Abstract
Background
Cardiovascular health (CVH) is a critical public health concern, with notable biological sex disparities impacting health outcomes. This study evaluates CVH status using the Life’s Essential 8 (LE8) metric among an employee of a government office of men and women in Birjand, Iran.
Methods
A cross-sectional study design was employed to assess CVH among employee of a government office in Birjand, Iran, from July 23 to September 27, 2023. Demographic information and the eight health factors were collected using standardized methods. The LE8 metric encompasses four health behaviors (smoking status, physical activity, diet, and sleep) and four health factors (body mass index, blood glucose levels, blood lipid levels, and blood pressure). Data were entered into SPSS, and analyses were conducted at a significance level of P ≤ 0.05 to compare LE8 scores and associated cardiovascular risk factors between biological sex. Data analysis was conducted using SPSS version 20.
Results
Of the total 319 individuals enrolled in the study, 251 (78.7%) were male and 68 (21.3%) were female. About 98.1% of the participants scored below the ideal CVH status, with significant biological sex differences observed. Women exhibited higher mean scores than men across most components of LE8, except for body mass index and physical activity. Women had more favorable levels of non-HDL cholesterol, blood pressure, blood glucose, and smoking prevalence, resulting in mean LE8 scores of 64.27 for women and 59 for men.
Conclusion
The study’s results indicated that less than 2% of the participants had an ideal cardiovascular health status. Most components of the 8 CVH factors were found to be in worse condition in men than in women. These findings highlight the critical necessity for focused, gender-sensitive interventions and strategic health planning aimed at enhancing cardiovascular health among both Iranian women and men. Therefore, further research in larger, more diverse populations is essential to address this pressing issue effectively.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12872-025-05201-w.
Keywords: Cardiovascular health, Biological sex disparities, Life's essential 8, Risk factors, Public health, Iran
Background
Cardiovascular diseases (CVD) continue to be the leading cause of death in both developed and developing countries worldwide. According to recent statistics, these diseases account for approximately 17.5 million deaths annually, representing 31% of all global fatalities [1]. Low- and middle-income countries (LMICs) account for 80% of fatalities from CVD, despite the fact that age-standardized mortality rates have decreased in many high-income countries as a result of improvements in health promotion and prevention. These areas deal disproportionately with issues like significant financial loads and scarce healthcare resources. Iran is no different; in 2016, the mean cost per patient was $1,881.4, resulting in $1.16 billion in total costs for CVD [2].
CVD is the most prevalent non-communicable disease and encompasses various conditions, including heart attacks, strokes, heart failure, and hypertension, often leading to multiple disabilities for individuals. These diseases have a multifactorial nature, which means that genetic factors, environmental influences, and individual habits work together to contribute to the onset of these issues [3]. Modifiable risk factors such as obesity, systolic hypertension, high levels of low-density lipoprotein (LDL) cholesterol, tobacco use, and diabetes significantly contribute to the prevalence and incidence of CVD [4]. These cardiovascular risk factors are also associated with various cardiovascular and non-cardiovascular outcomes. For example, tobacco use is strongly linked to premature mortality, while high blood pressure and non–high-density lipoprotein (non–HDL) cholesterol levels are more specifically associated with an increased incidence of CVD [5, 6].
In 2010, after several decades of declining mortality rates from CVD, the American Heart Association (AHA) shifted its focus from merely addressing existing heart diseases and their risk factors to promoting broader public health strategies. This change indicates that effective prevention and management of CVD require a comprehensive approach that includes lifestyle changes, health education, and policy initiatives to improve overall cardiovascular health. A new definition of cardiovascular health (CVH) is at the heart of this initiative. This definition is based on four health factors: ideal weight, blood pressure, total cholesterol, and blood glucose, along with three health behaviors: not smoking, eating a healthy diet, and engaging in regular physical activity [7]. In 2022, the AHA updated its CVH criteria by introducing Life’s Essential 8 (LE8), which includes sleep as a new factor to further improve CVH for individuals and communities [8]. Each criterion is rated as poor, moderate, or ideal based on established health guidelines, with optimal CVH being defined as meeting all eight criteria at ideal levels [9]. Numerous studies have shown that higher levels of CVH are associated with a reduced risk of conditions such as diabetes, CVD, cancer, heart failure, and cognitive decline [10, 11].
