Abstract Introduction NEW (Nutrition, Exercise, and Weight Management) LifeStyle is a web-based t... more Abstract Introduction NEW (Nutrition, Exercise, and Weight Management) LifeStyle is a web-based teaching and learning program designed by the Department of Family and Community Medicine at Wake For...
Introduction: Young women diagnosed with cancer are at an increased risk for infertility compared... more Introduction: Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population. Methods: Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a them...
Background: This was a pilot study that was conducted to: 1) determine feasibility ofrecruitment,... more Background: This was a pilot study that was conducted to: 1) determine feasibility ofrecruitment, adherence, and follow-up of calorie-restricted low-fat or low-carbohydrate diet plus exercise intervention among overweight and obese premenopausal women; 2) determine if these interventions promoted weight loss; and 3) investigate whether the interventions altered breast cancer biomarkers. Methods: 79 overweight and obese premenopausal women were enrolled in a 52-weekrandomized intervention trial of calorie-restricted low-fat versus calorie-restricted low-carbohydrate diet along with physical activity. Changes in body mass index (BMI) and breast cancer biomarkers such as insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were measured at baseline, 12, 34, and 52 weeks. Results: Among the 550 women screened, 81 were eligible and 79 agreed to participate. Boththe calorie-restricted low-fat and low-carbohydrate diets plus exercise resulted in s...
Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly ... more Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly increases the risk of stroke. While vitamin D deficiency is associated with AF risk factors, retrosp...
Subclinical liver impairment due to fibrosis could influence the development and detectability of... more Subclinical liver impairment due to fibrosis could influence the development and detectability of prostate cancer. To investigate the association between liver fibrosis and prostate cancer incidence and mortality, we included 5,284 men (mean age: 57.6 years, 20.1% Black) without cancer or liver disease at Visit 2 in the Atherosclerosis Risk in Communities study. Liver fibrosis was assessed using the aspartate aminotransferase to platelet ratio index, fibrosis 4 index (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS). Over 25 years, 215 Black and 511 White men were diagnosed with prostate cancer, and 26 Black and 51 White men died from the disease. We estimated HRs for total and fatal prostate cancer using Cox regression. FIB-4 [quintile 5 vs. 1: HR = 0.47, 95% confidence interval (CI): 0.29–0.77, Ptrend = 0.004] and NFS (HR = 0.56, 95% CI: 0.33–0.97, Ptrend = 0.03) were inversely associated with prostate cancer risk in Black men. Compared with no abnormal score, men with ≥1 abnormal score had a lower prostate cancer risk if they were Black (HR = 0.46, 95% CI: 0.24–0.89), but not White (HR = 1.04, 95% CI: 0.69–1.58). Liver fibrosis scores did not appear to be associated with fatal prostate cancer in Black or White men. Among men without a clinical diagnosis of liver disease, higher liver fibrosis scores were associated with lower incidence of prostate cancer in Black men, but not in White men, and not with fatal prostate cancer in either race. Further research is needed to understand the influence of subclinical liver disease on prostate cancer development versus detectability and the racial differences observed. Prevention Relevance: Investigating the link between liver fibrosis and prostate cancer risk and mortality, our study reveals the potential influence of liver health on prostate cancer development and on detection using PSA test, urging further research to understand the differential findings by race and to optimize prevention and intervention strategies.
