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202. Does the Association Between Hemoglobin A1c and Risk of Cardiovascular Events Vary by Residential Segregation? The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Author

Cummings, Doyle M., primary, Patil, Shivajirao P., primary, Long, D. Leann, primary, Guo, Boyi, primary, Cherrington, Andrea, primary, Safford, Monika M, primary, Judd, Suzanne E., primary, Howard, Virginia J, primary, Howard, George, primary, and Carson, April P., primary

Published
2021
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203. Egg consumption, overall diet quality, and risk of type 2 diabetes and coronary heart disease: A pooling project of US prospective cohorts

Author

Djoussé, Luc, primary, Zhou, Guohai, additional, McClelland, Robyn.L., additional, Ma, Nanxun, additional, Zhou, Xia, additional, Kabagambe, Edmond. K., additional, Talegawkar, Sameera.A., additional, Judd, Suzanne. E., additional, Biggs, Mary. L., additional, Fitzpatrick, Annette.L., additional, Clark, Cheryl. R., additional, Gagnon, David. R., additional, Steffen, Lyn. M., additional, Gaziano, J. Michael, additional, Lee, I-Min, additional, Buring, Julie. E., additional, and Manson, JoAnn.E., additional

Published
2021
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210. Rural/urban differences in the prevalence of stroke risk factors: A cross‐sectional analysis from the REGARDS study.

Author

Kamin Mukaz, Debora, Dawson, Erica, Howard, Virginia J., Cushman, Mary, Higginbotham, John C., Judd, Suzanne E., Kissela, Brett M., Safford, Monika M., Soliman, Elsayed Z., and Howard, George

Subjects
STROKE risk factors, HYPERTENSION, CONFIDENCE intervals, RURAL conditions, CROSS-sectional method, LEFT ventricular hypertrophy, POPULATION geography, DIABETES, ATRIAL fibrillation, RISK assessment, SOCIAL classes, DISEASE prevalence, DESCRIPTIVE statistics, METROPOLITAN areas, SMOKING, ODDS ratio, LONGITUDINAL method, HEART diseases
Abstract

Purpose: We previously described the magnitude of rural‐urban differences in the prevalence of stroke risk factors and stroke mortality. In this report, we sought to extend the understanding of rural‐urban differences in the prevalence of stroke risk factors by using an enhanced definition of rural‐urban status and assessing the impact of neighborhood socioeconomic status (nSES) on risk factor differences. Methods: This analysis included 28,242 participants without a history of stroke from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants were categorized into the 6‐level ordinal National Center for Health Statistics Urban‐Rural Classification Scheme. The prevalence of stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy, and heart disease) was assessed across the rural‐urban scale with adjustment for demographic characteristics and further adjustment for nSES score. Findings: Hypertension, diabetes, and heart disease were more prevalent in rural than urban regions. Higher odds were observed for these risk factors in the most rural compared to the most urban areas (odds ratios [95% CI]: 1.25 [1.11‐1.42] for hypertension, 1.15 [0.99‐1.33] for diabetes, and 1.19 [1.02‐1.39] for heart disease). Adjustment for nSES score partially attenuated the odds of hypertension and heart disease with rurality, completely attenuated the odds of diabetes, and unmasked an association of current smoking. Conclusions: Some of the higher stroke mortality in rural areas may be due to the higher burden of stroke risk factors in rural areas. Lower nSES contributed most notably to rural‐urban differences for diabetes and smoking. [ABSTRACT FROM AUTHOR]

Published
2022
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211. Socioeconomic status and psychological stress: Examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study.

Author

Cundiff, Jenny M., Bennett, Aleena, Carson, April P., Judd, Suzanne E., and Howard, Virginia J.

Subjects
STROKE, HEALTH services accessibility, SOCIAL determinants of health, BLACK people, RESEARCH methodology, RACE, POPULATION geography, HEALTH status indicators, INTERVIEWING, SEX distribution, SOCIAL classes, RESEARCH funding, DEMOGRAPHY, WHITE people, PSYCHOLOGICAL stress, SECONDARY analysis
Abstract

Socioeconomic status (SES) is a well‐established determinant of health. Disparities in stress are thought to partially account for SES‐health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well‐characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4‐item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex‐race‐region groups, the largest SES‐stress associations were for income and the smallest were for occupation. Race moderated SES‐stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress‐related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress. [ABSTRACT FROM AUTHOR]

Published
2022
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216. Correlates of a southern diet pattern in a national cohort study of blacks and whites: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Author

