Abstract P300: C-reactive Protein and Racial Differences in Type 2 Diabetes Incidence: Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kaitlyn M Peper ◽  
Boyi Guo ◽  
Leann Long ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Racial Difference ◽  
Incident Diabetes ◽  
Diabetes Incidence ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Difference ◽  
Adjusted Model ◽  
The Impact

Introduction: Black Americans have a higher incidence of diabetes and have elevated inflammatory biomarkers compared to white Americans. Elevated inflammation is a risk factor for diabetes but the impact of inflammation on the racial disparity in diabetes is unknown. Hypothesis: Elevated C-reactive protein (CRP) attenuates the observed black-white difference in incident diabetes. Methods: REGARDS enrolled 30,239 black and white adults aged ≥45 years from the contiguous US in 2003-07. This analysis included REGARDS participants without baseline diabetes who were assessed for diabetes 9 years later. RRs for incident diabetes by race were calculated using modified Poisson regression adjusting for risk factors known to contribute to the racial difference in diabetes incidence. The attenuation by CRP of the black-white RR of incident diabetes was calculated as the percent difference in the race RR in models with and without CRP adjustment; 95% CI for the difference was estimated using bootstrapping. Results: Of 11,073 participants without baseline diabetes (33% black, 67% white), black participants had higher CRP than white participants, and 12.5% developed incident diabetes. The black-white RR for incident diabetes in the base model was 1.74 (95% CI: 1.52, 1.99) for women and 1.44 (1.25, 1.66) for men. Baseline CRP mediated 21% (14, 29%) of this association in women and 20% (12, 34%) in men. These percent attenuations were similar in models adjusting for other diabetes risk factors but were diminished in a fully adjusted model; 5% (-4, 25%) in women and 7% (-43, 50%) in men (Figure). Conclusion: Adjustment for CRP in base models accounted for 20% and 21% of the excess risk of incident diabetes observed in black men and women, respectively, in this study. This substantial mediation persisted after adjusting for other risk factors but was diminished in the fully adjusted model. This suggests a role of inflammation in the diabetogenic effects of risk factors contributing to the observed racial difference in diabetes incidence.

Abstract P181: Contribution of C-Reactive Protein to Racial Disparities in Incident Hypertension: The REasons for Geographic And Racial Differences in Stroke Study (REGARDS)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Timothy B Plante ◽  
D L Long ◽  
George Howard ◽  
April P Carson ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Medication Use ◽  
Dietary Factors ◽  
C Reactive Protein ◽  
Incident Hypertension ◽  
Black And White ◽  
Reactive Protein ◽  
Stroke Study ◽  
Diet Pattern ◽  
The Impact

Introduction: In the US, blacks are at higher risk of hypertension than whites. The single largest contributor to this disparity is the Southern Diet pattern. Inflammation biomarkers are associated with risk of hypertension, and C-reactive protein (CRP) is higher in blacks than whites. We studied whether elevated CRP in blacks relative to whites contributes to the racial disparity in hypertension in blacks. Methods: We included 6,548 black and white men and women age ≥45 years from the REGARDS cohort without hypertension at baseline ('03-'07) and who completed visit 2 in '13-'16. Incident hypertension was defined as BP ≥140/90 mm Hg or hypertension medication use at visit 2. Using logistic regression, the black:white odds ratio (OR) for incident hypertension was calculated adjusting for age, sex, race, and baseline SBP. We assessed the percent change in the black:white OR for incident hypertension after adding CRP. The 95% CI was calculated using 1,000 bootstrapped samples. We determined the impact of known hypertension risk factors and anti-inflammatory medications on the percent mediation by CRP. Results: Hypertension developed in 46% of blacks and 33% of whites. Adjusting for demographics, the black:white OR (95% CI) was 1.51, which was reduced to 1.46, a 9.3% reduction (95% CI 5.4%, 13.2%) by CRP (Table). In models including exercise, waist circumference, BMI, and depressive symptoms, the percent mediation by CRP was 3.7% (1.0%, 6.4%). Similar patterns were seen for models incorporating socioeconomic factors and medication use. After adding Southern diet pattern and dietary Na/K ratio, CRP no longer attenuated the association (1.3% mediation; -1.5, 4.1). Conclusions: CRP significantly attenuated the black-white difference in incident hypertension; however, once dietary factors were accounted for, CRP had no impact on the black:white difference in incident hypertension. Thus, inflammation as measured by CRP, may be part of the reason that dietary factors influence the black:white disparity in incident hypertension.

