Hypertension Medication Use Research Articles

Validity assessment of self-reported medication use by comparing to pharmacy insurance claims

ObjectivesIn Japan, an annual health check-up and health promotion guidance programme was established in 2008 in accordance with the Act on Assurance of Medical Care for the Elderly. A self-reported...

Use of Pulmonary Hypertension Medications in Patients with Tetralogy of Fallot with Pulmonary Atresia and Multiple Aortopulmonary Collaterals.

Tetralogy of Fallot (TOF) with pulmonary atresia (PA) and multiple aortopulmonary collaterals (MAPCAs) is a rare and severe form of congenital heart disease with poor prognosis. Aortopulmonary collaterals expose pulmonary arterioles to systemic pressure resulting in pulmonary hypertension (PH). To date, reports regarding the role of PH medications in this population are sparse. The objective of this study was to assess the effect of PH medications in patients with TOF, PA and MAPCAs or similar anatomy, with emphasis on symptoms, echocardiography and invasive hemodynamics. A retrospective review was performed for patients at a single tertiary care pediatric center. Twelve of 66 patients were treated with PH medications (18 %), and eight of these patients had adequate follow-up for further analysis. Median age at last follow-up was 6 years (range 1.4-21 years). Median length of therapy with PH medication was 4 years (range 0.3-17 years). PH medications included sildenafil, bosentan, ambrisentan, inhaled treprostinil and prostacyclin infusion. PH therapy was associated with improvement in symptoms in all patients and improvement in PH by hemodynamic measures in the majority of patients. All patients underwent at least one cardiac intervention by catheterization or surgery while taking PH medication. Two patients died from non-PH-related causes. The remaining six patients are alive and remain on PH medication. This review indicates that PH medications are well tolerated by this patient group and provide symptomatic improvement. Further studies are required to determine whether PH medications provide long-term survival benefit for patients with complex congenital heart disease.

The severity of the metabolic syndrome increases over time within individuals, independent of baseline metabolic syndrome status and medication use: The Atherosclerosis Risk in Communities Study

Background and aimsThe severity of the metabolic syndrome (MetS) is linked to future cardiovascular disease. However, it is unclear whether MetS severity increases among individuals followed over time. MethodsWe assessed changes in a sex- and race/ethnicity-specific MetS severity Z-score over a 10-year period (visits 1–4) among 9291 participants of the Atherosclerosis Risk in Communities study cohort. We compared sex- and racial/ethnic subgroups for the rate of change in the MetS severity score and MetS prevalence as assessed using traditional ATP-III MetS criteria. We further examined effects of use of medications for hypertension, diabetes and dyslipidemia. ResultsOver the 10 years of follow-up, MetS severity Z-scores increased in 76% of participants from an overall mean of 0.08 ± 0.77 at baseline to 0.48 ± 0.96 at visit 4 with the greatest progression in scores observed among African-American women. Baseline MetS severity scores predicted the time until ATP-III MetS diagnosis, with a model-predicted 77.5% of individuals with a visit 1 MetS severity score of 0.75 progressing to ATP-III MetS within 10 years. The rate of increase in MetS severity score was higher among those younger at baseline but was independent of baseline MetS status or the use of medications to treat blood pressure, lipids and diabetes. ConclusionThe severity of metabolic derangements as measured using this MetS severity score increases over time within individuals and predicts diagnosis of ATP-III MetS. These data may have implications for tracking MetS related risk within individuals over time.

Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults: The Cardiovascular Health Study

ObjectivesThe goal of this study was to determine the relative contribution of major lifestyle factors on the development of heart failure (HF) in older adults. BackgroundHF incurs high morbidity, mortality, and health care costs among adults ≥65 years of age, which is the most rapidly growing segment of the U.S. population. MethodsWe prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1,380 cases) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study, which is a community-based cohort of older adults. Lifestyle factors included 4 dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a Biologic pattern, which was constructed using previous knowledge of cardiovascular disease dietary risk factors), 4 physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, and walking distance), alcohol intake, smoking, and obesity. ResultsNo dietary pattern was associated with developing HF (p > 0.05). Walking pace and leisure activity were associated with a 26% and 22% lower risk of HF, respectively (pace >3 mph vs. <2 mph; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; leisure activity ≥845 kcal/week vs. <845 kcal/week; HR: 0.78; 95% CI: 0.69 to 0.87). Modest alcohol intake, maintaining a body mass index <30 kg/m2, and not smoking were also independently associated with a lower risk of HF. Participants with ≥4 healthy lifestyle factors had a 45% (HR: 0.55; 95% CI: 0.42 to 0.74) lower risk of HF. Heterogeneity by age, sex, cardiovascular disease, hypertension medication use, and diabetes was not observed. ConclusionsAmong older U.S. adults, physical activity, modest alcohol intake, avoiding obesity, and not smoking, but not dietary patterns, were associated with a lower risk of HF.

