Comorbid Conditions Are Associated With Cognitive Impairment in Native Hawaiians and Pacific Islanders.

We examined the association between comorbid conditions and mild cognitive impairment (MCI) in Native Hawaiians and Pacific Islanders (NHPI) (n = 54). Cross-sectional, self-reported questionnaires were utilized to collect demographic, comorbid conditions, and MCI (via the AD8 index) data. Separate logistic regression models were conducted to investigate the relationship between comorbid conditions and MCI, adjusting for other covariates. We found significantly increased odds of MCI in those reporting high blood pressure (OR = 5.27; 95% CI: [1.36, 20.46]; p = 0.016), high cholesterol (OR = 7.30; 95% CI: [1.90, 28.14], p = 0.004), and prediabetes or borderline diabetes (OR = 4.53; 95% CI: [1.27, 16.16], p = 0.02) compared with those not reporting these respective conditions. These data show that hypertension, hypercholesterolemia, and prediabetes are associated with MCI in the NHPI community, suggesting that preventive strategies to reduce chronic conditions may also potentially slow cognitive decline in underrepresented/understudied NHPI.

Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans.

BACKGROUND: Studies generally show that higher acculturation is associated with greater cardiovascular disease (CVD) risk among immigrants in the United States (US). However, few studies have compared how proxies of acculturation are differentially associated with metabolic abnormalities measured using objective biomarkers, self-reported diagnosis, and medication use, particularly among East Asian Americans. METHODS: Survey data and biomarker measurements collected from random (non-fasting) blood samples of Chinese and Korean immigrants in the US (n = 328) were used to examine the associations between two proxies for acculturation (years living in the US and English speaking proficiency) with three cardiometabolic abnormalities (high triglyceride levels, diabetes, and hypercholesterolemia). Poisson regression models estimated prevalence ratios adjusted for demographic characteristics, socioeconomic factors, and body mass index. Gender, Asian subgroup, and household income were tested as potential effect modifiers. RESULTS: Living longer in the US was associated with greater likelihood of having high triglycerides. In addition, living longer in the US was associated with greater likelihood of diabetes for people with lower household income and greater likelihood of hypercholesterolemia for people with higher household income. Higher level of English proficiency was less consistently associated with higher cardiometabolic risk, although there was a significant association with greater likelihood of hypercholesterolemia. CONCLUSIONS: Longer time lived in the US is associated with higher risk of cardiometabolic abnormalities among Chinese and Korean Americans. Future studies of acculturation and cardiometabolic risk should carefully consider potential mechanisms and what proxy measures of acculturation capture. TRIAL REGISTRATION NUMBER: NCT03481296, date of registration: 3/29/2018.

APOE Gene Associated with Cholesterol-Related Traits in the Hispanic Population.

Genetic variants in the apolipoprotein E (APOE) gene are associated with lipid metabolism and lipid-related traits in the non-Hispanic population. There have been limited studies regarding the association between the APOE gene and hypercholesterolemia in the Hispanic population; therefore, our aim for this study is to examine the APOE gene's associations with cholesterol level and its related phenotypes. The APOE gene consists of three different alleles, ε2, ε3, and ε4, with ε4 being associated with dementia and cardiovascular diseases. A total of 1,382 subjects were collected from the Texas Alzheimer's Research and Care Consortium (TARCC, N = 1320) and the Initial Study of Longevity and Dementia from the Rio Grande Valley (ISLD-RGV, N = 62). Questionnaires on demographics, medical history, and blood/saliva samples were collected and APOE genotypes were performed. We observed allele frequencies of the APOE ε3 (96.7%), ε4 (22.6%) and ε2 (6.8%) alleles, respectively. Multivariable logistic regression revealed a significant association between the APOE ε4 allele and hypercholesteremia (p = 1.8 × 10-4) in our studied Hispanic population. We prove for the first time, that the APOE ε4 allele increases the risk for hypercholesterol in Hispanics. Further research is needed to confirm and supports our current findings.

Factors Associated With PCSK9 Inhibitor Initiation Among US Veterans.

