scholarly journals C-reactive protein and hypertension incidence in black and white Americans: REasons for Geographic And Racial Differences in Stroke (REGARDS) study

2020 ◽  
Author(s):  
Timothy B Plante ◽  
D Leann Long ◽  
Boyi Guo ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Racial Differences ◽  
Excess Risk ◽  
White Americans ◽  
C Reactive Protein ◽  
Incident Hypertension ◽  
Black And White ◽  
Reactive Protein ◽  
Regards Study ◽  
Adjusted Model ◽  
Excess Incidence

Abstract Background More inflammation is associated with greater risk incident hypertension, and black US adults have excess burden of hypertension. We investigated whether increased inflammation as quantified by higher C-reactive protein (CRP) explains the excess incidence in hypertension experienced by black US adults. Methods We included 6,548 black and white REGARDS participants without hypertension at baseline (2003-2007) who attended a second visit (2013-2016). Sex-stratified risk ratios (RR) for incident hypertension at the second exam in black compared to white individuals were estimated using Poisson regression adjusted for groups of factors known to partially explain the black-white differences in incident hypertension. We calculated the percent mediation by CRP of the racial difference in hypertension. Results Baseline CRP was higher in black participants. The black-white RR for incident hypertension in the minimally adjusted model was 1.33 (95% CI 1.22, 1.44) for males and 1.15 (1.04, 1.27) for females. CRP mediated 6.6% (95% CI 2.7, 11.3%) of this association in females and 19.7% (9.8, 33.2%) in males. In females, CRP no longer mediated the black-white RR in a model including waist circumference and body mass index, while in males the black-white difference was fully attenuated in models including income, education and dietary patterns. Conclusions Elevated CRP attenuated a portion of the unadjusted excess risk of hypertension in black adults, but this excess risk was attenuated when controlling for measures of obesity in females and diet and socioeconomic factors in males. Inflammation related to these risk factors might explain part of the black-white disparity in hypertension.

Abstract P181: Contribution of C-Reactive Protein to Racial Disparities in Incident Hypertension: The REasons for Geographic And Racial Differences in Stroke Study (REGARDS)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Timothy B Plante ◽  
D L Long ◽  
George Howard ◽  
April P Carson ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Medication Use ◽  
Dietary Factors ◽  
C Reactive Protein ◽  
Incident Hypertension ◽  
Black And White ◽  
Reactive Protein ◽  
Stroke Study ◽  
Diet Pattern ◽  
The Impact

Introduction: In the US, blacks are at higher risk of hypertension than whites. The single largest contributor to this disparity is the Southern Diet pattern. Inflammation biomarkers are associated with risk of hypertension, and C-reactive protein (CRP) is higher in blacks than whites. We studied whether elevated CRP in blacks relative to whites contributes to the racial disparity in hypertension in blacks. Methods: We included 6,548 black and white men and women age ≥45 years from the REGARDS cohort without hypertension at baseline ('03-'07) and who completed visit 2 in '13-'16. Incident hypertension was defined as BP ≥140/90 mm Hg or hypertension medication use at visit 2. Using logistic regression, the black:white odds ratio (OR) for incident hypertension was calculated adjusting for age, sex, race, and baseline SBP. We assessed the percent change in the black:white OR for incident hypertension after adding CRP. The 95% CI was calculated using 1,000 bootstrapped samples. We determined the impact of known hypertension risk factors and anti-inflammatory medications on the percent mediation by CRP. Results: Hypertension developed in 46% of blacks and 33% of whites. Adjusting for demographics, the black:white OR (95% CI) was 1.51, which was reduced to 1.46, a 9.3% reduction (95% CI 5.4%, 13.2%) by CRP (Table). In models including exercise, waist circumference, BMI, and depressive symptoms, the percent mediation by CRP was 3.7% (1.0%, 6.4%). Similar patterns were seen for models incorporating socioeconomic factors and medication use. After adding Southern diet pattern and dietary Na/K ratio, CRP no longer attenuated the association (1.3% mediation; -1.5, 4.1). Conclusions: CRP significantly attenuated the black-white difference in incident hypertension; however, once dietary factors were accounted for, CRP had no impact on the black:white difference in incident hypertension. Thus, inflammation as measured by CRP, may be part of the reason that dietary factors influence the black:white disparity in incident hypertension.

Abstract P011: Serum Adiponectin And Risk Of Incident Hypertension: The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study.

