Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study

Background Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population. Methods and findings We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21–95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants’ adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78–1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80–1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71–1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78–1.18), 0.94 (0.76–1.16), and 1.06 (0.86–1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74–1.61), 1.11 (0.76–1.61), and 0.79 (0.52–1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66–1.52), 0.91 (0.61–1.36), and 1.26 (0.84–1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods. Conclusions In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.

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Added value of cardiovascular calcifications for prediction of recurrent cardiovascular events and cardiovascular interventions in patients with established cardiovascular disease

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02164-9 ◽

2021 ◽

Author(s):

Cilie C. van ’t Klooster ◽

◽

Yolanda van der Graaf ◽

Hendrik M. Nathoe ◽

Michiel L. Bots ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Valve ◽

Cardiovascular Events ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Added Value ◽

Cvd Risk ◽

Major Cardiovascular Events ◽

Cox Proportional Hazards Models ◽

Cardiovascular Interventions

AbstractThe purpose is to investigate the added prognostic value of coronary artery calcium (CAC), thoracic aortic calcium (TAC), and heart valve calcium scores for prediction of a combined endpoint of recurrent major cardiovascular events and cardiovascular interventions (MACE +) in patients with established cardiovascular disease (CVD). In total, 567 patients with established CVD enrolled in a substudy of the UCC-SMART cohort, entailing cardiovascular CT imaging and calcium scoring, were studied. Five Cox proportional hazards models for prediction of 4-year risk of MACE + were developed; traditional CVD risk predictors only (model I), with addition of CAC (model II), TAC (model III), heart valve calcium (model IV), and all calcium scores (model V). Bootstrapping was performed to account for optimism. During a median follow-up of 3.43 years (IQR 2.28–4.74) 77 events occurred (MACE+). Calibration of predicted versus observed 4-year risk for model I without calcium scores was good, and the c-statistic was 0.65 (95%CI 0.59–0.72). Calibration for models II–V was similar to model I, and c-statistics were 0.67, 0.65, 0.65, and 0.68 for model II, III, IV, and V, respectively. NRIs showed improvement in risk classification by model II (NRI 15.24% (95%CI 0.59–29.39)) and model V (NRI 20.00% (95%CI 5.59–34.92)), but no improvement for models III and IV. In patients with established CVD, addition of the CAC score improved performance of a risk prediction model with classical risk factors for the prediction of the combined endpoint MACE+ . Addition of the TAC or heart valve score did not improve risk predictions.

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Dietary Omega-3 Fatty Acid Intake and Mortality in CKD Population: A 1999–2014 NHANES Analysis

American Journal of Nephrology ◽

10.1159/000520027 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Lan Li ◽

Nan-Hui Zhang ◽

Shu-Wang Ge ◽

Gang Xu

Keyword(s):

Cardiovascular Disease ◽

Fatty Acid ◽

Proportional Hazards ◽

Early Death ◽

Cox Proportional Hazards ◽

Omega 3 ◽

Pufa Intake ◽

Dietary Recall ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Introduction: High risk of early death, especially contributed to cardiovascular disease, exists in patients who have chronic kidney disease (CKD). And the burden of cardiovascular disease is able to be lightened by an increase in omega-3 polyunsaturated fatty acid (omega-3 PUFA). A diet high in omega-3 PUFA in the general population is protective, although it is inconclusive about its beneficial role in the CKD population. Methods: From the 1999 to 2014 National Health and Nutrition Examination Surveys (NHANES), we can collect 2,990 participants who suffered from CKD, who were classified into 4 groups: <0.86, 0.87–1.30, 1.31–1.92, and 1.93–9.65 g/day based on NHANES 24-h dietary recall questionnaire dietary omega-3 PUFA. Moreover, their mortality details were available to be obtained by linking NHANES to the National Death Index. The associations between dietary omega-3 PUFA and mortality were evaluated by constructing multivariable Cox proportional hazards models. Results: Over 8 years of a median follow-up, 864 deaths were recorded. The adjusted hazard ratios (95% confidence interval) for all-cause mortality of the diseased people with CKD in the 2nd (0.87–1.30 g/day), 3rd (0.87–1.30 g/day), and 4th (1.93–9.65 g/day) quartiles of dietary omega-3 PUFA were 0.94 (0.72, 1.23), 0.74 (0.54, 1.02), and 0.67 (0.48, 0.93), respectively, versus those with the lowest quartile of dietary omega-3 PUFA intake (<0.86 g/day) (p for trend = 0.011). Conclusion: There may be a inverse relation of dietary omega-3 PUFA intake and all-cause mortality in patients with CKD. Therefore, an increase of dietary omega-3 PUFA may be encouraged to be used clinically in patients with CKD.