Abstract 584: The Association of Psychosocial Risk Factors with Subclinical Atherosclerosis in South Asians

Objective: South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) are at higher risk of cardiovascular disease (CVD) than other ethnic groups, however this increased risk cannot be explained by traditional risk factors. We investigated the association of psychosocial risk factors with carotid intima media thickness (cIMT), a measure of subclinical CVD, in a community-based cohort of South Asians living in the United States. Methods: A total of 906 individuals from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, aged 40-83, were included in this cross-sectional analysis. High resolution B-mode ultrasonography was used to measure right and left common cIMT (CCA) and internal cIMT (ICA). Linear regression analyses were done to test the associations of the following psychosocial variables: anger, anxiety, depressive symptoms, current and prior 6-month life stress, social support, and everyday hassles with CCA and ICA. In a multivariable model, results were adjusted for the following traditional CVD risk factors: age, sex, systolic blood pressure, hypertension medication use, education, physical activity, diabetes, BMI, smoking, and total/HDL cholesterol ratio. Interaction effects between sex and psychosocial variables were also tested. Results: In age- and sex- adjusted analyses, current life stress and life stress over the past 6 months were positively associated with CCA [mean difference per 1-SD increase (CI) was 0.014 (0.001-0.028; p=0.042) and 0.015 (0.001-0.029; p=0.031), respectively], but were no longer significant after adjusting for other CVD covariates. There was a significant sex interaction with anxiety (p=0.044). Among men, anxiety was positively associated with CCA [mean difference per 1-SD increase (CI) was 0.021 (0.001-0.041; p=0.04) in age-adjusted analyses, and 0.022 (0.002-0.042; p=0.031) in a fully adjusted model]. ICA was not associated with any psychosocial factor. Conclusion: Compared to results in other ethnic groups, there was no significant association between trait anger and cIMT in South Asians. Anxiety was associated with CCA independent of traditional CVD risk factors in men alone.

The Relationship between Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Ligands Containing Apolipoprotein B and the Cardio-Ankle Vascular Index in Healthy Community Inhabitants: The KOBE Study.

Lectin-like oxidized low-density lipoprotein (LDL) receptor-1 ligands containing apolipoprotein B (LAB) and lectin-like oxidized LDL receptor-1 (LOX-1) are known as LOX-1-related modified LDL indicators. These indicators play an important role in the early phase atherosclerosis, but the relationship between these indicators and subclinical atherosclerosis, as represented by the cardio-ankle vascular index (CAVI), has not been assessed. We herein investigated the association of LOX-1- related modified LDL indicators and the CAVI in healthy, Japanese urban community inhabitants who were considered to be at low risk for cardiovascular disease (CVD). The participants were 515 healthy Japanese (310 men and 205 women) without a history of CVD, cancer or the use of medication for hypertension, diabetes or dyslipidaemia. To estimate the association between LOX-1-related modified LDL indicators (LAB, soluble form of LOX-1 (sLOX-1)) and the CAVI, we performed multivariable linear regression analyses with possible confounders such as the serum LDL cholesterol level. The plasma LAB showed a positive association with the CAVI in men (standardized coefficient: 0.11, p = 0.04). This relationship was not observed in women. On the other hand, no clear association was observed between the CAVI and the plasma sLOX-1 level in either sex. The plasma LAB levels may represent a useful marker for detecting potential atherosclerosis in healthy individuals considered to be at low risk for atherosclerosis and CVD. Further studies are needed to confirm the present findings.

Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case-control study.

To study previously identified associations between specific maternal hypertensive disorders and/or prenatal exposure to antihypertensive medication and birth defects. Case-control study. Slone Birth Defects Study, 1998-2010. A total of 5568 cases with birth defects and 7253 liveborn infants without malformations as controls. Adjusted odds ratios (aORs) for birth defects associated with prenatal exposure to maternal hypertensive disorders and/or antihypertensive medication were calculated using multivariable logistic regression analyses. Specific birth defects previously linked to maternal hypertension or antihypertensive medication use during pregnancy. Non-pharmacologically managed chronic hypertension was associated with a three-fold risk of oesophageal atresia (95% CI 1.2-8.3), and pre-eclampsia superimposed on non-pharmacologically managed chronic hypertension was associated with ventricular septal defects (aOR 3.9, 95% CI 1.3-11.7) and atrial septal defects (aOR 6.5, 95% CI 1.8-23.7). For chronic hypertension that was pharmacologically treated early in pregnancy, increased risks were observed for first-degree hypospadias (aOR 2.9, 95% CI 1.1-7.4). Non-pharmacologically managed pre-eclampsia was related to second-/third-degree hypospadias and ventricular septal defects. Pharmacological treatment for gestational hypertension was associated with a number of congenital heart defects. Our results confirm some, but not all, previously identified associations between pharmacologically treated and non-pharmacologically managed hypertensive disorders and specific birth defects. They support the hypothesis that physiological changes early in pregnancy that manifest in gestational hypertension and pre-eclampsia may play a role in the aetiology of major birth defects, including congenital heart defects and hypospadias.

