Background: The definition of hypertension (HTN) is based on systolic blood pressure (SBP) and di... more Background: The definition of hypertension (HTN) is based on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Recently, however, increased attention has been given to pulse pressure (PP) and mean arterial pressure (MAP) as potential risk factors of cardiovascular disease including stroke. We examined the relationship between 4 different blood pressure indices (SBP, DBP, PP, and MAP) and incident stroke. Methods: Data were derived from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged ≥45, enrolled between 2003 and 2007 from the continental United States. A computer-assisted telephone interview obtained demographics, medical history, health behaviors and health status. At 3-4 weeks post interview, an in-home visit was conducted by a trained technician who collected blood pressure, biometrics, and blood and urine samples following standard protocols. SBP and DBP were defined as the a...
<jats:p> <jats:bold>Background:</jats:bold> Coronary heart disease (CHD) mortal... more <jats:p> <jats:bold>Background:</jats:bold> Coronary heart disease (CHD) mortality has long been higher among US blacks compared with whites, especially among younger individuals. Recent progress on eliminating these disparities has not been reported. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We examined CHD mortality in the REGARDS study, a 30,239-member national prospective cohort study that oversampled blacks (41%) and residents of the southeastern US, recruiting from 2003-7. Baseline data included interviews and in-home collection of physiologic and medication data. Telephone follow-up was conducted every 6 months to detect endpoints, triggering medical record retrieval and expert adjudication. Deaths prompted interviews with next-of-kin or proxies, collection of medical records and death certificates. We examined risks for definite or probable CHD mortality overall, and separately for in-hospital and out-of-hospital CHD death. Cox models stratified on age 65 estimated hazard ratios (HR) for CHD mortality for blacks compared with whites, adjusting for sociodemographics and CHD risk factors. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> We analyzed 14,992 participants &lt;65 years of age (44% blacks) and 14,678 &gt;65 years of age (38% blacks). There were 126 CHD deaths among those age &lt;65 and 273 among those age &gt;65 over a mean follow-up of 4.2+1.5 SD years. Adjusting for age and region of residence, excess risks among blacks were generally more pronounced for those age &lt;65, but this excess risk attenuated after adding all risk factors, except for in-hospital mortality for those &gt;65 years of age (Table). </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> Risks for CHD mortality were higher among blacks, largely attributable to higher risk factor burden especially among the young, suggesting that targeted intervention efforts are needed to overcome this disparity. The excess risk for in-hospital mortality among older blacks warrants further attention. </jats:p> <jats:p> <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="g713.jpeg" /> </jats:p>
Introduction: Stress may increase risk for coronary heart disease (CHD) and death, especially for... more Introduction: Stress may increase risk for coronary heart disease (CHD) and death, especially for individuals living in poverty. Few prospective studies have examined the relationships between stre...