Background Few adults at high risk for atherosclerotic cardiovascular disease events use a PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor). Methods and Results Using data from the US Veterans Health Administration, we identified veterans who initiated a PCSK9i between January 2018 and December 2019, matched 1:4 to veterans who did not initiate this medication over this time period (case-cohort study). Two cohorts of veterans were analyzed: (1) atherosclerotic cardiovascular disease, with a most recent low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL; and (2) severe hypercholesterolemia (ie, familial hypercholesterolemia or any prior LDL-C ≥190 mg/dL, with most recent LDL-C ≥100 mg/dL). Conditional logistic regression was used to analyze factors associated with PCSK9i initiation, adjusting for all factors, simultaneously. There were 2394 initiators and 9576 noninitiators in the atherosclerotic cardiovascular disease cohort (median LDL-C, 141 and 96 mg/dL, respectively; P<0.001). Factors associated with a higher likelihood of PCSK9i initiation included age 65 to <75 versus <65 years, highest versus lowest quartile of median area-level income, familial hypercholesterolemia, former statin use, and current ezetimibe use. PCSK9i initiation was lower among veterans of a race/ethnicity other than non-Hispanic White. There were 245 initiators and 980 noninitiators in the severe hypercholesterolemia cohort (median LDL-C, 183 and 151 mg/dL, respectively; P<0.001). Age ≥75 versus <65 years, history of chronic kidney disease, former statin use, and current ezetimibe use were associated with a higher likelihood of PCSK9i initiation. Conclusions Several patient-level factors, including age, sex, and race/ethnicity, were significantly associated with PCSK9i initiation, suggesting an unmet treatment need in several patient groups.

Effects of Evolocumab on Low-Density Lipoprotein Cholesterol, Non-High Density Lipoprotein Cholesterol, Apolipoprotein B, and Lipoprotein(a) by Race and Ethnicity: A Meta-Analysis of Individual Participant Data From Double-Blind and Open-Label Extension Studies.

Background Prevalence of cardiovascular disease risk factors and rates of atherosclerotic cardiovascular disease outcomes vary across racial/ethnic groups. This analysis examined the effects of evolocumab on LDL-C (low-density lipoprotein cholesterol) levels and LDL-C goals achievement by race/ethnicity. Methods and Results Data from 15 phase 2 and 3 studies of treatment with evolocumab versus placebo or ezetimibe were pooled (n=7669). Results were analyzed by participant clinical characteristics and by self-identified race/ethnicity. Key outcomes included percent change from baseline in LDL-C, achievement of LDL-C <70 mg/dL, and LDL-C reduction of ≥50% at 12 weeks and at 1 to 5 years. Across 12-week studies, mean percent change in LDL-C from baseline in evolocumab-treated participants was -52% to -59% for White and -46% to -67% for non-White participants, across clinical characteristics groups. LDL-C <70 mg/dL was achieved in 43% to 84% and 62% to 94% and LDL-C reduction of ≥50% in 63% to 78% and 58% to 86%, respectively. In 1- to 5-year studies, mean percent change in LDL-C was -46% to -52% for White and -49% to -55% for non-White participants. LDL-C <70 mg/dL was achieved in 53% to 84% and 66% to 77%, and LDL-C reduction of ≥50% in 53% to 67% and 58% to 68%, respectively. The treatment effect on mean percent change in LDL-C differed only in participants with type 2 diabetes mellitus, with a larger reduction in Asian participants. The qualitative interaction P values were nonsignificant, indicating consistent directionality of effect. Conclusions Similar reduction in LDL-C levels with evolocumab was observed across racial/ethnic groups in 12-week and 1- to 5-year studies. Among those with diabetes mellitus, Asian participants had greater LDL-C reduction.

Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study.

Background: African Americans and other persons of African descent in the United States are disproportionately affected by cardiovascular diseases (CVD). Discrimination is associated with higher CVD risk among US adults; however, this relationship is unknown among African immigrants. Methods: The African Immigrant Health Study was a cross-sectional study of African immigrants in Baltimore-Washington, DC, with recruitment and data collection taking place between June 2017 and April 2019. The main outcome was elevated CVD risk, the presence of ≥3 CVD risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use, and poor diet. The secondary outcomes were these six individual CVD risk factors. The exposure was discrimination measured with the Everyday Discrimination Scale; summed scores ≥2 on each item indicated frequent experiences of discrimination. Resilience was assessed with the 10-item Connor-Davidson resilience scale. Logistic regression was used to examine the odds of elevated CVD risk, adjusting for relevant covariates. Results: We included 342 participants; 61% were females. The mean (±SD) age was 47(±11) years, 61% had at least a bachelor's degree, 18% had an income <$40,000, and 49% had lived in the US ≥15 years. Persons with frequent experiences of discrimination were 1.82 times (95%CI: 1.04-3.21) more likely to have elevated CVD risk than those with fewer experiences. Resilience did not moderate the relationship between CVD risk and discrimination. Conclusion: African immigrants with frequent experiences of discrimination were more likely to have elevated CVD risk. Targeted and culturally appropriate interventions are needed to reduce the high burden of CVD risk in this population. Health care providers should be aware of discrimination as a meaningful social determinant of CVD risk. At the societal level, policies and laws are needed to reduce the occurrence of discrimination among African immigrants and racial/ethnic minorities.

Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities.

Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 - December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2-3 (51%) were best for screening, while days 3-4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas. ABBREVIATIONS: CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board.

APLP2 gene polymorphisms are associated with high TC and LDL-C levels in Chinese population in Xinjiang, China.

Hyperlipidemia is one of the main risk factors for coronary artery disease (CAD). In the present study, we aimed to explore whether the single-nucleotide polymorphisms (SNPs) in amyloid precursor-like protein (APLP) 2 (APLP2) gene were associated with high lipid levels in Chinese population in Xinjiang, China. We recruited 1738 subjects (1187 men, 551 women) from the First Affiliated Hospital of Xinjiang Medical University, and genotyped three SNPs (rs2054247, rs3740881 and rs747180) of APLP2 gene in all subjects by using the improved multiplex ligation detection reaction (iMLDR) method. Our study revealed that the rs2054247 SNP was associated with serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) levels, and high-density lipoprotein cholesterol (HDL-C) in additive model (all P<0.05). The rs747180 SNP was associated with serum TC and LDL-C levels in additive model (all P<0.05). Our study revealed that both rs2054247 and rs747180 SNPs of the APLP2 gene were associated with high TC and LDL-C levels in Chinese subjects in Xinjiang.

Identification of two novel LDLR variants by Next Generation Sequencing.

INTRODUCTION: Familial hypercholesterolemia (FH) is an autosomal dominant inherited disease characterized by elevated plasma low-density lipoprotein cholesterol (LDL-C). Targeted Next Generation Sequencing (NGS) is a new opportunity to expand the existing pathogenic variants (PVs) spectrum associated to FH. Our aim was to report a diagnostic NGS-based approach to detect variants associated to FH. METHODS: We report two patients: a 48-year-old Asian woman, without known history of hypercholesterolemia and a 46-year-old Caucasian man, with childhood hypercholesterolemia. RESULTS: An effective NGS-based pipeline, FH-Devyser kit/Amplicon Suite, beginning from sequencing to data analysis, did not identify known PVs in the LDLR, APOB, APOE, LDLRAP1, STAP1 and PCSK9 genes, but revealed two novel LDLR variants (c.1564A>T, p.Ile522Phe and c.1688C>T, p.Pro563Leu). DISCUSSION AND CONCLUSIONS: This study showed that an effective NGS-based pipeline led to a definitive diagnosis in two FH families, allowing to plan their therapeutic treatment. Although the functional consequence of the two LDLR variants needs to be assessed in vitro, the in silico analysis and high preservation of the two amino acid positions observed in the LDLR protein, across different animal species, suggest that both variants are deleterious.

Cardiovascular risk factors in Mexico and the United States: a comparative cross-sectional study between the HABLE and MHAS participants.

INTRODUCTION: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. OBJECTIVE: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. METHOD: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. RESULTS: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). CONCLUSION: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.

INTRODUCCIÓN: En Estados Unidos se dispone de información acerca de la población mexicoamericana por el Estudio de Salud y Envejecimiento del Cerebro en Latinos Mayores (HABLE); en México se dispone de los resultados del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). OBJETIVO: Comparar la prevalencia de factores de riesgo cardiovascular entre hombres y mujeres de HABLE y ENASEM. MÉTODO: Se analizó transversalmente la prevalencia de hipertensión, diabetes, hipercolesterolemia y obesidad abdominal en 559 participantes de HABLE y se comparó con datos de 13 663 participantes del ENASEM. La comparación se realizó mediante t de Student y chi cuadrada, según el tipo de variable. RESULTADOS: El análisis demostró que la prevalencia de hipertensión (50 %, IC 95 % = 41.8-51.8), diabetes (35.5 %, IC 95 % = 27.6-43.8) y obesidad abdominal (59.3 %, IC 95 % = 50.5-68.1) fueron significativamente mayores en hombres del HABLE, mientras que las mujeres presentaron una prevalencia más elevada de diabetes (36.8 %, IC 95 % = 32.2-41.5) y obesidad abdominal (89.6 %, IC 95 % = 86.6-92.5). La hipercolesterolemia tuvo una prevalencia más elevada en mujeres del ENASEM (53.3 %, IC 95 % = 50.3-56.2). CONCLUSIÓN: La prevalencia de factores de riesgo cardiovascular fue mayor en mexicoamericanos participantes del HABLE, que en mexicanos participantes del ENASEM.

