Search

Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown.Determine the competing risk for the first cardiovascular event by subtype in Black and White men and women with prediabetes and diabetes.Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF, and non-cardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk (aHR) of ASCVD, HF, and non-cardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors.In 40,117 participants with 638,910 person-years of follow-up, 5,781 cases of incident ASCVD and 3,179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as first event was higher than HF in White men (35.4% vs. 11.6%), Black men (31.6% vs. 15.1%), and White women (24.3% vs 17.2%), but not in Black women (26.4% vs 28.4%). Within each group, aHR of ASCVD and HF was significantly higher in adults with diabetes compared with adults with normal FPG. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes.Black women with diabetes are more likely to develop HF as their first CVD event, while individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform tailoring primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.

Background: Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities. Methods: In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0–14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. Results: Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P P P Conclusions: Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.

PURPOSE: Movement behaviors (i.e. physical activity [PA], sedentary behavior [SB], and sleep) are intrinsically codependent, an issue resolved using compositional data analysis (CoDA). High-sensitivity C-reactive protein (hs-CRP) is a nonspecific inflammatory marker positively associated with cardiovascular diseases and affected by movement behaviors. Examine the relation between movement behaviors using CoDA and how time reallocation between two movement behaviors was associated with hs-CRP concentration. METHODS: The Jackson Heart Study was designed to investigate cardiovascular disease risk factors among African American participants in the Jackson, MS area. PA and sleep were self-reported with SB calculated as the remaining time in the day. RESULTS: The median untransformed hs-CRP concentration was 0.28 mg·dL (−1) (interquartile range; 0.11, 0.61). Reallocating 15 minutes of PA with SB, the hypothetical change in log hs-CRP concentration was 0.08 mg·dL (−1) (95% CIs; 0.04, 0.11) greater than the average log hs-CRP concentration. Substituting 15 minutes of SB or sleep with PA was associated with a hypothetical change in log hs-CRP concentration difference of −0.05 mg·dL (−1) (−0.08, −0.03) and −0.06 mg·dL (−1) (−0.08, −0.03), respectively. Reallocations between SB and sleep were not associated with the hypothetical difference in log hs-CRP concentration. CONCLUSIONS: Modeling estimates suggest replacing 15 minutes of SB with PA is associated with lower inflammation.

Background: Racial differences in cardiovascular disease (CVD) are likely related to differences in clinical and social factors. The relative contributions of these factors to Black-White differences in premature CVD have not been investigated. Methods: In Black and White adults aged 18 to 30 years at baseline in the CARDIA study (Coronary Artery Risk Development in Young Adults), the associations of clinical, lifestyle, depression, socioeconomic, and neighborhood factors across young adulthood with racial differences in incident premature CVD were evaluated in sex-stratified, multivariable-adjusted Cox proportional hazards models using multiply imputed data assuming missing at random. Percent reduction in the β estimate (log-hazard ratio [HR]) for race quantified the contribution of each factor group to racial differences in incident CVD. Results: Among 2785 Black and 2327 White participants followed for a median 33.9 years (25th–75th percentile, 33.7–34.0), Black (versus White) adults had a higher risk of incident premature CVD (Black women: HR, 2.44 [95% CI, 1.71–3.49], Black men: HR, 1.59 [1.20–2.10] adjusted for age and center). Racial differences were not statistically significant after full adjustment (Black women: HR, 0.91 [0.55–1.52], Black men: HR 1.02 [0.70–1.49]). In women, the largest magnitude percent reduction in the β estimate for race occurred with adjustment for clinical (87%), neighborhood (32%), and socioeconomic (23%) factors. In men, the largest magnitude percent reduction in the β estimate for race occurred with an adjustment for clinical (64%), socioeconomic (50%), and lifestyle (34%) factors. Conclusions: In CARDIA, the significantly higher risk for premature CVD in Black versus White adults was statistically explained by adjustment for antecedent multilevel factors. The largest contributions to racial differences were from clinical and neighborhood factors in women, and clinical and socioeconomic factors in men.

There is limited examination about coronavirus disease 19 (COVID-19)-related food handling concerns and practices that cause chemical or microbial contamination and illness, particularly among those with food insecurity. We investigated consumer food handling concerns and practices during the COVID-19 pandemic and whether they differed by food insecurity status. An online survey was distributed among Chicago, IL, residents between 15 July and 21 August 2020 (n = 437). Independent t tests and Fisher's exact tests were used to identify differences in food handling concerns and practices between those with and without food insecurity (alpha = 0.05). Survey items included questions about food handling practices that were considered safe or neutral (i.e., washing hands and produce with water, sanitizing food packaging) and unsafe (i.e., using cleaning agents to wash foods, leaving perishable foods outside) by using 5-point Likert-style scales or categorical responses (i.e., yes, no). Participant responses fell between "slightly" and "somewhat" concerned about contracting COVID-19 from food and food packaging (mean ± standard error [SE]: 2.7 ± 0.1). Although participants reported washing their hands before eating and before preparing foods at least "most of the time" (mean ± SE: 4.4 ± 0.0 and 4.5 ± 0.0, respectively), only one-third engaged in unsafe practices. The majority of participants (68%) indicated that they altered food handling practices due to the COVID-19 pandemic and received information about food safety from social media (61%). When investigating differences in concerns and practices by food insecurity status, food insecure participants were more concerned about COVID-19 foodborne transmission for all food items (all P0.001) and more frequently performed unsafe food handling practices than those with food security (all P0.001). Results from this study suggest more investigation is needed to understand barriers to safe food handling knowledge and practices, particularly among those with food insecurity.

Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use.We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension.Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting.1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016).Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications.At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption.These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.

