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Garcia RG, Staley R, Aroner S, Stowell J, Sclocco R, Napadow V, Barbieri R, Goldstein JM. Optimization of respiratory-gated auricular vagus afferent nerve stimulation for the modulation of blood pressure in hypertension. Front Neurosci 2022; 16:1038339. [PMID: 36570845 PMCID: PMC9783922 DOI: 10.3389/fnins.2022.1038339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background The objective of this pilot study was to identify frequency-dependent effects of respiratory-gated auricular vagus afferent nerve stimulation (RAVANS) on the regulation of blood pressure and heart rate variability in hypertensive subjects and examine potential differential effects by sex/gender or race. Methods Twenty hypertensive subjects (54.55 ± 6.23 years of age; 12 females and 8 males) were included in a within-person experimental design and underwent five stimulation sessions where they received RAVANS at different frequencies (i.e., 2 Hz, 10 Hz, 25 Hz, 100 Hz, or sham stimulation) in a randomized order. EKG and continuous blood pressure signals were collected during a 10-min baseline, 30-min stimulation, and 10-min post-stimulation periods. Generalized estimating equations (GEE) adjusted for baseline measures were used to evaluate frequency-dependent effects of RAVANS on heart rate, high frequency power, and blood pressure measures, including analyses stratified by sex and race. Results Administration of RAVANS at 100 Hz had significant overall effects on the reduction of heart rate (β = -2.03, p = 0.002). It was also associated with a significant reduction of diastolic (β = -1.90, p = 0.01) and mean arterial blood pressure (β = -2.23, p = 0.002) in Black hypertensive participants and heart rate in female subjects (β = -2.83, p = 0.01) during the post-stimulation period when compared to sham. Conclusion Respiratory-gated auricular vagus afferent nerve stimulation exhibits frequency-dependent rapid effects on the modulation of heart rate and blood pressure in hypertensive patients that may further differ by race and sex. Our findings highlight the need for the development of optimized stimulation protocols that achieve the greatest effects on the modulation of physiological and clinical outcomes in this population.
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Affiliation(s)
- Ronald G. Garcia
- Clinical Neuroscience Laboratory of Sex Differences in the Brain, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- School of Medicine, Universidad de Santander, Bucaramanga, Colombia
| | - Rachel Staley
- Clinical Neuroscience Laboratory of Sex Differences in the Brain, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Aroner
- Clinical Neuroscience Laboratory of Sex Differences in the Brain, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jessica Stowell
- Clinical Neuroscience Laboratory of Sex Differences in the Brain, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Scott Schoen and Nancy Adams Discovery Center for Recovery from Chronic Pain, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
- Department of Gastroenterology and Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vitaly Napadow
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Scott Schoen and Nancy Adams Discovery Center for Recovery from Chronic Pain, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Riccardo Barbieri
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jill M. Goldstein
- Clinical Neuroscience Laboratory of Sex Differences in the Brain, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Innovation Center on Sex Differences in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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Emerging roles of ferroptosis in cardiovascular diseases. Cell Death Dis 2022; 8:394. [PMID: 36127318 PMCID: PMC9488879 DOI: 10.1038/s41420-022-01183-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
The mechanism of cardiovascular diseases (CVDs) is complex and threatens human health. Cardiomyocyte death is an important participant in the pathophysiological basis of CVDs. Ferroptosis is a new type of iron-dependent programmed cell death caused by excessive accumulation of iron-dependent lipid peroxides and reactive oxygen species (ROS) and abnormal iron metabolism. Ferroptosis differs from other known cell death pathways, such as apoptosis, necrosis, necroptosis, autophagy and pyroptosis. Several compounds have been shown to induce or inhibit ferroptosis by regulating related key factors or signalling pathways. Recent studies have confirmed that ferroptosis is associated with the development of diverse CVDs and may be a potential therapeutic drug target for CVDs. In this review, we summarize the characteristics and related mechanisms of ferroptosis and focus on its role in CVDs, with the goal of inspiring novel treatment strategies.