Factores de riesgo cardiovascular en Estados Unidos y México: comparación de los estudios HABLE y ENASEM / Cardiovascular risk factors in Mexico and the United States: a comparative cross-sectional study between the HABLE and MHAS participants

Resumen Introducción: En Estados Unidos se dispone de información acerca de la población mexicoamericana por el Estudio de Salud y Envejecimiento del Cerebro en Latinos Mayores (HABLE); en México se dispone de los resultados del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Objetivo: Comparar la prevalencia de factores de riesgo cardiovascular entre hombres y mujeres de HABLE y ENASEM. Método: Se analizó transversalmente la prevalencia de hipertensión, diabetes, hipercolesterolemia y obesidad abdominal en 559 participantes de HABLE y se comparó con datos de 13 663 participantes del ENASEM. La comparación se realizó mediante t de Student y chi cuadrada, según el tipo de variable. Resultados: El análisis demostró que la prevalencia de hipertensión (50 %, IC 95 % = 41.8-51.8), diabetes (35.5 %, IC 95 % = 27.6-43.8) y obesidad abdominal (59.3 %, IC 95 % = 50.5-68.1) fueron significativamente mayores en hombres del HABLE, mientras que las mujeres presentaron una prevalencia más elevada de diabetes (36.8 %, IC 95 % = 32.2-41.5) y obesidad abdominal (89.6 %, IC 95 % = 86.6-92.5). La hipercolesterolemia tuvo una prevalencia más elevada en mujeres del ENASEM (53.3 %, IC 95 % = 50.3-56.2). Conclusión: La prevalencia de factores de riesgo cardiovascular fue mayor en mexicoamericanos participantes del HABLE, que en mexicanos participantes del ENASEM.

Abstract Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student’s t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.

Report of Health Behavior Modification Among Latinos Diagnosed With Multiple Cardiovascular Risk Factors.

INTRODUCTION: Hypertension, hypercholesterolemia, and type II diabetes are leading cardiovascular risk factors in the United States, and Latinos are disproportionately burdened by these chronic health conditions. The extent to which Latinos overall and by language spoken at home report health behavior modification following diagnosis is poorly understood. METHODS: Our inclusion criteria included participants sampled in the 2011-2016 waves of the National Health and Nutrition Examination Survey who self-identified as Latinos, were 20 years of age or above, and reported a diagnosis of hypertension, hypercholesterolemia or diabetes (N=2027). We examined associations between the language spoken at home and report of adoption of 3 recommended health behaviors in the past year: weight loss, leisure-time physical activity (LTPA) and smoking cessation. Separate log-binomial models were fit to estimate prevalence ratios (PRs) for each health behavior. RESULTS: Approximately one third (28%) of study participants had been diagnosed with diabetes and more than half reported a diagnosis of hypercholesterolemia (65%) or hypertension (60%). Most Latinos met the highest levels of smoking cessation criteria (82%), whereas less than a third met LTPA recommendations (29%) or attempted weight loss (24%) in the past year. Fully adjusted outcome specific models showed that exclusively speaking English at home was associated with a higher probability of reporting weight loss attempt and LTPA compared with Spanish only speakers, although only LTPA was statistically significant [weight loss PR: 1.23, 95% confidence interval (CI): 0.92, 1.65; LTPA PR: 1.74; 95% CI: 1.37, 2.20; smoking cessation PR: 0.93, 95% CI: 0.86, 1.01]. CONCLUSIONS: Our findings provide new evidence on patterns of behavioral modification in a population-based sample of Latinos diagnosed with chronic health conditions. Findings suggest the need to promote language and culturally relevant initiatives to increase the adoption of health-enhancing behaviors and improve chronic disease management among Spanish-speaking Latinos.

Cardiovascular disease risk factors among Latino farmworkers in Oregon.