Couch, Catharine A, primary, Gray, Marquita S, additional, Shikany, James M, additional, Howard, Virginia J, additional, Howard, George, additional, Long, D Leann, additional, McClure, Leslie A, additional, Manly, Jennifer J, additional, Cushman, Mary, additional, Zakai, Neil A, additional, Pearson, Keith E, additional, Levitan, Emily B, additional, and Judd, Suzanne E, additional

Published
2021
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217. Trajectory of Cognitive Decline After Sepsis

Author

Wang, Henry E., primary, Kabeto, Mohammed M., additional, Gray, Marquita, additional, Wadley, Virginia G., additional, Muntner, Paul, additional, Judd, Suzanne E., additional, Safford, Monika M., additional, Kempker, Jordan, additional, and Levine, Deborah A., additional

Published
2021
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219. Association of Sickle Cell Trait With Incidence of Coronary Heart Disease Among African American Individuals

Author

Hyacinth, Hyacinth I., primary, Franceschini, Nora, additional, Seals, Samantha R., additional, Irvin, Marguerite R., additional, Chaudhary, Ninad, additional, Naik, Rakhi P., additional, Alonso, Alvaro, additional, Carty, Cara L., additional, Burke, Gregory L., additional, Zakai, Neil A., additional, Winkler, Cheryl A., additional, David, Victor A., additional, Kopp, Jeffrey B., additional, Judd, Suzanne E., additional, Adams, Robert J., additional, Gee, Beatrice E., additional, Longstreth, W. T., additional, Egede, Leonard, additional, Lackland, Daniel T., additional, Greenberg, Charles S., additional, Taylor, Herman, additional, Manson, JoAnn E., additional, Key, Nigel S., additional, Derebail, Vimal K., additional, Kshirsagar, Abhijit V., additional, Folsom, Aaron R., additional, Konety, Suma H., additional, Howard, Virginia, additional, Allison, Matthew, additional, Wilson, James G., additional, Correa, Adolfo, additional, Zhi, Degui, additional, Arnett, Donna K., additional, Howard, George, additional, Reiner, Alexander P., additional, Cushman, Mary, additional, and Safford, Monika M., additional

Published
2021
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221. ProNT_Supp_VascMed_18AUG – Supplemental material for Pro-neurotensin/neuromedin N and risk of ischemic stroke: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Author

Nicoli, Charles D, Wettersten, Nicholas, Judd, Suzanne E, Howard, George, Howard, Virginia J, Struck, Joachim, and Cushman, Mary

Subjects
FOS: Clinical medicine, Cardiology, 110323 Surgery
Abstract

Supplemental material, ProNT_Supp_VascMed_18AUG for Pro-neurotensin/neuromedin N and risk of ischemic stroke: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study by Charles D Nicoli, Nicholas Wettersten, Suzanne E Judd, George Howard, Virginia J Howard, Joachim Struck and Mary Cushman in Vascular Medicine

Published
2020
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222. CKD Awareness and Longitudinal Health Outcomes: Results from the REGARDS Study

Author

Tummalapalli, Sri Lekha, Vittinghoff, Eric, Crews, Deidra C., Cushman, Mary, Gutiérrez, Orlando M., Judd, Suzanne E., Kramer, Holly J., Peralta, Carmen A., Tuot, Delphine S., Shlipak, Michael G., and Estrella, Michelle M.

Subjects
Aged, 80 and over, Male, Health Knowledge, Attitudes, Practice, Geography, Coronary Disease, Health Status Disparities, Middle Aged, urologic and male genital diseases, Severity of Illness Index, female genital diseases and pregnancy complications, Article, United States, Race Factors, Stroke, Risk Factors, Disease Progression, Albuminuria, Humans, Female, Longitudinal Studies, Renal Insufficiency, Chronic, Aged, Follow-Up Studies, Glomerular Filtration Rate
Abstract

