Definite Coronary Heart Disease Research Articles

Metabolomic Analysis of Coronary Heart Disease in an African American Cohort From the Jackson Heart Study

African American individuals have disproportionate rates of coronary heart disease (CHD) but lower levels of coronary artery calcium (CAC), a marker of subclinical CHD, than non-Hispanic White individuals. African American individuals may have distinct metabolite profiles associated with incident CHD risk compared with non-Hispanic White individuals, and examination of these differences could highlight important processes that differ between them. To identify novel biomarkers of incident CHD and CAC among African American individuals and to replicate incident CHD findings in a multiethnic cohort. This analysis targeted plasma metabolomic profiling of 2346 participants in the Jackson Heart Study (JHS), a prospective population-based cohort study that included 5306 African American participants who were examined at baseline (2000-2004) and 2 follow-up visits. Replication of CHD-associated metabolites was sought among 1588 multiethnic participants from the Women's Health Initiative (WHI), a prospective population-based multiethnic cohort study of 161 808 postmenopausal women who were examined at baseline (1991-1995) and ongoing follow-up visits. Regression analyses were performed for each metabolite to examine the associations with incident CHD and CAC scores. Data were collected from the WHI between 1994 and 2009 and from the JHS between 2000 and 2015. All data were analyzed from November 2020 to August 2021. Plasma metabolites. Incident CHD was defined as definite or probable myocardial infarction or definite fatal CHD in both the JHS and WHI cohorts. In the JHS cohort, silent myocardial infarction between examinations (as determined by electrocardiography) and coronary revascularization were included in the incident CHD analysis. Coronary artery calcium was measured using a 16-channel computed tomographic system and reported as an Agatston score. Among 2346 African American individuals in the JHS cohort, the mean (SD) age was 56 (13) years, and 1468 individuals (62.6%) were female. Among 1588 postmenopausal women in the WHI cohort, the mean (SD) age was 67 (7) years; 217 individuals (13.7%) self-identified as African American, 1219 (76.8%) as non-Hispanic White, and 152 (9.6%) as other races or ethnicities. In the fully adjusted model including 1876 individuals, 46 of 303 targeted metabolites were associated with incident CHD (false discovery rate q <0.100). Data for 32 of the 46 metabolites were available in the WHI cohort, and 13 incident CHD-associated metabolites from the JHS cohort were replicated in the WHI cohort. A total of 1439 participants from the JHS cohort with available CAC scores received metabolomic profiling. Nine metabolites were associated with CAC scores. Minimal overlap was found between the results from the incident CHD and CAC analyses, with only 3 metabolites shared between the 2 analyses. This cohort study identified metabolites that were associated with incident CHD among African American individuals, including 13 incident CHD-associated metabolites that were replicated in a multiethnic population and 9 novel metabolites that included N-acylamides, leucine, and lipid species. These findings may help to elucidate common and distinct metabolic processes that may be associated with CHD among individuals with different self-identified race.

Spatially Weighted Coronary Artery Calcium Score and Coronary Heart Disease Events in the Multi-Ethnic Study of Atherosclerosis.

A limitation of the Agatston coronary artery calcium (CAC) score is that it does not use all of the calcium density information in the computed tomography scan such that many individuals have a score of zero. We examined the predictive validity for incident coronary heart disease (CHD) events of the spatially weighted coronary calcium score (SWCS), an alternative scoring method for CAC that assigns scores to individuals with Agatston CAC=0. The MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study that conducted a baseline exam from 2000 to 2002 in 6814 participants including computed tomography scanning for CAC. Subsequent exams and systematic follow-up of the cohort for outcomes were performed. Statistical models were adjusted using the MESA risk score based on age, sex, race/ethnicity, systolic blood pressure, use of hypertension medications, diabetes, total and HDL (high-density lipoprotein) cholesterol, use of lipid-lowering medications, smoking status, and family history of heart attack. In the 3286 participants with Agatston CAC=0 at baseline and for whom SWCS was computed, 98 incident CHD events defined as definite or probably myocardial infarction or definite CHD death occurred during a median follow-up of 15.1 years. In this group, SWCS predicted incident CHD events after multivariable adjustment (hazard ratio=1.30 per SD of natural logarithm [SWCS] [95% CI, 1.04-1.60]; P=0.005); and progression from Agatston CAC=0 at baseline to CAC>0 at subsequent exams (multivariable-adjusted incidence rate difference per SD of natural logarithm [SWCS] per 100 person-years 1.68 [95% CI, 1.03-2.33]; P<0.0001). SWCS predicts incident CHD events in individuals with Agatston CAC score=0 as well as conversion to Agatston CAC>0 at repeat computed tomography scanning at later exams. SWCS has predictive validity as a subclinical phenotype and marker of CHD risk in individuals with Agatston CAC=0.

