Association between Circulating Protein C Levels and Incident Dementia: The Atherosclerosis Risk in Communities Study

Introduction: Hemostasis depends on the delicate balance between coagulants and anticoagulants. Higher levels of circulating coagulants have been associated with higher risk of cerebral infarctions and dementia. In contrast, higher levels of circulating protein C, an endogenous anticoagulant, have been associated with lower risk of cerebral infarctions, and the association between protein C levels and the risk of dementia is unknown. The goal of this study was to evaluate the association of circulating protein C levels in midlife and late life with incident dementia. Methods: Circulating protein C levels were measured using blood samples collected at the midlife baseline (1987–1989) and the late-life baseline (2011–2013) among 14,462 and 3,614 participants, respectively, in the Atherosclerosis Risk in Communities study. Protein C levels were measured using enzyme-linked immunosorbent assay at midlife and a modified aptamer-based assay at late life. Participants were followed up to 2013 from midlife and up to 2017 from late life. Incident dementia was ascertained during the follow-up periods using in-person cognitive and functional assessment, informant interviews, and International Classification of Diseases codes at hospitalization discharge and on death certificates. Cause-specific Cox regression models were used to evaluate the association between quintiles of circulating protein C and incident dementia. Results: From midlife (mean age of 54), 1,389 incident dementia events were observed over a median follow-up of 23 years. From late life (mean age of 75), 353 incident dementia events were observed over a median follow-up of 4.9 years. At both midlife and late life, circulating protein C had an inverse association with incident dementia after adjusting for demographic, vascular, and hemostatic risk factors, incident stroke as time-dependent covariate, and incorporating stabilized weights based on propensity scores (quintile 5 vs. quintile 1 as the reference, midlife hazard ratio 0.80, 95% confidence interval 0.66–0.96, p value for trend 0.04; late-life hazard ratio 0.84, 95% confidence interval: 0.55–1.28, p value for trend 0.04). Discussion/Conclusion: Circulating protein C has an inverse association with incident dementia independent of established risk factors, including stroke. Our results suggest studying anticoagulants in addition to coagulants can increase our understanding on the relationship between hemostasis and dementia.

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Triglyceride-glucose index in the development of peripheral artery disease: findings from the Atherosclerosis Risk in Communities (ARIC) Study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01319-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Jing-Wei Gao ◽

Qing-Yun Hao ◽

Ming Gao ◽

Kun Zhang ◽

Xiong-Zhi Li ◽

...

Keyword(s):

Risk Factors ◽

Surrogate Marker ◽

Hazard Ratio ◽

Trial Registration ◽

Atherosclerosis Risk In Communities ◽

Tyg Index ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Very High

Abstract Background It remains unclear whether triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, is prospectively associated with incident peripheral arterial disease (PAD). Methods We included 12,320 Atherosclerosis Risk in Communities Study participants (aged 54.3 ± 5.7 years) free of a history of PAD at baseline (visit 1: 1987–1989). The TyG index was determined using ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2), and measured at 5 visits between 1987 and 2013. Incident PAD was defined as the first hospitalization with PAD diagnosis or a new onset of measured ABI < 0.90 during follow-up visits. We quantified the association of both baseline and trajectories of TyG index with incident PAD using Cox regression and logistic regression analysis, respectively. Results Over a median follow-up of 23 years, 1300 participants developed PAD. After adjustment for traditional PAD risk factors, each 1-SD (0.58) increase in TyG index was associated with an 11.9% higher risk of incident PAD [hazard ratio, 1.119 (95% CI, 1.049–1.195)]. Results were similar when individuals were categorized by TyG index quartiles [hazard ratio, 1.239 (95% CI, 1.028–1.492); comparing extreme quartiles]. Four distinct trajectories of stable TyG indexes at various levels along the follow-up duration were identified [low (22.2%), moderate (43.2%), high (27.5%), and very high (7.1%) trajectory groups]. Compared with those with a TyG index trajectory at a low level, those participants with TyG index trajectories at high and very high levels had an even greater risk of future incident PAD [odds ratio (95%CI): 1.404 (1.132–1.740) and 1.742 (1.294–2.344), respectively] after multivariate adjustments for traditional PAD risk factors. Conclusions Higher TyG index is independently associated with an increased risk of incident PAD. Long-term trajectories of TyG index help identify individuals at a higher risk of PAD who deserve specific preventive and therapeutic approaches. Trial registration: Clinical trial registration number: The ARIC trial was registered at clinicaltrials.gov as NCT00005131.