One of the at-risk groups for cardiovascular diseases is employees. In the workplace, various factors can influence cardiovascular health. Factors such as long working hours, workplace stress, night shifts, exposure to chemicals and toxins, inappropriate work environments (such as extreme temperatures, high humidity, insufficient lighting, etc.), sedentary office jobs, lack of physical activity, poor dietary habits, and lack of social support at work can increase the risk of cardiovascular diseases and reduce standards of CVH [12–15]. Furthermore, lower levels of education are also associated with an increased risk of cardiovascular diseases and even premature cardiovascular mortality [16, 17].
The usage of LE8 provides a thorough and practical framework for measuring cardiovascular health, especially in the workplace. LE8 provides the early identification of at-risk individuals by combining key modifiable health behaviors with clinical variables. This is especially important in underserved areas like South Khorasan, where access to healthcare facilities may be restricted and workplace-based preventative activities can play a vital role in lowering long-term disease burden and health inequities. Therefore, given the importance of cardiovascular health in the workplace, this study aims to assess the cardiovascular health of employees in one of the government offices.
Methods
Participants and study design
From July 23 to September 27, 2023, a cross-sectional study was conducted involving 319 employees from a government office in South Khorasan in Birjand, Iran. Trained nurses completed standardized checklists to collect demographic and anthropometric data, including age, biological sex, marital status, educational level, height, weight, waist circumference, and blood pressure. Participants underwent fasting blood glucose and lipid profile tests after 10 to 12 h of fasting. The components of the 8CVH metrics were extracted from this data for further analysis. Informed consent was obtained from all participants, and the Ethics Committee of Birjand University of Medical Sciences granted ethical approval.
Determination of updated cardiovascular metrics using life’s essential 8
The LE8 cardiovascular health metrics encompass two main categories: behavioral factors and health factors. Behavioral factors include smoking status, physical activity, diet, and sleep, while health factors include body mass index (BMI), blood glucose levels, blood lipid levels, and blood pressure [8].
Behavioral factors
Behavioral factors were assessed: Diet was evaluated based on adherence to Mediterranean dietary guidelines using a self-reported food frequency questionnaire [18]. Physical activity was measured using the short form of the International Physical Activity Questionnaire (IPAQ), which included questions on different intensity levels. Nicotine exposure was self-reported, categorizing individuals into three groups: never smoked, ex-smoker, or current smoker, along with an assessment of the duration since cessation of smoking. Sleep health was determined by participants’ self-reported average hours of sleep per night [8, 19].
Health factors
Health factors were analyzed through various metrics: Blood pressure was measured by trained nurses using appropriate-sized cuffs according to the AHA recommendations. Blood lipid levels, including total cholesterol and HDL, were assessed through blood samples, with non-HDL cholesterol calculated from these values. Fasting blood glucose levels were evaluated from samples collected after a fasting period. Finally, BMI was calculated from objectively measured weight and height [8].
Quantification of cardiovascular health metrics
Each of the eight components was scored on a scale from 0 to 100. The overall LE8 score represents the average of these components [8, 20]. A negative scoring system was applied to smoking, blood pressure, and lipid levels [7, 8]. The eight CVH metrics were classified into three categories: ideal (≥ 80), intermediate (50–79), and poor (< 50) (Table 1).
Table 1.
