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He Y, Pavanello C, Hutchins PM, Tang C, Pourmousa M, Vaisar T, Song HD, Pastor RW, Remaley AT, Goldberg IJ, Costacou T, Sean Davidson W, Bornfeldt KE, Calabresi L, Segrest JP, Heinecke JW. Flipped C-Terminal Ends of APOA1 Promote ABCA1-Dependent Cholesterol Efflux by Small HDLs. Circulation 2024; 149:774-787. [PMID: 38018436 PMCID: PMC10913861 DOI: 10.1161/circulationaha.123.065959] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Cholesterol efflux capacity (CEC) predicts cardiovascular disease independently of high-density lipoprotein (HDL) cholesterol levels. Isolated small HDL particles are potent promoters of macrophage CEC by the ABCA1 (ATP-binding cassette transporter A1) pathway, but the underlying mechanisms are unclear. METHODS We used model system studies of reconstituted HDL and plasma from control and lecithin-cholesterol acyltransferase (LCAT)-deficient subjects to investigate the relationships among the sizes of HDL particles, the structure of APOA1 (apolipoprotein A1) in the different particles, and the CECs of plasma and isolated HDLs. RESULTS We quantified macrophage and ABCA1 CEC of 4 distinct sizes of reconstituted HDL. CEC increased as particle size decreased. Tandem mass spectrometric analysis of chemically cross-linked peptides and molecular dynamics simulations of APOA1, the major protein of HDL, indicated that the mobility of C-terminus of that protein was markedly higher and flipped off the surface in the smallest particles. To explore the physiological relevance of the model system studies, we isolated HDL from LCAT-deficient subjects, whose small HDLs (like reconstituted HDLs) are discoidal and composed of APOA1, cholesterol, and phospholipid. Despite their very low plasma levels of HDL particles, these subjects had normal CEC. In both the LCAT-deficient subjects and control subjects, the CEC of isolated extra-small HDL (a mixture of extra-small and small HDL by calibrated ion mobility analysis) was 3- to 5-fold greater than that of the larger sizes of isolated HDL. Incubating LCAT-deficient plasma and control plasma with human LCAT converted extra-small and small HDL particles into larger particles, and it markedly inhibited CEC. CONCLUSIONS We present a mechanism for the enhanced CEC of small HDLs. In smaller particles, the C-termini of the 2 antiparallel molecules of APOA1 are "flipped" off the lipid surface of HDL. This extended conformation allows them to engage with ABCA1. In contrast, the C-termini of larger HDLs are unable to interact productively with ABCA1 because they form a helical bundle that strongly adheres to the lipid on the particle. Enhanced CEC, as seen with the smaller particles, predicts decreased cardiovascular disease risk. Thus, extra-small and small HDLs may be key mediators and indicators of the cardioprotective effects of HDL.
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Affiliation(s)
- Yi He
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
| | - Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy (C.P., L.C.)
| | - Patrick M. Hutchins
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
| | - Chongren Tang
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
| | - Mohsen Pourmousa
- Laboratory of Computational Biology, National Heart, Lung, and Blood Institute (M.P., R.W.P.), National Institutes of Health, Bethesda, MD
| | - Tomas Vaisar
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
| | - Hyun D. Song
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (H.D.S., J.P.S.)
| | - Richard W. Pastor
- Laboratory of Computational Biology, National Heart, Lung, and Blood Institute (M.P., R.W.P.), National Institutes of Health, Bethesda, MD
| | - Alan T. Remaley
- Department of Laboratory Medicine (A.T.R.), National Institutes of Health, Bethesda, MD
| | - Ira J. Goldberg
- Department of Medicine, New York University, New York, NY (I.J.G.)
| | - Tina Costacou
- Department of Epidemiology, University of Pittsburgh, PA (T.C.)
| | - W. Sean Davidson
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, OH (W.S.D.)
| | - Karin E. Bornfeldt
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
| | - Laura Calabresi
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy (C.P., L.C.)
| | - Jere P. Segrest
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (H.D.S., J.P.S.)
| | - Jay W. Heinecke
- Department of Medicine, University of Washington, Seattle (Y.H., P.M.H., C.T., T.V., K.E.B., J.W.H.)
