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Background/Objective: An abnormal ankle-brachial index (ABI) strongly correlates with higher mortality in patients with cardiovascular disease however, the inverse link has not been established for cardiovascular (CV) health. The American Heart Association (AHA) aims to improve CV health by 20% by 2020 and has thus proposed the use of CV health metrics (Life's Simple 7 or LS7). This study examines the relationship of abnormally low ABI with CV health. Methods: We evaluated 5,308 men and women aged ≥40 years, without history of CVD or diabetes mellitus (DM), participating in NHANES from 1999-2004. Abnormally low ABI was defined as ABI< 1.00 which included borderline low [0.91-0.99] and low ABI [<=0.90]). LS7 was scored on a 0-14 point scale and calculated based on poor, intermediate and ideal categories of 7 health components: diet, BMI, smoking, physical activity, blood pressure, glucose and cholesterol. LS7 scores were categorized as inadequate (0-7points), average (8-11) and optimum (12-14) CV health. Ordinal logistic regression models identified associations between abnormal ABI and CV health, with adjustments for sex, age, race/ethnicity, socioeconomic status and hs-CRP. Results: The mean (95% CI) LS7 score was 7.4 (7.3-7.5), with the majority of the population (75.3%) clustered at the lower end of average CV health. Adjusted models demonstrated that, compared to those with inadequate CV health, those with average CV health experienced 28% lower odds of abnormal ABI (OR 0.72, 95% CI; 0.52-0.97). Further improving CV health from inadequate to optimum was associated with 78% lower odds of abnormal ABI (OR 0.22, 95% CI; 0.09-0.57). On examining individual components, only blood pressure was found to be significantly associated with lower odds of abnormal ABI. Those with intermediate, as compared to poor, blood pressure readings showed 32% lower odds of abnormal ABI (OR 0.68, 95% CI; 0.48-0.94) while those with ideal blood pressure showed a 61% lower odds of abnormal ABI (OR 0.39, 95% CI; 0.21-0.72). Discussion/Conclusion: Although those with average CV health experienced lower odds of abnormal ABI, improving CV health to optimum can significantly lower these odds. This suggests that optimizing cardiovascular health, particularly in those who have not yet been affected by CVD or DM, can significantly slow or prevent progression of systemic atherosclerosis. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the leading cause of death in the United States, so improving cardiovascular health (CVH) is a key population health goal. As part of public health efforts to achieve this, the American Heart Association recently developed a comprehensive CVH metric that incorporates smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and blood glucose. The objectives of the current study were to measure CVH in all US counties and identify key socioeconomic determinants of county-level CVH. Methods: Data from the Behavioral Risk Factor Surveillance System were used to determine calculate CVH for each county in 2009. Federal Information Processing Standards codes were used to obtain scores for counties with a sample size of 15 or more; 62% (1948 of 3142) of United States counties had available data. The main outcomes were age-standardized mean CVH score and percentage of poor or ideal health. Data on county-level socioeconomic indicators were abstracted from the Area Resource File. Results and Conclusions: Overall, 18% of the population had poor CVH, 77% had intermediate, and 5% had ideal. Between counties the average overall CVH varied from 2.13 to 4.80, the percentage of ideal health varied from 0% to 46%, and the percentage of poor health varied from 1% to 76%. Counties with the poorest health were in the Midwest and Southern regions. There is a moderate positive relationship between mean CVH and per capita income (r=0.355) and a weak positive relationship between mean CVH and percent urban population (r=0.245). In conclusion, there are few counties with a substantial percentage of their population with ideal health, there is a wide range of cardiovascular health status within the United States, and there is some association of increasing CVH with increasing income and urbanization. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) remains the leading cause of death in the U.S. Reducing the population burden of CVD will require an increased focus on understanding how to promote and support population-level cardiovascular health (CVH), which will include the ability to measure the presence of CVH, not merely the presence or absence of CVD. Recently, the American Heart Association developed a comprehensive metric designed to measure CVH at the population level. The metric includes smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and blood glucose. The purpose of this study was to assess how population-level CVH is related to the availability of health care providers and services within the county. Data from the Behavioral Risk Factor Surveillance System were used to calculate age-adjusted CVH for each county in 2009. Federal Information Processing Standards codes were used to obtain scores for counties with a sample size of 15 or more. Data on county-level health care services and providers were abstracted from the Area Resource File. The main outcomes were age-standardized mean CVH score. In total, 2236 counties were included in the analysis. Mean CVH score was 3.49 (0.39 SD). After adjustment for county population, county-level CVH score was positively correlated to per capita primary care physicians (rho=0.33, p<0.0001) and nurse practitioners (rho=0.106, p<0.0001). County CVH was also positively and significantly correlated to cardiovascular disease specialists (rho=0.220, p<0.0001). The number of per capita physicians assistants and dieticians / nutritionists were also positively associated with county CVH (rho=0.232, p<0.0001; rho=0.112, p=0.003, respectively). In assessing the effect of the availability of health care facilities, county CVH was positively associated with per capita county-level long term hospital beds, nursing home beds, and community mental health centers (rho/pvalues respectively: 0.122/<0.0001; 0.062/p=0.003; 0.078/<0.0001) but negatively associated with per capita county-level beds in skilled nursing facilities, home health agencies and federally qualified health centers (rho/p-values respectively: -0.189/<0.0001; -0.086/<0.0001; -0.065/0.002). Further study is needed to understand the marginal impact of health care providers and facilities on county CVH. [ABSTRACT FROM AUTHOR]

The removal of federal abortion protection has incited fear that restrictions on contraception may be next. Many states now imposing abortion restrictions and bans are in the South and Appalachian Regions of the U.S., where rates of unplanned pregnancy and poor health outcomes are already disproportionately high. Numerous studies have documented variable access to levonorgestrel EC (LNG EC) in community pharmacies, with particularly low rates of access at independent pharmacies that are more likely to be located in rural communities than chain pharmacies. Since the overturn of Roe v. Wade , some large chain pharmacies and online retailers are restricting the purchase of LNG EC, limiting its availability. Some legislators and activists are calling for a ban on EC based on a misunderstanding about its mechanism of action, equating it with abortion. At a time when access to the full range of contraceptive options is more critical than ever, already limited access to LNG EC is worsening. Extensive data on LNG EC availability in 509 pharmacies and 400 health clinics across West Virginia, contextualized with socioeconomic demographics, illustrate existing disparities in LNG EC access., Competing Interests: Cover Page Footnote No competing financial or editorial interests were reported by the authors of this commentary., (Copyright © 2023 Amie M. Ashcraft, Sarah Dotson, Sara Farjo, Courtney S. Pilkerton, and Pamela J. Murray.)