Prognosis of "pre-heart failure" clinical phenotypes.

BackgroundHeart failure (HF) is a clinical syndrome where diagnostic certainty varies. The prognosis of individuals with some clinical features of HF, but without the fully overt syndrome, is unclear. Therefore, we sought to evaluate their natural history.Methods and resultsBetween 1990 and 2009, all suspected HF cases in the Framingham Heart Study were adjudicated into 3 groups reflecting varying diagnostic certainty: definite (meeting HF diagnostic criteria; n = 479), possible (meeting HF criteria but with an alternative explanation for findings; n = 135), and probable (insufficient criteria for definite HF; n = 121) HF. Age-and-sex-matched individuals (n = 1112) without HF or cardiovascular disease (CVD) were controls. Using multivariable-adjusted Cox regression, we compared the possible/probable HF groups with controls regarding risk of incident definite HF, coronary heart disease (CHD), other CVD or death; and with definite HF regarding risk of latter three outcomes.During follow-up (mean 8.6 years), ~90% of individuals with possible, probable and definite HF experienced CVD events or died. Compared with controls, those with possible or probable HF experienced higher hazards for definite HF, CHD, other CVD and death (hazards ratios [HR] 1.35–9.31; p<0.05). The possible/probable groups did not differ from the definite HF group for risk of any outcome. Compared with the possible HF group, the probable HF group had a higher propensity for definite HF (HR 1.64, with a higher proportion of ischemic HF) but lower risk of death (HR 0.69).ConclusionsIndividuals meeting partial criteria for HF are at a substantial risk for progression to HF, CVD, and mortality.

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All-Cause Mortality inthe REGARDS Study.

BackgroundPreviously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all‐cause mortality in REGARDS participants with existing CHD.Methods and ResultsWe included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events—definite or probable MI or acute CHD death—and all‐cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant‐based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow‐up, there were 581 recurrent CHD events and 1098 deaths. In multivariable‐adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62–0.98; PT rend=0.036). The Southern dietary pattern was adversely associated with the hazard of all‐cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28–1.91; P Trend<0.001). The Mediterranean diet score was inversely associated with the hazard of all‐cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67–0.95; PT rend=0.014).ConclusionsThe Southern dietary pattern was associated with a greater hazard of all‐cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all‐cause mortality.

Associations between high levels of hostility and coronary heart disease in an open urban population among 25-64-year-old men

To establish the associations of the prevalence of coronary heart disease (CHD) with high levels of hostility in the open population of 25-64-year-old men in an average urbanized Siberian town. A cross-sectional epidemiological survey was conducted in a representative sample of the electorate of a Tyumen administrative district among 1000 males, with 250 being in each of 4 life decades (25-34, 35-44, 45-54, and 55-64 years). There were 850 (85%) responses. Different forms of CHD were identified by standard methods (the WHO exertional angina questionnaire, resting EEG, and Minnesota coding) used in epidemiological surveys. Definite CHD (DCHD) and possible CHD were identified. A continuous survey method was used by self-filling out the WHO MONICA-psychosocial questionnaire to estimate the levels of hostility. In an average urbanized Siberian town, the prevalence of high levels of hostility among 25-64-year-old men was 46.4% (age-adjusted rate). The high levels of hostility increased with age, peaking in the 55-64-year-old group. In the Tyumen male population aged 25-64-year-old, the odds ratio (OR) for coronary heart disease and high levels of hostility was 2.71; 95% confidence interval (CI), 1.63-4.52 (p<0.05); that for DCHD was almost twice higher (OR, 4.65; 95% CI, 2.14-10.12 (p<0.05). In the older men aged 55-64 years, OR for coronary heart disease and high levels of hostility was 5.42; 95% CI, 2.32-12.66 (p<0.05); that for DCHD was 25.85; 95% CI, 3.30-202.60 (p<0.05). Consequently, the epidemiological criteria for psychosocial risk factors, including hostility, which are detected by the standardized survey methods, should be used in prophylactic examinations of a male population and in the selection of able-bodied people with cardiovascular disease to be comprehensively examined and followed up.

