Search

Background: Diabetes and prediabetes are common among African Americans (AA), but the frequency and predictors of transition between normal, impaired glucose metabolism, and diabetes are not well-described. The aim of this study was to examine glucometabolic transitions and their association with the development of type 2 diabetes (T2D).Methods: AA participants of the Jackson Heart Study who attended baseline exam (2000-2004) and at least one of two subse­quent exams (2005-2008 and 2009-2013, ~8 years) were classified according to glycemic status. Transitions were defined as progression (deterioration) or remission (im­provement) of glycemic status. Multinomial logistic regression models with repeated measures were used to estimate the odds ratios (OR) for remission and progression with adjustment for demographic, anthro­pometric, behavioral, and biochemical factors.Results: Among 3353 participants, (mean age 54.6±12.3 years), 43% were normogly­cemic, 32% were prediabetes, and 25% had diabetes at baseline. For those with normal glucose at a visit, the probability at the next visit (~4years) of having prediabetes or diabetes was 38.5% and 1.8%, respectively. For those with prediabetes, the probability was 9.9% to improve to normal and 19.9% to progress to diabetes. Progression was as­sociated with baseline BMI, diabetes status, triglycerides, family history of diabetes, and weight gain (OR 1.04 kg, 95% CI:1.03-1.06, P=

Chronic exposure to stress is associated with metabolic syndrome (MetS), but the mechanism is unclear. We investigated the associations between chronic burden, sleep, and MetS in the Coronary Artery Risk Development in Young Adults Study.Chronic burden was self-reported (2000-2001) according to experiences with stressors for longer than 6 months. Wrist actigraphy-measured sleep duration and sleep efficiency were collected for 6 days; sleep duration, sleep quality, and daytime sleepiness were self-reported (2003-2004). MetS was measured during the clinic visit, from 2005 to 2006. Multivariable logistic and Cox proportional hazard models were fit to determine the associations of interest. Mediation by sleep was assessed using the product of coefficients approach.Among participants ( n = 606), the average (standard deviation) age was 40 (3.6) years, 58% were female, and 43% were Black. The prevalences of chronic burden, short sleep (≤6 hours), and MetS were 35%, 43% and 20.5%, respectively. High versus low chronic burden was associated with shorter self-reported sleep duration and higher daytime sleepiness. Chronic burden was associated with 1.85 higher odds (95% confidence interval = 1.11-3.09) of MetS. Sleep characteristics were not associated with MetS. There was no evidence that sleep mediated the chronic burden-MetS relation.Burden of chronic stress may be an emerging novel risk factor for both poor sleep and MetS.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

1.1. BACKGROUND: It was reported that Hemoglobin A1c (HbA1c) values of African-Americans (AAs) were on average higher than whites whereas AAs with Sickle-Cell-Trait (SCT) had lower HbA1c values compared to AAs without SCT despite controlling for average glycaemia. We evaluated the HbA1c-glucose relationship between AAs with and without SCT, and whites using data from two cohort studies. 1.2. METHODS: We pooled data from Coronary-Artery-Risk-Development-Study-in-Young-Adults (CARDIA, n= 5,115, 2005–2011) and the Jackson-Heart-Study (JHS, n=5,301, 2000–2013). Whole exome sequencing in JHS and TaqMan-SNP-Genotyping Assays in CARDIA determined the SCT status in AAs. HbA1c was measured by two NGSP-certified assays without reportedly clinically significant interference from hemoglobin S. Participants without data on SCT or with hemoglobin SS, CC or AC were excluded, resulting in 6,623 participants (n=3,575 from CARDIA and n=3,048 from JHS). Generalized-estimating-equations estimated the cross-sectional association between fasting glucose and HbA1c(outcome) amongst whites, AAs with SCT, and AAs without SCT controlling for clinical-demographic factors. 1.3. RESULTS: Our analyses included 2,003 whites, 4,253 AAs without SCT and 367 AAs with SCT. AAs with and without SCT had similar clinical-demographic characteristics, whereas whites have lower fasting- and 2-hour-glucose values than AAs. Despite higher fasting-glucose values in AAs with SCT versus whites, their HbA1c values were similar (p=0.39). In the subset with 2-hour-glucose values, HbA1c values in AAs with SCT were lower than whites (p=0.007) despite higher 2-hour-glucose values. 1.4. CONCLUSIONS: AAs with SCT have at least similar, if not lower, levels of mean HbA1c values than whites despite higher levels of glycaemia. Future research is warranted to assess whether these findings translate to clinical outcomes.

BACKGROUND: n-3 and n-6 PUFAs have physiologic roles in sleep processes, but little is known regarding circulating n-3 and n-6 PUFA and sleep parameters. OBJECTIVES: We sought to assess associations between biomarkers of n-3 and n-6 PUFA intake with self-reported sleep duration and difficulty falling sleeping in the Fatty Acids and Outcome Research Consortium. METHODS: Harmonized, de novo, individual-level analyses were performed and pooled across 12 cohorts. Participants were 35-96 y old and from 5 nations. Circulating measures included α-linolenic acid (ALA), EPA, docosapentaenoic acid (DPA), DHA, EPA + DPA + DHA, linoleic acid, and arachidonic acid. Sleep duration (10 cohorts, n = 18,791) was categorized as short (≤6 h), 7-8 h (reference), or long (≥9 h). Difficulty falling asleep (8 cohorts, n = 12,500) was categorized as yes or no. Associations between PUFAs, sleep duration, and difficulty falling sleeping were assessed by cross-sectional multinomial logistic regression using standardized protocols and covariates. Cohort-specific multivariable-adjusted ORs per quintile of PUFAs were pooled with inverse-variance weighted meta-analysis. RESULTS: In pooled analysis adjusted for sociodemographic characteristics and health status, participants with higher very long-chain n-3 PUFAs were less likely to have long sleep duration. In the top compared with the bottom quintiles, the multivariable-adjusted ORs (95% CIs) for long sleep were 0.78 (95% CI: 0.65, 0.95) for DHA and 0.76 (95% CI: 0.63, 0.93) for EPA + DPA + DHA. Significant associations for ALA and n-6 PUFA with short sleep duration or difficulty falling sleeping were not identified. CONCLUSIONS: Participants with higher concentrations of very long-chain n-3 PUFAs were less likely to have long sleep duration. While objective biomarkers reduce recall bias and misclassification, the cross-sectional design limits assessment of the temporal nature of this relation. These novel findings across 12 cohorts highlight the need for experimental and biological assessments of very long-chain n-3 PUFAs and sleep duration.

