Persistence of cardiovascular risk factor changes after the great recession: fixed effects analysis of prospective cohort data from the multi-ethnic study of atherosclerosis.

OBJECTIVE

Multiple prospective cohort studies, including the multi-ethnic study of atherosclerosis (MESA), have documented elevations in cardiovascular risk factors after the Great Recession (GR) of 2008, despite other studies that report mortality declines after the GR. It is possible that the deleterious effects of the GR on cardiovascular risk profiles are short-lived and reversed. We examine whether risk factor elevations seen in MESA in the 2010-2011 wave persist into the 2016-2018 wave of data collection.

DESIGN

Individual fixed effects (IFE) analysis of prospective cohort data from MESA, with rate of change in the risk factor (from wave 2 to later waves) as the dependent variable, effectively controlling for individual-specific linear trends in ageing and all time-invariant characteristics. Models included controls for time-varying characteristics.

SETTING

Communities centred around Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles, California; New York City, New York; and St. Paul, Minnesota.

PARTICIPANTS

All MESA participants who participated in at least two pre-GR waves and both post-GR waves; n=3101 (47% men, 25% African American, 21% Hispanic, 13% Asian).

OUTCOMES: Primary: Systolic blood pressure (SBP), pulse pressure (PP), fasting blood glucose, serum C-reactive protein (CRP). Secondary: Serum low density lipoprotein cholesterol (LDL-C) and Body Mass Index (BMI)

RESULTS

Mean SBP and PP in 2016-2018 were greater by 8.6 (95% CI 5.9 to 11.4) and 8.0 (95% CI 6.0 to 9.9) mm Hg, respectively, than predicted by individual-specific pre-GR linear ageing trends, and fasting blood glucose was 6.3% higher (95% CI 4.6 to 8.1). In comparison, corresponding increases in 2010-2011 were 2.5 and 3.0 mm Hg and 3.3%. CRP increased by 29.7% (95% CI 21.8 to 38.2) in 2010-2011 and 45.1% (95% CI 28.3 to 64.2) in 2016-2018. Mean BMI did not change in 2010-2011 but decreased by 0.5 kg/m2 (95% CI -0.7 to -0.2) in 2016-2018. LDL-C decreased by 4.4 (95% CI -6.5 to -2.2) and 5.2 (95% CI -9.5 to -0.9) mg/dL in the two post-GR waves.

CONCLUSIONS AND RELEVANCE: Post-GR increases in blood pressure, blood glucose and CRP in the USA not only persisted for 8-10 years after the GR but also grew in magnitude. In contrast, mean BMI and mean LDL-C reduced post-GR. Further studies are needed to uncover mechanisms (behavioural or otherwise) underlying the BMI and LDL-C reductions seen here, and the mortality consequences of these risk factor changes.