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Epidemiology of Heart Failure Stages in Middle‐Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016524 ◽

2021 ◽

Author(s):

Ramachandran S. Vasan ◽

Solomon K. Musani ◽

Kunihiro Matsushita ◽

Walter Beard ◽

Olushola B. Obafemi ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Left Ventricular ◽

Study Cohort ◽

Atherosclerosis Risk In Communities ◽

Cardiovascular Morbidity And Mortality ◽

Atherosclerosis Risk

Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993–1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) Stage 0 : no risk factors; (2) Stage A : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) Stage B : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) Stage C/D : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all‐cause mortality on follow‐up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow‐up (median 19.0 years), 309 participants developed overt HF, 390 incurred new‐onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person‐years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5‐ to 2‐fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community‐based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.

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Association Between Serum β-Alanine and Risk of Dementia

American Journal of Epidemiology ◽

10.1093/aje/kwz116 ◽

2019 ◽

Vol 188 (9) ◽

pp. 1637-1645 ◽

Cited By ~ 2

Author(s):

Jun Hata ◽

Tomoyuki Ohara ◽

Yoshinori Katakura ◽

Kuniyoshi Shimizu ◽

Shuntaro Yamashita ◽

...

Keyword(s):

General Population ◽

Alzheimer Disease ◽

Confidence Interval ◽

Vascular Dementia ◽

Hazard Ratio ◽

Inverse Association ◽

Confounding Factors ◽

Serum Concentrations ◽

Elderly Japanese

Abstract We examined the association between serum concentrations of β-alanine, a metabolite of carnosine and anserine, and the risk of dementia in a general population of elderly Japanese persons. In 2007, 1,475 residents of Hisayama, Japan, aged 60–79 years and without dementia were divided into 4 groups according to quartiles of serum β-alanine concentrations (quartile 1, lowest; quartile 4, highest) and followed for a median of 5.3 years. During follow-up, 117 subjects developed all-cause dementia (Alzheimer in 77 cases and vascular dementia in 31). The risk of all-cause dementia decreased with increasing serum β-alanine levels after adjustment for potential confounding factors (quartile 2, hazard ratio (HR) = 0.73 (95% confidence interval (CI): 0.45, 1.18); quartile 3, HR = 0.50 (95% CI: 0.28, 0.89); quartile 4, HR = 0.50 (95% CI: 0.27, 0.92); P = 0.01 for trend). A similar inverse association was observed for Alzheimer disease (quartile 2, HR = 0.78 (95% CI: 0.44, 1.38); quartile 3, HR = 0.53 (95% CI: 0.26, 1.06); quartile 4, HR = 0.53 (95% CI: 0.25, 1.10); P = 0.04 for trend) but not for vascular dementia. We found that higher serum β-alanine levels were significantly associated with lower risks of all-cause dementia and Alzheimer disease. Because serum β-alanine levels reflect intakes of carnosine/anserine, higher intakes of carnosine/anserine might be beneficial for the prevention of dementia.