P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nevi Pasko ◽  
Ariana Strakosha ◽  
Arieta Dedej ◽  
Loredana Kapidani ◽  
Fjona Nasto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Serum Triglyceride ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Arterial Complications ◽  
The Impact

Abstract Background and Aims Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers. Method The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements. Results A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it. Conclusion In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.

scholarly journals C-reactive protein and hypertension incidence in black and white Americans: REasons for Geographic And Racial Differences in Stroke (REGARDS) study

2020 ◽  
Author(s):  
Timothy B Plante ◽  
D Leann Long ◽  
Boyi Guo ◽  
George Howard ◽  
April P Carson ◽  
...  
Keyword(s):  
Racial Differences ◽  
Excess Risk ◽  
White Americans ◽  
C Reactive Protein ◽  
Incident Hypertension ◽  
Black And White ◽  
Reactive Protein ◽  
Regards Study ◽  
Adjusted Model ◽  
Excess Incidence

Abstract Background More inflammation is associated with greater risk incident hypertension, and black US adults have excess burden of hypertension. We investigated whether increased inflammation as quantified by higher C-reactive protein (CRP) explains the excess incidence in hypertension experienced by black US adults. Methods We included 6,548 black and white REGARDS participants without hypertension at baseline (2003-2007) who attended a second visit (2013-2016). Sex-stratified risk ratios (RR) for incident hypertension at the second exam in black compared to white individuals were estimated using Poisson regression adjusted for groups of factors known to partially explain the black-white differences in incident hypertension. We calculated the percent mediation by CRP of the racial difference in hypertension. Results Baseline CRP was higher in black participants. The black-white RR for incident hypertension in the minimally adjusted model was 1.33 (95% CI 1.22, 1.44) for males and 1.15 (1.04, 1.27) for females. CRP mediated 6.6% (95% CI 2.7, 11.3%) of this association in females and 19.7% (9.8, 33.2%) in males. In females, CRP no longer mediated the black-white RR in a model including waist circumference and body mass index, while in males the black-white difference was fully attenuated in models including income, education and dietary patterns. Conclusions Elevated CRP attenuated a portion of the unadjusted excess risk of hypertension in black adults, but this excess risk was attenuated when controlling for measures of obesity in females and diet and socioeconomic factors in males. Inflammation related to these risk factors might explain part of the black-white disparity in hypertension.

scholarly journals What factors explain the much higher diabetes prevalence in Russia compared with Norway? Major sex differences in the contribution of adiposity

2021 ◽  
Vol 9 (1) ◽  
pp. e002021
Author(s):  
Olena Iakunchykova ◽  
Maria Averina ◽  
Tom Wilsgaard ◽  
Sofia Malyutina ◽  
Alexander V Kudryavtsev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Glycated Hemoglobin ◽  
Population Based ◽  
Marginal Structural Models ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
High Prevalence ◽  
The Difference ◽  
Design And Methods