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Aneesh Singal ◽  
Mary Cushman ◽  
Neil A Zakai ◽  
Nels C Olson ◽  
George Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
The United States ◽  
Demographic Model ◽  
Incident Hypertension ◽  
Black And White ◽  
Hypertension Risk ◽  
Life Years ◽  
Regards Study ◽  
Adjusted Model

Background: Hypertension is a leading cause of disability-adjusted life years lost in the United States. Adiponectin is a cytokine secreted by adipocytes that increases insulin sensitivity, maintains vascular homeostasis, and is inversely associated with adiposity. We sought to determine the risk of incident hypertension by level of adiponectin at baseline. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled 30,239 Black and White US adults in 2003-2006, with a second visit ~9 years later. Adiponectin was measured at the baseline visit among a random sample of 4,400 participants who attended the second visit. Modified Poisson regression estimated the relative risk (RR) for incident hypertension by each 1 SD higher of log-transformed adiponectin level adjusting for age, race, and sex in a minimally adjusted model. The fully adjusted model added Southern Diet pattern, dietary ratio of sodium to potassium, BMI, waist circumference, and systolic blood pressure. Restricted cubic splines visualized RR of hypertension by level of adiponectin, relative to the median. Results: After excluding those with prevalent hypertension (threshold 140/90 mm Hg or blood pressure medication use; n=2477) and missing adiponectin (n =129), 1,877 participants remained (mean age 62 years, 49% male, 36% Black, with lower adiponectin in Black participants p<0.001). Incident hypertension occurred in 46% (95% CI 43, 50%) of Black adults and 32% (29, 34%) of White adults. The RR for incident hypertension for each 1-SD higher log adiponectin was 0.91 (0.83, 1.00) in the demographic model and 0.99 (0.89, 1.10) in the fully adjusted model. Hypertension risk was similar across the continuum of adiponectin ( Figure ). Conclusions: In a cohort of Black and White US adults without hypertension, level of adiponectin did not associate with risk of incident hypertension 9 years later after adjusting for other hypertension risk factors.

Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kaitlyn M Peper ◽  
Boyi Guo ◽  
Leann Long ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Racial Difference ◽  
Incident Diabetes ◽  
Diabetes Incidence ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Difference ◽  
Adjusted Model ◽  
The Impact

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

scholarly journals Neighborhood Walkability as a Predictor of Incident Hypertension in a National Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Alana C. Jones ◽  
Ninad S. Chaudhary ◽  
Amit Patki ◽  
Virginia J. Howard ◽  
George Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
Geographic Region ◽  
Incident Hypertension ◽  
Neighborhood Walkability ◽  
Black And White ◽  
Walk Score ◽  
Walkable Neighborhood ◽  
National Cohort ◽  
Regards Study

The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score &lt;70) walkable. The primary outcome was incident hypertension defined at the second visit (collected between 2013 and 2017). We derived risk ratios (RR) using modified Poisson regression adjusting for age, race, sex, geographic region, income, alcohol use, smoking, exercise, BMI, dyslipidemia, diabetes, and baseline blood pressure (BP). We further stratified by race, age, and geographic region. Among 6,894 participants, 6.8% lived in more walkable areas and 38% (N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P &lt; 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.

scholarly journals RACIAL DIFFERENCES IN ELEVATED C-REACTIVE PROTEIN AMONG U.S. OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S819-S819
Author(s):  
Heather R Farmer ◽  
Heather R Farmer ◽  
Linda A Wray ◽  
Hanzhang Xu ◽  
Ying Xian ◽  
...  
Keyword(s):  
Older Adults ◽  
Racial Differences ◽  
National Level ◽  
C Reactive Protein ◽  
Physiological Factors ◽  
Logistic Regression Models ◽  
Black And White ◽  
Reactive Protein ◽  
Nationally Representative ◽  
Retirement Study

Abstract C-reactive protein (CRP) is a marker of inflammation linked to numerous acute and chronic conditions. Studies have not considered racial differences in elevated CRP among older adults at the national level. We investigate racial differences in elevated CRP and the socioeconomic, psychosocial, behavioral, and physiological factors that contribute to these differences overall and by gender using a nationally-representative prospective cohort of 14,700 non-Hispanic black and white participants in the Health and Retirement Study followed from 2006 to 2014. Random effects logistic regression models showed that blacks were more likely to have elevated levels of CRP than whites. In men, the racial differences in elevated CRP were attributed to a combination of socioeconomic, psychosocial, and behavioral factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors. The findings from this work have potentially important implications for clinical practice and interventions targeting vulnerable segments of the population.