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Foucan L, Afassinou Y, Chingan-Martino V, Ancedy Y, Bassien-Capsa V, Galantine O, Nicolas L, Tabue Teguo M, Martino F, Larifla L. Metabolic Syndrome Components in a Nondiabetic Afro-Caribbean Population: Influence of Gender and Age. Metab Syndr Relat Disord 2022; 20:243-249. [PMID: 35167367 DOI: 10.1089/met.2021.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Our aim was to describe the prevalence of metabolic syndrome (MetS) and its components among Afro-Caribbean adults without diabetes and cardiovascular complications. Methods: Participants were recruited from a Health Center in Guadeloupe, French West Indies. MetS was defined according to the NCEP ATP III. Prevalence of MetS and MetS components were compared across age groups and sex. The odds ratios (ORs) and 95% confidence intervals were obtained using logistic regression. Results: There were 1011 participants (68.8% women, mean age 47.8 ± 11.8 years). Prevalence of MetS was 17.9% (21.1% women, 10.8% men) and increased by age in women. High blood pressure had the highest prevalence among men and among women ≥60 years. Prevalence of abdominal obesity (AbO) was higher in women than in men. High triglyceride levels were uncommon at all ages and, men and women <40 years, compared with the other groups had higher prevalence of low high-density lipoprotein cholesterol (HDL-C) levels. With multiple logistic regression, compared with adults <40 years, those ≥60 years had the highest OR for prevalent hypertension 7.8 (4.8-12.8); P < 0.001, AbO 2.1 (1.3-3.3); P = 0.002 and high fasting blood glucose levels 5.5 (3.1-9.8); P < 0.001. They also had lower odds for having low HDL-C than the younger ones (G1: age <40 years). Among persons ≥60 years, OR for MetS was 1.9 (1.1-3.6); P = 0.013 compared with the referent group. Compared with men, women had higher odds of MetS 2.2 (1.5-3.3); P < 0.001. Conclusion: Women were more likely to have MetS than men and persons ≥60 years were significantly more likely to have MetS than persons <40 years. Preventive measures are required to reduce the prevalence of MetS.
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Affiliation(s)
- Lydia Foucan
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,LAMIA, EA4540. University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Yaovi Afassinou
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Vaneva Chingan-Martino
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Yann Ancedy
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Valerie Bassien-Capsa
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Olivier Galantine
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Livy Nicolas
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | | | - Frederic Martino
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
| | - Laurent Larifla
- Research Team on Cardiometabolic Risk/ECM, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,LAMIA, EA4540. University of the Antilles, Pointe-à-Pitre, Guadeloupe, France.,Cardiology Unit, University Hospital, University of the Antilles, Pointe-à-Pitre, Guadeloupe, France
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Kaur H, Crawford DC, Liang J, Benchek P, Zhu X, Kallianpur AR, Bush WS. Replication of European hypertension associations in a case-control study of 9,534 African Americans. PLoS One 2021; 16:e0259962. [PMID: 34793544 PMCID: PMC8601554 DOI: 10.1371/journal.pone.0259962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Hypertension is more prevalent in African Americans (AA) than other ethnic groups. Genome-wide association studies (GWAS) have identified loci associated with hypertension and other cardio-metabolic traits like type 2 diabetes, coronary artery disease, and body mass index (BMI), however the AA population is underrepresented in these studies. In this study, we examined a large AA cohort for the generalizability of 14 Metabochip array SNPs with previously reported European hypertension associations. Methods To evaluate associations, we analyzed genotype data of 14 SNPs for their associations with a diagnosis of hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in a case-control study of an AA population (N = 9,534). We also performed an age-stratified analysis (>30, 30≥59 and ≥60 years) following the hypertension definition described by the 8th Joint National Committee (JNC). Associations were adjusted for BMI, age, age2, sex, clinical confounders, and genetic ancestry using multivariable regression models to estimate odds ratios (ORs) and beta-coefficients. Analyses stratified by sex were also conducted. Meta-analyses (including both BioVU and COGENT-BP cohorts) were performed using a random-effects model. Results We found rs880315 to be associated with systolic hypertension (SBP≥140 mmHg) in the entire cohort (OR = 1.14, p = 0.003) and within women only (OR = 1.16, p = 0.012). Variant rs17080093 associated with lower SBP and DBP (β = -2.99, p = 0.0352 and - β = 1.69, p = 0.0184) among younger individuals, particularly in younger women (β = -3.92, p = 0.0025 and β = -1.87, p = 0.0241 for SBP and