IntroductionCompared with many other countries Russia has a high prevalence of diabetes in men and women. However, contrary to what is found in most other populations, the risk is greater among women than men. The reasons for this are unclear.Research design and methodsPrevalence and risk factors for diabetes at ages 40–69 years were compared in two population-based studies: Know Your Heart (KYH) (Russia, 2015–2018, n=4121) and the seventh wave of the Tromsø Study (Tromsø 7) (Norway, 2015–2016, n=17 649). Diabetes was defined by the level of glycated hemoglobin and/or self-reported diabetes and/or diabetes medication use. Marginal structural models were used to estimate the role of key risk factors for diabetes in differences between the studies.ResultsAge-standardized prevalence of diabetes was higher in KYH compared with Tromsø 7 in men (11.6% vs 6.2%) and in women (13.2% vs 4.3%). Age-adjusted ORs for diabetes in KYH compared with Tromsø 7 were 2.01 (95% CI 1.68 to 2.40) for men and 3.66 (95% CI 3.13 to 4.26) for women. Adiposity (body mass index and waist circumference) explained none of this effect for men but explained 46.0% (39.6, 53.8) for women. Addition of smoking and C reactive protein, as further mediators, slightly increased the percentage explained of the difference between studies to 55.5% (46.5, 66.0) for women but only to 9.9% (−0.6, 20.8) for men.ConclusionsAdiposity is a key modifiable risk factor that appears to explain half of the almost threefold higher female prevalence of diabetes in Russia compared with Norway, but none of the twofold male difference.

scholarly journals Check-up and cardiovascular risk progression: is there a room for innovation?

2015 ◽  
Vol 13 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Raquel Dilguerian de Oliveira Conceição ◽  
Antonio Gabriele Laurinavicius ◽  
Nea Miwa Kashiwagi ◽  
José Antonio Maluf de Carvalho ◽  
Carlos Alberto Garcia Oliva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Alcohol Consumption ◽  
Smoking Habit ◽  
Final Analysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
The Impact ◽  
Number Of Individuals

ABSTRACT Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism.

scholarly journals Older Adults with Lowest Risk of Developing Type 2 Diabetes: Results from a Large and Diverse US Cohort (2003–2016) (OR22-06-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Lua Wilkinson ◽  
Tapan Mehta ◽  
W Timothy Garvey
Keyword(s):  
Type 2 Diabetes ◽  
Racial Differences ◽  
R Package ◽  
Progressive Increase ◽  
Continuous Variable ◽  
Incident Diabetes ◽  
Diabetes Incidence ◽  
Non Linear ◽  
The Impact

Abstract Objectives High rates of early obesity substantially increase lifetime risk of developing diabetes. The objective of this research is to examine the impact of this shift on type-2 diabetes risk and aging in a large and diverse U.S. cohort. Methods A nationally sampled, longitudinal survey, the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (2003–2007), a collection of sociobiological data, were observed through 2013–2016. We included black and white men and women aged ≥45 without diabetes at baseline for whom follow-up data was available. To assess incident diabetes as a function of age, we used the R package Segmented and examined whether this risk was constant over the whole range of age or whether the risk was non-linear with a threshold inflection value. After inspection of the data, age as a continuous variable appeared to have a piecewise relationship with incidence diabetes. A logistic model to see the effect of age on incident diabetes adjusting for sex and race was run. We estimated changes in odds for developing diabetes in ten years by age using restricted cubic spline knots. We estimated the breakpoint statistically using the psi argument in ‘segmented’. Odds ratios for developing diabetes on both sides of the breakpoint were calculated. Results Baseline age appeared to show a non-linear association with future diabetes incidence with a breakpoint at age 55 (P = 0.005). After 55 years, incident diabetes declined (slope at age 45–54.9: 0.06; CI: 0.02, 0.10; slope age ≥55: −0.02; CI −0.04, −0.01). Odds ratio for developing diabetes in ten years for those 45–55 years (OR: 1.18, 95% CI 1.02–1.37, P = 0.024) confirm this relationship – those 45–55 years have 18% higher odds of developing diabetes than those over 55. Conclusions This model estimated an age breakpoint of roughly 55 years of age when younger individuals were observed to have a progressive increase in incident diabetes while those 55 and older had a declining risk. Between 1992 and 2010, mean BMI in the US increased, resulting primarily from accelerated weight gain among persons initially normal and overweight - our findings argue for a careful data driven approach in considering the effects of age on incident diabetes to derive a more accurate prediction for diabetes. Funding Sources Lua Wilkinson is supported in part by NIH grant T32 DK062710. Supporting Tables, Images and/or Graphs

A system for predicting the development of coronary heart disease in miners with anthracosilicosis

