Introduction:

Cardiovascular disease is the number one cause of death in the world (Linderman et al.,
2018). The literature has shown that the major risk factors for cardiovascular disease
are hypercholesterolemia, diabetes, hypertension, obesity and smoking (Vasan et al.,
2005). Body mass index (BMI) has been the standard metric to define the height/weight
characteristics of an individual (Nuttall, 2015). In our study we want to see if there is a
correlation between BMI and systolic/diastolic blood pressure and serum cholesterol.
This correlation if it exists could directly link a higher BMI to a higher risk for
cardiovascular disease. If there is a correlation between BMI and
hypertension/cholesterol it could prove that decreasing one’s BMI can help reduce the
incidence of cardiovascular disease.

Methods:
For the three different parts of the project we used the statistical analysis software,
STATA.
Part 1:
For the first part we wanted to see if variables such as age, gender, education level,
annual income, BMI, cholesterol levels, and whether they check their blood pressure at
home had any correlation with having high blood pressure. We created a new variable
and divided systolic pressure if it was greater than 140mmHg as having “HighBP”, if the
pressure was lower than 140mmHg we called these “LowBP”. After creating these new
variables, we then conducted two sample t-tests for the non-categorical variables such
as age, BMI, and cholesterol levels and compared them to the “LowBP” and “HighBP”.
For the categorical variables such as gender, education level, annual income,
and blood pressure check at home we conducted a chi squared test. We did this to
check if there was a correlation between these variables and having HighBP. After
checking for the test conditions of having an expected value for each cell of 5.
Part 2:
For the second part we created a new variable from the BMI of the sample. If the BMI
was below 25.0 we labeled these as “Normal”, if the BMI was 25<30 we labeled it as
“Overweight” and if the BMI was greater than 30 we labeled it as “Obese”. We then
conducted three One-way ANOVA test between the new BMI categories and systolic
pressure, BMI categories and diastolic pressure, and BMI categories and cholesterol
levels. First we checked for equal variance using the Bartlett’s Test, once this condition
was met, we conducted the ANOVA. If we received a significant p-value > 0.05 we did
the Bonferroni test for multiple comparisons to see where the actual significant
correlation existed.

Part 3:
For the third part we aimed to conduct linear regressions to determine if there is a linear
relationship between systolic blood pressure and BMI, and cholesterol and BMI. We first
checked the conditions to see if all three variables systolic BP, BMI and cholesterol
were approximately normal by looking at histograms and conducting Shapiro-Wilkerson
tests. If we found no violations to the conditions then we went along and conducted
Pearson correlation coefficient tests to see if there was a correlation between the
variables. If there was, we then conducted a linear regression analysis to examine the
exact relationship. After the regression, we checked the studentized residuals,
standardized residuals, and normal residuals to make sure there was no normal
distribution in the residuals.

Results:
Part 1:
Appendix A:-
Model Table 1: Descriptive Statistics
Normal SBP High SBP
(<140 mmHg, N = (≥140mmHg,N =
862 ) 133)
P value
Age (in years, M (SD)) 46.32 (16.89) 64.75 (14.47) 0.000a
Gender
Male (%(n)) 47.33 (408) 53.38 (74) 0.170b
Female (%(n)) 52.67 (454) 46.62 (64)
Race
Hispanic White (% (n)) 19.14 (170) 16.54 (22) 0.142b
Non-Hispanic White (% (n)) 37.35 (322) 35.34 (47)
Non-Hispanic Black (% (n)) 25.64 (221) 34.59 (46)
Other (% (n)) 17.87 (154) 13.53 (18)
Education
Less than High School (% (n)) 20.88 (180) 39.85 (53) 0.000b
High School Grad (% (n)) 19.03 (164) 15.04 (20)
College (% (n)) 60.1 (518) 45.11 (60)
Annual household income
categories
<$25,000 (% (n)) 31.78 (274) 40.61 (54) 0.147b
 $25,000-$54,999 (% (n)) 28.88 (249) 30.07 (40)
≥$55,000 (% (n)) 39.34 (313) 29.32 (39)
Take blood pressure at home
Yes (% (n)) 24.48 (211) 45.11 (60) 0.000b
No (% (n)) 75.52 (651) 54.89 (73)

Body mass index kg/m2 (M (SD)) 28.81775 28.96241 0.831a

(7.100514) (7.523777)
Total serum cholesterol (M(SD)) 192.7343 194.1579 0.714a
(42.12691) (42.4569)
a- P-values from two sample t-test
b- P-values from chi2 test

The only results from the t-tests and chi squared tests checking to see if there was a
correlation between multiple variables and high BP were age, education level, and
whether they took their blood pressure at home. The p-value from the 2 sample t-test of
age and highBP was 0.000. This shows that older individuals are more likely tobe
affected by high blood pressure. The p-value for the chi square test between education
level and high BP was 0.000. This shows that the people who are less educated are
more likely to have high BP. Lastly, the p-value for whether they take their BP at home
and high BP was 0.000. This shows that if you take your blood pressure at home you
are more likely to have high BP.

