Inflammation and hemostasis in atrial fibrillation and coronary heart disease: The REasons for Geographic And Racial Differences in Stroke study

Background: The use of opioids has been linked to adverse cardiovascular outcomes, suggesting a potential for an association with atrial fibrillation (AF). Conversely, opioid agonists have shown to reduce AF development in animals. It is unknown whether the use of opioids is associated with AF. Objective: The aim of this study was to examine the baseline association between prescription opioid use and AF in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Methods: A total of 24,632 participants (mean age: 65 ± 9.4 years; 54% women; 40% blacks) were included in this analysis. Prescription use of opioids was ascertained by pill bottle review during the in-home study visit. AF was identified at baseline by the study electrocardiogram or self-reported history of a previous physician diagnosis. Logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CI) for the cross-sectional association between opioid use and AF. Results: A total of 1,887 (7.6%) participants reported opioid use and 2,086 (8.5%) had evidence of AF at baseline. A total of 235 (12.5%) opioid users and 1,851 (8.1%) non-opioid users had AF (p<0.001). In a model adjusted for age, sex, race, region of residence, income, and education, systolic blood pressure, high density lipoprotein cholesterol, total cholesterol, body mass index, smoking, diabetes, antihypertensive and lipid-lowering medications, aspirin, coronary heart disease, stroke, C-reactive protein, serum creatinine, albumin-to-creatinine ratio, peripheral arterial disease, and electrocardiographic left ventricular hypertrophy, opioid use was associated a higher prevalence of AF (OR=1.35, 95% CI=1.16, 1.57). The results were consistent across subgroups of stratified by age, sex, race, coronary heart disease, hypertension, and diabetes. Conclusions: In REGARDS, AF was more common among opioid users. Further research is needed to confirm our findings and to explore the underlying mechanisms of this association.

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Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study

Annals of Epidemiology ◽

10.1016/j.annepidem.2015.03.014 ◽

2015 ◽

Vol 25 (6) ◽

pp. 426-432 ◽

Cited By ~ 24

Author(s):

Mario Sims ◽

Nicole Redmond ◽

Yulia Khodneva ◽

Raegan W. Durant ◽

Jewell Halanych ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Depressive Symptoms ◽

Racial Differences ◽

Incident Coronary Heart Disease ◽

Stroke Study

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The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: Data from the Heart and Soul Study

American Heart Journal ◽

10.1016/j.ahj.2011.05.023 ◽

2011 ◽

Vol 162 (3) ◽

pp. 555-561 ◽

Cited By ~ 72

Author(s):

Christine C. Welles ◽

Mary A. Whooley ◽

Beeya Na ◽

Peter Ganz ◽

Nelson B. Schiller ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Heart Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Chads2 Score

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Risk of Acute Coronary Heart Disease After Sepsis Hospitalization in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Clinical Infectious Diseases ◽

10.1093/cid/cix248 ◽

2017 ◽

Vol 65 (1) ◽

pp. 29-36 ◽

Cited By ~ 12

Author(s):

Henry E Wang ◽

Justin X Moore ◽

John P Donnelly ◽

Emily B Levitan ◽

Monika M Safford

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences

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Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap316 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Yulia Khodneva ◽

Daniel Lackland ◽

Ronald Prineas ◽

Monika Safford

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Models ◽

Chd Risk ◽

Regards Study ◽

Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

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Abstract P276: Differential Association of D-dimer with Stroke and Coronary Heart Disease: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap276 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Neil A Zakai ◽

George Howard ◽

Leslie A McClure ◽

Suzanne E Judd ◽

Brett M Kissela ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Racial Differences ◽

Statistical Significance ◽

Female Gender ◽

Cox Models ◽

The Difference ◽

Chd Risk Factors ◽

D Dimer

Introduction: D-dimer, a marker of coagulation activation, has higher levels in blacks than whites and has been variably associated with stroke and coronary heart disease (CHD). Methods: REGARDS recruited 30,239 participants in their homes across the continental US between 2003-07; by design 55% were female, 41% black, and 56% lived in the southeast. In a case-cohort study, D-dimer was measured in 646 participants with incident stroke, 515 with incident CHD, and 1104 in a cohort random sample. D-dimer was log transformed and modeled per 1-unit increase. Cox models were used to determine the HR for vascular disease for D-dimer and the difference in HR (95% CI) by race and vascular disease calculated by bootstrapping with 1000 replicate samples and using the 2.5 and 97.5 percentiles of the distribution (see Table for model variables). Results: Median D-dimer was higher in blacks (0.45 mcg/mL; IQR 0.26, 0.85) than whites (0.38 mcg/mL; IQR 0.23, 0.69); p <0.001. D-dimer was higher with increasing age, female gender, diabetes, hypertension and prebaseline cardiovascular disease (all p <0.05). The table shows the HR of stroke and CHD by baseline D-dimer. In minimally-adjusted models, D-dimer was associated with both stroke and CHD. Accounting for Framingham stroke and CHD risk factors, D-dimer remained associated with CHD (HR 1.45; 95% CI 1.18, 1.79), but was marginally associated with stroke (HR 1.20; 95% CI 0.99, 1.45). The difference in the HR of D-dimer between CHD and stroke was 0.22 in the basic model and 0.25 in the Framingham model, but this difference was of marginal statistical significance (Table). There was no difference in the HRs for stroke or CHD for D-dimer in blacks compared to whites (Table). Discussion: The association of D-dimer with stroke appeared smaller than for CHD with similar associations by race. Findings suggest that hemostasis activation may play a greater role in pathogenesis of CHD than stroke. Further study is needed to confirm these findings and evaluate the association of D-dimer with different stroke subtypes.

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