The St. Louis African American health-heart study: methodology for the study of cardiovascular disease and depression in young-old African Americans

Background: Prior studies suggest that African Americans (AA) have lower prevalence of coronary artery calcium (CAC) compared to whites, yet CAC has similar ability to predict coronary heart disease (CHD) events. The role of CAC as a screening tool for CHD risk in AA is unclear. We compared the diagnostic accuracy for CHD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AA. Methods: CAC was measured in 2944 participants in the Jackson Heart Study, an NHLBI funded study of AA based in Jackson, MS. Approximately 8% of this cohort had known cardiovascular disease (CVD) defined as prior MI, angina, stroke, PTCA, CABG or PVD. Logistic regression, ROC and net reclassification index (NRI) analysis were used adjusting for age, gender, SBP, total and HDL cholesterol, smoking status, DM and BMI. FRS was calculated and those with DM were classified as high risk. Results: The mean age was 60, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.26 (1.17, 1.35), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. The FRS classified 30% of the cohort as high risk, 38.5% as intermediate risk and 31.5% as low risk. FRS classfied 51% of subjects with prevalent CVD as high risk. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD (see figure). Conclusion: In AA, the CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC in AA may be useful in identifying individuals at risk of CVD and reclassifying individuals with low and intermediate FRS.

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Abstract P012: Hypertension and Alterations in Left Ventricular Geometry in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.131.suppl_1.p012 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Marwah Abdalla ◽

John N Booth ◽

Keith M Diaz ◽

Mario Sims ◽

Paul Muntner ◽

...

Keyword(s):

Cardiovascular Disease ◽

African Americans ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Jackson Heart Study ◽

Antihypertensive Medications ◽

Geometric Patterns ◽

Ventricular Geometry ◽

Disease Outcomes ◽

Heart Study

Introduction: Compared with whites, African Americans (AAs) have a higher risk for hypertension-related cardiovascular disease outcomes, which may be related to alterations in left ventricular geometry. Scarce data exist on how the left ventricle remodels in response to hypertension among AAs. Hypothesis: We hypothesized that among AAs, hypertension will be associated with abnormal echocardiographic–derived left ventricular geometric patterns defined as concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Methods: We analyzed data from the Jackson Heart Study, a community-based AA cohort who completed a baseline exam that included clinic blood pressure (CBP) and 2D echocardiography (n=5,301). CR, CH, EH, and normal patterns were defined according to left ventricular mass index and relative wall thickness defined using standard American Society of Echocardiography recommendations. The analysis was restricted to 4,572 participants with complete CBP, information on antihypertensive medication, and echocardiographic data. Results: Mean ± SD age was 55.5 ± 12.7 years; 64% were female. Mean ± SD systolic and diastolic CBP was 127 ± 18 and 79 ± 11 mmHg, respectively; 2,785 (61%) of participants had hypertension (CBP ≥140/90 mmHg and/or taking antihypertensive medications). The prevalence of CR, CH, and EH were 10.1%, 5.2%, and 8.2%, respectively. In a multivariable-adjusted model with a normal pattern as the referent group, hypertension was associated with a greater risk of CR, CH, and EH: odds ratio 1.85 (95% confidence interval (CI) 1.43-2.38), 4.16 (95% CI 2.53-6.86), and 1.67 (95% CI: 1.26-2.23) respectively. Among hypertensive participants, older age was significantly associated with CR, CH, and EH after multivariable adjustment. Higher systolic CBP, current smoking and a higher number of classes of antihypertensive medications were additionally significantly associated with CH and EH. Male sex, and heavy and moderate alcohol consumption versus none were also significantly associated with CR. Conclusions: In conclusion, abnormal left ventricular geometry was present in almost 25% of AAs. Hypertension was associated with each abnormal geometric pattern, with approximately a four-fold greater odds for CH. Future studies should examine whether abnormal left ventricular geometric patterns, particularly CH, explains the increased risk of cardiovascular disease outcomes associated with hypertension in AAs.