Background: Average lifetime risk for heart failure (HF) is high but differs significantly across and within sex-race groups. No models for estimating long-term risk for HF exist, which would allow for earlier identification and interventions in high-risk subsets. The authors aim to derive 30-year HF risk equations. Methods: Adults between the ages of 20 to 59 years and free of cardiovascular disease at baseline from 5 population-based cohorts were included. Among 24 838 participants (55% women, 25% Black based on self-report), follow-up consisted of 599 551 person-years. Sex- and race-specific 30-year HF risk equations were derived and validated accounting for competing risk of non-HF death. HF was based on a clinical diagnosis. Model discrimination and calibration were assessed using 10-fold cross-validation. Finally, the model was applied to varying risk factor patterns for systematic examination. Results: The rate of incident HF was 4.0 per 1000 person-years. Harrell C statistics were 0.82 (0.80–0.83) and 0.84 (0.82–0.85) in White and Black men and 0.84 (0.82–0.85) and 0.85 (0.83–0.87) in White and Black women, respectively. Hosmer-Lemeshow calibration was acceptable, with χ 2 2 , risk was estimated to be 22.8% in a Black man, 13.7% in a White man, 13.0% in a Black woman, and 12.1% in a White woman. Conclusions: Sex- and race-specific equations for prediction of long-term risk of HF demonstrated high discrimination and adequate calibration.

AIMS/HYPOTHESIS: Type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) are prevalent diseases of metabolic origin. We examined the association between NAFLD and the development of type 2 diabetes among non-Asian adults, and whether the association differs by race. METHODS: We analysed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort study. Participants underwent non-contrast abdominal computed tomography (CT) at baseline (2010–2011) and assessment of glucose measures at the follow-up exam (2015–2016). NAFLD was defined as liver attenuation ≤51 Hounsfield units on CT images after exclusion for other liver fat causes. Race was self-reported. We used targeted maximum likelihood estimation (TMLE) with machine-learning algorithms to estimate difference in type 2 diabetes risk between the NAFLD and non-NAFLD groups. RESULTS: Of the 1995 participants without type 2 diabetes at baseline (mean age±SD, 50.0±3.6 years; 59% women; 55.0% White and 45.0% Black), 21.7% of White and 16.8% of Black participants had NAFLD at baseline, and 3.7% of White and 8.0% of Black participants developed type 2 diabetes at follow up. After multivariable adjustment, risk difference for type 2 diabetes associated with NAFLD vs no NAFLD was 4.1% (95% CI 0.3%, 7.9%) among White participants and −1.9% (95% CI −5.7%, 2.0%) in Black participants. CONCLUSIONS/INTERPRETATION: NAFLD was associated with a higher risk of type 2 diabetes among White participants but not among Black participants. This finding suggests that the effect of liver fat on impaired glucose metabolism may be smaller in Black than in White individuals.

Introduction: The WHO Physical Activity Guidelines recommend at least 2 days of resistance training (RT) per week. RCTs have shown a dose-response between RT volume and improving blood pressure, lipids, and markers of glycemia. There is discordance between the Guidelines recommending a frequency while empirical evidence supports a volume. Our objective was to test whether RT Guidelines and volume were associated with lower mortality. Methods: Data are from the 1999–2006 NHANES cycles. Participants self-reported past 30 days of physical activity including type, which was used to assign METs, number of sessions, and average session duration in minutes. Those who reported engaging in RT (push-ups, sit-ups, and weightlifting) with no missing data were included ( N =1,391). RT volume was measured in monthly MET-minutes, calculated as the product of the number of sessions, mean session duration, and intensity. Mortality was ascertained from the linked National Death Index through the end of 2019. Covariates included monthly aerobic physical activity volume, sex, age, and education. Cox proportional hazards regression was used to estimate hazard ratios for all-cause mortality by RT Guideline adherence and RT volume. Results: Participants had a mean age of 41.3±16.3 years and were mostly male (62.7%). Most participants met the Guidelines ( n =1,041, 74.8%). The mean monthly RT volume was 2,210±2,550 MET-minutes. Mortality incidence was 11.4% with a mean follow-up time of 189±41.6 months (159 events, 263,585 total person-months). Neither meeting the Guidelines nor monthly RT volume was associated with all-cause mortality (Table 1.). There was no evidence of effect modification by sex or age. Conclusions: According to these findings, current Guidelines promoting RT for health benefits are not supported by empirical data. However, the absence of an association between monthly RT volume and all-cause mortality warrants further investigation using better instrumentation for assessing RT volume.

Introduction: Circulating branched chain amino acid (BCAA) levels are associated with the development of diabetes mellitus (DM) and downstream ASCVD in middle-aged women. It is unknown if BCAAs in young adult men and women are associated with ASCVD events. BCAA levels may be dynamic in middle-aged adults prior to the development of DM or ASCVD events, thus cumulative BCAA measures in early life may better quantify exposure risk than a single measure at mid-life. Methods: We measured plasma BCAA levels in 3110 Coronary Artery Risk Development in Young Adults study participants using nuclear magnetic resonance (NMR) at Years (y) 2, 7, 15, and 20. To minimize missingness bias, BCAA levels were imputed for the residual 1835 participants without NMR measures. Cumulative BCAA exposure from 19-40y of age was calculated as the area under the curve using a spline-based mixed-effects model to estimate subject-specific BCAA trajectories from 19-40y. Sex-specific associations between cumulative BCAA exposure and incident ASCVD events after 40y of age were assessed by multivariable (Table) Cox proportional hazards regression models including BCAA levels and fasting blood glucose (FBG) at age 40y and further stratified by DM status. Results: Among 4945 participants (55.3% female), there were 255 ASCVD events and 675 DM cases over a median of 18.8 years of follow-up after age 40y. In adjusted models, cumulative BCAA exposure from 19-40y was associated with ASCVD events after 40y of age in women, but not men (Table). The associations in women were robust to adjustment for BCAAs and FBG at age 40y. There was no significant difference in the cumulative BCAA-ASCVD association among men or women who developed DM before ASCVD versus those who did not. Conclusions: Cumulative BCAA exposure in early adulthood is associated with ASCVD in women independent of mid-life BCAA levels. Elevated BCAA levels in women during early adulthood may reflect behaviors and/or metabolic pathways that increase risks for ASCVD independent of the development of hyperglycemia.