Supplementary Table 2. Effects of Randomization Assignment to Dietary Modification Intervention v... more Supplementary Table 2. Effects of Randomization Assignment to Dietary Modification Intervention vs. Comparison on Clinical Outcomes Before and After Termination of the Intervention in the Women's Health Initiative Dietary Modification Trial
Background: Aspirin is commonly used to treat pain and inflammation, and is recommended for some ... more Background: Aspirin is commonly used to treat pain and inflammation, and is recommended for some individuals for prevention of cardiovascular disease (CVD) and colorectal cancer. Observational studies suggest that aspirin use may also lower risk of prostate cancer. However, there is limited evidence on whether aspirin may protect against lethal prostate cancer in particular, and on whether benefits are consistent in black and white men. This study sought to determine the association between aspirin use and risk of total and lethal prostate cancer, overall and by race, among men in the Atherosclerosis Risk in Communities (ARIC) cohort. Methods: The ARIC study enrolled individuals from four U.S. communities in 1987-89. This analysis was restricted to white and black men from this cohort who had non-missing data on aspirin use and were cancer-free at baseline. Aspirin use was assessed at four study visits (V1: 1987-89, V2: 1990-92, V3: 1993-95, V4: 1996-98). Indication for aspirin use was reported at V4. Cancer outcomes were ascertained through 2012. Cox proportional hazards regression was used to estimate cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for total incident prostate cancer and lethal prostate cancer, defined as cancer that was advanced at diagnosis or fatal during follow-up. Models were adjusted for race, study center, year of birth, education, and family history of prostate cancer (time-fixed), and smoking status, body mass index, use of statins, diabetes, and coronary heart disease (time-varying). Stratified models and likelihood ratio tests were used to test for effect modification by race. Results: There were 6,594 men (5,060 white, 1,534 black) included in this analysis. Aspirin use was reported by 29%, 33%, 37% and 44% of men at V1, V2, V3, and V4, respectively. Through the end of 2012, 817 total incident prostate cancers, including 97 lethal prostate cancers, were diagnosed. Aspirin use was not associated with risk of total prostate cancer (HR 1.06, 95% CI 0.91-1.23). However, aspirin use was inversely associated with risk of lethal prostate cancer (HR 0.58, 95% CI 0.35-0.95). This association was consistent among both white men (HR 0.64, 95% CI 0.36-1.13) and black men (HR 0.47, 95% CI 0.16-1.35, p-interaction=0.45). When looked at by indication for use, the inverse association with lethal prostate cancer appeared to be only among men who reported using aspirin regularly for CVD prevention (HR 0.63, 95% CI 0.27-1.50). Conclusions: Aspirin use was inversely associated with lethal prostate cancer, but not total prostate cancer, in this study population. The association was not modified by race and was possibly restricted to men who used aspirin regularly for CVD prevention. Support: NHLBI, NCI, NPCR Citation Format: Lauren M. Hurwitz, Corinne E. Joshu, John R. Barber, Anna E. Prizment, Mara Z. Vitolins, Miranda R. Jones, Aaron R. Folsom, Misop Han, Elizabeth A. Platz. Aspirin use and risk of lethal prostate cancer in the Atherosclerosis Risk in Communities cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4947.
Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicit... more Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicities of cancer therapies and a high burden of CVD risk factors. We sought to evaluate the association of cancer survivorship with subclinical myocardial damage, as assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT) test results. We included 3,512 participants of the Atherosclerosis Risk in Communities Study who attended visit 5 (2011–2013) and were free of CVD (coronary heart disease, heart failure, or stroke). We used multivariate logistic regression to evaluate the cross-sectional associations of survivorship from any, non-sex-related, and sex-related cancers (e.g., breast, prostate) with elevated hs-cTnT (≥14 ng/L). Of 3,512 participants (mean age, 76 years; 62% women; 21% black), 19% were cancer survivors. Cancer survivors had significantly higher odds of elevated hs-cTnT (OR = 1.26, 95% CI: 1.03, 1.53). Results were similar for survivors of non-sex-related and colorectal cancers, but there was no association between survivorship from breast and prostate cancers and elevated hs-cTnT. Results were similar after additional adjustments for CVD risk factors. Survivors of some cancers might be more likely to have elevated hs-cTnT than persons without prior cancer. The excess burden of subclinical myocardial damage in this population might not be fully explained by traditional CVD risk factors.