AIMS/HYPOTHESIS: The aim of this work was to define metabolic correlates and pathways of diabetes pathogenesis in young adults during a subclinical latent phase of diabetes development. METHODS: We studied 2083 young adults of Black and White ethnicity in the prospective observational cohort Coronary Artery Risk Development in Young Adults (CARDIA) study (mean ± SD age 32.1 ± 3.6 years; 43.9% women; 42.7% Black; mean ± SD BMI 25.6 ± 4.9 kg/m(2)) and 1797 Framingham Heart Study (FHS) participants (mean ± SD age 54.7 ± 9.7 years; 52.1% women; mean ± SD BMI 27.4 ± 4.8 kg/m(2)), examining the association of comprehensive metabolite profiles with endophenotypes of diabetes susceptibility (adipose and muscle tissue phenotypes and systemic inflammation). Statistical learning techniques and Cox regression were used to identify metabolite signatures of incident diabetes over a median of nearly two decades of follow-up across both cohorts. RESULTS: We identified known and novel metabolites associated with endophenotypes that delineate the complex pathophysiological architecture of diabetes, spanning mechanisms of muscle insulin resistance, inflammatory lipid signalling and beta cell metabolism (e.g. bioactive lipids, amino acids and microbe- and diet-derived metabolites). Integrating endophenotypes of diabetes susceptibility with the metabolome generated two multi-parametric metabolite scores, one of which (a proinflammatory adiposity score) was associated with incident diabetes across the life course in participants from both the CARDIA study (young adults; HR in a fully adjusted model 2.10 [95% CI 1.72, 2.55], p

Objectives:Healthcare workers (HCWs) are a high-priority group for coronavirus disease 2019 (COVID-19) vaccination and serve as sources for public information. In this analysis, we assessed vaccine intentions, factors associated with intentions, and change in uptake over time in HCWs.Methods:A prospective cohort study of COVID-19 seroprevalence was conducted with HCWs in a large healthcare system in the Chicago area. Participants completed surveys from November 25, 2020, to January 9, 2021, and from April 24 to July 12, 2021, on COVID-19 exposures, diagnosis and symptoms, demographics, and vaccination status.Results:Of 4,180 HCWs who responded to a survey, 77.1% indicated that they intended to get the vaccine. In this group, 23.2% had already received at least 1 dose of the vaccine, 17.4% were unsure, and 5.5% reported that they would not get the vaccine. Factors associated with intention or vaccination were being exposed to clinical procedures (vs no procedures: adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.16–1.65) and having a negative serology test for COVID-19 (vs no test: AOR, 1.46; 95% CI, 1.24–1.73). Nurses (vs physicians: AOR, 0.24; 95% CI, 0.17–0.33), non-Hispanic Black (vs Asians: AOR, 0.35; 95% CI, 0.21–0.59), and women (vs men: AOR, 0.38; 95% CI, 0.30–0.50) had lower odds of intention to get vaccinated. By 6-months follow-up, >90% of those who had previously been unsure were vaccinated, whereas 59.7% of those who previously reported no intention of getting vaccinated, were vaccinated.Conclusions:COVID-19 vaccination in HCWs was high, but variability in vaccination intention exists. Targeted messaging coupled with vaccine mandates can support uptake.

Introduction: Black adults experience higher rates of cardiovascular disease (CVD) compared with White adults, particularly across young adulthood. To identify intervention targets to reduce disparities, we quantified the contribution of individual- and neighborhood-level determinants across young adulthood to Black-White differences in incidence of premature CVD. Methods: In Black and White adults (baseline age 18-30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, the associations of clinical, lifestyle, psychosocial, socioeconomic, and neighborhood determinants with racial disparities in incident CVD were evaluated with sex-stratified Cox proportional hazards models adjusted for time-updated risk factors. Percent reduction in the ß estimate (log-hazard ratio [HR]) for race quantified the contribution of each risk factor group, individually and combined, to incident CVD racial disparities. Results: In 1707 Black and 2001 White young adults followed for median 33.9 (IQR 33.7-34.0) years, Black adults had higher risk of incident CVD than White adults (Figure). The fully adjusted model yielded significant attenuation of the disparity: HR 1.22 (0.68-2.21) for Black vs. White women, HR 1.42 (0.91-2.23) for Black vs. White men. In women, clinical risk factors were associated with the largest percent reduction in the ß estimate (83%) for race. In men, socioeconomic, lifestyle and clinical risk factors were each associated with significant percent reductions in ß estimates (45%, 37%, and 28%, respectively). Conclusions: In CARDIA, risk for premature CVD was no longer significantly higher in Black vs. White adults after adjustment for upstream determinants across multiple domains. The largest contribution to racial disparities was from clinical factors in women and socioeconomic factors in men. These findings may inform earlier-life interventions to reduce disparities in premature CVD.

Background: Although one of the fastest-growing populations in the USA, Latinx individuals remain underrepresented in research. In this study, we aimed to identify how Latina/Latinx participants of the Environment, Leiomyomas, Latinas, and Adiposity Study (ELLAS) learned about the research study and what motivated them to participate. Materials and Methods: Using a standardized survey tool, bilingual staff interviewed participants and asked them, 1) how they heard about ELLAS and 2) to identify and rank their top three reasons for participating in ELLAS. Results: “Word of mouth” through a friend or relative was the most common method of learning about ELLAS (49.0%), followed by a “community outreach event” (29.3%). The three most common reasons for participating in ELLAS were “to learn more about women’s health” (83.3%), “to receive a free health assessment” (79.4%), and “to contribute to scientific knowledge” (59.5%). Correlation between demographic and socioeconomic characteristics and participant responses indicated that there are different reasons for participation based on these factors. Conclusions: Community engagement and word of mouth are vital to the successful recruitment of Latina/Latinx participants to research studies. Latinx participants are most motivated to participate by health benefits and health education, as well as altruistic aspects of research studies. Therefore, establishing mutually beneficial relationships within Latinx communities and appealing to motivations for research participation with close attention to the demographics of participants can both expand and allow for targeted recruitment efforts for this underrepresented group in research studies.

