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1.
Nutrients ; 14(13)2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35807924

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is a public health concern and Hispanic/Latinos are disproportionately affected. There is evidence for favorable effects of dietary intake of monounsaturated fatty acids (MUFA) on NAFLD, yet studies examining avocados as a source of MUFA on hepatic function have not been assessed. We investigated the effects of low (3) vs. high (14) avocado allotment on biomarkers of NAFLD, oxidative stress, and NAFLD fibrosis score in a sample of Hispanic/Latino adults. Primary outcomes include hepatic function biomarkers [gamma glutamyltransferase (GGT), high-sensitivity c-reactive protein (hsCRP), and NAFLD fibrosis score]. Unpaired, two-sided t-tests were used to assess mean differences between intervention groups at 6 months and analysis of covariance models were used to adjust for diet quality and change in avocado intake from baseline to 6 months. Multivariable linear regression models evaluated the baseline and post-intervention association between avocado allotment group and outcomes, adjusting for covariates and stratifying by prediabetes status. No statistically significant differences were observed between low and high avocado allotment groups in liver enzymes, GGT, hsCRP or NAFLD fibrosis score. Findings persisted after stratifying by prediabetes status. Varied intake of avocados resulted in no effects on biomarkers of NAFLD in healthy adults, free of severe chronic disease.


Assuntos
Hepatopatia Gordurosa não Alcoólica , Persea , Estado Pré-Diabético , Biomarcadores , Proteína C-Reativa , Análise de Dados , Ácidos Graxos Monoinsaturados , Fibrose , Hispânico ou Latino , Humanos , gama-Glutamiltransferase
2.
ESC Heart Fail ; 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35860859

RESUMO

AIMS: Resistin is a circulating inflammatory biomarker that is associated with cardiovascular disease. We investigated the associations of resistin and incident heart failure (HF) and its subtypes, as well as specific measures of subclinical HF (myocardial fibrosis and relevant biomarkers). METHODS: We analysed data from 1968 participants in the Multi-Ethnic Study of Atherosclerosis with measurements of plasma resistin levels at clinic visits from 2002 to 2005. Participants were subsequently followed for a median of 10.5 years for HF events. The associations between resistin levels and incident HF, HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF) were examined using multivariable Cox proportional hazards models. Linear regression models assessed the associations between resistin levels and myocardial fibrosis from cardiac magnetic resonance imaging, as well as hs-cTnT and NT-proBNP. RESULTS: The mean age of the cohort was 64.7 years, and 50.0% were female. Seventy-four participants (4%) developed incident HF during follow-up. In a Cox proportional hazards model adjusted for age, gender, education level, race/ethnicity, and traditional risk factors, higher resistin levels were significantly associated with incident HF (HR 1.44, CI 1.18-1.75, P = 0.001) and HFrEF (HR 1.47, CI 1.07-2.02, P = 0.016), but not with HFpEF (HR 1.25, CI 0.89-1.75, P = 0.195). Resistin levels showed no significant associations with myocardial fibrosis, NT-proBNP, or hs-cTnT levels. CONCLUSIONS: In a multi-ethnic cohort free of cardiovascular disease at baseline, elevated resistin levels were associated with incident HF, more prominently with incident HFrEF than HFpEF, but not with subclinical myocardial fibrosis or biomarkers of HF.

