Abstract P053: Diabetes Risk Prediction and Sickle Cell Trait in African Americans From CARDIA and the Jackson Heart Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Mary E Lacy ◽  
Gregory A Wellenius ◽  
Adolfo Correa ◽  
Mercedes R Carnethon ◽  
Robert I Leim ◽  
...  
Keyword(s):  
African Americans ◽  
Risk Prediction ◽  
Sickle Cell ◽  
Prediction Models ◽  
Sickle Cell Trait ◽  
Model Performance ◽  
Jackson Heart Study ◽  
Discriminative Ability ◽  
Heart Study

Introduction: Existing models to predict incident diabetes mellitus (DM) perform better in Whites than African Americans. In models that incorporate hemoglobin A1c (A1C) as a predictor of DM, the difference in model performance by race is more pronounced. In a recent study, we found that A1C was systematically underestimating glycemia in African Americans with sickle cell trait (SCT). Hypothesis: Given the poorer performance of DM prediction models in African Americans than Whites and the impact of SCT on the A1C-glycemia association, we hypothesized that incorporating sickle cell trait into DM prediction models would improve the ability of the model to predict future risk of DM. Methods: We pooled data collected from 2000-2012 on 3,122 African Americans (8.6% with SCT) from the Jackson Heart Study (JHS; n=2,065; mean age=54.71 years) and CARDIA (n=1,057; mean age=44.53). Over 5 years of follow-up in CARDIA and 10 years of follow-up in JHS, 85 CARDIA participants (8.1%) and 342 JHS participants (16.6%) developed DM. Using generalized estimating equations to account for correlation of repeated measures, we compared the discriminative ability and net reclassification improvement (NRI) resulting from the addition of SCT for a series of prediction models. Results: Overall, the addition of SCT to prediction models did not result in significant improvement in the discriminative ability. However, by the NRI index, the addition of SCT to measures of glycemia and to a fuller risk prediction model did improve prediction of DM. In the full model, adding SCT*A1C as a predictor resulted in 2% of events being reclassified as higher risk and 45% of non-events being reclassified as lower risk. Conclusion: Our results suggest that incorporating SCT into DM prediction for African Americans may result in modest improvement in model performance.

Abstract 14: Examining the Predictive Power and the Impact of Incorporating Hemoglobin A1c into Existing Diabetes Risk Prediction Models among African American Adults in the Jackson Heart Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Mary E Lacy ◽  
Gregory Wellenius ◽  
Charles B Eaton ◽  
Eric B Loucks ◽  
Adolfo Correa ◽  
...  
Keyword(s):  
Risk Prediction ◽  
Predictive Power ◽  
Prediction Models ◽  
Model Performance ◽  
Diabetes Risk ◽  
Risk Prediction Models ◽  
C Statistic ◽  
Heart Study ◽  
The Impact

Background: In 2010, the American Diabetes Association (ADA) updated diagnostic criteria for diabetes to include hemoglobin A1c (A1c). However, the appropriateness of these criteria in African Americans (AAs) is unclear as A1c may not reflect glycemic control as accurately in AAs as in whites. Moreover, existing diabetes risk prediction models have been developed in populations composed primarily of whites. Objectives were to (1) examine the predictive power of existing diabetes risk prediction models in the Jackson Heart Study (JHS), a prospective cohort of 5,301 AA adults and (2) explore the impact of incorporating A1c into these models. Methods: We selected 3 widely-used diabetes risk prediction models and examined their ability to predict 5-year diabetes risk among 3,185 JHS participants free of diabetes at baseline and who returned for the 5 year follow-up visit. Incident diabetes was identified at follow-up based on current antidiabetic medications, fasting glucose ≥126 mg/dl or A1c ≥6.5%. We evaluated model performance using model discrimination (C-statistic) and reclassification (net reclassification index (NRI) and integrated discrimination improvement (IDI)). For each of the 3 models, model performance in JHS was evaluated using (1) covariates identified in the original published model and (2) published covariates plus A1c. Results: Of 3,185 participants (mean age 53.7; 64.0% female), 9.8% (n=311) developed diabetes over 5 years of follow-up. Each diabetes prediction model suffered a drop in predictive power when applied to JHS using ADA 2010 criteria (Table 1). The performance of all 3 models improved significantly with the addition of A1c, as evidenced by the increase in C-statistic and improvement in reclassification. Conclusion: Despite evidence that A1c may not accurately reflect glycemic control in AAs as well as in whites, adding A1c to existing diabetes risk prediction models developed in primarily white populations significantly improved 5-year predictive power of all 3 models among AAs in the JHS.