2021 ◽  
Vol 61 (6) ◽  
pp. 365-370
Author(s):  
Nikolay I. Panev ◽  
Natalya A. Evseeva ◽  
Sergey N. Filimonov ◽  
Olga Yu. Korotenko ◽  
Igor P. Danilov
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Preventive Measures ◽  
Significant Risk ◽  
Excess Body Weight ◽  
C Reactive Protein ◽  
Bicycle Ergometry ◽  
Reactive Protein ◽  
The Impact

Introduction. Among underground miners, the pathology of the cardiovascular system is much more common than among workers on the surface, which indicates the negative role of the impact of harmful production factors. There is evidence of a high prevalence of traditional risk factors for the development of coronary heart disease among miners with dust pathology of the lungs. Preventive measures for coronary heart disease exist for the timely detection and elimination of risk factors. In this regard, it is relevant to optimize methods for predicting the risk of developing coronary heart disease in coal mine workers. The study aims to develop a system for predicting the probability of developing coronary heart disease in miners with anthracosilicosis based on determining the most significant risk factors. Materials and methods. The experts studied the frequency of coronary heart disease and its risk factors in 139 employees of the primary professions of coal mines. The scientists performed daily ECG monitoring, bicycle ergometry according to the Rose questionnaire. They also studied the indicators of lipid metabolism, hemostasis, the level of homocysteine, C-reactive protein, glycemia, the presence of excess body weight, constitutional and morphological types according to Rice-Eysenck and Tanner. The experts developed a predictive system using the Bayes method. We calculated a predictive coefficient for each factor. Scientists determined the probability of coronary heart disease by the value of the sum of prognostic coefficients. Results. Workers aged 45 years and older have the highest risk of developing coronary heart disease. The experience of working in harmful working conditions for 20 years or more, the presence of arterial hypertension, metabolic syndrome, respiratory failure, andromorphic constitutional-morphological type according to the Tanner index, as well as the presence of hyperhomocysteinemia, hyperfibrinogenemia, increased levels of soluble fibrin-monomer complexes and C-reactive protein - all these are the risks of developing coronary heart disease in miners with anthracosilicosis. Conclusions. The developed system of personalized prediction of the probability of developing coronary heart disease in miners with anthracosilicosis allows us to identify a group of high-risk workers for timely treatment and preventive measures for them.

scholarly journals C-reactive Protein/Albumin Ratio and Acute Kidney Injury after Radical Cystectomy among Elderly Patients: A Propensity Score-Matched Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Jihion Yu ◽  
Jun-Young Park ◽  
Seungsoo Ha ◽  
Jai-Hyun Hwang ◽  
Young-Kug Kim
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Radical Cystectomy ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Formula Group ◽  
The Impact ◽  
Postoperative Aki

Background. The C-reactive protein (CRP)/albumin ratio is a useful index used to represent patient inflammation and nutritional status. Elderly patients are at the highest risk for acute kidney injury (AKI). We clarified the impact of the preoperative CRP/albumin ratio on AKI and evaluated the impact of postoperative AKI on end-stage renal disease (ESRD) among elderly cystectomy patients. Methods. We included elderly patients ≥ 65   years of age who underwent radical cystectomy. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to identify risk factors for AKI. Propensity score-matched analysis and conditional logistic regression analysis were performed to elucidate the impact of the CRP/albumin ratio on AKI. The incidence of ESRD was compared between the non-AKI and AKI groups at 12 months after radical cystectomy. Results. AKI occurred in 110 patients (32.2%). The CRP/albumin ratio and 6% hydroxyethyl starch amount were risk factors for postoperative AKI. The optimal cut-off value for the CRP/albumin ratio predicting AKI was 0.1. After propensity score matching, the AKI incidence in the CRP/albumin ratio ≥ 0.1 group was higher than that in the CRP/albumin ratio < 0.1 group (46.7% vs. 20.6%, P < 0.001 ), and a CRP/albumin ratio ≥ 0.1 was associated with a higher AKI incidence ( odds   ratio = 4.111 , P < 0.001 ). The ESRD incidence was higher in the AKI group than in the non-AKI group (7.3% vs. 1.2%, P = 0.017 ). Conclusion. A CRP/albumin ratio ≥ 0.1 was associated with an increased incidence of AKI, which was associated with higher ESRD incidence among elderly cystectomy patients.

