1
|
Effoe VS, Mewissen MW, Bajwa TK, Khitha J, Kostopoulos L, Ammar KA, Nfor TK. Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry. Catheter Cardiovasc Interv 2024; 103:106-114. [PMID: 37983656 DOI: 10.1002/ccd.30912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Atherectomy use in treatment of femoropopliteal disease has significantly increased despite scant evidence of benefit to long-term clinical outcomes. AIMS We investigated the clinical benefits of atherectomy over standard treatment for femoropopliteal interventions. METHODS Using data from the Society of Vascular Surgery's Vascular Quality Initiative (VQI) registry, we identified patients who underwent isolated femoropopliteal interventions for occlusive disease. We compared 13,423 patients treated with atherectomy with 47,371 receiving standard treatment; both groups were allowed definitive treatment with a drug-coated balloon or stenting. The primary endpoint was major adverse limb events (MALEs), which is a composite of target vessel re-occlusion, ipsilateral major amputation, and target vessel revascularization. RESULTS Mean age was 69 ± 11 years, and patients were followed for a median of 30 months. Overall rates of complications were slightly higher in the atherectomy group than the standard treatment group (6.2% vs. 5.9%, p < 0.0001). In multivariable analysis, after adjusting for demographic and clinical covariates, atherectomy use was associated with a 13% reduction in risk of MALEs (adjusted odds ratio [aOR]: 0.87; 95% confidence interval [CI]: 0.77-0.98). Rates of major and minor amputations were significantly lower in the atherectomy group (3.2% vs. 4.6% and 3.3% vs. 4.3%, respectively, both p < 0.001), primarily driven by a significantly decreased risk of major amputations (aOR 0.69; 95% CI: 0.52-0.91). There were no differences in 30-day mortality, primary patency, and target vessel revascularization between the atherectomy and standard treatment groups. CONCLUSIONS In adults undergoing femoropopliteal interventions, the use of atherectomy was associated with a reduction in MALEs compared with standard treatment.
Collapse
Affiliation(s)
- Valery S Effoe
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Mark W Mewissen
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Tanvir K Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Jayant Khitha
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Louie Kostopoulos
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Khawaja A Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Tonga K Nfor
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| |
Collapse
|
2
|
Lee G, Kluwe B, Zhao S, Kline D, Nedungadi D, Brock GN, Odei JB, Kesireddy V, Pohlman N, Sims M, Effoe VS, Wu WC, Kalyani RR, Wand GS, Echouffo-Tcheugui J, Golden SH, Joseph JJ. Adiposity, aldosterone and plasma renin activity among African Americans: The Jackson Heart Study. Endocr Metab Sci 2023; 11:100126. [PMID: 37475849 PMCID: PMC10358448 DOI: 10.1016/j.endmts.2023.100126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Objective To analyze associations between adiposity and the renin-angiotensin-aldosterone system (RAAS) in a large African American (AA) cohort. Methods Cross-sectional associations of adiposity (body mass index [BMI], waist circumference [WC], waist:height ratio, waist:hip ratio, leptin, adiponectin, leptin:adiponectin ratio [LAR], subcutaneous [SAT] and visceral adipose tissue [VAT], and liver attenuation [LA]) with aldosterone, plasma renin activity (renin), and aldosterone:renin ratio (ARR) were assessed in the Jackson Heart Study using adjusted linear regression models. Results A 1-SD higher BMI was associated with a 4.8 % higher aldosterone, 9.4 % higher renin, and 5.0 % lower ARR (all p < 0.05). Log-leptin had the largest magnitude of association with renin (30.2 % higher) and ARR (9.6 % lower), while the strongest association of aldosterone existed for log-LAR (15.3 % higher) (all 1-SD, p < 0.05). SAT was only associated with renin. VAT was associated with higher aldosterone, renin, and ARR. Liver fat was associated with aldosterone and renin, but not ARR. Associations of WC, BMI, and SAT with aldosterone were greater in men while the association with VAT was greater in women (p-interactions < 0.05). Conclusion Multiple measures of adiposity are associated with the RAAS in AAs. Further studies should examine the role of RAAS in obesity-driven cardiometabolic diseases.
Collapse
Affiliation(s)
- Grace Lee
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Bjorn Kluwe
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - David Kline
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Divya Nedungadi
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Guy N. Brock
- Department of Biomedical Informatics, Center for
Biostatistics, The Ohio State University, Columbus, OH, USA
| | - James B. Odei
- Division of Biostatistics, The Ohio State University
College of Public Health, Columbus, OH, USA
| | - Veena Kesireddy
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Neal Pohlman
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical
Center, Jackson, MS, USA
| | - Valery S. Effoe
- Department of Medicine, Morehouse School of Medicine,
Atlanta, GA, USA
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Rita R. Kalyani
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Gary S. Wand
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Sherita H. Golden
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism,
Department of Internal Medicine, The Ohio State University College of Medicine,
Columbus, OH, USA
| |
Collapse
|
3
|
Kluwe B, Pohlman N, Kesireddy V, Zhao S, Tan Y, Kline D, Brock G, Odei JB, Effoe VS, Tcheugui JBE, Kalyani RR, Sims M, Taylor HA, Mongraw-Chaffin M, Akhabue E, Joseph JJ. The Role of Aldosterone and Ideal Cardiovascular Health in Incident Cardiovascular Disease: The Jackson Heart Study. Am J Prev Cardiol 2023; 14:100494. [PMID: 37114212 PMCID: PMC10126856 DOI: 10.1016/j.ajpc.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Background Higher levels of ideal cardiovascular health (ICH) are associated with lower levels of aldosterone and incidence of cardiovascular disease (CVD). However, the degree to which aldosterone mediates the association between ICH and CVD incidence has not been explored. Thus, we investigated the mediational role of aldosterone in the association of 5 components of ICH (cholesterol, body mass index (BMI), physical activity, diet and smoking) with incident CVD and the mediational role of blood pressure (BP) and glucose in the association of aldosterone with incident CVD in a cohort of African Americans (AA). Methods The Jackson Heart Study is a prospective cohort of AAs adults with data on CVD outcomes. Aldosterone, ICH metrics and baseline characteristics were collected at exam 1 (2000-2004). ICH score was developed by summing 5 ICH metrics (smoking, dietary intake, physical activity, BMI, and total cholesterol) and grouped into two categories (0-2 and ≥3 metrics). Incident CVD was defined as stroke, coronary heart disease, or heart failure. Cox proportional hazard regression models were used to model the association of categorical ICH score with incident CVD. The R Package Mediation was utilized to examine: 1) The mediational role of aldosterone in the association of ICH with incident CVD and 2) The mediational role of blood pressure and glucose in the association of aldosterone with incident CVD. Results Among 3,274 individuals (mean age: 54±12.4 years, 65% female), there were 368 cases of incident CVD over a median of 12.7 years. The risk of incident CVD was 46% lower (HR: 0.54; 95%CI 0.36, 0.80) in those with ≥3 ICH metrics at baseline compared to 0-2. Aldosterone mediated 5.4% (p = 0.006) of the effect of ICH on incident CVD. A 1-unit increase in log-aldosterone was associated with a 38% higher risk of incident CVD (HR 1.38, 95%CI: 1.19, 1.61) with BP and glucose mediating 25.6% (p<0.001) and 4.8% (p = 0.048), respectively. Conclusion Aldosterone partially mediates the association of ICH with incident CVD and both blood pressure and glucose partially mediate the association of aldosterone with incident CVD, emphasizing the potential importance of aldosterone and ICH in risk of CVD among AAs.