Life’s essential 8 CVH score
| Four Health Factors | Four Health Behaviors | ||
|---|---|---|---|
| Blood Pressure | Points | Diet | Points |
|
Systolic BP < 120 mmHg and Diastolic BP < 80 mmHg |
100 | 15–16 | 100 |
|
Systolic BP 120–129 mmHg and Diastolic BP < 80 mmHg |
75 | 12–14 | 80 |
|
Systolic BP 130–139 mmHg or Diastolic BP 80–89 mmHg |
50 | 8–11 | 50 |
|
Systolic BP 140–159 mmHg or Diastolic BP 90–99 mmHg |
25 | 4–7 | 25 |
|
Systolic BP ≥ 160 mmHg or Diastolic BP ≥ 100 mmHg |
0 | 0–3 | 0 |
| If drug-treated level, subtract 20 points | |||
| Non-HDL Cholesterol | Physical Activity | ||
| < 130 mg/dL | 100 | ≥ 150 min | 100 |
| 130–159 mg/dL | 60 | 120–149 min | 90 |
| 160–189 mg/dL | 40 | 90–119 min | 80 |
| 190–219 mg/dL | 20 | 60–89 min | 60 |
| ≥ 220 mg/dL | 0 | 30–59 min | 40 |
| If drug treated level, subtract 20 points | |||
|
Blood Glucose Glycosylated Hemoglobin A1C |
1–29 min | 20 | |
| Fasting blood glucose < 100 mg/dL with no history of diabetes mellitus | 100 | 0 min | 0 |
| Fasting blood glucose 100–125 mg/dL with no history of diabetes mellitus | 60 | Smoking | |
| Body Mass Index | Never smoked | 100 | |
| < 25.0 kg/m2 | 100 | Former smoker, quit ≥ 5 years ago | 75 |
| 25–29.9 kg/m2 | 70 | Former smoker, quit 1-<5 years ago | 50 |
| 30–34.9 kg/m2 | 30 |
Former smoker, quit < 1 year ago Currently using e-cigarettes |
25 |
| 35–39.9 kg/m2 | 15 | Current smoker | 0 |
| ≥ 40 kg/m2 | 0 | Sleep | |
| 7- <9 h | 100 | ||
| 9- <10 h | 90 | ||
| 6- <7 h | 70 | ||
| 5- <6 or ≥ 10 h | 40 | ||
| 4- <5 h | 20 | ||
| < 4 h | 0 | ||
Statistical analysis
Data analysis was conducted using SPSS version 20. Continuous variables with a normal distribution were presented as mean ± standard deviation, while categorical variables were reported as frequencies and percentages. Biological sex differences in the prevalence of heart health metrics were assessed using the chi-square test, specifically Fisher’s exact test. For continuous variables representing the total score of the eight CVH metrics, the Kruskal-Walli’s test was utilized. Statistical significance was defined as a P ≤ 0.05.
Results
The study included 319 participants; 251 (78.7%) were male. As presented in Table 2, the characteristics of the participants were analyzed by biological sex, revealing that men were significantly older (P-value = 0.007). In contrast, women exhibited a higher level of education (P-value = 0.039). No statistically significant differences were observed between biological sex for other characteristics, such as diabetes mellitus, hypertension, and dyslipidemia.
Table 2.
Comparison of demographic information and risk factors in participants by sex
| Characteristics | Female (n = 68) |
Male (n = 251) |
Total (n = 319) |
P-value | |
|---|---|---|---|---|---|
| Age (years) | 40.92 ± 7.53 | 43.73 ± 7.35 | 43.14 ± 7.47 | 0.007α | |
| Education | Literacy | 0 | 7 (3.6) | 7 (2.8) | 0.039β |
| Diploma and post-diploma | 1 (1.7) | 23 (11.7) | 24 (9.4) | ||
| Bachelor’s and Master’s Degree | 51 (87.9) | 148 (75.5) | 199 (78.3) | ||
| Doctorate and above | 6 (10.3) | 18 (9.2) | 24 (9.4) | ||
| DM | Yes | 8 (13.1) | 21 (10.4) | 29 (11.1) | 0.561 |
| No | 53 (86.9) | 180 (89.6) | 233 (88.9) | ||
| HTN | Yes | 5 (8.2) | 31 (15.4) | 36 (13.7) | 0.151 |
| No | 56 (91.8) | 170 (84.6) | 226 (86.3) | ||
| DLP | Yes | 6 (9.8) | 39 (19.4) | 45 (17.2) | 0.083 |
| No | 55 (90.2) | 162 (80.6) | 217 (82.8) | ||
| IHD | Yes | 2 (3.3) | 9 (4.5) | 11 (4.2) | 1 |
| No | 59 (96.7) | 191 (95.5) | 250 (95.8) | ||
Abbreviation: Diabetes mellitus (DM), Hypertension (HTN), Dyslipidemia (DLP), ischemic heart disease (IHD)
The P-value was obtained from the αANOVA and post-hoc Tukey or βchi-square tests as appropriate
Table 3 compares the AHA 8LE scores across biological sex. The results indicate significant differences in blood pressure, non-HDL cholesterol, and blood glucose, with men demonstrating poorer status in these metrics than women. Additionally, no significant differences were observed between biological sex in physical activity, diet quality, and sleep health.
