Abstract P080: The Combined Effect of Low Income and Low Education on Coronary Heart Disease Outcomes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background: Low income (LoINC) and low education (LoED) have both been associated with higher coronary heart disease (CHD) risk, but few studies have examined the combined effects of both LoINC and LoED. Hypothesis: The combination of LoINC and LoED is more strongly associated with incident CHD than either LoINC and LoED, or neither. Methods: REGARDS recruited 30,239 black and white participants aged > 45 years residing in the 48 contiguous US between 2003-2007. Baseline data included telephone interviews and in-home visits, and follow-up was conducted every 6 months to detect potential events with expert adjudication of endpoints based on medical record review. Low income (LoInc) was defined as annual household income <$35,000, and low education (LoEd) was defined as less than a high school education. Income and education were combined into four mutually exclusive exposure groups (noLoInc+noLoEd, noLoInc+LoEd, LoInc+noLoEd ,LoInc+LoEd, ). CHD outcomes were definite or probable myocardial infarction or acute CHD death. We constructed Cox models estimating the hazard ratios (HR) for CHD, sequentially adjusting for sociodemographics, health behaviors, physiologic parameters, access to healthcare, and stress and depression. Because of significant interaction by age (p<0.001), analyses were stratified at age 65. Results: We analyzed 24,461 participants without baseline CHD, with numbers in each income/education group as shown in the Table. LoInc+LoEd was associated with the highest risk of CHD among those aged < 65 years, but not among those >65 years of age. LoEd was associated with higher CHD risk in those age >65 years and LoInc was not, but LoInc was associated with higher CHD risk in those age < 65 years, but LoEd was not. Conclusion: LoInc+LoEd was associated with the highest CHD risk at younger ages, but not at higher ages. Income was more important than education for CHD risk at younger ages, but education was more important than income at older ages.

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Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap316 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Yulia Khodneva ◽

Daniel Lackland ◽

Ronald Prineas ◽

Monika Safford

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Models ◽

Chd Risk ◽

Regards Study ◽

Chd Risk Factors

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP<120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

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261Can a physical activity supportive environment reduce socioeconomic inequities in incident coronary heart disease?

International Journal of Epidemiology ◽

10.1093/ije/dyab168.243 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Pedro Gullon ◽

Usama Bilal ◽

Jana A. Hirsch ◽

Andrew Rundle ◽

Suzanne Judd ◽

...

Keyword(s):

Physical Activity ◽

Coronary Heart Disease ◽

Heart Disease ◽

Low Income ◽

Household Income ◽

Cox Models ◽

Supportive Environments ◽

Regards Study ◽

Adjusted Association ◽

Physical Activity Environments

Abstract Background This research aims to: (1) explore the contribution of physical activity supportive environments to income inequities in coronary heart disease (CHD) incidence, and (2) investigate whether income inequities in CHD incidence are modified by physical activity supportive environments. Methods We used data from the REGARDS study, which recruited US-residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n = 20808), followed until December 31st 2014. We categorized household income and treated it as ordinal: (1) $75,000+, (2) $35,000-$74,000, (3) $20,000-$34,000, and (4) <$20,000. We operationalized physical activity supportive environments within a 1-km residential buffer as density of walkable destinations and physical activity facilities, and proportion green land cover. Cox models were estimated the adjusted association of income with incident CHD, and tested effect modification by environment variables. Results We found a 17% (95% CI 8% to 25%) increased hazard of CHD per decrease in household income category. After adjusting for physical activity environments, the HR was attenuated by 3% (HR = 1.15), and the income-CHD association was stronger in areas lacking walking destinations (HR = 1.54 vs 1.16). Conclusions Physical activity supportive environments, especially those with walking destinations, may moderate associations between household income and CHD. Key messages Low-income individuals have greater risk of developing CHD, however, the built environment has a small moderating effect on this association. Income inequities in CHD were also noted to be higher in areas with no walking destinations

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Abstract P276: Differential Association of D-dimer with Stroke and Coronary Heart Disease: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap276 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Neil A Zakai ◽

George Howard ◽

Leslie A McClure ◽

Suzanne E Judd ◽

Brett M Kissela ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Racial Differences ◽