Collapse
|
4
|
Effoe VS, Mewissen MW, Bajwa TK, Khitha J, Kostopoulos L, Ammar KA, Nfor TK. CRT-300.05 Atherectomy Use Is Associated With Lower Rates of Major Adverse Limb Events Among Adults Undergoing Femoropopliteal Interventions: Insights From the Vascular Quality Initiative Registry. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
|
5
|
Joseph JJ, Rajwani A, Roper D, Zhao S, Kline D, Odei J, Brock G, Echouffo-Tcheugui JB, Kalyani RR, Bertoni AG, Effoe VS, Sims M, Wu WC, Wand GS, Golden SH. Associations of Cardiometabolic Multimorbidity With All-Cause and Coronary Heart Disease Mortality Among Black Adults in the Jackson Heart Study. JAMA Netw Open 2022; 5:e2238361. [PMID: 36282500 PMCID: PMC9597394 DOI: 10.1001/jamanetworkopen.2022.38361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE A combination of diabetes, coronary heart disease (CHD), and stroke has multiplicative all-cause mortality risk compared with any individual morbidity in White populations, but there is a lack of studies in Black populations in the US. OBJECTIVE To examine the association of cardiometabolic multimorbidity (diabetes, stroke, and CHD) individually and collectively with all-cause and CHD mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study included Black adults in the Jackson Heart Study followed over a median of 15 years. Baseline examinations were performed between 2000 and 2004, with follow-up on all-cause and CHD mortality through May 31, 2018. Participants were categorized into mutually exclusive groups at baseline: (1) free of cardiometabolic morbidity, (2) diabetes, (3) CHD, (4) stroke, (5) diabetes and stroke, (6) CHD and stroke, (7) diabetes and CHD, and (8) diabetes, stroke, and CHD. Data were analyzed from 2019 to 2021. EXPOSURE Cardiometabolic disease alone or in combination. MAIN OUTCOMES AND MEASURES The main outcomes were all-cause mortality and CHD mortality. Cox models estimated hazard ratios (HRs) with 95% CIs adjusted for sociodemographic and cardiovascular risk factors. RESULTS Among 5064 participants (mean [SD] age, 55.4 [12.8] years; 3200 [63%] women) in the Jackson Heart Study, 897 (18%) had diabetes, 192 (4%) had CHD, and 104 (2%) had a history of stroke. Among participants with cardiometabolic morbidities, the crude all-cause mortality rates were lowest for diabetes alone (24.4 deaths per 1000 person-years) and highest for diabetes, CHD, and stroke combined (84.1 deaths per 1000 person-years). For people with only 1 cardiometabolic morbidity, risk for all-cause mortality was highest for people with stroke (HR, 1.74; 95% CI, 1.24-2.42), followed by CHD (HR, 1.59 (95% CI, 1.22-2.08) and diabetes (HR, 1.50; 95% CI, 1.22-1.85), compared with no cardiometabolic morbidities. There were also increased risks of mortality with combinations of diabetes and stroke (HR, 1.71; 95% CI, 1.09-2.68), CHD and stroke (HR, 2.23; 95% CI, 1.35-3.69), and diabetes and CHD (HR, 2.28; 95% CI, 1.65-3.15). The combination of diabetes, stroke, and CHD was associated with the highest all-cause mortality (HR, 3.68; 95% CI, 1.96-6.93). Findings were similar for CHD mortality, but with a larger magnitude of association (eg, diabetes, stroke, and CHD: HR, 13.52; 95% CI, 3.38-54.12). CONCLUSIONS AND RELEVANCE In this cohort study, an increasing number of cardiometabolic multimorbidities was associated with a multiplicative increase in risk of all-cause mortality among Black adults, with a greater magnitude of association for CHD mortality.
Collapse
Affiliation(s)
- Joshua J. Joseph
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Aakash Rajwani
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Daniel Roper
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Songzhu Zhao
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - David Kline
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus
| | - Guy Brock
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Valery S. Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Wen-Chi Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gary S. Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| |
Collapse
|
6
|
Williams A, Zhao S, Brock G, Kline D, Echouffo-Tcheugui JB, Effoe VS, Bertoni AG, Michos ED, de Boer IH, Kestenbaum B, Golden SH, Joseph JJ. Vitamin D, parathyroid hormone, glucose metabolism and incident diabetes in the multiethnic study of atherosclerosis. BMJ Open Diabetes Res Care 2022; 10:10/5/e002931. [PMID: 36162866 PMCID: PMC9516211 DOI: 10.1136/bmjdrc-2022-002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Higher concentrations of serum 25-hydroxyvitamin D (25(OH)D) and lower concentrations of parathyroid hormone (PTH) are associated with lower insulin resistance and incident diabetes in non-Hispanic White and Hispanic Americans. Results are mixed in other populations, with no observational studies in a large multiethnic cohort. The association of serum 25(OH)D with diabetes may vary by adiposity level. RESEARCH DESIGN AND METHODS Among 5611 participants in the Multi-Ethnic Study of Atherosclerosis without diabetes at baseline, cross-sectional associations of serum 25(OH)D with homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-β were examined using linear regressions. The association of 25(OH)D with incident diabetes over 9 years was examined using Cox proportional hazard regression. RESULTS Black Americans had the highest proportion of individuals with 25(OH)D<20 ng/mL (61%) and White Americans had the least (17%). Serum 25(OH)D was inversely associated with HOMA-IR in fully adjusted models (-0.34% difference in HOMA-IR per ng/mL higher 25(OH)D, p<0.0001). Longitudinally, a 1 ng/mL higher serum 25(OH)D was associated with 2% lower risk of incident diabetes (HR 0.982, CI 0.974 to 0.991), and a 1 pg/mL higher serum PTH was associated with 1% higher risk of incident diabetes (HR 1.007, CI 1.004 to 1.010), both prior to adjustment for waist circumference. After adjusting for waist circumference, a 1 ng/mL higher 25(OH)D was associated with 1% lower risk of incident diabetes (HR 0.991, CI 0.983 to 1.000). The magnitude of association of serum 25(OH)D with incident diabetes was largest at lower waist circumference (p for interaction=0.025). There was no heterogeneity by race/ethnicity (p=0.317). CONCLUSIONS Serum 25(OH)D is inversely associated with insulin resistance and incident diabetes in a diverse cohort, including non-Hispanic White, Black, Hispanic and Chinese Americans. Future research should explore mechanisms for the interaction between serum 25(OH)D and adiposity in this relationship.