Table 3.
Sex differences of 8 CVH categories in participants
| Life’s Essential Component | Female n (%) | Male n (%) | Total n (%) | P-value | |
|---|---|---|---|---|---|
| Blood pressure | Low | 7 (10.3) | 87 (34.7) | 94 (29.5) | < 0.001 |
| Moderate | 34 (50) | 127 (50) | 161 (50) | ||
| High | 27 (39.7) | 37 (14.7) | 64 (20.1) | ||
| Non-HDL cholesterol | Low | 11 (16.2) | 80 (31.9) | 91 (28.5) | 0.012 |
| Moderate | 16 (23.5) | 66 (26.3) | 82 (25.7) | ||
| High | 41 (60.3) | 105 (41.8) | 146 (45.8) | ||
| Blood glucose | Low | 10 (14.7) | 37 (14.7) | 47 (14.7) | 0.023 |
| Moderate | 21 (30.9) | 121 (48.2) | 142 (44.5) | ||
| High | 37 (54.4) | 93 (37.1) | 130 (40.8) | ||
| BMI | Low | 15 (22.1) | 36 (14.3) | 51 (16) | 0.178 |
| Moderate | 40 (58.8) | 146 (58.2) | 186 (58.3) | ||
| High | 13 (19.1) | 69 (27.5) | 82 (25.7) | ||
| Diet | Low | 29 (42.6) | 147 (57.8) | 174 (54.6) | 0.062 |
| Moderate | 33 (48.6) | 94 (37.5) | 127 (39.8) | ||
| High | 6 (8.8) | 12 (4.7) | 18 (5.6) | ||
| Physical activity score | Low | 67 (98.5) | 244 (97.2) | 311 (97.5) | 1 |
| Moderate | 0 | 1 (0.4) | 1 (0.3) | ||
| High | 1 (1.5) | 6 (2.4) | 7 (2.2) | ||
| Smoke | Low | 0 | 19 (7.6) | 19 (6) | 0.017 |
| Moderate | 0 | 0 | 0 | ||
| High | 68 (100) | 232 (92.4) | 300 (94) | ||
| Sleep health | Low | 16 (23.5) | 44 (17.5) | 60 (18.8) | 0.293 |
| Moderate | 28 (41.2) | 129 (51.4) | 157 (49.2) | ||
| High | 24 (35.3) | 78 (31.1) | 102 (32) | ||
Data presented as frequency (percent), the Chi-square (fisher exact) test was used
Abbreviation: Non-HDL Non-High-Density Lipoprotein Cholesterol, BMI Body mass index
Table 4 compares mean CVH scores and AHA Life’s Essential eight metrics between women and men after adjustment for age, education level, and marital status. The results show that women performed significantly better in blood pressure and non-HDL cholesterol and had a higher adjusted overall CVH score (64.27) than men (59.0). No significant differences were found in mean scores for blood glucose, BMI, diet quality, physical activity, and sleep health between the two biological sex. Furthermore, men exhibited poorer scores in nicotine exposure (N = 90.14).
Table 4.