<jats:p> <jats:bold>Background:</jats:bold> Overweight and obese adults living ... more <jats:p> <jats:bold>Background:</jats:bold> Overweight and obese adults living with heart failure (HF) have lower mortality compared to those of normal weight. However, the specific relationships of overall weight status and central adiposity with mortality among those with HF are less well-defined. We examined the relationships among body mass index (BMI), waist circumference (WC) and mortality among patients hospitalized for HF in the REGARDS Study. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> REGARDS is a national cohort of US community-dwelling adults aged &gt;45 recruited from 2003 to 2007. We measured all-cause mortality rates among 565 participants hospitalized with HF who were normal weight (BMI 18.5-24.9 kg/m <jats:sup>2</jats:sup> ), overweight (BMI 25.0-29.9 kg/m <jats:sup>2</jats:sup> ), or obese (BMI &gt; 30.0 kg/m <jats:sup>2</jats:sup> ) at baseline. Underweight participants (BMI &lt; 18.5 kg/m <jats:sup>2</jats:sup> ) were excluded. Baseline WC, weight, and height were measured during an in-home exam. Index HF hospitalizations during follow-up were adjudicated by a panel of experts. Vital status was determined using the Social Security Death Index or the National Death Index. Cox proportional models estimated hazard ratios for all-cause mortality following the index HF hospitalization. Models were sequentially adjusted for WC, sociodemographics, HF severity (EF and BNP during HF hospitalization, prior history of HF, prior history of diastolic dysfunction), comorbidities, and health behaviors. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> Among 565 participants hospitalized for HF, 116 (21%) were normal weight, 209 (37%) overweight, and 240 (42%) obese at baseline. Over a mean follow-up of 2.5 years, 253 deaths occurred. In multivariable analyses, overweight was associated with lower all-cause mortality in all models (Table). Each 1-cm increase in WC was associated with higher risk of all-cause mortality, but the relationship was not statistically significant after health behaviors were added in the final model. . </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> Among adults hospitalized for HF, overweight as assessed by BMI may be associated with lower risk for mortality. However, central adiposity may confer higher risk of mortality. </jats:p> <jats:p> <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="g651.jpeg" /> </jats:p>
Introduction: Prospective studies of cognitive decline are vital for the identification of risk f... more Introduction: Prospective studies of cognitive decline are vital for the identification of risk factors and preventative strategies, but there is no established definition of cognitive decline in epidemiologic studies. To plan a case-cohort biomarker study, a panel of experts sought to identify 500 participants with significant cognitive decline in the REasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Methods: REGARDS is a population-based cohort of 30,239 black and white Americans enrolled from 2003-7 in their homes and followed by telephone. Global cognitive function was measured serially using the Six Item Screener (SIS), and learning, memory, and executive function using Word List Learning (WLL), Word List Recall (WLR), and Animal Fluency (AF) tests. In an initially cognitively intact cohort (SIS > 4 at baseline), cognitive decline was defined as performance 1.5 SD below the age-, race-, sex-, and education-based norms on 2 of 3 cognitive domain scor...
Introduction: People with unrecognized myocardial infarction (UMI) have elevated risk for cardiov... more Introduction: People with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death. Population-wide electrocardiogram screening for detection of UMI would be resource intensive. We therefore sought to develop assessment tools for targeted UMI screening. Methods: Using logistic regression and a backward selection procedure, we developed two models among 16,653 participants without coronary revascularization or known myocardial infarction in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. UMI was defined as electrocardiogram evidence (using the Minnesota Code system) of myocardial infarction without a self-reported history (n = 740). The basic model used demographics, self-reported medical history, blood pressure, and body mass index; the expanded model used information on 51 potential variables including health behaviors, clinical measurements, and participant-reported health scales and symptoms. Results: The basic m...
Introduction: To identify potential targets for eliminating disparities in cardiovascular disease... more Introduction: To identify potential targets for eliminating disparities in cardiovascular disease outcomes, we examined race-sex differences in awareness, treatment and control of hyperlipidemia in the REGARDS cohort. Methods: REGARDS recruited 30,239 blacks and whites aged ≥45 residing in the 48 continental US between 2003-7. Baseline data were collected via telephone interviews followed by in-home visits. We categorized participants into coronary heart disease (CHD) risk groups (CHD or risk equivalent [highest risk]; Framingham Coronary Risk Score [FRS] >20%; FRS 10-20%; FRS <10%) following the 3 rd Adult Treatment Panel. Prevalence, awareness, treatment and control of hyperlipidemia were described across risk categories and race-sex groups. Multivariable models examined associations for hyperlipidemia awareness, treatment and control between race-sex groups compared with white men, adjusting for predisposing, enabling and need factors. Results: There were 11,677 individuals...