Introduction Growing evidence suggests that sleep disturbance might be a risk factor for cognitive impairment in older adults. However, the association between device-based sleep duration, quality and cognitive function in midlife is poorly understood. Methods We examined 526 Black and White men and women who completed the sleep examination at baseline from 2003 to 2005 and had cognition evaluated 11 years later from the Coronary Artery Risk Development in Young Adults (CARDIA) study, Sleep duration and quality was assessed objectively using a wrist activity monitor and subjectively by Pittsburgh Sleep Quality Index (PSQI). We evaluated cognitive function using the Digit Symbol Substitution Test (DSST), Stroop test, Rey Auditory Verbal Learning Test (RAVLT), Montreal Cognitive Assessment (MoCA) and Letter Fluency and Category Fluency tests. Results This study included 305 (58%) women and 229 (44%) Black people, with a mean age of 40.1±3.6 years at baseline. After adjustment for age, sex, race, education, smoking, body mass index, depression, physical activity, hypertension and diabetes, actigraphy-measured sleep fragmentation index (calculated as the sum of the percentage of time spent moving and the percentage of immobile periods ≤ 1 minute) was significantly associated with all measures of cognition, except for fluency. Every standard deviation increase in sleep fragmentation index was associated with worse executive function [DSST (b=-1.80, 95%CI: -3.20, -0.41) and Stroop (b=-1.23, -0.25, -2.21)], worse verbal learning [RAVLT (b=-0.41, 95%CI: -0.66, -0.82)] and worse global cognition [MOCA (b=-0.41, 95%CI: -0.74, -0.16)]. Poorer sleep maintenance was associated with worse verbal learning (RAVLT) and global cognition (MOCA) of a similar magnitude. We did not find any association between objective sleep duration or subjective sleep quality and cognition. Conclusion Poorer actigraphy-measured sleep quality rather than sleep duration was associated with worse executive function, verbal learning and global cognition among middle-aged Black and White men and women. Sleep quality is important for cognitive health in midlife. Support (If Any)

Blood pressure (BP) is an inherently dynamic risk factor that can vary over time. Rather than representing random fluctuations, visit-to-visit BP variability is a reproducible measure that is associated with heart failure (HF). We tested the hypothesis that visit-to-visit BP variability was

Introduction: African Americans (AAs) have among the highest prevalence of type 2 diabetes in the U.S. Research has shown that positive affect and supportive networks are associated with better health outcomes and may improve regulation of physiological processes. We examined the extent to which psychosocial resources were protective of diabetes outcomes among a sample of 5,306 AAs. Hypothesis: Psychosocial resource measures are inversely associated with prediabetes and diabetes [defined by hemoglobin (Hb)A1c categories] and prevalent diabetes (defined by self-report diabetes status and medication use). Methods: Using data from the Jackson Heart Study (JHS), we evaluated the cross-sectional associations of four psychosocial-resource indicators (social support, optimism, religiosity, social networks) with two diabetes outcomes [1) HbA1c categories: normal (HbA1c ≤ 5.7%), at risk/pre-diabetic (5.7% < HbA1c < 6.5%), diabetic (HbA1c ≥ 6.5%) and 2) prevalent diabetes (vs. no diabetes)]. For each psychosocial-resource measure, we created high vs. low categories (median split) and continuous standard deviation (SD) units. Associations with HbA1c categories were examined using multinomial logistic regression to estimate odds ratios (OR 95% confidence interval-CI) of pre-diabetes (vs. normal) and diabetes (vs. normal). Associations with prevalent diabetes were examined using Poisson regression to estimate prevalence ratios (PR 95% CI) of diabetes (vs. no diabetes). Models adjusted for demographics, SES, waist circumference, health behaviors, and depression. Results: Participants with diabetes reported fewer psychosocial resources than those with pre-diabetes and normal HbA1c ( p social support was associated with an 11% lower odds of pre-diabetes (vs. normal HbA1c) (OR 0.89, 95% CI 0.81-0.99). High (vs. low) religiosity was associated with an increased odds of diabetes (vs. normal Hba1c) (OR 1.29, 95% CI 1.01-1.64) after full adjustment. Optimism and social networks were only associated with lower diabetes prevalence after adjustment for demographics and education, respectively. Conclusion: With the exception of religiosity, psychosocial-resource measures were inversely associated with diabetes. Social support and social networks, especially, should be considered when addressing the reduction of diabetes burden among AAs.

Introduction: Long-term blood pressure variability (BPV) refers to fluctuation in BP that occur over weeks, months and years. BPV has been identified as a risk factor for the development of subclinical and clinical cardiovascular events independent of mean BP. However, little is known about the factors associated with long-term BPV. We hypothesized that long-term BPV will vary by demographic, behavioral, anthropometric, lab, and clinical factors. Methods: Using data from the CARDIA study – a longitudinal population based cohort study, we investigated whether baseline demographics (age, sex, race, education); behavioral factors (smoking, alcohol intake, physical activity); anthropometric measures (height, weight, body mass index - BMI); lab markers (total cholesterol, high density lipoprotein cholesterol - HDL-C, low density lipoprotein cholesterol – LDL-C, triglycerides, fasting blood glucose, glomerular filtration rate - GFR); and history of asthma are associated with different indictors of long-term BPV. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify within-individual long-term BPV from baseline to visit 9 across 30 years. A least absolute shrinkage and selection operator (lasso) linear regression was used to identify variables that may be associated with long-term BPV and multivariate linear regression models were used to assess magnitude of association. Results: Participants were 3,095 individuals who were not taking antihypertensive medication (mean age 24.6 years, 45.5% male and 56.9% white). Mean VIM was 8.5 mmHg (SD=3.7) for systolic and 7.1 mmHg (SD=3.2) for diastolic BP. Age, sex, race, education, physical activity, alcohol intake, pack-years of smoking, height, weight, triglyceride, LDL-C and asthma were potential correlates of VIM or CV of diastolic BP by the lasso model. In addition to those variables, total cholesterol, HDL-C, fasting glucose, and GFR were potential correlates of VIM or CV of systolic BP. Variables that significantly associated with VIM of systolic BP were: age (years) (β=0.11, p Conclusion: Identifying factors associated with long-term BPV can be useful to detect individuals who may be at a greater risk for future higher long-term BPV, which in turn is associated with greater cardiovascular risk.