Abstract 2175: Prospective association between obesity and statin use with conversion from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer (PC)

Abstract BACKGROUND: HGPIN shares many phenotypic and genetic traits with PC, and historically, a patient with HGPIN at biopsy was at high-risk for PC at future biopsy. Although obesity and certain medications have been associated with PC risk, no lifestyle or chemoprevention recommendations are available to prevent PC in high-risk men with HGPIN. OBJECTIVE: Determine the prospective association between obesity and medication use for obesity-related comorbidities with the conversion from HGPIN to PC at follow-up. METHODS: Men seeking a prostate biopsy were targeted for recruitment. After consent, we measured weight, height, sitting height, and waist and hip circumferences, and demographics by questionnaire. Pathology charts were reviewed to identify patients with HGPIN and without PC or other suspicious findings. Medication use for diabetes, BPH, high cholesterol, and hypertension at recruitment were extracted from medical charts. There were 105 HGPIN patients with at least one follow-up prostate biopsy and thus with a potential for PC at follow-up. Multivariable logistic regression was used to determine the association between body size and medication use with PC risk, controlling for age at recruitment, number of follow-up biopsies (1, 2, &amp;gt;2), PSA (ng/ml), and prostate size (mls). RESULTS: Average age, PSA level, and prostate size were 65 years, 6.4 ng/ml, and 49 mls, respectively. Median follow-up was 5 years, and 13 patients had more than one follow-up biopsy. During follow-up, 45 men were diagnosed with PC. Increasing waist-hip ratio (WHR) was significantly associated with conversion from HGPIN to PC (OR = 2.26 (1.14, 4.47), p=0.02, per 0.1 increase in WHR). Men with a WHR &amp;gt; 1.00 were 2.7 times more likely to be diagnosed with PC compared to men with a WHR=&amp;lt;1.00 (p=0.02). Waist circumference (WC) was marginally associated with conversion to PC (OR = 1.04 (1.00, 1.08), p=0.05, per cm). BMI, height, and sitting height were not significantly associated with PC. Furthermore, use of statins or anti-hypertensive medications at baseline were marginally significantly associated with a lower PC risk (Statin: OR=0.43 (0.18, 1.06), p=0.06; HTN: OR=0.47 (0.20, 1.09), p=0.08). In contrast, diabetes and BPH medications, or regular aspirin use, were not associated with PC. Strengths include systematic HGPIN evaluation from one pathologist, little patient migration, measured body size, and medical chart data. However, inference is restricted to those HGPIN patients who received a follow-up biopsy. CONCLUSION: Centralized obesity measured as WHR increased the risk of PC among HGPIN patients, while statins and hypertension medications were associated marginally with lower PC risk. The role of hyperlipidemia and statins in PC progression following HGPIN development requires further investigation. Citation Format: Jay H. Fowke, Saundra Motley, Susan Byerly. Prospective association between obesity and statin use with conversion from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer (PC). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2175. doi:10.1158/1538-7445.AM2014-2175

Plasma lactate and incident hypertension in the atherosclerosis risk in communities study.

Recent evidence suggests that insufficient oxidative capacity or mitochondrial dysfunction may play a causal role in the development of high blood pressure. However, this hypothesis has not been tested in the general population. We hypothesized that lactate, a measure of oxidative capacity, would be positively associated with incident hypertension even after accounting for traditional hypertension risk factors. Plasma lactate was measured in 5,554 participants from the Atherosclerosis Risk in Communities (ARIC) Study with no subclinical or diagnosed hypertension at baseline (1996-1998). Incident hypertension was defined by self-report or hypertension medication use. Analyses were performed with Cox proportional hazards models. The mean age was 61.9 years, and the mean lactate was 0.8 mmol/L. During a median follow-up period of 11.9 years (range = 26.9 days to 13.4 years), there were 3,849 new cases of hypertension. The fourth quartile of lactate (compared with the first quartile) was associated with an elevated risk of hypertension (hazard ratio (HR) = 1.18; 95% confidence interval (CI) = 1.07-1.31) even after adjustment for traditional risk factors, including baseline systolic and diastolic blood pressure. This association was stronger when the population was restricted to participants with normal blood pressure (<120mm Hg/<80mm Hg; HR = 1.42; 95% CI = 1.23-1.63). In strata of sex, the association was strong in women vs. null in men (P interaction = 0.01). Plasma lactate is associated with incident hypertension in women, especially with a normal blood pressure (<120mm Hg/<80mm Hg). Future studies should elucidate the mechanisms underlying these observations.

Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia.

People with bipolar disorder or schizophrenia are at greater risk for obesity and other cardio-metabolic risk factors, and several prior studies have linked these risk factors to poorer cognitive ability. In a large ethnically homogenous outpatient sample, we examined associations among variables related to obesity, treated hypertension and/or diabetes and cognitive abilities in these two patient populations. In a study cohort of outpatients with either bipolar disorder (n = 341) or schizophrenia (n = 417), we investigated the association of self-reported body mass index and current use of medications for hypertension or diabetes with performance on a comprehensive neurocognitive battery. We examined sociodemographic and clinical factors as potential covariates. Patients with bipolar disorder were less likely to be overweight or obese than patients with schizophrenia, and also less likely to be prescribed medication for hypertension or diabetes. However, obesity and treated hypertension were associated with worse global cognitive ability in bipolar disorder (as well as with poorer performance on individual tests of processing speed, reasoning/problem-solving, and sustained attention), with no such relationships observed in schizophrenia. Obesity was not associated with symptom severity in either group. Although less prevalent in bipolar disorder compared to schizophrenia, obesity was associated with substantially worse cognitive performance in bipolar disorder. This association was independent of symptom severity and not present in schizophrenia. Better understanding of the mechanisms and management of obesity may aid in efforts to preserve cognitive health in bipolar disorder.

Baseline Prognostic Factors Predict Rapid Visual Field Deterioration in Glaucoma

To investigate baseline prognostic factors predicting rapid deterioration of the visual field in primary open-angle glaucoma patients. Seven hundred sixty-seven eyes of 566 glaucoma patients from the Advanced Glaucoma Intervention Study (AGIS) and the clinical database from Jules Stein Eye Institute's Glaucoma Division were included. The rates of decay at each visual field test location were calculated with pointwise exponential regression analysis (PER), and the rates were separated into faster and slower components for each series. Subjects with a faster component decay rate (≥ 36%/y) were defined as rapid progressors. Sex, race, age, visual acuity, intraocular pressure, mean deviation (MD), number of medications, use of diabetic or hypertension medications, and vertical cup-to-disc ratio at baseline were entered in a multivariable prognostic logistic regression model. The average (± SD) MD was -8.02 (± 6.13), and the average age was 68.64 (± 11.71) years for the study group. Two hundred twenty-two eyes (28.9%) were identified as rapid progressors. The following baseline factors were predictors of faster deterioration: worse MD (P < 0.001, odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.07-1.15), larger vertical cup-to-disc ratio (P = 0.001, OR: 1.23; 95% CI: 1.09-1.39), and older age (P = 0.02, OR: 1.24; 95% CI: 1.04-1.48). After excluding the variables related to glaucoma severity at baseline (baseline MD and baseline vertical cup-to-disc ratio), the likelihood of being a rapid progressor was 54% greater in African Americans than in Caucasians (P = 0.03, OR: 1.55; 95% CI: 1.06-2.27). Patients with more severe glaucomatous damage, as measured by both visual field or optic disc cupping and older age, are at highest risk for rapid worsening of the disease, as are African Americans compared to Caucasians. More aggressive treatment of such patients should be considered to prevent visual disability.

The association of smoking with medical treatment adherence in the workforce of a large employer.

PurposePrior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer.Patients and methodsThis study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression.ResultsControlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%–13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers.ConclusionCurrent smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy.

Abstract MP14: Relations of Arterial Stiffness and Incident Heart Failure in the Community