Background: Although the role of radon gas in lung carcinogenesis is well-known, relatively littl... more Background: Although the role of radon gas in lung carcinogenesis is well-known, relatively little is known about radon’s role in the pathogenesis or epidemiology of cerebrovascular disease. Methods: We therefore identified postmenopausal women without a history of stroke at the 1993-1998 screening visit of the Women’s Health Initiative Clinical Trials and Observational Study (WHI CT and OS). We linked their geocoded addresses to U.S. Environmental Protection Agency (EPA)-predicted, county-level, indoor, screening radon gas concentrations classified as follows: Zone 3 (<2 pCi/L), Zone 2 (2-4 pCi/L), and Zone 1 (>4 pCi/L). We identified incident strokes based on physician-reviewed, classified, and adjudicated medical records. We measured time from screening to the earliest stroke or censoring date (02/28/20). We used Cox proportional hazards models to estimate radon-related risk of stroke on an attained-age scale as a hazard ratio (HR) and 95% confidence interval (CI), adjustin...
BACKGROUNDAdherence to study medications is crucial to evaluating treatment effects in clinical t... more BACKGROUNDAdherence to study medications is crucial to evaluating treatment effects in clinical trials. To assess whether in the SPRINT trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment.METHODSThis study included 9,361 participants aged ≥50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted systolic blood pressure [SBP] <140 mm Hg) or an Intensive Treatment Group (targeted SBP <120 mm Hg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12- and 48-month (or close out) visit.RESULTSAdjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or blood pressure (BP) control. Low adherence was associated with a higher body mass index,...
RATIONALE AND OBJECTIVE The safety of intensive blood pressure (BP) targets is controversial for ... more RATIONALE AND OBJECTIVE The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in those with and without CKD. STUDY DESIGN Neuroimaging substudy of a randomized trial. SETTING & PARTICIPANTS A subset of participants in the Systolic Blood Pressure Intervention Trial who underwent brain MRI studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). INTERVENTION Participants were randomly assigned to intensive (systolic BP <120 mm Hg) versus standard (systolic BP <140 mm Hg) BP lowering. OUTCOMES The magnetic resonance imaging outcome measures were the four-year change in global cerebral blood flow, white matter lesion (WML) volume, and total brain volume. RESULTS A total of 716 randomized participants with mean age of 68 years were enrolled; follow-up imaging occurred after a median 3.9 years. Among participants with eGFR <60 ml/min/1.73m2 (N=234), the effects of intensive versus standard BP treatment on change in global cerebral blood flow, WMLs and total brain volume were 3.38 mL/100 g/min (95% CI 0.32, 6.44), -0.06 cm3 (asinh transformed, 95% CI -0.16, 0.04), and -3.8 cm3 (95% CI -8.3, 0.7), respectively. Among participants with UACR >30 mg/g (N=151), the effects of intensive versus standard BP treatment on change in global cerebral blood flow, WMLs and total brain volume were 1.91 ml/100g/min (95% CI -3.01, 6.82), 0.003 cm3 (asinh transformed, 95% CI -0.13, 0.13), and -7.0 cm3 (95% CI -13.3, -0.3), respectively. The overall treatment effects on cerebral blood flow and total brain volume were not modified by baseline eGFR or UACR; however the effect on WMLs was attenuated in participants with albuminuria (interaction p-value 0.04). LIMITATIONS Measurement variability due to multi-site design. CONCLUSIONS Among hypertensive adults with primarily early kidney disease, intensive versus standard blood pressure treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive blood pressure treatment targets on brain health in persons with early kidney disease.
Background Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast ... more Background Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive. Objectives Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity. Methods Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1–3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outc...
Abstract Introduction NEW (Nutrition, Exercise, and Weight Management) LifeStyle is a web-based t... more Abstract Introduction NEW (Nutrition, Exercise, and Weight Management) LifeStyle is a web-based teaching and learning program designed by the Department of Family and Community Medicine at Wake For...