Collapse
Affiliation(s)
- Amaris Williams
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David Kline
- Department of Biostatistics and Data Science, DIvision of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Valery S Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Alain G Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian H de Boer
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Bryan Kestenbaum
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Sherita H Golden
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
7
|
Gaillard T, Chen H, Effoe VS, Correa A, Carnethon M, Kalyani RR, Echouffo-Tcheugui JB, Joseph JJ, Bertoni AG. Glucometabolic State Transitions: The Jackson Heart Study. Ethn Dis 2022; 32:203-212. [PMID: 35909644 PMCID: PMC9311302 DOI: 10.18865/ed.32.3.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Diabetes and prediabetes are common among African Americans (AA), but the frequency and predictors of transition between normal, impaired glucose metabolism, and diabetes are not well-described. The aim of this study was to examine glucometabolic transitions and their association with the development of type 2 diabetes (T2D). Methods AA participants of the Jackson Heart Study who attended baseline exam (2000-2004) and at least one of two subsequent exams (2005-2008 and 2009-2013, ~8 years) were classified according to glycemic status. Transitions were defined as progression (deterioration) or remission (improvement) of glycemic status. Multinomial logistic regression models with repeated measures were used to estimate the odds ratios (OR) for remission and progression with adjustment for demographic, anthropometric, behavioral, and biochemical factors. Results Among 3353 participants, (mean age 54.6±12.3 years), 43% were normoglycemic, 32% were prediabetes, and 25% had diabetes at baseline. For those with normal glucose at a visit, the probability at the next visit (~4years) of having prediabetes or diabetes was 38.5% and 1.8%, respectively. For those with prediabetes, the probability was 9.9% to improve to normal and 19.9% to progress to diabetes. Progression was associated with baseline BMI, diabetes status, triglycerides, family history of diabetes, and weight gain (OR 1.04 kg, 95% CI:1.03-1.06, P=<.0001). Remission was strongly associated with weight loss (OR .97 kg, 95%CI: .95-.98, P<.001). Conclusions In AAs, glucometabolic transitions were frequent and most involved deterioration. From a public health perspective additional emphasis should be placed on weight control to preserve glucometabolic status and prevent progression to T2D.
Collapse
Affiliation(s)
- Trudy Gaillard
- Florida International University, Miami, FL, Address correspondence to Trudy Gaillard, PhD; Florida International University,
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Valery S. Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rita R. Kalyani
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua J. Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC,Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem NC
| |
Collapse
|
8
|
Joseph JJ, Pohlman NK, Zhao S, Kline D, Brock G, Echouffo-Tcheugui JB, Sims M, Effoe VS, Wu WC, Kalyani RR, Wand GS, Kluwe B, Hsueh WA, Abdalla M, Shimbo D, Golden SH. Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study. Circulation 2021; 143:2355-2366. [PMID: 33605160 PMCID: PMC8789344 DOI: 10.1161/circulationaha.120.050896] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. METHODS ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring phenotypes, adjusting for important confounders. RESULTS The mean age of participants was 59±11 years and 69% were female. In fully adjusted models, lower log-PRA was associated with higher clinic, awake, and asleep systolic BP and DBP (all P<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all P<0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (odds ratio [OR] 0.59 [95% CI, 0.49-0.71]), nocturnal hypertension (OR, 0.68 [95% CI, 0.58-0.79]), daytime and nocturnal hypertension (OR, 0.59 [95% CI, 0.48-0.71]), sustained hypertension (OR, 0.52 [95% CI, 0.39-0.70]), and masked hypertension (OR 0.75 [95% CI, 0.62-0.90]). A 1-unit higher log-aldosterone was associated with higher odds of nocturnal hypertension (OR, 1.38 [95% CI, 1.05-1.81]). Neither PRA nor aldosterone was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. CONCLUSIONS Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, in the clinic and during the awake and asleep periods. Further clinical investigation of novel and approved medications that target low renin physiology such as epithelial sodium channel inhibitors and mineralocorticoid receptor antagonists may be paramount in improving hypertension control in African Americans.
Collapse
Affiliation(s)
- Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Neal K. Pohlman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Kline
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guy Brock
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Valery S. Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary S. Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bjorn Kluwe
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Willa A. Hsueh
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marwah Abdalla
- Division of Cardiology, Columbia University, New York, NY, USA
| | - Daichi Shimbo
- Division of Cardiology, Columbia University, New York, NY, USA
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Kumar G, Effoe VS, Kumar A, Verma I, Sachdeva R. Intravascular ultrasound-guided catheter-based aspiration thrombectomy in patients with acute submassive pulmonary embolism: A case series. Cardiovasc Revasc Med 2021; 36:138-143. [PMID: 34099409 DOI: 10.1016/j.carrev.2021.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
Contrast pulmonary angiography by hand injection or power injection is widely used during catheter-based therapies for acute submassive and massive pulmonary embolism (PE). Particularly, in patients with pre-existing chronic kidney disease, this approach may present a prognostic challenge owing to a double-contrast load, initially during computed tomographic pulmonary angiography (CTPA), and during percutaneous treatment. Intravascular ultrasound (IVUS) has been used as an adjunctive imaging modality in the percutaneous treatment of chronic thromboembolic pulmonary hypertension, and in coronary and peripheral vascular interventions. We report a series of cases illustrating the use of IVUS in the management of acute PE. All five patients presented with an acute submassive PE with evidence of right ventricular (RV) strain (RV/LV ratio ≥ 0.90). Body mass index and B-type natriuretic peptide ranged from 18 to 47 kgm/m2 and 56-932 pg/mL (ref. ≤ 78), respectively. Three of the five patients had renal impairment prior to the procedure (acute kidney injury, AKI, and chronic kidney injury, CKD). Post-catheter-directed pulmonary embolectomy there was a modest reduction in mean pulmonary artery pressure in all five patients (range: -4 mmHg to -9 mmHg). The first case serves as a proof of concept of IVUS use in acute PE. This case series demonstrates that an IVUS-only approach in the catheter-directed management of acute submassive PE is feasible and may be of particular importance in patients with pre-existing renal dysfunction.
Collapse
Affiliation(s)
- Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States of America; Division of Cardiology, The Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Valery S Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Arnav Kumar
- Division of Cardiology, The Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Isha Verma
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States of America.