3.
Mayo Clin Proc ; 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35760597

RESUMO

OBJECTIVE: To determine the association of plasma lipids with the prevalence of subclinical atherosclerosis and 10-year risk of incident cardiovascular (CV) events among healthy individuals without dyslipidemia and with low risk factor burden. PATIENTS AND METHODS: The analysis (June 24, 2020, through June 12, 2021) included 1204 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) study who were current nonsmokers and did not have CV disease, hypertension (blood pressure ≥130/80 mm Hg or antihypertensive use), diabetes (fasting glucose ≥126 mg/dL or glucose-lowering medication use), and dyslipidemia (low-density-lipoprotein-cholesterol [LDL-C] ≥160 mg/dL, high-density-lipoprotein-cholesterol [HDL-C] <40 mg/dL, total cholesterol [TC] ≥240 mg/dL, triglycerides [TGs] ≥150 mg/dL, or lipid-lowering medication use) at baseline. Associations of lipids with baseline atherosclerosis (presence of carotid plaque and/or coronary calcification) and incident CV events over 10 years were examined using multivariable relative risk regression and Cox regression, respectively. RESULTS: At baseline, participants' median age was 54 (IQR, 49 to 62) years, and 10-year CV risk was 2.7% (IQR, 1.0% to 6.6%); 43.4% had subclinical atherosclerosis. A 1-SD higher LDL-C (23.4 mg/dL), TC (24.7 mg/dL), non-HDL-C (25.3 mg/dL), TC/HDL-C (0.75), and LDL-C/HDL-C (0.66) was associated with a higher prevalence of atherosclerosis of between 6% and 9% (P<.05). For every 1-SD higher LDL-C, non-HDL-C, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C (0.49), the 10-year incidence of CV events was significantly increased by 40%, 44%, 51%, 49%, and 39%, respectively. For every 1-SD lower HDL-C (13.5 mg/dL), CV risk was increased by 37%. Triglycerides had no association with either outcome. CONCLUSION: Except for TGs, all lipid variables were associated with atherosclerosis and future risk of CV disease among persons without dyslipidemia and with low risk factor burden.

4.
J Bone Miner Res ; 2022 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-35690917

RESUMO

Low vertebral bone mass is a major risk factor for vertebral compression fractures. Although sarcopenia has been shown to be associated with low bone mineral density (BMD), it is not known whether trunk musculature is directly associated with lumbar BMD, and whether exercise modifies this association. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we sought to determine the association of muscle density and fat fraction of the psoas, paraspinal, and oblique muscle groups with L3 lumbar volumetric BMD, and whether these associations were modified by exercise. We obtained L3 vBMD measurements, and fat and muscle measurements (in Hounsfield units [HU]) from abdominal computed tomography (CT) scans spanning the L2 -L4 intervertebral disc spaces. Muscle density was defined as the mean HU value for a muscle group area. Fat fraction was calculated as the mean HU value for the muscle group fat area/total muscle group area (cm2 ). Exercise data were self-reported (MET-minute/week). We utilized multivariable linear regression to evaluate these associations, stratified by gender, and adjusting for demographics, body mass index (BMI), smoking status, impaired fasting glucose, and corticosteroid and anti-resorptive medication use. Among 1923 MESA participants, mean ± standard deviation (SD) age was 62 ± 10 years, 49% were female, 40% white, 21% black, 26% Hispanic/Latino, and 13% Chinese. In fully adjusted analysis, for every 1-SD higher psoas fat fraction, there was a 3.19-SD lower L3 vBMD in men and 4.3-SD lower L3 vBMD in women (p < 0.001). For every 1-SD higher psoas density, there was a 0.2-SD higher L3 vBMD (p < 0.001) in men and 0.19-SD higher L3 vBMD (p < 0.001) in women. Findings were similar for paraspinal and oblique muscles. Intentional exercise did not modify these associations. In men and women, trunk muscle density was positively associated with higher lumbar BMD, suggesting a local association. Future studies are warranted to determine the temporality of this association. © 2022 American Society for Bone and Mineral Research (ASBMR).

5.
Prev Med ; 160: 107073, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35513129

RESUMO

Despite experiencing health inequities, less is known about neighborhood environments and physical activity among Hispanic/Latino adults compared to other populations. We investigated this topic in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Hispanic/Latino adults in the San Diego, California area of the U.S. completed measures of overall moderate-to-vigorous physical activity (MVPA) via accelerometry and domain-specific MVPA via questionnaire at Visits 1 (2008-2011; n = 4086) and 2 (2014-2017; n = 1776), ~6 years apart. 800-m home neighborhood buffers were used to create objective measures of residential, intersection, and retail density, bus/trolley stops, greenness, parks, and recreation area at Visit 1. Regression models tested the association of each neighborhood feature with MVPA at Visit 1 and over 6 years, adjusting for individual characteristics and neighborhood socioeconomic deprivation. At Visit 1, those in neighborhoods with higher vs. lower retail density or recreation area (+1 vs. -1 standard deviation from the mean) engaged in 10% more overall MVPA and 12-22% more active transportation. Those in neighborhoods with higher vs. lower residential density engaged in 22% more active transportation. Those in neighborhoods with higher vs. lower greenness and park count engaged in 14-16% more recreational MVPA. Neighborhood features were unassociated with changes in MVPA over 6 years. Although changes in MVPA over time were similar across neighborhoods, Hispanic/Latino adults living in neighborhoods with design features supportive of walking and recreational activity (e.g., greater residential and retail density, more parks and recreation facilities) were consistently more active. Improving neighborhood environments appears important for supporting physical activity among Hispanic/Latino adults.


