The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: The Jackson Heart Study

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 17930: Indices of Adiposity and Subclinical Cardiovascular Disease: the Jackson Heart Study(JHS)

Circulation ◽

10.1161/circ.130.suppl_2.17930 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Adedotun A Ogunsua ◽

Akintunde O Akinkuolie ◽

Olulade A Ayodele ◽

Jiankang Liu ◽

DeMarc Hickson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Adipose Tissue ◽

Characteristic Curve ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Logistic Regression Models ◽

C Statistic ◽

Heart Study ◽

Subclinical Cvd

Background: Evidence that indices of adiposity, which better account for central obesity, outperform body mass index (BMI) in discriminating presence versus absence of cardiovascular disease (CVD) are largely derived from Caucasian populations with limited and inconsistent findings in African Americans (AA). Characterization of the optimal measure of adiposity for improving CVD risk prediction and stratification in AAs is needed. Aim: We cross-sectionally evaluated the performance of BMI, waist circumference (WC), % body fat (%BF), waist to height ratio (WHtR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) in predicting the presence of subclinical CVD as defined by coronary artery calcification (CAC) and abdominal aorta calcification (AAC) in the JHS, a cohort of AAs. Methods: 2,253 participants (66% female, mean age: 55 years) with no prior CVD were studied. VAT, SAT, CAC and AAC were determined using CT scan, %BF was assessed with bioelectric impedance and other adiposity indices were measured using standard protocols. Logistic regression models were constructed and c statistic from receiver operating characteristic curve was used to assess the utility of each adiposity index in predicting CAC and AAC. Results: Prevalence of CAC and AAC were 43% and 63% respectively. In univariate analyses with CAC as outcome, c statistic for VAT, WHtR, WC, %BF, SAT and BMI ranged from 0.60-0.51 in decreasing order, and were statistically significantly higher when compared with BMI, except SAT and %BF. Similar results were noted for AAC. However, none of the indices improved risk discrimination beyond traditional CVD risk factors (Table). Conclusion: VAT had the highest discrimination capacity for subclinical CVD followed by WHtR and WC. These results suggest that though other adiposity measures performed slightly better than BMI, none of the measures contributed significantly to discriminating subclinical CVD beyond the traditional CVD risk factors.

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Abstract P107: Leucocyte Telomere Length and Cardiovascular Disease in the Jackson Heart Study

Circulation ◽

10.1161/circ.135.suppl_1.p107 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Stanford Mwasongwe ◽

Laura Raffield ◽

Yan Gao ◽

James G Wilson ◽

Abraham Aviv ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Telomere Length ◽

Left Ventricular ◽

Jackson Heart Study ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Heart Study ◽

Increased Risk ◽

Age And Sex

Background: In European descent populations, shorter leucocyte telomere length (LTL) has been associated with clinical and subclinical atherosclerosis, while longer LTL has been associated with greater left ventricular hypertrophy (LVH). We evaluated the relationship of LTL with subclinical indices of cardiovascular disease (CVD) (coronary artery calcification [CAC], abdominal aorta calcification [AAC], carotid intima media thickness [CIMT], left ventricular mass [LVM], and ankle-brachial index [ABI]) in African Americans (AAs). We also examined whether LTL is associated with CVD events and mortality. Methods: Analyses included participants of the Jackson Heart Study (JHS), a prospective cohort study of AAs, with LTL data (n=2,573) measured by Southern blot analysis in DNA from the baseline exam (2000-2004). Adjudicated CVD events (coronary heart disease [CHD], heart failure [HF] and stroke) and mortality were identified through December 2012. Relationships were assessed using linear, logistic regression models, or Tobit model (CAC and AAC due to left censoring) in STATA 14. Results: In an age and sex adjusted model, longer LTL was significantly associated with lower CAC ( P =0.049, β=-0.535; 95% confidence interval [CI], -1.066,-0.003); this association was no longer significant after adjusting for body mass index, current smoking and other CVD risk factors. There were no significant associations between LTL and AAC, CIMT, or LVM. LTL was associated with higher ABI ( P =0.017, β=0.023; 95% CI, 0.004, 0.042) when the highest was compared to the lowest LTL quartile in models adjusted for CVD risk factors. After a median follow-up of 9 years, longer LTL was associated with lower risk of incident ischemic stroke and total mortality in age and sex adjusted models, but these associations were no longer significant in models fully adjusted for CVD risk factors. Conclusions: In conclusion, among a community-based cohort of AAs, LTL was associated with increased ABI, indicative of increased risk of peripheral arterial disease, but there were no significant associations with other CVD indices and mortality after adjustment for established risk factors.

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Calcium Intake and CVD Risk Factors: Gender Differences in the Jackson Heart Study

Journal of the American Dietetic Association ◽

10.1016/j.jada.2009.06.307 ◽

2009 ◽

Vol 109 (9) ◽

pp. A91

Author(s):

M.E. Lartey-Rowser ◽

J. Lawrence ◽

K. Yadrick ◽

T. Carithers ◽

C. Connell

Keyword(s):

Risk Factors ◽

Gender Differences ◽

Calcium Intake ◽

Jackson Heart Study ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Heart Study

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Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study

Health & Place ◽

10.1016/j.healthplace.2017.04.002 ◽

2017 ◽

Vol 45 ◽

pp. 199-207 ◽

Cited By ~ 13

Author(s):

Xu Wang ◽

Amy H. Auchincloss ◽

Sharrelle Barber ◽

Stephanie L. Mayne ◽

Michael E. Griswold ◽

...

