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We examined whether resilience modified associations between allostatic load (AL), a physiological indicator of coping with repeated stressors, and cardiovascular disease (CVD) among 2758 African Americans in the Jackson Heart Study. Baseline AL was quantified using biological measures of metabolic, cardiovascular, and immune markers. We constructed a multidimensional resilience measure using validated questionnaires for social support, social networks, religious experiences, and optimism. Participants were followed until 2016 for stroke, coronary heart disease (CHD), and heart failure (HF). We used multivariable-adjusted, sex-stratified Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dichotomous AL and CVD. High AL was associated with CHD among women (HR = 1.73, 95% CI = 1.00, 2.99) and HF among women (HR = 1.52, 95% CI = 0.98, 2.37) and men (HR = 2.17, 95% CI = 1.28, 3.68). Among women, resilience did not modify the AL-CVD relationship. Among men, we observed higher stroke risk among men with low resilience (HR = 2.21, 95% CI = 0.94, 5.22) and no association among those with high resilience. Counterintuitively, high AL was associated with greater HF (HR = 5.80, 95% CI = 2.32, 14.47) in the subgroup of men with high resilience. Future studies addressing different facets of resilience are needed to elucidate underlying mechanisms for CVD prevention among African Americans.

OBJECTIVE The purposes of this study were to assess the association between changes in goal-striving stress (GSS) and changes in sleep duration in African Americans (AAs) and to determine if the association varies by sex, age, and/or educational attainment. METHODS We completed a longitudinal analysis using examination 1 (2000-2004, n = 5306) and examination 3 (2009-2013, n = 3819) data from the Jackson Heart Study, with a final sample of 3500. Changes in GSS and changes in sleep duration were calculated by subtracting examination 1 GSS from examination 3 GSS. Mean differences (β [standard error]) between changes in GSS and changes in sleep duration were assessed using linear regression models that adjusted for length of follow-up, sociodemographics, health behaviors/risk factors, and stressors. RESULTS In the fully adjusted models, the increase in GSS from examination 1 to examination 3 was associated with a decrease in sleep duration (in minutes) from examination 1 to examination 3 in the overall cohort (β = -7.72 [2.44], p < .002), in high school graduates (β = -21.23 [5.63], p < .001), and in college graduates (β = -7.57 [3.75], p = .044) but not in those with less than a high school education (β = 1.49 [8.35], p = .86) or those who attended college but did not graduate (β = 0.44 [4.94], p = .93). CONCLUSIONS Changes in GSS were inversely associated with changes in sleep duration over a mean period of 8 years in AA subgroups. Interventions that reduce stress related to goal striving should be considered to help improve sleep health in AAs.

African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one's life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort. Using examination 1 (2000-2004) and examination 3 (2009-2013) data from the Jackson Heart Study (n=2630), we examined associations of baseline levels of GSS with RKFD among AAs using multivariable Poisson regression models, adjusting for sociodemographics, health behaviors, chronic disease and discrimination. We also explored baseline cortisol as a mediator. The incidence of RKFD in this sample was 7.34% (mean years of follow-up: 8.06±0.84 years). The mean GSS score was 3.80 (±4.88) and total GSS score ranged from 0 to 36. Those who reported high (vs low) GSS were 1.60 times more likely to experience RKFD after full adjustment (incidence rate ratio (IRR) 1.60; 95% CI 1.11 to 2.14, p=0.01). After confirming cortisol as a mediator and adding it to the model, those who reported high (vs low) GSS had 1.58 times the rate of RKFD (IRR 1.58; 95% CI 1.09 to 2.30, p=0.0153). Stress related to not achieving goals was associated with a greater risk of RKFD in this sample of AAs.

