Abstract MP023: Changes in Systolic Blood Pressure Differs by Immigration History in a Cohort of Older Mexican Americans

Background: Studies on immigrant health suggest that foreign-born individuals have better health outcomes than their native-born counterparts due to health selection. However, effects of immigration history on changes in cardiovascular conditions and risk factors are less well understood. Objective and Hypothesis: We examined the association between immigration history and change in systolic blood pressure (SBP). We hypothesized that Mexican Americans born outside the US and immigrated after age 30 (FB30+), would have lower SBP at baseline and have slower increase in SBP compared to people who were born in the US (US-B) or immigrated from Mexico before age 30 (FB<30). Methods: Participants come from the Sacramento Area Latino Study on Aging (n=1789), a longitudinal cohort of community-dwelling older Mexican Americans (mean age=70.6 years); 51% were born in Mexico. Immigration history was categorized as US-B, FB<30, and FB30+. SBP measures were available at baseline and at five follow-ups over ten years. A mixed effects linear model was used to examine the association between immigration history and SBP. Other covariates included gender, education, current hypertension medication use, and baseline measures of age, BMI, and diabetes. Follow up time was defined as time since enrollment. Quadratic time was included to account for non-linear change in SBP. Two interaction terms (immigration history x linear time and immigration history x quadratic time) were included to assess differences in SBP change by nativity. Results: The study included 1598 participants after exclusions. The figure shows the predicted average SBP by immigration history over the study period, derived from the mixed linear model. Compared to US-B, the FB<30 and FB30+ experienced an average of 7.3 (95% CI 2.0-12.7) and 7.9 (95% CI 2.2-13.5) mmHg increase in SBP over the study period, respectively. Conclusions: In contrast to current literature, immigrants appeared to be at greater risk for adverse cardiovascular risk factors.

Download Full-text

Abstract 14069: Subclinical Impairment of Left Ventricular Function in Stage A Subjects in a Community-based Population

Circulation ◽

10.1161/circ.132.suppl_3.14069 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takuya Hasegawa ◽

Masanori Asakura ◽

Hideaki Kanzaki ◽

Hiroshi Asanuma ◽

Seiji Takashio ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Dysfunction ◽

Left Ventricular ◽

Community Dwelling ◽

Lv Function ◽

Mitral Annular Velocity ◽

Lv Mass ◽

Lv Diastolic Dysfunction

Introduction: Stage A heart failure (HF) is defined as an asymptomatic state with HF risk factors of hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic disease in the absence of obvious left ventricular (LV) structural changes including LV hypertrophy (LVH). ACC/AHA guidelines recommend us to treat these risk factors of Stage A HF patients to prevent the progression of HF, hinting us to investigate the prevalence of subclinical impairment of LV function in Stage A subjects in general populations. Methods: We studied 1162 community-dwelling subjects without obvious heart diseases (mean age, 63±11 years; 448 men, 714 women, 63% with hypertension and 11% with diabetes) in the annual health checkup in a rural community, Arita-cho, Saga, Japan. The population was divided into 3 groups; the subjects without either LVH or the HF risk factors ("Stage 0"), the subjects with the HF risk factors in the absence of LVH (Stage A) , and the subjects in the presence of LVH (Stage B). LV systolic and diastolic function were estimated by mitral annular velocity in systole (s'), and the waves of transmitral flow (E) and mitral annular velocity (e'), respectively. LVH was defined as the top quintile of LV mass index. Results: The subjects in Stage A had the lower and higher values of s' and E/e', respectively, and the higher prevalence of LV diastolic dysfunction than those in Stage 0, while 45% of Stages A subjects showed LV diastolic dysfunction (Table). In multivariate logistic analyses, age, systolic blood pressure and LV mass were independent determinants of s', whereas either overlapped or different risk factors, such as age, sex, systolic blood pressure, and body mass index emerged as the determinants for E/e'. Conclusions: Even without obvious LV remodeling, subclinical LV systolic and diastolic impairment was observed in Stage A subjects. The disparity of the risk factors between LV systolic and diastolic dysfunction may indicate their pathophysiological differences.

Download Full-text

Abstract TMP47: Risk Factors for Intracerebral Hemorrhage and the Racial Differences in the Impact of Age on Risk: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Stroke ◽

10.1161/str.44.suppl_1.atmp47 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Virginia J Howard ◽

Suzanne E Judd ◽

Brett M Kissela ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cohort Study ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Racial Differences ◽