Background: N-terminal pro brain natriuretic peptide (NT-proBNP) has been associated with myocard... more Background: N-terminal pro brain natriuretic peptide (NT-proBNP) has been associated with myocardial infarctions (MI), but less is known about the relationship between NT-proBNP and very small non ST-elevation MIs now routinely detectable with modern troponin assays. Since these “microsize MIs” confer high long-term coronary heart disease (CHD) risks, we examined the association of NT-proBNP with incident acute CHD events, total MIs, and two MI subtypes: microsize and typical MIs. Methods: REGARDS is a national cohort of 30,237 US community-dwelling black and white adults aged ≥45 recruited from 2003 to 2007. Expert-adjudicated outcomes included incident typical MIs (definite/probable MI with peak troponin ≥0.5 μg/L), incident microsize MIs (definite/probable MI with peak troponin <0.5 μg/L), and total incident acute CHD (nonfatal MIs or CHD deaths). Low-level troponin elevations with the peak at least twice the upper limit of normal which did not have a rising and/or falling pat...
National death certificate data suggest that racial disparities in acute coronary heart disease (... more National death certificate data suggest that racial disparities in acute coronary heart disease (CHD) mortality widened over the past decade for both men and women. To better understand this disparity, we examined black:white race-sex differences in overall, fatal and nonfatal acute CHD incidence in a large national biracial cohort. REGARDS is following 30,239 community-dwellers age ≥;45 years recruited between 2003-7 from 48 states. Recruitment was designed to balance race and sex; the final sample was 55% female and 41% black. Participants are telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication following national consensus recommendations. Acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. Among participants free of CHD at baseline, we examined black:white hazards for incident overall acute CHD, and, separately, fatal and nonfatal acute CHD...
Background: Elevated C-reactive protein (CRP) is associated with coronary heart disease (CHD) ris... more 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 ...
Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary hea... more Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute...
BACKGROUND High dietary sodium intake may induce a small, yet physiologically relevant rise in se... more BACKGROUND High dietary sodium intake may induce a small, yet physiologically relevant rise in serum sodium concentration, which associates with increased systolic blood pressure. Cellular data suggest that this association is mediated by increased endothelial cell stiffness. We hypothesized that higher serum sodium levels were associated with greater arterial stiffness in participants in the Systolic Blood Pressure Intervention Trial (SPRINT). METHODS Multivariable linear regression was used to examine the association between baseline serum sodium level and (i) pulse pressure (PP; n = 8,813; a surrogate measure of arterial stiffness) and (ii) carotid–femoral pulse wave velocity (CFPWV; n = 591 in an ancillary study to SPRINT). RESULTS Baseline mean ± SD age was 68 ± 9 years and serum sodium level was 140 ± 2 mmol/L. In the PP analysis, higher serum sodium was associated with increased baseline PP in the fully adjusted model (tertile 3 [≥141 mmol] vs. tertile 2 [139–140 mmol]; β = 0...
The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative s... more The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative stress, on hemodynamic parameters at rest and during physical exertion are unclear. The aims of this investigation were to examine the independent associations of TNF-α on myocardial oxygen demand at rest and during submaximal exercise, while also evaluating the association of TNF-α on exercise tolerance. Forty, postmenopausal women, provided blood samples and completed a modified-Balke protocol to measure maximal oxygen uptake (VO). Large artery compliance was measured by pulse contour analyses while rate-pressure product (RPP), an index of myocardial oxygen demand, was measured at rest and during two submaximal workloads (i.e., ≈55% and ≈75% VO). RPP was calculated by dividing the product of heart rate and systolic blood pressure (via auscultation) by 100. Exercise tolerance corresponded with the cessation of the graded exercise test. During higher-intensity exertion, ≈75% VO, multiple ...