Introduction: Young women diagnosed with cancer are at an increased risk for infertility compared... more Introduction: Young women diagnosed with cancer are at an increased risk for infertility compared to women without a cancer diagnosis. Consuming a healthful diet comprised of whole grains, fruits, vegetables, and unsaturated fats has been found to improve both fertility and cancer survivorship. Given this reason, dietary interventions tailored to support female cancer survivors with fertility challenges are of immense importance. Therefore, the aim of this study was to explore barriers and facilitators to healthful nutrition among female cancer survivors with fertility challenges, to inform the development of dietary interventions for this population. Methods: Using a formative research design, interview, survey, and dietary intake data were collected from 20 female cancer survivors of reproductive age. Participant-check focus group discussions were conducted to validate findings. All interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a them...
Background: This was a pilot study that was conducted to: 1) determine feasibility ofrecruitment,... more Background: This was a pilot study that was conducted to: 1) determine feasibility ofrecruitment, adherence, and follow-up of calorie-restricted low-fat or low-carbohydrate diet plus exercise intervention among overweight and obese premenopausal women; 2) determine if these interventions promoted weight loss; and 3) investigate whether the interventions altered breast cancer biomarkers. Methods: 79 overweight and obese premenopausal women were enrolled in a 52-weekrandomized intervention trial of calorie-restricted low-fat versus calorie-restricted low-carbohydrate diet along with physical activity. Changes in body mass index (BMI) and breast cancer biomarkers such as insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were measured at baseline, 12, 34, and 52 weeks. Results: Among the 550 women screened, 81 were eligible and 79 agreed to participate. Boththe calorie-restricted low-fat and low-carbohydrate diets plus exercise resulted in s...
Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly ... more Introduction: Atrial fibrillation (AF) is the most common arrhythmia in adults and significantly increases the risk of stroke. While vitamin D deficiency is associated with AF risk factors, retrosp...
Subclinical liver impairment due to fibrosis could influence the development and detectability of... more Subclinical liver impairment due to fibrosis could influence the development and detectability of prostate cancer. To investigate the association between liver fibrosis and prostate cancer incidence and mortality, we included 5,284 men (mean age: 57.6 years, 20.1% Black) without cancer or liver disease at Visit 2 in the Atherosclerosis Risk in Communities study. Liver fibrosis was assessed using the aspartate aminotransferase to platelet ratio index, fibrosis 4 index (FIB-4), and nonalcoholic fatty liver disease fibrosis score (NFS). Over 25 years, 215 Black and 511 White men were diagnosed with prostate cancer, and 26 Black and 51 White men died from the disease. We estimated HRs for total and fatal prostate cancer using Cox regression. FIB-4 [quintile 5 vs. 1: HR = 0.47, 95% confidence interval (CI): 0.29–0.77, Ptrend = 0.004] and NFS (HR = 0.56, 95% CI: 0.33–0.97, Ptrend = 0.03) were inversely associated with prostate cancer risk in Black men. Compared with no abnormal score, men with ≥1 abnormal score had a lower prostate cancer risk if they were Black (HR = 0.46, 95% CI: 0.24–0.89), but not White (HR = 1.04, 95% CI: 0.69–1.58). Liver fibrosis scores did not appear to be associated with fatal prostate cancer in Black or White men. Among men without a clinical diagnosis of liver disease, higher liver fibrosis scores were associated with lower incidence of prostate cancer in Black men, but not in White men, and not with fatal prostate cancer in either race. Further research is needed to understand the influence of subclinical liver disease on prostate cancer development versus detectability and the racial differences observed. Prevention Relevance: Investigating the link between liver fibrosis and prostate cancer risk and mortality, our study reveals the potential influence of liver health on prostate cancer development and on detection using PSA test, urging further research to understand the differential findings by race and to optimize prevention and intervention strategies.