African American adults suffer disproportionately from several non-communicable and infectious diseases. Among numerous contributing factors, perceived discrimination is considered a stressor for members of historically marginalized groups that contributes to health risk, although biological pathways are incompletely understood. Previous studies have reported associations between stress and both an up-regulation of non-specific (innate) inflammation and down-regulation of specific (adaptive) immunity. While associations between perceived discrimination and markers of inflammation have been explored, it is unclear if this is part of an overall shift that also includes down-regulated adaptive immunity. Relying on a large cross-section of African American adults (n = 3,319) from the Jackson Heart Study (JHS) in Jackson, Mississippi, we tested whether perceived everyday and lifetime discrimination as well as perceived burden from lifetime discrimination were associated with counts of neutrophils (innate), monocytes (innate), lymphocytes (adaptive), and the neutrophil-to-lymphocyte ratio (NLR), derived from complete white blood cell counts with differential. In addition, DNA methylation (DNAm) was measured on the EPIC array in a sub-sample (n = 1,023) of participants, allowing estimation of CD4T, CD8T and B lymphocyte proportions. Unexpectedly, high lifetime discrimination compared to low was significantly associated with lower neutrophils (b : -0.14, [95% CI: -0.24, -0.04]) and a lower NLR (b : -0.15, [95% CI: -0.25, -0.05]) after controlling for confounders. However, high perceived burden from lifetime discrimination was significantly associated with higher neutrophils (b : 0.17, [95% CI: 0.05, 0.30]) and a higher NLR (b : 0.16, [95% CI: 0.03, 0.29]). High perceived burden was also associated with lower lymphocytes among older men, which our analysis suggested might have been attributable to differences in CD4T cells. These findings highlight immune function as a potentially important pathway linking perceived discrimination to health outcomes.

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000-2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all p's for interaction terms0.06). In summary, optimism was associated with lower mortality rates among African-Americans in the Jackson Heart Study. Effect modification by sociodemographic factors should be further explored in additional research considering optimism and mortality in diverse populations. Positive factors, such as optimism, may provide important health assets that can complement ongoing public health efforts to reduce health disparities, which have traditionally focused primarily on risk factors.

Psychosocial stressors are determinants of increases in adiposity. Both psychosocial stressors and adiposity are higher among African Americans (AAs). Therefore, clarifying the stress-obesity link in AAs is important. The stress associated with goal striving is particularly relevant to AAs because opportunity for upward mobility is not always equal. Goal-striving stress (GSS) has not been assessed with adiposity, a potential result of GSS. Therefore, the objective of this study was to determine whether GSS would be associated with repeated measures of adiposity [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR)] in AAs. Linear mixed models were used to assess the relationship between GSS with repeated measures of adiposity across three exam periods among 2902 AAs, and sex was assessed as a moderator. Models were adjusted for demographics, health behaviours, morbidities, and daily discrimination. GSS was positively associated with repeated measures of adiposity in women but not men: WC [estimate (standard error) p-value] [0.003 (0.001) p < 0.01] and WHR [0.003 (0.0007) p < 0.01]. This suggests that high stress due to goal striving may contribute to greater increases in adiposity in AA women over time. Community-based interventions should continue to consider focused support group models as viable options for goal-striving related stress reduction.

BACKGROUND Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans. METHODS Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval—CI) of baseline (2000–2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother’s education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005–2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence. RESULTS High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension. CONCLUSION Efforts to prevent hypertension among African Americans should consider childhood and current SES status.

AIM: To examine the association of psychosocial resources with prevalent type 2 diabetes (T2D) in 5,104 African American men and women. METHODS: Using data from the Jackson Heart Study (JHS), we evaluated the cross-sectional associations of four psychosocial resources (social support, optimism, religiosity, and social networks) with T2D [fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5%, or use of diabetic medication]. Multivariable Poisson regression estimated prevalence ratios (PR, 95% confidence interval-CI) of T2D by each psychosocial measure, adjusting for demographics, SES, waist circumference, health behaviors, and depressive symptoms. RESULTS: Women reported greater religiosity and had more social networks than men (p