Abstract P004: Association of C-Reactive Protein with Incident Coronary Events in Blacks and Whites: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Neil A Zakai ◽  
Mary Cushman ◽  
Leslie A McClure ◽  
Todd M Brown ◽  
Stephen P Glasser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Cholesterol ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
C Reactive Protein ◽  
Cox Models ◽  
Reactive Protein ◽  
Chd Risk ◽  
Unit Increase ◽  
Chd Risk Factors

Background: Elevated C-reactive protein (CRP) is associated with coronary heart disease (CHD) risk independent of traditional CHD risk factors. Few studies include many non-white participants despite known racial differences in CRP. We assessed whether there were racial differences in the association between CRP and incident CHD in a large cohort of AA and white Americans. Methods: 30,239 AAs and whites were enrolled and examined in their homes across the US from 2003-07. CHD, defined as myocardial infarction or acute CHD death, was captured by participant report and physician medical record review. We used Cox models in those free of CHD at baseline to assess the association of CRP with incident CHD. Results: Over a median 3.7 years follow-up (maximum 5.9 years), 505 CHD events occurred in 24,297 individuals without baseline CHD (223 in 10,337 AA). AA had higher levels of many traditional CHD risk factors, including hypertension (69% vs 47%), diabetes (28% vs 13%), current smoking (17% vs 12%, all <0.01), but higher high-density lipoprotein cholesterol (54 vs 52 mg/dL, p<0.01) and similar total cholesterol (195 vs 192 mg/dL, p=0.16). Median CRP was higher in AA than whites (2.85 vs 1.82 mg/L, p<0.01), with 4,615/9,558 (48%) of blacks vs. 4,548/13,217 (34%) of whites having a CRP ≥3 mg/L (p<0.01) . The table presents the HR of CHD for CRP ≥3 mg/L and per 1 unit increase in log CRP stratified by race. AA did not have a higher hazard of CHD than whites in any model (data not shown). Discussion: Despite higher levels of CRP in AA, CRP was not differentially associated with CHD between AA and whites. Though the HR for CRP ≥3 mg/L appeared weaker in AA vs. whites this was not supported by a significant p-interaction. The paradox of an adverse CHD risk factor profile but similar risk of CHD was not explained by differential associations of CRP with CHD in AA vs. whites. Further analyses of fatal and non-fatal MI as well as the performance of traditional and non traditional CHD risk factors in AA vs. whites are warranted. Table Association of CRP with Incident CHD in African-Americans and Whites All HR (95% CI) Blacks HR (95% CI) Whites HR (95% CI) P-interaction between race and CRP CRP ≥3 mg/L Model 1 1.63 (1.35, 1.96) 1.46 (1.11, 1.93) 1.75 (1.37, 2.24) 0.57 Model 2 1.37 (1.14, 1.66) 1.26 (0.95, 1.67) 1.46 (1.13, 1.88) 0.52 Model 3 1.33 (1.10, 1.61) 1.20 (0.90, 1.61) 1.41 (1.10, 1.82) 0.58 Per 1 unit increase in log CRP Model 1 1.32 (1.22, 1.43) 1.29 (1.15, 1.45) 1.34 (1.20, 1.49) 0.95 Model 2 1.23 (1.13, 1.33) 1.23 (1.09, 1.39) 1.22 (1.09, 1.36) 0.81 Model 3 1.21 (1.12, 1.31) 1.21 (1.07, 1.37) 1.20 (1.07, 1.34) 0.73 Model 1: Age, Sex, and Region Model 2: Model 1 + Hypertension, Diabetes, Smoking, Total Cholesterol, HDL Cholesterol, Taking Dyslipidemia Meds Model 3: Model 2 + Income, Education

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