Left ventricular hypertrophy assessed by electrocardiography (ECG-LVH) is a marker of subclinical... more Left ventricular hypertrophy assessed by electrocardiography (ECG-LVH) is a marker of subclinical cardiac damage and a strong predictor of cardiovascular disease (CVD) events. The prevalence of ECG-LVH is increased in obesity and type 2 diabetes; however, there are no data on the long-term effects of weight loss on ECG-LVH. The purpose of this study was to determine whether an intensive lifestyle intervention (ILI) reduces ECG-LVH in overweight and obese adults with type 2 diabetes. Data from 4,790 Look AHEAD participants (mean age: 58.8 ± 6.8 years, 63.2% White) who were randomized to a 10-year ILI (n = 2,406) or diabetes support and education (DSE, n = 2,384) were included. ECG-LVH defined by Cornell voltage criteria was assessed every 2 years. Longitudinal logistic regression analysis with generalized estimation equations and linear mixed models were used to compare the prevalence of ECG-LVH and changes in absolute Cornell voltage over time between intervention groups, with tests...
To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 1... more To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender. Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed. Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was ...
Background The National Death Index ( NDI ) is widely used to detect coronary heart disease ( CHD... more Background The National Death Index ( NDI ) is widely used to detect coronary heart disease ( CHD ) and cardiovascular disease ( CVD ) deaths, but its reliability has not been examined recently. Methods and Results We compared CHD and CVD deaths detected by NDI with expert adjudication of 4010 deaths that occurred between 2003 and 2013 among participants in the REGARDS ( RE asons for Geographic And Racial Differences in Stroke) cohort of black and white adults in the United States. NDI derived CHD mortality had sensitivity 53.6%, specificity 90.3%, positive predictive value 54.2%, and negative predictive value 90.1%. NDI ‐derived CVD mortality had sensitivity 73.4%, specificity 84.5%, positive predictive value 70.6%, and negative predictive value 86.2%. Among NDI‐ derived CHD and CVD deaths, older age (odds ratios, 1.06 and 1.04 per 1‐year increase) was associated with a higher probability of disagreement with the adjudicated cause of death, whereas among REGARDS adjudicated CHD and...
Background: The definition of hypertension (HTN) is based on systolic blood pressure (SBP) and di... more Background: The definition of hypertension (HTN) is based on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Recently, however, increased attention has been given to pulse pressure (PP) and mean arterial pressure (MAP) as potential risk factors of cardiovascular disease including stroke. We examined the relationship between 4 different blood pressure indices (SBP, DBP, PP, and MAP) and incident stroke. Methods: Data were derived from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged ≥45, enrolled between 2003 and 2007 from the continental United States. A computer-assisted telephone interview obtained demographics, medical history, health behaviors and health status. At 3-4 weeks post interview, an in-home visit was conducted by a trained technician who collected blood pressure, biometrics, and blood and urine samples following standard protocols. SBP and DBP were defined as the a...
<jats:p> <jats:bold>Background:</jats:bold> Coronary heart disease (CHD) mortal... more <jats:p> <jats:bold>Background:</jats:bold> Coronary heart disease (CHD) mortality has long been higher among US blacks compared with whites, especially among younger individuals. Recent progress on eliminating these disparities has not been reported. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We examined CHD mortality in the REGARDS study, a 30,239-member national prospective cohort study that oversampled blacks (41%) and residents of the southeastern US, recruiting from 2003-7. Baseline data included interviews and in-home collection of physiologic and medication data. Telephone follow-up was conducted every 6 months to detect endpoints, triggering medical record retrieval and expert adjudication. Deaths prompted interviews with next-of-kin or proxies, collection of medical records and death certificates. We examined risks for definite or probable CHD mortality overall, and separately for in-hospital and out-of-hospital CHD death. Cox models stratified on age 65 estimated hazard ratios (HR) for CHD mortality for blacks compared with whites, adjusting for sociodemographics and CHD risk factors. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> We analyzed 14,992 participants &lt;65 years of age (44% blacks) and 14,678 &gt;65 years of age (38% blacks). There were 126 CHD deaths among those age &lt;65 and 273 among those age &gt;65 over a mean follow-up of 4.2+1.5 SD years. Adjusting for age and region of residence, excess risks among blacks were generally more pronounced for those age &lt;65, but this excess risk attenuated after adding all risk factors, except for in-hospital mortality for those &gt;65 years of age (Table). </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> Risks for CHD mortality were higher among blacks, largely attributable to higher risk factor burden especially among the young, suggesting that targeted intervention efforts are needed to overcome this disparity. The excess risk for in-hospital mortality among older blacks warrants further attention. </jats:p> <jats:p> <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="g713.jpeg" /> </jats:p>
Introduction: Stress may increase risk for coronary heart disease (CHD) and death, especially for... more Introduction: Stress may increase risk for coronary heart disease (CHD) and death, especially for individuals living in poverty. Few prospective studies have examined the relationships between stre...