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Education and Cardiovascular Health as Effect Modifiers of APOE ε4 on Dementia: The Atherosclerosis Risk in Communities (ARIC) Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab299 ◽

2021 ◽

Author(s):

Mark Lee ◽

Timothy M Hughes ◽

Kristen M George ◽

Michael E Griswold ◽

Sanaz Sedaghat ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Health ◽

Apoe Genotype ◽

Protective Effects ◽

Atherosclerosis Risk In Communities ◽

Dementia Risk ◽

Incident Dementia ◽

Atherosclerosis Risk

Abstract Background Both education and cardiovascular risk factors are strongly associated with dementia risk. However, it is not clear whether these associations persist or vary among individuals with high genetic risk for Alzheimer’s Disease. We examined the interactive relationship between lifestyle and genetic dementia risk factors in a prospective cohort study. Methods Our data came from the Atherosclerosis Risk in Communities study participants (n=13,715; baseline age 45-64; 25% Black; 55% female), who were followed for incident dementia from 1987 through 2017. We used Cox proportional hazard models to estimate the risk of dementia (ascertained through in-person examination, telephone cognitive screeners, and/or hospital and death records) associated with baseline education and cardiovascular risk factors (measured using the American Heart Association’s “Life Simple 7”) among ε4 carriers and non-carriers separately. We also examined differences by race and sex. Results 2,226 incident dementia cases occurred over a median 25 years of follow-up. Lower educational attainment and poorer cardiovascular health were associated with greater risk of incident dementia. There was an education by APOE status interaction (p=0.005) whereby the association of education and dementia was weaker for ε4 carriers (HR college graduates vs. less than high school: 0.71 (0.59-0.84) than non-carriers (0.54 (0.47-0.63)). There was no interaction between APOE status and cardiovascular health on dementia risk. These relationships did not vary significantly by race or sex. Conclusions Education and cardiovascular health were associated with lower dementia risk regardless of APOE genotype, though the protective effects of education were somewhat diminished among ε4 carriers.

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Stability of Cerebral Aneurysms After Stent-Assisted Coil Embolization

Neurosurgery ◽

10.1227/neu.0000000000000759 ◽

2015 ◽

Vol 77 (2) ◽

pp. 208-217 ◽

Cited By ~ 13

Author(s):

Won-Sang Cho ◽

Hyun Sook Hong ◽

Hyun-Seung Kang ◽

Jeong Eun Kim ◽

Young Dae Cho ◽

...

Keyword(s):

Risk Factors ◽

Propensity Score ◽

Confidence Interval ◽

Coil Embolization ◽

Neurological Complication ◽

Cerebral Aneurysms ◽

Hazard Ratio ◽

Stent Group ◽

Incomplete Occlusion

Abstract BACKGROUND: The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms. OBJECTIVE: To elucidate the effect of stents on radiologic outcomes and to analyze the risk factors for aneurysmal recanalization via propensity score matching. METHODS: From the 735 aneurysms treated with coil embolization with stents (n = 187) and without stents (n = 548) between 2009 and 2011, 157 propensity score-matched case pairs were selected. The recanalization rates and relevant risk factors were analyzed. The mean follow-up interval was 24.1 ± 11.3 months (range, 6-48 months) and 22.9 ± 11.4 months (range, 6-56 months) in the stent and nonstent groups, respectively (P = .388). RESULTS: The stent group demonstrated lower recanalization rates than the nonstent group during both the 6-month (1.9% vs 10.2%, P = .004) and the final follow-up periods (8.3% vs 18.5%, P = .005). The multivariate analysis identified the following significant factors for recanalization: the use of stents (hazard ratio, 0.40; 95% confidence interval, 0.21-0.76, P = .005), larger aneurysm size (hazard ratio, 1.21; 95% confidence interval, 1.11-1.31, P < .001), and initially incomplete occlusion (hazard ratio, 2.39; 95% confidence interval, 1.28-4.43, P = .006). The incidence of permanent neurological complication tended to be higher in the stent group than in the nonstent group (3.2% vs 0%, P = .063). CONCLUSION: In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon.

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Triglyceride-glucose index in the development of peripheral artery disease: findings from the Atherosclerosis Risk in Communities (ARIC) Study

10.21203/rs.3.rs-496937/v1 ◽

2021 ◽

Author(s):

Jing-Wei Gao ◽

Qing-Yun Hao ◽

Ming Gao ◽

Kun Zhang ◽

Xiong-Zhi Li ◽

...