Assessing Quality of Life and Medical Care in Chronic Angina: An Internet Survey.

BackgroundAngina is a clinical syndrome whose recognition relies heavily on self-report, so its identification can be challenging. Most data come from cohorts identified by physicians and nurses at the point of care; however, current widespread access to the Internet makes identification of community cohorts feasible and offers a complementary picture of angina.ObjectiveTo describe a population self-identified as experiencing chronic angina by use of an Internet survey.MethodsUsing email and an Internet portal, we invited individuals with a diagnosis of angina and recent symptoms to complete an Internet survey on treatment and quality of life (QOL). In total, 1147 surveys were received. The main analysis was further limited to those reporting a definite coronary heart disease (CHD) history (N=646, 56% of overall).ResultsOverall, about 15% reported daily angina and 40% weekly angina. Those with more frequent angina were younger, more often depressed, and reported a shorter time since diagnosis. They also had substantially worse treatment satisfaction, physical function, and overall QOL. Fewer than 40% were on ≥ 2 anti-anginals, even with daily angina. The subjects without a history of definite CHD had unexpectedly low use of antianginal and evidence-based medicines, suggesting either a lack of specificity in the use of self-reported angina to identify patients with CHD or lack of access to care.ConclusionsUse of inexpensive electronic tools can identify community-based angina cohorts for clinical research. Limitation to subjects with a definite history of CHD lends diagnostic face validity to the approach; however, other symptomatic individuals are also identified.

Abstract P080: The Combined Effect of Low Income and Low Education on Coronary Heart Disease Outcomes in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background: Low income (LoINC) and low education (LoED) have both been associated with higher coronary heart disease (CHD) risk, but few studies have examined the combined effects of both LoINC and LoED. Hypothesis: The combination of LoINC and LoED is more strongly associated with incident CHD than either LoINC and LoED, or neither. Methods: REGARDS recruited 30,239 black and white participants aged &gt; 45 years residing in the 48 contiguous US between 2003-2007. Baseline data included telephone interviews and in-home visits, and follow-up was conducted every 6 months to detect potential events with expert adjudication of endpoints based on medical record review. Low income (LoInc) was defined as annual household income &lt;$35,000, and low education (LoEd) was defined as less than a high school education. Income and education were combined into four mutually exclusive exposure groups (noLoInc+noLoEd, noLoInc+LoEd, LoInc+noLoEd ,LoInc+LoEd, ). CHD outcomes were definite or probable myocardial infarction or acute CHD death. We constructed Cox models estimating the hazard ratios (HR) for CHD, sequentially adjusting for sociodemographics, health behaviors, physiologic parameters, access to healthcare, and stress and depression. Because of significant interaction by age (p&lt;0.001), analyses were stratified at age 65. Results: We analyzed 24,461 participants without baseline CHD, with numbers in each income/education group as shown in the Table. LoInc+LoEd was associated with the highest risk of CHD among those aged &lt; 65 years, but not among those &gt;65 years of age. LoEd was associated with higher CHD risk in those age &gt;65 years and LoInc was not, but LoInc was associated with higher CHD risk in those age &lt; 65 years, but LoEd was not. Conclusion: LoInc+LoEd was associated with the highest CHD risk at younger ages, but not at higher ages. Income was more important than education for CHD risk at younger ages, but education was more important than income at older ages.

Abstract 03: Projected impact of shifting categories of hypertension on rates of coronary heart disease, heart failure and stroke: the Atherosclerosis Risk in Communities Study (ARIC)