Part II:

BP Systolic and BMI

Bartlett’s Test checks for equal variance.
After conducting One Way ANOVA test p-value is significant p>0.000, so we have to
conduct Bonferoni Test for Multiple Comparisons.
Bonferroni Test shows that the p-value between BMI = 1 (Normal) and BMI = 2
(Overweight) and BMI = 1 and BMI = 3 (Obese) are 0.000, which shows that the mean
systolic pressure between BMI 1 and the other BMIs (2,3) is significant. That the larger
BMI has a positive correlation for higher systolic pressure.

BP Diastolic and BMI

Bartlett’s test shows equal variance. After conducting the One way ANOVA test p-
value>0.005, which is significant and we have to conduct Bonferroni test for multiple
comparisons.
Bonferroni test shows that the p-value between BMI = 1 and BMI = 3 is 0.00, which
shows that the mean diastolic pressure between BMI 1 and 3 is significant. There is
only a significant difference in diastolic pressure between normal BMI and obese BMI.

Cholesterol BMI
Bartlett’s test shows equal variance. After conducting the One way ANOVA test p-
value>0.174, which is not significant and we do not have to conduct Bonferroni test for
multiple comparisons. There is no correlation between BMI and cholesterol levels.

Part III:

a) Systolic Blood Pressure and BMI

After creating a histogram of systolic BP and BMI we determined that the two
distributions are approximately normal, although with a slight right skew. We also
created a scatter plot for systolic BP and BMI and found a small amount of outliers at
the high end of the BMI scale. We left those outliers because there were only 3 from the
sample of 1000. We also conducted Shapiro-Wilk tests for normalcy on both systolic BP
and BMI to double-check normalcy.
The only violations to the assumption that could be found were that there were 3
outliers, but they would not affect the test enough. So we did not have to transform the
data in any way.
After conducting the Pearson Correlation coefficient we found that there was a
statistically significant (p=0.0002) linear correlation between between BMI as
independent variable and systolic BP as dependent variable.
Table 2, Regression Analysis

Residuals
Studentized Residuals

Standardized Residuals
The residuals of the regression show that there is no normal distribution in the residuals.
This shows that the relationship that the regression analysis showed is based on a
linear relationship. Although the regression analysis obtained a p-value of 0.000 this
shows that the linear relationship exists and is statistically significant, the R^2 value is
only of 0.0289. This shows that there is a linear relationship but it is extremely weak.
However, this does show that as BMI increases the systolic pressure does increase and
that there is a relationship between BMI and systolic pressure. The reason the R^2
value is miniscule is that there could be other factors that affect systolic pressure and
not only BMI.

b) Cholesterol and BMI

After creating a histogram of plasma cholesterol and BMI we determined that the two
distributions are approximately normal, although with a slight right skew. We also
created a scatter plot for cholesterol and BMI and found no outliers. We also conducted
Shapiro-Wilk tests for normalcy on both systolic BP and BMI to double-check normalcy.
There were no violations to the conditions of the test, so we did not have to transform
the data in any way.
After conducting the Pearson Correlation coefficient we found that there was a
statistically significant (p=0.0022) linear correlation between between BMI as
independent variable and plasma cholesterol as dependent variable. The R^2 value was
0.0969.

Table 3, regression analysis

Residuals
Standardized Residuals

Student Residuals
The residuals of the regression show that there is no normal distribution in the residuals.
This shows that the relationship that the regression analysis showed is based on a
linear relationship. The regression analysis obtained a p-value of 0.02 this shows that
there is no statistically significant relationship between BMI and plasma cholesterol.

Discussion:
From the first part of our statistical analysis we found that there was a significant
relationship between age and high blood pressure, and education level and high blood
pressure. This could help pinpoint that as people age they are more likely to have a
higher blood pressure and create an intervention against high BP in older adults. In
regard to education it shows that the less education an individual has the more likely
they are to have high blood pressure. This shows that more education, especially health
education is necessary in places with adults with low education levels.
From our statistical analysis we obtained that the strongest relationship between BMI
and any of the variables we studied was with BMI and systolic BP. In the ANOVA test
there was a significant difference between a higher BMI and a higher BP, and from the
regression analysis we also determined that there was a linear correlation between the
two. Although, this linear correlation was weak it still existed. This is an important piece
of knowledge because it could help gear a treatment for those who are suffering from a
high systolic blood pressure. It could help these people know that changing and
lowering their BMI can definitively decrease their systolic BP.
No strong correlations were found between high BMI and high plasma cholesterol. This
shows that high BMI is not necessarily a risk factor for high plasma cholesterol.
However, further studies are needed in order to definitively state that as fact.
This paper showed that BMI is a significant risk factor for hypertension and that if you
can reduce an individual’s BMI their hypertension can also be reduced. A further study
obtaining a sample of people with hypertension that lower their BMI can help elucidate
more on this subject.

References:
Linderman GC, Lu J, Lu Y, et al. Association of Body Mass Index With Blood Pressure Among 1.7
Million Chinese Adults. JAMA Netw Open. 2018;1(4):e181271.
doi:10.1001/jamanetworkopen.2018.1271
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr Today.
2015;50(3):117–128. doi:10.1097/NT.0000000000000092
Vasan RS, Sullivan LM, Wilson PW, Sempos CT, Sundström J, Kannel WB, et al. Relative
Importance of Borderline and Elevated Levels of Coronary Heart Disease Risk Factors. Ann
Intern Med. 2005;142:393–402. doi: 10.7326/0003-4819-142-6-200503150-00005