Background: Restless Legs Syndrome (RLS) is a neurological condition characterized by uncomfortable sensations in the legs at rest that leads to sleep disruption and impaired quality of life. Correlates of RLS in prior studies are inconsistent but include many correlates of cardiovascular disease (CVD) risk factors. The objective of our study is to describe the burden and correlates of RLS in an epidemiological study of middle-aged adults. Methods: Participants in the CARDIA study completed the Cambridge-Hopkins RLS questionnaire between 2020-2022. Sociodemographic characteristics, cigarette smoking, physical activity, alcohol intake, depressive symptoms, parity and menopausal status were determined based on self-report. Waist circumference, body mass index (BMI) and blood pressure were measured using standard procedures. Serum glucose and creatinine were measured in fasting samples. A spot urine collection was used to determine urinary albumin and creatinine. Hypertension and diabetes were determined based on current clinical guidelines. We carried out univariate and multivariable logistic regression modeling to identify correlates associated with RLS. Results: In 2337 CARDA participants (44% Black and 60% female) with a mean age of 55.2 years old (SD=3.6), 120 (5.5%) participants (white women=78, black women=12, white men=26 and black men=4) endorsed symptoms of RLS. White participants and females were significantly more likely to endorse having RLS (Table). Health behaviors assessed in our study were not associated with RLS; however, the presence of diabetes and markers of adverse kidney function (i.e., serum creatinine, ACR) were associated with a higher odds of RLS and these associations persisted in a multivariable model. Conclusion: Metabolic disorders that lead to microvascular and peripheral nerve damage were associated with RLS in this sample. Future research should investigate whether RLS and peripheral neuropathy are overlapping conditions.

Background: Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities. Methods: In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results: Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p Conclusions: In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.

Introduction: Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC. Methods: In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years). Results: Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B). Conclusions: High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with high prevalence of cardiovascular disease and its risk factors. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of NAFLD in cross-sectional studies. However, the relationship between long-term CVH patterns in early adulthood and prevalence of NAFLD in midlife remains unknown. We aimed to assess these patterns. Methods: We used data from participants (18-30 years at baseline) of the CARDIA study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by non-contrast computed tomography (CT) at year 25 follow up. Group-based trajectory modeling was used to create CVH trajectories, according to American Heart Association definitions, from baseline through follow-up year 20. NAFLD was defined as liver attenuation of < 51 HU after exclusions. Dichotomous logistic regression was used to examine associations of baseline CVH scores (n=2618) or CVH trajectory group (n=2529) and prevalence of NAFLD at year 25. Results: At baseline, 39% of 2618 participants had high and 5% had low CVH, respectively. At year 25, NAFLD prevalence was 23% (n = 609). At year 25, compared to those without NAFLD, participants with NAFLD were more likely be male (54.2% vs. 37.3%) and be a current smoker (27.1% vs. 21.7%) at baseline. Participants with low (HR = 3.24, 95% CI = 2.13, 4.95) and moderate (HR = 1.85, 95% CI = 1.50, 2.29) CVH scores at baseline were more likely to have a higher risk of prevalent NAFLD compared to participants with high CVH scores. Five distinct trajectories of CVH were identified. Lower and decreasing trajectories were associated with higher risk of prevalent NAFLD at year 25 compared to the high stable trajectory (Figure). Conclusion: Low CVH scores in young adulthood and low and decreasing CVH trajectories throughout early adulthood are associated with higher prevalence of NAFLD in midlife. Optimizing CVH in early adulthood is critical for lowering risk for prevalent NAFLD in midlife.

BACKGROUND Little attention has been paid to how well the American Heart Association's cardiovascular health (CVH) score predicts early‐onset diabetes in young adults. We investigated the association of CVH score with early‐ and later‐onset diabetes and with subsequent complications of diabetes. METHODS AND RESULTS Our sample included 4547 Black and White adults in the CARDIA (Coronary Artery Risk Development in Young Adults) study without diabetes at baseline (1985–1986; aged 18–30 years) with complete data on the CVH score at baseline, including smoking, body mass index, physical activity, diet quality, total cholesterol, blood pressure, and fasting blood glucose. Incident diabetes was determined based on fasting glucose, 2‐hour postload glucose, hemoglobin A1c, or self‐reported medication use throughout 8 visits for 30 years. Multinomial logistic regression was used to assess the association between CVH score and diabetes onset at age CONCLUSIONS Higher CVH score in young adulthood was associated with lower early‐ and later‐onset diabetes as well as diabetic complications.

Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1,148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000–2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis (LPA) revealed three psychosocial profile groups “Healthy”, “Distressed and Disadvantaged” and “Discriminated Against”. There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the “Distressed and Disadvantaged” profile were less likely to meet optimal HbA1c levels compared to individuals in the “Healthy” profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.

Background: Taking fewer than the widely promoted “10 000 steps per day” has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose–response relationship between steps per day and CVD can help inform clinical and public health guidelines. Methods: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance–weighted random effects models. Results: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, Conclusions: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician–patient communication and population health to reduce the risk of CVD.

