Abstract P091: Early Life Stressors and Adult Cardiovascular Health in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Virginia J Howard ◽  
Leann Long ◽  
Aleena Bennett ◽  
Leslie A McClure ◽  
Dawn O Kleindorfer ◽  
...  
Keyword(s):  
Family Violence ◽  
Racial Differences ◽  
Early Life ◽  
Cardiovascular Health ◽  
Population Based ◽  
Life Stressors ◽  
Behavioral Risk ◽  
Serious Illness ◽  
Black And White ◽  
Regards Study

Introduction: Prior research suggests early life stressors (ELS) influence development of cardiovascular (CV) risk over the lifecourse, but few national studies have evaluated this. We examined the association of ELS with adult CV defined by Life’s Simple 7 (LS7) score within a national US population-based cohort. Methods: We used data on 7,469 REGARDS participants (black and white adults, aged > 45 in 2003-2007), with clinical and behavioral risk factor data from questionnaires and direct measurement. Levels of LS7 components (blood pressure, total cholesterol, fasting glucose, physical activity, smoking, diet, body mass index) were coded as poor (0 points), intermediate (1 point) or ideal (2 points); the primary outcome, LS7 score, was the sum of the components. In 2012-2013, 7 ELS (death of parent, parents separated/divorced, family serious illness, witnessed family violence, family substance abuse, parent’s loss of job and parent incarcerated) were retrospectively assessed by mail questionnaire to active participants. Linear regression was used to characterize the relationship between each ELS and LS7 after adjustment for demographics and region of birth. Mediation by adult income and education was examined. Results: ELS were common, ranging from 3% for parent incarcerated to 29% for family serious illness. Lower LS7 was associated with each ELS, with significant association with witnessing family violence (-0.15; 95% CI: -0.29 to -0.02) (see figure.) Additional adjustment for adult education partially attenuated the effect estimates for witnessed family violence by 20.6% (95% CI: 2.0%, 39.1%); adjustment for adult income and education mediated the non-significant estimates for parental death, family illness and separation/divorce. Conclusions: Exposure to ELS was associated worse adult cardiovascular health; these associations were partially but not fully mediated by adult socioeconomic status. Further work is needed in categorization of ELS and examination of pathways underlying the associations.

Abstract P383: Do Geographic Patterns of Obesity Prevalence Correlate with Patterns of High Stroke Mortality?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Anh H Le ◽  
George Howard ◽  
David B Allison ◽  
Reena Oza-Frank ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Racial Differences ◽  
Population Based ◽  
Behavioral Risk ◽  
Stroke Mortality ◽  
Obesity Prevalence ◽  
Black And White ◽  
South Central ◽  
Prevalence Of Obesity ◽  
Reported Data ◽  
Stroke Belt

Background: Self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) survey show higher prevalence of obesity in the south, particularly for the East South Central(ESC) states of LA, MS, and AL. Because obesity is associated with hypertension and diabetes, higher prevalence of obesity has been hypothesized as a primary contributor to the stroke belt, an area of high stroke mortality in the southeast. We assessed measured obesity from the National Health and Nutrition Examination Survey (NHANES) and REasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort from 48 states, and compared geographic prevalence patterns across studies. Methods: Weighted obesity prevalence estimates (with 95% CIs) were calculated from NHANES (2003-2008; n = 6138), REGARDS (2003-2007; n = 30,183), and BRFSS (2003-2007; n = 67,742) in non-Hispanic black and white adults over 45 years of age in the census divisions. Obesity was defined as BMI >= 30 kg/m 2 . Results: There is a lack of concordance in the obesity prevalence (see Figure) between BRFSS and both REGARDS (top left) and NHANES (bottom right). In contrast, the comparison of REGARDS and NHANES (top right) shows good agreement in the estimated obesity prevalence for all divisions (including those containing the stroke belt states, shown in red). Conclusion: Our results indicate discordance in measured and self-reported obesity prevalence especially in the ESC division. The objectively measured obesity prevalence for both NHANES and REGARDS was high in the West North Central division including ND, SD, NE, KS, MN, IA, and MO. Factors other than obesity may contribute to the high prevalence of hypertension and diabetes, and high stroke mortality rates, in the stroke belt. Additionally, these data suggest that errors in self-reporting height and/or weight differ by region and may have distorted past estimates of obesity rates by region.

