Abstract P380: Risk of Cardiovascular Event by Metabolic Status and Presence of Subclinical Disease in African Americans: The Jackson Heart Study
Background. African Americans (AA) with diabetes (DM) and metabolic syndrome (MetS) are at a disproportionately higher risk of myocardial infarction (MI) and stroke compared to non-Hispanic whites with DM and MetS. We hypothesized that a higher prevalence of subclinical disease (ScD) contributes to the increased risk of event in AA.
Objective. We compared the cardiovascular disease (CVD) risk in AA with and without MetS and DM, stratified by ScD prevalence in a community-based sample.
Methods. We evaluated 4365 participants (mean age 53.8±12.3 years, 64.5% women) free of overt CVD who attended the first examination cycle of the Jackson Heart Study between 2000- 2004, when ScD measurements were routinely performed (CT for coronary calcium occurred in Exam 2). ScD was defined by on the presence of one or more of the following: peripheral artery disease (ankle-brachial index < 0.9), high coronary artery calcium (score >100), LV hypertrophy (LV mass index >51 g/m2.7), low LV ejection fraction (<50%) or microalbuminuria. Incident CVD was defined as an MI, coronary revascularization procedure, or stroke. We adjusted for age, sex, education status, LDL, smoking status and % dietary fat in multivariable analyses and compared the CVD risk in those with MetS but without DM and in those with DM to individuals without MetS or DM (referent). We estimated models adjusting for the presence of ScD and stratifying by the presence versus absence of ScD.
Results. Over a mean follow-up period of 6.2 years, the incidence rates of CVD (per 100) increased from 2.63 in those without MetS or DM to 5.97 in those with MetS but no DM and 12.23 in those with DM. Table 1 shows the risk of CVD event by MetS and ScD based on three separate models. Conclusion. In our large community-based sample of AAs, we observed that the presence of ScD conferred an increased risk of CVD in those with MetS but no DM and in participants with DM. Our findings identify ScD as a key mediator of CVD risk in AA overall, including individuals with metabolic disturbances and DM.
- © 2013 by American Heart Association, Inc.