Assuntos
Planejamento Ambiental , Saúde Pública , Ambiente Construído , Exercício Físico , Hispânico ou Latino , Humanos , Características de Residência , Caminhada
6.
Am J Prev Med ; 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35525685

RESUMO

INTRODUCTION: Little is known about the relationships between annual visit-to-visit blood pressure variability and heart failure subphenotypes. The aim of this analysis was to examine the association between blood pressure variability and incident heart failure with preserved and reduced ejection fraction. METHODS: Data from 23,918 postmenopausal women enrolled in the Women's Health Initiative Hormone Therapy Trials were analyzed. Blood pressure was measured at baseline (1993‒1998) and then annually through 2005. Variability was defined as the SD of the mean blood pressure across visits or the SD of the participant's regression line for blood pressure across visits. The outcome was the first heart failure hospitalization. Heart failure ascertainment and adjudications were through March 31, 2018. RESULTS: During a mean follow-up of 15.8 years, 913 incident cases of heart failure with preserved ejection fraction and 421 cases of heart failure with reduced ejection fraction were identified. In fully adjusted models, including mean longitudinal systolic and diastolic blood pressure and time-varying coronary events interim to heart failure hospitalization, women in the highest versus in the lowest quartile of SD of the mean systolic blood pressure were at a statistically significantly higher risk of heart failure with preserved ejection fraction (hazard ratio [95% CI]=1.61 [1.12, 2.31]) but not of heart failure with reduced ejection fraction (1.18 [0.70,1.96]). Conversely, the hazard ratio (95% CI) for the highest versus lowest quartile of SD of the mean diastolic blood pressure was 1.56 (0.89, 2.74) for heart failure with reduced ejection fraction and 1.19 (0.85,1.65) for heart failure with preserved ejection fraction. Results attenuated for SD of the participant's regression line when additionally adjusted for the temporal trend of systolic and diastolic blood pressure. CONCLUSIONS: Greater systolic blood pressure variability was associated with a higher risk of heart failure with preserved ejection fraction independent of mean blood pressure and coronary events interim to heart failure hospitalization.

7.
Chronobiol Int ; 39(8): 1087-1099, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35509113

RESUMO

Sleep duration, sleep efficiency, and sleep timing have been shown to have potential effects on metabolic functions relevant to circadian rhythms. It is not clear if the impact of sleep patterns on metabolic risk factors is through sociocultural and environmental factors or circadian misalignment. We investigated the associations of sleep patterns, chronotype, and social jet lag with metabolic syndrome among non-shift worker Hispanic/Latino adults. We used cross-sectional data from the Sueño Ancillary Study of The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data from a subsample of 2189 participants aged 18-64 years were used in the analysis. Mean nightly sleep duration, mean sleep onset time, mean sleep offset time, mean sleep midpoint time, sleep efficiency, sleep variability (standard deviation (SD) of sleep duration, and SD of sleep midpoint), and time spent above light exposure threshold (1000 lux) in a day were assessed by wrist actigraphy (Acti-watch Spectrum). Chronotype was determined by the reduced Morningness-Eveningness Questionnaire. Medical conditions including dyslipidemia, hypertension, and diabetes mellitus were determined from a fasting blood specimen and physical exam at the baseline visit. To determine whether sleep patterns, light levels, chronotype, and social jetlag are associated with metabolic syndrome, multivariable logistic regression models were fitted, including variables with P < .15 in the univariate analysis. The results of the multivariable analysis demonstrated that in participants older than 40 years, intermediate chronotype (vs early) was significantly associated with a higher risk of metabolic syndrome (Odds ratio (95%CI): 1.33 (1.04,1.7)), while later chronotype (vs. early) in participants younger than 40 years was significantly associated with a lower risk of metabolic syndrome (Odds ratio (95%CI): 0.37 (0.14, 0.96)). Also, higher sleep efficiency was significantly associated with decreased odds of metabolic syndrome (Odds ratio (95%CI): 0.98 (0.96, 0.99)). Nightly sleep duration was not significantly different between two groups of participants with and without metabolic syndrome in multivariable analyses. There was no significant association between social jet lag and metabolic syndrome in multivariable analysis (p = .286). Moreover, there was no significant association between chronotype and social jet lag in multivariable analysis. The association between metabolic syndrome and chronotype is age-dependent. While early chronotype is associated with metabolic syndrome in younger individuals, it tended to be associated with lower odds for metabolic syndrome in older individuals.