PURPOSE: Cardiovascular diseases (CVDs) are a leading cause of death among Latinos in the United States. The present study examines the prevalence of four CVD risk factors (diabetes, hypertension, hypercholesterolemia, and obesity) in a large sample of Latino farmworkers in Oregon. METHODS: We pooled secondary, cross-sectional data from Latino vineyard and winery farmworkers (n = 3382), in the north Willamette valley, Oregon, between 2004 and 2012. Prevalence was estimated for the four CVD risk factors under study. Multivariable logistic regression analyses were conducted to examine the association between CVD risk factors, sex, and other sociodemographic factors. RESULTS: Hypercholesterolemia (21.6%) and obesity (22.8%) were the most prevalent CVD risk factors among Latino farmworker participants. In multivariable analyses, men and women, aged 45-64 years, were more likely to have all four CVD risk factors than those aged 18-44. Living in the United States for ten years or more was associated with higher odds of hypertension (OR = 1.72, 95% CI: 1.17-2.54), and obesity (OR = 2.08, 95% CI: 1.57-2.76) among Latino farmworker men. Among Latino farmworker women, living in the United States for ten years or more increased the odds of obesity (OR = 1.81, 95% CI: 1.07-3.06). CONCLUSIONS: Our findings highlight the higher prevalence of CVD risk factors among Latino farmworkers and the need to address CVD risk factors in this population.

Prediabetes, diabetes, and other CVD-related conditions among Asian populations in Los Angeles County, 2014.

Objective: To assess the prevalence of four common health conditions related to cardiovascular disease risk among Asians in Los Angeles County. Methods: A survey of Asians in Los Angeles County was conducted utilizing purposive sampling to recruit from the region's Service Planning Areas 3 and 4; these underserved areas contain high density of Asian populations. Descriptive and multivariable regression analyses were performed to explore and describe potential associations between self-reported diagnoses of prediabetes, diabetes, hypertension, and high cholesterol and body mass index (measured with non-Asian versus Asian cut points) by race/ethnicity (Chinese/Filipino/Korean/Taiwanese/Thai/Vietnamese). Results: The survey response rate was nearly 60%. The analysis included 1,377 Asians, self-identified as either Chinese (n = 700), Filipino (n = 69), Korean (n = 339), Taiwanese (n = 48), Thai (n = 115), or Vietnamese (n = 106). Results showed that, in comparison to other Asians, Filipinos had the highest risks for two of the four conditions described. Other results by subgroup affirmed a similar heterogeneous pattern of Asian health locally. Conclusions: These and other results from the survey point to potential gaps in healthcare needs of Asians, and to opportunities where local public health efforts could help increase these populations' access to cardiovascular disease-related health and social services.

Associations Between Stress and Cardiovascular Disease Risk Factors Among Million Hearts Priority Populations.

PURPOSE: To estimate the effects of stress on hypertension and high cholesterol with a focus on Million Hearts priority populations. DESIGN: A population-based cross-sectional survey on cardiovascular health and its risk factors. SETTING: Million Hearts cardiovascular community screenings. SAMPLE: Deidentified data were collected on a convenience sample of 59 798 participants. MEASURES: Self-reported stress score using the Perceived Stress Scale-4 (PSS-4), blood pressure, and total cholesterol. ANALYSIS: Descriptive statistics were used to estimate the prevalence of high stress (PSS-4 score ≥ 9), prehypertension or hypertension, and elevated total cholesterol. Multiple logistic regression modeling was used to estimate the effect of stress on the risk of elevated blood pressure and total cholesterol. RESULTS: Twenty-four percent of the participants had high stress. Younger participants had an increased prevalence of high stress than older participants (28% vs 20%, P < .001). African Americans had a high prevalence of stress (26.4%), prehypertension or hypertension (65.4%), and elevated total cholesterol (48.6%). Compared to those with low stress, high stress was associated with significant higher risks of having prehypertension/hypertension (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.28-1.53) and elevated cholesterol (OR = 1.53, 95% CI = 1.41-1.66). CONCLUSIONS: Stress needs to be routinely identified and treated, especially in Million Hearts priority populations. More research is needed in designing culturally sensitive and effectively tailored interventions relative to both stress and disease management.

Cardiovascular disease risk factor burden and cognition: Implications of ethnic diversity within the Hispanic Community Health Study/Study of Latinos.