We sought to determine whether sustained poverty is associated with change in body mass index (BMI, calculated as weight (kg)/height (m)(2)) among 4,762 black and white adults from the Coronary Artery Risk Development in Young Adults study. Household income in the prior year and current BMI were measured at 7 visits between 1990 and 2015. Sustained poverty was the proportion of visits during which household income was below 200% of the federal poverty level (range, 0%–100%). Sustained poverty and BMI were time-updated. Mean age in 1990 was 30 years. In adjusted linear mixed-effects models, every 10% increase in sustained poverty was significantly associated with faster BMI growth among white men (0.004/year, 95% CI: 0.001, 0.008) and white women (0.003/year, 95% CI: 0.000, 0.006), and slower BMI growth among black men (−0.008/year, 95% CI: −0.010, −0.005) and black women (−0.003/year, 95% CI: −0.006, 0.000). In other words, being always versus never in poverty from 1990 to 2015 was predicted to result in greater BMI gain by 1.00 unit and 0.75 units among white men and women and less BMI gain by 2.0 units and 0.75 units among black men and women, respectively. Sustained poverty was a predictor of changes in BMI with differential associations according to race.

Introduction: Optimal cardiovascular health (CVH), based on lifestyle and clinical factors, is associated with lower risk of CV events and this may occur partly by preventing progression of arterial stiffness. We assessed the association of optimal lifestyle and clinical factors with changes in arterial stiffness in the Multi-Ethnic Study of Atherosclerosis. Methods: Among 2,729 participants (aged 44-84 years, 46.5% male), number of optimal lifestyle factors (BMI 500 METS minutes/week) and optimal clinical factors (systolic BP Results: On average, DC decreased by 5.3% and YEM increased by 24.4% over ten years. Mean optimal lifestyle score was 10.2 (range: 0-19) and optimal clinical score was 9.1 (range: 0-15) across 5 visits. There was no difference in arterial stiffness progression between individuals in the upper quartiles of optimal lifestyle score and those in the lowest quartile. A higher score on optimal clinical factors was inversely associated with progression in arterial stiffness. Linear trends in the increase of DC (P-trend Conclusion: Optimal CVH was associated with less arterial stiffening, but only the clinical factors were predicting arterial stiffness and lifestyle factors had no influence on arterial stiffness.

Introduction: Whether trajectories in fasting glucose (FG) and insulin resistance (HOMA-IR) during young adulthood, before the onset of diabetes, are associated with cardiac function and structure in middle adulthood is unclear. Hypothesis: We tested the hypothesis that as compared to low-stable trajectory of FG and HOMA-IR, an increasing trajectory for each would be associated with worse cardiac structure and function in middle adulthood. Methods: We determined FG and HOMA-IR for 2,198 CARDIA participants, age 18-30 years, at baseline (1985-1986) and 7, 10, 15, 20, and 25 year follow-up exams who fasted for >8 hours and were not pregnant and were free from diabetes at all exams. At year 30 (2016), Doppler echocardiography and 2D-guided M-mode echocardiography was performed, measuring left atrial dimension, relative wall thickness, left ventricular (LV) mass, LV mass indexed to height, LV ejection fraction percentage, LV end-diastolic and systolic volume, and LV mass to volume ratio. Trajectories were determined using latent class analysis (SAS Proc Traj). We used multivariable linear regression to estimate adjusted means for echo measures according to FG and HOMA-IR trajectory group after adjustment for potential confounding factors. Results: For individuals free from diabetes in midlife, we identified three trajectory groups for both FG and HOMA-IR, low-stable to increasing, moderate-increasing, and high-increasing. Compared to low-stable trajectory for FG, increasing trajectory was associated with greater LV end-diastolic volume, whereas for HOMA-IR increasing trajectory was associated with lower LV end-diastolic volume ( Table ). Increasing FG trajectory was also associated with greater left atrial dimension, while HOMA-IR was not. Conclusion: Trajectory of both FG and HOMA-IR during young adulthood, in the absence of diabetes, was most prominently and differentially associated with LV end-diastolic volume. Future research should elaborate on differential associations of FG and HOMA-IR trajectory.

Background: Compared with normal BMI, overweight status (body-mass index [BMI] 25.0-29.9 kg/m 2 ) appears to be associated with greater longevity, but it is unclear to what extent this comes at the expense of greater burden of cardiovascular disease (CVD) and years lived with CVD. Methods: We pooled individual-level data from 10 prospective cohorts and included adults free from CVD, stratified by index age (20-39, 40-59, and 60-79 years). We used: (1) modified Kaplan-Meier analysis to estimate lifetime risks for CVD events and non-cardiovascular death; (2) Irwin’s restricted mean to estimate years lived free from and with CVD; and (3) adjusted competing Cox models to estimate joint cumulative risks for CVD or non-cardiovascular death. Results: The mean (SD) baseline BMI in middle-age (ages 40-59 years) was 27.4 (4.1) kg/m 2 for men and 27.1 (6.0) kg/m 2 for women. Through 72,490 person-years of follow-up, 13,457 CVD events (coronary heart disease, stroke, and heart failure; including 6,309 CVD deaths) and 11,782 non-CVD deaths occurred in middle-aged participants. Compared with normal BMI, lifetime risks for CVD were higher in overweight and obese adults. Average years lived free from CVD were longest for normal BMI individuals, whereas years lived with CVD were longer for overweight and obese (FIGURE) . Compared with middle-aged men and women, respectively, with normal BMI, competing hazards ratios (95% CI) for incident CVD were 1.21 (1.14-1.28) and 1.32 (1.24-1.40) for BMI 25.0-29.9; 1.67 (1.55-1.79) and 1.85 (1.72-1.99) for BMI 30-39.9; and 3.14 (2.48-3.97) and 2.53 (2.20-2.91) for BMI 40.0 and greater. Similar patterns were observed in younger and older adults. Conclusions: Compared with normal BMI, both overweight and obesity are associated with similar or shorter total longevity and more years of life lived with CVD. These data suggest that the “obesity/overweight paradox” present after the diagnosis of CVD occurs because of earlier onset of CVD.