Background: The structure and function of the aorta and left ventricle are closely coupled, but the relations of arterial stiffness, pressure pulsatility, and wave reflection to clinical heart failure (HF) are not well described. Methods: We evaluated 2904 Framingham Heart Study participants (mean age 64+11 yrs, 56% F) who were free of clinical HF and myocardial infarction (MI). Carotid-femoral pulse wave velocity (CFPWV), central pulse pressure, forward wave amplitude, and augmentation index were assessed by applanation tonometry. Cox proportional hazards models accounted for competing risk of death and adjusted for age, sex, body mass index, mean arterial pressure, total and HDL cholesterol, use of hypertensive medications, prevalent diabetes, current smoking, and prevalent cardiovascular disease. Results: On follow-up (mean 9.2 years, limits 0.04-13 years), 170 participants developed new-onset HF while 106 experienced an MI. The incidence of HF rose across CFPWV tertiles ( Figure ). Each standard deviation (SD) higher CFPWV conferred a 50% (95% CI 1.21-1.85, p=0.0002) and 30% (95% CI 1.02-1.64, p=0.037) increased risk of incident HF in age- and sex-adjusted and multivariable-adjusted analyses, respectively. CFPWV was associated with increased risk of MI (hazards ratio [HR] per SD 1.46, 95% CI 1.01-2.12, p=0.04). The inclusion of interim MI in multivariable models attenuated the association of CFPWV with HF incidence (HR per SD 1.26, 95% CI 0.99-1.60, p=0.061). Central pulse pressure, forward wave amplitude, and augmentation index were not associated with incident HF in multivariable-adjusted models. Conclusions: Higher aortic stiffness as assessed by CFPWV is associated with increased risk of incident HF, mediated in part by the increased risk of interim MI associated with vascular stiffness. These findings illustrate the importance of ventricular-vascular coupling, and underscore the need for studies to examine the benefit of therapies that modify aortic stiffness for lowering the population burden of MI and HF.

Abstract P050: Serum Fibroblast Growth Factor 23 and Incident Hypertension: The Atherosclerosis Risk in Communities Study

Background: Elevated serum fibroblast growth factor-23 (FGF23), an endogenous hormone, is associated with endothelial dysfunction, chronic kidney disease, arterial wall stiffness, and inflammation. These factors may contribute to an increased risk of hypertension. To date, the association of FGF23 with incident hypertension has not been examined. Hypothesis: Elevated serum FGF23 will be positively associated with risk of incident hypertension. Methods: The ARIC study measured intact FGF23 in stored serum from 7,948 middle-aged men and women without hypertension at baseline (1990-92). Participants were examined during two follow-up visits, in 1993-95 and 1996-98. Incident hypertension was determined by measured blood pressure (DBP 90 mm Hg, or SBP140 mm Hg) and/or hypertension medication use during the follow-up exams. Multivariate Cox proportional hazards regression models and complementary log-log models were used to adjust for potential confounding variables. Results: During a median follow-up of 5.9 years, 27% (2,152/7,948) participants developed hypertension. A nonlinear association between serum FGF23 and incident hypertension was observed; only the highest decile of serum FGF23 was positively associated with incident hypertension (Table). After adjustment for demographics, the hazard ratio for incident hypertension was 1.37 (95% CI: 1.17, 1.60) for the highest decile of FGF23 compared to the lowest quintile. After adjustment for behaviors and adiposity the HR was 1.25 (95% CI: 1.07, 1.46). The association was further attenuated in the final model after adjusting for renal function (HR: 1.20, 95% CI: 1.03, 1.41). Complementary log-log models that accounted for interval censoring did not alter results. Conclusions: High levels ( 60.6 pg/mL) of FGF23 are associated with a modestly increased risk of incident hypertension in the general population. Next steps include replication of these findings in other cohorts, and examining the association with a longer follow-up period.

Abstract P146: Metabolic Score and Cardiovascular Disease Mortality among adults aged =18 years: a structural equation modeling approach - National Health and Nutrition Examination Survey III Linked Mortality File, 1988 - 2006, United States

