The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022)
Background and aimThis study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rura...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1467564/full |
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| author | Evangelia G. Sigala Christina Chrysohoou Fotios Barkas Evangelos Liberopoulos Petros P. Sfikakis Antigoni Faka Costas Tsioufis Christos Pitsavos Demosthenes Panagiotakos |
| author_facet | Evangelia G. Sigala Christina Chrysohoou Fotios Barkas Evangelos Liberopoulos Petros P. Sfikakis Antigoni Faka Costas Tsioufis Christos Pitsavos Demosthenes Panagiotakos |
| author_sort | Evangelia G. Sigala |
| collection | DOAJ |
| description | Background and aimThis study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rural settings.MethodsThe ATTICA Study is a prospective study conducted from 2002 onwards. At baseline, a random sample of 3,042 CVD-free adults (49.8% men) were randomly drawn from the population of the Attica region, in Greece, with 78% dwelling in urban and 22% in rural municipalities. Follow-up examinations were performed in 2006, 2012, and 2022. Of the total participants, 1,988 had complete data for CVD assessment in the 20-year follow-up.ResultsThe 10-year and 20-year CVD incidence was 11.8%, 28.0% in rural municipalities and 16.8%, 38.7% in urban municipalities, respectively (ps < 0.05). Unadjusted data analyses revealed significant differences in clinical, laboratory, and lifestyle-related CVD risk factors between urban and rural residents (ps < 0.05). Additionally, sex-based discrepancies in clinical, anthropometric, circulating, and lifestyle risk factors were observed in stratified analyses of urban and rural settings. Multivariate analyses, including generalized structural equation modeling (GSEM), revealed that the impact of the urban built environment on the long-term (20-year) CVD risk is mediated by lifestyle-related risk factors.ConclusionUrban inhabitants exhibit a higher long-term CVD incidence compared to their rural counterparts, which was partially explained by their lifestyle behaviors. Targeted strategic city planning efforts promoting healthier lifestyle-related behaviors at the micro-environment level could potentially mitigate built-environment impacts on CVD health. |
| format | Article |
| id | doaj-art-eca1aad94fb94cbabb39f4f0a0eb8979 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-eca1aad94fb94cbabb39f4f0a0eb89792025-01-09T12:00:24ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.14675641467564The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022)Evangelia G. Sigala0Christina Chrysohoou1Fotios Barkas2Evangelos Liberopoulos3Petros P. Sfikakis4Antigoni Faka5Costas Tsioufis6Christos Pitsavos7Demosthenes Panagiotakos8Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, GreeceFirst Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, GreeceDepartment of Internal Medicine, Medical School, University of Ioannina, Ioannina, GreeceFirst Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GreeceFirst Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GreeceDepartment of Geography, School of Environmental Sciences and Economics, Harokopio University, Athens, GreeceFirst Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, GreeceFirst Cardiology Clinic, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, GreeceDepartment of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, GreeceBackground and aimThis study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rural settings.MethodsThe ATTICA Study is a prospective study conducted from 2002 onwards. At baseline, a random sample of 3,042 CVD-free adults (49.8% men) were randomly drawn from the population of the Attica region, in Greece, with 78% dwelling in urban and 22% in rural municipalities. Follow-up examinations were performed in 2006, 2012, and 2022. Of the total participants, 1,988 had complete data for CVD assessment in the 20-year follow-up.ResultsThe 10-year and 20-year CVD incidence was 11.8%, 28.0% in rural municipalities and 16.8%, 38.7% in urban municipalities, respectively (ps < 0.05). Unadjusted data analyses revealed significant differences in clinical, laboratory, and lifestyle-related CVD risk factors between urban and rural residents (ps < 0.05). Additionally, sex-based discrepancies in clinical, anthropometric, circulating, and lifestyle risk factors were observed in stratified analyses of urban and rural settings. Multivariate analyses, including generalized structural equation modeling (GSEM), revealed that the impact of the urban built environment on the long-term (20-year) CVD risk is mediated by lifestyle-related risk factors.ConclusionUrban inhabitants exhibit a higher long-term CVD incidence compared to their rural counterparts, which was partially explained by their lifestyle behaviors. Targeted strategic city planning efforts promoting healthier lifestyle-related behaviors at the micro-environment level could potentially mitigate built-environment impacts on CVD health.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1467564/fullcardiovascular diseasesepidemiologyrisk assessmentbuilt environmenturban-rural disparitiescity planning |
| spellingShingle | Evangelia G. Sigala Christina Chrysohoou Fotios Barkas Evangelos Liberopoulos Petros P. Sfikakis Antigoni Faka Costas Tsioufis Christos Pitsavos Demosthenes Panagiotakos The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) Frontiers in Cardiovascular Medicine cardiovascular diseases epidemiology risk assessment built environment urban-rural disparities city planning |
| title | The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) |
| title_full | The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) |
| title_fullStr | The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) |
| title_full_unstemmed | The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) |
| title_short | The interplay between sex, lifestyle factors and built environment on 20-year cardiovascular disease incidence; the ATTICA study (2002–2022) |
| title_sort | interplay between sex lifestyle factors and built environment on 20 year cardiovascular disease incidence the attica study 2002 2022 |
| topic | cardiovascular diseases epidemiology risk assessment built environment urban-rural disparities city planning |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1467564/full |
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