Leukocyte telomere length and cardiovascular disease in African Americans: The Jackson Heart Study

Introduction: Leukocyte telomere length (LTL), a biomarker of cellular aging, is associated with human longevity. Psychosocial stressors are associated with shorter LTL. African Americans (AAs) experience greater stressor levels compared to other racial and ethnic groups. Research on associations of psychosocial factors with LTL among AAs is not well understood. Using Jackson Heart Study (JHS) data, we examined associations of psychosocial factors (negative affect and stressors) with LTL among AAs. Hypothesis: We hypothesized that psychosocial factors are inversely associated with LTL. Methods: Analysis was restricted to 2,516 JHS participants with LTL and psychosocial data between 2000-2004. Cross-sectional associations of negative affect [cynical distrust, anger-in, anger-out, depressive symptoms] and stressors [perceived stress, weekly stress inventory event (WSI-event), WSI-impact, major life event (MLE)] were examined with LTL among participants aged 21-95 years old (women=1,542; men=974). Psychosocial variables were measured by standardized questionnaires; LTL was measured by Southern blot. Summations of the four psychosocial measures were created for negative affect and stressors, with scores ranging from 4-12. We expressed each individual psychosocial measure into categories (tertiles: low, moderate, high) and in continuous standard deviation (SD) units. Using multivariable linear regression we evaluated the associations of psychosocial factors with mean differences (beta coefficient, b) in LTL adjusting for demographics (Model 1), socioeconomic status (SES) (Model 2), health behaviors, cardiovascular disease (CVD) risk factors (Model 3), and coping (Model 4). Results: High (vs low) anger-out was inversely associated with LTL in Model 1 (b = -0.043, p=0.008) and Model 2 (b = -0.0395, p=0.03), where 1-SD unit increase in anger-out was associated with shorter LTL. High (vs low) cumulative negative affect was marginally associated with insignificantly shorter LTL in Model 1 (b = -0.09, p=0.06) and Model 2 (b = -0.09, p=0.07) before transformation to SD units. There was no association between psychosocial stressors and shorter LTL in this sample. Paradoxically, high (vs low) WSI-event was positively associated with LTL (b =0.042, p=0.016), where 1-SD unit increase in WSI-event was associated with longer LTL after full adjustment. Conclusion: Depressive symptoms were associated with LTL shortening in the literature. The current study associates anger-out with shorter LTL, while WSI-event was associated with longer LTL among AAs in the JHS. Possibly, stress pathways that effect telomere length vary, where high stress can trigger LTL lengthening or shortening. Mechanisms of the paradoxical association between stress and telomere length must be further explored among AAs.

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Association of psychosocial factors with leukocyte telomere length among African Americans in the Jackson Heart Study

Stress and Health ◽

10.1002/smi.2848 ◽

2018 ◽

Vol 35 (2) ◽

pp. 138-145 ◽

Cited By ~ 2

Author(s):

Christina D. Jordan ◽

LáShauntá M. Glover ◽

Yan Gao ◽

Solomon K. Musani ◽

Stanford Mwasongwe ◽

...

Keyword(s):

African Americans ◽

Telomere Length ◽

Psychosocial Factors ◽

Leukocyte Telomere Length ◽

Jackson Heart Study ◽

Heart Study

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Abstract P159: Coronary Artery Calcium Score Improves the Net Reclassification Index of Prevalent Cardiovascular Disease In African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.125.suppl_10.ap159 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Joseph Yeboah ◽

