Search

Background To promote ideal cardiovascular health, the American Heart Association recommends adhering to Life's Simple 7 (LS7)—achieving healthy targets for body mass index, physical activity, dietary intake, blood pressure, fasting plasma glucose, and cholesterol, along with smoking abstinence. Poorer achievement of LS7 (lower score) has been associated with the development of hypertension and cardiovascular disease. However, less is known about the associations between LS7 and specific biomarkers linked to cardiovascular health: aldosterone, CRP (C‐reactive protein), and IL‐6 (interleukin‐6). Methods and Results We analyzed 379 individuals (age 18–66 years) from the HyperPATH (International Hypertensive Pathotype), who were maintained on ≥200 mEq of sodium daily for 1 week. We calculated a 14‐point summative LS7 score according to participants' baseline data. Based on the range of LS7 score in this population (3–14), we classified participants as “inadequate” (3–6), “average” (7–10), and “optimal” (11–14). Regression analyses found that a higher LS7 score group was associated with lower levels of serum and urinary aldosterone ( P trend P trend =0.001, respectively), lower plasma renin activity ( P trend P trend =0.023). Being in the “optimal” LS7 score group was associated with lower serum CRP ( P trend =0.001) and IL‐6 ( P trend =0.001). Conclusions A higher LS7 score was associated with a lower activity of the renin‐angiotensin‐aldosterone system and lower levels of the inflammatory markers CRP and IL‐6. These findings offer a possible link between ideal cardiovascular health targets and biomarkers known to play a central role in the development of cardiovascular disease.

Introduction: African Americans (AAs) have among the highest prevalence of type 2 diabetes in the U.S. Research has shown that positive affect and supportive networks are associated with better health outcomes and may improve regulation of physiological processes. We examined the extent to which psychosocial resources were protective of diabetes outcomes among a sample of 5,306 AAs. Hypothesis: Psychosocial resource measures are inversely associated with prediabetes and diabetes [defined by hemoglobin (Hb)A1c categories] and prevalent diabetes (defined by self-report diabetes status and medication use). Methods: Using data from the Jackson Heart Study (JHS), we evaluated the cross-sectional associations of four psychosocial-resource indicators (social support, optimism, religiosity, social networks) with two diabetes outcomes [1) HbA1c categories: normal (HbA1c ≤ 5.7%), at risk/pre-diabetic (5.7% < HbA1c < 6.5%), diabetic (HbA1c ≥ 6.5%) and 2) prevalent diabetes (vs. no diabetes)]. For each psychosocial-resource measure, we created high vs. low categories (median split) and continuous standard deviation (SD) units. Associations with HbA1c categories were examined using multinomial logistic regression to estimate odds ratios (OR 95% confidence interval-CI) of pre-diabetes (vs. normal) and diabetes (vs. normal). Associations with prevalent diabetes were examined using Poisson regression to estimate prevalence ratios (PR 95% CI) of diabetes (vs. no diabetes). Models adjusted for demographics, SES, waist circumference, health behaviors, and depression. Results: Participants with diabetes reported fewer psychosocial resources than those with pre-diabetes and normal HbA1c ( p social support was associated with an 11% lower odds of pre-diabetes (vs. normal HbA1c) (OR 0.89, 95% CI 0.81-0.99). High (vs. low) religiosity was associated with an increased odds of diabetes (vs. normal Hba1c) (OR 1.29, 95% CI 1.01-1.64) after full adjustment. Optimism and social networks were only associated with lower diabetes prevalence after adjustment for demographics and education, respectively. Conclusion: With the exception of religiosity, psychosocial-resource measures were inversely associated with diabetes. Social support and social networks, especially, should be considered when addressing the reduction of diabetes burden among AAs.