Introduction: Despite indications that blood pressure is positively related to vascular disease, with no evidence of a threshold, recommendations for population improvements in cardiovascular health are largely focused on populations with hypertension or prehypertension. Here we compare the impact of meeting the Healthy People 2020 goal of a 10% reduction in the proportion of adults with hypertension, with a 2 mm Hg reduction in population-wide levels of systolic blood pressure (SBP) on the incidence of heart failure (HF), coronary heart disease (CHD), and stroke. Methods: In the biracial Atherosclerosis Risk in Communities Study (n=15,744) cohort, blood pressure was measured at baseline (1987-1989) using standardized methodology. Thresholds to define prehypertension (SBP=120-139 or DBP=80-89 mm Hg) and hypertension (SBP ≥140 or DBP ≥ 90) were from JNC7. A first hospitalization with discharge diagnosis code of ‘428’ defined incident HF. Incident hospitalized (definite or probable) CHD and stroke was classified by physician panel. We used multivariable regression to estimate incidence rate differences (IRD) for HF, CHD, and stroke that could be associated with a 10% reduction in the proportion of individuals with prehypertension and hypertension, as compared to a population-wide 2 mm Hg decrease in SBP. Results: At baseline, there were 31% African Americans and 13% Caucasians with hypertension, and 38% African Americans and 33% Caucasians with prehypertension. Over a mean of 18.7 years of follow up, age-adjusted incidence rates for HF, CHD, and stroke were higher among African Americans than Caucasians. After adjusting for covariates measured at study baseline, a hypothetical 10% reduction in the proportions of individuals with hypertension and pre-hypertension was associated with a larger estimated effect for HF compared with CHD and stroke. For the 10% reduction in those with hypertension, we estimated 2/100,000 person-years (PY) and 8/100,000 PY fewer incident HF hospitalizations in Caucasians and African Americans, respectively. In contrast, a population-wide blood pressure reduction approach of 2 mm Hg was associated with an estimated 24/100,000 PY and 39/100,000 PY fewer incident HF events in Caucasians and African Americans, respectively. When extrapolated to the 2010 US population aged greater than 45 years, hypothetical interventions that shift the population distribution of SBP by 2 mm Hg potentially result in an additional reduction of 22,000 HF hospitalizations, 17,000 CHD events, and 11,000 stroke events annually when compared to a primary prevention approach aimed at populations with hypertension and pre-hypertension. Conclusion: Modest, population-wide shifts in SBP may produce greater reductions in HF, CHD, and stroke events than can be achieved by only targeting reductions for those with hypertension, particularly among African Americans.

Associations of the prevalence of cardiovascular diseases with a high level of depression in the open population of an average urbanized Siberian town

To reveal an association of the prevalence of coronary heart disease (CHD) and metabolic syndrome (MS) with a high level of depression in the open population of 25-64-year-old men in an average urbanized Siberian town. The survey was conducted on a representative sample formed from the voting list of 25-64-year-old men in one of the administrative districts of Tyumen. The standard WHO MONICA-psychosocial questionnaire was used to study associations of the prevalence of CHD and MS with a high level of depression within cardiologic screening. The age-adjusted prevalence of depression was 4.6% (a high rate) and 19% (a moderate rate) in the 25-64-year-old men of the average urbanized town of West Siberia. With advancing age, the high level of depression increased, peaking in a 55-64-year-old group. In high depression and CHD in the 25-64-year-old men, the odds ratio (OR) was 21.07 for high depression and 39.84 for a definite CHD form. High depression was significantly more common in MS patients in the open population of 25-64-year-old people of the average urbanized Siberian town and in the 55-64 year old age group. An association was found between high depression and a combination of MS components: a concurrence of abdominal obesity, hypertriglyceridemia, and lower high-density lipoprotein cholesterol (OR 13.13). The epidemiological criteria revealed by standardized survey methods for psychosocial factors, depression in particular, should be used during the preventive examinations of a male population and during the selection of able-bodied people with cardiovascular disease to undergo in-depth examination and follow-up.

Intake of total omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid and risk of coronary heart disease in the Spanish EPIC cohort study

Background and aimsThe evidence about the benefits of omega-3 fatty acid intake on coronary heart disease (CHD) is not consistent. We thus aimed to assess the relation between dietary intake of total omega-3 fatty acids (from plant and marine foods) and marine polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on the risk of CHD in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods and resultsThe analysis included 41,091 men and women aged 20–69 years, recruited from 1992 to1996 and followed-up until December 2004. Omega-3 fatty acid intake was estimated from a validated dietary questionnaire. Only participants with definite incident CHD event were considered as cases. Cox regression models were used to assess the association between the intake of total omega-3 fatty acids, EPA or DHA and CHD. A total of 609 participants (79% men) had a definite CHD event. Mean intakes of total omega-3 fatty acids, EPA and DHA were very similar in the cases and in the cohort, both in men and women. In the multivariate adjusted model, omega-3 fatty acids, EPA and DHA were not related to incident CHD in either men or women. The hazard ratios (HR) for omega-3 were 1.23 in men (95% CI 0.94–15.9, p = 0.20); and 0.77 in women (95% CI 0.46–1.30, p = 0.76). ConclusionIn the Spanish EPIC cohort, with a relatively high intake of fish, no association was found between EPA, DHA and total omega-3 fatty acid intake and risk of CHD.