Che L Smith ◽

Mario Sims ◽

Ervin Fox ◽

Yaorong Ge ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery ◽

High Risk ◽

African Americans ◽

Diagnostic Accuracy ◽

Coronary Artery Calcium ◽

Smoking Status ◽

Jackson Heart Study ◽

Net Reclassification Improvement ◽

Heart Study

Background: Prior studies suggest that African Americans (AA) have lower prevalence of coronary artery calcium (CAC) compared to whites, yet CAC has similar ability to predict coronary heart disease (CHD) events. The role of CAC as a screening tool for CHD risk in AA is unclear. We compared the diagnostic accuracy for CHD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AA. Methods: CAC was measured in 2944 participants in the Jackson Heart Study, an NHLBI funded study of AA based in Jackson, MS. Approximately 8% of this cohort had known cardiovascular disease (CVD) defined as prior MI, angina, stroke, PTCA, CABG or PVD. Logistic regression, ROC and net reclassification index (NRI) analysis were used adjusting for age, gender, SBP, total and HDL cholesterol, smoking status, DM and BMI. FRS was calculated and those with DM were classified as high risk. Results: The mean age was 60, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.26 (1.17, 1.35), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. The FRS classified 30% of the cohort as high risk, 38.5% as intermediate risk and 31.5% as low risk. FRS classfied 51% of subjects with prevalent CVD as high risk. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD (see figure). Conclusion: In AA, the CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC in AA may be useful in identifying individuals at risk of CVD and reclassifying individuals with low and intermediate FRS.

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Abstract P012: Hypertension and Alterations in Left Ventricular Geometry in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.131.suppl_1.p012 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Marwah Abdalla ◽

John N Booth ◽

Keith M Diaz ◽

Mario Sims ◽

Paul Muntner ◽

...

Keyword(s):

Cardiovascular Disease ◽

African Americans ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Jackson Heart Study ◽

Antihypertensive Medications ◽

Geometric Patterns ◽

Ventricular Geometry ◽

Disease Outcomes ◽

Heart Study

Introduction: Compared with whites, African Americans (AAs) have a higher risk for hypertension-related cardiovascular disease outcomes, which may be related to alterations in left ventricular geometry. Scarce data exist on how the left ventricle remodels in response to hypertension among AAs. Hypothesis: We hypothesized that among AAs, hypertension will be associated with abnormal echocardiographic–derived left ventricular geometric patterns defined as concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Methods: We analyzed data from the Jackson Heart Study, a community-based AA cohort who completed a baseline exam that included clinic blood pressure (CBP) and 2D echocardiography (n=5,301). CR, CH, EH, and normal patterns were defined according to left ventricular mass index and relative wall thickness defined using standard American Society of Echocardiography recommendations. The analysis was restricted to 4,572 participants with complete CBP, information on antihypertensive medication, and echocardiographic data. Results: Mean ± SD age was 55.5 ± 12.7 years; 64% were female. Mean ± SD systolic and diastolic CBP was 127 ± 18 and 79 ± 11 mmHg, respectively; 2,785 (61%) of participants had hypertension (CBP ≥140/90 mmHg and/or taking antihypertensive medications). The prevalence of CR, CH, and EH were 10.1%, 5.2%, and 8.2%, respectively. In a multivariable-adjusted model with a normal pattern as the referent group, hypertension was associated with a greater risk of CR, CH, and EH: odds ratio 1.85 (95% confidence interval (CI) 1.43-2.38), 4.16 (95% CI 2.53-6.86), and 1.67 (95% CI: 1.26-2.23) respectively. Among hypertensive participants, older age was significantly associated with CR, CH, and EH after multivariable adjustment. Higher systolic CBP, current smoking and a higher number of classes of antihypertensive medications were additionally significantly associated with CH and EH. Male sex, and heavy and moderate alcohol consumption versus none were also significantly associated with CR. Conclusions: In conclusion, abnormal left ventricular geometry was present in almost 25% of AAs. Hypertension was associated with each abnormal geometric pattern, with approximately a four-fold greater odds for CH. Future studies should examine whether abnormal left ventricular geometric patterns, particularly CH, explains the increased risk of cardiovascular disease outcomes associated with hypertension in AAs.

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Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.mp65 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John N Booth ◽

Keith M Diaz ◽

Samantha Seals ◽

Mario Sims ◽

Joseph Ravenell ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Blood Pressure Monitoring ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Cvd Risk ◽

Nocturnal Hypertension ◽

Heart Study ◽

All Cause Mortality

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

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Abstract P345: Prediction of Cardiovascular Disease Events and Death using Multiple Biomarkers in African Americans: the Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p345 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Solomon K Musani ◽

Ramachandran Vasan ◽

Aurelian Bidulescu ◽

Jung Lee ◽

Gregory Wilson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

African Americans ◽

High Sensitivity ◽

Serum Cortisol ◽

Jackson Heart Study ◽

Cvd Risk ◽

Risk Reclassification ◽

Heart Study ◽

Traditional Risk Factors

Background: The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood. Methods: We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors. Results: On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors. Conclusions: In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.

