Age and sex differences in cardiovascular risk factors at intake and completion of cardiac rehabilitation: chronologically young but cardiovascularly old?
Bibliographic record
Abstract
Abstract Background Cardiovascular disease (CVD) is increasing among younger and middle-aged adults (MA); perhaps in part due to, poor mental health, increased sedentary time, and low physical activity levels. Younger adults (YA) with CVD are more likely to experience worse mental health and are more likely to drop-out of cardiac rehabilitation (CR) when compared to MA and older adults (OA). Less is known regarding age and sex differences in CVD risk factors at intake and completion of CR. Purpose To evaluate differences in CVD risk factors among YA (≤44 yr), MA (45-64 yr), and OA (≥65 yr) patients who completed in-person CR and all risk factor-related questionnaires, at a Canadian hospital in 2023. Methods At intake and completion resting blood pressure was assessed. The Patient Health Questionnaire-9 (PHQ9), the Generalized Anxiety Disorder-7 (GAD7), and the Duke Activity Scale Index (DASI) were administered at both time points. A Chi-Square analysis was conducted to determine differences in the proportion of patients with elevated anxiety levels. A two-way analysis of variance with a Bonferroni post-hoc test was conducted to determine age and sex differences in risk factors. Results Of 512 total patients, 39 were YA (48.7% female), 180 were MA (27.7% female) and 293 were OA (33.7% female). No age-group or sex differences were observed for any outcome at intake or completion. Differences in elevated GAD-7 scores at intake (>10 moderate, >15 severe) were observed across age groups (χ2[2]=7.36, P=0.025). Within each group, 20.5% (female=3, male=5) of YA, 6.6% (female=2, male=10) of MA, and 10.2% (female=8, male=22) of OA demonstrated elevated GAD-7 scores. This difference was not apparent at completion (χ2[2]=0.580, P=0.748). No sex differences were observed in the proportion of elevated GAD-7 scores at intake or completion. Within age-groups, improvements in physical activity levels (YA intake:205.56; completion:225.26 mins/wk, P=<0.001; MA intake:179.14; completion:251.23 mins/wk P=<0.001; OA intake:179.03; completion:223.64 mins/wk, P=<0.001), the GAD-7 (YA intake:5.25; completion:3.00 points, P=<0.002; MA intake:3.52; completion:3.37 points, P=0.005; OA intake:3.65; completion:3.03 points, P=<0.001), and the DASI (YA intake:6.68; completion:8.12 METS, P=<0.001; MA intake:6.45; completion:7.84 METS, P=<0.001; OA intake:6.4; completion:7.8 METS, P=<0.001) were observed. Conclusions YA experience higher levels of anxiety upon entry into CR when compared to MA and OA. Completion of CR reduced the proportion of patients with elevated anxiety levels, with the greatest reductions among YA. The lack of differences in risk factor outcomes across age-groups is concerning. The CVD risk profile among those <44 years appears the same as those >65 years thus, warranting immediate action to increase physical activity levels and improve education surrounding CVD risk factors to elicit heart-healthy behaviours across the lifespan.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".