scholarly journals Sickle Cell Trait, European Ancestry, and Longitudinal Tracking of HbA1c Among African Americans: The Jackson Heart Study

Diabetes Care ◽  
2019 ◽  
Vol 42 (10) ◽  
pp. e166-e167
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Stanford E. Mwasongwe ◽  
Mario Sims ◽  
Samuel Dagogo-Jack ◽  
Sherita H. Golden ◽  
...  
Keyword(s):  
African Americans ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
European Ancestry ◽  
Jackson Heart Study ◽  
Longitudinal Tracking ◽  
Heart Study

Abstract P488: Discrimination and Hypertension Risk Among African Americans in The Jackson Heart Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Allana T Forde ◽  
Mario Sims ◽  
Paul Muntner ◽  
Tené Lewis ◽  
Amanda Onwuka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
African Americans ◽  
The United States ◽  
Jackson Heart Study ◽  
Incident Hypertension ◽  
Hypertension Risk ◽  
Heart Study ◽  
Low Levels

Background: African Americans have a higher risk for hypertension compared to other racial or ethnic groups in the United States. One possible explanation for this health disparity is perceived discrimination. Few studies have prospectively examined the association between discrimination and the incidence of hypertension. Methods: We examined the associations of everyday, lifetime, and stress from lifetime discrimination with incident hypertension and whether these associations differed by sex, discrimination attribution (i.e. the main reason for the discrimination event), and coping responses to discrimination among African Americans enrolled in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000-2004). Participants completed two follow-up study visits from 2005-2008 and 2009-2013. We used interval-censored Cox regression to estimate associations of discrimination with incident hypertension (antihypertensive medication use; and/or systolic blood pressure ≥ 140 mm Hg and diastolic blood pressure ≥ 90 mm Hg at follow-up visits 2 or 3) after adjustment for confounding variables. Results: Overall, 52% (954 of 1845) of participants developed hypertension over the follow-up period. After adjustment for age, sex, education and hypertension risk factors (body mass index, alcohol use, smoking, diet and physical activity), medium versus low levels of lifetime discrimination (hazard ratio-HR: 1.45, 95% confidence interval-CI: 1.15-1.82) and high versus low levels of lifetime discrimination (HR: 1.35, CI: 1.08-1.68) were associated with a higher incidence of hypertension. High versus low stress from lifetime discrimination was associated with hypertension risk after adjustment for demographics (HR: 1.20, CI: 1.02-1.41), but the association was attenuated after adjustment for hypertension risk factors (HR: 1.14, CI: 0.97-1.35). Lifetime discrimination and stress from discrimination were associated with an increased hypertension risk among females, but not males. No interactions with age, attribution or coping were present for any type of discrimination. Conclusions: Findings from this study support an association between lifetime discrimination and incident hypertension in African Americans.

scholarly journals Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

2019 ◽  
Vol 49 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Kabir O. Olaniran ◽  
Nwamaka D. Eneanya ◽  
Andrew S. Allegretti ◽  
Sophia H. Zhao ◽  
Maureen M. Achebe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
African American ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Increased Risk ◽  
The Mean