BACKGROUND: The majority of people with chronic kidney disease (CKD) are unaware of their kidney disease. Assessing the clinical significance of increasing CKD awareness has critical public health and healthcare delivery implications. Whether CKD awareness among persons with CKD is associated with longitudinal health behaviors, disease management, and health outcomes is unknown. METHODS: We analyzed data from participants with CKD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, longitudinal, population-based cohort. Our predictor was participant CKD awareness. Outcomes were 1) Health behaviors (smoking avoidance, exercise, and nonsteroidal anti-inflammatory drug [NSAID] use); 2) CKD management indicators (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, statin use, systolic blood pressure, fasting blood glucose, and body mass index); 3) change in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR); and 4) health outcomes (incident end-stage kidney disease [ESKD], coronary heart disease, stroke, and death). Logistic and linear regression were used to examine the association of baseline CKD awareness with outcomes of interest, adjusted for CKD stage and participant demographic and clinical factors. RESULTS: Of 6,529 participants with baseline CKD, 285 (4.4%) were aware of their CKD. Among the 3,586 participants who survived until follow-up (median 9.5 years), baseline awareness was not associated with subsequent odds of health behaviors, CKD management indicators, or changes in eGFR and UACR in adjusted analyses. Baseline CKD awareness was associated with increased risk of ESKD (HR=1.44; 95% CI: 1.08, 1.92) and death (HR=1.18; 95% CI: 1.00, 1.39), but not with subsequent coronary heart disease or stroke, in adjusted models. CONCLUSIONS: Individuals aware of their CKD were more likely to experience ESKD and death, suggesting that CKD awareness reflects disease severity. Most persons with CKD, including those that are high-risk, remain unaware of their CKD. There was no evidence of associations between baseline CKD awareness and longitudinal health behaviors, CKD management indicators, or eGFR decline and albuminuria.

Published
2020

223. A Prospective Study of Obesity, Metabolic Health and Cancer Mortality among Blacks and Whites

Author

Akinyemiju, Tomi, Moore, Justin Xavier, Pisu, Maria, Judd, Suzanne E., Goodman, Michael, Shikany, James M., Howard, Virginia J., Safford, Monika, and Gilchrist, Susan C.

Subjects
Male, obesity, Middle Aged, Survival Analysis, Article, metabolic syndrome, Body Mass Index, Cohort Studies, Risk Factors, Neoplasms, cancer, Humans, Female, Prospective Studies, race, Aged
Abstract

Introduction We examined whether metabolic health status increases the risk of cancer mortality, and whether this association varied by body mass index (BMI) category. Methods We performed a prospective study of 22,514 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We defined metabolic unhealthy status as having 3+ of the following: 1) elevated fasting glucose, 2) high triglycerides, 3) dyslipidemia, 4) hypertension, and 5) elevated waist circumference. We categorized participants into normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) groups. We performed Cox proportional hazards regression to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) for cancer mortality during follow-up. Results Among participants with normal weight, those who were metabolically unhealthy had increased risk of cancer mortality (HR: 1.57; 95% CI: 1.15 – 2.16) compared with metabolically healthy participants. Overall mortality risk for participants who were metabolically unhealthy and normal-weight was stronger for obesity-related cancers (HR: 2.31, 95% CI: 1.13 – 4.73). Compared with participants with normal weight, those who were metabolically healthy overweight were at reduced risk of any cancer mortality (adjusted HR: 0.79, 95% CI: 0.63-0.98). Conclusion There was an increased risk of overall- and obesity-related- cancer mortality among metabolically unhealthy normal weight participants.

Published
2017

225. C-Reactive Protein and Incident Hypertension in Black and White Americans in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort Study

Author

Plante, Timothy B, primary, Long, D Leann, additional, Guo, Boyi, additional, Howard, George, additional, Carson, April P, additional, Howard, Virginia J, additional, Judd, Suzanne E, additional, Jenny, Nancy Swords, additional, Zakai, Neil A, additional, and Cushman, Mary, additional

Published
2020
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228. Life’s Simple 7 and Incident Hypertension: The REGARDS Study

Author

Plante, Timothy B., primary, Koh, Insu, additional, Judd, Suzanne E., additional, Howard, George, additional, Howard, Virginia J., additional, Zakai, Neil A., additional, Booth, John N., additional, Safford, Monika M., additional, Muntner, Paul, additional, and Cushman, Mary, additional

Published
2020
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235. Epidemiologic Features of Recovery From SARS-CoV-2 Infection.

Author

Oelsner, Elizabeth C., Sun, Yifei, Balte, Pallavi P., Allen, Norrina B., Andrews, Howard, Carson, April, Cole, Shelley A., Coresh, Josef, Couper, David, Cushman, Mary, Daviglus, Martha, Demmer, Ryan T., Elkind, Mitchell S. V., Gallo, Linda C., Gutierrez, Jose D., Howard, Virginia J., Isasi, Carmen R., Judd, Suzanne E., Kanaya, Alka M., and Kandula, Namratha R.

Published
2024
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236. Pro-neurotensin/Neuromedin N and Hypertension Risk: A Prospective Study.