Leukocyte telomere length (LTL) is a biomarker of cellular aging. African Americans report more stress than other groups; however, the association of psychosocial stressors with biological aging among African Americans remains unclear. The current study evaluated the association of psychosocial factors (negative affect and stressors) with LTL in a large sample of African American men and women (n = 2,516) from the Jackson Heart Study. Using multivariable linear regression, we examined the sex-specific associations of psychosocial factors (cynical distrust, anger in and out, depressive symptoms, negative affect summary scores, global stress, weekly stress, major life events, and stress summary scores) with LTL. Model 1 adjusted for demographics and education. Model 2 adjusted for model 1, smoking, alcohol intake, physical activity, diabetes, hypertension, and high-sensitivity C-reactive protein. Among women, high (vs. low) cynical distrust was associated with shorter mean LTL in model 1 (b = -0.12; p = 0.039). Additionally, high (vs. low) anger out and expressed negative affect summary scores were associated with shorter LTL among women after full adjustment (b = -0.13; p = 0.011; b = -0.12, p = 0.031, respectively). High levels of cynical distrust, anger out, and negative affect summary scores may be risk factors for shorter LTL, particularly among African-American women.

Hispanic/Latinos have been underrepresented in genome-wide association studies (GWAS) for anthropometric traits despite notable anthropometric variability with ancestry proportions, and a high burden of growth stunting and overweight/obesity in Hispanic/Latino populations. This address this knowledge gap, we analyzed densely-imputed genetic data in a sample of Hispanic/Latino adults, to identify and fine-map common genetic variants associated with body mass index (BMI), height, and BMI-adjusted waist-to-hip ratio (WHRadjBMI). We conducted a GWAS of 18 studies/consortia as part of the Hispanic/Latino Anthropometry (HISLA) Consortium (Stage 1, n=59,769) and validated our findings in 9 additional studies (HISLA Stage 2, n=9,336). We conducted a trans-ethnic GWAS with summary statistics from HISLA Stage 1 and existing consortia of European and African ancestries. In our HISLA Stage 1+2 analyses, we discovered one novel BMI locus, as well two novel BMI signals and another novel height signal, each within established anthropometric loci. In our trans-ethnic meta- analysis, we identified three additional novel BMI loci, one novel height locus, and one novel WHRadjBMI locus. We also identified three secondary signals for BMI, 28 for height, and two for WHRadjBMI. We replicated >60 established anthropometric loci in Hispanic/Latino populations at genome-wide significance—representing up to 30% of previously-reported index SNP anthropometric associations. Trans-ethnic meta-analysis of the three ancestries showed a small-to-moderate impact of uncorrected population stratification on the resulting effect size estimates. Our novel findings demonstrate that future studies may also benefit from leveraging differences in linkage disequilibrium patterns to discover novel loci and additional signals with less residual population stratification.

Background: Psychosocial stressors, such as perceived discrimination and depressive symptoms, may shorten telomeres and exacerbate aging-related illnesses. Methods: Participants from the Jackson Heart Study at visit 1 (2000–2004) with LTL data and Center for Epidemiological Studies-Depression (CES-D) scores (n = 580 men, n = 910 women) were utilized. The dimensions of discrimination scores (everyday, lifetime, burden of lifetime, and stress from lifetime discrimination) were standardized and categorized as low, moderate, and high. Coping responses to everyday and lifetime discrimination were categorized as passive and active coping. Multivariable linear regression analyses were performed to estimate the mean difference (standard errors-SEs) in LTL by dimensions of discrimination and coping responses stratified by CES-D scores &lt, 16 (low) and ≥ 16 (high) and sex. Covariates were age, education, waist circumference, smoking and CVD status. Results: Neither everyday nor lifetime discrimination was associated with mean differences in LTL for men or women by levels of depressive symptoms. Burden of lifetime discrimination was marginally associated with LTL among women who reported low depressive symptoms after full adjustment (b = 0.11, SE = 0.06, p = 0.08). Passive coping with lifetime discrimination was associated with longer LTL among men who reported low depressive symptoms after full adjustment (b = 0.18, SE = 0.09, p &lt, 0.05), and active coping with lifetime discrimination was associated with longer LTL among men who reported high depressive symptoms after full adjustment (b = 1.18, SE = 0.35, p &lt, 0.05). Conclusions: The intersection of perceived discrimination and depressive symptomatology may be related to LTL, and the effects may vary by sex.