Statistical Significance ◽

Female Gender ◽

Cox Models ◽

The Difference ◽

Chd Risk Factors ◽

D Dimer

Introduction: D-dimer, a marker of coagulation activation, has higher levels in blacks than whites and has been variably associated with stroke and coronary heart disease (CHD). Methods: REGARDS recruited 30,239 participants in their homes across the continental US between 2003-07; by design 55% were female, 41% black, and 56% lived in the southeast. In a case-cohort study, D-dimer was measured in 646 participants with incident stroke, 515 with incident CHD, and 1104 in a cohort random sample. D-dimer was log transformed and modeled per 1-unit increase. Cox models were used to determine the HR for vascular disease for D-dimer and the difference in HR (95% CI) by race and vascular disease calculated by bootstrapping with 1000 replicate samples and using the 2.5 and 97.5 percentiles of the distribution (see Table for model variables). Results: Median D-dimer was higher in blacks (0.45 mcg/mL; IQR 0.26, 0.85) than whites (0.38 mcg/mL; IQR 0.23, 0.69); p <0.001. D-dimer was higher with increasing age, female gender, diabetes, hypertension and prebaseline cardiovascular disease (all p <0.05). The table shows the HR of stroke and CHD by baseline D-dimer. In minimally-adjusted models, D-dimer was associated with both stroke and CHD. Accounting for Framingham stroke and CHD risk factors, D-dimer remained associated with CHD (HR 1.45; 95% CI 1.18, 1.79), but was marginally associated with stroke (HR 1.20; 95% CI 0.99, 1.45). The difference in the HR of D-dimer between CHD and stroke was 0.22 in the basic model and 0.25 in the Framingham model, but this difference was of marginal statistical significance (Table). There was no difference in the HRs for stroke or CHD for D-dimer in blacks compared to whites (Table). Discussion: The association of D-dimer with stroke appeared smaller than for CHD with similar associations by race. Findings suggest that hemostasis activation may play a greater role in pathogenesis of CHD than stroke. Further study is needed to confirm these findings and evaluate the association of D-dimer with different stroke subtypes.

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Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Journal of the American Heart Association ◽

10.1161/jaha.116.003767 ◽

2016 ◽

Vol 5 (8) ◽

Cited By ~ 17

Author(s):

Nathalie Moise ◽

Yulia Khodneva ◽

Joshua Richman ◽

Daichi Shimbo ◽

Ian Kronish ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Depressive Symptoms ◽

Racial Differences ◽

Black And White ◽

Regards Study ◽

White Adults

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Abstract P150: Association of Cholesterol Measures With Coronary Heart Disease Risk in Blacks and Whites in the Reasons for Geographic and Racial Differences in Stroke Study (regards)

Circulation ◽

10.1161/circ.141.suppl_1.p150 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Neil Zakai ◽

Jessica Minnier ◽

Monika M Safford ◽

Lisandro Colantonio ◽

Marguerite M Irvin ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Total Cholesterol ◽

Racial Differences ◽

Cox Regression ◽

Disease Risk ◽

Point Estimate ◽

Chd Risk ◽

Increased Risk ◽

Blacks And Whites

Introduction: Abnormal plasma lipid levels associate with coronary heart disease (CHD) risk. Race interaction for these associations are not established. Hypothesis: We hypothesized that the association of HDL, LDL, and triglyceride with CHD is stronger in whites versus blacks. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort recruited 30,283 black and white individuals aged 45+ from the contiguous U.S. from 2003-7. Participants were followed until December 31, 2016 for CHD events (i.e., myocardial infarction or CHD death), participants with history of CHD at baseline were excluded. Cox regression models were used to assess the association between baseline lipids and incident CHD events adjusting for traditional cardiovascular risk factors. Results: With 23,894 participants (57.8% white and 58.4% female, mean age 64.11± 9.32), over a median 9.9 years of follow-up, 1,487 CHD events occurred (615 among blacks). Overall, higher total Cholesterol, LDL cholesterol, and triglycerides were associated with increased risk of CHD in both blacks and whites with no evidence of a race interaction (Table 1). For HDL, the point estimate was more protective in whites (HR 0.90) than in blacks (HR 0.98), but the interaction was non-significant (p=0.15). However, when HDL was stratified into clinical categories (<40, 40-59, and ≥60), the reduction in point estimates was maintained among whites (HR 1.00, 0.88, and 0.74) but not among blacks (HR 1.00, 1.31, and 1.19) for HDL <40, 40-59, and ≥60 respectively, p-interaction 0.01. Conclusion: Total cholesterol, LDL, and triglycerides predict CHD risk equally in blacks and whites in the REGARDS study, however there is heterogeneity in the protective effect by race, especially when traditional clinical categories are used. In whites, higher HDL is associated with reduced risk, whereas in blacks the association is not maintained. These findings suggest that HDL levels are a more viable metric for white than blacks to predict CHD risk.

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