ASSOCIATION BETWEEN CORONARY HEART DISEASE PREVALENCE AND ATTITUDES TOWARDS HEALTH AND PREVENTION IN THE MALE POPULATION OF TUMEN CITY

Aim. To assess the associations between the prevalence of coronary heart disease (CHD) and the attitudes towards one’s own health and prevention among 25–64-year-old male residents of Tumen City. Material and methods. The representative study sample was selected from the electoral lists of 25–64-year-old men — residents of one Tumen City district. As a part of a cardiovascular screening examination, the prevalence of CHD and the attitudes towards one’s own health and prevention were assessed, using the standard WHO MONICA-psychosocial questionnaire. Results. In male residents of Tumen City, aged 25–64 years, possible CHD and CHD by extended epidemiological criteria were associated with higher odds of perceived effectiveness of preventive measures, as well as with lower odds of severe disease development in previously healthy people. Men with definite CHD, compared to their healthy peers, were more sceptical about the potential of modern medicine in terms of cardiovascular disease (CVD) treatment and less sceptical about its potential in the area of CVD prevention. Conclusion. In the open population of Tumen City men aged 25–64 years, the presence of CHD was linked to a negative self-evaluation of health and more prevalent health complains. However, only men with definite CHD demonstrated a more responsible attitude towards their own health.

Abstract 029: Racial Disparities in Coronary Heart Disease Mortality in the Regards Study

Background: Coronary heart disease (CHD) mortality has long been higher among US blacks compared with whites, especially among younger individuals. Recent progress on eliminating these disparities has not been reported. Methods: We examined CHD mortality in the REGARDS study, a 30,239-member national prospective cohort study that oversampled blacks (41%) and residents of the southeastern US, recruiting from 2003-7. Baseline data included interviews and in-home collection of physiologic and medication data. Telephone follow-up was conducted every 6 months to detect endpoints, triggering medical record retrieval and expert adjudication. Deaths prompted interviews with next-of-kin or proxies, collection of medical records and death certificates. We examined risks for definite or probable CHD mortality overall, and separately for in-hospital and out-of-hospital CHD death. Cox models stratified on age 65 estimated hazard ratios (HR) for CHD mortality for blacks compared with whites, adjusting for sociodemographics and CHD risk factors. Results: We analyzed 14,992 participants &lt;65 years of age (44% blacks) and 14,678 &gt;65 years of age (38% blacks). There were 126 CHD deaths among those age &lt;65 and 273 among those age &gt;65 over a mean follow-up of 4.2+1.5 SD years. Adjusting for age and region of residence, excess risks among blacks were generally more pronounced for those age &lt;65, but this excess risk attenuated after adding all risk factors, except for in-hospital mortality for those &gt;65 years of age (Table). Conclusions: Risks for CHD mortality were higher among blacks, largely attributable to higher risk factor burden especially among the young, suggesting that targeted intervention efforts are needed to overcome this disparity. The excess risk for in-hospital mortality among older blacks warrants further attention.

Abstract P316: Prehypertension and Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Objective: The independent prognostic value of prehypertension (preHTN) for incident coronary heart disease (CHD) remains unsettled. Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study, we examined associations between preHTN and incident acute CHD and CVD death. Methods: REGARDS includes 30,239 black and white community-dwelling adults age 45 and older at baseline. Recruitment occurred from 2003-7, with baseline interviews and in-home data collection for physiologic measures. Follow-up is conducted by telephone every 6 months to detect events and deaths, which are adjudicated by experts. Systolic BP was categorized into &lt;120 mmHg (n=4385), 120-129 mmHg (n=4000), 130-139 (n=2066), and hypertension was categorized into controlled (&lt;140/90 mmHg on treatment) (n=8378), and uncontrolled (&gt;140/90 mmHg) (n=5364). Incident acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. CVD death was defined as acute CHD, stroke, heart failure or other cardiovascular disease related. Cox proportional hazards models estimated the hazard ratios (HR) for incident CHD by BP categories, adjusting for sociodemographics and CHD risk factors. Results: The 23,393 participants free of CHD at baseline were followed for a median of 4.4 years. Mean age was 64.1, 58% were women and 42% were black. There was a significant interaction between sex and BP categories, therefore analyses were stratified by sex. There were 252 non-fatal and fatal acute CHD events among women and 407 among men. Among women, compared with SBP&lt;120 mmHg, BP categories above SBP 120 mmHg were associated with incident CHD (adjusted HR for SBP120-129 mmHg=1.94 {95% CI 1.04-3.62]; SBP 130-139 mmHg=1.92 {0.95-3.87}; controlled HTN=2.16 {1.25-3.75}; uncontrolled HTN=3.25 {1.87-5.65}) in fully adjusted models. Among men, only uncontrolled HTN was associated with incident CHD (HR=1.55 {1.11-2.17}). Conclusion: In this sample, preHTN may be associated with incident CHD among women but not men.