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Khamis RY, Hartley A, Caga-Anan M, Pandey SS, Marceddu C, Kojima C, Chang SH, Boyle JJ, Johnson JL, Björkbacka H, Guo L, Finn AV, Virmani R, Nilsson J, Haskard DO. Monoclonal Autoantibody Against a Cryptic Epitope on Tissue-Adherent Low-Density Lipoprotein for Molecular Imaging in Atherosclerosis. JACC Cardiovasc Imaging 2022; 15:1458-1470. [PMID: 35926905 DOI: 10.1016/j.jcmg.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/05/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antibody-based constructs for molecular imaging and therapeutic delivery provide promising opportunities for the diagnosis and treatment of atherosclerosis. OBJECTIVES The authors aimed to generate and characterize immunoglobulin (Ig)G monoclonal autoantibodies in atherosclerosis for targeting of novel molecular determinants. METHODS The authors created hybridomas from an unimmunized low-density lipoprotein (LDL) receptor-deficient (Ldlr-/-) mouse and selected an IgG2b isotype autoantibody, LO9, for further characterization. RESULTS LO9 reacted well with native LDL bound to immobilized matrix components and less well to oxidized LDL. LO9 binding to immobilized native LDL was not neutralized by fluid-phase native LDL, indicating an adhesion-dependent epitope. The authors localized the epitope to a 20 amino-acid peptide sequence (P5) in the globular amino-terminus of apolipoprotein B. LO9 reacted with antigen in mouse atherosclerosis and in both human stable and ruptured coronary atherosclerosis. Furthermore, in vivo near-infrared fluorescence molecular tomographic imaging, and ex vivo confocal microscopy showed that intravenously injected LO9 localized beneath endothelium of the aortic arch in Ldlr-/- mice, in the vicinity of macrophages. CONCLUSIONS The authors believe LO9 is the first example of an IgG autoantibody that reacts with a native LDL epitope revealed by adherence to tissue matrix. Antibodies against adherent native LDL have potential as molecular targeting agents for imaging of and therapeutic delivery to atherosclerosis.
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Affiliation(s)
- Ramzi Y Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mikhail Caga-Anan
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Samata S Pandey
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Cinzia Marceddu
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Chiari Kojima
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Shang-Hung Chang
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Division of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Joseph J Boyle
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jason L Johnson
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Liang Guo
- CVPath Institute, Gaithersburg, Maryland, USA
| | | | | | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Dorian O Haskard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Bec J, Vela D, Phipps JE, Agung M, Unger J, Margulies KB, Southard JA, Buja LM, Marcu L. Label-Free Visualization and Quantification of Biochemical Markers of Atherosclerotic Plaque Progression Using Intravascular Fluorescence Lifetime. JACC Cardiovasc Imaging 2021; 14:1832-42. [PMID: 33221238 DOI: 10.1016/j.jcmg.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to systematically investigate whether plaque autofluorescence properties assessed with intravascular fluorescence lifetime imaging (FLIm) can provide qualitative and quantitative information about intimal composition and improve the characterization of atherosclerosis lesions. BACKGROUND Despite advances in cardiovascular diagnostics, the analytic tools and imaging technologies currently available have limited capabilities for evaluating in situ biochemical changes associated with luminal surface features. Earlier studies of small number of samples have shown differences among the autofluorescence lifetime signature of well-defined lesions, but a systematic pixel-level evaluation of fluorescence signatures associated with various histological features is lacking and needed to better understand the origins of fluorescence contrast. METHODS Human coronary artery segments (n = 32) were analyzed with a bimodal catheter system combining multispectral FLIm with intravascular ultrasonography compatible with in vivo coronary imaging. Various histological components present along the luminal surface (200-μm depth) were systematically tabulated (12 sectors) from each serial histological section (n = 204). Morphological information provided by ultrasonography allowed for the accurate registration of imaging data with histology data. The relationships between histological findings and FLIm parameters obtained from 3 spectral channels at each measurement location (n = 33,980) were characterized. RESULTS Our findings indicate that fluorescence lifetime from different spectral bands can be used to quantitatively predict the superficial presence of macrophage foam cells (mFCs) (area under the receiver-operator characteristic curve: 0.94) and extracellular lipid content in advanced lesions (lifetime increase in 540-nm band), detect superficial calcium (lifetime decrease in 450-nm band area under the receiver-operator characteristic curve: 0.90), and possibly detect lesions consistent with active plaque formation such as pathological intimal thickening and healed thrombus regions (lifetime increase in 390-nm band). CONCLUSIONS Our findings indicate that autofluorescence lifetime provides valuable information for characterizing atherosclerotic lesions in coronary arteries. Specifically, FLIm can be used to identify key phenomena linked with plaque progression (e.g., peroxidized-lipid-rich mFC accumulation and recent plaque formation).