Assuntos
Síndrome do Jet Lag , Síndrome Metabólica , Idoso , Ritmo Circadiano , Estudos Transversais , Hispânico ou Latino , Humanos , Saúde Pública , Sono , Inquéritos e Questionários
8.
Am J Hypertens ; 35(8): 679-687, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35561332

RESUMO

Hypertension (HTN) is a well-established risk factor for cardiovascular diseases (CVDs), including ischemic heart disease, stroke, heart failure, and atrial fibrillation. The prevalence of HTN, as well as mortality rates attributable to HTN, continue to increase, particularly in the United States and among Black populations. The risk of HTN involves a complex interaction of genetics and modifiable risk factors, including dietary patterns. In this regard, there is accumulating evidence that links dietary intake of red meat with a higher risk of poorly controlled blood pressure and HTN. However, research on this topic contains significant methodological limitations, which are described in the review. The report provided below also summarizes the available research reports, with an emphasis on processed red meat consumption and how different dietary patterns among certain populations may contribute to HTN-related health disparities. Finally, this review outlines potential mechanisms and provides recommendations for providers to counsel patients with evidence-based nutritional approaches regarding red meat and the risk of HTN, as well as CVD morbidity and mortality.


Assuntos
Fibrilação Atrial , Hipertensão , Carne Vermelha , Pressão Sanguínea , Dieta/efeitos adversos , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Carne Vermelha/efeitos adversos , Fatores de Risco , Estados Unidos/epidemiologia
9.
Nutr Metab Cardiovasc Dis ; 32(6): 1418-1426, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35459606

RESUMO

BACKGROUND AND AIMS: The DASH diet conveys protection against type 2 diabetes mellitus (T2D) Via plant-based and non-plant-based recommendations. Research has not identified which glucose homeostasis pathways are improved. We examined associations between adherence to a DASH diet and six glucose homeostasis traits, probing whether associations could be attributed to the plant-based (DASH-P) and/or non-plant based (DASH-NP) components. METHODS AND RESULTS: We included data from 295 adults without T2D (age 59.3 ± 9.00 years; 63.46% non-Hispanic White and 36.54% African American, self-reported race ancestry) participating in the Microbiome and Insulin Longitudinal Evaluation Study (MILES). An oral glucose tolerance test (OGTT) yielded fasting plasma glucose, insulin, C-peptide, and insulin secretion, sensitivity, and disposition index. Habitual dietary intake was assessed by food frequency questionnaire (FFQ). Associations between DASH components and glucose homeostasis traits were examined, controlling for demographics, body mass index (BMI), physical activity, and energy intake. For significant associations, the models were repeated with scores for DASH-P and DASH-NP as predictors in the same model. DASH and DASH-P scores were inversely associated with fasting plasma glucose (DASH:ß = -0.036 ± 0.012,P = 0.005; DASH-P: ß = -0.04 ± 0.017,P = 0.002), and positively associated with insulin sensitivity (DASH:ß = 0.022 ± 0.012,P = 0.042; DASH-P: = 0.036 ± 0.015,P = 0.014). The DASH score was also associated with disposition index (ß = 0.026 ± 0.013,P = 0.038), but this association did not reach significance with DASH-P (ß = 0.035 ± 0.018,P = 0.051). No associations were observed with DASH-NP score (all P > 0.05). CONCLUSIONS: DASH diet is associated with improvement in specific glucose homeostasis traits, likely arising from increased plant-based foods. Such research may help tailor future dietary advice to specific metabolic risk, and to food groups most effective at improving these.