Abstract P114: Association of Psychosocial Wtress with Incident Coronary Heart Disease and All-cause Mortality among Low and High Income Individuals in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: Stress may increase risk for coronary heart disease (CHD) and death, especially for individuals living in poverty. Few prospective studies have examined the relationships between stress, CHD and mortality among minorities, who are more likely to be poor. We studied the association of perceived stress with incident CHD and mortality in a large biracial cohort. Methods: REGARDS includes 30,239 community-dwelling black and white participants age &gt;45 years recruited from 2003-07. Recruitment oversampled the Stroke Belt and Buckle and included residents of 48 states. Participants were telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication. CHD was defined as definite or probable myocardial infarction or CHD death. Stress was assessed using the 4-item Cohen’s Perceived Stress Scale (PSS). Among participants free of CHD at baseline, Cox models estimated hazard ratios for incident CHD and all-cause mortality through 12/31/2009, adjusting for socioedemographic, clinical, and behavioral CHD risk factors, and testing for interactions by race and income. Results: The analytic sample included 24,439 subjects with mean age 64.1 years (SD+9.3), with 58% women and 42% blacks. Over a mean follow-up of 4.2 (maximum 6.9) years, there were 659 incident acute CHD events and 1320 deaths. Analyses were stratified by income (Table) due to significant interactions with stress; no significant interactions were found by race. The highest quartile of stress was associated with higher risk for incident CHD among those with low income (HR 1.36, {95% CI 1.04, 1.78}) but not high income (HR 0.82, {95% CI 0.57, 1.16}). This relationship was slightly attenuated with full adjustment. Each increasing quartile of stress was associated with increasingly higher risk of death for those with low but not high income. Conclusion: Stress may confer greater risks of CHD and death for individuals with low but not high income.

Abstract MP77: Projected Impact of Shifting Population Distributions of Blood Pressure on Rates of Coronary Heart Disease, Heart Failure and Stroke: The Atherosclerosis Risk in Communities Study

Introduction: Rates of cerebrovascular disease, heart failure (HF), and coronary heart disease (CHD), increase progressively as blood pressure rises. Several authors have estimated the theoretical effects of shifting the population distribution of blood pressure; however few studies have examined the degree to which modest decrements in blood pressure affect HF incidence, or included a racially diverse population. Methods: Incident HF was identified by a first hospitalization with discharge diagnosis code of 428.X. Incident hospitalized (definite or probable) CHD and stroke were classified according to protocol. We used multivariable regression to estimate incidence rate differences (IRD) for HF, CHD, and stroke that could be associated with a two mm Hg reduction in systolic blood pressure (SBP) in 15,744 participants from the Atherosclerosis Risk in Communities Study. Results: Over a mean of 18.3 years of follow up, age-adjusted incidence rates for HF, CHD, and stroke were higher among African American than Caucasians (Table 1). After adjusting for antihypertensive use, gender, and age, a two mm Hg decrement in SBP across the total population was associated with an estimated 24/100,000 person-years (PY) and 39/100,000 PY fewer incident HF events in Caucasians and African Americans, respectively. The projected disease reductions were of smaller absolute magnitude for incident CHD and incident stroke. Extrapolation to the African American and Caucasian U.S. populations age greater than 45 years suggests that a two mmHg decrement in SBP could result in approximately 22,000 fewer incident HF events, 15,000 fewer incident CHD events, and 5,000 fewer incident stroke events annually. Conclusion: Our results suggest that modest shifts in SBP, consistent with what could theoretically be achieved through population level lifestyle interventions, could substantially decrease the incidence of HF, stroke, and CHD in the United States, especially among African American populations.