Supplementary Table 2. Effects of Randomization Assignment to Dietary Modification Intervention v... more Supplementary Table 2. Effects of Randomization Assignment to Dietary Modification Intervention vs. Comparison on Clinical Outcomes Before and After Termination of the Intervention in the Women's Health Initiative Dietary Modification Trial
Background: Aspirin is commonly used to treat pain and inflammation, and is recommended for some ... more Background: Aspirin is commonly used to treat pain and inflammation, and is recommended for some individuals for prevention of cardiovascular disease (CVD) and colorectal cancer. Observational studies suggest that aspirin use may also lower risk of prostate cancer. However, there is limited evidence on whether aspirin may protect against lethal prostate cancer in particular, and on whether benefits are consistent in black and white men. This study sought to determine the association between aspirin use and risk of total and lethal prostate cancer, overall and by race, among men in the Atherosclerosis Risk in Communities (ARIC) cohort. Methods: The ARIC study enrolled individuals from four U.S. communities in 1987-89. This analysis was restricted to white and black men from this cohort who had non-missing data on aspirin use and were cancer-free at baseline. Aspirin use was assessed at four study visits (V1: 1987-89, V2: 1990-92, V3: 1993-95, V4: 1996-98). Indication for aspirin use was reported at V4. Cancer outcomes were ascertained through 2012. Cox proportional hazards regression was used to estimate cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for total incident prostate cancer and lethal prostate cancer, defined as cancer that was advanced at diagnosis or fatal during follow-up. Models were adjusted for race, study center, year of birth, education, and family history of prostate cancer (time-fixed), and smoking status, body mass index, use of statins, diabetes, and coronary heart disease (time-varying). Stratified models and likelihood ratio tests were used to test for effect modification by race. Results: There were 6,594 men (5,060 white, 1,534 black) included in this analysis. Aspirin use was reported by 29%, 33%, 37% and 44% of men at V1, V2, V3, and V4, respectively. Through the end of 2012, 817 total incident prostate cancers, including 97 lethal prostate cancers, were diagnosed. Aspirin use was not associated with risk of total prostate cancer (HR 1.06, 95% CI 0.91-1.23). However, aspirin use was inversely associated with risk of lethal prostate cancer (HR 0.58, 95% CI 0.35-0.95). This association was consistent among both white men (HR 0.64, 95% CI 0.36-1.13) and black men (HR 0.47, 95% CI 0.16-1.35, p-interaction=0.45). When looked at by indication for use, the inverse association with lethal prostate cancer appeared to be only among men who reported using aspirin regularly for CVD prevention (HR 0.63, 95% CI 0.27-1.50). Conclusions: Aspirin use was inversely associated with lethal prostate cancer, but not total prostate cancer, in this study population. The association was not modified by race and was possibly restricted to men who used aspirin regularly for CVD prevention. Support: NHLBI, NCI, NPCR Citation Format: Lauren M. Hurwitz, Corinne E. Joshu, John R. Barber, Anna E. Prizment, Mara Z. Vitolins, Miranda R. Jones, Aaron R. Folsom, Misop Han, Elizabeth A. Platz. Aspirin use and risk of lethal prostate cancer in the Atherosclerosis Risk in Communities cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4947.
Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicit... more Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicities of cancer therapies and a high burden of CVD risk factors. We sought to evaluate the association of cancer survivorship with subclinical myocardial damage, as assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT) test results. We included 3,512 participants of the Atherosclerosis Risk in Communities Study who attended visit 5 (2011–2013) and were free of CVD (coronary heart disease, heart failure, or stroke). We used multivariate logistic regression to evaluate the cross-sectional associations of survivorship from any, non-sex-related, and sex-related cancers (e.g., breast, prostate) with elevated hs-cTnT (≥14 ng/L). Of 3,512 participants (mean age, 76 years; 62% women; 21% black), 19% were cancer survivors. Cancer survivors had significantly higher odds of elevated hs-cTnT (OR = 1.26, 95% CI: 1.03, 1.53). Results were similar for survivors of non-sex-related and colorectal cancers, but there was no association between survivorship from breast and prostate cancers and elevated hs-cTnT. Results were similar after additional adjustments for CVD risk factors. Survivors of some cancers might be more likely to have elevated hs-cTnT than persons without prior cancer. The excess burden of subclinical myocardial damage in this population might not be fully explained by traditional CVD risk factors.