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Abstract P114: Low Prevalence of Ideal Cardiovascular Health Metrics among African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p114 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Luc Djousse ◽

Andrew Petrone ◽

Chad Blackshear ◽

Michael Griswold ◽

Jane Harman ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Cardiovascular Health ◽

Smoking Status ◽

Jackson Heart Study ◽

Men And Women ◽

Ideal Cardiovascular Health ◽

Heart Study

Background: While the prevalence of cardiovascular health metrics or Life’s Simple Seven (LSS) has been shown to be far from optimal in the US, such information has been predominantly reported in Caucasians. The burden of cardiovascular disease among African Americans underscores the need to evaluate the prevalence and secular trends of LSS in other ethnic groups. Objective: To test the hypothesis that the prevalence of the LSS is far from ideal among participants of the Jackson Heart Study. Methods: We analyzed LSS with 3,500 African Americans from the Jackson Heart Study, using data from their first clinic visit (2000-2004). Standard methods were used to measure blood pressure, glucose, body mass index (BMI), and cholesterol. Information on physical activity, smoking, and diet was collected with interviewer-administered questionnaires. Each of the LSS metrics (smoking status, diet, physical activity, BMI, fasting blood glucose, total cholesterol, and blood pressure) was categorized as poor, intermediate, or ideal, as defined by the AHA guidelines. Results: The mean age at baseline was 56.9 ± 12.2 years and 2,350 participants (67%) were women. Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 6.6%, 25.8%, 32.7%, 21.6%, 10.6%, 2.3%, 0.4%, and 0%, respectively. Corresponding values for women were 3.2%, 28.1%, 32.9%, 22.3%, 10.1%, 2.9%, 0.38%, and 0%. While about two-thirds of men and women reported ideal smoking status, almost none reported ideal diet quality, and few met recommendations for BMI and blood pressure ( Figure) . Conclusions: Our data are consistent with less than optimal prevalence of cardiovascular health metrics in both men and women from the Jackson Heart Study. The lower prevalence of meeting ideal recommendations for diet, physical activity, BMI, and blood pressure underscores the need for targeted interventions to improve these modifiable lifestyle factors in order to reduce the burden of cardiovascular disease among African-Americans.

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Genetics and geography of leukocyte telomere length in sub-Saharan Africans

Human Molecular Genetics ◽

10.1093/hmg/ddaa187 ◽

2020 ◽

Vol 29 (18) ◽

pp. 3014-3020

Author(s):

Steven C Hunt ◽

Matthew E B Hansen ◽

Simon Verhulst ◽

Michael A McQuillan ◽

William Beggs ◽

...

Keyword(s):

Cardiovascular Disease ◽

Genetic Variation ◽

African Americans ◽

Telomere Length ◽

Leukocyte Telomere Length ◽

Associated Diseases ◽

European Americans ◽

Sub Saharan

Abstract Leukocyte telomere length (LTL) might be causal in cardiovascular disease and major cancers. To elucidate the roles of genetics and geography in LTL variability across humans, we compared LTL measured in 1295 sub-Saharan Africans (SSAs) with 559 African–Americans (AAms) and 2464 European–Americans (EAms). LTL differed significantly across SSAs (P = 0.003), with the San from Botswana (with the oldest genomic ancestry) having the longest LTL and populations from Ethiopia having the shortest LTL. SSAs had significantly longer LTL than AAms [P = 6.5(e-16)] whose LTL was significantly longer than EAms [P = 2.5(e-7)]. Genetic variation in SSAs explained 52% of LTL variance versus 27% in AAms and 34% in EAms. Adjustment for genetic variation removed the LTL differences among SSAs. LTL genetic variation among SSAs, with the longest LTL in the San, supports the hypothesis that longer LTL was ancestral in humans. Identifying factors driving LTL variation in Africa may have important ramifications for LTL-associated diseases.

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