Abstract P309: Vulnerabilities to Health Disparities and Statin Use in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Praful Schroff ◽  
Christopher M Gamboa ◽  
Raegan W Durant ◽  
Asikhame Oikeh ◽  
Joshua S Richman ◽  
...  
Keyword(s):  
Health Insurance ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
Poverty Line ◽  
Older Age ◽  
Small City ◽  
Framingham Risk ◽  
Federal Poverty Line ◽  
Regards Study ◽  
Statin Use

Introduction: Statins reduce the incidence of major cardiovascular disease events, but many individuals do not receive them. The AHRQ National Healthcare Disparities Report identifies several vulnerable populations, but few studies have examined statin use from the perspective of the presence of multiple vulnerabilities in the same individual. Hypothesis: A greater number of vulnerabilities is associated with lower statin use. Methods: This study used data from the REGARDS study, which included 30,239 adults of age 45 and older recruited between 2003 and 2007 from the 48 contiguous US states. Baseline data included a 45-minute telephone interview and an in-home visit. Vulnerabilities included older age, black race, being a woman, rural/small city residence, area level poverty, Southeastern residence, and lack of health insurance. Prevalence ratios were estimated from Poisson models and adjusted for factors influencing health services utilization (education, awareness of hyperlipidemia, medication adherence, cigarette smoking, depressive symptoms, obesity, high-density lipoprotein cholesterol, physical functioning and Adult Treatment Panel III Framingham Risk Group). Results: The study sample included 18,047 individuals of mean age 65.8 years with indications for statin therapy; 41.7% were black, 50.8% were women, 8.7% lived in a rural area/small city, 25.2% lived in areas with >25% of residents living below the Federal poverty line, 55.0% lived in the Southeastern states and 6% did not have health insurance. Older age, being black, being a woman, area level poverty, and health insurance were significantly associated with lower statin use. Statin use decreased as the number of vulnerabilities increased. Conclusions: A greater burden of healthcare disparity vulnerabilities was associated with a graded pattern of lower statin use. Individuals with multiple vulnerabilities have the greatest risk of under treatment and should be targeted for intervention.

scholarly journals My Brother's Keeper: Healthcare Experiences of the Poor in One Texas City

2019 ◽  
Vol 7 (1) ◽  
pp. 22-25
Author(s):  
Matthew Chase Mulloy
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Healthcare Professionals ◽  
Poverty Line ◽  
The United States ◽  
The Poor ◽  
Healthcare Experiences ◽  
Federal Poverty Line ◽  
Texas City

Access to healthcare is an important issue in the United States. The purpose of this study was to explore ways in which individuals living under the federal poverty line experience negative interactions with the health care system. I interviewed 11 individuals in the Waco area who are currently living under the federal poverty guideline. Answers were recorded and analyzed. Common themes amongst the participants included (1) financial insecurity combined with a lack of health insurance discouraged individuals from visiting a healthcare provider, (2) inadequate transportation to a healthcare establishment, (3) feelings of disrespect when receiving treatment from healthcare professionals, and (4) difficulty following up with treatment. In conclusion, the problems that arise in the healthcare system regarding the treatment of individuals living in poverty cannot be attributed solely to lack of funds.

scholarly journals Association Between HDL Cholesterol and Incident Cognitive Impairment in Black and White Adults in The Reasons For Geographic and Racial Differences in Stroke Study

2021 ◽  
Author(s):  
Robert Rosenson ◽  
Mary Cushman ◽  
Emily C. McKinley ◽  
Paul Muntner ◽  
Zhixin Wang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Stroke Event ◽  
Low Hdl ◽  
Regards Study

Abstract BACKGROUND: Low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with incident cognitive impairment (ICI) in some, but not all studies. METHODS: We examine the association between HDL-C and ICI among 18,378 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants without cognitive impairment or stroke at baseline in 2003 to 2007, and who did not have a stroke event during follow-up. RESULTS: Over a median follow-up of 9.6 years, 1,359 participants developed ICI. In fully adjusted models, the RR for ICI was 1.51 (95% CI 1.06, 2.15) in White women and 1.25 (95% CI 0.95, 1.65) in Black women. The association was not statistically significant afrter adjustment for triglycerides. There was no evidence of an association between HDL-C and ICI among White or Black men. CONCLUSIONS: Low HDL-C was associated with a higher risk of ICI in White and Black women in models not including triglycerides.

scholarly journals Associations between cardiovascular disease, cancer, and very low high-density lipoprotein cholesterol in the REasons for Geographical and Racial Differences in Stroke (REGARDS) study

2018 ◽  
Vol 115 (1) ◽  
pp. 204-212 ◽  
Author(s):  
Peter Penson ◽  
D Leann Long ◽  
George Howard ◽  
Virginia J Howard ◽  
Steven R Jones ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Density Lipoprotein ◽  
Multiple Imputation ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
Complete Case ◽  
All Cause Mortality ◽  
Low Hdl ◽  
Regards Study ◽  
Reduced Risk