Introduction: There is mounting evidence linking social support to restorative health processes and favorable cardiovascular risk profiles. However, observational studies have yielded inconsistent findings on the associations of social support networks with cardiovascular health in Hispanic/Latino adults with diabetes. We examined the cross-sectional associations of structural social support and traditional cardiovascular disease ( CVD ) risk factors in a diverse sample of Hispanic/Latino adults with diabetes. Hypothesis: Persons with lower indices of social support will have higher odds of adverse CVD risk factors. Methods: This analysis included 2,994 adult participants ages 18-74 with diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL—2008-2011). Select items from the Social Network Inventory were used to assess indices of structural social support, i.e., network size (number of children, parents, and in-laws) and frequency of familial contact. Standardized methods were used to measure diabetes and other CVD risk factors -- abdominal obesity, body mass index, hypertension, hypercholesterolemia, and smoking status. Multivariate regression was used to examine associations of structural support with individual CVD risk factors with demographics, acculturation, physical health, and psychological distress included as covariates. Results: There were no significant cross-sectional associations of structural support indices with abdominal obesity, hypertension, hypercholesterolemia, or smoking status. There was a marginally significant (OR: 1.05; 95% CI 1.00-1.12) trend toward higher odds of obesity in participants reporting a larger family unit (including children, parents, and in-laws) ( Table 1 ). Conclusions: Structural social support was marginally associated with higher odds of obesity in Hispanic/Latino adults with diabetes. Alternate forms of social support should be further explored as potential markers of cardiac risk in Hispanics/Latinos with diabetes.

Background: The associations of combined modifiable risk factors for incident diabetes (physical activity, television watching, dietary intake, sleep disordered breathing and smoking) are less well investigated in African Americans (AAs). Hypothesis: We hypothesized that an optimal modifiable lifestyle risk factor score would be inversely associated with incident diabetes among AAs. Design and Methods: Data on modifiable risk factors was collected by questionnaire at baseline (2000-2004) in a population-based sample of AAs in the Jackson Heart Study. Incident diabetes (fasting glucose ≥126 mg/dl, physician diagnosis, use of diabetes drugs, or HbA1c ≥ 6.5%) was assessed over 12 years, among adults without prevalent diabetes at baseline. Participants were excluded for missing data on baseline covariates or diabetes follow-up. Incidence rate ratios (IRR) were estimated using Poisson regression modeling adjusting for age, sex, education, current occupation status, systolic blood pressure and body-mass index. Modifiable lifestyle factors (regular exercise, healthy diet, smoking avoidance, lower amounts of television watching and low sleep disordered breathing burden) were combined in risk score categories of poor (0-3 points), average (4-7 points), optimal (8-11 points). Results: Among 3,252 adults (mean age 53.3 years, 64% female) there were 560 incident diabetes cases (median follow-up 7.6 years). An average or optimal compared to a poor modifiable lifestyle risk score was associated with a 21% (IRR 0.79, 95% CI: 0.62, 0.99) and 31% (IRR 0.69, 95% CI: 0.48, 1.01) lower risk of diabetes, respectively, in a monotonic fashion (p=0.03). Body-mass index (BMI) and glycemic status at baseline modified the association of lifestyle risk score with diabetes - among participants with BMI < 30 kg/m 2 , IRRs for average or optimal compared to poor categories were 0.60 (95% CI: 0.40, 0.91) and 0.53 (95% CI: 0.29, 0.97), respectively, compared to 0.90 (95% CI 0.67, 1.21) and 0.83 (95% CI: 0.51, 1.34) among participants with BMI ≥ 30 kg/m 2 . For participants with normoglycemia (normal fasting glucose and HbA1c) at baseline, the IRRs for average or optimal compared to poor categories were 0.64 (95% CI: 0.43, 0.96) and 0.57 (95% CI: 0.31, 1.04), respectively, compared to 0.90 (95% CI 0.69, 1.19) and 0.80 (95% CI: 0.52, 1.23) among participants with prediabetes at baseline. Conclusions: Modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, with greater effects among those with lower adiposity and normoglycemia. Lifestyle interventions to reduce obesity have focused on individuals with high BMI and/or prediabetes (high risk approach). Our study suggests that AAs at the lower end of the diabetes risk spectrum may derive significant long-term benefit from diabetes prevention strategies focused on the outlined modifiable lifestyle risk factors.

Introduction: Whether multiple unique trajectories in fasting glucose (FG) and insulin resistance (HOMA-IR) are present during young adulthood and if such trajectories are associated with cognitive function in middle adulthood is unclear. Hypothesis: We hypothesized that a high-increasing trajectory of FG and HOMA-IR in the absence of diabetes during young adulthood would be associated with lower level of cognitive function in midlife compared to a low trajectory. Methods: We studied 2,650 CARDIA participants, age 18 to 30 years (1985-1986) to determine FG and HOMA-IR at baseline and 7, 10, 15, and 20 year follow-up exams (≥ 8 hours fasting and not pregnant). Using latent class analysis (SAS Proc Traj), we determined trajectory groups for FG and HOMA-IR through year 20. Cognitive function was assessed at year 25 (2010-2011) with three cognitive tests including the Digit Symbol Substitution Test (DSST; a test of sustained attention, psychomotor speed, working memory, and executive function), Rey-Auditory Verbal Learning Test (RAVLT; verbal memory), and Stroop Test (executive function). We used multivariable linear regression to estimate adjusted means for each cognitive test according to trajectory group for both FG and HOMA-IR for individuals free from diabetes during follow-up, after adjustment for potential confounding factors. Results: We identified three trajectory groups for FG and HOMA-IR for individuals free from diabetes in middle adulthood, qualitatively low-stable to increasing, moderate-increasing, and high-increasing. Compared to the low FG trajectory group, the high FG trajectory group had significantly lower mean score for the RAVLT, shown in the Table . Otherwise, cognitive test scores generally did not differ according to FG or HOMA-IR trajectory group. Conclusion: In this community-based sample of individuals free from diabetes, a high-increasing FG trajectory through young adulthood was associated with worse memory in midlife.

Higher sedentary time (ST) and lower moderate-to-vigorous intensity physical activity (MVPA) have been independently associated with obesity, but most available studies are cross-sectional and measure ST and MVPA by self-report. It has also been suggested that obesity may predict future ST rather than ST leading to future obesity. Objective: To investigate whether objective ST and MVPA were associated with current and 5-year changes in body mass index (BMI) and waist circumference (WC). Methods: We analyzed 1,963 CARDIA participants (aged 38-50 years, 57% female, 41% black) with accelerometry data (≥4 days with ≥10 hr/day) in 2005-2006. BMI and WC were assessed concurrently and 5 years later. Linear regression evaluated cross-sectional and longitudinal associations between ST and MVPA with BMI and WC across all participants and in race/gender groups due to the presence of interactions. Standardized coefficients (β std ) reflect differences per each 1.7 hr/day increase in ST and each time MVPA increases by a factor of 2. Results: Average ST was 8.1 ± 1.7 hr/day and 21% met MVPA guidelines of 150 min/wk. During the 5 year follow-up, BMI and WC increased in all groups (Table, all p Conclusions: ST and MVPA were each associated with general and abdominal obesity cross-sectionally, but mostly did not predict 5-year changes in these outcomes. These findings do not support that lower ST and higher MVPA will curtail unfavorable gains in general and abdominal obesity over 5 years, but could result from a relationship where greater obesity leads to higher ST and inactivity.