The MECA study is unique in that it will study CVD resilience in blacks at both the individual and community (census tract) level in the Atlanta Metropolitan Area. It is well established that blacks suffer from greater cardiovascular morbidity and mortality than whites in the United States. Not all blacks suffer from poor cardiovascular health, some individuals manage to live long healthy lives without ever developing cardiovascular conditions. The causes of this resilience are not known. Both individual and community level factors may be responsible for cardiovascular risk and resilience in blacks. The first stage of the MECA study was to identify “at risk” and resilient communities based on their rates of CVD related ED visits, hospitalizations and mortality. Objectives: To determine if in fact a wide distribution of CVD rates exist among Blacks in census tracts in Metro Atlanta. To determine if there were still large differences in rates when black household income was controlled for. Methods: Count data on CVD related emergency department and hospitalizations for blacks aged 35-64 living in census tracts in the Atlanta--Athens-Clarke--Sandy Springs combined statistical area during 2010-2014 were obtained from the Georgia Hospital Association. CVD mortality data for the same population for the same time period were obtained from the Georgia Department of Public Health. In order to control for the socioeconomic status, age and gender distribution of the neighborhoods, negative binomial regression models controlling for median black household income, percent of 5-year age groupings, and percent male were estimated for each of the outcomes. Residuals in top 25% were considered to be “at risk tracts (high rate) while residuals in the bottom 25% were considered resilient (low rate tracts). Results: 106 tracts were resilient for at least 2 of the 3 outcomes, 188 were “at risk” for 2 out of 3 outcomes. Both types of tracts were located throughout the Atlanta metropolitan area. Mean black household income in the tracts are similar (resilient: $46,335, “at risk”: $44,721). Black CVD hospitalization event rate was 28 vs. 132 per 1000 population(p Conclusion: We have identified census tracts in Metro Atlanta that have large differences in premature CVD outcomes for Blacks despite having similar mean income levels. The next phase of the MECA study will examine census tract and survey data to elucidate what contextual (demographic, food environment, reported neighborhood characteristics) and individual level (behavioral, psychological, social) factors may be associated with the different rates of CVD in resilient and “at risk” census tracts.

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

Introduction: African Americans (AA) have a higher risk for cardiovascular disease (CVD) than Whites. This disparity has been attributed to risk factors such as hypertension, diabetes, and obesity. This disparity has also been attributed to psychosocial factors across groups. Using Jackson Heart Study (JHS) data, we examined the associations of negative affect and stress measures with CVD risk factors and prevalent CVD among AA. Hypothesis: Negative affect and stress measures are associated with prevalent CVD risk factors and CVD among men and women in the JHS. Methods: Cross-sectional associations of negative affect (cynicism, anger in, anger out, and depressive symptoms) and stress (global stress, weekly stress, and major life events) with prevalent BMI, hypertension, diabetes and CVD were examined among 5,301 participants 34-85 years old (women=3,360; men=1,941). We estimated mean differences in BMI and prevalence ratios (PR) of hypertension, diabetes and CVD with measures of negative affect and stress and adjusted for demographic and clinical risk factors. Results: Men had higher cynical distrust and anger in scores than women (p Conclusion: Efforts to reduce disparities in CVD may need to address environmental and psychosocial factors that place AA at higher risk.

Immediate reperfusion therapy to restore coronary blood flow is recommended for all eligible patients with acute myocardial infarction. However, reperfusion therapy is reportedly underutilized among African Americans, even when they are eligible. Reasons for the lack of use have not been fully explored.We examined the demographic, clinical, and treatment data of 10,469 African Americans with acute myocardial infarction who were eligible for reperfusion therapy, enrolled in the National Registry of Myocardial Infarction-2 from June 1994 through March 1998.The mean age was 62.58 (+/-14.4) years, and 44.7% were female. Although eligible, 47% of the African Americans in this study did not receive reperfusion therapy. In a multivariate analysis, the absence of chest pain at presentation (odds ratio [OR] 0.31, 95% CI 0.26-0.37) and initial admission diagnoses other than definite myocardial infarction (OR for receipt of reperfusion0.12) were the strongest predictors of lack of early reperfusion therapy. Progressive delays in hospital arrival and hospital evaluation predicted a lower likelihood of early reperfusion. Prior stroke (OR 0.63, 95% CI 0.50-0.78), myocardial infarction (OR 0.75, 95% CI 0.65-0.86), and congestive heart failure (OR 0.49, 95% CI 0.40-0.60) were all associated with lack of reperfusion therapy.Almost half of eligible African American patients with myocardial infarction did not receive reperfusion therapy. Potential reasons may include atypical presentation, patient and institutional delay, and underappreciation of myocardial infarction by care providers. Strategies to address these factors may improve the rate of use of reperfusion therapy.

