Abstract MP51: Lifetime Risk For Cardiovascular Disease Stratified By Fasting Glucose Level

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Michael P Bancks ◽  
Hongyan Ning ◽  
Norrina B Allen ◽  
Mercedes R Carnethon ◽  
Justin Echouffo Tcheugui ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Fasting Glucose ◽  
White Men ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Black And White ◽  
Kaplan Meier ◽  
Target Prevention ◽  
The Difference ◽  
Middle Aged Adults

Introduction: Diabetes and insulin resistance are major contributors to atherosclerotic cardiovascular disease (ASCVD) risk, but the lifetime risks (LTR) associated with normoglycemia, impaired fasting glucose (IFG), and diabetes (DM) in middle-aged adults have not been reported. Hypothesis: Higher fasting glucose (FG) category will be associated with a monotonic increase in the LTR for ASCVD. Methods: We pooled data from 7 observational cohorts of US black and white men and women followed from 1960 through 2015. Categories of FG were normoglycemia (<100 mg/dl), IFG (100-125 mg/dl), and DM (≥126 mg/dl or use of DM medications). ASCVD was defined as fatal and nonfatal coronary heart disease (CHD) and fatal and nonfatal stroke. Individuals were free of symptomatic ASCVD at index age 55 years. LTR for incident ASCVD after age 55 was estimated according to FG category using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-ASCVD death. Results: Our sample included 19630 individuals (6197 blacks, 11015 women) without a prior ASCVD event. Mean baseline FG level was 90.1 mg/dl for normoglycemics, 107.4 mg/dl for IFG, and 176.6 mg/dl for DM. Greater age, body mass index, blood pressure, and male sex and black race were associated with increasing FG category. LTR for ASCVD through age 85 among women was 15.5% for normoglycemics, 16.4% for IFG, and 38.6% for DM (Figure 1A). Among men, LTR for ASCVD through age 85 was 22.2% for normoglycemia, 25.0% for IFG, and 47.7% for DM (Figure 1B). The difference in LTR for ASCVD between normoglycemics and IFG was not statistically significant for women (LTR difference 95% confidence interval (CI): -3.8, 2.0) or men (LTR difference 95% CI: -5.8, 0.2). Conclusion: LTRs for ASCVD were similar among normoglycemia and IFG categories. However, LTR among middle-aged participants with DM were 39-48%; approximately twice as high as those with IFG. These data strongly support the importance of public health and clinical strategies that target prevention of incident DM by midlife.

scholarly journals Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease

2020 ◽  
Author(s):  
Aniruddh P. Patel ◽  
Minxian Wang ◽  
James P. Pirruccello ◽  
Patrick T. Ellinor ◽  
Kenney Ng ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
South Asian ◽  
Clinical Importance ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Lipoprotein A ◽  
Hazard Ratios ◽  
Middle Aged Adults ◽  
Relationship Of

Objective: Lipoprotein(a) concentrations are associated with atherosclerotic cardiovascular disease (ASCVD), and new therapies that enable potent and specific reduction are in development. In the largest study conducted to date, we address 3 areas of uncertainty: (1) the magnitude and shape of ASCVD risk conferred across the distribution of lipoprotein(a) concentrations; (2) variation of risk across racial and clinical subgroups; (3) clinical importance of a high lipoprotein(a) threshold to guide therapy. Approach and Results: Relationship of lipoprotein(a) to incident ASCVD studied in 460 506 middle-aged UK Biobank participants. Over a median follow-up of 11.2 years, incident ASCVD occurred in 22 401 (4.9%) participants. Median lipoprotein(a) concentration was 19.6 nmol/L (25th–75th percentile 7.6–74.8). The relationship between lipoprotein(a) and ASCVD appeared linear across the distribution, with a hazard ratio of 1.11 (95% CI, 1.10–1.12) per 50 nmol/L increment. Substantial differences in concentrations were noted according to race—median values for white, South Asian, black, and Chinese individuals were 19, 31, 75, and 16 nmol/L, respectively. However, risk per 50 nmol/L appeared similar—hazard ratios of 1.11, 1.10, and 1.07 for white, South Asian, and black individuals, respectively. A high lipoprotein(a) concentration defined as ≥150 nmol/L was present in 12.2% of those without and 20.3% of those with preexisting ASCVD and associated with hazard ratios of 1.50 (95% CI, 1.44–1.56) and 1.16 (95% CI, 1.05–1.27), respectively. Conclusions: Lipoprotein(a) concentrations predict incident ASCVD among middle-aged adults within primary and secondary prevention contexts, with a linear risk gradient across the distribution. Concentrations are variable across racial subgroups, but the associated risk appears similar.