Comparison of adjusted mean scores for overall 8CVH by sex
| Life’s Essential Component (scores) | Female (n = 68) | Male (n = 251) | P-value | ||
|---|---|---|---|---|---|
| Unadjusted mean (95% CI) |
Adjusted mean (95% CI) |
Unadjusted mean (95% CI) |
Adjusted mean (95% CI) |
||
| Blood pressure | 69.74 (62.88, 76.60) | 71.47 (64.11–78.84) | 47.78 (44.21–51.35) | 48.27 (44.29–52.25) | < 0.001 |
| Non-HDL cholesterol | 77.65 (70.48–84.82) | 77.83 (69.85–85.81) | 66.09 (62.36–69.82) | 65.79 (61.48–70.09) | 0.010 |
| Blood glucose | 73.82 (65.84–81.79) | 73.47 (65.00-81.95) | 67.37 (63.22–71.52) | 70.50 (65.93–75.08) | 0.546 |
| BMI | 66.380 (60.94–71.82) | 67.54 (61.63–73.44) | 75.36 (69.52–75.19) | 72.75 (69.56–75.93) | 0.129 |
| Diet | 43.59 (39.96–47.22) | 43.47 (39.08–47.85) | 39.82 (37.93–41.71) | 39.71 (37.35–42.08) | 0.141 |
| Physical activity score | 7.72 (3.96–11.48) | 7.47 (2.88–12.07) | 9.86 (7.91–11.82) | 10.14 (7.66–12.62) | 0.318 |
| Smoke | 100 | 100 | 91.04 (88.14–93.93) | 90.14 (86.46–93.81) | 0.027 |
| Sleep health | 72.75 (67.39–78.11) | 72.33 (65.85–78.81) | 74.48 (71.70-77.28) | 74.71 (71.21–78.21) | 0.527 |
| Overall score | 63.86 (61.49–66.24) | 64.27 (61.71–66.83) | 58.60 (57.36–59.84) | 59.0 (57.62–60.38) | < 0.001 |
*Data are presented as means (95% CI), unadjusted and adjusted for age, marital status, education from linear regression models
†P values for sex-specific differences in adjusted means
Figure 1 indicates employees’ overall CVH scores categorized into ideal, intermediate, and poor. Notably, only 1.9% of participants scored 80 or higher, qualifying them for the perfect category. Figure 2 illustrates the status of the 8CVH factors in both biological sexes, revealing that a small percentage of individuals in both biological sexes achieved ideal status in behavioral factors, ranging from 0.8% to 1.5% for the ideal condition of these behavioral factors.
Fig. 1.
Distribution of total score 8CVH in participants
Fig. 2.
Distribution of the 8CVH components by sex
Discussion
Our results reveal that 98.1% of participants had below-ideal CVH scores. Within this context, significant biological sex differences were observed, with women exhibiting better outcomes in terms of education level and age compared to men. The mean age of women was lower, which likely contributed to their more favorable health metrics. Moreover, a more significant proportion of women had achieved higher education levels. In all components of the LE8 score, women had higher mean scores than men, except for BMI and physical activity. Our analysis, which controlled for age, marital status, and education, showed significant differences between biological sex in non-HDL cholesterol levels, blood pressure, blood glucose, and smoking prevalence—factors that were notably more favorable among women (mean scores: 59 for men vs. 64.27 for women). These findings align with previous research, corroborating the notion that women generally have better cardiovascular health outcomes when compared to men [21–23].
In a study conducted by Janković et al., the percentage of women with ideal CVH was double that of men (6% vs. 3%). Additionally, a higher rate of individuals achieving five or more ideal CVH metrics was observed among women (21% vs. 13% in men) [21]. These results are consistent with those of Joseph et al., who revealed that only 4.5% of individuals surveyed had an ideal CVH status, with women performing better than men [22]. Similarly, a study by Shim et al., conducted among 5,691 participants, revealed that 29.6% (n = 1,685), 56.4% (n = 3,208), and 14% (n = 798) displayed poor, intermediate, and ideal CVH, respectively. This study also highlighted that woman maintained a more favorable CVH status than men, consistent with our findings, where only 1.9% of participants attained ideal CVH score [23]. A study by Shetty et al. reported the average LE8 score for men as 67.2 (0.4) and for women as 71.4 (0.4), showing that women achieved higher scores than men in all components of the LE8 score except for physical activity [24]. The findings of this study are consistent with previous research indicating that men generally exhibit poorer cardiovascular health metrics than women [21–24]. For instance, a systematic review by Regitz-Zagrosek et al.emphasized that a substantial proportion of clinical manifestations of coronary artery disease (CAD) is attributable to obstructive CAD, predominantly caused by atherosclerosis, which accounts for 90–95% of acute coronary syndrome (ACS) cases. The high rate of obstructive CAD is partly due to a higher accumulation of atherosclerotic risk factors in men compared to women. Moreover, men carry a more significant burden of traditional cardiovascular risk factors such as hypertension and dyslipidemia, contributing to their higher rates of obstructive coronary artery disease and acute coronary syndromes compared to women [25]. Because men and women have different risk factors and hormones, there is a significant variation in the incidence of cardiovascular disease. Atherosclerotic disease incidence is low in premenopausal women, increases in postmenopausal women, and returns to premenopausal levels in postmenopausal women receiving estrogen therapy [26]. According to data reviews, estrogen’s direct actions on blood arteries contribute significantly to its cardiovascular protective effects. The blood vessels, like the reproductive organs, bone, and brain, is now recognized as a critical target of estrogen impact. Estrogen promotes vasodilatation and prevents atherosclerosis and the blood vessels’ reaction to damage [27].
