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Cumulative Effects of Multiple Modifiable Risk Factors on Cardiovascular Disease Mortality

Jonathan Yunzhou Xiong1, Kai Goldenstein Vonkiel1, Lance Ridpath1

  • 1Department of Clinical Sciences, West Virginia School of Osteopathic Medicine, 400 Lee Street, Lewisburg, WV 24901, USA.

Journal of Clinical Medicine
|February 27, 2026
PubMed

Insights

The cumulative impact of multiple risk factors significantly increases cardiovascular disease mortality in West Virginia counties. Addressing combined socioeconomic and healthcare access issues is crucial for reducing deaths.

Area of Science:

  • Public Health
  • Epidemiology
  • Health Services Research

Background:

  • Cardiovascular disease (CVD) remains a leading cause of mortality.
  • Understanding the impact of cumulative risk factors on CVD mortality is essential for targeted interventions.
  • West Virginia presents a unique setting to study the interplay of socioeconomic and healthcare access factors on CVD outcomes.

Purpose of the Study:

  • To evaluate the association between the cumulative burden of modifiable risk factors and cardiovascular disease mortality in West Virginia counties.
  • To determine if combined risk factors have a synergistic effect on CVD mortality beyond their individual contributions.

Main Methods:

  • Retrospective observational study analyzing CVD mortality rates and modifiable risk factors (income, PCP ratio, Food Desert Status) in West Virginia counties (2011-2020).
  • Data sourced from Census Bureau, AMA, USDA, and WV HHS.
  • Multiple linear regression and ANOVA were employed to analyze the relationships between risk factors and CVD mortality.

Main Results:

  • Combined risk factors showed a stronger association with CVD mortality than individual factors.
  • Each individual risk factor (Income, PCP Ratio, FDS) was significantly associated with CVD mortality.
  • Significant two-way interactions were found between PCP Ratio and Income, and FDS and Income, indicating synergistic effects.

Conclusions:

  • Counties with multiple cumulative risk factors experienced disproportionately higher CVD mortality.
  • The combined effect of risk factors on CVD mortality exceeds the sum of their individual impacts.
  • Addressing cumulative socioeconomic and healthcare access factors at the county level is critical for mitigating CVD mortality.

Keywords:
cardiovascular diseasedeath rate

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