Heterogeneity in Trajectories of Systolic Blood Pressure among Young
                        Adults in Qingdao Port Cardiovascular Health Study

Abstract Heterogeneous exposure associations (HEAs) can be defined as differences in the association of an exposure with an outcome among subgroups that differ by a set of characteristics. In this article, we intend to foster discussion of HEAs in the epidemiologic literature and present a variant of the random forest algorithm that can be used to identify HEAs. We demonstrate the use of this algorithm in the setting of the association between systolic blood pressure and death in older adults. The training set included pooled data from the baseline examination of the Cardiovascular Health Study (1989–1993), the Health, Aging, and Body Composition Study (1997–1998), and the Sacramento Area Latino Study on Aging (1998–1999). The test set included data from the National Health and Nutrition Examination Survey (1999–2002). The hazard ratios ranged from 1.25 (95% confidence interval: 1.13, 1.37) per 10-mm Hg increase in systolic blood pressure among men aged ≤67 years with diastolic blood pressure greater than 80 mm Hg to 1.00 (95% confidence interval: 0.96, 1.03) among women with creatinine concentration ≤0.7 mg/dL and a history of hypertension. HEAs have the potential to improve our understanding of disease mechanisms in diverse populations and guide the design of randomized controlled trials to control exposures in heterogeneous populations.

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Abstract TP164: Blood Pressure and Heart Rate Measures and Risk of Covert Brain Infarction and Worsening White Matter in Older Adults

Stroke ◽

10.1161/str.48.suppl_1.tp164 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lester Y Leung ◽

Traci M Bartz ◽

Kenneth Rice ◽

James Floyd ◽

Bruce Psaty ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Heart Rate ◽

White Matter ◽

Cardiovascular Health ◽

Brain Infarction ◽

Health Study ◽

Cardiovascular Health Study ◽

Mri Findings ◽

Increased Risk

Introduction: Covert brain infarction (CBI) and worsening white matter grade (WMG) on serial MRI are associated with increased risk for ischemic stroke and dementia. Hypothesis: We sought to evaluate the association of various measures of blood pressure and heart rate with these MRI findings. Methods: In the Cardiovascular Health Study, a longitudinal cohort study of cardiovascular disease in older adults, we used relative risk regression to assess the risk of incident CBI and worsening WMG associated with mean, variability, and trend in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) measured at four or more annual clinic visits between two brain MRIs. We included participants who underwent both brain MRIs and had no change in antihypertensive medication status, no CBI on the initial MRI, and no stroke before the follow-up MRI. Results: Among 897 eligible participants, incident CBI occurred in 15% and worsening WMG in 27%. Mean SBP mean was strongly associated with increased risk for incident CBI (RR per 10 mmHg 1.29; 95% CI, 1.13-1.47), and DBP mean was strongly associated with increased risk for worsening WMG (RR per 10 mmHg 1.43; 95% CI, 1.23-1.67). DBP variability may be associated with incident CBI (RR per 10 mmHg 1.71; 95% CI, 1.10-2.65), The HR measures were not associated with these MRI findings. Conclusions: Elevated mean levels of blood pressure contribute to covert cerebrovascular diseases. Control of mean blood pressure levels, even in older adults, remains a high priority for prevention of vascular brain injury.

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Trends in Blood Pressure and High-Sensitivity Cardiac Troponin-T With Cardiovascular Disease: The Cardiovascular Health Study

American Journal of Hypertension ◽

10.1093/ajh/hpz102 ◽

2019 ◽

Vol 32 (10) ◽

pp. 1013-1020 ◽

Cited By ~ 1

Author(s):

David M Tehrani ◽

Wenjun Fan ◽

Vijay Nambi ◽

Julius Gardin ◽

Calvin H Hirsch ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Troponin ◽

Cardiovascular Health ◽

Troponin T ◽

High Sensitivity ◽

Health Study ◽

Cardiovascular Health Study ◽

Cvd Risk ◽

Over Time

AbstractBackgroundHigh-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD.METHODSThe Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2–3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120–139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5–13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up.RESULTSAmong 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04–1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08–2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01).CONCLUSIONAn increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.