AbstractAimsRelatively little is known about the health outcomes associated with very low plasma concentrations of high-density lipoprotein cholesterol (HDL-C) mainly because of the small numbers of individuals with such extreme values included in clinical trials. We, therefore, investigated the association between low and very low HDL-C concentration at baseline and incident all-cause-mortality, death from malignant disease (i.e. cancer), and with fatal or non-fatal incident coronary heart disease (CHD) in individuals from the Reasons for Geographical And Racial Differences in Stroke (REGARDS) study.Methods and resultsAnalysis was based on 21 751 participants from the REGARDS study who were free of CHD, other cardiovascular disease, and cancer at baseline and were categorized by baseline HDL-C into <30 mg/dL (very low), 30–<40 mg/dL (low), and ≥40 mg/dL (reference). A series of incremental Cox proportional hazards models were employed to assess the association between the HDL-C categories and outcomes. Statistical analysis was performed using both complete case methods and multiple imputations with chained equations. After adjustment for age, race, and sex, the hazard ratios (HRs) comparing the lowest and highest HDL-C categories were 1.48 [95% confidence interval (CI) 1.28–1.73] for all-cause mortality, 1.35 (95% CI 1.03–1.77) for cancer-specific mortality and 1.39 (95% CI 0.99–1.96) for incident CHD. These associations became non-significant in models adjusting for demographics, cardiovascular risk factors, and treatment for dyslipidaemia. We found evidence for an HDL paradox, whereby low HDL (30–<40 mg/dL) was associated with reduced risk of incident CHD in black participants in a fully adjusted complete case model (HR 0.63; 95% CI 0.46–0.88) and after multiple imputation analyses (HR 0.76; 95% CI 0.58–0.98). HDL-C (<30 mg/dL) was significantly associated with poorer outcomes in women for all outcomes, especially with respect to cancer mortality (HR 2.31; 95% CI 1.28–4.16) in a fully adjusted complete case model, replicated using multiple imputation (HR 1.81; 95% CI 1.03–3.20).ConclusionLow HDL-C was associated with reduced risk of incident CHD in black participants suggesting a potential HDL paradox for incident CHD. Very low HDL-C in women was significantly associated with cancer mortality in a fully adjusted complete case model.

scholarly journals The Association of Statin Use and Statin Type and Cognitive Performance: Analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

2010 ◽  
Vol 33 (5) ◽  
pp. 280-288 ◽  
Author(s):  
Stephen P. Glasser ◽  
Virginia Wadley ◽  
Suzanne Judd ◽  
Bhumika Kana ◽  
Valerie Prince ◽  
...  
Keyword(s):  
Performance Analysis ◽  
Cognitive Performance ◽  
Racial Differences ◽  
Regards Study ◽  
Statin Use

Abstract P075: Genetic European Ancestry And Incident Diabetes Mellitus In Black Individuals-Insights From The SPRINT Trial

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Vibhu Parcha ◽  
Brittain F Heindl ◽  
Rajat Kalra ◽  
Shreya Rao ◽  
Ambarish Pandey ◽  
...  
Keyword(s):  
Racial Differences ◽  
Lower Risk ◽  
Cox Regression ◽  
Density Lipoprotein ◽  
Incident Diabetes ◽  
European Ancestry ◽  
Framingham Risk ◽  
Genetically Determined ◽  
Ancestry Proportions ◽  
Ancestry Proportion

Background: A metabolic paradox of lower triglyceride (TG) and higher high-density lipoprotein cholesterol (HDL-C) levels but a higher incidence of diabetes has been described in Blacks. We evaluated the association of genetic ancestry-related variants with the risk of incident diabetes in self-identified Black individuals in the Systolic Blood Pressure (BP) Intervention Trial (SPRINT). Methods: The genetic European ancestry proportions were estimated using 106 biallelic genotype markers in non-diabetic Black participants. Participants were stratified into tertiles (T1-T3) of European ancestry proportions. Multivariable-adjusted association of baseline metabolic syndrome indices (fasting plasma glucose [FPG], TG, HDL-C, body mass index [BMI], and BP) with the ancestry proportion was assessed. Multivariable-adjusted Cox regression was used to assess the risk of incident diabetes (FPG ≥126 mg/dL or self-reported diabetes treatment) across tertiles. Results: In 2,466 participants with median European ancestry 19% (13 - 27%), those in T1 were relatively younger, with lower Framingham risk score, and worse renal function (p<0.05 for all). At baseline, higher European ancestry proportion was associated with higher TG and lower HDL-C levels after controlling for clinical and demographic factors (p<0.05 for both). FPG, BMI, and BP were not significantly associated with ancestry proportion. Compared with T1, those in second (HR: 0.64 [95% CI: 0.45-0.90]) and third tertiles (HR: 0.61 [0.44-0.89]) had a lower risk of incident diabetes after controlling for covariates. Specifically, a 5% increment in European ancestry was associated with a 29% lower risk of incident diabetes (HR: 0.71 [0.55-0.93]). No interaction was observed between intensive BP control strategy and European ancestry proportion tertiles on incident diabetes. Conclusions: Genetic factors may account for racial differences in TG and HDL-C levels. The higher risk of incident diabetes in Blacks may similarly be genetically determined.

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