Statin Trials, Cardiovascular Events, and Coronary Artery Calcification: Implications for a Trial-Based Approach to Statin Therapy in MESA.

OBJECTIVES: This study sought to determine whether coronary artery calcium (CAC) could be used to optimize statin allocation among individuals for whom trial-based evidence supports efficacy of statin therapy. BACKGROUND: Recently, allocation of statins was proposed for primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on proven efficacy from randomized controlled trials (RCTs) of statin therapy, a so-called trial-based approach. METHODS: The study used data from MESA (Multi-Ethnic Study of Atherosclerosis) with 5,600 men and women, 45 to 84 years of age, and free of clinical ASCVD, lipid-lowering therapy, or missing information for risk factors at baseline examination. RESULTS: During 10 years' follow-up, 354 ASCVD and 219 hard coronary heart disease (CHD) events occurred. Based on enrollment criteria for 7 RCTs of statin therapy in primary prevention, 73% of MESA participants (91% of those >55 years of age) were eligible for statin therapy according to a trial-based approach. Among those individuals, CAC = 0 was common (44%) and was associated with low rates of ASCVD and CHD (3.9 and 1.7, respectively, per 1,000 person-years). There was a graded increase in event rates with increasing CAC score, and in individuals with CAC >100 (27% of participants) the rates of ASCVD and CHD were 18.9 and 12.7, respectively. Consequently, the estimated number needed to treat (NNT) in 10 years to prevent 1 event varied greatly according to CAC score. For ASCVD events, the NNT was 87 for CAC = 0 and 19 for CAC >100. For CHD events, the NNT was 197 for CAC = 0 and 28 for CAC >100. CONCLUSIONS: Most MESA participants qualified for trial-based primary prevention with statins. Among the individuals for whom trial-based evidence supports efficacy of statin therapy, CAC = 0 and CAC >100 were common and associated with low and high cardiovascular risks, respectively. This information may guide shared decision making aimed at targeting evidence-based statins to those who are likely to benefit the most.

Genetic architecture of lipid traits in the Hispanic community health study/study of Latinos.

BACKGROUND: Despite ethnic disparities in lipid profiles, there are few genome-wide association studies investigating genetic variation of lipids in non-European ancestry populations. In this study, we present findings from genetic association analyses for total cholesterol, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides in a large Hispanic/Latino cohort in the U.S., the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). METHODS: We estimated a heritability of approximately 20% for each lipid trait, similar to previous estimates in Europeans. To search for novel lipid loci, we performed conditional association analysis in which the statistical model was adjusted for previously reported SNPs associated with any of the four lipid traits. SNPs that remained genome-wide significant (P < 5 × 10-8) after conditioning on known loci were evaluated for replication. RESULTS: We identified eight potentially novel lipid signals with minor allele frequencies <1%, none of which replicated. We tested previously reported SNP-trait associations for generalization to Hispanics/Latinos via a statistical framework. The generalization analysis revealed that approximately 50% of previously established lipid variants generalize to HCHS/SOL based on directional FDR r-value < 0.05. Some failures to generalize were due to lack of power. CONCLUSIONS: These results demonstrate that many loci associated with lipid levels are shared across populations.

Perceived Discrimination and Nocturnal Blood Pressure Dipping Among Hispanics: The Influence of Social Support and Race.

OBJECTIVE: Little is known about the relationship of perceived racism to ambulatory blood pressure (ABP) in Hispanics. We explored possible associations between ABP nocturnal dipping and perceived racism in a Hispanic cohort. METHODS: Participants included 180 community-dwelling Hispanics from the Northern Manhattan Study. Measures included perceived racism, socioeconomic status, social support, and ABP monitoring. Nocturnal ABP nondipping was defined as a less than 10% decline in the average asleep systolic blood pressure relative to the awake systolic blood pressure. RESULTS: Overall, 77.8% of participants reported some form of perceived racism (Perceived Ethnic Discrimination Questionnaire scores >1.0). Greater social support was associated with less perceived discrimination (Spearman r = -0.54, p < .001). Those with higher perceived discrimination scores reported more depressive symptoms (r = 0.25, p < .001). Those with higher Perceived Ethnic Discrimination Questionnaire scores were less likely to show nocturnal ABP nondipping in multivariate models (odds ratio = 0.40, confidence interval = 0.17-0.98, p = .045). Among those with low perceived racism, black Hispanic participants were more likely to have nocturnal ABP nondipping (82.6%) compared with white Hispanics (53.9%; p = .02). Among those with high perceived racism, no associations between race and the prevalence of ABP nondipping was found (black Hispanic = 61.5% versus white Hispanic = 51.4%, p = .39; p interaction = .89). CONCLUSIONS: Perceived racism is relatively common among US Hispanics and is associated with ABP. Nondipping of ABP, a potential cardiovascular risk factor, was more common in black Hispanic participants with low perceived racism. This finding may reflect different coping mechanisms between black versus white Hispanics and related blood pressure levels during daytime exposures to discrimination.