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of ­African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

scholarly journals APOL1, Sickle Cell Trait, and CKD in the Jackson Heart Study

2021 ◽  
Author(s):  
Bessie A. Young ◽  
James G. Wilson ◽  
Alex Reiner ◽  
Bryan Kestenbaum ◽  
Nora Franceschini ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Jackson Heart Study ◽  
Heart Study

Abstract 005: Cumulative Stress Exposure is Associated With Incident Hypertension in African Americans: Findings From the Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Tanya M Spruill ◽  
Mark J Butler ◽  
S J Thomas ◽  
Gabriel S Tajeu ◽  
Sheila F Castaneda ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Chronic Stress ◽  
Cumulative Exposure ◽  
Stress Exposure ◽  
Jackson Heart Study ◽  
Incident Hypertension ◽  
Heart Study ◽  
Increased Risk

Introduction and Hypothesis: Chronic stress has been associated with incident hypertension but evidence is mixed, particularly in African Americans. We tested the hypothesis that higher cumulative exposure to stress would be associated with increased risk of developing hypertension in the Jackson Heart Study (JHS), a prospective study of cardiovascular disease in African Americans. Methods: Analyses included 1,442 JHS participants free of hypertension at baseline (2000-2004) who completed at least 3 annual follow-up telephone interviews. Incident hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg or use of antihypertensive medications at Exam 2 (2005-2008) or Exam 3 (2009-2013). A single-item measure of stress (“How much stress have you experienced over the past year?”) was completed during annual interviews, and the percentage of assessments in each measurement interval (i.e., between Exams 1 and 2, between Exams 2 and 3) in which high stress was reported was categorized as No Chronic Stress (0%), Low Chronic Stress (1-33.3%) or High Chronic Stress (>33.3%). Chronic stress exposure in each interval was used to predict incident hypertension at the following exam among participants free of hypertension at the start of the interval using repeated measures Poisson regression models with progressive adjustment for age, sex, years between exams and other relevant risk factors (education, marital status, parental history of hypertension, baseline SBP and DBP, body mass index, diabetes, chronic kidney disease). Results: The 1,442 participants in this analysis contributed data to 1,987 measurement intervals. The mean age was 49±0.26 years and 41% were male. During follow-up (median, 8 years), 44.0% of participants developed hypertension. The percentage of intervals with No, Low and High chronic stress was 62.3%, 9.2% and 28.6%, respectively. Multivariable-adjusted risk ratios (95% confidence interval) for incident hypertension associated with Low (vs. No) and High (vs. No) chronic stress were 1.11 (0.90-1.37) and 1.21 (1.06-1.38), respectively ( P trend=0.005). This association remained statistically significant after further adjustment for baseline stress ( P trend=0.014) and potential behavioral mediators (smoking, alcohol use, physical activity, diet; P trend=0.03). In stratified analyses, the association was present in women ( P trend=0.002), younger participants (<50 years old; P trend=0.007) and those with normal BP at baseline ( P trend=0.001). Conclusion: We found that African Americans reporting higher chronic stress over time are at increased risk of developing hypertension, independent of baseline stress levels and cardiovascular and behavioral risk factors. Future studies should evaluate the use of stress management interventions to support primary prevention of hypertension in this high risk population.

scholarly journals Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 715-723 ◽  
Author(s):  
Allana T. Forde ◽  
Mario Sims ◽  
Paul Muntner ◽  
Tené Lewis ◽  
Amanda Onwuka ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
The United States ◽  
Hazard Ratio ◽  
Jackson Heart Study ◽  
Incident Hypertension ◽  
Hypertension Risk ◽  
Heart Study ◽  
Low Levels

