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Chen C, Xun P, McClure LA, Brockman J, MacDonald L, Cushman M, Cai J, Kamendulis L, Mackey J, He K. Serum mercury concentration and the risk of ischemic stroke: The REasons for Geographic and Racial Differences in Stroke Trace Element Study. Environ Int 2018; 117:125-131. [PMID: 29738916 PMCID: PMC5997556 DOI: 10.1016/j.envint.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Although biologically plausible, epidemiological evidence linking exposure to methylmercury with increased risk of ischemic stroke is limited. The effects of methylmercury may be modified by selenium, which is an anti-oxidant that often co-exists with mercury in fish. OBJECTIVES To examine the association between serum mercury levels with the incidence of ischemic stroke and to explore the possible effect modifications by serum selenium levels and demographic and geographic factors. METHODS A case-cohort study was designed nested in the REasons for Geographic and Racial Differences in Stroke cohort, including 662 adjudicated incident cases of ischemic stroke and 2494 participants in a randomly selected sub-cohort. Serum mercury was measured using samples collected at recruitment. Multivariable-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated using the Barlow-weighting method for the Cox proportional hazards regression model. RESULTS No statistically significant association was observed between serum mercury concentration and the incidence of ischemic stroke (the highest vs. lowest quintile of mercury levels: HR = 0.82; 95% CI = 0.55-1.22; P for linear trend = 0.42). Sex (P for interaction = 0.06), but not serum selenium levels, modified the association; a more evident trend toward lower incidence of ischemic stroke with higher mercury levels was observed among women. CONCLUSION This study does not support an association between mercury and the incidence of ischemic stroke within a population with low-to-moderate level of exposure. Further studies are needed to explore the possibility of mercury-induced ischemic stroke toxicity in other populations at higher exposure levels.
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Affiliation(s)
- Cheng Chen
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - John Brockman
- Columbia Research Reactor, University of Missouri, Columbia, MO 65211, USA
| | - Leslie MacDonald
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226, USA
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT 05401, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lisa Kamendulis
- Department of Environmental Health, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Jason Mackey
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Ka He
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA.
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Imtiaz Ahmad M, Mosley CD, O'Neal WT, Judd SE, McClure LA, Howard VJ, Howard G, Soliman EZ. Smoking and risk of atrial fibrillation in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Cardiol 2017; 71:113-117. [PMID: 28886993 DOI: 10.1016/j.jjcc.2017.07.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether smoking increases the risk of atrial fibrillation (AF) remains debatable due to inconsistent reports. METHODS We examined the association between smoking and incident AF in 11,047 participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, one of the largest biracial, population-based cohort studies in the USA. Baseline (2003-2007) cigarette smoking status and amount (pack-years) were self-reported. Incident AF was determined by electrocardiography and history of a prior physician diagnosis at a follow-up examination conducted after a median of 10.6 years. RESULTS During follow-up, 954 incident AF cases were identified; 9.5% in smokers vs. 7.8% in non-smokers; p<0.001. In a model adjusted for socio-demographics, smoking (ever vs. never) was associated with a 15% increased risk of AF [OR (95%CI): 1.15(1.00, 1.31)], but this association was no longer significant after further adjustment for cardiovascular risk factors [OR (95% CI): 1.12 (0.97, 1.29)]. However, heterogeneities in the association were observed among subgroups; the association was stronger in young vs. old participants [OR (95%CI): 1.31 (1.03, 1.67) vs. 0.99 (0.83-1.18) respectively; interaction p-value=0.005] and in those with vs. without prior cardiovascular disease [OR (95%CI): 1.18 (0.90, 1.56) vs. 1.06 (0.90, 1.25) respectively; interaction p-value 0.0307]. Also, the association was significant in blacks but not in whites [OR (95%CI): 1.51 (1.12, 2.05) vs. 0.99 (0.84, 1.16), respectively], but the interaction p-value did not reach statistical significance (interaction p-value=0.65). CONCLUSIONS The association between smoking and AF is possibly mediated by a higher prevalence of cardiovascular risk factors in smokers, but there is marked heterogeneity in the strength of this association among subgroups which may explain the conflicting results in prior studies.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Candice D Mosley