DBP respectively). SNP rs1530440 associated with higher SBP and DBP measurements (younger individuals β = 4.1, p = 0.039 and β = 2.5, p = 0.043 for SBP and DBP; (younger women β = 4.5, p = 0.025 and β = 2.9, p = 0.028 for SBP and DBP), and hypertension risk in older women (OR = 1.4, p = 0.050). rs16948048 increases hypertension risk in younger individuals (OR = 1.31, p = 0.011). Among mid-age women rs880315 associated with higher risk of hypertension (OR = 1.20, p = 0.027). rs1361831 associated with DBP (β = -1.96, p = 0.02) among individuals older than 60 years. rs3096277 increases hypertension risk among older individuals (OR = 1.26 p = 0.0015), however, this variant also reduces SBP among younger women (β = -2.63, p = 0.0102). Conclusion These findings suggest that European-descent and AA populations share genetic loci that contribute to blood pressure traits and hypertension. However, the OR and beta-coefficient estimates differ, and some are age-dependent. Additional genetic studies of hypertension in AA are warranted to identify new loci associated with hypertension and blood pressure traits in this population.
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Affiliation(s)
- Harpreet Kaur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Dana C. Crawford
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Jingjing Liang
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Penelope Benchek
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | | | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
| | - Asha R. Kallianpur
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States of America
| | - William S. Bush
- Genomic Medicine Institute, Cleveland Clinic/Lerner Research Institute, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, United States of America
- * E-mail:
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Marroush TS, Sharma AV, Botros B, Szpunar S, Rosman HS, Mehta RH. Differences in Baseline Characteristics and Outcomes in Young Caucasians and African Americans with Acute Myocardial Infarction. Am J Med Sci 2020; 361:238-243. [PMID: 33054977 DOI: 10.1016/j.amjms.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of acute myocardial infarction (AMI) in young patients is increasing. While race-related differences in clinical characteristics and outcomes for older AMI patients have been well-studied, such differences in young patients are unknown. METHODS We performed a retrospective review of charts of Caucasian and African American (AA) patients <50 years of age, presenting with AMI between 2010 and 2017 in an urban, community hospital in Detroit, Michigan. RESULTS A total of 271 patients were identified with 156 being AAs (57.5%). Mean age was 43 years which was similar in both groups. AAs with AMI were 2.2 times more likely to be women and to have a history of diabetes and 1.2 times more likely to have BMI >30 kg/m2. History of coronary artery disease (1.8-fold) and hypertension (1.5-fold) were also more common in AAs. Overall presenting features were similar, other than that AAs presented more often with non-ST-elevation MI and tended to present less often with cardiac arrest. No differences were observed in the angiographic findings or in-hospital outcomes in the two groups, with the exception of lower need of mechanical support in AAs. CONCLUSIONS In conclusion, our data provide important, not previously described information on race-related differences in history, presentation, clinical and angiographic features and outcomes in AAs compared with Caucasians younger than 50 with AMI. These findings may have implications for tailoring specific preventive strategies to decrease the incidence of AMI and its associated adverse events in both racial groups.
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Affiliation(s)
- Tariq S Marroush
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States.
| | - Amreeta V Sharma
- Department of Internal Medicine, Ascension Saint John Hospital, Detroit, MI, United States
| | - Bassent Botros
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States
| | - Susanna Szpunar
- Department of Graduate Medical Education, Ascension Saint John Hospital, Detroit, MI, United States
| | - Howard S Rosman
- Division of Cardiovascular Disease, Ascension Saint John Hospital, Detroit, MI, United States
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Wagata M, Ishikuro M, Obara T, Nagai M, Mizuno S, Nakaya N, Nakamura T, Hirata T, Tsuchiya N, Metoki H, Ogishima S, Hozawa A, Kinoshita K, Kure S, Yaegashi N, Yamamoto M, Kuriyama S, Sugawara J. Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy. Pregnancy Hypertens 2020; 22:119-125. [PMID: 32791355 DOI: 10.1016/j.preghy.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 07/12/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women's own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study's population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women's own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02-2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84-6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.
