Cigarette Smoking and Subclinical Peripheral Arterial Disease in Blacks of the Jackson Heart Study.

Background Prevalence of peripheral artery disease ( PAD ) is significantly higher among blacks as compared with non-Hispanic whites, but the role of cigarette smoking in PAD is understudied in blacks. We aimed to evaluate the relationship between cigarette smoking and PAD in blacks in the (JHS) Jackson Heart Study. Methods and Results JHS participants (n=5306) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers. We examined multivariable logistic and robust linear regression models to estimate the associations between baseline smoking status, smoking intensity, and measures of subclinical PAD (ankle-brachial index [visit 1] and aortic calcium by computed tomography [visit 2]) to yield odds ratios and ß-coefficients (estimated adjusted difference) to compare each smoking status with never smokers (reference group). There were 3579 (68%) never smokers, 986 (19%) past smokers, and 693 (13%) current smokers self-identified at baseline. After adjustment for covariates, current smokers had increased risk of ankle-brachial index <1 (odds ratio, 2.2, 95% CI, 1.5-3.3) and increased risk of abdominal aortic (odds ratio, 8.4, 95% CI, 5.8-12.0) and aortoiliac calcium (odds ratio, 9.6, 95% CI, 6.7-13.7). When stratifying by smoking intensity, those smoking more than 20 cigarettes daily (1 pack) had higher likelihood of subclinical PAD by all of these measures compared with lower-intensity use, suggesting a dose-dependent relationship. Conclusions In a large black cohort, cigarette smoking was associated with measures of subclinical PAD in a dose-dependent manner. These findings highlight the association between smoking and PAD in blacks and support further research exploring the impact of interventions on smoking cessation to reduce PAD in this population.

Goal-Striving Stress Is Associated with Chronic Kidney Disease Among Participants in the Jackson Heart Study.

OBJECTIVE: Research that assesses the relationship between psychosocial factors and chronic kidney disease (CKD) among African Americans (AAs) is limited. Using the Jackson Heart Study (JHS) cohort data, we investigated the association of goal-striving stress (GSS)-the stress experienced from not reaching goals-with prevalent CKD among AAs. DESIGN: This was a cross-sectional analysis of JHS exam 1 data that assessed the relationship between GSS and CKD. SETTING AND PARTICIPANTS: We utilized a sample from the JHS (n = 4967), an AA sample of women and men, 35-84 years old from the Jackson, MS metro area. MAIN OUTCOME MEASURES: The baseline relationship between GSS levels (low, moderate, and high) and CKD (eGFR < 60 mL/min/1.73m2) was evaluated using a logistic regression model to estimate odds ratios (OR) on a 95% confidence interval (CI). The final model was adjusted for sex, age, socioeconomic status, health behaviors, risk factors, and total stress. RESULTS: After full adjustment, the odds of prevalent CKD increased by 52% (OR 1.52; 95% CI 1.04, 2.24) for those reporting high (versus low) GSS. CONCLUSIONS: Deficiencies between goal aspiration and achievement were associated with prevalent CKD. Potential interventions might consider the impact GSS contributes to prevalent CKD.

Cigarette Smoking and Incident Heart Failure: Insights From the Jackson Heart Study.

BACKGROUND: Cigarette smoking has been linked with several factors associated with cardiac dysfunction. We hypothesized that cigarette smoking is associated with left ventricular (LV) structure and function, and incident heart failure (HF) hospitalization. METHODS: We investigated 4129 (never smoker n=2884, current smoker n=503, and former smoker n=742) black participants (mean age, 54 years; 63% women) without a history of HF or coronary heart disease at baseline in the Jackson Heart Study. We examined the relationships between cigarette smoking and LV structure and function by using cardiac magnetic resonance imaging among 1092 participants, cigarette smoking and brain natriuretic peptide levels among 3325 participants, and incident HF hospitalization among 3633 participants with complete data. RESULTS: After adjustment for confounding factors, current smoking was associated with higher mean LV mass index and lower mean LV circumferential strain (P<0.05, for both) in comparison with never smoking. Smoking status, intensity, and burden were associated with higher mean brain natriuretic peptide levels (all P<0.05). Over 8.0 years (7.7-8.0) median follow-up, there were 147 incident HF hospitalizations. After adjustment for traditional risk factors and incident coronary heart disease, current smoking (hazard ratio, 2.82; 95% confidence interval, 1.71-4.64), smoking intensity among current smokers (≥20 cigarettes/d: hazard ratio, 3.48; 95% confidence interval, 1.65-7.32), and smoking burden among ever smokers (≥15 pack-years: hazard ratio, 2.06; 95% confidence interval, 1.29-3.3) were significantly associated with incident HF hospitalization in comparison with never smoking. CONCLUSIONS: In blacks, cigarette smoking is an important risk factor for LV hypertrophy, systolic dysfunction, and incident HF hospitalization even after adjusting for effects on coronary heart disease.

