Purpose The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a comprehensive multicenter community based cohort study of Hispanics/Latinos in the United States. Methods The Study ...rationale, objectives, design, and implementation are described in this report. Results The HCHS/SOL will recruit 16,000 men and women who self-identify as Hispanic or Latino, 18 to 74 years of age, from a random sample of households in defined communities in the Bronx, Chicago, Miami, and San Diego. The sites were selected so that the overall sample would consist of at least 2000 persons in each of the following origin designations: Mexican, Puerto Rican and Dominican, Cuban, and Central and South American. The study includes research in the prevalence of and risk factors for heart, lung, blood and sleep disorders, kidney and liver function, diabetes, cognitive function, dental conditions, and hearing disorders. Conclusions The HCHS/SOL will (1) characterize the health status and disease burden in the largest minority population in the United States; (2) describe the positive and negative consequences of immigration and acculturation of Hispanics/Latinos to the mainstream United States life-styles, environment and health care opportunities; and (3) identify likely causal factors of many diseases in a population with diverse environmental exposures, genetic backgrounds, and early life experiences.
A risk score for atrial fibrillation (AF) has been developed by the Framingham Heart Study; however, the applicability of this risk score, derived using data from white patients, to predict new-onset ...AF in nonwhites is uncertain. Therefore, we developed a 10-year risk score for new-onset AF from risk factors commonly measured in clinical practice using 14,546 subjects from the Atherosclerosis Risk In Communities (ARIC) study, a prospective community-based cohort of blacks and whites in the United States. During 10 years of follow-up, 515 incident AF events occurred. The following variables were included in the AF risk score: age, race, height, smoking status, systolic blood pressure, hypertension medication use, precordial murmur, left ventricular hypertrophy, left atrial enlargement, diabetes, coronary heart disease, and heart failure. The area under the receiver operating characteristics curve (AUC) of a Cox regression model that included the previous variables was 0.78, suggesting moderately good discrimination. The point-based score developed from the coefficients in the Cox model had an AUC of 0.76. This clinical risk score for AF in the Atherosclerosis Risk In Communities cohort compared favorably with the Framingham Heart Study's AF (AUC 0.68), coronary heart disease (CHD) (AUC 0.63), and hard CHD (AUC 0.59) risk scores and the Atherosclerosis Risk In Communities CHD risk score (AUC 0.58). In conclusion, we have developed a risk score for AF and have shown that the different pathophysiologies of AF and CHD limit the usefulness of a CHD risk score in identifying subjects at greater risk of AF.
Most population-based estimates of incident hospitalized heart failure (HF) have not differentiated acute decompensated heart failure (ADHF) from chronic stable HF nor included racially diverse ...populations. The Atherosclerosis Risk in Communities Study conducted surveillance of hospitalized HF events (age ≥55 years) in 4 US communities. We estimated hospitalized ADHF incidence and survival by race and gender. Potential 2005 to 2009 HF hospitalizations were identified by International Classification of Diseases, Ninth Revision, Clinical Modification , codes; 6,168 records were reviewed to validate ADHF cases. Population estimates were derived from US Census data; 50% of eligible hospitalizations were classified as ADHF, of which 63.6% were incident ADHF and 36.4% were recurrent ADHF. The average incidence of hospitalized ADHF was 11.6 per 1,000 persons, aged ≥55 years, per year, and recurrent hospitalized ADHF was 6.6 per 1,000 persons/yr. Age-adjusted annual ADHF incidence was highest for black men (15.7 per 1,000), followed by black women (13.3 per 1,000), white men (12.3 per 1,000), and white women (9.9 per 1,000). Of incident ADHF events with heart function assessment (89%), 53% had reduced the ejection fraction (heart failure with reduced ejection fraction HFrEF) and 47% had preserved ejection fraction (heart failure with preserved ejection fraction HFpEF). Black men had the highest proportion of acute HFrEF events (70%); white women had the highest proportion of acute HFpEF (59%). Age-adjusted 28-day and 1-year case fatality after an incident ADHF was 10.4% and 29.5%, respectively. Survival did not differ by race or gender. In conclusion, ADHF hospitalization and HF type varied by both race and gender, but case fatality rates did not. Further studies are needed to explain why black men are at higher risk of hospitalized ADHF and HFrEF.
Heart failure (HF) is increasing in prevalence in the United States. Little data exists on race and gender differences in HF incidence rates and case fatality. The Atherosclerosis Risk in Communities ...(ARIC) cohort is a population-based study from 4 United States communities (1987 to 2002). Prevalent HF cases (n = 750) were identified by self-report and were excluded. Incident HF was defined by the International Classification of Diseases codes for HF (428.0 to 428.9, I50) from a hospitalization (n = 1,206) or death certificate (n = 76). There were 1,282 incident HF cases over 198,417 person-years. The age-adjusted incidence rate (per 1,000 person-years) for Caucasian women, 3.4, was significantly less compared with all other groups (Caucasian men, 6.0; African-American women, 8.1; African-American men, 9.1). Age-adjusted HF incidence rates were greater for African-Americans than Caucasians, but adjustment for confounders attenuated the difference. The adjusted African-American-to-Caucasian hazard ratio was 0.86 (95% confidence interval, 0.70 to 1.06) for men, and similarly, 0.93 (95% confidence interval, 0.46 to 1.90) for women during the second half of follow-up. The hazard ratio for women during the first half of follow-up was 1.79 (95% confidence interval, 1.25 to 2.55). Thirty-day, 1-year, and 5-year case fatalities following hospitalization for HF were 10.4%, 22%, and 42.3%, respectively. African-Americans had a greater 5-year case fatality compared with Caucasians (p <0.05). In conclusion, heart failure incidence rates in African-American women were more similar to those of men than of Caucasian women. The greater HF incidence in African-Americans than in Caucasians is largely explained by African-Americans’ greater levels of atherosclerotic risk factors.