Objectives. Prior research has reported an association between perceived discrimination and health outcomes among African Americans, and there is growing interest in the pathways in which it gets ‘under the skin.’ One such pathway may be through the association with behavioral risk factors. Using Jackson Heart Study data, we examined whether perceived reports of discrimination were associated with behavioral risk factors among African Americans. Methods. Cross-sectional associations of perceived reports of everyday discrimination, lifetime discrimination, and burden of lifetime discrimination with smoking status, physical activity, percent calories from fat in diet, and hours of sleep were examined among 4,939 participants 20–95 years old (women=3,123; men=1,816). We estimated odds ratios (OR) of current smoking and mean differences in physical activity, fat in diet and hours of sleep with measures of discrimination and adjusted for age and socioeconomic status. Results. Men were more likely to smoke than women, and had higher physical activity scores. Women reported slightly more hours of sleep than men. Men and women reported similar percentages of calories from fat in diet. After adjustment for age and socioeconomic status, perceived everyday discrimination was associated with more smoking and a greater percentage of calories from fat in diet in men and women (OR for smoking: 1.13, 95%CI 1.00–1.28 and 1.19, 95%CI 1.05–1.34; mean difference in percent calories from fat in diet: 0.37, p Conclusions. Behavioral risk factors offer a potential mechanism through which perceived discrimination affects health in African Americans.

Background: The presence of chronic kidney disease is greater in African Americans than in non-Hispanic whites. Though there is data to show a relation between endothelial dysfunction and end-stage kidney disease, the relation to mild and moderate chronic kidney disease (particularly in African Americans) is unclear. Methods and Results: Digital arterial tonometry was performed during Exam 2 and 3 of the Jackson Heart Study using the endoPAT2000. Data from digital arterial tonometry included baseline pulse wave amplitude (BPA) as a measure of endothelial tone and reactive hyperemic index (F-RHI) as a measure of endothelial function. For this study, the estimated glomerular filtration rate (eGFR) was calculated using the MDRD equation. Those participants with eGFR < 60 ml/min/1.73m2 were defined as having CKD. Participants with eGFR < 15 ml/min/1.73m2 were excluded from the analysis. Microalbuminuria in this study was defined as a urinary albumin:creatinine ratio ≥ 17mg/g in men and ≥ 25 mg/g in women. We compared the differences in least square means adjusted for age and sex, and adjusted for multiple traditional clinical covariates using a generalized linear model. Results: There were 834 participants in the study population (mean age 58.5 years, 61% women); 87 (10.4%) participants with CKD and 108 (13.0%) with microalbuminuria. In age and sex adjusted samples, we found that both BPA and F-RHI were significantly associated with CKD in the pooled samples. However in multivariable adjusted analysis the relation was no longer significant in either the pooled or sex-specific samples. In the multivariable adusted analysis,BPA was significantly (P=0.036) associated with microalbuminuria in men and F-RHI was weakly significantly (P=0.08) associated with microalbuminuria in women. Conclusion: We found that endothelial dysfunction as measured by digital arterial tonometry is not significantly associated with chronic kidney disease. There is an association of endothelial tone in men and endothelial dysfunction in women with microalbuminuria.