Early life stress (ELS) is associated with increased morbidity and mortality across the lifecourse. Studies observing a relationship between ELS and stress physiology (cortisol), may help explain the connection to poor health outcomes, but have been limited by cortisol measures used.We examined the association between ELS measured by a Risky Family (RF) environment questionnaire, and adult diurnal cortisol profile inclusive of multiple cortisol measures.RF and cortisol were collected from Coronary Artery Risk Development in Young Adults Study participants at follow-up (Year 15). Complete case (n = 672) data were included in multi-variable regression analyses with log transformed cortisol measures (outcomes) including wake-up cortisol, cortisol awakening response [CAR], AUC and five other cortisol diurnal curve measures.Participants were age 39.9 + /- 3.7 years and 51.6% Black. For every 1 unit increase in RF, there was a 1.4% greater wake-up cortisol and flatter CAR after adjustment for age, sex, income, and smoking (B=0.014, p = 0.023; B=-0.014, p = 0.028, respectively). Each unit increase in caregiver warmth/affection was associated with a 6.9% higher (steeper) CAR (B=0.069, p = 0.03). Results remained significant after adjusting for other covariates except social support in adulthood. An interaction between child abuse and caregiver warmth was nearly significant (p = 0.068), such that for those with exposure to the greatest caregiver warmth and lowest child abuse, CAR was steepest CONCLUSIONS: We demonstrate that ELS is associated with altered cortisol regulation in adulthood. However, further research is needed to assess how healthy relationships throughout the life course may modulate cortisol regulation in adulthood.

BACKGROUND: Computed tomography (CT) imaging complements spirometry and may provide insight into racial disparities in respiratory health. OBJECTIVE: To determine the difference in emphysema prevalence between Black and White adults with different measures of normal spirometry results. DESIGN: Observational study using clinical data and spirometry from the CARDIA (Coronary Artery Risk Development in Young Adults) study obtained in 2015 to 2016 and CT scans done in 2010 to 2011. SETTING: 4 U.S. centers. PARTICIPANTS: Population-based sample of Black and White adults. MEASUREMENTS: Self-identified race and visually identified emphysema on CT in participants with different measures of “normal” spirometry results, calculated using standard race-specific and race-neutral reference equations. RESULTS: A total of 2674 participants (485 Black men, 762 Black women, 659 White men, and 768 White women) had both a CT scan and spirometry available for analysis. Among participants with a race-specific FEV(1) between 80% and 99% of predicted, 6.5% had emphysema. In this group, emphysema prevalence was 3.9-fold (95% CI, 2.1- to 7.1-fold; 15.5% vs. 4.0%) higher among Black men than White men and 1.9-fold (CI, 1.0- to 3.8-fold; 6.6% vs. 3.4%) higher among Black women than White women. Among participants with a race-specific FEV(1) between 100% and 120% of predicted, 4.0% had emphysema. In this category, Black men had a 6.4-fold (CI, 2.2- to 18.7-fold; 13.9% vs. 2.2%) higher prevalence of emphysema than White men, whereas Black and White women had a similar prevalence of emphysema (2.6% and 2.0%, respectively). The use of race-neutral equations to identify participants with an FEV(1) percent predicted between 80% and 120% attenuated racial differences in emphysema prevalence among men and eliminated racial differences among women. LIMITATION: No CT scans were obtained during the most recent study visit (2015 to 2016) when spirometry was done. CONCLUSION: Emphysema is often present before spirometry findings become abnormal, particularly among Black men. Reliance on spirometry alone to differentiate lung health from lung disease may result in the underrecognition of impaired respiratory health and exacerbate racial disparities. PRIMARY FUNDING SOURCE: National Institutes of Health.

BackgroundHispanic/Latino youth are disproportionately burdened by obesity and have a high prevalence of prediabetes and dyslipidemia. Differences in parent and child acculturation related to language use and preference (i.e., language acculturation) are associated with adverse cardiometabolic health behaviors, but no study has examined associations with cardiometabolic markers.PurposeTo determine whether discordance in parent–child language acculturation (parent–child acculturation gap) was associated with poor youth cardiometabolic health.MethodsHispanic/Latino 8–16-year-olds (n = 1,466) and parents from the Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) were examined. Mean scores for the Brief ARSMA-II’s Anglo (AOS) and Latino (LOS) Orientation Scales represented language acculturation. Cardiometabolic markers included youth body mass index (BMI) percentile, blood pressure percentiles, and dysglycemia and hyperlipidemia measures. Missing data were imputed. Survey-weighted multivariable linear regression examined the association of youth, parent, and youth × parent (the acculturation gap) AOS and LOS scores separately with each cardiometabolic marker.ResultsYouth reported greater English and lower Spanish use than parents. Greater discordance in AOS scores was associated with elevated BMI percentile only (p-for-interaction < .01). The LOS acculturation gap was not associated with any outcome. Adjustment for acculturative stress, family functioning and closeness, parenting style, and youth’s diet and physical activity did not alter findings. Removal of nonsignificant acculturation gaps did not indicate an association between individual youth or parent AOS or LOS scores and any cardiometabolic marker.ConclusionsDiscordance in Hispanic/Latino parent–child dyads’ English use may relate to increased risk for childhood obesity. Future studies should identify mediators of this association.

Background: Multisociety guidelines recommend a goal systolic blood pressure (BP) Methods: We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001–2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c. Results: Uncontrolled BP was present in 48% (95% CI, 49%–56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%–58%] compared with 47% [43%–51%], P Conclusions: We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF sample with significant differences in BP control by race and ethnicity.

Hypertrophic cardiomyopathy (HCM) is a global and relatively common cause of patient morbidity and mortality and is among the first reported monogenic cardiac diseases. For 30 years, the basic etiology of HCM has been attributed largely to variants in individual genes encoding cardiac sarcomere proteins, with the implication that HCM is fundamentally a genetic disease. However, data from clinical and network medicine analyses, as well as contemporary genetic studies show that single gene variants do not fully explain the broad and diverse HCM clinical spectrum. These transformative advances place a new focus on possible novel interactions between acquired disease determinants and genetic context to produce complex HCM phenotypes, also offering a measure of caution against overemphasizing monogenics as the principal cause of this disease. These new perspectives in which HCM is not a uniformly genetic disease but likely explained by multifactorial etiology will also unavoidably impact how HCM is viewed by patients and families in the clinical practicing community going forward, including relevance to genetic counseling and access to healthcare insurance and psychosocial wellness.