Ramirez et al. also reported that within the young adult demographic, the prevalence of hypertension is notably lower in women compared to men. This disparity is attributed to the influence of sex hormones, characteristics related to the renin-angiotensin system, and gender-specific variations in social determinants of health [28]. Subgroup analysis additionally revealed that gender served as a statistically significant moderator for ideal smoking behavior, with a higher percentage of females (81%) identifying as non-smokers compared to males (60%). This disparity can partly be attributed to the lower prevalence of smoking among women than men, possibly reflecting societal norms and attitudes surrounding tobacco use. However, it is essential to note that epidemiological evidence indicates that smoking poses a more potent cardiovascular risk factor for women [29, 30]. As the trend in female smoking continues to rise, this finding underscores the urgent need for tobacco control policies that specifically address the challenges women face regarding smoking and its associated health risks. Effective interventions tailored to women can be pivotal in reducing the prevalence of smoking-related cardiovascular diseases. Furthermore, our analysis highlighted a statistically significant difference in ideal blood pressure levels between females (42%) and males (30%). This observation aligns with global trends indicating a higher prevalence of elevated blood pressure among men. However, the difference in ideal blood pressure was only statistically significant in the Americas and the European Region [31]. This finding reflects broader health disparities between biological sex and emphasizes the importance of developing region-specific strategies for blood pressure management that take biological sex dynamics into account. Therefore, it is essential for public health initiatives to better focus on interventions aimed at reducing hypertension and promoting cardiovascular health for both men and women.
Several studies have investigated biological sex disparities in ideal CVH status and explored the potential reasons for these differences [32, 33]. Masoumi S et al. conducted a study to investigate the gender differences in risk factors for cardiovascular disease and score among healthcare workers. According to the study, no women were at high risk, and 6 (0.4%), 16 (1%), and 1,562 (98.6%) were at intermediate, borderline, and low risk, respectively, while 8 (0.6%) males were at high risk, 140 (11.1%), 162 (12.9%), and 948 (75.4%) were at intermediate, borderline, and low risk. Furthermore, the risk score for atherosclerotic cardiovascular disease (ASCVD) differed significantly between genders (P < 0.001). As a result, it was discovered that women were at lesser risk of ASCVD, whereas men were far more susceptible. It appears that women have focused more on their health and preventive initiatives as healthcare providers [34].
Significant variations in the average LE8 score between men and women may stem from many factors. Generally, women tend to pay more attention to their health. They are more likely than men to adopt healthier behaviors, such as maintaining a balanced diet and engaging in regular health monitoring. These differences can be attributed to biological, social, and cultural influences shaping health-related behaviors. For instance, women are generally more inclined to adhere to medical advice and actively participate in prevention and healthcare programs [24]. This heightened awareness and proactive approach to health can lead to better management of risk factors associated with cardiovascular health. Additionally, social norms may encourage women to seek healthcare and prioritize their well-being, while men might engage in riskier behaviors or neglect preventive care. Also, several studies have shown that women in early adulthood are more likely to seek medical help and follow up with healthcare providers more consistently than their male counterparts. This trend may help explain the higher scores observed in categories such as blood pressure, blood lipids, and blood glucose for women [35, 36]. As a result, these findings highlight a concerning state of cardiovascular health in men compared to women and underscore the urgent need for greater focus on managing risk factors, including cholesterol levels, blood pressure, and smoking habits [37].