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Affiliation(s)
- Maiko Wagata
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Masato Nagai
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Mizuno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takumi Hirata
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naho Tsuchiya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku Medical Pharmaceutical University, Sendai, Japan
| | - Soichi Ogishima
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kinoshita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Nobuo Yaegashi
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junichi Sugawara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan.
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Association between dietary carotenoid intakes and hypertension in adults: National Health and Nutrition Examination Survey 2007-2014. J Hypertens 2020; 37:2371-2379. [PMID: 31356404 DOI: 10.1097/hjh.0000000000002200] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Few epidemiological studies concentrated on dietary carotenoids and hypertension since new hypertension guideline released in 2017. Thus, this study was aimed to evaluate their association. METHODS Data from National Health and Nutrition Examination Survey (NHANES) 2007-2014 were used in this cross-sectional study. Dietary carotenoids data were obtained from 24-h dietary recall interviews. Hypertension was defined as SBP at least 130 mmHg or DBP at least 80 mmHg, taking antihypertensive medicine or self-report. Logistic regression models and restricted cubic spline models were applied to explore the associations between α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein with zeaxanthin, and total carotenoids from diet and supplements and hypertension. Total carotenoids showed significant reductive risk of hypertension at 100 μg/kg per day and over. RESULTS A total of 17 398 adults aged 20 years and over were identified. High dose of β-carotene, lycopene, lutein with zeaxanthin, and total carotenoids were significantly associated with decreased risk of hypertension in crude results. After multivariate-adjustment in model 2, the odds ratios (OR) with 95% confidence intervals (CI) of β-cryptoxanthin, lycopene, lutein with zeaxanthin and total carotenoids for hypertension were 0.79 (0.67-0.93), 0.85 (0.73-0.98), 0.69 (0.58-0.83), 0.73 (0.62-0.86) for the highest versus lowest quartile intakes, respectively. Dose-response analyses showed that all of the carotenoids were inversely associated with hypertension in a linear manner. Total carotenoids showed significant effect of lower risk of hypertension at 100 μg/kg per day. CONCLUSION Intakes of α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein with zeaxanthin, and total carotenoids were inversely associated with hypertension in US adults. The intake of total carotenoids was suggested at least 100 μg/kg per day for general adult population.
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Heffernan KS, Lefferts WK, Atallah-Yunes NH, Glasgow AC, Gump BB. Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children. Front Pediatr 2020; 8:132. [PMID: 32296669 PMCID: PMC7138203 DOI: 10.3389/fped.2020.00132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Wesley K Lefferts
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois-Chicago, Chicago, IL, United States
| | - Nader H Atallah-Yunes
- Division of Pediatric Cardiology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Alaina C Glasgow
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Brooks B Gump
- Department of Public Health, Syracuse University, Syracuse, NY, United States
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Li Z, Wang W, Liu H, Li S, Zhang D. The association of serum zinc and copper with hypertension: A meta-analysis. J Trace Elem Med Biol 2019; 53:41-48. [PMID: 30910205 DOI: 10.1016/j.jtemb.2019.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/13/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The association of serum zinc (Zn), copper (Cu) with the risk of hypertension (HT) remains controversial. Therefore, we conducted a meta-analysis to explore the relationships. METHODS We searched relevant literatures on PubMed and Web of Science up to September 2018. Pooled standard mean difference (SMD) with corresponding 95% confidence interval (CI) was calculated by random effects model.I2 was used to evaluate heterogeneity among studies. RESULTS 25 articles of serum Zn and 22 articles of serum Cu were included in meta-analysis. HT patients had lower serum Zn [SMD (95%CI): -0.612(-0.951, -0.274), z = 3.54, Pfor z <0.001; I2 = 97.0%, PforI2 <0.001], whereas no significant difference of serum Cu was shown between HT patients and controls [SMD (95%CI): 0.153(-0.101, 0.407)]. Also, male HT patients had lower serum Zn [SMD (95%CI): -1.443(-2.868, -0.017), z = 1.98, Pfor z = 0.047; I2 = 98.8%, PforI2 <0.001]. In subgroup analysis, a lower serum Zn was observed in HT patients in studies conducted in Europe [-1.066(-1.759, -0.374)], in case-control studies [-0.718(-1.294, -0.142)], in matched case-control studies [-0.939(-1.646, -0.233)] and studies involving treated patients [-1.416(-2.195, -0.638)]. Meanwhile, a higher serum Cu was found in HT patients in studies conducted in Africa [1.96(1.402, 2.518)], and in matched case-control studies [0.655(0.204, 1.107)]. CONCLUSION The present meta-analysis indicates that serum Zn level in HT patients was significantly lower than that in controls, while no significantly different serum Cu level was found between HT patients and controls. Future studies are needed to confirm these results in future research.