Keyword(s):

Cox Regression ◽

Surrogate Marker ◽

Hazard Ratio ◽

Cardiovascular Risks ◽

Atherosclerosis Risk In Communities ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Atherosclerosis Risk ◽

Artery Disease

Abstract Background It remains unclear whether triglyceride-glucose (TyG) index, a surrogate marker of IR, was prospectively associated with incident PAD. Methods We included 12573 ARIC (Atherosclerosis Risk in Communities Study) participants free of PAD at baseline (1987–1989). The TyG index was determined using ln(fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2), and measured during 5 visits between 1987 and 2013. Incident PAD was defined as the first hospitalization with PAD diagnosis. We quantified the association of both baseline and trajectories of TyG index with incident PAD using Cox regression and logistic regression analysis, respectively. Results Over a median follow-up of 23 years, there were 1331 cases of incident PAD. After adjustment for traditional PAD risk factors, each 1-SD (0.58) increase in TyG index was associated with an 18.9% higher risk of incident PAD (hazard ratio, 1.189 [95% CI, 1.106–1.278]). Results were similar when individuals were categorized by TyG index quartiles (hazard ratio, 1.363 [95% CI, 1.125–1.652]; comparing extreme quartiles). Four distinct trajectories of TyG index were identified (low-increasing [43.0%], moderate-stable [22.3%], moderate-decreasing [27.6%], and high-decreasing [7.1%]). Trajectories of elevated TyG index levels had greater incident PAD after multivariable adjustment for potential cardiovascular risks. Compared with moderate-stable group (reference), high-decreasing group was associated with the highest risk of future incident PAD (odds ratio, 2.314 [95%CI, 1.687–3.175]). Conclusion Higher TyG index is independently associated with incident PAD. Long-term trajectories of TyG index help identify individuals at a higher risk of future PAD who deserve appropriate follow-up to detect asymptomatic disease.

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Abstract P003: Trajectories of Cardiovascular Risk Factors / Outcomes and Atrial Fibrillation in a 25 Year Follow-up: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.129.suppl_1.p003 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Faye L Lopez ◽

Sunil K Agarwal ◽

Elsayed Z Soliman ◽

Lin Y Chen ◽

Lindsay G Smith ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Index Date ◽

Reference Group ◽

Large Population ◽

Population Based ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Aric Study

Background: Little attention has been devoted to the timing of risk factor development in relation to atrial fibrillation (AF) diagnosis. We assessed the long term trajectories of risk factors and cardiovascular (CV) outcomes in the Atherosclerosis Risk in Communities (ARIC) study, a US community-based cohort. Methods: Our analysis included 2134 individuals with incident AF and 5674 controls matched with cases 1:3 on age, sex, race and center, participating in the ARIC study. Information on incident AF and risk factors / CV outcomes (obesity, hypertension, smoking, diabetes, heart failure (HF), myocardial infarction (MI), and stroke) was obtained during 5 study exams between 1987 and 2013, and surveillance of CV events through 2010. The prevalence of risk factors / CV outcomes in the period before and after the diagnosis of AF (and the corresponding index date for controls) was modeled using general estimating equations models. Adjusted odds ratios (OR) of risk factors / CV outcomes were calculated, using the index date ±2.5 years as the reference group. The interaction of time with AF was used to compare differences in trajectories. Results: During a median follow-up of 24 years, we observed diverse trajectories in the prevalence of risk factors and CV outcomes among AF patients, with steep increases in the prevalence of stroke, MI and HF during the period close to AF diagnosis, while trajectories for hypertension and diabetes showed monotonic increases, and those for smoking and obesity suggested decreases in prevalence after AF diagnosis (Figure A). The trajectories over time for hypertension, obesity, HF, stroke and MI were significantly different based on AF status, with lower increments among those without AF (Figure A and B). Conclusion: In this large population-based study, trajectories in the odds of risk factors and CV outcomes were diverse, suggesting they could have different roles in the pathogenesis of AF. The prevalence of CV outcomes increased after AF diagnosis, and trajectories differed by AF status.