African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States. One possible explanation for this disparity is discrimination. Few studies have examined the association between discrimination and incidence of hypertension. We examined whether everyday discrimination, lifetime discrimination, and stress from discrimination were associated with incident hypertension and whether these associations differed by gender, age, discrimination attribution, and coping responses to discrimination among African Americans in the Jackson Heart Study. Discrimination was self-reported by 1845 African Americans aged 21 to 85 years without hypertension at baseline (2000–2004). Participants completed 2 follow-up study visits from 2005 to 2008 and 2009 to 2013. We used Cox proportional hazards regression to estimate associations of discrimination with incident hypertension. Overall, 52% (n=954) of the participants developed hypertension over the follow-up period. After adjustment for age, gender, socioeconomic status and hypertension risk factors, medium versus low levels of lifetime discrimination (hazard ratio, 1.49 [95% CI, 1.18–1.89]), and high versus low levels of lifetime discrimination (hazard ratio, 1.34 [95% CI, 1.07–1.68]) were associated with a higher incidence of hypertension. No statistically significant interactions with gender, age, attribution, or coping were present. Higher stress from lifetime discrimination was associated with higher hypertension risk after adjustment for demographics (hazard ratio for high versus low, 1.19 [95% CI, 1.01–1.40]), but the association was attenuated after adjustment for hypertension risk factors (hazard ratio, 1.14 [95% CI, 0.97–1.35]). Lifetime discrimination may increase the risk of hypertension in African Americans.

Abstract 023: Left Ventricular Hypertrophy and Elevated Biomarkers of Chronic Myocardial Injury May Identify African Americans With a Very High Risk for Heart Failure Development: Findings From The Jackson Heart Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Ambarish PANDEY ◽  
Neil Keshvani ◽  
Colby Ayers ◽  
Adolfo Correa ◽  
Mark Drazner ◽  
...  
Keyword(s):  
High Risk ◽  
African Americans ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Myocardial Injury ◽  
Significant Risk ◽  
Left Ventricular ◽  
Jackson Heart Study ◽  
Heart Study

Introduction: African Americans (AA) have a disproportionate greater burden of risk factors and higher risk of HF than Whites. However, the factors underlying the transition from at-risk to clinical HF in AA is not well understood. We aimed to examine the independent and joint effects of subclinical myocardial injury, as measured by highly sensitive assays for cardiac troponin (hs-TnI) and left ventricular hypertrophy (LVH), on risk of HF in AA. Methods: Participants from the Jackson Heart Study, a prospective study of AA adults, without prevalent HF at baseline (2000-2004) were stratified into categories based on elevation in hs-cTnI (>6 ng/L) and presence of LVH (LV mass > 96 g/m 2 in women and > 116 g/m 2 in men). The risk of incident HF across different LVH and hs-cTnI groups was assessed using adjusted Cox models. Results: We included 3,796 participants (54 y, 64% women, 17.2% with elevated hs-TnI & 6.1% with LVH) with median follow up of 9.8 y and 285 incident HF events. In adjusted analyses, LVH and higher hs-TnI at baseline were independently associated with risk of HF [HR (95% CI): LVH (vs. no LVH) = 2.2(1.6 - 2.9); Log hs-cTnI (per unit higher)=1.6(1.5 - 1.8)]. A significant interaction was observed between LVH and hs-TnI for the risk of HF (p-int < 0.0001) with the highest risk among individuals with both LVH and elevated hs-TnI [43% incidence, HR (95% CI): 5.7(3.9 - 8.2)]. In contrast, LVH in absence of hs-TnI elevation was not associated with HF risk [ Figure ]. Among 2,367 participants with repeat assessment of hs-TnI at 5 year follow-up, increase in hs-TnI levels on follow-up was also associated with significantly higher risk of HF [HR (95% CI) per 1 unit increase = 1.03 (1.02 - 1.06)] Conclusions: The combination of LVH and elevated hs-TnI levels identifies a malignant preclinical HF phenotype in AAs with a remarkably high absolute risk of HF over a 10-year f/u period. Longitudinal increase in hs-TnI levels is also associated with significant risk of HF. Targeting these high-risk subsets may be an important strategy to mitigate HF risk in blacks.