Introduction Chronic kidney disease (CKD) is greatly affected by social determinants of health. Whether low educational attainment is associated with incident CKD in young adults is unclear. Methods We evaluated the association of education with incident CKD in 3139 Coronary Artery Risk Development in Young Adults participants. We categorized education into low (high school and less), medium (college), and high (master’s and professional studies) groups. Incident CKD was defined as new development of estimated glomerular filtration rate (eGFR) Results At baseline, mean age was 35.0 ± 3.6 years, 47% were Black, and 55% were women. Participants with lower educational attainment were less likely to have high income and health insurance and to engage in a healthy lifestyle. Over 20 years, 407 participants developed CKD (13%). Compared with individuals with low educational attainment, those with medium and high educational attainment had an unadjusted hazard ratios for CKD of 0.79 (95% confidence interval [CI] 0.65–0.97) and 0.44 (95% CI, 0.30–0.63), respectively. This association was no longer significant after adjusting for income, health insurance, lifestyle, and health status. Low educational attainment was significantly associated with a change in eGFR in crude and adjusted analyses, although the association was attenuated in the multivariable models (low: –0.83 [95% CI, –0.91 to –0.75], medium: –0.80 (95% CI, –0.95 to –0.64), and high: –0.70 (95% CI, –0.89 to –0.52) ml/min per 1.73 m2 per yr). Conclusions Health care access, lifestyle, and comorbid conditions likely help explain the association between low educational attainment and incident CKD in young adults.

Fine particulate air pollution

Background: Whereas cardiovascular disease (CVD) metrics define risk in individuals >40 years of age, the earliest lesions of CVD appear well before this age. Despite the role of metabolism in CVD antecedents, studies in younger, biracial populations to define precise metabolic risk phenotypes are lacking. Methods: We studied 2330 White and Black young adults (mean age, 32 years; 45% Black) in the CARDIA study (Coronary Artery Risk Development in Young Adults) to identify metabolite profiles associated with an adverse CVD phenome (myocardial structure/function, fitness, vascular calcification), mechanisms, and outcomes over 2 decades. Statistical learning methods (elastic nets/principal components analysis) and Cox regression generated parsimonious, metabolite-based risk scores validated in >1800 individuals in the Framingham Heart Study. Results: In the CARDIA study, metabolite profiles quantified in early adulthood were associated with subclinical CVD development over 20 years, specifying known and novel pathways of CVD (eg, transcriptional regulation, brain-derived neurotrophic factor, nitric oxide, renin–angiotensin). We found 2 multiparametric, metabolite-based scores linked independently to vascular and myocardial health, with metabolites included in each score specifying microbial metabolism, hepatic steatosis, oxidative stress, nitric oxide modulation, and collagen metabolism. The metabolite-based vascular scores were lower in men, and myocardial scores were lower in Black participants. Over a nearly 25-year median follow-up in CARDIA, the metabolite-based vascular score (hazard ratio, 0.68 per SD [95% CI, 0.50–0.92]; P =0.01) and myocardial score (hazard ratio, 0.60 per SD [95% CI, 0.45–0.80]; P =0.0005) in the third and fourth decades of life were associated with clinical CVD with a synergistic association with outcome ( P interaction =0.009). We replicated these findings in 1898 individuals in the Framingham Heart Study over 2 decades, with a similar association with outcome (including interaction), reclassification, and discrimination. In the Framingham Heart Study, the metabolite scores exhibited an age interaction ( P =0.0004 for a combined myocardial–vascular score with incident CVD), such that young adults with poorer metabolite-based health scores had highest hazard of future CVD. Conclusions: Metabolic signatures of myocardial and vascular health in young adulthood specify known/novel pathways of metabolic dysfunction relevant to CVD, associated with outcome in 2 independent cohorts. Efforts to include precision measures of metabolic health in risk stratification to interrupt CVD at its earliest stage are warranted.

Objective Food insecurity is associated with consumption of phosphate additive-laden processed food and beverage products, which could result in higher levels of fibroblast growth factor 23 (FGF23) to compensate for the increased dietary phosphate load. We sought to determine whether food insecurity is associated with higher levels of FGF23. We stratified analyses by race since differences may occur between food insecurity and diet quality across races. Design and Methods The longitudinal community-based Coronary Artery Risk Development in Young Adults Study recruited from 4 US centers: Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA, during the cohort inception in 1985/1986. This analysis included 3,421 black and white participants from Coronary Artery Risk Development in Young Adults follow-up years 20, 25, and 30 who were enrolled in the study between the ages of 18 and 30 years. Econometric fixed effects models stratified by race that adjust by design for all time-invariant covariates were used to model the longitudinal association of food insecurity, defined as the self-reported ability to afford desired quantity and quality of food. The main outcome of interest was changing to the highest quartile of plasma FGF-23 concentrations. Results During follow-up, 29% of blacks and 14% of whites experienced change in food security. Developing food insecurity was associated with a 1.48 greater odds of increasing to the highest quartile of FGF23 (95% confidence interval 1.02-2.15) among blacks; however, there was no significant longitudinal association among whites (odds ratio = 1.14, 95% confidence interval 0.67-1.95). Conclusions Among blacks, food insecurity was associated with an increase in levels of FGF23. Although phosphate consumption was presumed to mediate the association between food insecurity and FGF23 levels, we were unable to directly test this pathway.