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Abstract MP02: Quantifying The Impact Of Maintenance And Changes Of Lifestyles On Risk Of Cardiovascular Disease And All-cause Mortality - The Doetinchem Cohort Study

Circulation ◽

10.1161/circ.129.suppl_1.mp02 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gerben Hulsegge ◽

Martha L Daviglus ◽

Yvonne T van der Schouw ◽

Henriëtte A Smit ◽

W M Verschuren

Keyword(s):

Cardiovascular Disease ◽

Proportional Hazards ◽

Healthy Lifestyle ◽

Single Point ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Physically Active ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

The Impact

Background: It is not fully understood to what extent changes in lifestyle over time influence the risk of cardiovascular disease (CVD) and death among healthy adults, since most studies assessed lifestyle at a single point in time. Objective: To investigate the association of maintenance and changes in lifestyle profiles over 5 years with risk of CVD and all-cause mortality. Methods: Healthy lifestyle factors (HLF), i.e., healthy diet, physically active, not smoking, moderate alcohol consumption, sufficient sleep duration, and normal weight were assessed among 5,290 CVD- and cancer-free adults aged 25-65 years in 1993-1997 (baseline examination). Participants were categorized as having unhealthy (0-2 HLF), moderately healthy (3-4 HLF), or healthy (5-6 HLF) lifestyles. They were subdivided as maintained, improved, or deteriorated HLF 5 years later (1998-2002). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CI) for combined fatal and non-fatal CVD and all-cause mortality following the risk-change period were estimated using Cox proportional hazards models. Results: Individuals who maintained their HLF had 62% lower risk of CVD (HR: 0.38, 95%CI: 0.23-0.64) (Figure 1) and 54% for all-cause mortality (HR: 0.46, 95%CI: 0.27-0.77) than those who maintained unhealthy lifestyles. In general, compared to maintenance of HLF, improvement and deterioration of HLF were associated with better or worse HRs than their baseline risks for CVD and all-cause mortality, respectively. Conclusion: Maintenance of a healthy lifestyle is associated with significant and independent low risk of CVD and all-cause mortality. Effort is needed to improve the adoption and maintenance of a healthy lifestyle.

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Joint Association of Modifiable Lifestyle and Metabolic Health Status with Incidence of Cardiovascular Diabetes and All-Cause mortality: A Perspective Cohort Study

10.21203/rs.3.rs-133364/v1 ◽

2020 ◽

Author(s):

Yingting Zuo ◽

Haibin Li ◽

Shuohua Chen ◽

Xue Tian ◽

Dapeng Mo ◽

...

Keyword(s):