Assuntos
Diabetes Mellitus Tipo 2 , Abordagens Dietéticas para Conter a Hipertensão , Hipertensão , Microbiota , Adulto , Idoso , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta , Abordagens Dietéticas para Conter a Hipertensão/métodos , Homeostase , Humanos , Insulina/metabolismo , Pessoa de Meia-Idade
10.
Nat Genet ; 54(3): 263-273, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35256806

RESUMO

Analyses of data from genome-wide association studies on unrelated individuals have shown that, for human traits and diseases, approximately one-third to two-thirds of heritability is captured by common SNPs. However, it is not known whether the remaining heritability is due to the imperfect tagging of causal variants by common SNPs, in particular whether the causal variants are rare, or whether it is overestimated due to bias in inference from pedigree data. Here we estimated heritability for height and body mass index (BMI) from whole-genome sequence data on 25,465 unrelated individuals of European ancestry. The estimated heritability was 0.68 (standard error 0.10) for height and 0.30 (standard error 0.10) for body mass index. Low minor allele frequency variants in low linkage disequilibrium (LD) with neighboring variants were enriched for heritability, to a greater extent for protein-altering variants, consistent with negative selection. Our results imply that rare variants, in particular those in regions of low linkage disequilibrium, are a major source of the still missing heritability of complex traits and disease.


Assuntos
Estudo de Associação Genômica Ampla , Herança Multifatorial , Alelos , Estudo de Associação Genômica Ampla/métodos , Humanos , Desequilíbrio de Ligação , Herança Multifatorial/genética , Polimorfismo de Nucleotídeo Único/genética
11.
J Hum Hypertens ; 2022 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-35296776

RESUMO

We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.

12.
Diabetes Metab J ; 2022 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-35350091

RESUMO

Background: The weight-adjusted waist index (WWI) reflected body compositional changes with aging. This study was to investigate the association of WWI with abdominal fat and muscle mass in a diverse race/ethnic population. Methods: Computed tomography (CT) data from 1,946 participants for abdominal fat and muscle areas from the Multi-Ethnic Study of Atherosclerosis (785 Whites, 252 Asians, 406 African American, and 503 Hispanics) were used. Among them, 595 participants underwent repeated CT. The WWI was calculated as waist circumference (cm) divided by the square root of body weight (kg). The associations of WWI with abdominal fat and muscle measures were examined, and longitudinal changes in abdominal composition measures were compared. Results: In all race/ethnic groups, WWI was positively correlated with total abdominal fat area (TFA), subcutaneous fat area, and visceral fat area, but negatively correlated with total abdominal muscle area (TMA) and abdominal muscle radiodensity (P<0.001 for all). WWI showed a linear increase with aging regardless of race and there were no significant differences in the WWI distribution between Whites, Asians, and African Americans. In longitudinal analyses, over 38.6 months of follow-up, all abdominal fat measures increased but muscle measures decreased, along with increase in WWI. The more the WWI increased, the more the TFA increased and the more the TMA decreased. Conclusion: WWI showed positive associations with abdominal fat mass and negative associations with abdominal muscle mass, which likely reflects the abdominal compositional changes with aging in a multi-ethnic population.

13.
JAMA Netw Open ; 5(2): e2146461, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35107574

RESUMO

Importance: Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. Objective: To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. Design, Setting, and Participants: This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease. Exposures: Social isolation and loneliness were ascertained using validated questionnaires. Main Outcomes and Measures: The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. Results: Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). Conclusions and Relevance: In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Solidão , Isolamento Social , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Pós-Menopausa , Estudos Prospectivos , Estados Unidos , Saúde da Mulher
14.
Artigo em Inglês | MEDLINE | ID: mdl-35132401

RESUMO

BACKGROUND: Adipokines play a role in cardiometabolic pathways. Coronary artery calcium (CAC) progression prognosticates cardiovascular disease (CVD) risk. However, the association of adipokines with CAC progression is not well established. We examined the association of adipokines with CAC progression in a multi-ethnic cohort free of CVD at baseline. METHODS: We included 1,904 randomly-selected adults enrolled in the Multi-Ethnic Study of Atherosclerosis who had both adipokine levels [leptin, resistin, adiponectin] and CAC by CT measured at either exam 2 (2002-2004) or exam 3 (2004-2005). CAC was previously measured at exam 1 (2000-2002) and a subset (n=566) had CAC measured at exam 5 (2010-2012). We used logistic regression to examine odds of CAC progression between exam 1 and 2/3 (defined as >0 Agatston units of change/year). We used linear mixed effect models to examine CAC progression from exam 2/3 to 5. RESULTS: At exam 2/3, the mean age was 65(10) yrs; 50% women. In models adjusted for sociodemographic factors and BMI, the highest tertile of leptin, compared to lowest, was associated with an increased odds of CAC progression over the preceding 2.6yrs [OR 1.60 (95% CI: 1.10-2.33)]. In models further adjusted for visceral fat and CVD risk factors, the highest tertile of leptin was statistically significantly associated with a 4% (1-7%) greater CAC progression over an average of 7yrs. No associations were seen for resistin and adiponectin. CONCLUSIONS: Higher leptin levels were independently, but modestly, associated with CAC progression. Atherosclerosis progression may be one mechanism through which leptin confers increased CVD risk.

