scholarly journals Kidney Measures with Diabetes and Hypertension on Cardiovascular Disease: The Atherosclerosis Risk in Communities Study

2015 ◽  
Vol 41 (4-5) ◽  
pp. 409-417 ◽  
Author(s):  
Nadine Alexander ◽  
Kunihiro Matsushita ◽  
Yingying Sang ◽  
Shoshana Ballew ◽  
Bakhtawar K. Mahmoodi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Regression Models ◽  
Estimated Glomerular Filtration Rate ◽  
Cox Regression ◽  
Cardiovascular Outcomes ◽  
Creatinine Ratio ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Lower Egfr

Background: Whether the association of chronic kidney disease (CKD) with cardiovascular risk differs based on diabetes mellitus (DM) and hypertension (HTN) status remains unanswered. Methods: We investigated 11,050 participants from the Atherosclerosis Risk in Communities Study (fourth examination (1996-1998)) with follow-up for cardiovascular outcomes (coronary disease, heart failure and stroke) through 2009. Using the Cox regression models, we quantified cardiovascular risk associated with estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) in individuals with and without DM and/or HTN and assessed their interactions. Results: Individuals with DM and HTN generally had higher cardiovascular risk relative to those without at all the levels of eGFR and ACR. Cardiovascular risk increased with lower eGFR and higher ACR regardless of DM and HTN status (e.g. adjusted hazards ratio (HR) for eGFR 30-44 vs. 90-104 ml/min/1.73 m2, 2.32 (95% CI, 1.66-3.26) in non-diabetics vs. 1.83 (1.25-2.67) in diabetics and 2.45 (2.20-5.01) in non-hypertensives vs. 1.51 (1.27-1.81) in hypertensives and corresponding adjusted HR for ACR 30-299 vs. <10 mg/g, 1.70 (1.45-2.00) vs. 1.34 (1.10-1.64) and 1.42 (1.10-1.85) vs. 1.57 (1.36-1.81), respectively). Only the ACR-DM interaction reached significance, with a shallower relative risk gradient among diabetics than among non-diabetics (p = 0.02). Analysis of individual cardiovascular outcomes showed similar results. Conclusion: Although individuals with DM and HTN generally had higher cardiovascular risk relative to those without these complications, both low eGFR and high ACR were associated with cardiovascular diseases regardless of the presence or absence of DM and HTN. These findings reinforce the importance of CKD in cardiovascular outcomes.

scholarly journals Triglyceride-glucose index in the development of peripheral artery disease: findings from the Atherosclerosis Risk in Communities (ARIC) Study

2021 ◽  
Author(s):  
Jing-Wei Gao ◽  
Qing-Yun Hao ◽  
Ming Gao ◽  
Kun Zhang ◽  
Xiong-Zhi Li ◽  
...  
Keyword(s):  
Cox Regression ◽  
Surrogate Marker ◽  
Hazard Ratio ◽  
Cardiovascular Risks ◽  
Atherosclerosis Risk In Communities ◽  
Tyg Index ◽  
Triglyceride Glucose Index ◽  
Atherosclerosis Risk ◽  
Artery Disease

Abstract Background It remains unclear whether triglyceride-glucose (TyG) index, a surrogate marker of IR, was prospectively associated with incident PAD. Methods We included 12573 ARIC (Atherosclerosis Risk in Communities Study) participants free of PAD at baseline (1987–1989). The TyG index was determined using ln(fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2), and measured during 5 visits between 1987 and 2013. Incident PAD was defined as the first hospitalization with PAD diagnosis. We quantified the association of both baseline and trajectories of TyG index with incident PAD using Cox regression and logistic regression analysis, respectively. Results Over a median follow-up of 23 years, there were 1331 cases of incident PAD. After adjustment for traditional PAD risk factors, each 1-SD (0.58) increase in TyG index was associated with an 18.9% higher risk of incident PAD (hazard ratio, 1.189 [95% CI, 1.106–1.278]). Results were similar when individuals were categorized by TyG index quartiles (hazard ratio, 1.363 [95% CI, 1.125–1.652]; comparing extreme quartiles). Four distinct trajectories of TyG index were identified (low-increasing [43.0%], moderate-stable [22.3%], moderate-decreasing [27.6%], and high-decreasing [7.1%]). Trajectories of elevated TyG index levels had greater incident PAD after multivariable adjustment for potential cardiovascular risks. Compared with moderate-stable group (reference), high-decreasing group was associated with the highest risk of future incident PAD (odds ratio, 2.314 [95%CI, 1.687–3.175]). Conclusion Higher TyG index is independently associated with incident PAD. Long-term trajectories of TyG index help identify individuals at a higher risk of future PAD who deserve appropriate follow-up to detect asymptomatic disease.