<jats:p> <jats:bold>Background:</jats:bold> Overweight and obese adults living ... more <jats:p> <jats:bold>Background:</jats:bold> Overweight and obese adults living with heart failure (HF) have lower mortality compared to those of normal weight. However, the specific relationships of overall weight status and central adiposity with mortality among those with HF are less well-defined. We examined the relationships among body mass index (BMI), waist circumference (WC) and mortality among patients hospitalized for HF in the REGARDS Study. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> REGARDS is a national cohort of US community-dwelling adults aged &gt;45 recruited from 2003 to 2007. We measured all-cause mortality rates among 565 participants hospitalized with HF who were normal weight (BMI 18.5-24.9 kg/m <jats:sup>2</jats:sup> ), overweight (BMI 25.0-29.9 kg/m <jats:sup>2</jats:sup> ), or obese (BMI &gt; 30.0 kg/m <jats:sup>2</jats:sup> ) at baseline. Underweight participants (BMI &lt; 18.5 kg/m <jats:sup>2</jats:sup> ) were excluded. Baseline WC, weight, and height were measured during an in-home exam. Index HF hospitalizations during follow-up were adjudicated by a panel of experts. Vital status was determined using the Social Security Death Index or the National Death Index. Cox proportional models estimated hazard ratios for all-cause mortality following the index HF hospitalization. Models were sequentially adjusted for WC, sociodemographics, HF severity (EF and BNP during HF hospitalization, prior history of HF, prior history of diastolic dysfunction), comorbidities, and health behaviors. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> Among 565 participants hospitalized for HF, 116 (21%) were normal weight, 209 (37%) overweight, and 240 (42%) obese at baseline. Over a mean follow-up of 2.5 years, 253 deaths occurred. In multivariable analyses, overweight was associated with lower all-cause mortality in all models (Table). Each 1-cm increase in WC was associated with higher risk of all-cause mortality, but the relationship was not statistically significant after health behaviors were added in the final model. . </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> Among adults hospitalized for HF, overweight as assessed by BMI may be associated with lower risk for mortality. However, central adiposity may confer higher risk of mortality. </jats:p> <jats:p> <jats:inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="g651.jpeg" /> </jats:p>
Introduction: Prospective studies of cognitive decline are vital for the identification of risk f... more Introduction: Prospective studies of cognitive decline are vital for the identification of risk factors and preventative strategies, but there is no established definition of cognitive decline in epidemiologic studies. To plan a case-cohort biomarker study, a panel of experts sought to identify 500 participants with significant cognitive decline in the REasons for Geographical and Racial Differences in Stroke (REGARDS) cohort. Methods: REGARDS is a population-based cohort of 30,239 black and white Americans enrolled from 2003-7 in their homes and followed by telephone. Global cognitive function was measured serially using the Six Item Screener (SIS), and learning, memory, and executive function using Word List Learning (WLL), Word List Recall (WLR), and Animal Fluency (AF) tests. In an initially cognitively intact cohort (SIS > 4 at baseline), cognitive decline was defined as performance 1.5 SD below the age-, race-, sex-, and education-based norms on 2 of 3 cognitive domain scor...