Background: Metabolic syndrome (MetS) has been traditionally defined as abnormal values of at least three of the following components [systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), HDL cholesterol, triglycerides (TG), and fasting glucose (FG)]. However, there is concern that cut-points used to define abnormality are inappropriate for certain populations and which components are present matters. Methods: Using structural equation modeling (SEM), we estimated a continuous MetS scores as a latent variable based on the actual values of SBP, DBP, WC, HDL, TG, and FG by gender and race subgroups for 7791 participants from NHANES III, 1988-94. Data were linked with National Death Index to determine mortality status and cause of death up to December 31, 2006. Cox proportional hazard ratios were estimated to test the association between each MetS continuous component, MetS scores estimated from SEM, and traditionally defined MetS (yes/no) with cardiovascular disease (CVD) mortality adjusted for age, race, gender, smoking status, education, physical activity, alcohol consumption, and medication use for diabetes, hypertension, or high cholesterol. Results: For men, continuous MetS components individually associated with CVD mortality were SBP [Hazard ratio (HR) = 1.24, 95% confidence interval (CI) = 1.11 [[Unable to Display Character: &amp;#8211;]] 1.38], DBP (HR = 1.36, 95% CI = 1.15 [[Unable to Display Character: &amp;#8211;]] 1.61), and TG (HR = 1.01, 95% CI = 1.01 [[Unable to Display Character: &amp;#8211;]] 1.02). In women, SBP (HR = 1.21, 95% CI = 1.11 [[Unable to Display Character: &amp;#8211;]] 1.32) and DBP (HR = 1.28, 95% CI = 1.06 [[Unable to Display Character: &amp;#8211;]] 1.54) were associated with CVD mortality. Traditionally defined MetS or number of MetS components were not significantly associated with CVD mortality [men (MetS HR = 1.10, 95% CI = 0.73 [[Unable to Display Character: &amp;#8211;]] 1.66; # of MetS components HR = 1.05, 95% CI = 0.89 [[Unable to Display Character: &amp;#8211;]] 1.23) and women (MetS HR = 0.97, 95% CI = 0.68 [[Unable to Display Character: &amp;#8211;]] 1.38; # of MetS components HR = 1.10, 95% CI = 0.97 [[Unable to Display Character: &amp;#8211;]] 1.25)]. However, significant associations between MetS score and CVD mortality were found in men (HR = 1.43, 95% CI = 1.07 [[Unable to Display Character: &amp;#8211;]] 1.90) and women (HR = 1.34, 95% CI = 1.07 [[Unable to Display Character: &amp;#8211;]] 1.69). In subgroup analyses, the association between the MetS score and CVD mortality was greater among Mexican-American women (HR = 2.84, 95% CI = 1.46 [[Unable to Display Character: &amp;#8211;]] 5.53) and non-Hispanic black women (HR = 2.14, 95% CI = 1.48 [[Unable to Display Character: &amp;#8211;]] 3.08) compared to non-Hispanic white women (HR = 1.26, 95% CI = 1.001 [[Unable to Display Character: &amp;#8211;]] 1.59). When comparing models using the MetS score with those using traditionally defined MetS or number of abnormal MetS components, goodness-of-fit and concordance were better for all models with the MetS score based on Harrell’s C-statistics, Gönen &amp; Heller’s K-statistics, Akaike information criterion, and Bayesian information criterion. Conclusions: When investigating CVD risk and associations with MetS components, MetS score was a better predictor and risk assessment tool for CVD mortality than traditional defined MetS.

Abstract P319: Comparing Coronary Artery Calcium among U.S. South Asians with Four Racial/Ethnic Groups: The MASALA and MESA Studies

Background: South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease (CVD) which cannot be fully explained by traditional risk factors. We created a community-based cohort of South Asians (MASALA) and compared the prevalence of coronary artery calcium (CAC) to four racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: We compared 803 South Asians to the four racial/ethnic groups (2,622 Whites, 1,893 African Americans, 1,496 Latinos and 803 Chinese Americans), all free of CVD. We created pooled multivariate Poisson models to examine the effect of race/ethnicity with CAC after adjusting for sex, age, clinical site, education, smoking, BMI, diabetes, hypertension, HDL-, LDL-cholesterol, and cholesterol lowering medication use. Results: The age-adjusted prevalence of any CAC was similar between White and South Asian men (68%), but was lower in Latino (58%), Chinese American (58%) and African American men (51%). South Asian women had similar CAC prevalence as other ethnic minority women but significantly lower than White women (37% vs. 43%, p&lt;0.05). The figure shows the mean CAC scores among each of the five racial/ethnic groups by 5-year increments in age. After adjusting for all covariates, South Asian men were similar to White men and had higher CAC scores compared to African Americans, Latinos and Chinese Americans. In fully adjusted models, CAC scores were similar for South Asian women compared to all MESA groups. However, South Asian women ≥70 years had a higher prevalence of any CAC than all other racial/ethnic groups. Conclusions: South Asian men are more similar to Whites than the other race/ethnic groups in MESA. The high burden of subclinical atherosclerosis in South Asians may partly explain higher rates of CVD in South Asians. Follow-up data from the MASALA study will determine whether CAC is associated with incident CVD among South Asians and if this relationship differs from that observed in other racial/ethnic groups.