Health Status ◽

Proportional Hazards ◽

Healthy Lifestyle ◽

Cox Proportional Hazards ◽

Metabolic Health ◽

Metabolic Risk ◽

Cvd Risk ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Joint Associations

Abstract Background We investigated the joint associations of modifiable lifestyle and metabolic factors with incident cardiovascular disease (CVD) and all-cause mortality.MethodsThis study included 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of CVD at baseline from Kailuan study during 2006 to 2007 and followed them until new-onset CVD event, death or December 31, 2017. Baseline metabolic health status was assessed by Adult Treatment Panel-III (ATP-III) criteria and five lifestyle factors was collected using a self-reported questionnaire. We performed Cox proportional hazards models to evaluate the joint associations.Results During a median follow-up of 11.03 years, we observed 6,590 CVD events and 9,218 all-cause mortality. Participants within more metabolic risk components and least healthy lifestyle had the highest CVD risk (hazard ratio [HR] 2.06 [95% CI 1.77-2.39]) and mortality risk (HR 1.53 [95% CI 1.31-1.78]), as compared with the less metabolic risk components and most healthy lifestyle group. Compared with the most healthy lifestyle, the HR of CVD for participants with least healthy lifestyle was 1.26 (95% CI 1.17–1.37) in the category with low metabolic risk, 1.16 (95% CI 1.03–1.31) and 1.07 (95% CI 0.90–1.27) for those with medium and high metabolic risk, respectively.ConclusionsWe showed that healthy lifestyle and metabolic health were associated with a lower risk of CVD and all-cause mortality. The association between metabolic risk and the risk of CVD was not modified by healthy lifestyle. Our results indicated that healthy lifestyle should be promoted even for people with high metabolic risk.

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Risk and Timing of Cardiovascular Disease After Androgen-Deprivation Therapy in Men With Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.59.1792 ◽

2015 ◽

Vol 33 (11) ◽

pp. 1243-1251 ◽

Cited By ~ 121

Author(s):

Sean O'Farrell ◽

Hans Garmo ◽

Lars Holmberg ◽

Jan Adolfsson ◽

Pär Stattin ◽

...

Keyword(s):

Prostate Cancer ◽

Cardiovascular Disease ◽

Androgen Deprivation Therapy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Androgen Deprivation ◽

Gnrh Agonists ◽

Cvd Risk ◽

Comparison Cohort ◽

Using Data

Purpose Findings on the association between risk of cardiovascular disease (CVD) and the duration and type of androgen-deprivation therapy (ADT) in men with prostate cancer (PCa) are inconsistent. Methods By using data on filled drug prescriptions in Swedish national health care registers, we investigated the risk of CVD in a cohort of 41,362 men with PCa on ADT compared with an age-matched, PCa-free comparison cohort (n = 187,785) by use of multivariable Cox proportional hazards regression models. Results From 2006 to 2012, 10,656 men were on antiandrogens (AA), 26,959 were on gonadotropin-releasing hormone (GnRH) agonists, and 3,747 underwent surgical orchiectomy. CVD risk was increased in men on GnRH agonists compared with the comparison cohort (hazard ratio [HR] of incident CVD, 1.21; 95% CI, 1.18 to 1.25; and orchiectomy: HR, 1.16; 95% CI, 1.08 to 1.25). Men with PCa on AA were at decreased risk (HR of incident CVD, 0.87; 95% CI, 0.82 to 0.91). CVD risk was highest during the first 6 months of ADT in men who experienced two or more cardiovascular events before therapy, with an HR of CVD during the first 6 months of GnRH agonist therapy of 1.91 (95% CI, 1.66 to 2.20), an HR of CVD with AA of 1.60 (95% CI, 1.24 to 2.06), and an HR of CVD with orchiectomy of 1.79 (95% CI, 1.16 to 2.76) versus the comparison cohort. Conclusion Our results support that there should be a solid indication for ADT in men with PCa so that benefit outweighs potential harm; this is of particular importance among men with a recent history of CVD.

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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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Abstract 17: Association of Race and Sex with Cardiovascular Disease and Non-Cardiovascular Disease Mortality: The REasons for Geographic and Racial Differences in Stroke study

Circulation ◽

10.1161/circ.135.suppl_1.17 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Gabriel S Tajeu ◽