Abstract P362: Association of DNA Methylation Age With Risk of Type 2 diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Nicholas S Roetker ◽  
James S Pankow ◽  
Heather H Nelson ◽  
Weihua Guan ◽  
Chindo Hicks ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dna Methylation ◽  
Blood Cell ◽  
Regression Models ◽  
Chronological Age ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Dna Methylation Age

Introduction: It has been proposed that DNA methylation patterns can be used to characterize rate of aging, but it is not known whether methylation age associates with aging-related diseases and conditions independently of chronological age and other risk factors. Hypothesis: There is a positive association between age acceleration (defined as the difference between DNA methylation age and chronological age) and risk of type 2 diabetes (T2D). Methods: We estimated DNA methylation age in African American men and women of the Atherosclerosis Risk in Communities Study using two published predictors. Incident T2D was identified from follow-up visits and telephone interviews. Logistic and Cox proportional hazards regression models were used to estimate the association of age acceleration with incident T2D, modeling age acceleration both continuously and categorically in three percentile groups (0-25th, 25-75th, 75-100th). Regression models were adjusted for chronological age, sex, white blood cell distribution, education, smoking, alcohol, sport index, body mass index, waist to hip ratio, blood pressure, antihypertensive and lipid-lowering medication, HDL and LDL cholesterol, and triglycerides. Results: After adjustment for chronological age, sex, and white blood cell type proportions, those with greater age acceleration were more likely to have prevalent T2D (p-trend ≤ 0.003 across percentile categories of age acceleration for both DNA methylation predictors). Among 1,547 participants who were free of T2D at baseline (mean age: 56 years, range: 47-70), there were 170 incident cases of T2D over a mean 5.4 years of follow-up. T2D incidence was not associated with age acceleration in either crude or risk factor-adjusted models. In the fully-adjusted logistic regression models, odds ratios (95% confidence intervals) for T2D across the percentile categories of age acceleration were 1 (ref.), 0.92 (0.58, 1.45), and 1.42 (0.84, 2.40); and 1 (ref.), 0.87 (0.55, 1.39), and 0.93 (0.52, 1.64), respectively, for the two DNA methylation age predictors. Conclusion: In conclusion, DNA methylation age acceleration, proposed as a marker of the rate of aging, was associated cross-sectionally with prevalent diabetes, but did not predict risk of T2D independently of chronological age. Additional prospective studies are needed to explore relationships with development of other chronic conditions in order to determine if DNA methylation age can serve as a useful proxy for rate of aging.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

Abstract P116: Trait Anger Increases Short-term and Long-term Risk for Recurrent CHD: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Janice E Williams ◽  
Sharon B Wyatt ◽  
Kathryn M Rose ◽  
David J Couper ◽  
Anna Kucharska-Newton
Keyword(s):  
Cigarette Smoking ◽  
Trait Anger ◽  
Middle Aged ◽  
Short Term ◽  
Men And Women ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Aric Study

Though several large epidemiologic studies have demonstrated the positive association of anger with coronary heart disease (CHD) onset, a dearth of population-based evidence exists regarding the relationship of anger to the clinical course of CHD among people with established disease. Trait anger is conceptualized as a stable personality trait and defined as the tendency to experience frequent and intense anger. Therefore, it is plausible that the effects of trait anger on CHD are long standing. We assessed the hypothesis that trait anger predicts short-term and long-term risk for recurrent CHD among middle-aged men and women. Participants were 611 black or white men and women, ages 48 - 67, who had a history of CHD at the second clinical examination (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. They were followed for the recurrence of CHD (myocardial infarction or fatal CHD) from 1990 through three different time intervals: 1995, 2003, and 2009 (maximum follow-up = 19.0 years). Trait anger (measured at Visit 2) was assessed using the Spielberger Trait Anger Scale, with scores categorized as high, moderate, and low. Cox proportional hazards regression analyses were adjusted for age, sex, race-center, educational level, waist-to-hip ratio, plasma LDL-and HDL-cholesterol levels, hypertension, diabetes, cigarette smoking status, and pack-years of cigarette smoking. After 3 - 5 years of follow-up, the risk for recurrent CHD among participants with high trait anger was more than twice that of their counterparts with low trait anger (2.24 [95% C.I: 1.14 to 4.40]). After 11 - 13 years, the risk was 80% greater (1.80 [95% C.I: 1.17 to 2.78]) and after 17 - 19 years, it was 70% greater (1.70 [95% C.I: 1.15 to 2.52]). The risk for recurrent CHD was strongest in the first time interval but remained strong and statistically significant through 19 years of follow-up. In conclusion, the experience of frequent and intense anger increases short-term and long-term risk for recurrent CHD in middle-aged men and women.