Sex related differences in mri features between two etiologically different osteoarthritis subpopulations: data from the osteoarthritis initiative

Purpose: The observed heterogeneity in osteoarthritis with respect to e.g. risk factors, symptoms, affected joints and progression, gave rise to the idea that OA is in fact a collection of distinct disease subtypes. In this study we explored whether two etiologically distinct subtypes of knee OA with equal radiological OA severity, differ in osteoarthritis features as seen on MRI. The subtypes comprised a group with metabolic syndrome and a group of lean physically active subjects. Methods: From all subjects of the Osteoarthritis Initiative (OAI) incidence subcohort, who had a KL score ≥ 2 in at least one knee at 48 months follow-up, we included two groups of 50 subjects, matched for KL score. To be included in the metabolic syndrome group subjects needed to have a BMI > 30 kg/m2 or abdominal circumference >94 cm for males or >80 cm for females. Further, 2 out of 3 of the following criteria needed to be present: hypertension (RR > 130/85 mmHg or use of hypertension medication), insulin resistance (reported high blood sugar or use of diabetic medication) or dyslipidemia (use of lipid lowering medication). Inclusion criteria for the physically active lean group were a BMI < 25 kg/m2 and a Physical activity scale for the elderly (PASE) score ≥ 2, which indicates strenuous sport/recreation activities. MRI scans made at 48 month follow-up were requested for these subjects from the OAI database, and one randomly selected OA knee from each subject was scored using the MRI Osteoarthritis Knee Score (MOAKS). Results: The metabolic syndrome group consisted of 28 females and 22 males with an average age of 63.4 years while the physically active lean group consisted of 37 females and 13 males with an average age of 61.3 years. Scores for bone marrow lesions (BMLs), and cartilage damage were consistently higher in most of the knee compartments in the metabolic syndrome group, but only for females and only significant for cartilage damage. In the lateral tibia, however, scores for BMLs and cartilage damage were lower in the metabolic syndrome group, for both sexes. Osteophyte scores were higher for all compartments in the metabolic syndrome group, irrespective of sex, though these differences were only significant for a few compartments in females (see Fig.). Scores of meniscal tears and Hoffa synovitis were significantly higher in the physically active lean group while high prepatellar signal was more often seen in the metabolic syndrome group, especially in the females. Conclusions: Metabolic OA and OA related to physical activity showed clear differences in MRI OA features, depending on sex and knee compartment. Intriguing is the difference between men and women in the pattern in which cartilage damage and BMLs are distributed over the compartments (see Fig.). This is suggestive of differences in biomechanics of the knee between the sexes, which have been shown to underlie the higher prevalence of patello-femoral problems in women. The fact that metabolic syndrome is associated with worse scores in women but not in men might be attributed to differences in fat distribution. Fat in females is deposited mostly subcutaneously, while males have more visceral fat. The subcutaneous amount of fat is related to leptin levels, and interestingly, leptin levels have been shown to influence OA, especially in women. Another interesting finding is that osteophyte scores behave differently than scores for BMLs and cartilage damage, in that the distribution over the compartments is less pronounced, and that scores are higher in the metabolic syndrome group, for both sexes. This suggests that the etiological process for osteophyte development is at least partly independent from the processes that influence cartilage damage and BMLs. In conclusion, these results suggest that different etiological processes in knee OA do lead to differences in structural degradation, which is probably modulated by biomechanical loads in the different compartments of the knee.

The association of metabolic syndrome markers with adhesive capsulitis

Research has associated adhesive capsulitis with diabetes mellitus but suggests that glucose-mediated injury may begin before diabetes is diagnosed. The period preceding diabetes is often marked by metabolic syndrome. We investigated the relationship between metabolic syndrome components (insulin resistance, hypertension, dyslipidemia, and obesity) and the development of adhesive capsulitis using a case-control study. We retrospectively reviewed 150 consecutive adhesive capsulitis patient charts to determine the prevalence of obesity and of medications used for treating metabolic syndrome elements and compared these with previously reported nationwide values. The prevalence of anti-hyperglycemia medications in the adhesive capsulitis cohort was 18.4% (95% confidence interval [CI], 12.9%-25.7%), twice the national rate of diagnosed diabetes of 7.6% (95% CI, 6.7%-8.5%). In the 20- to 39-year-old group, the prevalence of anti-hyperglycemic medications, 26.3% (95% CI, 11.8%-48.8%), was over 10 times the nationwide rate. The overall prevalence of hypertensive medication use in the adhesive capsulitis group, 33.1% (95% CI, 25.9%-41.2%), was notably higher than the nationwide rate, 21.6% (95% CI, 19.8%-23.4%). In the 40- to 64-year-old group, the prevalence of hypertensive medication use, 36.8% (95% CI, 28.6%-46.0%), was notably higher than the nationwide rate of 24.5% (95% CI, 22.2%-27.0%). The prevalence of anti-lipid medications and obesity was similar between the groups. The relationship between adhesive capsulitis and metabolic syndrome remains unclear. Our results confirm previous work associating hyperglycemia with adhesive capsulitis. We have also shown a possible association of hypertension, part of metabolic syndrome and a proinflammatory condition, with adhesive capsulitis, which has not been previously described.