Monika M Safford ◽

George Howard ◽

Rikki M Tanner ◽

Paul Muntner

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cvd Risk ◽

Hazard Ratios ◽

Stroke Study ◽

Cvd Mortality

Introduction: Black Americans have higher rates of cardiovascular disease (CVD) mortality compared with whites. Differences in sociodemographic, psychosocial, CVD, and other risk factors may explain increased mortality risk. Methods: We analyzed data from 29,015 REasons for Geographic and Racial Differences in Stroke study participants to determine factors that may explain the higher hazard ratio for CVD and non-CVD mortality in blacks compared with whites. Cause of death was adjudicated by trained investigators. Within age-sex sub-groups, we used Cox proportional hazards regression with progressive adjustment to estimate black:white hazard ratios. Results: Overall, 41.0% of participants were black, and 54.9% were women. Over a mean follow-up of 7.1 years (maximum 12.3 years), 5,299 participants died (1,797 CVD and 3,502 non-CVD deaths). Among participants < 65 years of age, the age and region adjusted black:white hazard ratio for CVD mortality was 2.28 (95% CI: 1.68-3.10) and 2.32 (95% CI: 1.80-3.00) for women and men, respectively, and for participants ≥ 65 was 1.54 (95% CI: 1.30-1.82) and 1.35 (95% CI: 1.16-1.57) for women and men, respectively ( Table ). The higher black:white hazard ratios for CVD mortality were no longer statistically significant after multivariable adjustment, with the largest attenuation occurring with sociodemographic and CVD risk factor adjustment. Among participants < 65 years of age, the age and region adjusted black:white hazard ratios for non-CVD mortality were 1.51 (95% CI: 1.24-1.85) and 1.76 (95% CI: 1.46-2.13) for women and men, respectively, and for participants ≥ 65 was 1.12 (95% CI: 1.00-1.26) and 1.34 (95% CI: 1.20-1.49) for women and men, respectively. The higher black:white hazard ratios for non-CVD mortality were attenuated after adjustment for sociodemographics. Conclusions: Black:white differences are larger for CVD than non-CVD causes of death. The increased CVD mortality for blacks compared with whites is primarily explained by sociodemographic and CVD risk factors.

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Urinary Ethyl Glucuronide as Measure of Alcohol Consumption and Risk of Cardiovascular Disease: A Population‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.119.014324 ◽

2020 ◽

Vol 9 (7) ◽

Cited By ~ 1

Author(s):

Inge A. T. van de Luitgaarden ◽

Ilse C. Schrieks ◽

Lyanne M. Kieneker ◽

Daan J. Touw ◽

Adriana J. van Ballegooijen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Alcohol Consumption ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Self Report ◽

Ethyl Glucuronide ◽

Categorical Variables ◽

Study Cohort ◽

Cvd Risk ◽

All Cause Mortality

Background Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease (CVD) and all‐cause mortality compared with heavy drinkers and abstainers. To date, studies have relied on self‐reported consumption, which may be prone to misclassification. Urinary ethyl glucuronide (EtG) is an alcohol metabolite and validated biomarker for recent alcohol consumption. We aimed to examine and compare the associations of self‐reported alcohol consumption and EtG with CVD and all‐cause mortality. Methods and Results In 5676 participants of the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) study cohort, EtG was measured in 24‐hour urine samples and alcohol consumption questionnaires were administered. Participants were followed up for occurrence of first CVD and all‐cause mortality. Cox proportional hazards regression models, adjusted for age, sex, and CVD risk factors, were fitted for self‐reported consumption, divided into 5 categories: abstention, 1 to 4 units/month (reference), 2 to 7 units/week, 1 to 3 units/day, and ≥4 units/day. Similar models were fitted for EtG, analyzed as both continuous and categorical variables. Follow‐up times differed for CVD (8 years; 385 CVD events) and all‐cause mortality (14 years; 724 deaths). For both self‐reported alcohol consumption and EtG, nonsignificant trends were found toward J‐shaped associations between alcohol consumption and CVD, with higher risk in the lowest (hazard ratio for abstention versus 1–4 units/month, 1.42; 95% CI, 1.02–1.98) and highest drinking categories (hazard ratio for ≥4 units/day versus 1–4 units/month, 1.11; 95% CI, 0.68–1.84). Neither self‐report nor EtG was associated with all‐cause mortality. Conclusions Comparable associations with CVD events and all‐cause mortality were found for self‐report and EtG. This argues for the validity of self‐reported alcohol consumption in epidemiologic research.