Community Dwelling ◽

Longitudinal Cohort Study ◽

Longitudinal Cohort ◽

Regards Study

Introduction: Because of low incidence rates, risk factors for intracerebral hemorrhage (ICH) have largely been estimated in case/control studies, very selected population cohorts, or by pooling of multiple longitudinal cohorts. Methods: REGARDS is a longitudinal cohort study of 30,239 African American (AA) and white community-dwelling participants aged 45 and over, recruited from the 48 contiguous US states. Physician-adjudicated incident stroke events in the REGARDS study were used to assess risk factors for ICH among those stroke-free at baseline. Results: A total of 62 ICH events occurred over an average 5.6 year follow-up among 27,760 participants stroke-free at baseline. In multivariable models, there was a significant (p = 0.0066) interaction between race and age; ICH risk dramatically increases with age for whites (HR = 2.03 per 10 year difference; 95% CI: 1.14 - 2.86), but there was little evidence of increasing risk with age in AAs (HR = 1.01 per 10 year difference; 95%: 0.65 - 1.58). This differential impact of age underlies a substantial excess in AA-to-white risk at age 45 (HR = 5.30; 95% CI: 1.41 - 19.91), but a marginally lower risk at age 85 (HR = 0.33; 95% CI: 0.10 - 1.05) (see figure). Risk of ICH was also significantly higher for men than women (HR = 2.60; 95% CI: 1.50 - 4.48), in those with higher systolic blood pressure (HR = 1.19 per 10 mmHg difference; 95% CI: 1.05 - 1.36), and for warfarin use to non-use (HR = 2.24; 95% CI: 1.01 - 5.00). Diabetes, chronic kidney disease, cholesterol components, smoking, alcohol use, and aspirin use were not related to ICH risk. Discussion: Additional research is needed to understand the striking AA-to-white differences in ICH risk across the age spectrum. In addition, higher systolic blood pressure, male sex, and warfarin were confirmed as substantial ICH risk factors in the general population. Other factors found to be significant in other studies were not confirmed in this single cohort, population-based, longitudinal cohort study.

Download Full-text

Long-term effects (>24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high risk subjects: a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.253 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

H Bergum ◽

I Sandven ◽

TO Klemsdal

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Systolic Blood Pressure ◽

Total Cholesterol ◽

Cardiovascular Risk Factors ◽

Lifestyle Intervention ◽

Small Study ◽

Long Term Effects

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Norwegian health department Background The evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk. Methods Eligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient- and study-level variables. Results Small-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of -0.13, 95% confidence interval (CI): -0.21 to -0.04, with moderate heterogeneity (I² = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = -1.86, 95% CI: -3.14 to -0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI: -0.08 to 0.11). For the outcome total cholesterol SMD was -0.06, 95% CI: -0.13 to 0.00, with no heterogeneity (I² = 0%), indicating no effect of the intervention. Conclusion Lifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.

Download Full-text

Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu13082618 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2618

Author(s):

Chesney K. Richter ◽

Ann C. Skulas-Ray ◽

Trent L. Gaugler ◽

Stacey Meily ◽

Kristina S. Petersen ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Vascular Function ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Lipoprotein Profile ◽

Cranberry Juice ◽

Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

Download Full-text

Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.137.suppl_1.p052 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Nancy S Jenny ◽

Nels C Olson ◽

Alicia M Ellis ◽

Margaret F Doyle ◽

Sally A Huber ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Nk Cells ◽

Nk Cell ◽

Agatston Score ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

Download Full-text

Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

European Journal of Preventive Cardiology ◽

10.1177/2047487319877268 ◽

2019 ◽

Vol 27 (9) ◽

pp. 978-987 ◽

Cited By ~ 4

Author(s):

Kristofer Hedman ◽

Nicholas Cauwenberghs ◽

Jeffrey W Christle ◽

Tatiana Kuznetsova ◽

Francois Haddad ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Exercise Testing ◽

Lower Risk ◽

Metabolic Equivalents ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Clinical Exercise Testing

Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects ( n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

Download Full-text

A U-Shaped Association Between Home Systolic Blood Pressure and Four-Year Mortality in Community-Dwelling Older Men

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1999.tb01559.x ◽

1999 ◽

Vol 47 (12) ◽

pp. 1415-1421 ◽

Cited By ~ 67

Author(s):

Kiyohito Okumiya ◽

Kozo Matsubayashi ◽

Tomoko Wada ◽

Michiko Fujisawa ◽

Yasushi Osaki ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Older Men ◽

Community Dwelling

Download Full-text

Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants

BMJ ◽

10.1136/bmj.k4247 ◽

2018 ◽

pp. k4247 ◽

Cited By ~ 44

Author(s):

Elizabeth R C Millett ◽

Sanne A E Peters ◽

Mark Woodward

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Sex Differences ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Uk Biobank ◽

