Search

Background While optimal cardiovascular risk factor (CRF) profile is associated with lower mortality, morbidity, and healthcare expenditures among individuals with atherosclerotic cardiovascular disease (ASCVD), less is known regarding its impact on financial hardship from medical bills. Therefore, we assessed whether an optimal CRF profile is associated with a lower burden of financial hardship from medical bills and a reduction in cost-related barriers to health. Methods We used a nationally representative sample of adults between 18 and 64 years from the National Health Interview Survey between 2013 and 2017. We assessed ASCVD status and the number of risk factors to categorize the study population into 4 mutually exclusive categories: ASCVD (irrespective of CRF profile) and non-ASCVD with poor, average, and optimal CRF profile. Adjusted logistic regression model was used to determine the association of ASCVD/CRF profile with financial hardship from medical bills and cost-related barriers to health (cost-related medication non-adherence (CRN), foregone/delayed care, and high financial distress). Results We included 119,388 non-elderly adults, representing 189 million individuals annually across the United States. Non-ASCVD/optimal CRF profile individuals had a lower prevalence of financial hardship and an inability paying medical bills when compared with individuals with ASCVD (24% vs 45% and 6% vs 19%, respectively). Among individuals without ASCVD and an optimal CRF profile, the prevalence of each cost-related barrier to health was, Highlights • Nearly 1 in 5 individuals with ASCVD reported an inability to pay medical bills. • Only 6% of those with optimal CRF profile were unable to pay medical bills. • Optimal CRF profile had the lowest odds of all outcomes like high financial distress. • Worse outcomes among individuals with poor/low income and lack of insurance. • Optimal CRF profile was protective despite poor/low income and lack of insurance.

Background Habitual cocoa consumption has been shown to improve cardiometabolic risk. This study compared the effects of two doses of cocoa on blood pressure and other cardiometabolic risk factors in adults with stage 1 hypertension. Methods Randomized, controlled, modified Latin square parallel design to compare effects of two daily doses (i.e., 5 vs. 10 g) of cocoa powder in cocoa-containing products for 8 weeks on cardio-metabolic risk factors in 122 adults (average age 53.6 years; 63 women and 59 men) with stage 1 hypertension on no more than one medication. Results Daily cocoa consumption did not improve (p > 0.05) blood pressure, endothelial function, lipid profile, or insulin resistance in analyses of our entire sample. Daily consumption of cocoa, compared to placebo, reduced blood pressure in participants on ACE inhibitors (24-hour SBP: − 3.2 ± 9.3 vs. 3.6 ± 8.5; p = 0.038, 24-hour DBP: − 2.0 ± 5.0 vs. 2.3 ± 5.6 mm Hg; p = 0.023), beta blockers (− 4.6 ± 3.2 vs. 1.8 ± 2.8 mm Hg; p = 0.009) or diuretics (24-hour SBP 5.5 ± 7.4 vs. − 0.6 ± 4.7; p = 0.022); and improved endothelial function (3.1 ± 2.3 vs. − 3.4 ± 7.4%; p = 0.031) in participants on beta blockers. Dose-response on blood pressure was evident in participants on ACE inhibitors, with more benefit from the high dose compared to the low dose. Conclusions Including cocoa in the diet of patients with stage 1 hypertension seems to exert differential beneficial effects on cardiometabolic risk factors in certain sub-groups of patients.