Abstract T P151: Fibroblast Growth Factor 23 and Carotid Plaque: the Northern Manhattan Study (NOMAS)

Introduction: Fibroblast growth factor 23 (FGF23), a hormone that regulates phosphate homeostasis, has recently been linked with mortality, cardiovascular events, and stroke. While limited evidence suggests that FGF23 is associated with arterial calcification in chronic kidney disease (CKD), data on the association between FGF23 and carotid plaque are lacking, especially in population-based studies. This study aimed to determine if relative elevations of FGF23 are associated with presence and area of carotid plaque in a race/ethnically diverse community-based sample. Methods: There were 1,512 stroke-free NOMAS participants with FGF23 levels and 2D carotid ultrasound data available (mean age, 68±9; 61% women; 62% Hispanic, 18% black, 18% white, 2% other). We evaluated the association of FGF23, continuously and by quintiles, with presence of carotid plaque using logistic regression models and with plaque area (cubic root transformed) using linear regression models, adjusting for age, sex, race/ethnicity, estimated glomerular filtration rate (eGFR), body mass index, smoking, alcohol use, blood pressure, fasting glucose, lipids, and hypertension, diabetes, and dyslipidemia medication use. Results: Participants with FGF23 levels in the top quintile had greater odds of having carotid plaque (OR=1.5 95% CI=1.0-2.2, p=0.04) and larger plaque area (beta=0.3, 95% CI=0.1-0.5, p=0.006) than those in the lowest quintile, adjusting for eGFR and demographic factors, although the association was attenuated after adjusting for vascular risk factors. Linear regression models also showed that log transformed FGF23 was associated with greater plaque area adjusting for eGFR and sociodemographic factors (beta=0.2, 95% CI=0.03-0.3, p=0.02), and this remained marginally significant after adjusting for vascular risk factors (beta=0.1, 95% CI=0.0-0.3, p=0.05). Conclusions: These data suggest that FGF23 is associated with the likelihood and burden of carotid atherosclerosis in a stroke-free community based sample. Our finding that the association between FGF23 and carotid plaque measures was weaker after adjusting for vascular risk factors suggests possible mediation and requires further study.

Risk factors for reduced glomerular filtration rate in a Nicaraguan community affected by Mesoamerican nephropathy.

Mesoamerican nephropathy, also known as chronic kidney disease of unknown etiology, is widespread in Pacific coastal Central America. The cause of the epidemic is unknown, but the disease may be linked to multiple factors, including diet as well as environmental and occupational exposures. As many as 50% of men in some communities have Mesoamerican nephropathy. Describe prevalence of reduced glomerular filtration rate in a region of Nicaragua suspected to harbor high rates of Mesoamerican nephropathy; and investigate potential risk factors for such reduction associated with agricultural work (such as pesticide exposure and specific agricultural tasks associated with increased heat stress); sugar consumption; and traditional factors such as age, sex, diabetes, hypertension and nephrotoxic medication use. This study uses a cross-sectional design with nested case-control analysis. Cases were individuals with estimated glomerular filtration rates of <60mL/min/1.73m2 and controls were individuals with those >90mL/min/1.73m2, estimated using serum creatinine. Data on nutrition, past medical history, medication and substance use, and agricultural behaviors and exposures were collected using medical questionnaires from June through August, 2012. Venous blood and urine samples were collected to assess hemoglobin A1c, and dipstick proteinuria, respectively; anthropometry and blood pressure measurements were made using standard techniques. Analyses were conducted using chi square, and univariate and multiple logistic regression. Of 424 individuals in the study, 151 had an occupational history in agriculture. Prevalence of glomerular filtration rate <60mL/min/1.73m2 was 9.8% among women and 41.9% among men (male to female ratio = 4.3, p<0.0001). Proteinuria =300 mg/dL was observed in <10% of participants with decreased glomerular filtration rate. Hemoglobin A1c and use of NSAIDs were not associated with decreased glomerular filtration rate. Although systolic and diastolic blood pressure was higher among participants with decreased glomerular filtration rate (p <0.001), hypertension was uncommon. Significant agricultural risk factors for reduced glomerular filtration rate included increased lifetime days cutting sugarcane during the dry season (OR 5.86, 95% CI 2.45-14.01), nondeliberate pesticide inhalation (OR 3.31, 95% CI 1.32-8.31), and sugarcane chewing (OR 3.24, 95% CI 1.39-7.58). Our findings demonstrate a high prevalence of chronic kidney disease not linked to traditional risk factors, and suggest it may be associated instead with occupational exposure to heat stress in conjunction with pesticide inhalation, sugarcane chewing and sugar intake during the workday.