Abstract T P146: Vitamin D Deficiency is Associated With Stroke in Black and White Participants of the REGARDS Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Virginia J Howard ◽  
Paul Muntner ◽  
Brett M Kissela ◽  
Bhupesh Panwar ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Racial Differences ◽  
Sex Education ◽  
The United States ◽  
Dietary Vitamin ◽  
Equal Distribution ◽  
Black And White ◽  
Increased Risk ◽  
Regards Study

Objective: Black Americans are at greater risk of both stroke and vitamin D deficiency than white Americans. We have previously shown that both higher dietary vitamin D and sunlight exposure are associated with decreased risk of stroke; however, serum 25(OH) is thought to be a better marker of vitamin D status. Methods: Using a case cohort design, we examined the association of plasma 25(OH)D with incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white participants from across the United States enrolled between 2003 and 2007. Medical records were reviewed by physicians and strokes were classified on the basis of symptoms and neuroimaging. Strokes through July 1, 2011 were included. A stratified cohort sample was selected to ensure approximately equal numbers of black and white participants and an equal distribution across ages. We used Cox proportional hazards models weighted back to the original 30,239 participants, excluding those with history of stroke. Serum 25(OH)D was measured by Immunodetection Systems ELISA. Results: Over mean follow-up of 4.4 years, there were 539 ischemic and 71 hemorrhagic strokes. The stroke-free sub-cohort included 939 participants. After adjustment for age, race, sex, education, diabetes, hypertension, smoking, atrial fibrillation, heart disease, physical activity, kidney function, calcium and phosphorous, 25(OH)D level 30 ng/mL. The direction of association was similar for hemorrhagic stroke though not statistically significant (HR=1.59; 95%CI=0.78, 3.24). Vitamin D deficiency was associated with an increased risk of all stroke (HR=1.54; 95%CI=1.05, 2.23). This effect was greater in blacks (HR=2.09; 95%CI=1.09, 3.99) than whites (HR=1.38; 95%CI=0.78, 2.42). Results were not as strong when we modeled 25(OH)D as a continuous variable (HR=0.99 per 1 ng/ml change in 25(OH)D; 95%CI=0.98, 1.01). Discussion: Similar to low vitamin D intake, vitamin D deficiency is a risk factor for incident stroke. These findings support evidence from cardiovascular and cancer epidemiology that treating low 25(OH)D may prevent strokes.

Abstract MP50: Neighborhood Social And Economic Environment And Heart Failure Risk Among Adults With & Without Diabetes: The Reasons For Geographic And Racial Differences In Stroke (regards) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Gargya Malla ◽  
Andrea Cherrington ◽  
Monika M Safford ◽  
Parag Goyal ◽  
Doyle M Cummings ◽  
...  
Keyword(s):  
Heart Failure ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Economic Environment ◽  
Individual Level ◽  
Black And White ◽  
Regards Study ◽  
Year 2000

Background: Heart failure (HF) mortality rates have been increasing since 2011. Individual-level education and occupation have been inversely associated with HF mortality among those with diabetes mellitus (DM) but not among those without DM. However, less is known about the association between neighborhood social and economic environment (NSEE) and HF risk and whether this association varies by DM status. Methods: This study included 21,244 Black and White adults age >=45 years at baseline (2003-07) from the REGARDS Study. NSEE quartiles were created using z-scores based on 6 census tract variables from year 2000 (% <high school education, % unemployed, % household with <$30,000, % living in poverty, % on public assistance, % without car). Incident HF events (fatal or non-fatal) were adjudicated based on hospitalization with HF signs and symptoms, supportive imaging or biomarkers. Diabetes was defined as fasting glucose >=126 mg/dL or random glucose >=200 mg/dL or use of diabetes medications. Cox proportional hazards regression was used to obtain hazard ratios (95% CI) with HF follow-up through 2016. Results: Mean age was 65 years, 54% were women, 61% were White and 18% had prevalent DM at baseline. During a median 10.1 years, 829 incident HF events occurred. Among adults with DM, neighborhood disadvantage was associated with an increased HF risk , but this association was not statistically significant (Table). Among adults without DM, the risk of HF was higher for participants living in any neighborhood that was not the most advantaged, and the magnitude of association was smiliar across NSEE quartiles. Conclusion: Adults living in disadvantaged neighborhoods had a higher risk of HF, particularly among those without DM. Addressing neighborhood social and economic conditions may be important for HF prevention.