Avoiding the looming Latino/Hispanic cardiovascular health crisis: a call to action.

Cardiovascular disease (CVD) is the leading cause of death among the largest and fastest growing ethnic minority in the United States, Latinos/Hispanics. To review recent findings on the prevalence of CVD, CVD risk factors, and related illnesses in the US Latino/Hispanic population, an extensive PubMed and Internet literature search for studies published from January 1995 to July 2005 was conducted, using a combination of search terms. Data validity was assessed based on the quality of the source and a consensus of the authors on perceived validity. The review found limitations in current research as well as treatment methods and options for Latino/Hispanic persons at risk for developing CVD and related illnesses. Because of these limitations and the large public health concern, additional research is required to fully determine the best predictors of CVD and diabetes in Latino/Hispanic patients. A combined effort of health-influencing and health-governing bodies is needed on all levels to address the CVD problem in the Latino/Hispanic population.

Avoiding the looming Latino/Hispanic cardiovascular health crisis: a call to action.

CONTEXT: Cardiovascular disease (CVD) is the leading cause of death among the largest and fastest growing ethnic minority in the United States, Latinos/Hispanics. CVD risk factors such as metabolic syndrome, obesity, and diabetes are prevalent in Latinos/Hispanics at alarming rates. It is therefore imperative to understand this population's risk of CVD and the most effective and culturally sensitive treatment methods. OBJECTIVES: To review recent findings on the prevalence of CVD, CVD risk factors, and related illnesses in the US Latino/Hispanic population, and discuss gaps in the current knowledge. To summon a call for greater action on the part of governmental agencies, pharmaceutical companies, academia, industry media, professional and community organizations to address the escalating health problem of CVD and related illnesses, such as diabetes, in the Latino/Hispanic population. DATA SOURCES: An extensive PubMed and Internet literature search for studies published from January 1995 to July 2005 was conducted, using a combination of search terms (cardiovascular disease, CVD, Latino, Hispanic, prevention, guidelines, clinical trials, interventions). STUDY SELECTION: Studies meeting initial search criteria were distilled using the date of publication, study population size, and specific relevance to the topic being reviewed. DATA EXTRACTION: Data validity was assessed based on the quality of the source (large sample size, government agencies, major publications) and a consensus of the authors on perceived validity. DATA SYNTHESIS: The review found limitations in current research as well as treatment methods and options for Latinos/Hispanics at risk for developing CVD and related illnesses. CONCLUSIONS: Due to limitations in current data and trials and public health concern, additional research needs to be conducted to fully determine the best predictors of CVD and diabetes in Latino/Hispanic patients. A combined effort on the part of health-influencing and health-governing bodies is needed on all levels in order to address the CVD problem in the Latino/Hispanic population.

Cardiovascular disease prevention and care in Latino and Hispanic subjects.

OBJECTIVE: To determine the scope, impact, and health care limitations relative to cardiovascular disease (CVD) in the Latino-Hispanic population. METHODS: We reviewed MEDLINE and PubMed for studies published from January 1995 to June 2005 using a combination of search terms (epidemiology, Hispanic, CVD) and chose articles for review on the basis of direct informational relevance to the current status of preventive treatment and barriers to health care for CVD among the Latino-Hispanic community. Additional information was gathered through a general Internet search by using Google with the aforementioned search terms and a review of the US Bureau of the Census and governmental statistics related to these terms found through governmental Web sites. RESULTS: For proactive reduction of rates of CVD among the Latino-Hispanic population in the United States, preventive interventions should be targeted. Several barriers exist to providing effective preventive care to the Latino-Hispanic community. Medical research involving the Latino-Hispanic population is sparse, many Latino and Hispanic subjects do not have health insurance or a regular source of health care, and poor English-language ability and low education and literacy levels limit awareness and inhibit communications between Latino and Hispanic persons and the health care system. CONCLUSION: The prevalence and growth of CVD in the US Latino-Hispanic community provide a clear warning that the public health problem presented by CVD in the Latino-Hispanic population is already substantial and will become much more severe in the coming decades. Actions to manage and minimize this problem are urgently needed.

Effects of race and socioeconomic status in the incidence of hypertension and increased left ventricular mass: a review

Cardiovascular disease remains the leading cause of death in the United States, and for still unexplained reasons, some groups have higher incidence. Specifically, blacks, Hispanics and those of lower socioeconomic status have increased incidence of hypertension and increased let ventricular mass (LVM). Several mechanisms have been proposed as underlying these I associations including genetics, kidney development, diet, stress, sympathetic nervous system activation, increased peripheral resistance, cardiovascular reactivity, 24-hour blood pressure and nighttime dipping of blood pressure. The evidence supporting these associations, underlying mechanisms as well as the implications of increased hypertension and LVM in these groups is reviewed in this article