АSSOCIATION BETWEEN OXIDATIVE-ANTIOXIDANT MODIFICATIONS OF LOW-DENSITY LIPOPROTEINS AND CORONARY HEART DISEASE IN A MALE POPULATION OF NOVOSIBIRSK

Aim. To investigate the association between potentially atherogenic oxidativeantioxidant modifications of low-density lipoproteins (LDL) and coronary heart disease (CHD) in a male population. Material and methods. A population-based survey included 1024 male residents ofNovosibirskCity, aged 47–73 years. The participants underwent a questionnaire survey, a standard cardiologic survey, anthropometry, blood pressure measurement, and electrocardiography. “Definite CHD” (Functional Class II–IV stable effort angina) was registered in 223 men (21,8%), according to validated epidemiologic, clinical, and functional criteria. Blood biochemistry analyses focused on the levels of total cholesterol (TCH), triglycerides (TG), high-density lipoprotein cholesterol (HDL–CH), high-sensitivity C-reactive protein (hsCRP), glucose, baseline levels of lipid peroxidation (LPO) products and fat-soluble antioxidants (alpha-tocopherol, retinol, beta-carotene, and xanthines) in LDL, LDL oxidation resistance in vitro, and an concentration of autoantibodies to oxidised LDL (oxLDL). Results. There were positive correlations and independent associations between the oxidative LDL modifications, in particular between reduced LDL oxidation resistance and CHD. On the other hand, there were negative correlations between the antioxidant LDL modifications (such as reduced alpha-tocopherol levels in LDL) and CHD. The prevalence of CHD was higher in participants with baseline levels of LPO products in LDL &gt;0,8 nM MDA/mg LDL protein and with reduced LDL oxidation resistance (baseline levels &gt;5,4 nM MDA/mg LDL protein vs. levels &gt;13,2 nM MDA/mg LDL protein at later stages of LDL oxidation). However, the prevalence of CHD was lower in individuals with LDL levels of alpha-tocopherol &gt;1,06 mg/mg LDL protein. Conclusion. These findings agree with the previously obtained data on the key role of oxidative LDL modifications in the pathogenesis of atherosclerosis and CHD.

Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country

Social position has yet to be established as a risk factor of coronary heart disease (CHD). Our aim was to investigate an individual life-course social position gradient link with CHD incidence in the EPIC-Spain cohort. 41,066 participants, mostly 30-65 years old, and free of cardiovascular disease at baseline (1992-1996) were followed up for a mean of 10.4 years. A combined score of paternal occupation in childhood and own adult education was used to assess individual life-course risk accumulation. Hazard ratios of CHD were estimated using Cox models, stratifying by centre, and age, and adjusting for cardiovascular risk factors. 583 participants (80 % men) developed a definite CHD event. Paternal occupational class IV was associated with CHD in all models in men. The educational gradient remained significant after adjusting for diet and physical activity (p = 0.01). All adjusted risk of incident CHD rose by 23 % (95 % CI 6-42 %) per category increase of life-course social position score in men. No significant associations were found in women. Individual life-course social position gradient was adversely related to incident CHD in Spanish men.

Abstract 045: Race-Sex Differences in Risk for Incident Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

National death certificate data suggest that racial disparities in acute coronary heart disease (CHD) mortality widened over the past decade for both men and women. To better understand this disparity, we examined black:white race-sex differences in overall, fatal and nonfatal acute CHD incidence in a large national biracial cohort. REGARDS is following 30,239 community-dwellers age ≥;45 years recruited between 2003-7 from 48 states. Recruitment was designed to balance race and sex; the final sample was 55% female and 41% black. Participants are telephoned every 6 months for CVD endpoints, with retrieval of medical records, death certificates, interviews with next-of-kin, and expert adjudication following national consensus recommendations. Acute CHD was defined as definite or probable myocardial infarction (MI) or acute CHD death. Among participants free of CHD at baseline, we examined black:white hazards for incident overall acute CHD, and, separately, fatal and nonfatal acute CHD for men and women through 2008, adjusting incrementally for sampling, sociodemographics and CHD risk factors. The study sample numbered 24,431 with mean age 64.1 (SD±9.3). Over a mean follow-up of 3.4 (maximum 5.9) years, 48.7% (55/113) of black men, 33.0% (38/115) of black women, 23.0% (46/200) of white men and 24.1% (21/87) of white women died at their presentation of acute CHD. Black:white hazard ratios for overall, fatal and nonfatal acute CHD from incrementally adjusted models stratified on sex are presented in the Table. Black men and women had over twice the age-adjusted hazard of incident fatal acute CHD compared to whites, not entirely explained by excess risk factor burden among blacks. Although socio-economic and CHD risk factors among blacks continue to be major contributors to fatal incident acute CHD, known risk factors did not fully explain the disparity between black and white men; causes of the elevated risk among black men need to be better understood if widening CHD mortality disparities are to be reversed.