15.
Am J Epidemiol ; 191(5): 886-899, 2022 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-35015809

RESUMO

Visceral adipose tissue (VAT) is a strong prognostic factor for cardiovascular disease and a potential target for cardiovascular risk stratification. Because VAT is difficult to measure in clinical practice, we estimated prediction models with predictors routinely measured in general practice and VAT as outcome using ridge regression in 2,501 middle-aged participants from the Netherlands Epidemiology of Obesity study, 2008-2012. Adding waist circumference and other anthropometric measurements on top of the routinely measured variables improved the optimism-adjusted R2 from 0.50 to 0.58 with a decrease in the root-mean-square error (RMSE) from 45.6 to 41.5 cm2 and with overall good calibration. Further addition of predominantly lipoprotein-related metabolites from the Nightingale platform did not improve the optimism-corrected R2 and RMSE. The models were externally validated in 370 participants from the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS, 2006-2009) and 1,901 participants from the Multi-Ethnic Study of Atherosclerosis (MESA, 2000-2007). Performance was comparable to the development setting in PIVUS (R2 = 0.63, RMSE = 42.4 cm2, calibration slope = 0.94) but lower in MESA (R2 = 0.44, RMSE = 60.7 cm2, calibration slope = 0.75). Our findings indicate that the estimation of VAT with routine clinical measurements can be substantially improved by incorporating waist circumference but not by metabolite measurements.


Assuntos
Gordura Intra-Abdominal , Obesidade , Tecido Adiposo , Índice de Massa Corporal , Humanos , Metabolômica , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Prospectivos , Circunferência da Cintura
16.
J Am Soc Echocardiogr ; 35(6): 579-587.e5, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35063614

RESUMO

BACKGROUND: Pericardial fat has been associated with adverse cardiovascular outcomes through adiposity-associated inflammation and insulin resistance, which in turn are linked to cardiac dysfunction. We sought to evaluate the association between pericardial fat volume and cardiac structure and function in adults without baseline cardiovascular disease. METHODS: We analyzed data from the Multi-Ethnic Study of Atherosclerosis. Linear regression was used to examine the association between pericardial fat volume (by cardiac computed tomography during exam 1, 2000-2002) and cardiac function by echocardiography, six-minute walk distance (6MWD), and symptom severity as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (exam 6, 2016-18). RESULTS: Among 3,032 participants, each 1 SD (39.3 cm3) increase in pericardial fat volume was associated with lower (worse) absolute left atrial reservoir strain (ß = -0.98%; 95% CI, -1.29, -0.68; P < .001), right ventricular free wall strain (ß = -0.75%; 95% CI, -1.00, -0.51; P < .001), and right atrial reservoir strain (ß = -0.59%; 95% CI, -1.00, -0.19; P < .01) after adjustment for potential confounders. Greater pericardial fat volume was associated with lower 6MWDs (ß = -5.70 m; 95% CI, -10.34, -1.06; P = .02) but not with Kansas City Cardiomyopathy Questionnaire-12 scores or N-terminal pro b-type natriuretic peptide after multivariable adjustment. CONCLUSIONS: In a population-based cohort of adults, pericardial fat volume was independently associated with subclinical atrial and right ventricular dysfunction and reduced 6MWD. These distinct changes in cardiac structure and function suggest a potential mechanistic role for pericardial fat in early heart failure.