Introduction Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). It is unknown how substituting time in sedentary behavior with sleep or physical activity affects overall CVH. Methods Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis Sleep Ancillary Study. Eligible participants (N = 1718) wore Actiwatch accelerometers for 24 h and had at least 3 d of valid accelerometry. The American Heart Association's Life's Simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 min of sedentary time for an equivalent amount of sleep, light-intensity physical activity (LIPA), or moderate to vigorous physical activity (MVPA). Results Substituting 30 min of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β (95% confidence interval) = 0.077 (0.056), 0.039 (0.033), and 0.485 (0.127), respectively]. Substituting 30 min of sedentary time to sleep was associated with lower body mass index (BMI). Substituting 30 min of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Substituting 30 min of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI. Conclusions Sleep, LIPA, and MVPA are all associated with more favorable overall CVH and several key risk factors for cardiovascular disease. These findings underscore the importance of lifestyle modifications in improving CVH.

Objective:To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA.Design:Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression.Setting:São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.Participants:Adolescents (12–16 years) living in São Paulo (n 189) and USA (n 787).Results:ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99).Conclusions:Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.

ObjectiveTo test the hypothesis that end-stage renal disease (ESRD) risk exposure during young adulthood is related to worse cognitive performance in midlife.MethodsWe included 2,604 participants from the population-based Coronary Artery Risk Development in Young Adults (CARDIA) Study (mean age 35 years, 54% women, 45% Black). Estimated glomerular filtration rate and albumin-to-creatinine ratio were measured every 5 years at year (Y) 10 through Y30. At each visit, moderate/high risk of ESRD according to the Kidney Disease: Improving Global Outcomes guidelines (estimated glomerular filtration rate 2 or albumin-to-creatinine ratio >30 mg/g) was defined, totaled over examinations, and categorized into 0 episodes, 1 episode, and >1 episodes of ESRD risk. At Y30, participants underwent global and multidomain cognitive assessment. We used analysis of covariance to assess the association of ESRD risk categories with cognitive function, controlling for cardiovascular risk factors.ResultsOver the course of 20 years, 427 participants (16% of the study population) had ≥1 episodes of ESRD risk exposure. Individuals with more risk episodes had lower composite cognitive function (p < 0.001), psychomotor speed (p < 0.001), and executive function (p = 0.007). All these associations were independent of sociodemographic status and cardiovascular risk factors.ConclusionsIn this population-based longitudinal study, we show that episodes of decline in kidney function over the young-adulthood course are associated with worse cognitive performance at midlife. Preserving kidney function in young age needs to be investigated as a potential strategy to preserve cognitive function in midlife.

Adults with type 2 diabetes are at an increased risk of developing certain brain or mental disorders, including stroke, dementia, and depression. Although these disorders are not usually considered classic microvascular complications of diabetes, evidence is growing that microvascular dysfunction is one of the key underlying mechanisms. Microvascular dysfunction is a widespread phenomenon in people with diabetes, including effects on the brain. Cerebral microvascular dysfunction is also apparent in adults with prediabetes, suggesting that cerebral microvascular disease processes start before the onset of diabetes. The microvasculature is involved in the regulation of many cerebral processes that when impaired predispose to lacunar and haemorrhagic stroke, cognitive dysfunction, and depression. Main drivers of diabetes-related cerebral microvascular dysfunction are hyperglycaemia, obesity and insulin resistance, and hypertension. Increasing amounts of data from observational studies suggest that diabetes-related microvascular dysfunction is associated with a higher risk of stroke, cognitive dysfunction, and depression. Cerebral outcomes in diabetes might be itnproved following treatments targeting the pathways through which diabetes damages the microcirculation. These treatments might include drugs that reduce dicarbonyl compounds, augment cerebral insulin signalling, or imnprove blood-brain barrier permeability and cerebral vasoreactivity.

Background: A malignant subphenotype of left ventricular hypertrophy (LVH) has been described, in which minimal elevations in cardiac biomarkers identify individuals with LVH at high risk for developing heart failure (HF). We tested the hypothesis that a higher prevalence of malignant LVH among blacks may contribute to racial disparities in HF risk. Methods: Participants (n=15 710) without prevalent cardiovascular disease were pooled from 3 population-based cohort studies, the ARIC Study (Atherosclerosis Risk in Communities), the DHS (Dallas Heart Study), and the MESA (Multi-Ethnic Study of Atherosclerosis). Participants were classified into 3 groups: those without ECG-LVH, those with ECG-LVH and normal biomarkers (hs-cTnT (high sensitivity cardiac troponin-T) Results: Over the 10-year follow-up period, HF occurred in 512 (3.3%) participants, with 5.2% in black men, 3.8% in white men, 3.2% in black women, and 2.2% in white women. The prevalence of malignant LVH was 3-fold higher among black men and women versus white men and women. Compared with participants without LVH, the adjusted hazard ratio for HF was 2.8 (95% CI, 2.1–3.5) in those with malignant LVH and 0.9 (95% CI, 0.6–1.5) in those with LVH and normal biomarkers, with similar findings in each race/sex subgroup. Mediation analyses indicated that 33% of excess hazard for HF among black men and 11% of the excess hazard among black women was explained by the higher prevalence of malignant LVH in blacks. Of black men who developed HF, 30.8% had malignant LVH at baseline, with a corresponding population attributable fraction of 0.21. The proportion of HF cases occurring among those with malignant LVH, and the corresponding population attributable fraction, were intermediate and similar among black women and white men and lowest among white women. Conclusions: A higher prevalence of malignant LVH may in part explain the higher risk of HF among blacks versus whites. Strategies to prevent development or attenuate risk associated with malignant LVH should be investigated as a strategy to lower HF risk and mitigate racial disparities.