Introduction: Long-term blood pressure variability (BPV) has been shown to be associated with target-organ damage independent of mean BP. However, little is known about the factors that determine long-term BPV. Reduced lung function is associated with incidence of hypertension and may also predict long-term BPV. Objective: To investigate the association between lung function and future long-term variability in systolic and diastolic BP among young adults. Methods: We used data from Coronary Artery Risk Development in Young Adults Study among 3318 participants (mean age 26.4 years, 35% Males at baseline). Lung function was measured by forced vital capacity (FVC - the amount of air that can be maximally and forcibly expelled from the lungs after a maximal inhalation) at years 0, 2, 5, 10, and 20. BPV was measured using: i) average real variability (ARV) - mean of the absolute differences in BP between successive visits and ii) standard deviation (SD) of BP from years 0 to 25. In separate multiple linear regression models, ARV and SD of systolic and diastolic BP were regressed on quartiles and continuous variables of baseline FVC and FVC change from peak value to year 10 value. Results: ARV and SD of systolic and diastolic BPs were significantly lower among participants with higher baseline FVC (quartiles 2, 3 and 4) as compared to those in quartile 1 after adjusting for mean BP and other confounders. Similarly, individuals who showed greater decline in FVC from peak to year 10 value (quartiles 3 and 4) showed significant higher ARV and SD of systolic and diastolic BPs as compared to those in quartile 1. Similar results were found when FVC was used as a continuous variable. There was significant trend in the association of long-term BPV with quartiles of baseline FVC and FVC change from peak to year 10 value (Table 1). Conclusion: Among young adults, lower baseline FVC and higher decline in FVC over time was associated with higher long-term BPV independent of mean BP. Deterioration in lung function seems to be an independent risk factor for long-term BPV.

Background: To assess the frequency and determinants of transitions between normal fasting glucose (NFG), prediabetes and diabetes in an African American cohort. Methods: We included participants from the Jackson Heart Study who attended the baseline exam (2000-2004) and at least one of two subsequent exams (2005-2008 and 2009-2013), and were not missing data (fasting glucose, hemoglobin A1c, diabetes medication) used classify the glycemic status of participants as NFG, prediabetes, and diabetes at each visit. Transitions were defined as progression (deterioration) or remission (improvement) of glycemic status. Two transitions were possible for those attending all 3 visits. A generalized multinomial logit model, accounting for repeated measures from individuals with 2 transitions as clusters, was used to estimate the odds ratios (OR) for remission versus stable and progression versus stable, adjusting for demographic, anthropometric, behavioral, and biochemical factors. Results: Among 3,316 participants (baseline mean age 55 years, 36% male, 32% with IFG, 24% with diabetes) with data on at least one consecutive transition, 58.5% remained in their baseline status, 32.5% experienced a progression, 3.0% a remission, and 6.1% both a remission and progression. Among those classified as NFG, prediabetes, and diabetes at baseline: 1) progression occurred among 59%, 39%, and 2%; and 2) remission occurred among 7%, 13%, and 7%, respectively. The average weight change between exams was +1.4 kg for those experiencing only a progression and -4.5 kg for those with only a remission. Subsequent analyses included 2171 with complete data for all covariates which included baseline age, sex, education, BMI, smoking, alcohol use, hypertension medication, systolic blood pressure, log(triglycerides), baseline diabetes status, change in weight and change in log(CRP) between visits. The outcome of remission was associated only with weight change. A 1 kg increment in weight change was associated with a reduced likelihood of remission (OR 0.97, 95%CI: 0.96 - 0.99, p Conclusions: In a contemporary adult African American population, transitions between glucometabolic statuses were frequent and most commonly involved deterioration. Weight changes between examinations were strongly associated with both remission and progression.

Introduction: Hypertension is strongly linked to obesity. Blood pressure variability (BPV), a novel BP phenotype with potential clinical significance, may also be associated with increased adiposity. We aimed to investigate the relationship between body fat distribution and average BP and BPV in the short- and long-term. Methods: Using data from the Dallas Heart Study, we assessed within-visit (short-term) and visit-to-visit (long-term) BPV (average real variability [ARV], defined as the average of absolute differences of BP between successive BP measures) during a 5-month follow-up period (2000-2002). Five BP measures were taken at each of the 3 visits (two in-office and one in-home survey). The associations of visceral (VAT) and abdominal subcutaneous adipose tissue (SAT) quantified by MRI and lower body subcutaneous fat (LBF) by DEXA with BP phenotypes were assessed using multivariable-adjusted linear regression. Results: 2595 participants with mean age 44 years; 54 % women; 68 % non-White; mean BMI 29 kg/m2, mean SBP 127 mmHg and DBP 79 mmHg were included. The short-term ARV of SBP at home and office, and long-term ARV of SBP over 3 visits were 4.0±2.4 mm Hg, 4.1±2.5 mmHg, and 9.8±7.1 mmHg, respectively. VAT, SAT, and LBF were not associated with short-term ARV of SBP, while higher VAT was associated with lower long-term ARV of SBP (Table). VAT was strongly associated with average SBP in the short- and long-term, while higher LBF was associated with lower average SBP in the short- and long-term. Conclusions: Greater VAT is associated with persistently higher short- and long-term average BP with lower variability over visits. The presence of persistently elevated BP, coupled with lower BPV, associated with visceral adiposity may impose higher cardiac workload and consequently increase cardiac hypertrophy and risk for heart failure.

