We included 5474 White, Black, Hispanic, and Chinese participants who attended Exam 2 of the MESA study and had complete data on the 3 measures of religiosity. Participants were excluded if they did not attend exam 2 of the MESA study. Participants who attended exam 1 but did not attend exam 2 were more likely to be Chinese and Hispanic, and less likely to have attended college, but were generally similar to those participants who attended exam 2 with regard to comorbidities and atherosclerosis burden. Baseline characteristics of the study sample are shown in and , stratified by the frequency of religious participation and spirituality score, respectively. Results for frequency of prayer or meditation were very similar to those for frequency of religious participation (data not shown). In unadjusted analyses, those who practiced religion more frequently tended to be older, female, and black (). Systolic blood pressure and BMI were generally higher, while prevalence of smoking was lower, among those who practiced more frequently. Those indicating higher levels of spirituality were more likely to be female and black; they also had higher systolic blood pressure and BMI, but a lower prevalence of smoking ().
Characteristic of MESA Participants by Frequency of Religious Practice (N=5474)
Characteristic of Participants by Frequency of Feelings of Spirituality (N=5474)
Frequency of Religious Participation, Risk Factors and Subclinical Atherosclerosis
As shown in , after adjustment for demographic covariates (including age, sex, race, education and income), more frequent religious participants were more likely to be obese and less likely to smoke than those who did not participate at all. Compared with those who never participate in religious activities, each group of religious participants (once or twice a year, monthly, weekly, and daily) was significantly more likely to be obese. Weekly and daily participants had a significantly lower prevalence of smoking than those who never participate. After further adjustment for demographics and smoking status, more frequent religious participants remained significantly more likely to be obese than less frequent participants. The associations of religious participation with obesity and smoking were not attenuated by adjustment for an emotional social support index measured at Exam 1. After adjustment for demographics and risk factor levels, there were no consistent associations observed between frequency of religious participation and prevalence or severity of subclinical CVD (), as measured by CAC, CC-IMT, LV mass and ABI. Results stratified by frequency of prayer/meditation were similar to those stratified by frequency of religious participation (data not shown).
Adjusted Odds Ratios and Beta-Coefficients of Risk Factors and Subclinical Atherosclerosis by Frequency of Participation in Religious Practice (N=5474)
Spirituality, Risk Factors and Subclinical Atherosclerosis
After adjustment for demographics, those with the highest levels of spirituality were significantly more likely to be obese and less likely to smoke (). There was also a significantly greater prevalence of obesity and lesser prevalence of smoking among those with low and moderate spirituality, compared with the referent group with the lowest spirituality. After further adjustment for demographics and smoking status, those with greater spirituality remained more likely to be obese. The associations of spirituality with obesity and smoking were not attenuated by adjustment for an emotional social support index measured at Exam 1. There were no statistically significant associations observed between any level of spirituality and prevalence or extent of subclinical CVD.
Adjusted Odds Ratios and Beta-Coefficients of Risk Factors and Subclinical Atherosclerosis by Spirituality (N=5474)
Joint Effects of Religious Participation and Spirituality
In a secondary analysis, to assess whether frequency of religious participation or spirituality might have a greater association with obesity or smoking, we adjusted for both dimensions of religiosity simultaneously. For smoking, the magnitude of association was attenuated for both dimensions of religiosity with simultaneous adjustment. For obesity, however, the magnitude of effect and statistical significance for both frequency of participation and spirituality were maintained.
Dimensions of Religiosity and Incident CVD Events
During a mean follow up of 4.1 years, there were 152 incident CVD events, including 9 CVD deaths, 42 myocardial infarctions, 53 hospitalizations for unstable angina, 11 TIAs, 13 cases of congestive heart failure, and 24 strokes. After adjustment for demographics and risk factor levels, none of the dimensions of religiosity appeared to be associated consistently with CVD events (). As expected, there were no differences observed between religiosity and specific CVD event types (data not shown) given the low numbers of some types of events.
Figure 1 Adjusted Hazards Ratios (95% CI) for CVD Events by Frequency of Religious Participation, Frequency of Prayer or Meditation, and Spirituality. Hazards ratios were adjusted for demographics (age, sex, race, education and income), RFs (hypertension, diabetes, (more ...)