Background The pathophysiology of mental stress–induced myocardial ischemia, which occurs at lower heart rates than during physical stress, is not well understood. Methods and Results The Psychophysiological Investigations of Myocardial Ischemia Study (PIMI) evaluated the physiological and neuroendocrine functioning in unmedicated patients with stable coronary artery disease and exercise-induced ischemia. Hemodynamic and neurohormonal responses to bicycle exercise, public speaking, and the Stroop test were measured by radionuclide ventriculography, ECG, and blood pressure and catecholamine monitoring. With mental stress, there were increases in heart rate, systolic blood pressure, cardiac output, and systemic vascular resistance that were correlated with increases in plasma epinephrine. During exercise, systemic vascular resistance fell, and there was no relationship between the hemodynamic changes and epinephrine levels. The fall in ejection fraction was greater with mental stress than exercise. During mental stress, the changes in ejection fraction were inversely correlated with the changes in systemic vascular resistance. Evidence for myocardial ischemia was present in 92% of patients during bicycle exercise and in 58% of patients during mental stress. Greater increases in plasma epinephrine and norepinephrine occurred with ischemia during exercise, and greater increases in systemic vascular resistance occurred with ischemia during mental stress. Conclusions Mental stress–induced myocardial ischemia is associated with a significant increase in systemic vascular resistance and a relatively minor increase in heart rate and rate-pressure product compared with ischemia induced by exercise. These hemodynamic responses to mental stress can be mediated by the adrenal secretion of epinephrine. The pathophysiological mechanisms involved are important in the understanding of the etiology of myocardial ischemia and perhaps in the selection of appropriate anti-ischemic therapy.

Psychological factors are linked to outcomes in coronary artery disease (CAD) pts but the mechanisms are obscure. The PIMI is a NIH multicenter study designed to test the overall hypothesis that manifestations and expressions of ischemia are influenced by specific psycho-physiologic mechanisms. Accordingly, 200 pts, mean age 62, with CAD and ischemia responses on treadmill were studied. Ambulatory ECG (AECG) monitoring, psychological instrument batteries and plasma biochemical tests were applied to identify mechanisms associated with ischemia during daily life, exercise and mental stress without influence of cardiac medications. Daily life ischemia (AECG) occurred in 41% of pts (95% with ischemia were asymptomatic) and was associated with lower hostility (p l 0.01) and anger expression (p l 0.03) scores compared with those without daily life ischemia. An inverse association between magnitude of daily life ischemia and these scores was observed. No differences were found for depression (Beck) or anxiety scores. On treadmill all pts had ischemia (ST segment depression) but 44% had angina. Angina expression was associated with higher depression (p =0.002), anxiety (State, p = 0.002 and Trait, p = 0.01) and autonomic perception (p = 0.05) scores than no angina. Depression best predicted time to angina (Cox model, p = 0.007). During mental stress (Stroop and speech tasks) ischemia (radionuclide ventriculogram (RVG) or ST segment abnormalities) occurred in 79% of pts (95% with ischemia were asymptomatic) and associated with higher Reward, Dependence, (Temperament and Character Inventory, p l 0.02) and level of irritation during Stroop task (p l 0.01). Plasma norepinephrine remained low, but epinephrine doubled and systolic pressure increased. No associations were found for medical or demographic factors examined. During bicycle exercise ischemia (RVG abnormality) occurred in 94% of pts (64% with ischemia were asymptomatic) yet norepinephrine increased three-fold. In summary, daily life ischemia (usually asymptomatic) is associated with suppressed hostility, anger and emotion but not depression or anxiety. Mental stress ischemia (mostly asymptomatic and with epinephrine release) is related to temperament characteristics. Exercise stress ischemia, on the other hand, more often evokes symptoms and marked norepinephrine release but symptom expression seems dependent upon depression, anxiety and autonomic perception. Mechanisms responsible for ischemia evoked in different settings and its symptomatic expression involve complex interactions of behavioral, physiological and psychophysiological factors.