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What the Jackson Heart Study Has Taught Us About Diabetes and Cardiovascular Disease in the African American Community: a 20-year Appreciation

Current Diabetes Reports ◽

10.1007/s11892-021-01413-4 ◽

2021 ◽

Vol 21 (10) ◽

Author(s):

Tennille Leak-Johnson ◽

Fengxia Yan ◽

Pamela Daniels

Keyword(s):

Cardiovascular Disease ◽

African American ◽

African American Community ◽

Jackson Heart Study ◽

Heart Study

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Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.133.suppl_1.mp65 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

John N Booth ◽

Keith M Diaz ◽

Samantha Seals ◽

Mario Sims ◽

Joseph Ravenell ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Blood Pressure Monitoring ◽

Masked Hypertension ◽

Jackson Heart Study ◽

Cvd Risk ◽

Nocturnal Hypertension ◽

Heart Study ◽

All Cause Mortality

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

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Association Between Cardiometabolic Factors and Dizziness in African Americans: The Jackson Heart Study

Journal of the American Academy of Audiology ◽

10.1055/s-0041-1722949 ◽

2021 ◽

Author(s):

Amrita Ray ◽

Christopher Spankovich ◽

Charles E. Bishop ◽

Dan Su ◽

Yuan-I Min ◽

...

Keyword(s):

Blood Pressure ◽

African American ◽

African Americans ◽

Noise Exposure ◽

Medication Use ◽

Blood Pressure Medication ◽

Jackson Heart Study ◽

Screening Questionnaire ◽

Heart Study ◽

Cardiometabolic Factors

Abstract Background Balance dysfunction is a complex, disabling health condition that can present with multiple phenotypes and etiologies. Data regarding prevalence, characterization of dizziness, or associated factors is limited, especially in an African American population. Purpose The aim of the study is to characterize balance dysfunction presentation and prevalence in an African American cohort, and balance dysfunction relationship to cardiometabolic factors. Research Design The study design is descriptive, cross sectional analysis. Study Sample The study sample consist of N = 1,314, participants in the Jackson Heart Study (JHS). Data Collection and Analysis JHS participants were presented an initial Hearing health screening questionnaire (N = 1,314). Of these, 317 participants reported dizziness and completed a follow-up Dizziness History Questionnaire. Descriptive analysis was used to compare differences in the cohorts' social-demographic characteristics and cardiometabolic variables to the 997 participants who did not report dizziness on the initial screening questionnaire. Based on questionnaire responses, participants were grouped into dizziness profiles (orthostatic, migraine, and vestibular) to further examine differences in cardiometabolic markers as related to different profiles of dizziness. Logistical regression models were adjusted for age, sex, education, reported noise exposure, and hearing sensitivity. Results Participants that reported any dizziness were slightly older and predominantly women. Other significant complaints in the dizzy versus nondizzy cohort included hearing loss, tinnitus, and a history of noise exposure (p < 0.001). Participants that reported any dizziness had significantly higher prevalence of hypertension, blood pressure medication use, and higher body mass index (BMI). Individuals with symptoms alluding to an orthostatic or migraine etiology had significant differences in prevalence of hypertension, blood pressure medication use, and BMI (p < 0.001). Alternatively, cardiometabolic variables were not significantly related to the report of dizziness symptoms consistent with vestibular profiles. Conclusion Dizziness among African Americans is comparable to the general population with regards to age and sex distribution, accordingly to previously published estimates. Participants with dizziness symptoms appear to have significant differences in BMI and blood pressure regulation, especially with associated orthostatic or migraine type profiles; this relationship does not appear to be conserved in participants who present with vestibular etiology symptoms.

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Differential DNA Methylation and Cardiometabolic Risk in African American Mother-Adolescent Dyads

Biological Research For Nursing ◽

10.1177/10998004211039017 ◽

2021 ◽

pp. 109980042110390

Author(s):

Amanda Elswick Gentry ◽

Jo Robins ◽

Mat Makowski ◽

Wendy Kliewer

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Dna Methylation ◽

African American ◽

African Americans ◽

Waist Circumference ◽

Low Income ◽

Cardiometabolic Risk ◽

Disease Risk ◽

Cardiovascular Disease Risk

Background: Cardiovascular disease disproportionately affects African Americans as the leading cause of morbidity and mortality. Among African Americans, compared to other racial groups, cardiovascular disease onset occurs at an earlier age due to a higher prevalence of cardiometabolic risk factors, particularly obesity, hypertension and type 2 diabetes. Emerging evidence suggests that heritable epigenetic processes are related to increased cardiovascular disease risk, but this is largely unexplored in adolescents or across generations. Materials and Methods: In a cross-sectional descriptive pilot study in low-income African American mother-adolescent dyads, we examined associations between DNA methylation and the cardiometabolic indicators of body mass index, waist circumference, and insulin resistance. Results: Four adjacent cytosine and guanine nucleotides (CpG) sites were significantly differentially methylated and associated with C-reactive protein (CRP), 62 with waist circumference, and none to insulin resistance in models for both mothers and adolescents. Conclusion: Further study of the relations among psychological and environmental stressors, indicators of cardiovascular disease, risk, and epigenetic factors will improve understanding of cardiovascular disease risk so that preventive measures can be instituted earlier and more effectively. To our knowledge this work is the first to examine DNA methylation and cardiometabolic risk outcomes in mother-adolescent dyads.