Introduction: People with unrecognized myocardial infarction (UMI) have elevated risk for cardiov... more Introduction: People with unrecognized myocardial infarction (UMI) have elevated risk for cardiovascular events and death. Population-wide electrocardiogram screening for detection of UMI would be resource intensive. We therefore sought to develop assessment tools for targeted UMI screening. Methods: Using logistic regression and a backward selection procedure, we developed two models among 16,653 participants without coronary revascularization or known myocardial infarction in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. UMI was defined as electrocardiogram evidence (using the Minnesota Code system) of myocardial infarction without a self-reported history (n = 740). The basic model used demographics, self-reported medical history, blood pressure, and body mass index; the expanded model used information on 51 potential variables including health behaviors, clinical measurements, and participant-reported health scales and symptoms. Results: The basic m...
Introduction: To identify potential targets for eliminating disparities in cardiovascular disease... more Introduction: To identify potential targets for eliminating disparities in cardiovascular disease outcomes, we examined race-sex differences in awareness, treatment and control of hyperlipidemia in the REGARDS cohort. Methods: REGARDS recruited 30,239 blacks and whites aged ≥45 residing in the 48 continental US between 2003-7. Baseline data were collected via telephone interviews followed by in-home visits. We categorized participants into coronary heart disease (CHD) risk groups (CHD or risk equivalent [highest risk]; Framingham Coronary Risk Score [FRS] >20%; FRS 10-20%; FRS <10%) following the 3 rd Adult Treatment Panel. Prevalence, awareness, treatment and control of hyperlipidemia were described across risk categories and race-sex groups. Multivariable models examined associations for hyperlipidemia awareness, treatment and control between race-sex groups compared with white men, adjusting for predisposing, enabling and need factors. Results: There were 11,677 individuals...
Background: N-terminal pro brain natriuretic peptide (NT-proBNP) has been associated with myocard... more Background: N-terminal pro brain natriuretic peptide (NT-proBNP) has been associated with myocardial infarctions (MI), but less is known about the relationship between NT-proBNP and very small non ST-elevation MIs now routinely detectable with modern troponin assays. Since these “microsize MIs” confer high long-term coronary heart disease (CHD) risks, we examined the association of NT-proBNP with incident acute CHD events, total MIs, and two MI subtypes: microsize and typical MIs. Methods: REGARDS is a national cohort of 30,237 US community-dwelling black and white adults aged ≥45 recruited from 2003 to 2007. Expert-adjudicated outcomes included incident typical MIs (definite/probable MI with peak troponin ≥0.5 μg/L), incident microsize MIs (definite/probable MI with peak troponin <0.5 μg/L), and total incident acute CHD (nonfatal MIs or CHD deaths). Low-level troponin elevations with the peak at least twice the upper limit of normal which did not have a rising and/or falling pat...
National death certificate data suggest that racial disparities in acute coronary heart disease (... more National death certificate data suggest that racial disparities in acute coronary heart disease (CHD) mortality widened over the past decade for both men and women. To better understand this disparity, we examined black:white race-sex differences in overall, fatal and nonfatal acute CHD incidence in a large national biracial cohort. REGARDS is following 30,239 community-dwellers age ≥;45 years recruited between 2003-7 from 48 states. Recruitment was designed to balance race and sex; the final sample was 55% female and 41% black. Participants are telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication following national consensus recommendations. Acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. Among participants free of CHD at baseline, we examined black:white hazards for incident overall acute CHD, and, separately, fatal and nonfatal acute CHD...
Background: Elevated C-reactive protein (CRP) is associated with coronary heart disease (CHD) ris... more 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 ...
Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary hea... more Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into <120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (<140/90 mmHg on treatment) (n=8378), and uncontrolled (>140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute...