| |
Collapse
|
10
|
Nouthe B, Noubiap JJ, Effoe VS. Meta-Analysis: Valve-in-Valve TAVR Versus Redo SAVR. JACC Cardiovasc Interv 2021; 14:1157. [PMID: 34016415 DOI: 10.1016/j.jcin.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
|
11
|
Abe T, Olanipekun T, Effoe VS, Igwe J, Egbuche O, Ogunbayo G, Amah C, Chang A, Morkeh P, Huynh K, Echols M, Onwuanyi A. TRENDS, PREDICTORS, AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION COMPLICATED BY IN-HOSPITAL CARDIAC ARREST. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Effoe VS, Kumar G, Sachdeva R. Intravascular ultrasound-guided pulmonary artery embolectomy for saddle pulmonary embolism. Catheter Cardiovasc Interv 2021; 97:E385-E389. [PMID: 32432829 DOI: 10.1002/ccd.28985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 11/12/2022]
Abstract
A percutaneous catheter-directed treatment approach is preferred among patients with acute submassive pulmonary embolism (PE) and chronic kidney disease (CKD), who are at significant risk of bleeding with thrombolytics. Limiting contrast volume in these patients could reduce morbidity and mortality associated with contrast-induced acute kidney injury (CI-AKI). We present the case of a 61-year-old African American woman (BMI 46.9 kg/m2 ) with multiple comorbidities, including a PE 3 years prior (not currently on anticoagulation) and CKD (GFR 33 ml/min/1.73/m2 ), presented to the emergency department with 3 weeks of dyspnea on exertion which worsened 3-5 days preceding her presentation. On examination, she was hemodynamically stable, oxygen saturation was 88% on 5 l, in mild respiratory distress with bilateral lower extremity pitting edema. Troponin was 0.06 ng/ml (ref. <0.04), B-type natriuretic peptide was 932 pg/ml (ref. ≤78), arterial oxygen partial pressure was 56 (ref. 80-110) and hemoglobin was 10.1 g/dl (ref. 11.3-15.0). Computed tomography pulmonary angiography performed with IV contrast showed a saddle embolus with evidence of right heart strain (RV/LV ratio: 2.05). A transthoracic echocardiogram showed a dilated RV and mean pulmonary artery pressure was 53 mmHg on right heart catheterization. She underwent a successful catheter-directed pulmonary embolectomy with the aid of an intravascular ultrasound (IVUS) along with fluoroscopy. To prevent CI-AKI, intravenous contrast was not used for the procedure. To the best of our knowledge, this is the first reported case of an "IVUS-only" approach in a patient with acute submassive PE and CKD.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Gautam Kumar
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, USA.,Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
13
|
Musonge-Effoe JE, Alema-Mensah E, Effoe VS, Akinnawo F, Caplan L. The association between health care coverage and prevalence of cardiovascular diseases and diabetes over a 10-year period. Prev Med 2020; 132:105983. [PMID: 31954838 DOI: 10.1016/j.ypmed.2020.105983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/31/2019] [Accepted: 01/12/2020] [Indexed: 01/03/2023]
Abstract
Persons without health care coverage have poorer health outcomes. We investigated the association between health care coverage and trends in the prevalence of cardiovascular disease (CVD) and diabetes pre- and post-Affordable Care Act (ACA) periods. Using data from 3,824,678 surveyed adults in the Behavioral Risk Factor Surveillance System survey from 2007 - 2016, we calculated the yearly prevalence of CVD and diabetes. Using logistic regression, we investigated the association between health care coverage and CVD and diabetes, controlling for sociodemographic factors (age, sex, race, marital status, education and income). The mean age of participants was 55.3 ± 18.9 years. Health care coverage increased from 88.6% in 2007 to 93% in 2016. The prevalence of CVD and diabetes increased from pre- to post-ACA periods. After adjustment, in pre-ACA period, the odds ratio (OR) for the association between health care coverage and CVD and diabetes was 1.32 (95% CI:1.30-1.34) and 1.44 (95% CI:1.41-1.46), respectively; in the post-ACA period, the OR was 1.26 (95% CI:1.22-1.30) and 1.48 (95% CI:1.44-1.52), respectively. We found a significant association between health care coverage and trends in the prevalence of CVD and diabetes in the pre- and post-ACA periods.
Collapse
Affiliation(s)
- Joffi E Musonge-Effoe
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America.
| | - Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Valery S Effoe
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Femi Akinnawo
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Lee Caplan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| |
Collapse
|
14
|
Echouffo-Tcheugui JB, Chen H, Kalyani RR, Sims M, Simpson S, Effoe VS, Correa A, Bertoni AG, Golden SH. Glycemic Markers and Subclinical Cardiovascular Disease: The Jackson Heart Study. Circ Cardiovasc Imaging 2020; 12:e008641. [PMID: 30879330 DOI: 10.1161/circimaging.118.008641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We investigated the associations of glycemic markers (HbA1C [hemoglobin A1C], fasting plasma glucose, and insulin resistance-homeostasis model assessment of insulin resistance) with subclinical cardiovascular disease (CVD) among blacks. Methods We included 4303 community-dwelling blacks (64% women; mean age, 54.5 years) without prevalent CVD. Subclinical CVD was defined as ≥1 of the following: any coronary artery calcification (CAC), elevated carotid intima-media thickness (cIMT), left ventricular (LV) hypertrophy, LV ejection fraction <50%, and peripheral artery disease (ankle-brachial index, <0.90). Estimates of cross-sectional associations of glycemic markers (fasting plasma glucose, HbA1C, and homeostasis model assessment of insulin resistance) with subclinical CVD measures were adjusted for traditional CVD risk factors. Results Each 1% increment in HbA1C was associated with higher odds of CAC, abnormal cIMT, and subclinical CVD (all P <0.001). Adjusted mean values of LV mass (LVM), LVM index, relative wall thickness, CAC, and cIMT were increasingly abnormal with worsening HbA1C categories (all P<0.05). Each 10-mg/dL increase in fasting plasma glucose was associated with higher odds of LV hypertrophy, CAC, abnormal cIMT, and subclinical CVD (all P <0.005). Adjusted mean values of LVM, LVM index, relative wall thickness, CAC, ankle-brachial index, and cIMT were more abnormal across categories of worsening fasting plasma glucose (all P <0.05). Each unit increment in log-transformed homeostasis model assessment of insulin resistance conferred a higher odd of having LV hypertrophy ( P<0.01). Across quartiles of homeostasis model assessment of insulin resistance, we observed progressively abnormal adjusted mean values of LVM, LVM index, relative wall thickness, and ankle-brachial index (all P <0.01). Conclusions Among blacks, glycemic markers were differentially associated with various measures of subclinical CVD.
Collapse
Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.)
| | - Haiying Chen
- Department of Biostatistical Sciences (H.C., S.S.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.)
| | - Mario Sims
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson (M.S., A.C.)
| | - Sean Simpson
- Department of Biostatistical Sciences (H.C., S.S.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Valery S Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA (V.S.E.)
| | - Adolfo Correa
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson (M.S., A.C.)
| | - Alain G Bertoni
- Department of Epidemiology and Prevention (A.G.B.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MA (J.B.E.-T., R.R.K., S.H.G.).,Welch Prevention Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University, Baltimore, MD (S.H.G.)
| |
Collapse
|
15
|
Olanipekun T, Effoe VS, Olanipekun O, Igbinomwanhia E, Kola-Kehinde O, Fotzeu C, Bakinde N, Harris R. Factors influencing the uptake of influenza vaccination in African American patients with heart failure: Findings from a large urban public hospital. Heart Lung 2020; 49:233-237. [PMID: 31982176 DOI: 10.1016/j.hrtlng.2019.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/22/2019] [Accepted: 12/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Evidence suggests that annual influenza vaccination may prevent acute heart failure exacerbation episodes and improve survival. OBJECTIVE Determine the influenza vaccination rate among African American patients with heart failure and identify predictors of uptake. METHODS African American patients with heart failure were recruited at Grady Memorial Hospital, Atlanta GA between October 1, 2017 and April 28, 2018 (N = 281). All participants completed a questionnaire. RESULTS Mean age of the sample was 50.5 ± 11.5 years (58% male). The influenza vaccination rate among the patients was 46% (n = 129/281). Patients who received vaccination information and recommendation from their physician, especially cardiologists, were significantly more likely to be vaccinated than those who did not (P<0.05). Major reasons for declining vaccination included fear of getting sick from influenza vaccine and distrust of the pharmaceutical companies that produce vaccines. CONCLUSIONS Recommendation of influenza vaccines by physicians during medical consultations and cardiology visits may improve uptake rates in heart failure patients.