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Abstract P345: Prediction of Cardiovascular Disease Events and Death using Multiple Biomarkers in African Americans: the Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p345 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Solomon K Musani ◽

Ramachandran Vasan ◽

Aurelian Bidulescu ◽

Jung Lee ◽

Gregory Wilson ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

African Americans ◽

High Sensitivity ◽

Serum Cortisol ◽

Jackson Heart Study ◽

Cvd Risk ◽

Risk Reclassification ◽

Heart Study ◽

Traditional Risk Factors

Background: The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood. Methods: We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors. Results: On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors. Conclusions: In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.

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Abstract P150: Aldosterone Dysregulation Increases Cardiovascular Risk in African-American Youth

Circulation ◽

10.1161/circ.125.suppl_10.ap150 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Gregory A Harshfield ◽

Evan Mulloy ◽

Melinda Beavers

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

African American ◽

African Americans ◽

Early Development ◽

Salt Intake ◽

Target Organ Damage ◽

Target Organ ◽

High Salt ◽

High Salt Intake

Background: The prevalence of hypertension and blood pressure-related target organ damage in African-Americans is among the highest in the world. We hypothesize that this is in part due to aldosterone dysregulation among African-Americans beginning in youth and leading to the early development of cardiovascular disease in this population. To begin to test this hypothesis, we examined ethnic differences in aldosterone regulation in normal, healthy adolescents. Methods: The subjects in this study were 145 (60 Caucasian, 85 African-American) healthy, normotensive youth aged 15–19 years. Testing was performed following 72 hours on a controlled sodium diet. Testing consisted of the collection of aldosterone, systolic blood pressure (SBP), and urinary sodium excretion (U Na V) during continuous water intake (400 ml total) over a 2 hour period. An echocardiogram was also performed to measure target organ changes. Log transformations were performed on aldosterone levels prior to analyses. Results: African-American compared to Caucasian subjects had higher casual SBP (109±10 v 104±10; p=.006) and relative wall thickness (0.32±.03 v 0.34±.04; p=.003). During the testing procedure African-Americans also had lower levels of aldosterone (4.78±.6 v 4.35±.6 pg/ml; p =.001). In the Caucasian subjects only, aldosterone was inversely correlated with U Na V (r=−0.427; p=.001) and U Na V was positively correlated with SBP (r=0.356; p=.001). The subjects were divided into those in the upper and lower quartiles of salt intake for further analysis. The interaction between race and salt intake was significant for aldosterone (F=7.173; p=.008). Caucasian subjects with high salt intake had lower aldosterone (4.56±.59 v 5.02±0.59 pg/ml). However, aldosterone levels did not differ by salt intake in African-Americans. Summary and Conclusion: African-American subjects did not show the expected associations between aldosterone and the pressure natriuresis relation. Furthermore, African-Americans on the high salt intake failed to suppress aldosterone. These findings are consistent with our hypothesis that aldosterone dysregulation in youth may lead to the early development of cardiovascular disease in Africans-Americans.

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Abstract MP58: Racial Residential Segregation is Associated With Worse Cardiovascular Health in African American Adults: The Jackson Heart Study

Circulation ◽

10.1161/circ.137.suppl_1.mp58 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Sharrelle Barber ◽

Kiarri Kershaw ◽

Xu Wang ◽

Mario Sims ◽

Julianne Nelson ◽

...