Since the beginning of this century, there have been concerted efforts to enhance understanding of sex and biological sex differences in CVD and to increase awareness of heart disease among women. For policies and prevention efforts to be successful, they must be carefully investigated and targeted according to biological sex differences. A nuanced understanding of these disparities in CVD can lead to more effective prevention and treatment strategies for both biological sexes. Moreover, continued efforts are essential to dismantle the persistent belief that cardiovascular disease predominantly affects men [38]. Such misconceptions can lead to under-recognition and under-treatment of CVD in women, who may present with different symptoms and risk profiles than men. Therefore, healthcare providers and policymakers must champion initiatives to educate the public and healthcare communities about recognizing cardiovascular disease in all populations, especially among women. By fostering a more comprehensive understanding of CVD across biological sex, we can work towards more effective interventions that ultimately improve cardiovascular health outcomes for everyone.
Using LE8, this study analyzes cardiovascular health among employees in an underserved area of Iran, a demographic that is frequently underrepresented in studies. LE8’s combination of behavioral and clinical characteristics enables early risk detection, allowing for targeted workplace interventions to lower future illness burden. This study fills a key knowledge gap about cardiovascular health in socioeconomically disadvantaged employment settings, impacting preventative interventions and policy development.
Limitations
The results of this study have the following limitations: its cross-sectional design limits the ability to determine causal relationships between health metrics and demographic or lifestyle factors. It only provides a snapshot in time without considering changes over time. Moreover, reliance on self-reported data concerning dietary patterns, physical activity, nicotine exposure, and sleep health may introduce biases. Since this study was conducted in a specific geographic area, its findings may not be generalizable to other populations or regions where health behaviors may differ. Furthermore, the absence of anthropometric evaluations, including the modified Haller index (MHI) [39], signifies a lost opportunity to investigate structural thoracic dimensions as possible indicators of cardiovascular risk. Subsequent research should include these measures to offer a more thorough assessment of cardiovascular health.
Conclusion
The results of this study demonstrated that residents of a governmental organization do not possess an ideal status in cardiovascular health, which was consistent for both biological sexes. Differences were observed in the cardiovascular health factors of women and men, with women’s health generally showing better outcomes. Even after adjusting for age, education, and marital status, these differences remained statistically significant across most factors. Therefore, LE8 can function as an effective screening instrument within workplace health initiatives, facilitating the early identification of risks and the implementation of targeted preventive measures. Also, similar longitudinal and interventional studies must be conducted on a larger scale and in various populations across Iran. These findings suggest preventive educational programs should be designed and implemented throughout the community, particularly in governmental offices. Additionally, workplace factors in various offices should be examined to implement changes that can significantly contribute to employee health. This is crucial, as a community’s development is contingent upon its individuals’ health.
Supplementary Information
Acknowledgements
This article presents the results of a research project conducted by the faculty of Birjand University of Medical Sciences (code 6353). The authors thank all of the Razi Hospital Clinical Research Development Unit.
Authors’ contributions
Conceptualization: Samira Karbasi, Saeede Khosravi Bizhaem, Toba Kazemi; Data Collection: Saeede Khosravi Bizhaem,,Toba Kazemi; Data Analysis: Saeede Khosravi Bizhaem; Interpretation of Results: Samira Karbasi, Razie jafarizadeh, Saeede Khosravi Bizhaem, Toba Kazemi; Writing of the manuscript : Samira Karbasi, Razie jafarizadeh, Saeede Khosravi Bizhaem, Toba Kazemi; All authors approved the final version of the manuscript.
Funding
The funding was provided by the Research and Technology Deputy of Birjand University of Medical Sciences.
Data availability
The dataset presented in the study is available on request from the corresponding author during submission or after publication.
Declarations
Ethics approval and consent to participate
The study is approved under the Ethics Committee of Birjand University of Medical Sciences (Ethics No: IR.BUMS.REC.1402.210). It was conducted in accordance with the ethical principles of human experimentation in the Declaration of Helsinki. All participants provided informed consent prior to participation and were allowed to discontinue participation at any time for any reason.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not applicable.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The dataset presented in the study is available on request from the corresponding author during submission or after publication.