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Affiliation(s)
- Zhaoying Li
- Department of Epidemiology and Health Statistics, The Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, The Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Hui Liu
- Department of Epidemiology and Health Statistics, The Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Suyun Li
- Department of Epidemiology and Health Statistics, The Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, The Medical College of Qingdao University, Qingdao, Shandong Province, China.
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Williams IC, Park MH, Tsang S, Sperling SA, Manning C. Cognitive Function and Vascular Risk Factors Among Older African American Adults. J Immigr Minor Health 2019; 20:612-618. [PMID: 28417319 DOI: 10.1007/s10903-017-0583-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To evaluate the association between vascular risk factors and cognitive impairment among older African American (AA) adults in a primary care clinic. Participants included 96 AA adults aged 60 years or older who were evaluated for global and domain-specific cognition. Participants were interviewed using the Computerized Assessment of Memory and Cognitive Impairment (CAMCI). The relationship between CAMCI cognitive domain scores and vascular risk factors were examined using hierarchical regression models. Patients who smoked, those with higher SBP/DBP values had lower accuracy rates on CAMCI cognitive domains (attention, executive, memory).Those with higher BMI had better attention scores. Patients with higher HbA1C values had worse verbal memory. Patients with higher blood pressure were significantly faster in responding to tasks in the executive domain. Primary care providers working with older AA adults with these VRFs could implement cognitive screening earlier into their practice to reduce barriers of seeking treatment.
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Affiliation(s)
- Ishan C Williams
- School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Moon Ho Park
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Siny Tsang
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Scott A Sperling
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Carol Manning
- Department of Neurology, Memory Disorders Clinic, University of Virginia, Charlottesville, VA, USA
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12
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Racial Differences in Aortic Stiffness in Children. J Pediatr 2017; 180:62-67. [PMID: 27817877 PMCID: PMC5183467 DOI: 10.1016/j.jpeds.2016.09.071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/06/2016] [Accepted: 09/29/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate racial differences in central blood pressure and vascular structure/function as subclinical markers of atherosclerotic cardiovascular disease in children. STUDY DESIGN This cross-sectional study recruited 54 African American children (18 female, 36 male; age 10.5 ± 0.9 years) and 54 white children (27 female, 26 male; age 10.8 ± 0.9 years) from the Syracuse City community as part of the Environmental Exposures and Child Health Outcomes study. Participants underwent blood lipid and vascular testing on 2 separate days. Carotid artery intima-media thickness and aortic stiffness were measured by ultrasonography and carotid-femoral pulse wave velocity, respectively. Blood pressure was assessed at the brachial artery and estimated in the carotid artery using applanation tonometry. RESULTS African American children had significantly higher pulse wave velocity (4.8 ± 0.8 m/s) compared with white children (4.2 ± 0.7 m/s; P < .05), which remained significant after adjustment for confounding variables including socioeconomic status. African American children had significantly higher intima-media thickness (African American 0.41 ± 0.06, white 0.39 ± 0.05 mm), and carotid systolic blood pressure (African American 106 ± 11, white 102 ± 8 mm Hg; P < .05) compared with white children, although these racial differences were no longer present after covariate adjustments for height. CONCLUSIONS Racial differences in aortic stiffness are present in childhood. Our findings suggest that racial differences in subclinical cardiovascular disease occur earlier than previously recognized.