Keyword(s):

African American ◽

African Americans ◽

Residential Segregation ◽

Cardiovascular Health ◽

Jackson Heart Study ◽

Racial Residential Segregation ◽

African American Adults ◽

Heart Study ◽

Neighborhood Environments ◽

The Impact

Introduction: Racial residential segregation results in increased exposure to adverse neighborhood environments for African Americans; however, the impact of segregation on ideal cardiovascular health (CVH) has not been examined in large, socioeconomically diverse African American samples. Using a novel spatial measure of neighborhood-level racial residential segregation, we examined the association between segregation and ideal CVH in the Jackson Heart Study (JHS). Hypothesis: Racial residential segregation will be associated with worse cardiovascular health among African American adults. Methods: The sample included 4,354 men and women ages 21-93 from the baseline exam of the JHS (2000-2004). Racial residential segregation was assessed at the census-tract level. Data on racial composition (% African American) from the 2000 US Census was used to calculate the local G i * statistic- a spatially-weighted z-score that represents how much a neighborhood’s racial/ethnic composition deviates from the larger metropolitan area. Ideal CVH was assessed using the AHA Life’s Simple Seven (LS7) index which includes 3 behavioral (nutrition, physical activity, and smoking) and 4 biological (systolic BP, glucose, BMI, and cholesterol) metrics of CVH. Multivariable regression models were used to test associations between segregation and the LS7 index continuously (range: 0-14) and categorically (Inadequate: 0-4; Average: 5-9; and Optimal: 10-14). Covariates included age, sex, income, education, and insurance status. Results: The average LS7 summary score was 7.03 (±2.1) and was lowest in the most racially segregated neighborhood environments (High Segregation: 6.88 ±2.1 vs. Low Segregation: 7.55 ±2.1). The prevalence of inadequate CVH was higher in racially segregated neighborhoods (12.3%) compared to neighborhoods that were the least segregated (6.9%). After adjusting for key socio-demographic characteristics, racial residential segregation was inversely associated with ideal CVH (B=-0.041 ±0.02, p=0.0146). Moreover, a 1-SD unit increase in segregation was associated with a 6% increased odds of having inadequate CVH (OR: 1.06, 95% CI: 1.00-1.12, p=0.0461). Conclusion: In conclusion, African Americans in racially segregated neighborhoods are less likely to achieve ideal CVH even after accounting for individual-level factors. Policies aimed at restricting housing segregation/discrimination and/or structural interventions designed to improve neighborhood environments may be viable strategies to improving CVH in this at-risk population.

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Abstract P114: Low Prevalence of Ideal Cardiovascular Health Metrics among African Americans: The Jackson Heart Study

Circulation ◽

10.1161/circ.129.suppl_1.p114 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Luc Djousse ◽

Andrew Petrone ◽

Chad Blackshear ◽

Michael Griswold ◽

Jane Harman ◽

...

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Cardiovascular Disease ◽

African Americans ◽

Cardiovascular Health ◽

Smoking Status ◽

Jackson Heart Study ◽

Men And Women ◽

Ideal Cardiovascular Health ◽

Heart Study

Background: While the prevalence of cardiovascular health metrics or Life’s Simple Seven (LSS) has been shown to be far from optimal in the US, such information has been predominantly reported in Caucasians. The burden of cardiovascular disease among African Americans underscores the need to evaluate the prevalence and secular trends of LSS in other ethnic groups. Objective: To test the hypothesis that the prevalence of the LSS is far from ideal among participants of the Jackson Heart Study. Methods: We analyzed LSS with 3,500 African Americans from the Jackson Heart Study, using data from their first clinic visit (2000-2004). Standard methods were used to measure blood pressure, glucose, body mass index (BMI), and cholesterol. Information on physical activity, smoking, and diet was collected with interviewer-administered questionnaires. Each of the LSS metrics (smoking status, diet, physical activity, BMI, fasting blood glucose, total cholesterol, and blood pressure) was categorized as poor, intermediate, or ideal, as defined by the AHA guidelines. Results: The mean age at baseline was 56.9 ± 12.2 years and 2,350 participants (67%) were women. Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 6.6%, 25.8%, 32.7%, 21.6%, 10.6%, 2.3%, 0.4%, and 0%, respectively. Corresponding values for women were 3.2%, 28.1%, 32.9%, 22.3%, 10.1%, 2.9%, 0.38%, and 0%. While about two-thirds of men and women reported ideal smoking status, almost none reported ideal diet quality, and few met recommendations for BMI and blood pressure ( Figure) . Conclusions: Our data are consistent with less than optimal prevalence of cardiovascular health metrics in both men and women from the Jackson Heart Study. The lower prevalence of meeting ideal recommendations for diet, physical activity, BMI, and blood pressure underscores the need for targeted interventions to improve these modifiable lifestyle factors in order to reduce the burden of cardiovascular disease among African-Americans.

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