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Lewis CE, Bantle JP, Bertoni AG, Blackburn G, Brancati FL, Bray GA, Cheskin LJ, Curtis JM, Egan C, Evans M, Foreyt JP, Ghazarian S, Gibbs BB, Glasser S, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Kitzman D, Knowler WC, Lipkin E, Michaels S, Montez MG, Nathan DM, Nyenwe E, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Ryan DH, Wadden TA, Wagenknecht LE, Wyatt H, Wing RR, Yanovski SZ. History of Cardiovascular Disease, Intensive Lifestyle Intervention, and Cardiovascular Outcomes in the Look AHEAD Trial. Obesity (Silver Spring) 2020; 28:247-258. [PMID: 31898874 PMCID: PMC6980987 DOI: 10.1002/oby.22676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/19/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, there was suggestive evidence of heterogeneity for prespecified baseline CVD history subgroups (interaction P = 0.063). Event rates were higher in the ILI group among those with a CVD history (hazard ratio 1.13 [95% CI: 0.90-1.41]) and lower among those without CVD (hazard ratio 0.86 [95% CI: 0.72-1.02]). METHODS This study conducted post hoc analyses of the rates of the primary composite outcome and components, adjudicated cardiovascular death, nonfatal myocardial infarction (MI), stroke, and hospitalization for angina, as well as three secondary composite cardiovascular outcomes. RESULTS Interaction P values for the primary and two secondary composites were similar (0.060-0.064). Of components, the interaction was significant for nonfatal MI (P = 0.035). This interaction was not due to confounding by baseline variables, different intervention responses for weight loss and physical fitness, or hypoglycemic events. In those with a CVD history, statin use was high and similar by group. In those without a CVD history, low-density lipoprotein cholesterol levels were higher (P = 0.003) and statin use was lower (P ≤ 0.001) in the ILI group. CONCLUSIONS Intervention response heterogeneity was significant for nonfatal MI. Response heterogeneity may need consideration in a CVD-outcome trial design.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey M. Curtis
- Southwestern American Indian Center, Phoenix, AZ; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ; St. Joseph’s Hospital and Medical Center, Phoenix
| | - Caitlin Egan
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | | | | | - Helen P. Hazuda
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | - James O. Hill
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | | | - Van S. Hubbard
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
| | | | | | | | - Steven E. Kahn
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | | | - William C. Knowler
- Southwestern American Indian Center, Phoenix; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Edward Lipkin
- VA Puget Sound Health Care System, University of Washington; Seattle, WA
| | | | - Maria G. Montez
- University of Texas Health Science Center at San Antonio; San Antonio, TX
| | | | | | - Jennifer Patricio
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | - Anne Peters
- University of Southern California; Los Angeles, CA
| | - Xavier Pi-Sunyer
- St. Luke’s Roosevelt Hospital Center, Columbia University; New York, NY
| | | | | | - Donna H. Ryan
- Pennington Biomedical Research Center; Baton Rouge, LA
| | | | | | - Holly Wyatt
- University of Colorado Anschutz Medical Campus; Aurora, CO
| | - Rena R. Wing
- The Miriam Hospital, Brown Medical School; Providence, RI
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; MD
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Irshad Z, Chmel N, Adya R, Zammit VA. Hepatic VLDL secretion: DGAT1 determines particle size but not particle number, which can be supported entirely by DGAT2. J Lipid Res 2018; 60:111-120. [PMID: 30397187 PMCID: PMC6314258 DOI: 10.1194/jlr.m089300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/14/2018] [Revised: 10/08/2018] [Indexed: 12/25/2022] Open
Abstract