Recent studies showed that such retinal vascular signs as quantitative retinal vascular caliber were associated with increased risk of incident coronary heart disease (CHD), but whether these retinal ...vascular signs add to the prediction of CHD over and above traditional CHD risk factors was not addressed. Whether these signs add to the prediction of CHD over and above the Framingham risk score in people (n = 9,155) without diabetes selected from the ARIC Study was investigated. Incident CHD was ascertained using standardized methods, and retinal vascular caliber and other retinal signs were measured from retinal photographs. After a mean of 8.8 years of follow-up, there were 700 incident CHD events. Women with wider retinal venular caliber (hazard ratio 1.27/1-SD increase, 95% confidence interval 1.08 to 1.50) and narrower retinal arteriolar caliber (hazard ratio 1.31/1-SD decrease, 95% confidence interval 1.10 to 1.56) had a higher risk of incident CHD after adjusting for Framingham risk score variables. Area under the receiver operator characteristic curve increased from 0.695 to 0.706 (1.7% increase) with the addition of retinal vascular caliber to the Framingham risk model. Risk prediction models with and without retinal vascular caliber both fitted the data and were well calibrated for women. In men, retinal vascular caliber was not associated with CHD risk after adjustment. Other retinal vascular signs were not associated with 10-year incident CHD in men or women. In conclusion, although retinal vascular caliber independently predicted CHD risk in women, the incremental predictive ability over that of the Framingham model was modest and unlikely to translate meaningfully into clinical practice.
Purpose To assess the long-term association of military combat stress with coronary heart disease (CHD) and ischemic stroke (IS). Methods The association between exposure to military combat and the ...occurrence of CHD and IS was assessed among 5,347 men in the Atherosclerosis Risk in Communities (ARIC) study. Outcomes were assessed an average of 36 years after entry into military service during the eras of World War II, the Korean War, and the Vietnam conflict. Results Veterans were more likely to be older, white, and of higher socioeconomic status than non-veterans. No differences in CHD period prevalence rates were noted among the three exposure groups, overall or by era of service. Associations between combat and ischemic stroke period prevalence may be modified by father's education, although confidence intervals were wide and event rates small. Conclusions Overall, middle-aged veterans with distant combat exposure are not at increased cardiovascular risk compared to those without combat exposure.
Purpose To examine the effect of correcting coronary heart disease (CHD) risk factors for long-term within-person variation on CHD risk. Methods By using 5533 men and 7301 women from the ...Atherosclerosis Risk in Communities (ARIC) study, we compared models incorporating risk factors measured at a single visit and models incorporating additional measurements for systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol taken 3 years before baseline. Results The largest change away from null was observed for systolic blood pressure, ie, hazard ratio (HR) 1.38 to 1.69 (+81%) in women and HR 1.26 to 1.41 (+56%) in men. HRs also decreased for age (−32% in women, −9% in men), race (−67% in women), the presence of diabetes (−13% in men and women), and medication use for hypertension (−27% in women, −26% in men) and cholesterol (−97% in women, HR 1.06–0.93 in men). The area under the ROC curve did not improve significantly in men or women, whereas reclassification was only significant in women (net reclassification improvement 5.4%, p = 0.016). Conclusions Modeling long-term variation in CHD risk factors had a substantial impact on HR estimates, with new effect estimates further from the null for some risk factors and closer for others including age and medication use, but only improved risk classification in women.
Abstract Purpose Clinical guidelines recommend early reperfusion treatment in myocardial infarction (MI) patients to reduce the cardiac damage. Epidemiologic definitions of MI are often based on the ...evolution of the cardiac lesion. We aim to study the effect of treatment on the estimates of rates and 20-year time trends of MI. Methods A Multinational Monitoring of trends and determinants in Cardiovascular disease (MONICA) register was active between 1985 and 2004 to survey 35- to 64-year-old residents in Brianza, Northern Italy. To the well-established MONICA definite MI, we added the MONICA possible nonfatal MI receiving either myocardial revascularization or thrombolysis within 24 hours from onset. The average annual relative changes in incidence rate and 28-day case fatality percentage were estimated from log-linear models. Results In our population, characterized by a monotonic decrease in coronary heart disease (CHD) mortality rates, the incident rate for the standard MONICA definite MI decreased yearly by 3% in both gender groups. The addition of selected revascularizations halved the downward trends in incidence rate in men and women; conversely, the decline in 28-day case fatality became steeper. Conclusions From an epidemiologic perspective, the increasing proportion of acute events efficaciously treated with revascularization therapy affects the estimate and the interpretation of time trends in MI incidence and CHD mortality.
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