Author

Nicoli, Charles D, Long, D Leann, Plante, Timothy B, Howard, George, Judd, Suzanne E, Schulte, Janin, and Cushman, Mary

Subjects
BLOOD pressure, RENIN-angiotensin system, LONGITUDINAL method, POISSON regression, HYPERTENSION
Abstract

Background Neurotensin, a neuropeptide with direct cardiac effects, has been associated with prospective risk of hypertension-related conditions through measurement of its precursor, pro-neurotensin/neuromedin N (pro-NT/NMN). Its association with incident hypertension has not been evaluated. Methods From 2003 to 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30,239 Black or White adults age ≥45. Pro-NT/NMN was measured in 1,692 participants without baseline hypertension (self-reported antihypertensive use or blood pressure ≥140/90 mm Hg) who underwent follow-up assessment in 2013–2016. A sensitivity analysis was conducted using a lower threshold (≥130/80 mm Hg) to define hypertension. Three robust Poisson regression models were fitted to risk of incident hypertension, adding demographics, cardiometabolic risk factors, and dietary covariates. Results Six hundred and fourteen participants developed hypertension over 9.4 years of follow-up. Pro-NT/NMN ranged from 14 to 1,246 pmol/l, with median [interquartile range] 154 [112, 206] pmol/l. Pro-NT/NMN was not associated with hypertension overall (fully adjusted incidence rate ratio per SD increment log pro-NT/NMN 1.03, 95% confidence interval 0.95–1.11). Results of sensitivity analysis did not differ substantially. Conclusions Baseline pro-NT/NMN was not associated with incident hypertension. This may be a result of neurotensin's long-term interactions with other molecular regulators of blood pressure, such as the renin–angiotensin–aldosterone system. [ABSTRACT FROM AUTHOR]

Published
2022
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237. Atrial fibrillation and risk of incident heart failure with reduced versus preserved ejection fraction.

Author

Nicoli, Charles D., O'Neal, Wesley T., Levitan, Emily B., Singleton, Matthew J., Judd, Suzanne E., Howard, George, Safford, Monika M., and Soliman, Elsayed Z.

Subjects
HEART failure, ATRIAL fibrillation, VENTRICULAR ejection fraction, CORONARY disease, CARDIOVASCULAR diseases risk factors, ATRIAL fibrillation diagnosis, LEFT heart ventricle, PROGNOSIS, STROKE volume (Cardiac output), HEART physiology, DISEASE complications
Abstract

Objective: Associations between atrial fibrillation (AF) and heart failure (HF) have been established. We compared the extent to which AF is associated with each primary subtype of HF, with reduced (HFrEF) versus preserved ejection fraction (HFpEF).Methods: We included 25 787 participants free of baseline HF from the REGARDS (REasons for Geographic And Racial Differences in Stroke) cohort. Baseline AF was ascertained from ECG and self-reported history of physician diagnosis. Incident HF events were determined from physician-adjudicated review of hospitalisation medical records and HF deaths. Based on left ventricular ejection fraction (LVEF) at the time of HF event, HFrEF, HFpEF, and mid-range HF were defined as LVEF <40%, ≥50% and 40%-49%, respectively. Multivariable Cox proportional-hazards models examined the association between AF and HF. The Lunn-McNeil method was used to compare associations of AF with incident HFrEF versus HFpEF.Results: Over a median of 9 years of follow-up, 1109 HF events occurred (356 HFpEF, 388 HFrEF, 77 mid-range and 288 unclassified). In a model adjusted for sociodemographics, cardiovascular risk factors, and incident coronary heart disease, AF was associated with increased risk of all HF events (HR 1.67, 95% CI 1.38 to 2.01). The associations of AF with HFrEF versus HFpEF events did not differ significantly (HR 1.87 (95% CI 1.38 to 2.54) and HR 1.65 (95% CI 1.20 to 2.28), respectively; p value for difference=0.581). These associations were consistent in sex and race subgroups.Conclusions: AF is associated with both HFrEF and HFpEF events, with no significant difference in the strength of association among these subtypes. [ABSTRACT FROM AUTHOR]

Published
2022
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249. Does the Association Between Hemoglobin A1c and Risk of Cardiovascular Events Vary by Residential Segregation? The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Author

Cummings, Doyle M., primary, Patil, Shivajirao P., additional, Long, D. Leann, additional, Guo, Boyi, additional, Cherrington, Andrea, additional, Safford, Monika M., additional, Judd, Suzanne E., additional, Howard, Virginia J., additional, Howard, George, additional, and Carson, April P., additional

Published
2020
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