Occupational standing and change in the Ankle-Brachial Index: the Jackson Heart Study

2020 ◽  
pp. oemed-2020-106905
Author(s):  
Ciaran P Friel ◽  
Andrea T Duran ◽  
Marwah Abdalla ◽  
Jonathan T Unkart ◽  
John Bellettiere ◽  
...  
Keyword(s):  
African Americans ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Significant Decline ◽  
Jackson Heart Study ◽  
Peripheral Artery ◽  
Community Based ◽  
Heart Study ◽  
Artery Disease

BackgroundA growing interest in reducing occupational sitting has resulted in public health efforts to encourage intermittent standing in workplaces. However, concerns have been raised that standing for prolonged periods may expose individuals to new health hazards, including lower limb atherosclerosis. These concerns have yet to be corroborated or refuted. The purpose of this study was to investigate the association between occupational standing and adverse changes in the Ankle-Brachial Index (ABI).MethodsWe studied 2121 participants from the Jackson Heart Study, a single-site community-based study of African-Americans residing in Jackson, MS. Occupational standing (‘never/seldom’, ‘sometimes’, ‘often/always’) was self-reported at baseline (2000–2004). ABI was measured at baseline and again at follow-up (2009–2013).ResultsOver a median follow-up of 8 years, 247 participants (11.6%) exhibited a significant decline in ABI (eg, ABI decline >0.15). In multivariable-adjusted models, higher occupational standing was not significantly associated with ABI decline (occupational standing sometimes vs never/seldom: OR 1.05; 95% CI 0.67, 1.66; occupational standing often/always vs never/seldom: OR 1.22; 95% CI 0.77, 1.94). Similarly, higher occupational standing was not associated with low ABI at follow-up reflective of peripheral artery disease (ABI <0.90) or high ABI at follow-up reflective of incompressible vessels (ABI >1.40).ConclusionsIn this community-based study of African-Americans, we found no evidence that occupational standing is deleteriously associated with adverse changes in ABI over a median follow-up of 8.0 years. These findings do not provide evidence implicating occupational standing as a risk factor for lower limb atherosclerosis.

scholarly journals Sickle Cell Trait and Renal Function in Hispanics in the United States: the Northern Manhattan Study

2017 ◽  
Vol 27 (1) ◽  
pp. 11 ◽  
Author(s):  
Nicole D. Dueker ◽  
David Della-Morte ◽  
Tatjana Rundek ◽  
Ralph L. Sacco ◽  
Susan H. Blanton
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
The United States ◽  
Genetic Mutation ◽  
Single Mutation ◽  
Increased Risk

<p class="Pa7">Sickle cell anemia (SCA) is a common hematological disorder among individu­als of African descent in the United States; the disorder results in the production of abnormal hemoglobin. It is caused by homozygosity for a genetic mutation in HBB; rs334. While the presence of a single mutation (sickle cell trait, SCT) has long been considered a benign trait, recent research suggests that SCT is associated with renal dysfunction, including a decrease in estimated glomerular filtration rate (eGFR) and increased risk of chronic kidney disease (CKD) in African Americans. It is currently unknown whether similar associations are observed in Hispanics. Therefore, our study aimed to determine if SCT is associated with mean eGFR and CKD in a sample of 340 Dominican Hispanics from the Northern Manhattan Study. Using regression analyses, we tested rs334 for association with eGFR and CKD, adjusting for age and sex. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equa­tion and CKD was defined as eGFR &lt; 60 mL/min/1.73 m2. Within our sample, there were 16 individuals with SCT (SCT carriers). We found that SCT carriers had a mean eGFR that was 12.12 mL/min/1.73m2 lower than non-carriers (P=.002). Additionally, SCT carriers had 2.72 times higher odds of CKD compared with non-carriers (P=.09). Taken together, these novel results show that Hispanics with SCT, as found among African Americans with SCT, may also be at increased risk for kidney disease.</p><p class="Pa7"><em>Ethn Dis. </em>2017; 27(1)<strong>:</strong>11-14; doi:10.18865/ed.27.1.11.</p><p class="Pa7"> </p>

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