Background Inflammation is implicated as one of many factors related to the development of chronic disease; thus, identifying its modifiable risk factors offers potential intervention targets to reduce risk. Purpose To investigate whether depression and anxiety symptoms may indirectly affect high-sensitivity C-reactive protein (hs-CRP) and plasminogen activator inhibitor-1 (PAI-1) through sleep duration and adiposity (i.e., percentage body fat and waist circumference). Methods Multiple regression analyses were performed on Hispanic Community Health Study/Study of Latinos Youth (ages 8–16 years) cross-sectional baseline data, which were weighted to adjust for sampling design. Data were collected at a clinical assessment, including fasting blood samples, self-report surveys, and objectively measured anthropometrics. Results Adjusting for sociodemographic covariates, depression symptoms were associated with log hs-CRP (β = .011, p = .047) but not PAI-1 (p = .285). Percentage body fat and waist circumference were positively related to depression symptoms (p = .026 and p = .028, respectively) and log hs-CRP (p < .001 for both). When including adiposity in the hs-CRP model, the associations of depression symptoms with hs-CRP were attenuated and became nonsignificant. Monte Carlo confidence intervals (CIs) showed that the indirect effects from depression symptoms to CRP through percentage body fat (95% CI: .0006, .0119) and waist circumference (95% CI: .0004, .0109) were statistically significant. Conclusions Results indicate that the association between psychological distress and inflammation may occur indirectly through adiposity in Hispanic/Latino children. If findings are replicated in causal designs, reducing depression symptoms and adiposity among Hispanic/Latino children may be avenues for primary prevention of inflammation in later years.

Purpose Although social support has been shown to be associated with survival among persons with cardiovascular disease, little research has focused on whether social support, measured before the onset of heart failure, can enhance survival after diagnosis. The objective of this study was to assess the association between prediagnosis social support and postdiagnosis survival among older adults with heart failure. Methods We obtained the data from the Cardiovascular Health Study, which included noninstitutionalized adults aged 65 years or older from four sites in the United States with primary enrollment in 1989–1990. We used two measures of social support, the Lubben Social Network Scale and the Interpersonal Support Evaluation List. The analytic data set included 529 participants with a social support measure within two years before diagnosis of heart failure. Results After adjustment for demographic covariates, cardiovascular risk factors, and general health status, mortality rates were lower among participants in the highest tertile of social network scores (HR 0.74, 95% CI: 0.59, 0.93) and the middle tertile (HR 0.73 [0.58, 0.90]), compared with the lowest tertile. Results with interpersonal support were null. Conclusions These findings suggest that prediagnosis structural social support may modestly buffer heart failure patients from mortality.

Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index (BMI), is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study.1893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L (126 mg/dL), 2-h glucose on OGTT ≥11.1 mmol/L (200 mg/dL) (2010-11 only), HbAAlthough more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.

Background: Physical activity (PA) and lactation individually benefit cardiometabolic health. Joint associations of PA and lactation with cardiometabolic risk factors have not been described. Methods: We averaged PA across all attended exams and summed total lactation duration in 1,068 Black and White parous women who attended the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) examination. Two categories were created for PA (-PA: below median; +PA: ≥median) and lactation duration (-L: Results: Median PA=256 exercise units (IQR: 168-379), and 581 (54%) of participants reported cumulative lactation duration ≥3 months. Of the 1,068 participants, 303 were in the -PA/-L category, 231 in -PA/+L, 184 in +PA/-L, and 350 in +PA/+L. Participants in the +PA/+L category were older, had more years of education, lower BMI, gained less weight during follow-up, and were less likely to be Black versus the -PA/-L category. Mean cardiometabolic risk scores improved across categories and were not significantly different between -PA/+L and +PA/-L: -PA/-L: 0.23±0.04, -PA/+L: 0.08±0.04, +PA/-L: -0.02±0.05, +PA/+L: -0.23±0.03 all p≤0.08. After adjustment, +PA/+L assignment was associated with a lower (better) cardiometabolic risk score (β= -0.15, 95%CI: -0.25, -0.04) with no interactive effect of race, p=0.22. Associations were nonsignificant after accounting for 30-year change in BMI. Conclusions: Attaining above average PA combined with ≥3 months of lactation was associated with the most favorable cardiometabolic risk score in Black and White women. Participants who achieved either one of these behaviors had lower risk scores versus those with neither behavior. Attaining these levels of PA and/or lactation may reduce cardiometabolic risk in parous women due to less weight gain over time.

Background: Food insecurity (FI), the limited access to healthy and affordable food, is a social determinant of health that hinders blood pressure (BP) control in individuals with hypertension. Cross-sectional studies that examine this relationship do not allow for observations over time. We used longitudinal data on CARDIA Study participants with hypertension to examine the association between FI and BP control over 15 years. Methods: Generalized estimating equations were used to examine the association between FI and BP control across repeated observations on 605 participants with physician diagnosed and self-reported hypertension. Participants had some FI if they endorsed any of the following statements: “We have enough food to eat, but not always the kinds of food we want to eat”; “Sometimes we don’t have enough food to eat”; “Often we don’t have enough food to eat.” We estimated odds ratios (OR) and 95% confidence interval (CI) for control of systolic blood pressure (SBP) Results: FI was reported by 21.7% of study participants (N=131). FI was reported in Black participants (N=106), and women (N=89) most. Gender modified the association of FI with BP control, whereby food insecure women were less likely to control BP Table 1. Other interactions were not significant. Conclusions: Food insecure women had more difficulty with BP control than food insecure men. Explanations for the differential influence of FI on men and women should be studied so that targeted interventions can be developed.