Abstract P030: Variations in Cardiovascular Risk Among Different Clinical Presentations of Metabolic Syndrome in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Background: Some individuals classified as having metabolic syndrome (MetSyn) are centrally obese while others are not with unclear implications for cardiovascular (CV) risk. Methods: REGARDS is following 30,239 individuals ≥45 years of age living in 48 states recruited from 2003-7. MetSyn risk factors were defined using the AHA/NHLBI/IDF harmonized criteria with central obesity being defined as ≥88 cm in women and ≥102 cm in men. Participants with and without central obesity were stratified by whether they met &gt;2 or ≤2 of the other 4 MetSyn criteria, resulting in the creation of 4 groups. To ascertain CV events, participants are telephoned every 6 months with expert adjudication of potential events following national consensus recommendations and based on medical records, death certificates, and interviews with next-of-kin or proxies. Acute coronary heart disease (CHD) was defined as definite or probable myocardial infarction or acute CHD death. To determine the association between these 4 groups and incident acute CHD, we constructed Cox proportional hazards models in those free of CHD at baseline by race/gender group, adjusting for sociodemographic variables. Results: A total of 20,018 individuals with complete data on MetSyn components were free of baseline CHD. Mean age was 64+/−9 years, 58% were women, and 42% were African American. Over a mean follow-up of 3.4 (maximum 5.9) years, there were 442 acute CHD events. In the non-centrally obese with&gt;2 other risk factors, risk for CHD was higher for all but AA men, though significant only for white men. In contrast, in the centrally obese with &gt;2 other risk factors, risk was doubled for women, but only non-significantly and modestly increased for men. Only AA women with central obesity and ≤2 other risk factors had increased CHD risk (Table). Conclusion: The CHD risk associated with the MetSyn varies by the presence of central obesity as well as the race and gender of the individual.

Abstract MP013: Strong Inverse Relation between Physical Activity and Incidence of Cardiovascular Disease in African Americans: the Atherosclerosis Risk in Communities Study

Introduction: Although there is substantial evidence that physical activity reduces risk of cardiovascular disease (CVD), the few studies that included African Americans offer inconclusive evidence and did not study stroke and heart failure separately. Objective: We examined, in African Americans and Caucasians in the Atherosclerosis Risk in Communities study (ARIC), the association of physical activity with CVD incidence (n=1,039) and its major components - stroke (n=350), heart failure (n=633), and coronary heart disease (n=442) - over a follow-up period of 21 years. Methods: ARIC is a population-based biracial cohort study of 45– to 64-yr-old adults at the baseline visit in 1987–89. Physical activity was assessed using the modified Baecke physical activity questionnaire and categorized by the American Heart Association’s ideal CVD health guidelines: poor, intermediate, and ideal physical activity. An incident CVD event was defined as the first occurrence of 1) heart failure, 2) definite or probable stroke, or 3) coronary heart disease, defined as a definite or probable myocardial infarction or definite fatal coronary heart disease. Results: We included 3,707 African Americans and 10,018 Caucasians free of CVD at the baseline visit. After adjustment for age, sex, cigarette smoking, alcohol intake, hormone therapy use, education, and ‘Western’ and ‘Prudent’ dietary pattern scores, higher physical activity was inversely related to CVD, heart failure, and coronary heart disease incidence in African Americans and Caucasians (p-values for trend tests &lt;.0001), and with stroke in African Americans. Hazard ratios (95% confidence intervals) for CVD for intermediate and ideal physical activity, respectively, compared to poor, were similar by race: 0.65 (0.56, 0.75) and 0.59 (0.49, 0.71) for African Americans, and 0.74 (0.66, 0.83) and 0.67 (0.59, 0.75) for Caucasians (p-value for interaction = 0.38). Physical activity was also associated similarly in African Americans and Caucasians for each of the individual CVD outcomes (coronary heart disease, heart failure, and stroke), with an approximate one-third reduction in risk for intermediate and ideal physical activity versus poor physical activity- this reduction was statistically significant. Conclusions: In conclusion, our findings reinforce public health recommendations that regular physical activity is important for CVD risk reduction, including reductions in stroke and heart failure. They provide strong new evidence that this risk reduction applies to African Americans as well as Caucasians and support the idea that some physical activity is better than none.