scholarly journals Design of REGARDS: A National Cohort of Black and White Adults to Study Disparities in Stroke and Cognitive Function

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 856-856
Author(s):  
Virginia Howard ◽  
Mary Cushman ◽  
Virginia Wadley ◽  
Jennifer Manly ◽  
Suzanne Judd ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Medical Records ◽  
Home Visit ◽  
Cardiovascular Health ◽  
Black And White ◽  
Global Cognitive Function ◽  
National Cohort ◽  
Regards Study ◽  
Stroke Belt ◽  
White Adults

Abstract The REGARDS study enrolled 30,239 whites and blacks aged >45 from 2003 – 2007, with oversampling of blacks and residents of the Stroke Belt. Potential participants were mailed a letter/brochure followed by telephone call. After verbal consent, telephone interview assessed cardiovascular health and cognitive function. In a home visit, measurements of risk factors, biological samples, EKG, written consent were obtained; during the in-home visit, self-administrated questionnaires were left to be completed and returned. Participants are followed for hospitalizations via telephone at 6-month intervals. Annually and biennially, brief and more comprehensive assessments of global cognitive function are conducted. Medical records for suspected strokes are collected with adjudication by stroke experts. A 2nd in-home and telephone assessment was conducted 2013-2016, approximately 10 years after baseline. This presentation will describe the methodological details of REGARDS, progress on the specific aims of the current grant, and establish the context for the remaining presentations.

scholarly journals Life’s Simple 7 and Incident Hypertension: The REGARDS Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Timothy B. Plante ◽  
Insu Koh ◽  
Suzanne E. Judd ◽  
George Howard ◽  
Virginia J. Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Incident Hypertension ◽  
Black And White ◽  
Stroke Study ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
Regards Study ◽  
White Adults

Background The Life’s Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure, cholesterol, glucose) to estimate an individual’s level of cardiovascular health. The association between cardiovascular health and incident hypertension is unresolved. Hypertension’s threshold was recently lowered and it is unclear if better cardiovascular health is associated with lower risk of incident hypertension with the updated threshold or in a multirace cohort. We sought to assess the association between better LS7 score and risk of incident hypertension among Black and White adults using a 130/80 mm Hg hypertension threshold. Methods and Results We determined the association between LS7 metric and incident hypertension in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) study, including participants free of baseline hypertension (2003–2007) who completed a second visit between 2013 and 2016. Hypertension was defined as systolic/diastolic blood pressure ≥130/80 mm Hg or antihypertensive medication use. Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points. We generated a 14‐point score by summing points. Among 2930 normotensive participants (20% Black, 80% White), the median (25th–75th percentiles) LS7 total score was 9 (8–10) points. Over a median follow‐up of 9 years, 42% developed hypertension. In the fully adjusted model, each 1‐point higher LS7 score had a 6% lower risk of incident hypertension (risk ratio, 0.94 per 1 point; 95% CI, 0.92–0.96). Conclusions Better cardiovascular health was associated with lower risk of incident hypertension using a 130/80 mm Hg hypertension threshold among Black and White adults.

Abstract W MP64: Incident Stroke and Alcohol Consumption among Older Adults

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Solveig A Cunningham ◽  
Aleena Mosher ◽  
Suzanne E Judd ◽  
Lisa M Matz ◽  
Edmond K Kabagambe ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Racial Differences ◽  
Medical Records ◽  
Stroke Risk ◽  
Proportional Hazard ◽  
Black And White ◽  
Stroke Risk Factors ◽  
Regards Study ◽  
White Adults