High-Intensity Cigarette Smoking Is Associated With Incident Diabetes Mellitus In Black Adults: The Jackson Heart Study.

BACKGROUND: Previous reports on whether smoking is associated with insulin resistance and diabetes mellitus have yielded inconsistent findings. We aimed to evaluate the relationship between cigarette smoking and incident diabetes mellitus in the Jackson Heart Study. METHODS AND RESULTS: Jackson Heart Study participants enrolled at baseline without prevalent diabetes mellitus (n=2991) were classified by self-report as current smokers, past smokers (smoked ≥400 cigarettes/life and no longer smoking), or never smokers. We quantified smoking intensity by number of cigarettes smoked daily; we considered ≥20 cigarettes per day (1 pack) "high-intensity." We defined diabetes mellitus as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5% or International Federation of Clinical Chemistry units HbA1c 48 mmol/mol, or use of diabetes mellitus medication. We estimated the adjusted associations of smoking status, intensity, and dose (pack-years) with incident diabetes mellitus using Poisson regression models. At baseline there were 361 baseline current (1-10 cigarettes per day [n=242]; ≥20 [n=119]), 502 past, and 2128 never smokers. From Visit 1 to Visit 3 (mean 8.0±0.9 years), 479 participants developed incident diabetes mellitus. After adjustment for covariates, baseline current smokers who smoked less than a pack/d and past smokers had similar rates of incident diabetes mellitus compared with never smokers (incidence rate ratios 1.04, 95% confidence interval, 0.69-1.58 and 1.08, 95% confidence interval, 0.82-1.42, respectively). Baseline current high-intensity smokers had a 79% (95% confidence interval, 1.14-2.81) higher incidence of diabetes mellitus compared with never smokers. Smoking dose (per 10 pack-years) was also associated with a higher incidence of diabetes mellitus (incidence rate ratios 1.10, 95% confidence interval, 1.03-1.19) in adjusted models. CONCLUSIONS: High-intensity cigarette smoking and smoking pack-years are associated with an increased risk of developing diabetes mellitus in blacks.

The relationship between gamma-glutamyl transferase levels and chronic kidney disease among Appalachian adults.

BACKGROUND: Serum gamma-glutamyl transferase (GGT), a marker of oxidative stress has been associated with diabetes and hypertension, which are risk factors for chronic kidney disease (CKD). However, it is unclear whether serum GGT is independently associated with CKD. METHODS: We analyzed data from a population-based study of Appalachian adults residing in six communities in Ohio and West Virginia, who were aged > or = 18 years (n = 55,187, 52% women). Serum GGT was examined as gender-specific quintiles (quintiles 1-5 in women: 0-11 U/L, 12-14 U/L, 15-19 U/L, 20-29 U/L and > 29 U/L; quintiles 1-5 in men: 0-17 U/L, 18-23 U/L, 24-30 U/L, 31-45 U/L, and > 45 U/L). The main outcome of interest was CKD (n = 4482), defined as an estimated glomerular filtration rate of < 60 mL/ min/1.73 m2 from serum creatinine. RESULTS: Higher serum GGT levels were not found to be associated with CKD after adjusting for age, education, smoking, alcohol intake, body mass index (BMI), diabetes, hypertension and total cholesterol. In women, compared to quintile 1 of GGT, the odds ratio (OR) (95% confidence interval [CI]) of CKD associated with quintile 5 was 0.93 (0.82-1.06); p-trend = 0.3102. Similarly, in men, compared to quintile 1 of GGT, the odds ratio (OR) (95% confidence interval [CI]) of CKD associated with quintile 5 was 0.94 (0.80-1.10); p-trend = 0.4372. Subgroup analyses that examined the relation between GGT and CKD by alcohol intake and BMI categories also showed a consistent null association. CONCLUSION: In a community-based sample of Appalachian adults, higher serum GGT was not found to be independently associated with CKD.