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Reese JA, Roman MJ, Deen JF, Ali T, Cole SA, Devereux RB, Fretts AM, Howard WJ, Lee ET, Malloy K, Umans JG, Zhang Y. Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study. J Am Heart Assoc 2024; 13:e031741. [PMID: 38445515 PMCID: PMC11010025 DOI: 10.1161/jaha.123.031741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although many studies on the association between dyslipidemia and cardiovascular disease (CVD) exist in older adults, data on the association among adolescents and young adults living with disproportionate burden of cardiometabolic disorders are scarce. METHODS AND RESULTS The SHFS (Strong Heart Family Study) is a multicenter, family-based, prospective cohort study of CVD in an American Indian populations, including 12 communities in central Arizona, southwestern Oklahoma, and the Dakotas. We evaluated SHFS participants, who were 15 to 39 years old at the baseline examination in 2001 to 2003 (n=1440). Lipids were measured after a 12-hour fast. We used carotid ultrasounds to detect plaque at baseline and follow-up in 2006 to 2009 (median follow-up=5.5 years). We identified incident CVD events through 2020 with a median follow-up of 18.5 years. We used shared frailty proportional hazards models to assess the association between dyslipidemia and subclinical or clinical CVD, while controlling for covariates. Baseline dyslipidemia prevalence was 55.2%, 73.6%, and 78.0% for participants 15 to 19, 20 to 29, and 30 to 39 years old, respectively. Approximately 2.8% had low-density lipoprotein cholesterol ≥160 mg/dL, which is higher than the recommended threshold for lifestyle or medical interventions in young adults of 20 to 39 years old. During follow-up, 9.9% had incident plaque (109/1104 plaque-free participants with baseline and follow-up ultrasounds), 11.0% had plaque progression (128/1165 with both baseline and follow-up ultrasounds), and 9% had incident CVD (127/1416 CVD-free participants at baseline). Plaque incidence and progression were higher in participants with total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥160 mg/dL, or non-high-density lipoprotein cholesterol ≥130 mg/dL, while controlling for covariates. CVD risk was independently associated with low-density lipoprotein cholesterol ≥160 mg/dL. CONCLUSIONS Dyslipidemia is a modifiable risk factor that is associated with both subclinical and clinical CVD, even among the younger American Indian population who have unexpectedly high rates of significant CVD events. Therefore, this population is likely to benefit from a variety of evidence-based interventions including screening, educational, lifestyle, and guideline-directed medical therapy at an early age.
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Affiliation(s)
- Jessica A Reese
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | | | - Jason F Deen
- Departments of Pediatrics and Medicine University of Washington Seattle WA USA
| | - Tauqeer Ali
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Shelley A Cole
- Population Health Texas Biomedical Research Institute San Antonio TX USA
| | | | - Amanda M Fretts
- Department of Epidemiology University of Washington Seattle WA USA
| | - Wm James Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science Washington DC USA
| | - Elisa T Lee
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Kimberly Malloy
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Jason G Umans
- MedStar Health Research Institute Hyattsville MD USA
- Georgetown-Howard Universities Center for Clinical and Translational Science Washington DC USA
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
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Reese JA, Roman MJ, Deen JF, Ali T, Cole SA, Devereux RB, Fretts AM, Howard BV, Lee ET, Malloy K, Singh P, Umans JG, Zhang Y. Subclinical atherosclerosis in adolescents and young adults and the risk of cardiovascular disease: The Strong Heart Family Study (SHFS). Nutr Metab Cardiovasc Dis 2022; 32:1863-1871. [PMID: 35680485 PMCID: PMC9377778 DOI: 10.1016/j.numecd.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Rates of cardiovascular disease (CVD) among American Indians (AI) have been increasing. Although we have observed an association between atherosclerosis and CVD in older adults, the potential association among young AI is unclear. Therefore, we aim to describe the prevalence of atherosclerosis among young AI and determine its association with CVD and all-cause mortality. METHODS AND RESULTS We evaluated AI participants from the Strong Heart Family Study (SHFS), who were <40 years old and CVD free at the baseline examination, 2001-2003 (n = 1376). We used carotid ultrasound to detect baseline atherosclerotic plaque. We identified CVD events and all-cause mortality through 2019, with a median follow-up of 17.8 years. We used shared frailty Cox Proportional Hazards models to assess the association between atherosclerosis and time to CVD event or all-cause mortality, while controlling for covariates. Among 1376 participants, 71 (5.2%) had atherosclerosis at baseline. During follow-up, 120 (8.7%) had CVD events and 104 (7.6%) died from any cause. CVD incidence was higher in participants who had baseline atherosclerosis (13.51/1000 person-years) than in those who did not (4.95/1000 person-years, p = 0.0003). CVD risk and all-cause mortality were higher in participants with atherosclerosis, while controlling for covariates (CVD HR = 1.85, 95%CI = 1.02-3.37, p = 0.0420; all-cause mortality HR = 2.04, 95%CI = 1.07-3.89, p = 0.0291). CONCLUSIONS Among young AI, atherosclerosis was independently associated with incident CVD and all-cause mortality later in life. Thus, atherosclerosis begins early in life and interventions in adolescents and young adults to slow the progression of disease could prevent or delay CVD events later in life.