OBJECTIVE: Investigate the association of dispositional optimism with chronic kidney disease (CKD) and rapid kidney function decline (RKFD) and determine if there is modification by age, sex, and educational attainment among African Americans. METHODS: Optimism was measured using the 6-item Life Orientation Test-Revised scale (categorized into tertiles and log transformed) among participants from the Jackson Heart Study (n=1960). CKD was defined as the presence of albuminuria or reduced glomerular filtration rate of 3 ml/min/1.73m(2)/year between baseline and exam 3 (2009–2013). The cross-sectional and prospective associations between optimism and kidney outcomes were tested using multivariable logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI), adjusting for demographics, education, risk factors, behaviors, and depressive symptoms. We tested effect modification by age, sex, and education. RESULTS: 569 participants had CKD and 326 were classified as having RKFD by exam 3. After full adjustment, the OR for CKD was 0.73 for those who reported high (vs. low) optimism (95% CI 0.55–0.99) and 0.56 (95% CI 0.27–1.15) for the optimism score. After 7.21 median years of follow up, the OR for RKFD was 0.51 for those who reported high (vs. low) optimism (95% CI 0.34–0.76), and 0.26 (95% CI 0.10–0.56) for the optimism score, after full adjustment. There was no evidence of effect modification by demographics or educational attainment. CONCLUSIONS: Higher optimism was associated with a lower odds of CKD and a lower odds of RKFD.

Background Goal‐striving stress (GSS), the stress from striving for goals, is associated with poor health. Less is known about its association with cardiovascular disease (CVD). Methods and Results We used data from the JHS (Jackson Heart Study), a study of CVD among blacks (21–95 years old) from 2000 to 2015. Participants free of CVD at baseline (2000–2004) were included in this analysis (n=4648). GSS was examined in categories (low, moderate, high) and in SD units. Incident CVD was defined as fatal or nonfatal stroke, coronary heart disease (CHD), and/or heart failure. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident CVD by levels of GSS, adjusting for demographics, socioeconomic status, health behaviors, risk factors, and perceived stress. The distribution of GSS categories was as follows: 40.77% low, 33.97% moderate, and 25.26% high. Over an average of 12 years, there were 140 incident stroke events, 164 CHD events, and 194 heart failure events. After full adjustment, high (versus low) GSS was associated with a lower risk of stroke (HR, 0.38; 95% CI, 0.17–0.83) and a higher risk of CHD (HR, 1.91; 95% CI, 1.10–3.33) among women. A 1‐standard deviation unit increase in GSS was associated with a 31% increased risk of CHD (HR, 1.31; 95% CI, 1.10–1.56) among women. Conclusions Higher GSS may be a risk factor for developing CHD among women; however, it appears to be protective of stroke among women. These analyses should be replicated in other samples of black individuals.

There is little research examining the social patterning of electronic nicotine delivery system (ENDS) use. This study investigated the association between socioeconomic status (SES) (education, income, and employment status) and current and former ENDS use. Data were collected from 2561 participants from the American Heart Association Tobacco Regulatory and Addiction Center (A-TRAC) online survey. Participants were 18–64 years old and reported demographic, SES, and ENDS use. Poisson regression was used to estimate prevalence ratios (PR 95% confidence interval-CI) of participants’ current and former (vs. never) ENDS use. Models were adjusted for age, sex, sexual orientation, race/ethnicity, marital status, and reasons for ENDS use. In the unadjusted analysis, ENDS use was primarily patterned by education and employment status. College educated persons (versus those with less than a high school diploma) had a 37% greater prevalence of current ENDS use (PR 1.37, 95% CI 1.20–1.55), and a 16% greater prevalence of former ENDS use (PR 1.16, 95% CI 1.06–1.28) in the fully-adjusted model. Persons with household incomes above $90K (versus less than $20,000) had a greater prevalence of current (PR 1.30, 95% CI 1.19–1.41) and former (PR 1.17, 95% CI 1.05–1.30) ENDS use. Those who were employed (versus not employed) had a 13% greater prevalence of current ENDS use (PR: 1.13, 95% CI 1.07–1.19) after full adjustment. Higher SES (versus lower SES) persons were more likely to use ENDS.