Abstract 15642: Race Sex Disparities in Atherosclerotic Cardiovascular Disease in Hospitalized Patients With Diabetes, 2005-2015 Potential Warning Signs for Future U.S. Public Health

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gursukhman Sidhu ◽  
Charisse J Ward ◽  
Keith Ferdinand
Keyword(s):  
Cardiovascular Disease ◽  
Renal Failure ◽  
Black Women ◽  
Black Men ◽  
Odds Ratio ◽  
White Men ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Secondary Diagnosis ◽  
The U.S

Introduction: Despite a recent gradually slowing and perhaps recent increase in the burden of atherosclerotic cardiovascular disease (ASCVD) related hospitalization in the United States population with diabetes, it is unclear whether the prior downward trend was uniform or there was an unbalanced division amongst sex and race. Methods: Adults aged ≥40 years old with comorbid diabetes as a secondary diagnosis were identified using the U.S. 2005-2015 National (Nationwide) Inpatient Sample (NIS) data. The prevalence of other modifiable cardiovascular risk factors (hypertension, dyslipidemia, smoking/substance abuse, obesity, and renal failure), procedures like major amputations in the secondary diagnosis field and their association with ASCVD (acute coronary syndrome (ACS), coronary artery disease (CAD), stroke, or peripheral arterial disease (PAD)) as the first-listed diagnosis were determined. Complex samples multivariate regression was used to determine the odds ratio (O.D.) with 95% confidence limits (C.L.s). Sex and race risk-adjusted ASCVD related in-hospital mortality rates were estimated. Results: The rate of total ASCVD hospitalizations adjusted to the U.S. census population increased by 5.7% for black men compared to 4% for black women cumulatively compared to a stable downtrend in white men and white women. There was a higher odd of an ASCVD hospitalizations if there was comorbid hypertension (Odds Ratio (OR 1.29; 95% Confidence Interval (CI) 95% 1.28 - 1.31), dyslipidemia (OR 2.03; 95% CI 2.01 - 2.05), renal failure (OR 1.84; 95% CI 1.82 - 1.86), and smoking/substance use disorder (OR 1.31; 95% CI 1.29 - 1.33). When compared to white men, black men (OR 1.43; 95% CI 1.3 - 1.57) and black women (OR 1.15; 95% CI 1.04 - 1.27) had a higher likelihood of undergoing a major limb amputation during an ASCVD hospitalization. Conclusions: Blacks with diabetes continue to have a higher hospitalizations burden with a concomitant disparity in procedures and outcomes.

Abstract 14677: Distribution of 10- and 30-year Predicted Risks for Atherosclerotic Cardiovascular Disease in the United States: NHANES 2015 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nilay S Shah ◽  
Hongyan Ning ◽  
Amanda Perak ◽  
Norrina B Allen ◽  
John T Wilkins ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Life Course ◽  
Risk Model ◽  
The United States ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Ascvd Risk ◽  
The Life Course ◽  
Predicted Risk

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

scholarly journals Fibroblast Growth Factor 23 and Incident Cardiovascular Disease and Mortality in Middle‐Aged Adults

2021 ◽  
Author(s):  
Shejuti Paul ◽  
Mandy Wong ◽  
Ehimare Akhabue ◽  
Rupal C. Mehta ◽  
Holly Kramer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Growth Factor ◽  
Fibroblast Growth Factor ◽  
Fibroblast Growth Factor 23 ◽  
Hazard Ratio ◽  
Fibroblast Growth ◽  
Heart Failure Hospitalization ◽  
Middle Aged ◽  
Middle Aged Adults