BACKGROUND High dietary sodium intake may induce a small, yet physiologically relevant rise in se... more BACKGROUND High dietary sodium intake may induce a small, yet physiologically relevant rise in serum sodium concentration, which associates with increased systolic blood pressure. Cellular data suggest that this association is mediated by increased endothelial cell stiffness. We hypothesized that higher serum sodium levels were associated with greater arterial stiffness in participants in the Systolic Blood Pressure Intervention Trial (SPRINT). METHODS Multivariable linear regression was used to examine the association between baseline serum sodium level and (i) pulse pressure (PP; n = 8,813; a surrogate measure of arterial stiffness) and (ii) carotid–femoral pulse wave velocity (CFPWV; n = 591 in an ancillary study to SPRINT). RESULTS Baseline mean ± SD age was 68 ± 9 years and serum sodium level was 140 ± 2 mmol/L. In the PP analysis, higher serum sodium was associated with increased baseline PP in the fully adjusted model (tertile 3 [≥141 mmol] vs. tertile 2 [139–140 mmol]; β = 0...
The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative s... more The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative stress, on hemodynamic parameters at rest and during physical exertion are unclear. The aims of this investigation were to examine the independent associations of TNF-α on myocardial oxygen demand at rest and during submaximal exercise, while also evaluating the association of TNF-α on exercise tolerance. Forty, postmenopausal women, provided blood samples and completed a modified-Balke protocol to measure maximal oxygen uptake (VO). Large artery compliance was measured by pulse contour analyses while rate-pressure product (RPP), an index of myocardial oxygen demand, was measured at rest and during two submaximal workloads (i.e., ≈55% and ≈75% VO). RPP was calculated by dividing the product of heart rate and systolic blood pressure (via auscultation) by 100. Exercise tolerance corresponded with the cessation of the graded exercise test. During higher-intensity exertion, ≈75% VO, multiple ...
Left ventricular hypertrophy assessed by electrocardiography (ECG-LVH) is a marker of subclinical... more Left ventricular hypertrophy assessed by electrocardiography (ECG-LVH) is a marker of subclinical cardiac damage and a strong predictor of cardiovascular disease (CVD) events. The prevalence of ECG-LVH is increased in obesity and type 2 diabetes; however, there are no data on the long-term effects of weight loss on ECG-LVH. The purpose of this study was to determine whether an intensive lifestyle intervention (ILI) reduces ECG-LVH in overweight and obese adults with type 2 diabetes. Data from 4,790 Look AHEAD participants (mean age: 58.8 ± 6.8 years, 63.2% White) who were randomized to a 10-year ILI (n = 2,406) or diabetes support and education (DSE, n = 2,384) were included. ECG-LVH defined by Cornell voltage criteria was assessed every 2 years. Longitudinal logistic regression analysis with generalized estimation equations and linear mixed models were used to compare the prevalence of ECG-LVH and changes in absolute Cornell voltage over time between intervention groups, with tests...
To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 1... more To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender. Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed. Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was ...
Background The National Death Index ( NDI ) is widely used to detect coronary heart disease ( CHD... more Background The National Death Index ( NDI ) is widely used to detect coronary heart disease ( CHD ) and cardiovascular disease ( CVD ) deaths, but its reliability has not been examined recently. Methods and Results We compared CHD and CVD deaths detected by NDI with expert adjudication of 4010 deaths that occurred between 2003 and 2013 among participants in the REGARDS ( RE asons for Geographic And Racial Differences in Stroke) cohort of black and white adults in the United States. NDI derived CHD mortality had sensitivity 53.6%, specificity 90.3%, positive predictive value 54.2%, and negative predictive value 90.1%. NDI ‐derived CVD mortality had sensitivity 73.4%, specificity 84.5%, positive predictive value 70.6%, and negative predictive value 86.2%. Among NDI‐ derived CHD and CVD deaths, older age (odds ratios, 1.06 and 1.04 per 1‐year increase) was associated with a higher probability of disagreement with the adjudicated cause of death, whereas among REGARDS adjudicated CHD and...
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