Background: Although the role of radon gas in lung carcinogenesis is well-known, relatively littl... more Background: Although the role of radon gas in lung carcinogenesis is well-known, relatively little is known about radon’s role in the pathogenesis or epidemiology of cerebrovascular disease. Methods: We therefore identified postmenopausal women without a history of stroke at the 1993-1998 screening visit of the Women’s Health Initiative Clinical Trials and Observational Study (WHI CT and OS). We linked their geocoded addresses to U.S. Environmental Protection Agency (EPA)-predicted, county-level, indoor, screening radon gas concentrations classified as follows: Zone 3 (<2 pCi/L), Zone 2 (2-4 pCi/L), and Zone 1 (>4 pCi/L). We identified incident strokes based on physician-reviewed, classified, and adjudicated medical records. We measured time from screening to the earliest stroke or censoring date (02/28/20). We used Cox proportional hazards models to estimate radon-related risk of stroke on an attained-age scale as a hazard ratio (HR) and 95% confidence interval (CI), adjustin...
BACKGROUNDAdherence to study medications is crucial to evaluating treatment effects in clinical t... more BACKGROUNDAdherence to study medications is crucial to evaluating treatment effects in clinical trials. To assess whether in the SPRINT trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment.METHODSThis study included 9,361 participants aged ≥50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted systolic blood pressure [SBP] <140 mm Hg) or an Intensive Treatment Group (targeted SBP <120 mm Hg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12- and 48-month (or close out) visit.RESULTSAdjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or blood pressure (BP) control. Low adherence was associated with a higher body mass index,...
RATIONALE AND OBJECTIVE The safety of intensive blood pressure (BP) targets is controversial for ... more RATIONALE AND OBJECTIVE The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in those with and without CKD. STUDY DESIGN Neuroimaging substudy of a randomized trial. SETTING & PARTICIPANTS A subset of participants in the Systolic Blood Pressure Intervention Trial who underwent brain MRI studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). INTERVENTION Participants were randomly assigned to intensive (systolic BP <120 mm Hg) versus standard (systolic BP <140 mm Hg) BP lowering. OUTCOMES The magnetic resonance imaging outcome measures were the four-year change in global cerebral blood flow, white matter lesion (WML) volume, and total brain volume. RESULTS A total of 716 randomized participants with mean age of 68 years were enrolled; follow-up imaging occurred after a median 3.9 years. Among participants with eGFR <60 ml/min/1.73m2 (N=234), the effects of intensive versus standard BP treatment on change in global cerebral blood flow, WMLs and total brain volume were 3.38 mL/100 g/min (95% CI 0.32, 6.44), -0.06 cm3 (asinh transformed, 95% CI -0.16, 0.04), and -3.8 cm3 (95% CI -8.3, 0.7), respectively. Among participants with UACR >30 mg/g (N=151), the effects of intensive versus standard BP treatment on change in global cerebral blood flow, WMLs and total brain volume were 1.91 ml/100g/min (95% CI -3.01, 6.82), 0.003 cm3 (asinh transformed, 95% CI -0.13, 0.13), and -7.0 cm3 (95% CI -13.3, -0.3), respectively. The overall treatment effects on cerebral blood flow and total brain volume were not modified by baseline eGFR or UACR; however the effect on WMLs was attenuated in participants with albuminuria (interaction p-value 0.04). LIMITATIONS Measurement variability due to multi-site design. CONCLUSIONS Among hypertensive adults with primarily early kidney disease, intensive versus standard blood pressure treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive blood pressure treatment targets on brain health in persons with early kidney disease.
Background Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast ... more Background Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive. Objectives Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity. Methods Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1–3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outc...
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