Assuntos
Aterosclerose , Cardiomiopatias , Tecido Adiposo/diagnóstico por imagem , Adiposidade , Adulto , Aterosclerose/diagnóstico , Humanos , Pericárdio/diagnóstico por imagem
17.
Diabetes Metab Res Rev ; 38(2): e3488, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34328704

RESUMO

AIMS: Previous characterisation of body composition as a type 2 diabetes mellitus (T2DM) risk factor has largely focused on adiposity, but less is known about the independent role of skeletal muscle. We examined associations between abdominal muscle and measures of glucose regulation. MATERIALS AND METHODS: Cross-sectional analysis of 1,891 adults enrolled in the Multi-Ethnic Study of Atherosclerosis. Multivariable regression assessed associations between abdominal muscle area and density (measured by computed tomography) with fasting glucose, homeostasis model assessment of insulin resistance (HOMA-IR), and prevalent T2DM (fasting glucose ≥126 mg/dL or medication use). RESULTS: In minimally adjusted models (age, sex, race/ethnicity, income), a 1-SD increment in abdominal muscle area was associated with higher HOMA-IR (ß = 0.20 ± SE 0.03; 95%CI: 0.15, 0.25; P < 0.01) and odds of T2DM (OR = 1.47; 95%CI: 1.18, 1.84; P < 0.01), while higher density was associated with lower fasting glucose (-4.49 ± 0.90; -6.26, -2.72; P < 0.01), HOMA-IR (-0.16 ± 0.02; -0.20, -0.12; P < 0.01), and odds of T2DM (0.64; 0.52, 0.77; P < 0.01). All associations persisted after adjustment for comorbidities and health behaviours. However, after controlling for height, BMI, and visceral adiposity, increasing muscle area became negatively associated with fasting glucose (-2.23 ± 1.01; -4.22, -0.24; P = 0.03), while density became positively associated with HOMA-IR (0.09 ± 0.02; 0.05, 0.13; P < 0.01). CONCLUSIONS: Increasing muscle density was associated with salutary markers of glucose regulation, but associations inverted with further adjustment for body size and visceral adiposity. Conversely, after full adjustment, increasing muscle area was associated with lower fasting glucose, suggesting some patients may benefit from muscle-building interventions.


Assuntos
Aterosclerose , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Músculos Abdominais , Adulto , Aterosclerose/etiologia , Glicemia , Índice de Massa Corporal , Estudos Transversais , Glucose , Humanos , Resistência à Insulina/fisiologia
18.
Soc Sci Med ; 292: 114496, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34774366

RESUMO

Neighborhood-level socioeconomic deprivation can increase risk for higher blood pressure or hypertension, while greater neighborhood safety and walkability may protect against hypertension. Large-scale prospective research, particularly among Hispanics/Latinos, is lacking. We examined cross-sectional and prospective associations between neighborhood environments and blood pressure and hypertension among 3851 Hispanic/Latinos enrolled in the Hispanic Community Health Study/Study of Latinos San Diego, CA cohort. Addresses from Visit 1 (2008-2011) were geocoded and neighborhood characteristics were determined as part of the SOL CASAS ancillary study. Home addresses were geocoded and home areas created using 800 m circular radial buffers. Neighborhood indices socioeconomic deprivation, residential stability, and social disorder were created using Census and other publicly available data. Walkability was computed as density of intersections, retail spaces, and residences. Greenness was measured via satellite imagery using the Normalized Difference Vegetation Index. Visit 1 and Visit 2 (2014-2017) clinical outcomes included systolic (SBP) and diastolic (DBP) blood pressure, as well as prevalent and 6-year incident hypertension, defined as SBP/DBP ≥140/90 mmHg or antihypertensive medication use. Complex survey regression models adjusted for covariates revealed cross-sectional associations between greater walkability and lower SBP (B = -0.05; 95% CI: -0.09, -0.003). In prospective analyses, greater neighborhood social disorder was related to increasing SBP (B = 0.05; 95% CI: 0.01, 0.09) and DBP (B = 0.07; 95% CI: 0.02, 0.12) over time. Greater socioeconomic deprivation (OR = 1.47; 95% CI: 1.06, 2.04) and greater social disorder (OR = 1.25; 95% CI: 1.02, 1.54) were associated with higher odds of incident hypertension. All other associations were not significant. Beyond individual-level characteristics, greater neighborhood social disorder and socioeconomic deprivation were related to adverse changes in blood pressure over 6 years among Hispanics/Latinos. Neighborhood social environment may help identify, or be an area for future intervention for, cardiovascular risk among Hispanics/Latinos.