Collapse
Affiliation(s)
- Titilope Olanipekun
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States.
| | - Valery S Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Olalekan Olanipekun
- Department of Internal Medicine, Advocate Illinois Masonic Med. Center, Chicago, IL, United States
| | - Efehi Igbinomwanhia
- Department of Internal Medicine, Advocate Illinois Masonic Med. Center, Chicago, IL, United States
| | - Onaopepo Kola-Kehinde
- Department of Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Claudia Fotzeu
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States
| | - Nicolas Bakinde
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States
| | - Rachael Harris
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States; Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, United States
| |
Collapse
|
16
|
Effoe VS, O'Neal W, Santos R, Rubinsztain L, Zafari AM. Pseudo-Wellens syndrome, acute pancreatitis, and an anomalous coronary artery: a case report. J Med Case Rep 2019; 13:387. [PMID: 31884973 PMCID: PMC6936050 DOI: 10.1186/s13256-019-2315-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies. Case presentation A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features. Conclusions Clinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.
Collapse
Affiliation(s)
- V S Effoe
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - W O'Neal
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - R Santos
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L Rubinsztain
- Atlanta Veterans Health Care System, Decatur, GA, USA.,Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - A M Zafari
- Atlanta Veterans Health Care System, Decatur, GA, USA. .,Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA. .,Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
17
|
Joseph JJ, Bennett A, Echouffo Tcheugui JB, Effoe VS, Odei JB, Hidalgo B, Dulin A, Safford MM, Cummings DM, Cushman M, Carson AP. Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Diabetologia 2019; 62:426-437. [PMID: 30643923 PMCID: PMC6392040 DOI: 10.1007/s00125-018-4792-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6-6.9 mmol/l]). METHODS A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003-2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0-1, 2-3 and ≥4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors. RESULTS Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with ≥4 vs 0-1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk (RR 0.20; 95% CI 0.10, 0.37), while participants with baseline IFG (n = 1754) had 13% lower risk (RR 0.87; 95% CI 0.58, 1.30) (p for interaction by baseline glucose status <0.0001). Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338). CONCLUSIONS/INTERPRETATION A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.
Collapse
Affiliation(s)
- Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210, USA.
| | - Aleena Bennett
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Justin B Echouffo Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valery S Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - James B Odei
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Bertha Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Akilah Dulin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Monika M Safford
- Division of General Internal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Doyle M Cummings
- Department of Public Health and Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Mary Cushman
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| |
Collapse
|
18
|
Effoe VS, Ghali JK. Norepinephrine Versus Epinephrine in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2018; 72:2412. [DOI: 10.1016/j.jacc.2018.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 10/27/2022]
|
19
|
Joseph JJ, Echouffo Tcheugui JB, Effoe VS, Hsueh WA, Allison MA, Golden SH. Renin-Angiotensin-Aldosterone System, Glucose Metabolism and Incident Type 2 Diabetes Mellitus: MESA. J Am Heart Assoc 2018; 7:e009890. [PMID: 30371168 PMCID: PMC6201432 DOI: 10.1161/jaha.118.009890] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/27/2018] [Indexed: 12/27/2022]
Abstract
Background Mechanistic studies suggest that aldosterone impairs glucose metabolism. We investigated the cross-sectional associations of aldosterone and plasma renin activity with fasting plasma glucose, insulin resistance ( IR ), β-cell function, and longitudinal association with incident diabetes mellitus among adults in MESA (the multiethnic study of atherosclerosis) prospective cohort study. Methods and Results Homeostatic model assessment of IR ( HOMA 2- IR ) and HOMA 2-β were used to estimate IR and β-cell function, respectively. Incident diabetes mellitus was defined as fasting plasma glucose ≥126 mg/dL or anti-diabetic medication use at follow-up. Linear regression was used to examine cross-sectional associations of aldosterone with fasting plasma glucose, HOMA 2- IR and HOMA 2-β; Cox regression was used to estimate hazard ratios ( HR ) for incident diabetes mellitus with multivariable adjustment. There were 116 cases of incident diabetes mellitus over 10.5 years among 1570 adults (44% non-Hispanic white, 13% Chinese American, 19% Black, 24% Hispanic American, mean age 64±10 years, 51% female). A 100% increase in log-aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA 2- IR and 6% higher HOMA 2-β ( P<0.01). A 1- SD increase in log-aldosterone was associated with a 44% higher risk of incident diabetes mellitus ( P<0.01) with the greatest increase of 142% ( P<0.01) observed in Chinese Americans ( P for interaction=0.09 versus other ethnicities). Similar cross-sectional findings for log-plasma renin activity existed, but log-plasma renin activity was not associated with incident diabetes mellitus after full adjustment. Conclusions Aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and blacks, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation.
Collapse
Affiliation(s)
- Joshua J. Joseph
- Division of Endocrinology, Diabetes and MetabolismThe Ohio State University Wexner Medical CenterColumbusOH
| | - Justin B. Echouffo Tcheugui
- Division of Endocrinology, Diabetes and HypertensionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
| | | | - Willa A. Hsueh
- Division of Endocrinology, Diabetes and MetabolismThe Ohio State University Wexner Medical CenterColumbusOH
| | - Matthew A. Allison
- Department of Family Medicine and Public HealthUniversity of California – San DiegoLa JollaCA
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and MetabolismJohns Hopkins University School of MedicineBaltimoreMD
| |
Collapse
|
20
|
Ajose TA, Olanipekun T, Effoe VS, Bakinde N. Intestinal ultrasound in assessment of suspected Crohn's disease in patients with negative ileocolonoscopy: a paradigm shift? Therap Adv Gastroenterol 2018; 11:1756284818787397. [PMID: 30023005 PMCID: PMC6047238 DOI: 10.1177/1756284818787397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/12/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Titilope Olanipekun
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Valery S. Effoe
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Nicolas Bakinde
- Department of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| |
Collapse
|
21
|
Joseph JJ, Echouffo-Tcheugui JB, Talegawkar SA, Effoe VS, Okhomina V, Carnethon MR, Hsueh WA, Golden SH. Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans. Am J Prev Med 2017; 53:e165-e174. [PMID: 28818415 PMCID: PMC5704929 DOI: 10.1016/j.amepre.2017.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/17/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs. METHODS Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016. RESULTS Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30. CONCLUSIONS A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity.
Collapse
Affiliation(s)
- Joshua J Joseph
- Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio; Johns Hopkins University, School of Medicine, Baltimore, Maryland.
