C-reactive protein and subclinical cardiovascular disease among African-Americans: (the Jackson Heart Study)

Compositional analysis of movement behaviors' association on high-sensitivity c-reactive protein: the Jackson heart study

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.

Association Between Occupational Sitting With High Sensitivity C-Reactive Protein: The Jackson Heart Study

Modifiable, behavioral risk factors like occupational sitting may contribute to inflammation, an important cardiovascular risk factor. This study evaluated the association of self-reported occupational sitting with changes in c-reactive protein (CRP) and the role of sex. We examined occupational sitting and baseline CRP levels for 2889 African American participants in the Jackson Heart Study. Four multivariable linear regression models were estimated to determine the association of occupational sitting and CRP. Analyses were conducted in 2020. The mean age was 50.8 years and 61% were female. Participants who reported occupational sitting as “often/always” had CRP levels of 4.9±6.8 mg/L, “sometimes” had levels of 4.8±8.1 mg/L, and “never/seldom” had levels of 4.3±6.8 mg/L. In the unadjusted model, “often/always” engaging in occupational sitting was significantly associated with higher levels of CRP when compared to “never/seldom” ( P < .05). This differed by sex with female participants who reported “often/always” occupational sitting had CRP levels of 6.0±7.6 mg/L compared to only 5.1±6.9 mg/L for “never/seldom.” Neither the overall association nor the female-specific association remained statistically significant in the adjusted models. We found an association between occupational sitting and inflammation, measured by CRP. This association varied by sex but did not remain significant after fully adjusting for covariates.

Social Integration and Quality of Social Relationships as Protective Factors for Inflammation in a Nationally Representative Sample of Black Women

Social integration and supportive relationships protect against cardiovascular disease (CVD). However, prior studies have examined heterogeneous samples which may obscure unique relationships within groups. We investigate the association between social relationships and inflammation-a known CVD risk factor-in Black women, a population with higher rates of CVD and CVD mortality. Secondary data from wave 4 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The sample was comprised of 1829 Black women aged 24-34 years. Social integration was a z-score standardized measure of four items (marital/cohabitation status, church attendance, volunteerism, close friendships). Data on the quality of three relationship types was available: perceived happiness with a romantic relationship and perceived closeness to mother and father figure. Inflammation was measured via high-sensitivity C-reactive protein (hs-CRP) in which levels were categorized based on clinical cut-points for risk of CVD (< 1 mg/L = low risk-reference, 1-3 mg/L = moderate risk, > 3-10 mg/L = high risk, > 10 mg/L = very high risk). Multivariable logistic regression was conducted accounting for the complex survey design and wave 4 control measures (e.g., body mass index, smoking, medications, acute illness, overall health, sociodemographic factors). No significant associations were found between level of social integration and hs-CRP levels. With respect to relationship quality, women who reported they were very happy with their romantic relationship were less likely than those who were only fairly happy or unhappy to have hs-CRP levels in the moderate- (AOR = 0.36, 95% CI = 0.17, 0.75), high (AOR = 0.20, 95% CI = 0.08, 0.49), or very high CVD-risk category (AOR = 0.36, 95% CI = 0.16, 0.80). Women who reported they were somewhat/quite/very close to their mother figure (AOR = 0.48, 95% CI = 0.25, 0.92) and those who reported having no mother figure (AOR = 0.25, 95% CI = 0.08, 0.77) were less likely than women reporting being not very close/not close at all with their mother figure to have hs-CRP levels in the moderate- vs. low-risk category. No statistically significant associations were found between father-figure relationship and hs-CRP CVD risk category. In summary, social integration and the quality of specific social relationships were significantly associated with inflammation in young adult Black women. Thus, interventions designed to enhance social connectedness and positive social relationships among Black women may have the potential to be protective for CVD risk. Further researches with the longitudinal social relationship and inflammatory measures are needed to better understand how changes in social relationships may influence CVD risk over the life course.