Abstract P447: Index of Concentration at the Extremes and Diabetes Prevalence: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Gargya Malla ◽  
D. Leann Long ◽  
Nyesha C Black ◽  
Sha Zhu ◽  
Jalal Uddin ◽  
...  
Keyword(s):  
Racial Differences ◽  
Community Level ◽  
Diabetes Prevalence ◽  
Median Income ◽  
Census Tracts ◽  
Individual Level ◽  
Black And White ◽  
The Us ◽  
Regards Study ◽  
Increase Diabetes Risk

Background: Stark regional and racial disparities in diabetes prevalence exist in the US. Community-level factors (e.g., median income) have been associated with higher diabetes prevalence. However, few studies have investigated how community-level spatial polarization, specifically in race and income, may relate to diabetes burden. Objective: To investigate the association between the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and income at the community-level, and individual-level diabetes prevalence. Methods: This analysis included 24,752 Black and White adults age ≥ 45 years at baseline (2003-2007) from the REGARDS Study. The ICE measure quantifies the concentration of community affluence and poverty in a census tract using both income and race jointly, with values ranging from -1 (most deprived) to +1 (most privileged). Diabetes was defined as fasting glucose ≥ 126 mg/dL or random glucose ≥ 200 mg/dL or use of diabetes medication. Modified Poisson regression was used to obtain prevalence ratios and 95% CI for the association of ICE quartiles with prevalent diabetes. Results: The overall prevalence of diabetes was 21% and was highest for adults living in the most deprived census tracts (28.3%) and lowest for those living in the most privileged census tracts (12.5%). The association between ICE and prevalent diabetes was graded in crude analyses but attenuated after adjustment for individual-level sociodemographic, lifestyle and clinical factors (Table). Conclusion: Communities with greater polarization in race and income had a higher burden of diabetes. This association was mostly explained by individual-level socioeconomic and lifestyle factors. Further investigation of community-level attributes and how they relate to individual-level factors that increase diabetes risk is needed.

scholarly journals Life’s Simple 7 and Incident Hypertension: The REGARDS Study

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Timothy B. Plante ◽  
Insu Koh ◽  
Suzanne E. Judd ◽  
George Howard ◽  
Virginia J. Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Incident Hypertension ◽  
Black And White ◽  
Stroke Study ◽  
Life’S Simple 7 ◽  
Life's Simple 7 ◽  
Regards Study ◽  
White Adults

Background The Life’s Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure, cholesterol, glucose) to estimate an individual’s level of cardiovascular health. The association between cardiovascular health and incident hypertension is unresolved. Hypertension’s threshold was recently lowered and it is unclear if better cardiovascular health is associated with lower risk of incident hypertension with the updated threshold or in a multirace cohort. We sought to assess the association between better LS7 score and risk of incident hypertension among Black and White adults using a 130/80 mm Hg hypertension threshold. Methods and Results We determined the association between LS7 metric and incident hypertension in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) study, including participants free of baseline hypertension (2003–2007) who completed a second visit between 2013 and 2016. Hypertension was defined as systolic/diastolic blood pressure ≥130/80 mm Hg or antihypertensive medication use. Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points. We generated a 14‐point score by summing points. Among 2930 normotensive participants (20% Black, 80% White), the median (25th–75th percentiles) LS7 total score was 9 (8–10) points. Over a median follow‐up of 9 years, 42% developed hypertension. In the fully adjusted model, each 1‐point higher LS7 score had a 6% lower risk of incident hypertension (risk ratio, 0.94 per 1 point; 95% CI, 0.92–0.96). Conclusions Better cardiovascular health was associated with lower risk of incident hypertension using a 130/80 mm Hg hypertension threshold among Black and White adults.

scholarly journals Neighborhood Walkability as a Predictor of Incident Hypertension in a National Cohort Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Alana C. Jones ◽  
Ninad S. Chaudhary ◽  
Amit Patki ◽  
Virginia J. Howard ◽  
George Howard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
Geographic Region ◽  
Incident Hypertension ◽  
Neighborhood Walkability ◽  
Black And White ◽  
Walk Score ◽  
Walkable Neighborhood ◽  
National Cohort ◽  
Regards Study

The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score &lt;70) walkable. The primary outcome was incident hypertension defined at the second visit (collected between 2013 and 2017). We derived risk ratios (RR) using modified Poisson regression adjusting for age, race, sex, geographic region, income, alcohol use, smoking, exercise, BMI, dyslipidemia, diabetes, and baseline blood pressure (BP). We further stratified by race, age, and geographic region. Among 6,894 participants, 6.8% lived in more walkable areas and 38% (N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P &lt; 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.

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