Jackson Heart Study: A Perspective at Ten Years

Abstract

The Jackson Heart Study was established with the goal of reversing the epidemic of cardiovascular disease (CVD) in African Americans. CVD, encompassing both heart disease and stroke, is the leading cause of death and disability in the United States, and the CVD rate is higher in African Americans than whites. The prevalence of CVD is 45% in African American men, 47% in African American women, 38% in white men, and 34% in white women [1]. The disproportionately high rate of CVD in African Americans occurs even when socioeconomic and health insurance status are similar [2, 3]. To elucidate the reasons for the high CVD rate in African Americans, The Jackson Heart Study, modeled after the landmark Framingham Heart Study, was established. In 1948, the Framingham Heart Study began in Framingham, MA with the random enrollment of two thirds of the residents in this eastern Massachusetts town. The original cohort consisted of 5,209 men and women. More than 98% of the participants were white. The cohort was evaluated prospectively, and subsequent generations were added: the Offspring cohort in 1971 and the Third Generation cohort in 2002 (http://www.framinghamheartstudy.org). From this extensive, prospective, multigenerational database, clear and convincing evidence of the dangers of high blood pressure, high blood cholesterol, and smoking were established. Therefore, data from the Framingham Heart Study has had a significant impact on health and environmental policy in the United States. In addition, using the original and offspring cohorts, a risk score for the prediction of CVD has been established and is known as the Framingham Risk Score [4]. Yet, even with the Framingham Risk Score, CVD mortality remains significantly higher in African Americans than whites. Hence, the need for a longitudinal study of CVD specifically focused on African Americans is clear. To evaluate the epidemiology and pathophysiology of cardiovascular risk and disease in African Americans, the Jackson Heart Study began in 2000 in Jackson, MS. For several reasons, Jackson was an ideal location for a prospective study of CVD risk in African Americans. Mississippi has the highest rate of CVD in the nation [1]. Additionally, the African American community in Jackson was familiar with participation in prospective studies of CVD risk. Jackson residents had previously participated in the Atherosclerosis Risk in Communities (ARIC) study. The ARIC study was an investigation of the causes and progression of atherosclerosis. African Americans enrolled in ARIC were specifically recruited from Jackson. Therefore, from 1987 to 1988, 3,732 African Americans from Jackson aged 45 to 64 years participated in ARIC [5, 6]. The ARIC study not only established Jackson as a high-risk community, but also exposed the community to the benefits of clinical research. Therefore, the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD) chose Jackson as the site for the major prospective study of CVD in African Americans. The Jackson Heart Study was structured as a partnership between three institutions in Mississippi: the University of Mississippi Medical Center, Jackson State University, and Tougaloo College, with funding and active guidance from the NHLBI and NIMHD [7].