Abstract WP475: Pro-neurotensin/neuromedin N is Associated With Incident Cognitive Impairment in Women

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Charles D Nicoli ◽  
Virginia J Howard ◽  
Joachim Struck ◽  
Jennifer J Manly ◽  
Mary Cushman
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Racial Differences ◽  
Race Difference ◽  
Black And White ◽  
Regards Study ◽  
Neuromedin N ◽  
Adjusted Model ◽  
Nested Case Control ◽  
Relationship Of

Introduction: Neurotensin (NT) is a neuropeptide implicated in cardiovascular and metabolic disease. As such, it is a candidate risk factor for cognitive impairment. We are not aware of studies reporting the relationship of NT and incident cognitive impairment (ICI). NT can be estimated in plasma by measuring its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN). Hypothesis: Higher fasting plasma pro-NT/NMN is associated with risk of ICI. Methods: Prospective nested case-control study in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS enrolled 30,239 Black and White adults aged ≥45 from 2003-2007. Baseline pro-NT/NMN was measured by immunoassay in 497 controls and 399 cases of ICI over 3.5 years follow up. ICI was identified using a 3-test cognitive battery biannually. Multivariable logistic regression was used to calculate odds ratios (OR) of ICI by pro-NT/NMN quartiles. Race and sex differences were studied with stratified models and interaction testing (with p <0.10 significant). Results: There was no association of 4 th vs. 1 st -quartile proNT/NMN with ICI in the overall group (see table), nor significant associations of the 2 nd and 3 rd quartiles with ICI in any group The OR differed significantly by sex; women had a 90% increased odds in the demographic-adjusted model, only slightly attenuated by risk factor adjustment. There was no race difference in associations. Conclusions: Higher circulating pro-NT/NMN was associated with ICI in women but not men. This could be due to cerebral vasoconstrictive effects of NT and estrogen-mediated differences in transcription. Confirmatory study is required.

scholarly journals Metabolic Syndrome, C-Reactive Protein, and Mortality in U.S. Blacks and Whites: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Diabetes Care ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. 2284-2290 ◽  
Author(s):  
Takeki Suzuki ◽  
Jenifer Voeks ◽  
Neil A. Zakai ◽  
Nancy Swords Jenny ◽  
Todd M. Brown ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Racial Differences ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Blacks And Whites ◽  
Regards Study

Abstract T P146: Vitamin D Deficiency is Associated With Stroke in Black and White Participants of the REGARDS Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Virginia J Howard ◽  
Paul Muntner ◽  
Brett M Kissela ◽  
Bhupesh Panwar ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Racial Differences ◽  
Sex Education ◽  
The United States ◽  
Dietary Vitamin ◽  
Equal Distribution ◽  
Black And White ◽  
Increased Risk ◽  
Regards Study

Objective: Black Americans are at greater risk of both stroke and vitamin D deficiency than white Americans. We have previously shown that both higher dietary vitamin D and sunlight exposure are associated with decreased risk of stroke; however, serum 25(OH) is thought to be a better marker of vitamin D status. Methods: Using a case cohort design, we examined the association of plasma 25(OH)D with incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white participants from across the United States enrolled between 2003 and 2007. Medical records were reviewed by physicians and strokes were classified on the basis of symptoms and neuroimaging. Strokes through July 1, 2011 were included. A stratified cohort sample was selected to ensure approximately equal numbers of black and white participants and an equal distribution across ages. We used Cox proportional hazards models weighted back to the original 30,239 participants, excluding those with history of stroke. Serum 25(OH)D was measured by Immunodetection Systems ELISA. Results: Over mean follow-up of 4.4 years, there were 539 ischemic and 71 hemorrhagic strokes. The stroke-free sub-cohort included 939 participants. After adjustment for age, race, sex, education, diabetes, hypertension, smoking, atrial fibrillation, heart disease, physical activity, kidney function, calcium and phosphorous, 25(OH)D level 30 ng/mL. The direction of association was similar for hemorrhagic stroke though not statistically significant (HR=1.59; 95%CI=0.78, 3.24). Vitamin D deficiency was associated with an increased risk of all stroke (HR=1.54; 95%CI=1.05, 2.23). This effect was greater in blacks (HR=2.09; 95%CI=1.09, 3.99) than whites (HR=1.38; 95%CI=0.78, 2.42). Results were not as strong when we modeled 25(OH)D as a continuous variable (HR=0.99 per 1 ng/ml change in 25(OH)D; 95%CI=0.98, 1.01). Discussion: Similar to low vitamin D intake, vitamin D deficiency is a risk factor for incident stroke. These findings support evidence from cardiovascular and cancer epidemiology that treating low 25(OH)D may prevent strokes.

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