Although overweight/obesity is a risk factor for ASCVD, it is not accounted for in the pooled cohort equations (PCE). It is unknown whether the performance of the PCE varies across body mass index (BMI) categories, which is a particularly important knowledge gap given the high prevalence of obesity

Introduction: The public health burden of obesity in the United States is well documented and obesogenic environments, including the neighborhoods in which individuals live, have emerged as important determinants of obesity risk. Studies examining the association between neighborhood context and obesity have primarily focused on the socioeconomic and built/physical environment and have been mostly cross-sectional. Objective: To investigate associations between neighborhood social environment and incident obesity and to determine if these associations are modified by gender. Methods: Study participants were enrolled in MESA from 2000-2002 and followed for an average of 9.5 years. Obesity was defined as body mass index of ≥30 kg/m 2 using weight and height measurement obtained at baseline and 4 follow-up examinations. Neighborhood social environment was assessed using a survey of area residents and MESA participants that asked them to rate their neighborhood (1-mile area surrounding the home) across dimensions of safety, social cohesion, and aesthetic quality. Cox proportional hazards models, with a robust covariance matrix estimator to adjust for clustering within neighborhoods, were used to test study hypotheses. Results: Among the 3965 participants free from obesity at baseline and with complete data on study covariates, the mean age was 62 (SD=10) and 508 participants developed obesity over the study follow-up. In multivariable models, there were significant associations between neighborhood social environment indicators (Table 1) and incident obesity among men, independent of individual and neighborhood-level confounders (age, gender, race/ethnicity, education, income, neighborhood socioeconomic factors, and neighborhood physical environment). No associations were present among women. Conclusion: Neighborhood-level risk factors are complex and future research is necessary to better understand the increased risk of obesity among men living in better neighborhood social environments.

Introduction: Research on the association between neighborhood environments and systolic blood pressure (SBP) is limited, predominantly cross-sectional, and has produced mixed results. Investigating specific aspects of neighborhood environments in relation to changes in SBP may help to identify the most important interventions for reducing the population burden of hypertension. Hypothesis: Better neighborhood food, physical activity, and social environments will be associated with lower baseline levels of SBP and smaller increases in SBP over time. Methods: The Multi-Ethnic Study of Atherosclerosis recruited participants from six sites in the U.S., aged 45-84 (mean 59) and free of clinical cardiovascular disease at baseline. Those with non-missing data for key variables were included (N=5,997); the analytic sample was 52.5% female, 39.1% White, 27.3% Hispanic, 11.9% Black, and 21.7% Chinese, with median follow-up time of 9.2 years (IQR 4.5) and SBP measured at three or more exams for 91.3% of participants. SBP in subjects taking anti-hypertensive medication were replaced with multiply imputed estimates of unmedicated SBP, imputed at each exam. Summary measures of neighborhood food and physical activity environments incorporated survey-based scales (healthy food availability and walking environment) and GIS-based measures (density of favorable food stores and recreational resources). The summary measure of the social environment combined survey-based measures of social cohesion and safety. Neighborhoods were defined by a one-mile buffer around each participant’s home address. Linear mixed models were used to model associations of time-varying cumulative average neighborhood environmental summary measures with SBP over time, adjusting for individual-level covariates (demographics, individual- and neighborhood-level SES); models with and without adjustment for baseline SBP were used to evaluate associations of neighborhood environments with SBP trajectories. Results: In models mutually adjusted for all three neighborhood domains and covariates, living in a better physical activity environment was associated with lower SBP at baseline (-1.34 mmHg [95% CI: -2.24, -0.45] per standard deviation higher cumulative average physical activity summary score), while living in a better social environment was associated with higher SBP at baseline (1.00 mmHg [0.39, 1.63] per standard deviation higher); food environment scores were not associated with baseline SBP. After adjustment for baseline SBP, there was no association between any neighborhood environments and trajectories of SBP. Conclusions: Better food and physical activity environments were associated with lower baseline SBP, while better social environments were associated with higher baseline SBP. Neighborhood environments appear to have minimal direct effect on SBP trajectories.

Background: Physiologic adaptations occurring across successive pregnancies may increase the risk of adverse cardiovascular health outcomes in later life. Previous studies have found an association between higher parity and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS and higher birth rates than non-Hispanic women. Hypothesis: We assessed the hypothesis that higher parity is associated with the prevalence of components of the MetS in a cohort of Hispanic/Latina women. Methods: There were 9,482 Hispanic/Latina women of diverse backgrounds, aged 18-74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from 2008-2011. Components of the MetS were defined according to the AHA/NHLBI criteria and included abdominal obesity (waist circumference ≥88cm), elevated triglycerides (≥150 mg/dL), low HDL cholesterol ( Results: At HCHS/SOL baseline, women reported none (19.2%), one (18.9%), two (25.3%), three (19.7%), four (9.3%), and five or more (7.6%) prior live births. Compared to women with only one live birth, women with four live births had the highest odds of abdominal obesity (OR=2.5, 95% CI 1.8, 3.3) and those with five or more live births had the highest odds of low HDL cholesterol (OR=1.5, 95% CI 1.2, 1.9), elevated glucose (OR=1.8, 95% CI 1.3, 2.3), elevated triglycerides (OR=1.4, 95% CI 1.01, 1.8), and high blood pressure (OR=1.5, 95% CI 1.1, 2.0), after adjusting for age, Hispanic background, education, marital status, income, nativity, smoking, physical activity, menopause status, oral contraceptive use, hormone replacement therapy, and field center. Further adjustment for body mass index attenuated these associations for all MetS components, including abdominal obesity (OR=1.5, 95% CI 1.1, 2.2), low HDL cholesterol (OR=1.3, 95% CI 1.03, 1.7), and elevated glucose (OR=1.6, 95% CI 1.2, 2.1), but the associations for triglycerides and blood pressure were no longer statistically significant. Conclusion: Higher parity is associated with the prevalence of selected components of the MetS among U.S. Hispanic/Latina women. High parity among Latinas with a high prevalence of abdominal obesity suggests a context of high risk for metabolic dysregulation. A better characterization of the links between pregnancy, adiposity, and body fat distribution is needed.

Diabetes prevalence is rising rapidly, and diabetes disproportionately affects Hispanics and other underserved groups. Chronic stress may contribute to diabetes risk, but few studies have examined this relationship in U.S. Hispanics. We examined associations of chronic stress with fasting glucose, glucose tolerance, and glycosylated hemoglobin (HbA1c) in Hispanics without diabetes, and also assessed indirect effects of stress through inflammation (CRP). Participants were 3,923 men and women, aged 18-74, without diabetes, from the four U.S. field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary study. Participants completed a measure of chronic life stress and a physical exam with oral glucose tolerance test. In a multivariate regression analysis with adjustment for demographic and health covariates, higher chronic stress was related to higher fasting glucose (standardized regression coefficient: β = .09, p .01), postload glucose (β = .07, p .05), and HbA1c levels (β = .08, p .01). However, there was no indirect effect of stress through inflammation. Findings suggest that higher chronic stress is associated with poorer glucose regulation in Hispanics, prior to the onset of a clinical diabetes diagnosis.