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Fan F, Qi L, Jia J, Xu X, Liu Y, Yang Y, Qin X, Li J, Li H, Zhang Y, Huo Y. Noninvasive Central Systolic Blood Pressure Is More Strongly Related to Kidney Function Decline Than Peripheral Systolic Blood Pressure in a Chinese Community-Based Population. Hypertension 2016; 67:1166-72. [PMID: 27141056 DOI: 10.1161/hypertensionaha.115.07019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/09/2016] [Indexed: 01/13/2023]
Abstract
This study aimed to investigate the association of noninvasive central aortic blood pressure with kidney function decline in a Chinese community-based population with normal kidney function at baseline. A total of 3153 Chinese participants from an atherosclerosis cohort were included in our analysis. The primary outcome was renal function decline defined as a drop in estimated glomerular filtration rate (eGFR) category accompanied by a ≥25% drop in eGFR from baseline; or a sustained decline in eGFR of >5 mL/min per 1.73 m(2)/y. The secondary outcomes were rapid eGFR decline (a decline in eGFR of >3 mL/min per 1.73 m(2)/y) and new incidence of chronic kidney disease. Participants were 56.6±8.5 years old, 36.0% were males, and 48.8% had hypertension. Mean (SD) baseline eGFR was 101.2±10.6 mL/min per 1.73 m(2) After a mean 2.35-year follow-up, the incidence of renal function decline, rapid eGFR decline and chronic kidney disease were 7.3%, 19.7%, and 0.7%, respectively. In multivariate logistic-regression analyses, central and peripheral systolic blood pressure (SBP) were both independently associated with all outcomes after adjustment for various confounders. When peripheral SBP was forced into the model with central SBP simultaneously, its significant association with the 3 outcomes all disappeared; however, central SBP was still significantly related with all outcomes even after further adjusting peripheral SBP. In conclusion, central SBP is a stronger predictor compared with peripheral SBP for early kidney function decline in a Chinese community-based population with normal kidney function at baseline.
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Affiliation(s)
- Fangfang Fan
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Litong Qi
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Jia Jia
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Xin Xu
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yan Liu
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yang Yang
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Xianhui Qin
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Jianping Li
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Haixia Li
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.)
| | - Yan Zhang
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.).
| | - Yong Huo
- From the Departments of Cardiology (F.F., L.Q., J.J., Y.Y., J.L., Y.Z., Y.H.) and Clinical Laboratory (H.L.), Peking University First Hospital, Beijing, China; State Key Laboratory for Organ Failure Research, Renal Division, National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.X., X.Q.); and Department of Emergency, Tsinghua University, YuQuan Hospital, Beijing, China (Y.L.).
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The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age, and Traditional Risk Factors. Sci Rep 2016; 6:20303. [PMID: 26842423 PMCID: PMC4740809 DOI: 10.1038/srep20303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/30/2015] [Indexed: 02/07/2023] Open
Abstract
Systemic inflammation promotes cardiovascular disease. Inflammatory connective tissue diseases (CTD) like lupus and rheumatoid arthritis associate with cardiovascular risk, but it is unknown whether particular groups of patients have enhanced propensity for atherosclerotic cardiovascular disease (ASCVD) associated with their CTD. Analysis of aggregate health record data at a large U.S. academic center identified CTD and ASCVD status for 287,467 African American and white adults. ASCVD prevalence in those with CTD was 29.7% for African Americans and 14.7% for white patients with prevalence ratios, compared to those without CTD, of 3.1 and 1.8, respectively. When different types of CTD were analyzed individually (rheumatoid arthritis; lupus; scleroderma; Sjögren Syndrome; dermatomyositis/polymyositis; unspecified/mixed CTD; other inflammatory arthropathy), increased ASCVD rates were found in nearly all subsets, always with higher prevalence ratios in African Americans. The prevalence ratio of ASCVD was particularly high in young African Americans. Furthermore, individuals lacking traditional cardiovascular risk factors had more ASCVD if they had CTD (prevalence ratio 2.9). Multivariate analysis confirmed a positive interaction between CTD and African-American race and a negative interaction between CTD and age. The factors driving the observed disproportionate CTD-associated ASCVD in African Americans, young adults, and those without traditional risk factors warrant further study.