Hazard Ratios

AbstractObjectivesTo investigate sex differences in risk factors for incident myocardial infarction (MI) and whether they vary with age.DesignProspective population based study.SettingUK Biobank.Participants471 998 participants (56% women; mean age 56.2) with no history of cardiovascular disease.Main outcome measureIncident (fatal and non-fatal) MI.Results5081 participants (1463 (28.8%) of whom were women) had MI over seven years’ mean follow-up, resulting in an incidence per 10 000 person years of 7.76 (95% confidence interval 7.37 to 8.16) for women and 24.35 (23.57 to 25.16) for men. Higher blood pressure indices, smoking intensity, body mass index, and the presence of diabetes were associated with an increased risk of MI in men and women, but associations were attenuated with age. In women, systolic blood pressure and hypertension, smoking status and intensity, and diabetes were associated with higher hazard ratios for MI compared with men: ratio of hazard ratios 1.09 (95% confidence interval 1.02 to 1.16) for systolic blood pressure, 1.55 (1.32 to 1.83) for current smoking, 2.91 (1.56 to 5.45) for type 1 diabetes, and 1.47 (1.16 to 1.87) for type 2 diabetes. There was no evidence that any of these ratios of hazard ratios decreased with age (P>0.2). With the exception of type 1 diabetes, the incidence of MI was higher in men than in women for all risk factors.ConclusionsAlthough the incidence of MI was higher in men than in women, several risk factors were more strongly associated with MI in women compared with men. Sex specific associations between risk factors and MI declined with age, but, where it occurred, the higher relative risk in women remained. As the population ages and the prevalence of lifestyle associated risk factors increase, the incidence of MI in women will likely become more similar to that in men.

Download Full-text

Relation Between Preclinical Atherosclerosis and Venous Thromboembolism in Patients With Thrombophilias – Longitudinal Study

Physiological Research ◽

10.33549/physiolres.932879 ◽

2014 ◽

pp. S403-S409 ◽

Cited By ~ 1

Author(s):

O. AUZKÝ ◽

R. DEMBOVSKÁ ◽

J. MRÁZKOVÁ ◽

Š. NOVÁKOVÁ ◽

L. PAGÁČOVÁ ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Longitudinal Study ◽

Venous Thromboembolism ◽

Waist Circumference ◽

Systolic Blood Pressure ◽

Body Mass ◽

History Of ◽

Preclinical Atherosclerosis

Preclinical atherosclerosis may represent a risk factor for venous thromboembolism (VTE). In longitudinal study we followed longitudinally 96 patients (32 men) with thrombophilias with (n=51) and without (n=45) history of VTE. In both groups we studied the changes of preclinical atherosclerosis at peripherally located arteries detected by ultrasound. In addition, we assessed changes in selected risk factors of atherosclerosis. During the mean follow-up of 56.0±7.62 months we did not find significant change in preclinical atherosclerosis defined as Belcaro score in either group (–3 % in the VTE group vs 0 % in non VTE group). Significant increase in body mass index (1.03±1.98 kg*m-2, resp. 1.21±1.67 kg*m-2, p<0.01) and non-significant increase in systolic blood pressure were detected in both groups. Waist circumference increased significantly only in patients without VTE (4.11±7.84 cm, p<0.05). No differences in changes of risk factors under study between both groups were detected. In summary, patients with thrombophilia and history of VTE showed no evidence of greater progression of atherosclerosis or increase in traditional risk factors of atherosclerosis than patients with thrombophilia without history of VTE. Unfavorable changes of body mass index, waist circumference and systolic blood pressure were detected in both groups during study period.

Download Full-text

Abstract P011: Cardiovascular Risk Factors and Longevity

Circulation ◽

10.1161/circ.137.suppl_1.p011 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Michelle C Odden ◽

Andreea Rawlings ◽

Alice Arnold ◽

Mary Cushman ◽

Mary Lou Biggs ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Systolic Blood Pressure ◽

Cardiovascular Risk Factors ◽

Old Age ◽

Repeated Measures ◽

Ldl Cholesterol ◽

Low Cardiovascular Risk

Introduction: Cardiovascular disease is the leading cause of mortality in old age, yet there is limited research on the patterns of cardiovascular risk factors that predict survival to 90 years. Hypothesis: The patterns of cardiovascular risk factors that portend longevity will differ from those that confer low cardiovascular risk. Methods: We examined repeated measures of blood pressure, LDL-cholesterol, and BMI from age 67 and survival to 90 years in the Cardiovascular Health Study (CHS). CHS is a prospective study of 5,888 black and white adults in two waves (1989-90 and 1992-93) from Medicare eligibility lists in four counties in the U.S. We restricted to participants aged 67 to 75 years at baseline to control for birth cohort effects and examined repeated measures of cardiovascular risk factors throughout the late-life course. We fit logistic regression models to predict survival to age 90 using generalized estimating equations, and modeled the risk factors as linear, a linear spline, and clinically relevant categories. Models were adjusted for demographics and medication use, and we also examined whether the association of each risk factor with longevity varied by the age of risk factor measurement. Best fit models are presented. Results: Among 3,645 participants in the birth cohort, 1,160 (31.8%) survived to 90 by June 16 th , 2015. Higher systolic blood pressure in early old age was associated with reduced odds for longevity, but there was an interaction with age such that the association crossed the null at 80 years. (Table) Among those with LDL-cholesterol <130 mg/dL, higher LDL-cholesterol was associated with greater longevity; at levels above 130 mg/dL there was no association between LDL-cholesterol and longevity. BMI had a u-shaped association with longevity. Conclusions: In summary, the patterns of risk factors that predict longevity differ from that considered to predict low cardiovascular risk. The risk of high systolic blood pressure appears to depend on the age of blood pressure measurement.

Download Full-text