Introduction Perceiving discriminatory treatment may contribute to systemic inflammation, a risk factor of cardiovascular pathophysiology. This study evaluated the association of self-reported discrimination with changes in high–sensitivity C-reactive protein and the mediating role of adiposity. Methods The sample included 5,145 African-Americans, aged 21–92 years, in the Jackson Heart Study. Everyday, lifetime, and burden from perceived discrimination comprised primary predictors in 3 sets of multivariable linear regression models of baseline (2000–2004) discrimination and natural logarithm of high–sensitivity C-reactive protein. Multivariable linear mixed models assessed mean changes in natural logarithm of high–sensitivity C-reactive protein over the study period (2000–2013). Mediation was quantified by percentage changes in estimates adjusted for BMI, waist circumference, and waist-to-height ratio. Multiple imputation addressed missingness in baseline covariates and in high–sensitivity C-reactive protein taken at all 3 study examinations. Analyses were conducted in 2018. Results In cross-sectional analyses, male participants in the middle and highest tertiles of lifetime discrimination had natural logarithm of high–sensitivity C-reactive protein levels that were 0.13 (95% CI= −0.24, −0.01) and 0.15 (95% CI= −0.27, −0.02) natural logarithm(mg/dL) lower than those in the lowest tertile. In longitudinal analyses, all participants reporting more frequent everyday discrimination had a 0.07 natural logarithm(mg/dL) greater increase in natural logarithm of high–sensitivity C-reactive protein per examination than those reporting none (95% CI=0.01, 0.12). A similar trend emerged for lifetime discrimination and changes in natural logarithm of high–sensitivity C-reactive protein (adjusted mean increase per visit: 0.04 natural logarithm[mg/dL], 95% CI=0.01, 0.08). Adiposity did not mediate the longitudinal associations. Conclusions Everyday and lifetime discrimination were associated with significant high–sensitivity C-reactive protein increases over 13 years. The physiologic response to discrimination may lead to systemic inflammation.

Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans.Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval-CI) of baseline (2000-2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother's education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005-2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence.High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension.Efforts to prevent hypertension among African Americans should consider childhood and current SES status.

Background Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. Methods Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. Results After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16–1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01–1.52 and PR 1.13 95% CI 1.03–1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03–1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46–0.84). Conclusions Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.

Background: The burden of chronic kidney disease (CKD) and incidence of end-stage renal disease are greater among African Americans than other racial and ethnic groups. A number of studies have attributed the higher prevalence of CKD to traditional risk factors and lower socioeconomic status. However, few studies have examined the association of kidney disease with dispositional optimism, the expectation that positive things will happen. Hypothesis: We hypothesize that there would be an inverse association between optimism and CKD and RKFD. Objective: To examine the association of optimism with CKD at baseline (2000-2004) and rapid kidney function decline (RKFD) between exams 1 and 3 (2000-2013) among African Americans. Methods: We examined 5292 African American participants from the Jackson Heart Study. Optimism was measured using the 6-item Life Orientation Test-Revised (LOT-R) scale and was categorized into tertiles. CKD at baseline was defined as the presence of albuminuria or reduced glomerular filtration rate (eGFR) 2 , or report of dialysis at baseline examination. RKFD was defined as a decline > 4 ml/min/1.73m 2 / year between exams 1 and 3. The associations between optimism and kidney outcomes were tested using multivariable logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex, education, income, waist circumference, alcohol intake, physical activity, smoking, diabetes, and hypertension. Results: After exclusion of missing CKD status, there were 682/3422 (19.9%) cases of CKD at exam 1 and 303/3706 (8.2%) who had RKFD at exam 3. Participants with CKD and RKFD were less optimistic ( p Conclusions: Higher optimism was associated with a lower odds of CKD and a lower odds of RKFD over a period of 7 years in this sample of African Americans.

