Ministry of Health, Welfare, and Sports; European Commission; and the Municipality of Rotterdam. Dr. Kavousi is supported by the VENI grant (91616079) from ZonMw. Dr. Bos was supported by a fellowship of the BrightFocus Foundation (A2017424F). Oscar L. Rueda-Ochoa receives a scholarship from COLCIENCIAS-Colombia and support from Universidad Industrial de Santander,UIS-Colombia. None of the funders had any role in study design; study conduct; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article.

Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Amanda Perak ◽  
Norrina B Allen ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Risk Model ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Ascvd Risk ◽  
The Life Course ◽  
Predicted Risk

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

Role of Screening Tests in the Detection and Management of Blood Pressure Abnormalities Among Young Population

Angiology ◽  
2016 ◽  
Vol 68 (5) ◽  
pp. 441-446 ◽  
Author(s):  
Mehmet Karaduman ◽  
Mustafa Aparci ◽  
Murat Unlu ◽  
Cengiz Ozturk ◽  
Sevket Balta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Mass Index ◽  
Heart Rate ◽  
Medical Records ◽  
Screening Tests ◽  
Young Population ◽  
Males And Females ◽  
Apparently Healthy

The prevalence of hypertension is increasing among young population worldwide. So there is an interest in detecting prehypertension and hypertension in childhood. We determined blood pressure (BP) recorded at a screening test in a young population. We retrospectively evaluated the medical records including systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, height, and body mass index (BMI) of 685 male and 130 female apparently healthy adolescents. We evaluated the prevalence of BP categories: normotension, prehypertension, and hypertension. The prevalence of normotension (n = 369), prehypertension (n = 333), and hypertension (n = 113) was 45.3%, 40.9% and 13.9%, respectively; prehypertension and hypertension were significantly higher among males. The prevalence of prehypertension and hypertension was significantly higher among overweight males and females. The BMI significantly correlated with SBP, DBP, and heart rate among both genders. The prevalence of prehypertension and hypertension is high among Turkish adolescents. Screening tests focused on BP and BMI measurement may help detect the young population at risk of hypertension and cardiovascular disease in the future.

scholarly journals A pilot study investigating the relationship between heart rate variability and blood pressure in young adults at risk for cardiovascular disease

2022 ◽  
Vol 28 (1) ◽  
Author(s):  
Linda P. Bolin ◽  
Amelia D. Saul ◽  
Lauren L. Bethune Scroggs ◽  
Carolyn Horne
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pilot Study ◽  
Family History ◽  
Diastolic Blood Pressure ◽  
Biofeedback Training ◽  
Paced Breathing ◽  
History Of

Abstract Background Cardiovascular disease is one of the leading causes of death globally with hypertension being a primary cause of premature death from this disease process. Individuals with a family history of cardiovascular disease and hypertension are at a greater risk for developing the same sequela. Autonomic cardiac control is important in the level of cardiac function. One intervention that is effective in improving cardiovascular function is heart rate variability biofeedback training. The purpose of our study was to determine the effectiveness of heart rate biofeedback training on HRV and blood pressure in individuals with a family history of cardiovascular disease. Methods Thirty-four participants (76.5% female, 22.7 ± 4.3 years) completed a baseline assessment and training using an established short-term HRV protocol followed by two weeks of at-home paced breathing employing a smartphone application. The participants were then reassessed in a biofeedback clinic. Results The participants physiological measures showed a significant increase in means between pre and post intervention of SDNN (t (32) = 2.177, p =.037) and TP, (t (32) = 2.327 p = .026). Correlation noted a medium effect on diastolic blood pressure and high frequency heart rate variability, F, r = .41, n =33, p < .05. A multiple regression with all predictor variables in the model found no significance with diastolic and systolic blood pressure. Conclusions The findings from this pilot study demonstrated that a two-week paced breathing intervention may assist in reducing heart rate and diastolic blood pressure while improving heart rate variability.

scholarly journals Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk

2021 ◽  
Author(s):  
Deepak Palakshappa ◽  
Edward H. Ip ◽  
Seth A. Berkowitz ◽  
Alain G. Bertoni ◽  
Kristie L. Foley ◽  
...  
Keyword(s):  
Mental Health ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Food Insecurity ◽  
Access To Care ◽  
Risk Score ◽  
Equation Modeling ◽  
Care Pathways ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk

Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross‐sectional study of adults (aged 40–79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10‐year ASCVD risk categorized as low (<5%), borderline (≥5% –<7.5%), intermediate (≥7.5%–<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food‐insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high‐risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P <0.001), psychological/mental health (β, 0.612; SE, 0.043; P <0.001), and access to care (β, 0.110; SE, 0.036; P =0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.

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