We investigated whether, in view of its activity being expressed on both aspects of the endoplasmic reticulum (ER; dual membrane topology), diacylglycerol acyltransferase 1 (DGAT1) plays a distinctive role in determining the triglyceride (TAG) content of VLDL particles secreted by the liver. Mice in which the DGAT1 gene was specifically ablated in hepatocytes (DGAT1-LKO mice) had the same number of VLDL particles (apoB concentration) in the plasma 1 h after Triton 1339 treatment, but these particles were approximately half the size of VLDL particles secreted by control mice and had a proportionately decreased content of TAG, with normal cholesterol and cholesteryl ester contents. Analyses of purified microsomal fractions prepared from 16 h fasted control and DAGT1-LKO mice showed that the TAG/protein ratio in the ER was significantly lower in the latter. Electron micrographs of these livers showed that those from DGAT1-LKO mice did not show the increased lipid content of the smooth ER shown by control livers. The effects of DGAT1- and DGAT2-specific inhibitors on apoB secretion by HepG2 cells showed that DGAT1 is not indispensable for apoB secretion and demonstrated redundancy in the ability of the two enzymes to support apoB secretion. Therefore, our findings show that DGAT1 is essential for the complete lipidation and maturation of VLDL particles within the lumen of the ER, consistent with its dual topology within the ER membrane. In the mouse, DGAT2 can support apoB secretion (particle number) even when TAG availability for full VLDL lipidation is restricted in the absence of DGAT1.
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Affiliation(s)
- Zehra Irshad
- Translational and Experimental Medicine, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Nikola Chmel
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Raghu Adya
- Translational and Experimental Medicine, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Victor A Zammit
- Translational and Experimental Medicine, Warwick Medical School, Coventry CV4 7AL, United Kingdom
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Minissian MB, Kilpatrick S, Eastwood JA, Robbins WA, Accortt EE, Wei J, Shufelt CL, Doering LV, Merz CNB. Association of Spontaneous Preterm Delivery and Future Maternal Cardiovascular Disease. Circulation 2018; 137:865-871. [PMID: 29459472 PMCID: PMC5967638 DOI: 10.1161/circulationaha.117.031403] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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] [Indexed: 12/24/2022]
Abstract
Cardiovascular disease (CVD) risk factors are well established. However, little is known about a woman's cardiovascular response to pregnancy, which appears to be an early marker of future maternal CVD risk. Spontaneous preterm delivery (sPTD) has been associated with a ≤3-fold increased risk of maternal CVD death later in life compared with having a term delivery. This review focuses on 3 key areas to critically assess the association of sPTD and future maternal CVD risk: (1) CVD risk factors, (2) inflammatory biomarkers of interest, and (3) specific forms of vascular dysfunction, such as endothelial function and arterial stiffness, and mechanisms by which each may be linked to sPTD. The association of sPTD with subsequent future maternal CVD risk suggests that a woman's abnormal response to pregnancy may serve as her first physiological stress test. These findings suggest that future research is needed to understand why women with sPTD may be at risk for CVD to implement effective interventions earlier in a woman's life.
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Affiliation(s)
- Margo B Minissian
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute (M.B.M., J.W., C.L.S., C.N.B.M.)
- Brawerman Nursing Institute (M.B.M.)
- School of Nursing, University of California, Los Angeles (M.B.M., J.E., W.A.R., L.V.D.)
| | - Sarah Kilpatrick
- Department of Obstetrics and Gynecology (S.K., E.E.A.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jo-Ann Eastwood
- School of Nursing, University of California, Los Angeles (M.B.M., J.E., W.A.R., L.V.D.)
| | - Wendie A Robbins
- School of Nursing, University of California, Los Angeles (M.B.M., J.E., W.A.R., L.V.D.)
| | - Eynav E Accortt
- Department of Obstetrics and Gynecology (S.K., E.E.A.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute (M.B.M., J.W., C.L.S., C.N.B.M.)
| | - Chrisandra L Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute (M.B.M., J.W., C.L.S., C.N.B.M.)
| | - Lynn V Doering
- School of Nursing, University of California, Los Angeles (M.B.M., J.E., W.A.R., L.V.D.)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute (M.B.M., J.W., C.L.S., C.N.B.M.)