Introduction: Obesity is a public health epidemic, with a US prevalence of 39.8%. African Americans (AAs) have an even greater prevalence of obesity (46.8%), when compared to non-Hispanic whites at (37.9%). Behavioral risk factors, such as poor diet and sedentary lifestyle, are important antecedents to obesity, but psychosocial risk factors such as stress and perceived discrimination are also determinants of obesity. Goal-striving stress, (GSS), the difference between aspiration and achievement, weighted by the level of disappointment if goals are not reached, may be an important stressor among AAs that may influence measures of adiposity; however, this has yet to be explored. The objective of this study was to examine the relationship between GSS and measures of adiposity in AAs. Hypothesis: GSS is positively associated with measures of adiposity, including BMI, waist circumference, waist-to-height ratio (WHR), and neck circumference. Methods: We analyzed data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. GSS was derived assessing the difference between aspiration for the following year and current achievement (both using a 10-point scale), weighted by a disappointment is achievement is not reached, using 4-point scale. GSS was then divided by the standard deviation (SD) (5.05) to create GSS-SD units. BMI was measured in kg/m 2 and waist and neck circumference was measured in cm. WHR was derived from waist circumference and height measured in cm. We excluded participants with missing data on GSS, measures of adiposity, and covariates. Spline regression analyses were used to obtain the coefficient. Models were adjusted for sex, age, socioeconomic status, alcohol, smoking, physical activity, nutrition, hypertension, diabetes, history of cardiovascular disease, and discrimination. Results: There were 4360 participants included in this analysis; 64.29% female with a mean (± SD) age of 55.47 (± 12.57) years and mean BMI of 31.85 (±7.20) kg/m 2 , mean waist circumference of 100.75 (±16.14) cm, mean WHR of 59.80% (± 9.78), and mean neck circumference of 38.53 (±3.76) cm. After full adjustment, significant results show a positive association of GSS with waist circumference (b=1.30; p=0.0418) and WHR (b=0.80; p=0.0299). GSS was not associated with BMI or neck circumference. Conclusion: GSS was positively associated with measures of adiposity, specifically waist circumference and WHR. Potential interventions should consider the extent to which GSS may contribute to increases in adiposity. Also, future research should explore the longitudinal associations of GSS with measures of adiposity.

Background: Research has reported that measures of resilience, such as optimism, social support, and religious coping are positively associated with longevity, but there are limited studies on the genetic contribution of resilience among African Americans. Utilizing Jackson Heart Study (JHS) data, we examined the heritability estimates of markers of resilience and their association with proportion of West African genetic ancestry (pAfr) in order to understand familial patterns of resilience among African Americans. Hypothesis: We hypothesized that genetic variation would contribute significantly to variation in indicators of resilience, and that pAfr will be positively associated with greater resilience in African Americans. Methods: Resilience measures (optimism, social support, social networks, religious experiences, and religious practices and coping) were obtained from validated questionnaires. Scores were created for each resilience measure and then all measures were summed to create a total resilience score among 1,200 related and 1,456 unrelated individuals of the JHS cohort. We then analyzed the subset of related individuals to estimate polygenic heritability for resilience measures using Sequential Oligogenic Linkage Analysis Routines (SOLAR), and evaluated the subset of unrelated participants for the association between resilience and pAfr using a multiple linear regression model. The pAfr was estimated from more than 1,400 ancestry informative markers that differentiate West African genetic ancestry from European ancestry using HAPMIX genetic software. In both analyses, we controlled for age, sex, age-by-sex interaction, education, physical activity, smoking and depressive symptoms. Results: In related individuals, we found a significant proportion of variation (h 2 ±SE; p-value) due to familial correlation on religious practices and coping (0.15±0.09; p=0.0371); religious experience (0.26±0.09; p Conclusion: In this sample of African Americans, we found evidence that variation in markers of resilience are influenced by genetic ancestry and sex. West African genetic background was associated with markers of resilience in men only. Due to lack of household effects we could not account for influence of the common environment, which is a limitation of these findings. However, because we found genetic influences of resilience, future studies that explore associations with longevity loci are warranted.