Lipoprotein changes often precede incident type 2 diabetes and may be diabetogenic, but effects of lipid-lowering medications, ethnicity and sex on these associations are unclear. In the Multi-Ethnic Study of Atherosclerosis, among 5636 men and women, ages 45-84, without baseline diabetes or CVD, 694 diabetes cases were identified during mean follow-up of 7.7 years. NMR spectroscopy was used to measure lipoprotein particle concentrations and size, including a calculated lipoprotein-related insulin resistance score (LP-IR), on baseline plasma. Analyses were stratified by baseline lipid-lowering medication (primarily statin) use, as “untreated” (n=4816) or “treated” (n=820), and by glucose 1.5, p

Background: Nonalcoholic Fatty Liver Disease (NAFLD) and excess visceral adipose tissue (VAT) are associated with cardiovascular disease (CVD). Recent studies suggest that NAFLD and coronary artery calcification (CAC) are related independent of VAT. In a population-based cross-sectional sample of black and white adults free from prevalent liver or heart disease, we tested the hypothesis that NAFLD is associated with the presence of CAC and abdominal aortoiliac calcification (AAC) independent of VAT and other CVD risk factors. Methods: Participants from the Coronary Artery Risk Development in Young Adults study (Y25 exam) with concurrent computed tomography quantification of liver fat, CAC and AAC were included (n=2,163). NAFLD was defined as liver attenuation ≤ 40 Hounsfield Units after exclusion of other causes of liver fat (medication/alcohol use). Using the Agatston method, CAC/AAC presence was defined as a score > 0. Logistic regression models were used to calculate odds ratios and 95% confidence intervals. Results: Participant age was 49.9 (3.7) years and the sample was equally distributed by sex (55.6% female) and race (50.1% black). Mean BMI was 30.6 (7.1). The CAC and AAC prevalence was 26.5% and 49.6%. NAFLD prevalence was 9.6%. NAFLD participants were 50.1 (3.7) years old and more likely to be male (59.8% vs. 51.7%, p Conclusion: In contrast to prior studies, our results suggest that the relationship between NAFLD and subclinical CVD is mediated by the presence of other CVD risk factors.

Background: Few studies have examined GWAS (Genome-Wide Association Study) SNP associations in subgroups because there is limited power in single studies. To better understand the association of GWAS SNPs with incident T2D in normal weight and overweight/obese individuals, we examined the association of rs7903146 in TCF7L2 with incident T2D in three pooled prospective cohorts. We hypothesize the association with rs7903146 will be stronger in normal weight T2D than in overweight T2D. Methods: African Americans and Whites in the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of diabetes at the first study visit and had rs7903146 genotyping were included in the analysis. Incident T2D was ascertained based on fasting glucose ≥ 126 mg/dl, or self-report of diabetes medication use at subsequent study visits. Normal weight T2D was designated in participants with BMI < 25 kg/m2 and overweight/obese T2D was designated in participants with BMI ≥ 25 kg/m2 at the time of T2D ascertainment. Multinomial logistic regression was used to calculate odds ratios for incident normal weight and overweight/obese T2D compared to no T2D by rs7903146 genotypes. Results: In the pooled cohort of 18,037, over a follow-up time ranging from 7-21 years, there were 1857 incident cases of T2D: 179 normal weight and 1678 overweight/obese. rs7903146 allele frequencies and estimated odds ratios were similar in Africans Americans and Whites, so combined analyses are presented. Each copy of the T (minor) allele of rs7930146 was associated with 1.17 (95% C.I. =1.08-1.26, p=.00005) greater odds of incident T2D in the entire combined cohort. Each copy of the T allele was associated with a 1.29 greater odds of incident normal weight T2D (95% C.I. = 1.03-1.61, p = .025) and a 1.15 greater odds of incident overweight/obese T2D (95% C.I. = 1.06-1.25, p = .0004). A stronger association of rs7903146 with incident normal weight T2D was consistently observed across all three cohorts and both racial groups. However, the strengths of associations for the two weight groups were not significantly different (p > .05), although, in this exploratory analysis, we had only 12% power to detect a significant difference given the observed odds ratio between these two groups in multinomial analyses. Discussion: In this analysis, the effect size for the association of SNP rs7903146 appeared stronger in normal weight than overweight/obese T2D but the OR were not significantly different; GWAS variants may have stronger effects on T2D risk in normal weight individuals. The effect size for rs7903146 was smaller than observed in large case-control diabetes GWAS, possibly due to our prospective study design and our exclusion of many earlier-onset cases, which were prevalent cases of diabetes at the MESA and ARIC baseline exams.

Background: Sedentary behaviors such as television viewing or “playing games on the computer” are associated with obesity and increased cardiovascular risk. Little is known about the relationship between sedentary behaviors and adverse social contexts, particularly discriminatory experiences. Objective: To explore the cross-sectional relation of sedentary behavior and adverse social contexts in a large sample of middle-aged black and white men and women. Methods: Participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study with measures of discriminatory experiences and sedentary behaviors from the Year 25 exam in 2010 were included in the analysis (n=3,267). Participants were coded as experiencing discrimination if they responded yes to feeling discrimination based on gender, race, SES, or weight. The primary outcome variable, sedentary behavior, was defined by self-report as the overall number of hours per week spent in 6 behaviors: watching television, using the computer for non-work activities, listening to music, reading, talking on the phone, or texting. Linear regression was used to model the association of discrimination with sedentary time adjusted for age, race, gender, education and traditional CHD risk factors. Results: Participants were 50.2 years old (SD= 3.6), average time spent in sedentary behavior was 6.95 hrs/ day (SD=3.7), and 55% of the participants reported 1+ discriminatory experiences. In the full sample, there was a marginally significant positive relationship between discriminatory experiences and sedentary behavior (β=0.27, SE=0.3, p=.06), whereby participants who reported discrimination spent more time in sedentary behavior than those who did not report discrimination independent of demographic and traditional cardiovascular risk factors. Black participants spent more time sedentary than White participants (8.33 (SE=4.16) hrs/day vs. 5.78 (SE=2.75) hrs/day; p Conclusions: The association of discriminatory experiences with sedentary behaviors was only present among White participants in the study. Future research should investigate other psychosocial factors that may be negatively associated with sedentary behaviors among Black Americans.