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Blood Pressure Variability and the Risk of All-Cause Mortality, Incident Myocardial Infarction, and Incident Stroke in the Cardiovascular Health Study

American Journal of Hypertension ◽

10.1093/ajh/hpt092 ◽

2013 ◽

Vol 26 (10) ◽

pp. 1210-1217 ◽

Cited By ~ 55

Author(s):

Astrid M. Suchy-Dicey ◽

Erin R. Wallace ◽

Mitchell S. Elkind ◽

Maria Aguilar ◽

Rebecca F. Gottesman ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Blood Pressure Variability ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

All Cause Mortality

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The Association Between Time Since Last Meal and Blood Pressure in Older Adults: The Cardiovascular Health Study

Journal of the American Geriatrics Society ◽

10.1046/j.1365-2389.2003.51264.x ◽

2003 ◽

Vol 51 (6) ◽

pp. 824-828 ◽

Cited By ~ 13

Author(s):

Nicholas L. Smith ◽

Bruce M. Psaty ◽

Gale H. Rutan ◽

Thomas Lumley ◽

David Yanez ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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Abstract 3744: Cystatin C Is Associated With Mitral Annular Calcification In Elderly Adults: Results From The Cardiovascular Health Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_851-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Folkert W Asselbergs ◽

Dariush Mozaffarian ◽

Ronit Katz ◽

Bryan Kestenbaum ◽

Linda F Fried ◽

...

Keyword(s):

Blood Pressure ◽

Kidney Disease ◽

Cystatin C ◽

Cardiovascular Health ◽

Hdl Cholesterol ◽

Health Study ◽

Cardiovascular Health Study ◽

Mitral Annular Calcification ◽

Waist To Hip Ratio ◽

Annular Calcification

Background : A high prevalence of cardiac calcification has been observed in patients with end-stage kidney disease. The association between cardiac calcification and milder kidney disease has been less thoroughly characterized. We hypothesize that renal function is associated with mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVS) in elderly. Methods and results : From the Cardiovascular Health Study (CHS), we analyzed 3,929 subjects (74 ± 5 years, 60% women), who underwent a 2-dimensional echocardiogram between 1994 –1995. Measures of kidney function were creatinine-based estimated glomerular filtration rate (eGFR) as calculated by the MDRD equation and cystatin C levels. MAC was present in 42 %, AAC in 44%, and AVS in 54% of the subjects. Subjects with MAC, AAC, and AVS were significantly older and significantly more subjects used anti-hypertensive medication and had prevalent cardiovascular disease (p<0.05). Participants with MAC had higher blood pressure levels, LDL-cholesterol levels, waist to hip ratio, fibrinogen levels and a higher prevalence of diabetes (p<0.05). Participants with AVS were more likely to be male, had higher systolic blood pressure, lower HDL-cholesterol, and higher waist to hip ratio (p<0.05). Levels of cystatin C were significantly higher in subjects with MAC in comparison to subjects without MAC (mean ± standard deviation 1.12 ± 0.33 versus 1.07 ± 0.25 mg/L, p<0.001). We found similar differences in those with and without AAC (1.11 ± 0.33 versus 1.07 ± 0.25 mg/L, p<0.001). Using logistic regression analysis, there was a significant and graded association between quartiles of Cystatin C levels and MAC (adjusted odds ratios and 95% confidence intervals) 1.0, 1.09 (0.91 to 1.32), 1.16 (0.96 to 1.40), and 1.27 (1.04 to 1.55) for quartiles 1 through 4 respectively (p for trend 0.017). In addition, Cystatin C levels were significantly associated with AAC (p<0.001), but this association became non-significant after adjustment for co-variates (p<0.174). No associations were present between Cystatin C and aortic sclerosis, and eGFR and cardiac calcifications. Conclusion : Cystatin C was significantly associated with the presence of MAC in a population-based cohort of elderly.

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