Background African Americans (AAs) report a higher frequency of certain stressors over their lifetime which may impact biological processes that can impair sleep. For this reason, goal-striving stress (GSS), the difference between aspiration and achievement, weighted by disappointment, may contribute to poor sleep quality and suboptimal sleep duration among AAs. Methods We completed a cross-sectional analysis using exam 1 data (2000-2004) from the Jackson Heart Study (JHS) (n=4943). GSS was self-reported and categorized in tertiles of low, moderate, and high. Participants self-reported the number of hours they slept each night and rated their sleep quality as (1) very poor to (5) excellent. Sleep duration categories included the following: short sleep (≤6 hours), normal sleep (7-8 hours) and long sleep (≥ 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Relative risk ratios (RRRs 95% confidence intervals-CI) were estimated for sleep duration and sleep quality categories by GSS using logistic regression. Results After full adjustment, there were no significant associations between GSS and sleep duration categories. However, participants who reported high (versus low) GSS had a 20% greater risk (1.20 95% CI: 1.01, 1.43) of low (versus high) sleep quality in the fully adjusted model. Conclusion The stress due to the deficit between goal aspiration and achievement was associated with poor sleep quality. Future investigations should examine the association of changes in GSS with changes in sleep duration and sleep quality.

Little research has examined associations of positive psychosocial factors with the American Heart Association Life's Simple 7™ (LS7) among African Americans. This study examined the associations between positive optimistic orientation and LS7 among African Americans. Using exam 1 data (2000–2004) from the Jackson Heart Study, we examined cross-sectional associations of optimism (in tertiles) with LS7 components [smoking, physical activity, diet, body mass index, blood pressure, cholesterol, glucose] and a composite LS7 score (classified as poor, intermediate, ideal) among 4734 African Americans free of cardiovascular disease. Multivariable prevalence regression was used to estimate prevalence ratios (PR, 95% confidence interval-CI) of intermediate and ideal (vs. poor) individual LS7 components and composite LS7 score by optimism levels, adjusting for demographics, socioeconomic status, and depressive symptoms. For LS7 components with low prevalence, we estimated odds ratios. A greater percentage of participants with high vs. low optimism were younger, female, high SES, and not depressed. After full covariate adjustment, the prevalence ratio of ideal (vs. poor) composite LS7 score was 1.24 for participants who reported high (vs. low) optimism (95% CI 1.09–1.42) at exam 1. Higher levels of optimism were also associated with greater prevalence of ideal (vs. poor) physical activity and smoking. Promoting positive optimistic orientation may be an important step toward increasing the likelihood of achieving optimal cardiovascular health among African Americans.

Introduction: Research shows that compared to non-Hispanic whites, African Americans (AAs) have poorer sleep quality, lower mean sleep duration, and a higher prevalence of sleep-disordered breathing. AAs also report more frequent exposures to certain stressors over the life course, which may impact physiological processes that may impair sleep. Goal-striving-stress (GSS), the discrepancy between aspiration and achievement, weighted by the subjective probability of success, and the level of disappointment experienced if goals are not reached, may be an important stressor among AA’s that may influence sleep; however this has yet to be explored. The objective of this study was to assess the relationship between GSS and sleep duration and sleep quality in AAs. Hypothesis: We assessed the hypothesis that high (versus low) GSS would be associated with short or long sleep duration and poor sleep quality. Methods: We utilized data from the baseline exam of the Jackson Heart Study (JHS; n=5306), an AA sample of women and men, 35-84 years old. There were a total of 5082 participants in the sample; 63.34% female with a mean age of 55.30 (± 12.75) and mean sleep duration of 6.43 hours (±1.51). The sample was categorized into GSS tertiles: low (n=2121), moderate (n=1716), high (n=1296). Participants self-reported sleep duration (hours) and rated their sleep quality. Sleep duration was categorized as short ( < 6 hours), normal (7 or 8 hours) and long ( > 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Logistic regression models were used to obtain odds ratios (OR, 95% confidence interval-CI) to assess the associations of GSS levels with sleep duration and sleep quality categories. Models were adjusted for sex, age, socioeconomic status, health behaviors, discrimination, and health outcomes. Results: Significant results showed that participants who reported high (versus low) GSS had a 29% increased odds [1.29 (1.10, 1.52)] of short (versus normal) sleep after full adjustment. Participants who reported high (versus low) GSS had a 42% increased odds [1.42 (1.20, 1.67)] of low (versus high) sleep quality after full adjustment. Conclusion In conclusion, the deficit between goal aspiration and achievement is associated with short sleep duration and poor sleep quality. Potential interventions should consider the extent to which GSS may contribute to the development of short sleep duration and poor sleep quality.