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15
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Kovesdy CP, Norris KC, Boulware LE, Lu JL, Ma JZ, Streja E, Molnar MZ, Kalantar-Zadeh K. Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans. Circulation 2015; 132:1538-48. [PMID: 26384521 PMCID: PMC4618085 DOI: 10.1161/circulationaha.114.015124] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 08/10/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. METHODS AND RESULTS We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all-cause mortality (adjusted hazard ratio, 0.76; 95% confidence interval, 0.75-0.77; P<0.001) and 37% lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95% confidence interval, 0.62-0.65; P<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95% confidence interval, 0.97-1.01; P=0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate ≥ 60 mL·min⁻¹·1.73 m⁻² in NHANES (adjusted hazard ratio, 1.42; 95% confidence interval, 1.09-1.87). CONCLUSIONS Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population.
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Affiliation(s)
- Csaba P Kovesdy
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.).
| | - Keith C Norris
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - L Ebony Boulware
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - Jun L Lu
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - Jennie Z Ma
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - Elani Streja
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - Miklos Z Molnar
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
| | - Kamyar Kalantar-Zadeh
- From Nephrology Section, Memphis VA Medical Center, TN (C.P.K.); Division of Nephrology, University of Tennessee Health Science Center, Memphis (C.P.K., J.L.L., M.Z.M.); Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (K.C.N.); Department of Medicine, Duke University, Durham, NC (L.E.B.); Department of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville (J.Z.M.); and Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange (E.S., K.K.-Z.)
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Ortega LM, Sedki E, Nayer A. Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy. Nefrologia 2015; 35:139-45. [PMID: 26300506 DOI: 10.1016/j.nefro.2015.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 01/11/2023] Open
Abstract
Arterial hypertension is prevalent in the black population in the United States. It is directly related to cardiovascular and kidney damage. Its pathogenesis is complex and includes the high incidence of obesity, salt sensitivity and the activation of the renin-angiotensin-aldosterone system. This complexity requires a therapeutic combination that includes changes in dietary habits and appropriate antihypertensive regimes. The International Society of Hypertension in Blacks recommends initiating dietary intervention for values of systolic/diastolic arterial blood pressure above 115/75 mmHg and maintaining arterial blood pressure below 135/85 mmHg using appropiate antihypertensive medication. The most adequate antihypertensive drug for this population has yet to be determined.
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Affiliation(s)
- Luis M Ortega
- Division of Nephrology and Hypertension. Allegheny General Hospital/Temple University School of Medicine. Pittsburgh, Pennsylvania (Estados Unidos).