Variables associated with subclinical atherosclerosis in a cohort of rheumatoid arthritis patients: Sex-specific associations and differential effects of disease activity and age

OBJECTIVE

To advance the study of variables associated with subclinical atherosclerosis in rheumatoid arthritis (RA) with special consideration for the degree of disease activity, age and gender.

METHODS

The carotid intima-media thickness (cIMT) and the presence of carotid atherosclerotic plaques along with clinical and biochemical characteristics were determined in 214 RA patients.

RESULTS

Adjusted analysis reveals that men had a 0.059 mm significantly increased cIMT compared with women (p = 0.001; R2 = 3.8%) and that age was associated with cIMT (β = 0.0048 mm; p = 0.0001; R2 = 16%). Interestingly, we observed a significant interaction between gender and age. Thus, the effect of age on cIMT was significantly increased (12%) in men compared with women (p-value for interaction term = 0.041). Moreover, adjusted multivariable linear regression analysis revealed that disease activity score (DAS28) was significantly associated with cIMT in women (β = 0.021; p = 0.018: R2 = 0.03) but not men. In particular, women with high disease activity had a 0.079 mm increased cIMT compared with women in remission (p = 0.026). In addition, men in remission had a 0.134 mm increased cIMT compared with women in remission (p = 0.003; R2 = 8.7%). Active patients did not exhibit differences in cIMT values. Furthermore, 43% of patients presented carotid plaques. The variables independently associated with carotid plaques were age, smoking, health assessment questionnaire, erythrocyte sedimentation rate and rheumatoid factor (p<0.0001; R2 = 46%).

CONCLUSION

In our cohort of patients with RA, DAS28 and age are differentially associated with cIMT in men and women. Our findings could explain the contradictory results that have previously been published in the literature.

Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study)

There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.

The Relationship between Neutrophil-to-Lymphocyte Ratio and Aortic Arch Calcification in Ischemic Stroke Patients

BACKGROUND

Inflammation plays a central role in atherogenesis and artery calcification. Although neutrophil-to-lymphocyte ratio (NLR) has been introduced as an inflammatory marker for atherosclerosis, the relationship between NLR and aortic arch calcification (AAC) has not been studied. This study aimed to determine the association between NLR and AAC.

METHODS

A total of 749 participants were enrolled. Demographic and clinical data were collected. Degree of AAC in each enrolled patient was determined with Agatston method based on a neck computed tomography angiography. NLR was divided into 4 groups according to quartile values. Generalized linear model (ordinal probit) was performed to assess the association between NLR quartiles and severity of AAC.

RESULTS

There were 151 (20.2%), 153 (20.4%), and 445 (59.4%) patients classified as without AAC, with mild AAC, and with severe AAC, respectively. Patients with severe AAC had the highest NLR values (2.37[1.79-3.42] versus 2.29[1.55-2.96] versus 2.17[1.64-2.91], P = .025) compared to patients without AAC and with mild AAC. In age- and sex-adjusted models, patients with the highest NLR (quartile 4) were correlated with severer AAC (β = .348 ± .128, P = .006) compared to those with the lowest levels (quartile 1). The correlation between NLR quartile 4 and severer AAC still existed (β = .335 ± .129, P = .009) in multivariable-adjusted model.

CONCLUSIONS

This study suggested that NLR may reflect the severity of AAC. NLR may be considered as a valuable predictor of the degree of artery calcification.

Capacity-Building for Career Paths in Public Health and Biomedical Research for Undergraduate Minority Students: A Jackson Heart Study Success Model

OBJECTIVE

This article chronicles the building of individual student capacity as well as faculty and institutional capacity, within the context of a population-based, longitudinal study of African Americans and cardiovascular disease. The purpose of this article is to present preliminary data documenting the results of this approach.

DESIGN

The JHS Scholars program is designed, under the organizational structure of the Natural Sciences Division at Tougaloo College, to provide solid preparation in quantitative skills through: good preparation in mathematics and the sciences; a high level of reading comprehension; hands-on learning experiences; and mentoring and counseling to sustain the motivation of the students to pursue further studies.