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Abstract
Background The knowledge of the impact of cardiovascular risk factors at different ages has mainly been based on different studies performed at different ages. This study aimed to investigate the change in impact of traditional cardiovascular risk factors over the aging process in subjects followed for 4 decades. Methods and Results In the ULSAM (Uppsala Longitudinal Study of Adult Men) study, 2322 men originally investigated in 1970 to 1974 have been followed regarding cardiovascular diseases until the end of 2013. This cohort has been investigated physically at ages 50, 60, 70, 77, and 82 years regarding body mass index, low‐density lipoprotein‐ and high‐density lipoprotein‐cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure, fasting glucose, and smoking. These data were used to model the interactions between risk factors and age regarding incident myocardial infarction (n=540), ischemic stroke (n=343), or heart failure (n=397). Significant interactions were observed between age and the set of traditional risk factors regarding all 3 outcomes (P<0.05 for all). Generally, a decline in the rate ratios was seen with aging for most risk factors, being most pronounced for body mass index regarding myocardial infarction and for systolic blood pressure regarding ischemic stroke and heart failure. However, low‐density lipoprotein‐cholesterol was significantly related to incident myocardial infarction, whereas both body mass index and fasting glucose were significantly related to incident heart failure also at a high age. Conclusions Using a longitudinal design in middle‐aged men spanning 4 decades showed that the impact of traditional cardiovascular risk factors generally declined with aging. However, some of the risk factors remained significantly associated with incident cardiovascular disease also at old age.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Centre (UCR), Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Centre (UCR), Uppsala University, Uppsala, Sweden
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Howard G, Safford MM, Moy CS, Howard VJ, Kleindorfer DO, Unverzagt FW, Soliman EZ, Flaherty ML, McClure LA, Lackland DT, Wadley VG, Pulley L, Cushman M. Racial Differences in the Incidence of Cardiovascular Risk Factors in Older Black and White Adults. J Am Geriatr Soc 2016; 65:83-90. [PMID: 27666895 DOI: 10.1111/jgs.14472] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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: 11/29/2022]
Abstract
OBJECTIVES To describe the incidence of cardiovascular risk factors, or race-related disparities in incidence, across the age spectrum in adults. DESIGN Longitudinal cohort. SETTING National sample. PARTICIPANTS Community-dwelling black and white adults recruited between 2003 and 2007. MEASUREMENTS Incident hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation over 10 years of follow-up in 10,801 adults, stratified according to age (45-54, 55-64, 65-74, ≥75). RESULTS There was no evidence (P ≥ .68) of an age-related difference in the incidence of hypertension for white men (average incidence 38%), black men (48%), or black women (54%), although for white women incidence increased with age (45-54, 27%; ≥75, 40%). Incidence of diabetes mellitus was lower at older ages for white men (45-54, 15%; ≥75, 8%), black men (45-54, 29%; ≥75, 13%), and white women (45-54, 11%; ≥75, 4%), although there was no evidence (P = .11) of age-related changes for black women (average incidence 21%). For dyslipidemia, incidence for all race-sex groups was approximately 20% for aged 45 to 54 but approximately 30% for aged 54 to 64 and 65 to 74 and approximately 22% for aged 75 and older. Incidence of atrial fibrillation was low at age 45 to 54 (<5%) but for aged 75 and older was approximately 20% for whites and 11% for blacks. The incidence of hypertension, diabetes mellitus, and dyslipidemia was higher in blacks across the age spectrum but lower for atrial fibrillation. CONCLUSION Incidence of risk factors remains high in older adults. Blacks have a higher incidence of hypertension, diabetes mellitus, and dyslipidemia after age 45, underscoring the ongoing importance of prevention of all three conditions in mid- to later life.
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Affiliation(s)
- George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Elsayed Z Soliman
- Department of Epidemiology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | - Leslie A McClure
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Daniel T Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Virginia G Wadley
- Department of Gerontology, Geriatrics and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - LeaVonne Pulley
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mary Cushman
- Department of Medicine, School of Medicine, University of Vermont, Burlington, Vermont
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