Background: Alcohol consumption may reduce the risk of stroke. While both stroke and alcohol consumption patterns differ by race and sex, it is not known to what extent alcohol consumption contributes to the elevated risk of stroke in some groups, particularly in men and blacks in general. Methods: Risk of stroke was studied in 25,162 black and white adults aged 45+, in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Information on alcohol consumption was obtained by telephone interview at baseline. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke; medical records are retrieved and adjudicated by physicians Proportional hazard models, adjusted for demographic, socioeconomic, and stroke risk factors , were used. Results: Participants’ mean age was 64.7 years; 40% were black and 56% were women with 867 stroke events and a median follow-up time of 7.6 years. Compared to current drinkers, non-drinkers had 36% higher hazards of incident stroke which was significantly higher consistent across all race-sex groups except black men. Risks were particularly high among past drinkers (50% higher than among current drinkers), as would be expected since many may have stopped drinking due to health problems. However, risks were also elevated among lifetime abstainers. Differences in stroke risks were explained by demographic and socioeconomic differences between drinkers and non-drinkers. Among those who are current drinkers, those who consumed <1 drink per week had significantly lower hazards of stroke than moderate drinkers, and these protective factors remained marginally significant after accounting for demographic, socioeconomic, behavioral and health characteristics. Conclusions: Results suggest that individuals who do not currently consume alcohol may experience higher risks of stroke, which may be due in part due to socio-demographic and other characteristics associated with consuming alcohol.

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.

Abstract P091: Early Life Stressors and Adult Cardiovascular Health in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Virginia J Howard ◽  
Leann Long ◽  
Aleena Bennett ◽  
Leslie A McClure ◽  
Dawn O Kleindorfer ◽  
...  
Keyword(s):  
Family Violence ◽  
Racial Differences ◽  
Early Life ◽  
Cardiovascular Health ◽  
Population Based ◽  
Life Stressors ◽  
Behavioral Risk ◽  
Serious Illness ◽  
Black And White ◽  
Regards Study

Introduction: Prior research suggests early life stressors (ELS) influence development of cardiovascular (CV) risk over the lifecourse, but few national studies have evaluated this. We examined the association of ELS with adult CV defined by Life’s Simple 7 (LS7) score within a national US population-based cohort. Methods: We used data on 7,469 REGARDS participants (black and white adults, aged > 45 in 2003-2007), with clinical and behavioral risk factor data from questionnaires and direct measurement. Levels of LS7 components (blood pressure, total cholesterol, fasting glucose, physical activity, smoking, diet, body mass index) were coded as poor (0 points), intermediate (1 point) or ideal (2 points); the primary outcome, LS7 score, was the sum of the components. In 2012-2013, 7 ELS (death of parent, parents separated/divorced, family serious illness, witnessed family violence, family substance abuse, parent’s loss of job and parent incarcerated) were retrospectively assessed by mail questionnaire to active participants. Linear regression was used to characterize the relationship between each ELS and LS7 after adjustment for demographics and region of birth. Mediation by adult income and education was examined. Results: ELS were common, ranging from 3% for parent incarcerated to 29% for family serious illness. Lower LS7 was associated with each ELS, with significant association with witnessing family violence (-0.15; 95% CI: -0.29 to -0.02) (see figure.) Additional adjustment for adult education partially attenuated the effect estimates for witnessed family violence by 20.6% (95% CI: 2.0%, 39.1%); adjustment for adult income and education mediated the non-significant estimates for parental death, family illness and separation/divorce. Conclusions: Exposure to ELS was associated worse adult cardiovascular health; these associations were partially but not fully mediated by adult socioeconomic status. Further work is needed in categorization of ELS and examination of pathways underlying the associations.

Abstract P102: Potential U.S. Population Impact Of Low Cardiovascular Health In Terms Of Preventable Loss Of Life-span And Health-span

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sadiya S Khan ◽  
Hongyan Ning ◽  
Norrina B Allen ◽  
Joshua D Bundy ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Life Span ◽  
Cardiovascular Health ◽  
Survey Design ◽  
Population Based ◽  
Years Of Life Lost ◽  
Middle Aged ◽  
Black And White ◽  
Life Years ◽  
The Us ◽  
White Adults