SETTING

This program is on the campus of a private Historically Black College in Mississippi.

PARTICIPANTS

The participants in the program are undergraduate students.

MAIN OUTCOME MEASURES

Data, which included information on major area of study, institution attended, degrees earned and position in the workforce, were analyzed using STATA 14.

RESULTS

Of 167 scholars, 46 are currently enrolled, while 118 have graduated. One half have completed graduate or professional programs, including; medicine, public health, pharmacy, nursing, and biomedical science; approximately one-fourth (25.4 %) are enrolled in graduate or professional programs; and nearly one tenth (9.3%) completed graduate degrees in law, education, business or English.

CONCLUSIONS

These data could assist other institutions in understanding the career development process that helps underrepresented minority students in higher education to make career choices on a path toward public health, health professions, biomedical research, and related careers.

User-Friendly Data-Sharing Practices for Fostering Collaboration within a Research Network: Roles of a Vanguard Center for a Community-Based Study

Although various attempts have been made to build collaborative cultures for data sharing, their effectiveness is still questionable. The Jackson Heart Study (JHS) Vanguard Center (JHSVC) at the NIH-funded Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) Data Coordinating Center (DCC) may be a new concept in that the data are being shared with a research network where a plethora of scientists/researchers are working together to achieve their common goal. This study describes the current practices to share the JHS data through the mechanism of JHSVC. The JHS is the largest single-site cohort study to prospectively investigate the determinants of cardiovascular disease among African-Americans. It has adopted a formal screened access method through a formalized JHSVC mechanism, in which only a qualified scientist(s) can access the data. The role of the DCC was to help RTRN researchers explore hypothesis-driven ideas to enhance the output and impact of JHS data through customized services, such as feasibility tests, data querying, manuscript proposal development and data analyses for publication. DCC has implemented these various programs to facilitate data utility. A total of 300 investigators attended workshops and/or received training booklets. DCC provided two online and five onsite workshops and developed/distributed more than 250 copies of the booklet to help potential data users understand the structure of and access to the data. Information on data use was also provided through the RTRN website. The DCC efforts led to the production of five active manuscript proposals, seven completed publications, 11 presentations and four NIH grant proposals. These outcomes resulted from activities during the first four years; over the last couple of years, there were few new requests. Our study suggested that DCC-customized services enhanced the accessibility of JHS data and their utility by RTRN researchers and helped to achieve the principal goal of JHSVC of scientific productivity. In order to achieve long-term success, the following, but not limited to these, should be addressed in the current data sharing practices: preparation of new promotional strategies in response to changes in technology and users’ needs, collaboration with the Network statisticians, harmonization of the JHS data with the other local-based heart datasets to meet the needs of the potential users from the broader geographical areas, adoption of the RTRN comprehensive data-sharing policy to broaden the variety of research topics and implementation of an ongoing monitoring program to evaluate its success.

Combined association of physical activity and diet with C-reactive protein among smokers

Background

In the general population, both physical activity and dietary behavior are independently associated with less systemic inflammation, with this relationship less examined among smokers. To our knowledge, no study has examined the combined association of both physical activity and dietary behavior on systemic inflammation among daily smokers, which was the purpose of this study.

Methods

Data from the 2003–2006 NHANES were employed. 810 adult smokers provided C-reactive protein data (CRP; a marker of inflammation), and sufficient physical activity (accelerometry) and dietary data (healthy eating index).

Results

The fully adjusted model showed that participants meeting physical activity guidelines and eating a healthy diet (β = −0.34, p = 0.03) had lower CRP levels when compared to those not engaging in these health behaviors, but only having one health behavior was not a significant predictor of CRP (β = −0.19, p = 0.14).

Conclusions

Smokers engaging in regular physical activity while consuming a healthy diet demonstrate lower CRP levels than their counterparts. When taken together, these behaviors may mitigate inflammation associated with various chronic diseases, which is of particular importance as very few smokers successfully quit smoking.