Keyword(s):

Risk Factors ◽

African Americans ◽

Health Behavior ◽

Social Environment ◽

Jackson Heart Study ◽

Heart Study

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Abstract P439: Risk Factor Profile and Prevalence of Subclinical Disease in African Americans with Diabetes and Metabolic Syndrome: The Jackson Heart Study

Circulation ◽

10.1161/circ.127.suppl_12.ap439 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Kamel A Gharaibeh ◽

Vanessa Xanthakis ◽

Jung Hye Sung ◽

Tandaw S Samdarshi ◽

Herman A Taylor ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

African Americans ◽

Left Ventricular ◽

Jackson Heart Study ◽

Cvd Risk ◽

Metabolic Derangement ◽

Risk Factor Profile ◽

Subclinical Disease ◽

Heart Study

Background . Metabolic derangements such as diabetes (DM) and metabolic syndrome (MetS) are common in African Americans (AA) and contribute to the higher cardiovascular disease (CVD) mortality in this group. A greater prevalence of subclinical disease (ScD) among those with DM and MetS in the AA community may be an explanatory factor. Objective . We assessed the CVD risk factor profile and distribution of ScD among AA with DM and MetS in the Jackson Heart Study (JHS). Methods . We evaluated 4,365 AA participants [mean age (SD) of 53.8 (12.3) years, 64.5% women] free of overt CVD who attended JHS Exam 1 (between 2000- 2004), when ScD assessment was routinely performed(with the exception of CT for coronary calcium that occurred in Exam2). SCD measures included 1) peripheral artery disease (PAD, defined as ankle-brachial index<0.9), 2) high coronary artery calcium (CAC, defined as score>100), 3) left ventricular (LV) hypertrophy (LVH defined as left ventricular mass index>51 g/m 2.7 , 4) low LV ejection fraction (low EF, defined as an EF<50%), and 5) microalbuminuria (MA, defined as an albumin-to-creatinine ratio>25 μg/mg in men and >35 μg/mg in women). We compared the distribution of standard CVD risk factors and ScD prevalence in 1) those without DM or MetS (referent), 2) those with MetS but no DM and 3) those with DM. Results . In our study sample, 1,089 (24.9%) had MetS with no DM and 752 (17.2%) had DM. Compared to the referent group, groups with metabolic derangement tended to be older, female, hypertensive, obese, and had lower HDL, higher fasting glucose, and higher triglycerides levels. Table 1 compares the distribution of ScD for the three groups, and demonstrates the greater odds of. CAC, LVH and microalbuminuria in participants with MetS or DM. Conclusion . In our large community-based sample of AAs, we observed a significantly high prevalence of ScD overall, especially so in participants with MetS and DM. These findings likely contribute to the high CVD rates in AA with MetS and DM. -->

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Neighborhood Disadvantage, Neighborhood Safety and Cardiometabolic Risk Factors in African Americans: Biosocial Associations in the Jackson Heart Study

PLoS ONE ◽

10.1371/journal.pone.0063254 ◽

2013 ◽

Vol 8 (5) ◽

pp. e63254 ◽

Cited By ~ 36

Author(s):

Cheryl R. Clark ◽

Mark J. Ommerborn ◽

DeMarc A. Hickson ◽

Kya N. Grooms ◽

Mario Sims ◽

...

Keyword(s):

Risk Factors ◽

African Americans ◽

Cardiometabolic Risk ◽

Neighborhood Disadvantage ◽

Cardiometabolic Risk Factors ◽

Jackson Heart Study ◽

Neighborhood Safety ◽

Heart Study

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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 P488: Discrimination and Hypertension Risk Among African Americans in The Jackson Heart Study

Circulation ◽

10.1161/circ.141.suppl_1.p488 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Allana T Forde ◽

Mario Sims ◽

Paul Muntner ◽

Tené Lewis ◽

Amanda Onwuka ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

African Americans ◽

The United States ◽

Jackson Heart Study ◽

Incident Hypertension ◽

Hypertension Risk ◽

Heart Study ◽

Low Levels

Background: African Americans have a higher risk for hypertension compared to other racial or ethnic groups in the United States. One possible explanation for this health disparity is perceived discrimination. Few studies have prospectively examined the association between discrimination and the incidence of hypertension. Methods: We examined the associations of everyday, lifetime, and stress from lifetime discrimination with incident hypertension and whether these associations differed by sex, discrimination attribution (i.e. the main reason for the discrimination event), and coping responses to discrimination among African Americans enrolled in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed two follow-up study visits from 2005-2008 and 2009-2013. We used interval-censored Cox regression to estimate associations of discrimination with incident hypertension (antihypertensive medication use; and/or systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mm Hg at follow-up visits 2 or 3) after adjustment for confounding variables. Results: Overall, 52% (954 of 1845) of participants developed hypertension over the follow-up period. After adjustment for age, sex, education and hypertension risk factors (body mass index, alcohol use, smoking, diet and physical activity), medium versus low levels of lifetime discrimination (hazard ratio-HR: 1.45, 95% confidence interval-CI: 1.15-1.82) and high versus low levels of lifetime discrimination (HR: 1.35, CI: 1.08-1.68) were associated with a higher incidence of hypertension. High versus low stress from lifetime discrimination was associated with hypertension risk after adjustment for demographics (HR: 1.20, CI: 1.02-1.41), but the association was attenuated after adjustment for hypertension risk factors (HR: 1.14, CI: 0.97-1.35). Lifetime discrimination and stress from discrimination were associated with an increased hypertension risk among females, but not males. No interactions with age, attribution or coping were present for any type of discrimination. Conclusions: Findings from this study support an association between lifetime discrimination and incident hypertension in African Americans.

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