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Rembert N, He K, Judd SE, McClure LA. The geographic distribution of trace elements in the environment: the REGARDS study. Environ Monit Assess 2017; 189:84. [PMID: 28138888 PMCID: PMC5822713 DOI: 10.1007/s10661-016-5733-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/30/2016] [Indexed: 05/31/2023]
Abstract
Research on trace elements and the effects of their ingestion on human health is often seen in scientific literature. However, little research has been done on the distribution of trace elements in the environment and their impact on health. This paper examines what characteristics among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study are associated with levels of environmental exposure to arsenic, magnesium, mercury, and selenium. Demographic information from REGARDS participants was combined with trace element concentration data from the US Geochemical Survey (USGS). Each trace element was characterized as either low (magnesium and selenium) or high (arsenic and mercury) exposure. Associations between demographic characteristics and trace element concentrations were analyzed with unadjusted and adjusted logistic regression models. Individuals who reside in the Stroke Belt have lower odds of high exposure (4th quartile) to arsenic (OR 0.33, CI 0.31, 0.35) and increased exposure to mercury (OR 0.65, CI 0.62, 0.70) than those living outside of these areas, while the odds of low exposure to trace element concentrations were increased for magnesium (OR 5.48, CI 5.05, 5.95) and selenium (OR 2.37, CI 2.22, 2.54). We found an association between levels of trace elements in the environment and geographic region of residence, among other factors. Future studies are needed to further examine this association and determine whether or not these differences may be related to geographic variation in disease.
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Affiliation(s)
- Nicole Rembert
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ka He
- Department of Epidemiology and Biostatistics, Indiana University at Bloomington, Bloomington, IN, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA.
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Lee LT, Alexandrov AW, Howard VJ, Kabagambe EK, Hess MA, McLain RM, Safford MM, Howard G. Race, regionality and pre-diabetes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Prev Med 2014; 63:43-7. [PMID: 24594101 PMCID: PMC4621076 DOI: 10.1016/j.ypmed.2014.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/02/2013] [Revised: 02/07/2014] [Accepted: 02/23/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the association between race, region and pre-diabetes. METHOD The study used 2003-2007 United States baseline data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study for this cross-sectional analysis. Participants in this study were 45years or older at recruitment. Logistic regression was used to assess whether race and region are associated with pre-diabetes independent of demographics, socioeconomic factors and risk factors. RESULTS Twenty-four percent of the study participants (n=19,889) had pre-diabetes. The odds ratio (95% confidence interval) for having pre-diabetes was 1.28 (1.19-1.36) for blacks relative to whites and 1.18 (1.10-1.26) for people living in the Stroke Belt region relative to the other parts of the United States. The odds of having pre-diabetes for Stroke Belt participants changed minimally after additional adjustment for race (OR=1.20; 1.13-1.28), age and sex (OR=1.24; 1.16-1.32), socioeconomic status (OR=1.22; 1.15-1.31) and risk factors (OR=1.26; 1.17-1.35). In the adjusted model, being black was independently associated with pre-diabetes (OR=1.19; 1.10-1.28). CONCLUSION The prevalence of pre-diabetes was higher for both blacks and whites living in the Stroke Belt relative to living outside the Stroke Belt, and the prevalence of pre-diabetes was higher for blacks independent of region.
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Affiliation(s)
- Loretta T Lee
- UAB School of Nursing, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-1210, USA.
| | - Anne W Alexandrov
- UAB School of Nursing, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-1210, USA.
| | - Virginia J Howard
- Ryals School for Public Health, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-0113, USA.
| | - Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 316 Room 2, Nashville, TN 37203, USA.
| | - Mary A Hess
- UAB School of Nursing, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-1210, USA.
| | - Rhonda M McLain
- UAB School of Nursing, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-1210, USA.
| | - Monika M Safford
- Department of Medicine, Division of Preventive Medicine, The University of Alabama at Birmingham, 1720 2nd Ave South Birmingham, AL 35294-0113, USA.
| | - George Howard
- Ryals School for Public Health, The University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-0113, USA.
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