Abstract MP083: Autonomic Imbalance at the Level of Atrioventricular Node, but Not at the Level of Sinus Node, is Associated With Sudden Cardiac Death: The Atherosclerosis Risk in Community Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Srini V Mukundan ◽  
Muammar M Kabir ◽  
Jason Thomas ◽  
Golriz Sedaghat ◽  
Jonathan W Waks ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cox Regression ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Av Node ◽  
Atherosclerosis Risk In Communities ◽  
Autonomic Imbalance ◽  
Summary Effect ◽  
Atherosclerosis Risk

Introduction: Autonomic imbalance, quantified by decreased heart rate variability (HRV), is associated with increased cardiovascular mortality. It is unknown if autonomic influences on sinus and atrioventricular (AV) nodes are equally important for the risk of sudden cardiac death (SCD). Hypothesis: Autonomic influences on sinus and AV node are equally strongly associated with increased SCD, non-sudden cardiac death (non-SCD), and non-cardiac death. Methods: Baseline visit 10-second ECGs (n=14,250) of the Atherosclerosis Risk in Communities (ARIC) cohort were analyzed. Normalized variance of P-onset to P-onset intervals (PPVN) and QRS-onset to QRS-onset intervals (QQVN) was calculated to assess autonomic influence on sinus and AV node respectively. Normalized variance of Rpeak - Rpeak intervals was determined as HRV measure. Values were log-transformed to normalize distribution. SCD served as primary outcome. Secondary outcomes were non-SCD and non-cardiac death. Three Cox regression models were constructed for dichotomized at 20 th percentile predictor variables. Results: Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-SCDs (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. In paired analysis, LogPPVN was significantly larger than LogQQVN (-7.28±1.06 vs. -7.72±1.24; P<0.0001). There was no difference between LogQQVN and Log RRVN (-7.72±1.24 vs -7.72±1.23; P=0.364). After full adjustment, LogRRVN and LogQQVN were significantly associated with non-SCD and SCD. Association with non-SCD was stronger. LogPPVN was independently associated with non-SCD but not SCD. No value was associated with non-cardiac death. Conclusion: Autonomic imbalance at the AV node, with likely summary effect at the bundle of His, is associated with SCD and non-SCD. Autonomic imbalance at the SA node is associated with non-SCD only. Autonomic input to SA and AV node should be further studied.

Abstract P014: Lower eGFR and Proteinuria Were Independently Associated With Lower Cognitive Abilities in Community-dwelling Men in Japan: SESSA study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Akira Fujiyoshi ◽  
Takayoshi Ohkubo ◽  
Katsuyuki Miura ◽  
Akihiko Shiino ◽  
Naoko Miyagawa ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Cognitive Abilities ◽  
Estimated Glomerular Filtration Rate ◽  
Subclinical Atherosclerosis ◽  
Community Dwelling ◽  
Community Based ◽  
Lower Egfr ◽  
The Mean ◽  
The Relationship

Introduction: The relationship between chronic kidney disease (CKD) and cognitive function remains to be determined. Existing studies focused primarily on estimated glomerular filtration rate (eGFR) but not proteinuria in relation to cognitive function. Hypothesis: In a community-based sample, lower eGFR and presence of proteinuria are cross-sectionally independently associated with lower cognition. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined participants from Shiga, Japan in 2006-08 at baseline. Among 824 male participants in the follow-up exam (2010-12), we restricted our analyses to those who underwent the Cognitive Abilities Screening Instrument (CASI), age ≥65 years-old, free of stroke, with no missing pertinent covariates. We calculated eGFR (creatinine-based) according to the 2012-guideline by the Japanese Society of Nephrology. We then divided the participants into three groups by eGFR of ≥60, 59-40, and <40 (mL/min/1.73m 2 ), and separately divided into three groups according to proteinuria using urine dipstick: (-), (-/+), and ≥(1+). We defined CKD as either eGFR <60 or proteinuria ≥ (-/+). In linear regression with CASI score being a dependent variable, we computed the score adjusted for age, highest education attained, smoking, drinking, body mass index, hypertension, diabetes, and dyslipidemia. Results: We analyzed 541 men. The mean [standard deviation] of age and unadjusted score were 72.6 [4.3] years and 89.7 [6.0]. Prevalence of CKD was 56%. The score was significantly lower in participants with CKD than those without it (P=0.03). eGFR and proteinuria categories were separately and jointly associated with lower CASI score in a graded fashion (Ps for trend <0.05 in all the models tested. Table 1 ). Conclusions: Lower eGFR and higher degree of proteinuria were independently associated with lower cognitive function in the community-based men. CKD even in its early phase may predispose to lower cognitive function.

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