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AUTOMATED MEASUREMENT OF MUSCLE DENSITY ON COMPUTED TOMOGRAPHY (CT) PREDICTS ALL-CAUSE MORTALITY IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3234 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S883-S883

Author(s):

Leon Lenchik ◽

Ryan Barnard ◽

Robert D Boutin ◽

Stephen B Kritchevsky ◽

Ashley A Weaver ◽

...

Keyword(s):

Proportional Hazards ◽

Learning Algorithm ◽

Cox Proportional Hazards ◽

Muscle Density ◽

National Lung Screening Trial ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Automated Machine Learning ◽

Lung Screening ◽

Paraspinous Muscle

Abstract The purpose was to examine the association of paraspinous muscle density (CT surrogate of myosteatosis) with all-cause mortality in 6803 men and 4558 women, age 60-69 years (mean age 63.6) in the National Lung Screening Trial. Our fully-automated machine learning algorithm: 1) selected the appropriate CT series, 2) chose a single CT image at the level of T12 vertebra, 3) segmented the left paraspinous muscle, and 4) recorded the muscle density in Hounsfield Units (HU). Association between baseline muscle density and all-cause mortality was determined using Cox proportional hazards models, adjusted for age, race, body mass index, pack years of smoking, and presence of diabetes, lung disease, cardiovascular disease, and cancer at enrollment. After a mean 6.44 ± 1.06 years of follow-up, 635 (9.33%) men and 265 (5.81%) women died. In men, lower muscle density on baseline CT examinations was associated with increased all-cause mortality (HR per SD = 0.90; CI = 0.83, 0.99; p=0.03). Each standard deviation (7.8 HU) decrease in muscle density was associated with a 10% increase in mortality. In women, the association did not reach significance.

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Blood Pressure Change from Normal to 2017 ACC/AHA Defined Stage 1 Hypertension and Cardiovascular Risk

Journal of Clinical Medicine ◽

10.3390/jcm8060820 ◽

2019 ◽

Vol 8 (6) ◽

pp. 820 ◽

Cited By ~ 4

Author(s):

Joung Sik Son ◽

Seulggie Choi ◽

Gyeongsil Lee ◽

Su-Min Jeong ◽

Sung Min Kim ◽

...

Keyword(s):

Blood Pressure ◽

Proportional Hazards ◽

Heart Association ◽

Pressure Change ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Stage 1 ◽

Second Period

The purpose of this study was to investigate the clinical significance of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) defined stage 1 hypertension (systolic blood pressure (SBP) 130–139 mmHg or diastolic blood pressure (DBP) 80–89 mmHg), and increase in BP from previously normal BP in Korean adults. We conducted a retrospective analysis of 60,866 participants from a nationally representative claims database. Study subjects had normal BP (SBP < 120 mmHg and DBP < 80 mmHg), no history of anti-hypertensive medication, and cardiovascular disease (CVD) in the first period (2002–2003). The BP change was defined according to the BP difference between the first and second period (2004–2005). We used time-dependent Cox proportional hazards models in order to evaluate the effect of BP elevation on mortality and CVD with a mean follow-up of 7.8 years. Compared to those who maintained normal BP during the second period, participants with BP elevation from normal BP to stage 1 hypertension had a higher risk for CVD (adjusted hazard ratio (aHR) 1.23; 95% confidence interval (CI), 1.08–1.40), and ischemic stroke (aHR 1.32; 95% CI, 1.06–1.64). BP elevation to 2017 ACC/AHA defined elevated BP (SBP 120–129 mmHg and DBP < 80 mmHg) was associated with an increased risk of CVD (aHR 1.26; 95% CI, 1.06–1.50), but stage 1 isolated diastolic hypertension (SBP < 130 and DBP 80–89 mmHg) was not significantly related with CVD risk (aHR 1.12; 95% CI, 0.95–1.31).

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