Introduction: Individuals who maintain optimal cardiovascular health (CVH) live a longer, healthier life without cardiovascular disease (CVD). In order to quantify the population burden of sub-optimal CVH, we estimated potential loss of health- and life-span in a nationally representative sample of middle-aged US black and white adults. Methods: We first calculated individual-level composite CVH scores (range 0-14 points), including all 7 AHA-defined CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, glucose, and cholesterol) using data from middle-aged participants (40-49 years) from 3 population-based cohorts. We categorized participants into low (0-6), moderate (7-9), and high (10-14) CVH and used Irwin’s restricted means to estimate years lived free of and with CVD. Next, we determined the contemporary prevalence of low, moderate, and high CVH in middle-aged black and white adults (40-59 years) pooled from 3 NHANES survey cycles (2011-2016). Finally, we generated estimates of CVD-free and overall years of life lost in moderate and low CVH compared to high CVH subgroups, weighted to the US population accounting for the NHANES complex survey design. Results: Of 12,906 participants in the pooled cohort, 23% were black and 56% women. Low and moderate CVH were associated with 4.41±0.02 and 1.86±0.01 fewer healthy years lived without CVD and 2.43±0.02 and 1.09±0.01 fewer overall years of life, respectively. This resulted in a greater proportion of life lived with CVD across all race-sex groups (FIGURE). When weighted to the US population, we estimate that approximately 230.8 (203.5, 258.0) and 97.1 (95% CI 85.6, 108.6) million healthy life years will be lost due to low and moderate CVH, respectively, in middle-aged adults. Conclusions: The projected loss of healthy CVD-free years and total life years due to low and moderate CVH is substantial. Maintenance of optimal CVH into mid-life may represent a significant opportunity to extend healthspan and mitigate disparities in the US population.

scholarly journals Obtaining Accelerometer Data in a National Cohort of Black and White Adults

2015 ◽  
Vol 47 (7) ◽  
pp. 1531-1537 ◽  
Author(s):  
VIRGINIA J. HOWARD ◽  
J. DAVID RHODES ◽  
ALEENA MOSHER ◽  
BRENT HUTTO ◽  
MARGARET S. STEWART ◽  
...  
Keyword(s):  
Accelerometer Data ◽  
Black And White ◽  
National Cohort ◽  
White Adults

Abstract MP19: Glycemic Load is Associated with Increased Odds of Cognitive Impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Keith Pearson ◽  
Virginia Wadley ◽  
Barbara Gower ◽  
James Shikany ◽  
Paula Chandler-Laney ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Racial Differences ◽  
Glycemic Index ◽  
Cognitive Assessment ◽  
Glycemic Load ◽  
Cognitive Status ◽  
Total Carbohydrate ◽  
Black And White ◽  
National Cohort ◽  
Regards Study

Introduction: Carbohydrate quality and quantity have been associated with several chronic diseases, but few studies have investigated associations with cognitive impairment. The objective of this study was to test the hypothesis that higher glycemic load (GL), glycemic index (GI), and available carbohydrate intakes are associated with higher odds of incident cognitive impairment in a large, prospective cohort. Methods: This analysis utilized the REGARDS study, a national cohort of 30,239 black and white participants (age > 45 yr). Dietary intake was assessed by the Block98 food frequency questionnaire, from which values for GL, GI, and available carbohydrate (total carbohydrate minus dietary fiber) were estimated. Incident cognitive impairment was defined as shifting from an intact cognitive status (a score >4) at the first cognitive assessment to an impaired cognitive status (a score ≤4) at the most recent cognitive assessment, measured by the Six-Item Screener. Logistic regression was used to evaluate the odds of incident cognitive impairment by quintile of GL, GI, and available carbohydrate. Results: This analysis included 16,755 participants free of stroke and cognitive impairment at baseline. A total of 1,513 cases of incident cognitive impairment were observed over a mean follow-up of 7.5 years. After adjustment for sociodemographic variables and cognitive risk factors, participants in the highest quintile of glycemic load had 42% higher odds of incident cognitive impairment compared to those in the lowest quintile (Q5 vs Q1: OR=1.42; 95% CI: 1.06, 1.89; p for trend: 0.02). Similarly, participants in the highest quintile of available carbohydrate had 42% higher odds of incident cognitive impairment (Q5 vs Q1: OR=1.42; 95% CI: 1.05, 1.91; p for trend: 0.04). No significant associations were observed with glycemic index (See Table 1). Conclusion: Consuming a dietary pattern lower in available carbohydrate and glycemic load may aid in the preservation of cognitive function in older ages.

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