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Affiliation(s)
- Jessica A Reese
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mary J Roman
- Weill Cornell Medical College, New York, NY, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle WA, USA
| | - Tauqeer Ali
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shelley A Cole
- Population Health, Texas Biomedical Research Institute, San Antonio, TX, USA
| | | | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Elisa T Lee
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly Malloy
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Peng H, Zhu Y, Yeh F, Cole SA, Best LG, Lin J, Blackburn E, Devereux RB, Roman MJ, Lee ET, Howard BV, Zhao J. Impact of biological aging on arterial aging in American Indians: findings from the Strong Heart Family Study. Aging (Albany NY) 2017; 8:1583-92. [PMID: 27540694 PMCID: PMC5032684 DOI: 10.18632/aging.101013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
Telomere length, a marker of biological aging, has been associated with cardiovascular disease (CVD). Increased arterial stiffness, an indicator of arterial aging, predicts adverse CVD outcomes. However, the relationship between telomere length and arterial stiffness is less well studied. Here we examined the cross-sectional association between leukocyte telomere length (LTL) and arterial stiffness in 2,165 American Indians in the Strong Heart Family Study (SHFS). LTL was measured by qPCR. Arterial stiffness was assessed by stiffness index β. The association between LTL and arterial stiffness was assessed by generalized estimating equation model, adjusting for sociodemographics (age, sex, education level), study site, metabolic factors (fasting glucose, lipids, systolic blood pressure, and kidney function), lifestyle (BMI, smoking, drinking, and physical activity), and prevalent CVD. Results showed that longer LTL was significantly associated with a decreased arterial stiffness (β=-0.070, P=0.007). This association did not attenuate after further adjustment for hsCRP (β=-0.071, P=0.005) or excluding participants with overt CVD (β=-0.068, P=0.012), diabetes (β=-0.070, P=0.005), or chronic kidney disease (β=-0.090, P=0.001). In summary, shorter LTL was significantly associated with an increased arterial stiffness, independent of known risk factors. This finding may shed light on the potential role of biological aging in arterial aging in American Indians.
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Affiliation(s)
- Hao Peng
- Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA 70112, USA
| | - Yun Zhu
- Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA 70112, USA
| | - Fawn Yeh
- Center for American Indian Health Research, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc, Timber Lake, SD 57656, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics at the University of California, San Francisco, CA 94143, USA
| | - Elizabeth Blackburn
- Department of Biochemistry and Biophysics at the University of California, San Francisco, CA 94143, USA
| | - Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Mary J Roman
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Elisa T Lee
- Center for American Indian Health Research, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | | | - Jinying Zhao
- Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA 70112, USA
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Gribble MO, Voruganti VS, Cole SA, Haack K, Balakrishnan P, Laston SL, Tellez-Plaza M, Francesconi KA, Goessler W, Umans JG, Thomas DC, Gilliland F, North KE, Franceschini N, Navas-Acien A. Linkage Analysis of Urine Arsenic Species Patterns in the Strong Heart Family Study. Toxicol Sci 2015. [PMID: 26209557 DOI: 10.1093/toxsci/kfv164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Arsenic toxicokinetics are important for disease risks in exposed populations, but genetic determinants are not fully understood. We examined urine arsenic species patterns measured by HPLC-ICPMS among 2189 Strong Heart Study participants 18 years of age and older with data on ~400 genome-wide microsatellite markers spaced ~10 cM and arsenic speciation (683 participants from Arizona, 684 from Oklahoma, and 822 from North and South Dakota). We logit-transformed % arsenic species (% inorganic arsenic, %MMA, and %DMA) and also conducted principal component analyses of the logit % arsenic species. We used inverse-normalized residuals from multivariable-adjusted polygenic heritability analysis for multipoint variance components linkage analysis. We also examined the contribution of polymorphisms in the arsenic metabolism gene AS3MT via conditional linkage analysis. We localized a quantitative trait locus (QTL) on chromosome 10 (LOD 4.12 for %MMA, 4.65 for %DMA, and 4.84 for the first principal component of logit % arsenic species). This peak was partially but not fully explained by measured AS3MT variants. We also localized a QTL for the second principal component of logit % arsenic species on chromosome 5 (LOD 4.21) that was not evident from considering % arsenic species individually. Some other loci were suggestive or significant for 1 geographical area but not overall across all areas, indicating possible locus heterogeneity. This genome-wide linkage scan suggests genetic determinants of arsenic toxicokinetics to be identified by future fine-mapping, and illustrates the utility of principal component analysis as a novel approach that considers % arsenic species jointly.
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Affiliation(s)
- Matthew O Gribble
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California;
| | - Venkata Saroja Voruganti
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina; UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, Texas
| | - Poojitha Balakrishnan
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sandra L Laston
- South Texas Diabetes and Obesity Institute, University of Texas Health Science Center, San Antonio-Regional Academic Health Center, Brownsville, Texas
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Biomedical Research Institute, Hospital Clinic de Valencia-INCLIVA, Valencia, Spain
| | - Kevin A Francesconi
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | - Walter Goessler
- Institute of Chemistry-Analytical Chemistry, University of Graz, Graz, Austria
| | - Jason G Umans
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia; MedStar Health Research Institute, Hyattsville, Maryland
| | - Duncan C Thomas
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Frank Gilliland
- *Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kari E North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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