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sameera A Talegawkar
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health at the George Washington University, Washington, District of Columbia
| | - Valery S Effoe
- Division of Public Health Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | | | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Willa A Hsueh
- Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Sherita H Golden
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| |
Collapse
|
22
|
Joseph JJ, Echouffo-Tcheugui JB, Kalyani RR, Yeh HC, Bertoni AG, Effoe VS, Casanova R, Sims M, Wu WC, Wand GS, Correa A, Golden SH. Aldosterone, Renin, Cardiovascular Events, and All-Cause Mortality Among African Americans: The Jackson Heart Study. JACC Heart Fail 2017; 5:642-651. [PMID: 28822744 DOI: 10.1016/j.jchf.2017.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/18/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study examined the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD), using a composite endpoint of coronary heart disease, stroke, and/or heart failure and mortality among African Americans in the Jackson Heart Study. BACKGROUND There is a paucity of data for the association of aldosterone and PRA with incident CVD or all-cause mortality among community-dwelling African Americans. METHODS A total of 4,985 African American adults, 21 to 94 years of age, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (from 2000 to 2004). Incident events included coronary heart disease and stroke (assessed from 2000 to 2011) and heart failure (assessed from 2005 to 2011). Cox models were used to estimate hazard ratios (HRs) for incident CVD and mortality, adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake, and body mass index. RESULTS Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HR of 1.26 (95% confidence intervals [CI]: 1.14 to 1.40) and 1.16 (95% CI: 1.02 to 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04 to 1.23) and 1.12 (95% CI: 1.01 to 1.24) for mortality, respectively. CONCLUSIONS Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among African Americans.
Collapse
Affiliation(s)
- Joshua J Joseph
- Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Bostons, Massachusetts
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hsin-Chieh Yeh
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alain G Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Valery S Effoe
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ramon Casanova
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gary S Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sherita H Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
23
|
Effoe VS, Carnethon MR, Echouffo-Tcheugui JB, Chen H, Joseph JJ, Norwood AF, Bertoni AG. The American Heart Association Ideal Cardiovascular Health and Incident Type 2 Diabetes Mellitus Among Blacks: The Jackson Heart Study. J Am Heart Assoc 2017. [PMID: 28637777 PMCID: PMC5669153 DOI: 10.1161/jaha.116.005008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The concept of ideal cardiovascular health (CVH), defined by the American Heart Association primarily for coronary heart disease and stroke prevention, may apply to diabetes mellitus prevention among blacks. Methods and Results Our sample included 2668 adults in the Jackson Heart Study with complete baseline data on 6 of 7 American Heart Association CVH metrics (body mass index, healthy diet, smoking, total cholesterol, blood pressure, and physical activity). Incident diabetes mellitus was defined as fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes mellitus drugs, or glycosylated hemoglobin ≥6.5%. A summary CVH score from 0 to 6, based on presence/absence of ideal CVH metrics, was derived for each participant. Cox regression was used to estimate adjusted hazard ratios. Mean age was 55 years (65% women) with 492 incident diabetes mellitus events over 7.6 years (24.6 cases/1000 person‐years). Three quarters of participants had only 1 or 2 ideal CVH metrics; no participant had all 6. After adjustment for demographic factors (age, sex, education, and income) and high‐sensitivity C‐reactive protein, each additional ideal CVH metric was associated with a 17% diabetes mellitus risk reduction (hazard ratio, 0.83; 95% CI, 0.74–0.93). The association was attenuated with further adjustment for homeostasis model assessment for insulin resistance (hazard ratio, 0.89; 95% CI, 0.79–1.00). Compared with participants with 1 or no ideal CVH metric, diabetes mellitus risk was 15% and 37% lower in those with 2 and ≥3 ideal CVH metrics, respectively. Conclusions The AHA concept of ideal CVH is applicable to diabetes mellitus prevention among blacks. These associations were largely explained by insulin resistance.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA .,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arnita F Norwood
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.,Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, NC
| |
Collapse
|
24
|
Effoe VS, McClendon EE, Rodriguez CJ, Wagenknecht LE, Evans GW, Chang PP, Bertoni AG. Diabetes status modifies the association between carotid intima-media thickness and incident heart failure: The Atherosclerosis Risk in Communities study. Diabetes Res Clin Pract 2017; 128:58-66. [PMID: 28448893 PMCID: PMC5501651 DOI: 10.1016/j.diabres.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/21/2017] [Accepted: 04/07/2017] [Indexed: 11/21/2022]
Abstract
AIMS Increasing carotid intima-media thickness (CIMT) is associated with incident heart failure (HF). We investigated whether this association differs by diabetes status. METHODS We characterized 13,590 Atherosclerosis Risk in Communities Study participants free of baseline HF into normal fasting glucose (NFG, glucose <100mg/dl), impaired fasting glucose (IFG, glucose 100-125mg/dl), and type 2 diabetes (T2D, glucose ≥126mg/dl, self-report, or use of diabetes drugs). CIMT was assessed by B-mode ultrasound. Incident HF was defined using ICD-9 or 10 codes from hospitalizations and death certificates. Cox regression was used to estimate hazard ratios (HR) for incident HF, adjusting for age, sex, race, education, hypertension medication, blood pressure, BMI, waist circumference, HDL, LDL, triglycerides, lipid-lowering medication, smoking, alcohol, serum creatinine, and interim CHD. RESULTS T2D participants had higher mean CIMT (0.79±0.20mm), compared to IFG (0.75±0.19mm) and NFG (0.70±0.17mm) (p<0.0001). Over 20.6years of median follow-up, 15% developed HF. Rates of HF (per 1000 person-years) were substantially higher for those with T2D (24.7), compared to IFG (7.7) and NFG (5.8). In adjusted analyses, the CIMT-HF association was significantly modified by diabetes status (Pinteraction=0.015): for NFG (HR per SD increase in CIMT: 1.27; 95%CI: 1.20-1.34), IFG (HR 1.18; 95%CI: 1.11-1.25) and T2D (HR 1.12; 95%CI: 1.05-1.21). CONCLUSIONS CIMT is associated with increased risk of HF, particularly among persons without diabetes. Due to a high absolute risk of HF among adults with T2D, CIMT may be a less reliable predictor.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA.