| | - Emad Sedki
- Division of Nephrology and Hypertension. Allegheny General Hospital/Temple University School of Medicine. Pittsburgh, Pennsylvania (Estados Unidos)
| | - Ali Nayer
- Division of Nephrology and Hypertension. University of Miami Miller School of Medicine. Miami, Florida (Estados Unidos)
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Rodriguez F, Ferdinand KC. Hypertension in minority populations: new guidelines and emerging concepts. Adv Chronic Kidney Dis 2015; 22:145-53. [PMID: 25704352 DOI: 10.1053/j.ackd.2014.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 12/15/2022]
Abstract
Persistent disparities in hypertension, CKD, and associated cardiovascular disease have been noted in the United States among racial/ethnic minority groups. Overall, these disparities are largely mediated by social determinants of health. Yet, emerging data suggest additional biologic factors in racial/ethnic disparities in hypertension prevalence, complications, particularly CKD, and responses to treatment. Nevertheless, race is a social construct and not a physiologic concept, and ethnicity, federally defined as the binary "Hispanic/Latino" or "not Hispanic/Latino," is also imprecise. However, race/ethnicity categories may help interpret health-related data, including surveillance and research, and are important in ensuring that clinical trials remain generalizable to diverse populations. There is significant heterogeneity among prespecified groups and, perhaps, greater genetic differences within than between certain racial/ethnic groups. This review will explore hypertension epidemiology, pathophysiology, and management among the diverse and growing US minority groups, specifically African Americans and Hispanics because much less data are available across the wide spectrum of diverse populations. We will highlight the intersection of hypertension and increasingly prevalent CKD, particularly in African Americans. Finally, we propose multidimensional treatment approaches to hypertension among diverse populations, encompassing population, community, health system, and individual-based approaches.
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Williams SF, Nicholas SB, Vaziri ND, Norris KC. African Americans, hypertension and the renin angiotensin system. World J Cardiol 2014; 6:878-889. [PMID: 25276290 PMCID: PMC4176798 DOI: 10.4330/wjc.v6.i9.878] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/28/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system (RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.
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Glasser SP, Lynch AI, Devereux RB, Hopkins P, Arnett DK. Hemodynamic and echocardiographic profiles in African American compared with White offspring of hypertensive parents: the HyperGEN study. Am J Hypertens 2014; 27:21-6. [PMID: 24242823 DOI: 10.1093/ajh/hpt178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Alterations in cardiovascular structure and function have been shown to precede the finding of elevated blood pressure. METHODS This study is part of the Hypertension Genetic Epidemiologic Network (HyperGEN) in which genetic and environmental determinants of hypertension were investigated in 5 geographical field centers. All nonhypertensive offspring (n = 1,035) were included from the entire HyperGEN study population that consists of 2,225 hypertensive patients and 1,380 nonhypertensive patients who had adequate echocardiographic left ventricular (LV) mass measurements. Participants were compared by self-declared race (African American and white). RESULTS Nonhypertensive African American offspring were younger (aged 31 years vs. 38 years), more likely to be female, and had a higher body mass index (BMI) and higher systolic blood pressure (SBP) than their white counterparts. After adjusting for age, sex, SBP, pulse pressure (PP), BMI, diabetes status, and family effects, we observed statistically significant and potentially pathophysiological differences (all with P ≤ 0.001) with greater LV mass/height, relative wall thickness, and posterior wall thickness and with lesser midwall shortening, PP/stroke volume, and (PP/stroke volume)/fat-free body mass. CONCLUSION This study shows that ethnic differences in hemodynamic and echocardiographic profiles exist in a large, population-based cohort of nonhypertensive offspring of hypertensive parents.
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Affiliation(s)
- Stephen P Glasser
- Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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Abstract
Epidemiologic studies, animal models, and preliminary clinical trials in children implicate uric acid in the development of essential hypertension. Controversy remains as to whether the observations indicate a general mechanism or a surrogate phenomenon. We sought to determine whether uric acid is a causative mediator of increased blood pressure (BP) and impaired vascular compliance. We report a randomized, double-blinded, placebo-controlled trial comparing 2 mechanisms of urate reduction with placebo in prehypertensive, obese, adolescents, aged 11 to 17 years. Subjects were randomized to the xanthine oxidase inhibitor, allopurinol, uricosuric, probenecid, or placebo. Subjects treated with urate-lowering therapy experienced a highly significant reduction in BP. In clinic systolic BP fell 10.2 mm Hg and diastolic BP fell 9.0 mm Hg in treated patients compared with a rise of 1.7 mm Hg and 1.6 mm Hg systolic and diastolic BP, respectively in patients on placebo. Urate-lowering therapy also resulted in significant reduction in systemic vascular resistance. These data indicate that, at least in adolescents with prehypertension, uric acid causes increased BP that can be mitigated by urate lowering therapy.
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