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Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts

European Journal of Preventive Cardiology ◽

10.1177/2047487320909065 ◽

2020 ◽

pp. 204748732090906 ◽

Cited By ~ 2

Author(s):

P Bazal ◽

A Gea ◽

AM Navarro ◽

J Salas-Salvadó ◽

D Corella ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Coffee Consumption ◽

Hazard Ratio ◽

Interquartile Range ◽

Caffeine Intake ◽

Inverse Association ◽

The Sun ◽

Caffeinated Coffee

Aims The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. Methods and results We included 18,983 and 6479 participants from the ‘Seguimiento Universidad de Navarra’ (SUN) and ‘Prevención con Dieta Mediterránea’ (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1–7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5–13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8–5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1–7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36–0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49–1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44–0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. Conclusion Intermediate levels of caffeinated coffee consumption (1–7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.

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Risk of incident dementia in late-life depression treated with antidepressants: A nationwide population cohort study

Journal of Psychopharmacology ◽

10.1177/0269881120944152 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1134-1142

Author(s):

Jian-An Su ◽

Chih-Cheng Chang ◽

Yao-Hsu Yang ◽

Ko-Jung Chen ◽

Yueh-Ping Li ◽

...

Keyword(s):

Confidence Interval ◽

Proportional Hazards ◽

Late Life ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Late Life Depression ◽

Design Data ◽

High Exposure ◽

Incident Dementia ◽

Exposure Dosage

Background: Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied. Methods: Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998–2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval. Results: Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91–1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95–1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results. Conclusion: Antidepressants did not increase the risk of incident dementia in patients with late-life depression.

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Factors Related to Differences in Retention among African Americans and White Participants in the Atherosclerosis Risk in Communities Study (ARIC) Prospective Cohort: 1987-2013

Ethnicity & Disease ◽

10.18865/ed.27.1.31 ◽

2017 ◽

Vol 27 (1) ◽

pp. 31 ◽

Cited By ~ 1

Author(s):

Kristen M. George ◽

Aaron R. Folsom ◽

Anna Kucharska-Newton ◽

Tom H. Mosley ◽

Gerardo Heiss

Keyword(s):

Risk Factors ◽

African Americans ◽

Longitudinal Research ◽

Dropping Out ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Minority Participants

Background: Few studies have addressed retention of minorities, particularly African Americans, in longitudinal research. Our aim was to determine whether there was differential retention between African Americans and Whites in the ARIC cohort and identify cardiovascular disease (CVD) risk factors and indicators of socioeconomic status (SES) associated with these retention differences.Methods: 15,688 participants, 27% African American and 73% White, were included from baseline, 1987-1989, and classified as having died, lost or withdrew from study contact, or remained active in study calls through 2013. Life tables were created illustrating retention patterns stratified by race, from baseline through visit 5, 2011- 2013. Prevalence tables stratified by race, participation status, and center were created to examine CVD risk factors and SES at baseline and visit 5.Results: 54% of African Americans compared with 62% of Whites were still in follow-up by 2013. This difference was due to an 8% higher cumulative incidence of death among African Americans. Those who remained in follow-up had the lowest baseline CVD risk factors and better SES, followed by those who were lost/withdrew, then those who died. Whites had lower levels of most CVD risk factors and higher SES than African Americans overall at baseline and visit 5; though, the magnitude of visit 5 differences was less.Conclusions: In the ARIC cohort, retention differed among African Americans and Whites, but related more to mortality differences than dropping-out. Additional research is needed to better characterize the factors contributing to minority participants’ recruitment and retention in longitudinal research.Ethn Dis. 2017;27(1):31-38; doi:10.18865/ed.27.1.31.

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