| | - Eric E McClendon
- Division of Cardiology, University of Mississippi Medical Centre, Jackson, MS, USA
| | - Carlos J Rodriguez
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Lynne E Wagenknecht
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Gregory W Evans
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Patricia P Chang
- Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| |
Collapse
|
25
|
Effoe VS, Wagenknecht LE, Echouffo Tcheugui JB, Chen H, Joseph JJ, Kalyani RR, Bell RA, Wu WCH, Casanova R, Bertoni AG. Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study. J Am Heart Assoc 2017; 6:JAHA.116.004229. [PMID: 28154164 PMCID: PMC5523745 DOI: 10.1161/jaha.116.004229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Studies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA‐IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks. Methods and Results IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA‐IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA‐IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD‐only, 58 stroke‐only, and 11 CHD/stroke) over a median follow‐up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67–0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA‐IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55–0.92 and hazard ratio 1.33, 95% CI: 1.03–1.72, respectively), but not stroke risk. The logHOMA‐IR and CHD association was present in men, but not in women (Pinteraction=0.01). Conclusions Both HOMA‐IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA‐IR and CHD association was present in men, but not in women.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of General Internal Medicine, Morehouse School of Medicine, Atlanta, GA .,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC
| | - Lynne E Wagenknecht
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC
| | | | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rita R Kalyani
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.,Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, NC
| | - Wen-Chih H Wu
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Ramon Casanova
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC.,Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, NC
| |
Collapse
|
26
|
Joseph JJ, Echouffo-Tcheugui JB, Kalyani RR, Yeh HC, Bertoni AG, Effoe VS, Casanova R, Sims M, Correa A, Wu WC, Wand GS, Golden SH. Aldosterone, Renin, and Diabetes Mellitus in African Americans: The Jackson Heart Study. J Clin Endocrinol Metab 2016; 101:1770-8. [PMID: 26908112 PMCID: PMC4880170 DOI: 10.1210/jc.2016-1002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Previous research has suggested that activation of the renin-angiotensin-aldosterone system may promote insulin resistance and β-cell dysfunction, but the association with incident diabetes in African Americans is unknown. OBJECTIVE We examined the association of aldosterone and renin with insulin resistance, β-cell function, and incident diabetes in a large African American cohort. DESIGN The Jackson Heart Study is a prospective study of the development and progression of cardiovascular disease in African Americans. SETTING Participants were recruited from the tricounty area of metropolitan Jackson, Mississippi. PARTICIPANTS A total of 5301 African American adults, aged 21–94 years, were assessed at baseline and through 12 years of follow-up. Data on aldosterone, renin, and risk factors were collected at baseline (2000–2004). Diabetes (fasting glucose ≥ 126 mg/dL, physician diagnosis, use of diabetes drugs, or glycated hemoglobin ≥ 6.5%) was assessed at baseline and through 12 years of follow-up. Participants were excluded for missing data on baseline covariates or diabetes follow-up. Cox regression was used to estimate hazard ratios (HR) for incident diabetes using sequential modeling adjusting for age, sex, education, occupation, systolic blood pressure, current smoking, physical activity, dietary intake, and body mass index. EXPOSURES Aldosterone, renin, and diabetes risk factors were measured. OUTCOME Outcomes included the homeostatic model assessment of insulin resistance (HOMA-IR) and incident diabetes. RESULTS Among 3234 participants over a median of 8.0 years of follow-up, there were 554 cases of incident diabetes. Every 1% increase in log-transformed aldosterone was associated with a 0.18% higher log-transformed HOMA-IR in cross-sectional analyses of nondiabetic participants (P < .001). Log-transformed aldosterone and renin levels in the fifth vs first quintile were associated with a 78% (HR 1.78, 95% confidence interval 1.35–2.34) and 35% (HR 1.35, 95% confidence interval 1.06–1.72) increase in diabetes risk, respectively, in fully adjusted models. CONCLUSIONS Activation of the renin-angiotensin-aldosterone system may play a significant role in the development of insulin resistance and diabetes in African Americans.
Collapse
Affiliation(s)
- Joshua J Joseph
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Hsin-Chieh Yeh
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Alain G Bertoni
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Valery S Effoe
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Ramon Casanova
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Mario Sims
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Adolfo Correa
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Wen-Chih Wu
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Gary S Wand
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Sherita H Golden
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| |
Collapse
|
27
|
Effoe VS, Chen H, Moran A, Bertoni AG, Bluemke DA, Seeman T, Darwin C, Watson KE, Rodriguez CJ. Acculturation is associated with left ventricular mass in a multiethnic sample: the Multi-Ethnic Study of Atherosclerosis. BMC Cardiovasc Disord 2015; 15:161. [PMID: 26631068 PMCID: PMC4668673 DOI: 10.1186/s12872-015-0157-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022] Open
Abstract
Background Acculturation involves stress-related processes and health behavioral changes, which may have an effect on left ventricular (LV) mass, a risk factor for cardiovascular disease (CVD). We examined the relationship between acculturation and LV mass in a multiethnic cohort of White, African-American, Hispanic and Chinese subjects. Methods Cardiac magnetic resonance assessment was available for 5004 men and women, free of clinical CVD at baseline. Left ventricular mass index was evaluated as LV mass indexed by body surface area. Acculturation was characterized based on language spoken at home, place of birth and length of stay in the United States (U.S.), and a summary acculturation score ranging from 0 = least acculturated to 5 = most acculturated. Mean LV mass index adjusted for traditional CVD risk factors was compared across acculturation levels. Results Unadjusted mean LV mass index was 78.0 ± 16.3 g/m2. In adjusted analyses, speaking exclusively English at home compared to non-English language was associated with higher LV mass index (81.3 ± 0.4 g/m2 vs 79.9 ± 0.5 g/m2, p = 0.02). Among foreign-born participants, having lived in the U.S. for ≥ 20 years compared to < 10 years was associated with greater LV mass index (81.6 ± 0.7 g/m2 vs 79.5 ± 1.1 g/m2, p = 0.02). Compared to those with the lowest acculturation score, those with the highest score had greater LV mass index (78.9 ± 1.1 g/m2 vs 81.1 ± 0.4 g/m2, p = 0.002). There was heterogeneity in which measure of acculturation was associated with LV mass index across ethnic groups. Conclusions Greater acculturation is associated with increased LV mass index in this multiethnic cohort. Acculturation may involve stress-related processes as well as behavioral changes with a negative effect on cardiovascular health.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27127, USA.
| | - Haiying Chen
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27127, USA.
| | - Andrew Moran
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA.
| | - Alain G Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27127, USA.
| | - David A Bluemke
- National Institutes of Health/Clinical Center, Bethesda, MD, USA.
| | - Teresa Seeman
- Division of Geriatrics, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Christine Darwin
- University of California at Los Angeles Research Center, Los Angeles, CA, USA.
| | - Karol E Watson
- Division of Cardiology, University of California at Los Angeles School of Medicine, Los Angeles, CA, USA.
| | - Carlos J Rodriguez
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27127, USA.
| |
Collapse
|
28
|
Effoe VS, Correa A, Chen H, Lacy ME, Bertoni AG. High-Sensitivity C-Reactive Protein Is Associated With Incident Type 2 Diabetes Among African Americans: The Jackson Heart Study. Diabetes Care 2015; 38:1694-700. [PMID: 26068864 PMCID: PMC4542275 DOI: 10.2337/dc15-0221] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/15/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies on the association between hs-CRP and incident type 2 diabetes among African Americans have been inconclusive. We examined the association between hs-CRP and incident diabetes in a large African American cohort (Jackson Heart Study). RESEARCH DESIGN AND METHODS hs-CRP was measured in 3,340 participants. Incident diabetes was defined by fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or A1C ≥6.5% (48 mmol/mol) at follow-up. Cox regression was used to estimate hazard ratios (HRs) for incident diabetes, adjusting for age, sex, education, diabetes family history, alcohol, HDL, triglycerides, hypertension status, hypertension medications, physical activity, BMI, HOMA-insulin resistance (HOMAIR), and waist circumference. RESULTS Participants (63% women) were aged 53.3 ± 12.5 years. During a median follow-up of 7.5 years, 17.4% developed diabetes (23.1/1,000 person-years, 95% CI 21.3-25.1). After adjustment, the HR (hs-CRP third vs. first tertile) was 1.64 (95% CI 1.26-2.13). In separate models, further adjustment for BMI and waist circumference attenuated this association (HR 1.28 [95% CI 0.97-1.69] and 1.35 [95% CI 1.03-1.78, P < 0.05 for trend], respectively). Upon adding HOMAIR in the models, the association was no longer significant. In adjusted HOMAIR-stratified analysis, the hs-CRP-diabetes association appeared stronger in participants with HOMAIR <3.0 compared with HOMAIR ≥3.0 (P < 0.0001 for interaction). The association was also stronger among nonobese participants, although not significant when adjusted for HOMAIR. CONCLUSIONS Low-grade inflammation, as measured by hs-CRP level, may have an important role in the development of diabetes among African Americans with a lesser degree of insulin resistance.