Background Higher circulating fibroblast growth factor 23 (FGF23) associates with greater risk of cardiovascular disease (CVD) and mortality in older adults. The association of FGF23 with cardiovascular outcomes in younger populations has been incompletely explored. Methods and Results We measured C‐terminal FGF23 (cFGF23) and intact FGF23 (iFGF23) in 3151 middle‐aged adults (mean age, 45±4) who participated in the year 20 examination of the CARDIA (Coronary Artery Risk Development in Young Adults) study. We used separate Cox proportional hazards models to examine the associations of cFGF23 and iFGF23 with incident CVD and mortality, adjusting models sequentially for sociodemographic, clinical, and laboratory factors. A total of 157 incident CVD events and 135 deaths occurred over a median 7.6 years of follow‐up (interquartile range, 4.1–9.9). In fully adjusted models, there were no statistically significant associations of FGF23 with incident CVD events (hazard ratio per doubling of cFGF23: 1.14, 95%CI 0.97,1.34; iFGF23: 0.76, 95%CI 0.57,1.02) or all‐cause mortality (hazard ratio per doubling of cFGF23, 1.17; 95% CI, 1.00–1.38; iFGF23, 0.86; 95% CI, 0.64–1.17). In analyses stratified by CVD subtypes, higher cFGF23 was associated with greater risk of heart failure hospitalization (hazard ratio per doubling of cFGF23, 1.52; 95% CI, 1.18–1.96) but not coronary heart disease or stroke, whereas iFGF23 was not associated with CVD subtypes in any model. Conclusions In middle‐aged adults with few comorbidities, higher cFGF23 and iFGF23 were not independently associated with greater risk of CVD events or death. Higher cFGF23 was independently associated with greater risk of heart failure hospitalization.

The Employment Effects of Wage Discrimination against Black Men

ILR Review ◽  
1996 ◽  
Vol 49 (2) ◽  
pp. 302-316 ◽  
Author(s):  
Marjorie L. Baldwin ◽  
William G. Johnson
Keyword(s):  
Black Men ◽  
Wage Differential ◽  
White Men ◽  
Wage Discrimination ◽  
Employment Rate ◽  
Employment Effects ◽  
Black And White ◽  
Relative Employment ◽  
The Difference ◽  
Employment Rates

When labor supply curves are upward-sloping, wage discrimination against black men reduces not only their relative wages, but also their relative employment rates. Using data from the 1984 Survey of Income and Program Participation, the authors estimate wage discrimination against black men and, for the first time, quantify the effects of that discrimination on the employment of black and white men. They find that 62% of the difference in offer wages to black and white men, and 67% of the difference in their observed wages, cannot be attributed to differences in productivity. Assuming that the unexplained wage differential is attributable entirely to employer discrimination, then the disincentive effects of wage discrimination reduced the relative employment rate of black men from 89% to 82% of white men's employment rate. Thus, wage discrimination and its employment effects resulted in a substantial transfer of resources from blacks to whites in 1984.

scholarly journals Barriers and Motivators of Physical Activity Participation in Middle-Aged and Older Adults—A Systematic Review

2019 ◽  
Vol 27 (6) ◽  
pp. 929-944 ◽  
Author(s):  
Karl Spiteri ◽  
David Broom ◽  
Amira Hassan Bekhet ◽  
John Xerri de Caro ◽  
Bob Laventure ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Social Influences ◽  
Age Groups ◽  
Middle Aged ◽  
Quantitative Studies ◽  
The Difference ◽  
Middle Aged Adults ◽  
Health Promotion Interventions ◽  
Barriers And Motivators

Identifying the difference in the barriers and motivators between middle-aged and older adults could contribute toward the development of age-specific health promotion interventions. The aim of this review was to synthesize the literature on the barriers and motivators for physical activity in middle-aged (50–64 years) and older (65–70 years) adults. This review examined qualitative and quantitative studies using the theoretical domain framework as the guiding theory. The search generated 9,400 results from seven databases, and 55 articles meeting the inclusion criteria were included. The results indicate that the barriers are comparable across the two age groups, with environmental factors and resources being the most commonly identified barriers. In older adults, social influences, reinforcement, and assistance in managing change were the most identified motivators. In middle-aged adults, goal-setting, the belief that an activity will be beneficial, and social influences were identified as the most important motivators. These findings can be used by professionals to encourage engagement with and adherence to physical activity.

scholarly journals Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

2018 ◽  
Vol 7 (10) ◽  
Author(s):  
Stephen P. Juraschek ◽  
Natalie Daya ◽  
Lawrence J. Appel ◽  
Edgar R. Miller ◽  
John William McEvoy ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Middle Aged ◽  
Subclinical Cardiovascular Disease ◽  
Middle Aged Adults
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