Assuntos
Saúde Pública , Características de Residência , Pressão Sanguínea , Estudos Transversais , Humanos , Fatores de Risco
19.
Arch Gerontol Geriatr ; 98: 104576, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34826770

RESUMO

BACKGROUND: This study evaluated the association between changes in physical performance and blood pressure (BP) (e.g., systolic [SBP], diastolic [DBP], pulse pressure) in older women. METHODS: 5627 women (mean age 69.8 ± 3.7 y) with grip strength, chair stand, gait speed performance and clinic-measured BP at baseline and at least one follow-up (years 1, 3 or 6) were included. Generalized estimating equation analysis of multivariable models with standardized point estimates described the longitudinal association between physical performance and BP changes in the overall cohort, and in models stratified by baseline cardiovascular disease (CVD), time-varying antihypertensive medication use (none, ≥1) and enrollment age (65-69 y; 70-79 y). RESULTS: Overall, each z-score unit increment in grip strength was associated with 0.59 mmHg (95% CI 0.10, 1.08) higher SBP, and 0.39 mmHg (95% CI 0.11, 0.67) higher DBP. In stratified models, a standardized increment in grip strength was associated with higher SBP in women without CVD (0.81; 95% CI 0.23-1.39), among antihypertensive medication users (0.93; 95% CI 0.44, 1.41) and non-users (0.37; 95% CI 0.03, 0.71), and in those aged 65-69 y (0.64; 95% CI 0.04, 1.24). Similarly, a standardized increment in any of the three performance measures was associated with modestly higher DBP in antihypertensive medication users, and those aged 70-79 y. Associations between any performance measure and pulse pressure change were not significant. CONCLUSION: These results suggest a positive, and statistically significant relationship between physical performance and BP that appears to be influenced by CVD history, antihypertensive medication use, and age.


Assuntos
Doenças Cardiovasculares , Hipertensão , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Desempenho Físico Funcional , Saúde da Mulher
20.
JAMA Netw Open ; 4(12): e2138071, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882182

RESUMO

Importance: Some prior evidence suggests that adverse pregnancy outcomes (APOs) may be associated with heart failure (HF). Identifying unique factors associated with the risk of HF and studying HF subtypes are important next steps. Objective: To investigate the association of APOs with incident HF overall and stratified by HF subtype (preserved vs reduced ejection fraction) among postmenopausal women in the Women's Health Initiative (WHI). Design, Setting, and Participants: In 2017, an APO history survey was administered in the WHI study, a large multiethnic cohort of postmenopausal women. The associations of 5 APOs (gestational diabetes, hypertensive disorders of pregnancy [HDP], low birth weight, high birth weight, and preterm delivery) with incident adjudicated HF were analyzed. In this cohort study, the association of each APO with HF was assessed using logistic regression models and with HF subtypes using multinomial regression, adjusting for age, sociodemographic characteristics, smoking, randomization status, reproductive history, and other APOs. Data analysis was performed from January 2020 to September 2021. Exposures: APOs (gestational diabetes, HDP, low birth weight, high birth weight, and preterm delivery). Main Outcomes and Measures: All confirmed cases of women hospitalized with HF and HF subtype were adjudicated by trained physicians using standardized methods. Results: Of 10 292 women (median [IQR] age, 60 [55-64] years), 3185 (31.0%) reported 1 or more APO and 336 (3.3%) had a diagnosis of HF. Women with a history of any APO had a higher prevalence of hypertension, diabetes, coronary heart disease, or smoking. Of the APOs studied, only HDP was significantly associated with HF with a fully adjusted odds ratio (OR) of 1.75 (95% CI, 1.22-2.50), and with HF with preserved ejection fraction in fully adjusted models (OR, 2.06; 95% CI, 1.29-3.27). In mediation analyses, hypertension explained 24% (95% CI, 12%-73%), coronary heart disease 23% (95% CI, 11%-68%), and body mass index 20% (95% CI, 10%-64%) of the association between HDP and HF. Conclusions and Relevance: In this large cohort of postmenopausal women, HDP was independently associated with incident HF, particularly HF with preserved ejection fraction, and this association was mediated by subsequent hypertension, coronary heart disease, and obesity. These findings suggest that monitoring and modifying these factors early in women presenting with HDP may be associated with reduced long-term risk of HF.


Assuntos
Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Saúde da Mulher/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Pós-Menopausa , Gravidez , Fatores de Risco , Estados Unidos/epidemiologia
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