Collapse
Affiliation(s)
- Valery S Effoe
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Haiying Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mary E Lacy
- Department of Epidemiology, Brown University, Providence, RI
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
29
|
Effoe VS, Suerken CK, Quandt SA, Bell RA, Arcury TA. The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults. J Appl Gerontol 2015; 36:1054-1069. [PMID: 26320147 DOI: 10.1177/0733464815602116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Medication adherence is a major health concern, particularly among older adults who have one or more chronic conditions. We examined the association between complementary therapy use and medication adherence among older community-dwelling adults. In a bi-ethnic sample of 165 adults aged 65 years and older, anthropometric variables, data on chronic medical conditions, and medication use were assessed. Medication adherence was modeled as a score (<50%, 50%-75%, and >75%) and complementary therapy use was categorized as a binary variable. Over half of the participants (50.3%) were female, and 47.3% were African American. Complementary therapy use was prevalent (87.9%) and did not differ by sex, ethnicity, income, and educational attainment. Medication adherence score was >75% in 84.8% of complementary therapy users and 80.0% of non-users ( p = .61). Despite a high use of complementary therapy in this population, there was no apparent association with low medication adherence.
Collapse
Affiliation(s)
- Valery S Effoe
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Sara A Quandt
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ronny A Bell
- 1 Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | |
Collapse
|
30
|
Balti EV, Ngo-Nemb MC, Lontchi-Yimagou E, Atogho-Tiedeu B, Effoe VS, Akwo EA, Dehayem MY, Mbanya JC, Gautier JF, Sobngwi E. Association of HLA class II markers with autoantibody-negative ketosis-prone atypical diabetes compared to type 2 diabetes in a population of sub-Saharan African patients. Diabetes Res Clin Pract 2015; 107:31-6. [PMID: 25511714 DOI: 10.1016/j.diabres.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
AIM We investigated the association of HLA DRB1 and DQB1 alleles, haplotypes and genotypes with unprovoked antibody-negative ketosis-prone atypical diabetes (A(-) KPD) in comparison to type 2 diabetes (T2D). METHODS A(-) KPD and T2D sub-Saharan African patients aged 19-63 years were consecutively recruited. Patients positive for cytoplasmic islet cell, insulin, glutamic acid decarboxylase or islet antigen-2 autoantibodies were excluded. Odds ratios were obtained via logistic regression after considering alleles with a minimum frequency of 5% in the study population. Bonferroni correction was used in the case of multiple comparisons. RESULTS Among the 130 participants, 35 (27%) were women and 57 (44%) were A(-) KPD. DRB1 and DQB1 allele frequencies were similar for both A(-) KPD and T2D patients; they did not confer any substantial risk even after considering type 1 diabetes susceptibility and resistance alleles. We found no association between A(-) KPD and the derived DRB1*07-DQB1*02:02 (OR: 0.55 [95%CI: 0.17-1.85], P=0.336); DRB1*11-DQB1*03:01 (OR: 2.42 [95%CI: 0.79-7.42], P=0.123); DRB1*15-DQB1*06:02 (OR: 0.87 [95%CI: 0.39-1.95], P=0.731) and DRB1*03:01-DQB1*02:01 (OR: 1.48 [95%CI: 0.55-3.96], P=0.437) haplotypes. Overall, we did not find any evidence of susceptibility to ketosis associated with DRB1 and DQB1 genotypes (all P>0.05) in A(-) KPD compared to T2D. Similar results were obtained after adjusting the analysis for age and sex. CONCLUSION Factors other than DRB1 and DQB1 genotype could explain the propensity to ketosis in A(-) KPD. These results need to be confirmed in a larger population with the perspective of improving the classification and understanding of the pathophysiology of A(-) KPD.
Collapse
Affiliation(s)
- Eric V Balti
- Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium; National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Marinette C Ngo-Nemb
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Eric Lontchi-Yimagou
- Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon; Université Paris Diderot, Paris, France
| | - Barbara Atogho-Tiedeu
- Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon
| | - Valery S Effoe
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Elvis A Akwo
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Mesmin Y Dehayem
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Jean-Claude Mbanya
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon; University of Technology, Kingston, Jamaica
| | - Jean-François Gautier
- Université Paris Diderot, Paris, France; Department of Diabetes and Endocrinology, Saint-Louis Hospital, Paris, France; INSERM, UMRS 872, Cordeliers Research Center, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Eugene Sobngwi
- National Obesity Center, Yaounde Central Hospital and Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon; Molecular Medicine and Metabolism Laboratories, Biotechnology Center, University of Yaounde 1, Yaounde, Cameroon.
| |
Collapse
|
31
|
Effoe VS, Rodriguez CJ, Wagenknecht LE, Evans GW, Chang PP, Mirabelli MC, Bertoni AG. Carotid intima-media thickness is associated with incident heart failure among middle-aged whites and blacks: the Atherosclerosis Risk in Communities study. J Am Heart Assoc 2014; 3:e000797. [PMID: 24815496 PMCID: PMC4309069 DOI: 10.1161/jaha.114.000797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Increased carotid intima‐media thickness (IMT) is associated with subclinical left ventricular myocardial dysfunction, suggesting a possible role of carotid IMT in heart failure (HF) risk determination. Methods and Results Mean far wall carotid IMT, measured by B‐mode ultrasound, was available for 13 590 Atherosclerosis Risk in Communities study participants aged 45 to 64 years and free of HF at baseline. HF was defined using ICD‐9 428 and ICD‐10 I‐50 codes from hospitalization records and death certificates. The association between carotid IMT and incident HF was assessed using Cox proportional hazards analysis with models adjusted for demographic variables, major CVD risk factors, and interim CHD. There were 2008 incident HF cases over a median follow‐up of 20.6 years (8.1 cases per 1000 person‐years). Mean IMT was higher in those with HF than in those without (0.81 mm±0.23 versus 0.71 mm±0.17, P<0.001). Unadjusted rate of HF for the fourth compared with the first quartile of IMT was 15.4 versus 3.9 per 1000 person‐years; P<0.001. In multivariable analysis, after adjustment, each standard deviation increase in IMT was associated with incident HF (HR 1.20 [95% CI: 1.16 to 1.25]). After adjustment, the top quartile of IMT was associated with HF (HR 1.60 [95% CI: 1.37 to 1.87]). Results were similar across race and gender groups. Conclusions Increasing carotid IMT is associated with incident HF in middle‐aged whites and blacks, beyond risks explained by major CVD risk factors and CHD. This suggests that carotid IMT may be associated with HF through mechanisms different from myocardial ischemia or infarction.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | |
Collapse
|