OBJECTIVE: Hispanics/Latinos have some of the highest prevalence rates for cardiovascular disease risk factors, but stark differences exist by self-reported background. Cardiovascular disease risk factors negatively impact cognition in Hispanics/Latinos; less is known about these relationships by Hispanic/Latino backgrounds. We investigated cognitive associations with cardiovascular disease risk factor burden in a diverse cohort, the Hispanic Community Health Study/Study of Latinos. METHODS: Baseline data from this observational study of cardiovascular disease and its antecedents was collected from 2008-2011. We included 7,121 participants 45-74 years old from Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American backgrounds. Dichotomous indicators for hypertension, diabetes, hypercholesterolemia, obesity, and smoking were evaluated and totaled, with participants grouped by lowest (0-2), middle (3) or highest (4-5) burden. Cognitive testing included the Brief Spanish English Verbal Learning Test, letter fluency, and digit symbol substitution. RESULTS: In separate fully-adjusted linear regression models, lower fluency and digit symbol substitution performance were restricted to the highest compared to the lowest burden group; whereas the middle burden group displayed impaired memory performance compared to the lowest burden group (p-values≤0.05). Background interacted with burden for learning and memory performance. That is, the association of burden level (i.e., lowest, middle, or highest) with cognitive performance was modified by background (e.g., Mexicans vs Cuban). CONCLUSIONS: Hispanics/Latinos with higher levels of cardiovascular disease risk factor burden displayed lower levels of cognitive performance, with learning and memory performance modified by background.

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: HCHS/SOL participants were age 18-74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). RESULTS: Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. CONCLUSION: Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

Lack of ethnic differences in the pharmacokinetics and pharmacodynamics of evolocumab between Caucasian and Asian populations.

AIMS: To evaluate the potential ethnic differences in the pharmacokinetics (PK) and pharmacodynamics (PD) of evolocumab in Caucasian and Asian populations using population PK/PD modelling analysis. METHODS: Data from different ethnic groups in 5 Phase I clinical trials, including two American studies, one Japanese study and two Chinese studies, were chosen for model building and evaluation. A target-mediated drug disposition model together with an indirect response model best captured evolocumab binding and the removal of unbound proprotein convertase subtilisin/kexin type 9 (PCSK9) as well as a reduction in circulating low-density lipoprotein cholesterol (LDL-C). Ethnicity and other related factors (body weight, target expression level etc.) were analysed as potential covariates. RESULTS: The estimated linear clearance and volume of evolocumab were 0.24 l day-1 and 2.75 l, respectively, which was consistent with the previous modelling results from the American trials. The time course of the LDL-C reduction was described by an indirect response model with the elimination rate of LDL-C being modulated by unbound PCSK9. The concentration of unbound PCSK9 associated with the half-maximal inhibition of LDL-C elimination was 1.28 nmol l-1 . Both the PK and PD characteristics were consistent between the Caucasian and Asian populations. CONCLUSION: The target-mediated drug disposition model successfully described the PK and PD characteristics of evolocumab, and this analysis found no significant differences in the PK/PD relationship for its LDL-C lowering effects between Caucasians and Asians.

Comparison of the efficacy and level of adherence for morning versus evening versus before bedtime administration of simvastatin in hypercholesterolemic patients.

BACKGROUND: Simvastatin is usually taken in the evening due to the circadian rhythm of hepatic cholesterol biosynthesis. The degree of reduction of low-density lipoprotein cholesterol (LDL-C) and the level of adherence to different administration time remained unknown in the Malaysian population. This study aims to investigate the effect of simvastatin on the percentage changes of lipid profile and the level of adherence to when simvastatin was instructed to be taken at different timing. METHODS: Nine primary care health clinics across Malaysia participated in this study. 147 statin-naive subjects were selected through convenient sampling and randomised into one of the three arms (after breakfast, after dinner or before bedtime). Differences on percentage reduction of LDL-C from baseline and level of adherence among the three groups at week-16 were compared. The main outcomes measured in this study were the percentage change of lipid parameters and the percentage of high-adherence (MMAS=8) at week-16. RESULTS: 59.2% of the patients were male. The mean age of the study population was 53.93± 10.85 years. Most of the patients were Malays (69.4%); followed by Indians (22.4%) and Chinese (8.2%). LDL-C decreased from 4.26 (Standard Deviation, SD1.01) to 2.36 (SD0.69)mmol/L at week-16 for patients taking simvastatin before bedtime; an absolute reduction of 44.95%.The differences of LDL-C percentage reduction between three arms were significantly different (p<0.001). The greatest LDL-C reduction was observed when simvastatin was taken before bedtime and revealed 56.2% patients with high-adherence at week-16. CONCLUSION: Simvastatin showed superior LDL-reduction and higher level of adherence when being instructed to be taken before bedtime.