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/1.73m(2)) 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.

Summary Background Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p Interpretation Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice. Funding National Institutes of Health Research Health Technology Assessment Programme, British Heart Foundation.

Although discrimination among African Americans (AAs) has been linked to various health outcomes, few studies have examined associations of multiple measures of discrimination with prevalent subclinical disease in a large sample of AAs. To examine the associations of measures of discrimination and coping responses to discrimination with prevalent subclinical disease among AAs in the Jackson Heart Study (JHS); and whether this association is modified by sex. We examined the associations of everyday, lifetime, and burden of lifetime discrimination with carotid intima-media thickness (cIMT), and left ventricular hypertrophy (LVH) among 3029 AAs in the JHS. Prevalence ratios (PR 95% confidence interval—CI) and odds ratios (OR 95% CI) were estimated for above-median cIMT and LVH, respectfully, adjusting for demographic, behavioral, and clinical risk factors. No significant associations were found between everyday and lifetime discrimination and median cIMT and LVH. Participants who reported high (vs. no) burden of lifetime discrimination had a 48% reduced odds of LVH (OR, 0.52; 95% CI, 0.29, 0.94) after full adjustment. There was evidence of effect modification by sex in the association of coping with everyday discrimination and LVH after full adjustment (p value for interaction

Please note the following correction in the Methods section of this article: The definition for goal-striving stress in the Jackson Heart Study included achievement defined as “where one was in life 10 years ago,” using a 10-point scale.

Background There is a paucity of research examining the relationship between kidney stones and risk of cardiovascular disease while considering individuals of different race-ethnicities. Purpose The purpose of this study was to examine the association between history of kidney stones and increased odds of atherosclerotic cardiovascular disease (via the Pooled Cohort Equations) across race-ethnicity groups. Methods 5571 participants aged 40–79 from the 2007–2012 cycles of the NHANES were used for this study. A history of kidney stones was collected from survey data. Predicted odds of having a 10-year atherosclerotic cardiovascular disease (ASCVD) event was assessed from the Pooled Cohort Equations. Results After adjustments, having kidney stones was not associated with an increase odds of having an ASCVD event within the next 10-years (OR 1.03; 95% CI: 0.58–1.82, P = 0.91). However, among non-Hispanic blacks, those with kidney stones had a 2.24 increased odds (OR 2.24; 95% CI: 1.08–4.66; P = 0.03) of having an ASCVD event within the next 10-years when compared to non-Hispanic blacks with no history of a kidney stone. Conclusion Kidney stones were associated with 10-year risk of a future ASCVD event among non-Hispanic blacks.

Objectives: 1) To examine the association of multiple dimensions of discrimination with reported trust and satisfaction with providers; 2) to report within-group differences among African Americans (AAs). Methods: Descriptive cross sectional study. The study population included AAs aged 35 to 84 years from the Jackson Heart Study (JHS) (N=5,301). Poisson regression (PR) was used to quantify the association between perceived discrimination and reported trust and satisfaction with providers before and after controlling for selected characteristics. Main Measures: Measures of perceived discrimination included everyday, lifetime, burden from lifetime discrimination, and stress from discrimination. Outcomes included trust and satisfaction with providers. Results: The mean everyday discrimination score was 2.11 (SD±1.02), and the mean lifetime discrimination score was 2.92 (SD±2.12). High (vs low) levels of everyday discrimination were associated with a 3% reduction in the prevalence of trust in providers (PR .97, 95% CI .96, .99) in all models. In fully-adjusted models, high (vs low) lifetime discrimination was associated with a 4% reduction in the prevalence of trust and satisfaction (PR .96, 95% CI .95, .98). Burden of discrimination was not associated with trust or satisfaction, but stress from discrimination was inversely associated with satisfaction. Conclusions: The significant association between discrimination and mistrust and dissatisfaction suggests that health care providers should be made aware of AA perceptions of discrimination, which likely affects their levels of trust and satisfaction.Ethn Dis. 2017;27(3):209-216; doi:10.18865/ed.27.3.209