Introduction: In 2017, the ACC/AHA revised the blood pressure (BP) guideline to lower the BP threshold for diagnosing and treating hypertension in older adults. Pharmacologic treatment is recommended for systolic BP (SBP) ≥130 mmHg in all older adults aged ≥65 years. Data on BP changes before and after publication of the guideline are needed to inform quality of care initiatives. Methods: We included participants from the Atherosclerosis Risk in Communities Study who attended a pre-guideline (2016-2017) and post-guideline (2018-2019) visit with a pre-guideline SBP between 120-159 mm Hg. We categorized participants based on their pre-guideline SBP according to the 2017 guideline: not reclassified to treatment (SBP 120-129), reclassified to stage 1 hypertension (SBP 130-139), or reclassified to stage 2 hypertension (SBP 140-159). To estimate the association of the 2017 guideline with SBP change, we performed a quasi-experimental analysis using difference-in-differences (DiD) regression. We compared changes in SBP between participants affected (SBP 130-139, 140-159) and those not affected (SBP 120-129) by the new SBP target, adjusted for traditional risk factors. Results: Of 2195 participants aged 71-94 years, mean (SD) SBP was 137.2 (10.8) mm Hg, and 77% were on antihypertensive therapy at the pre-guideline visit. Among participants with SBP ≥130 pre-guideline, 31% were at goal SBP Table ). Results were similar when stratified by sex and race. Conclusions: In a sample of community-based older adults, the post-guideline period was associated with significantly lower SBP in those reclassified to Stage 1 or Stage 2 hypertension. However, significant gaps exist in BP control and only a minority met the updated treatment goal.

Introduction: Body mass index (BMI) does not capture tissue composition and thus is unable to assess the contribution of each tissue type to cardiometabolic health. This limitation of BMI may explain the paradoxical association of BMI-weight status with mortality for those with type 2 diabetes (T2D), and merits investigation of individual tissues. We assessed the relationship between body composition and incident T2D and assessed for differences by BMI-weight status. We hypothesized that greater lean mass (LM) would be associated with lower risk for T2D for all BMI groups. Methods: Black and White participants from CARDIA without T2D in 2005-06 (baseline) were included in this longitudinal analysis ( N =2,473). LM and fat mass (FM) were assessed via dual-energy X-ray absorptiometry. Incident T2D was defined using American Diabetes Association cut points for fasting and post-load glucose, glycated hemoglobin, and diabetes medication use. We used Cox proportional hazards regression to estimate hazard ratios (HR) for incident T2D over 10 years according to 1-standard deviation (SD) increment in LM (1 SD=1g) and assessed for potential effect measure modification (EMM) of this association by weight status. We assessed a secondary exposure, LM:FM ratio, in relation to incident T2D. Results: Mean baseline age was 45.2±3.6 years (57% White and 57% female). The cumulative incidence of T2D was 7.2% (178 events, total person years=21,421.7). Before and after adjustment, neither LM nor LM:FM were significantly associated with T2D (Table), and we did not observe evidence for EMM by weight status for any association. Conclusions: LM in middle adulthood does not appear to be associated with T2D risk. Whether incorporation of data for other tissue depots is informative to T2D risk merits evaluation.

Introduction: Discrimination is a stressor often coped with through unhealthy behavioral responses that can lead to weight gain. Given that discrimination can be experienced by many different social groups, there is greater need to understand the role of discrimination and weight gain across racial and gender groups. This study assessed whether perceived lifetime discriminatory experiences are associated with weight and weight gain longitudinally among Black and White adults. Hypothesis: We hypothesized that greater self-reported perceptions of discrimination will be associated with greater weight and weight gain longitudinally, with greater lifetime discriminatory experiences among women and Black participants. Methods: Data from 2,906 adults (40.2 years of age; 45.2% Black; 56.8% female; 184.2 lbs.; 12.8% endorsing 3 or more domains of lifetime discrimination) from 2000-2001 (year 15) of the CARDIA study were included. Linear regression was used to examine the association between discrimination and weight cross-sectionally, and weight change between years 15 and 30 (2015-2016). Results: Black men (50.8%) and women (41.6%) reported racial discrimination as the most common form of discrimination they experienced (endorsed 3 or more domains), while White men (6.4%) and women (25.4%) reported SES and gender-discrimination as the most common form of discrimination they experienced, respectively. Racial and SES-discrimination were positively associated with weight, whereas racial-, gender-, SES-, or total lifetime discrimination were not associated with weight change (Table). Conclusion: Higher racial and class-based discrimination experiences were associated with higher weight, while longitudinal findings did not support our hypotheses. Given the more common experiences of perceived discrimination among women and Black participants, continued longitudinal studies into the pathways by which discrimination leads to weight gain in these groups early in life is vital.

PURPOSE: To describe maximal and submaximal cardiorespiratory fitness from early adulthood to midlife and examine differences in maximal fitness at age 20 and changes in fitness over-time by sub-categories of socio-demographic, behavioral, and health-related factors. METHODS: Data include 5,018 Coronary Artery Risk Development in Young Adults participants [mean (SD) age 24.8 (3.7) years, 53.3% female and 51.4% Black participants] who completed at least one maximal graded exercise test at baseline and/or the Year 7 and 20 exams. Maximal and submaximal fitness were estimated by exercise duration and heart rate at the end of stage 2. Multivariable adjusted linear mixed models were used to estimate fitness trajectories using age as the mechanism for time after adjustment for covariates. Fitness trajectories from ages 20 to 50 in 5-year increments were estimated overall and by sub-groups determined by each factor after adjustment for duration within the less favorable category. RESULTS: Mean (95% confidence interval) maximal fitness at age 20 and 50 years was 613 (607, 616) and 357 (350, 362) seconds; submaximal heart rate during this period also reflected age-related fitness declines [126 (125, 127) and 138 (137, 138) beats per minute]. Compared to men, women had lower maximal fitness at age 20 (p

BACKGROUND: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality. METHODS: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models. FINDINGS: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]). INTERPRETATION: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity. FUNDING: US Centers for Disease Control and Prevention.