المؤلفون: John S. Kim, Yifei Sun, Pallavi Balte, Mary Cushman, Rebekah Boyle, Russell P. Tracy, Linda M. Styer, Taison D. Bell, Michaela R. Anderson, Norrina B. Allen, Pamela J. Schreiner, Russell P. Bowler, David A. Schwartz, Joyce S. Lee, Vanessa Xanthakis, Margaret F. Doyle, Elizabeth A. Regan, Barry J. Make, Alka M. Kanaya, Sally E. Wenzel, Josef Coresh, Carmen R. Isasi, Laura M. Raffield, Mitchell S. V. Elkind, Virginia J. Howard, Victor E. Ortega, Prescott Woodruff, Shelley A. Cole, Joel M. Henderson, Nicholas J. Mantis, Monica M. Parker, Ryan T. Demmer, Elizabeth C. Oelsner

المصدر: Nature Communications, Vol 15, Iss 1, Pp 1-12 (2024)

مصطلحات موضوعية: Science

الوصف: Abstract This study investigates correlates of anti-S1 antibody response following COVID-19 vaccination in a U.S. population-based meta-cohort of adults participating in longstanding NIH-funded cohort studies. Anti-S1 antibodies were measured from dried blood spots collected between February 2021-August 2022 using Luminex-based microsphere immunoassays. Of 6245 participants, mean age was 73 years (range, 21-100), 58% were female, and 76% were non-Hispanic White. Nearly 52% of participants received the BNT162b2 vaccine and 48% received the mRNA-1273 vaccine. Lower anti-S1 antibody levels are associated with age of 65 years or older, male sex, higher body mass index, smoking, diabetes, COPD and receipt of BNT16b2 vaccine (vs mRNA-1273). Participants with a prior infection, particularly those with a history of hospitalized illness, have higher anti-S1 antibody levels. These results suggest that adults with certain socio-demographic and clinical characteristics may have less robust antibody responses to COVID-19 vaccination and could be prioritized for more frequent re-vaccination.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2041-1723

URL الوصول: https://doaj.org/article/70812139a43e4ea6855d4d113d776773

المؤلفون: Anjali Gupta, Lauren E. Wilson, Laura C. Pinheiro, Amy H. Herring, Tyson Brown, Virginia J. Howard, Tomi F. Akinyemiju

المصدر: SSM: Population Health, Vol 24, Iss , Pp 101546- (2023)

مصطلحات موضوعية: Education, Mortality, Social determinants of health, Health behaviors, Public aspects of medicine, RA1-1270, Social sciences (General), H1-99

الوصف: Background: Low educational attainment is associated with excess cancer mortality. However, the mechanisms driving this association remain unknown. Methods: Using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we evaluated the associations of participant and parental/caregiver education with cancer mortality using Cox proportional hazards models, adjusting for socio-demographic characteristics and health conditions. We used principal components analysis to generate indices of measures representing the social determinants of health (SDOH) and health behaviors. We used structural equation modeling to determine if the association between educational attainment and cancer mortality was mediated by these domains. Results: Among 30,177 REGARDS participants included in this analysis, 3798 (12.6%) had less than a high school degree. In fully adjusted models, those without a high school education experienced about 50% greater risk of death than high school graduates and higher (White participants HR: 1.47; 95% CI: 1.23, 1.76 and Black HR: 1.54; 95% CI: 1.33, 1.79). There was evidence of a modest mediation effect for the association between education and cancer mortality by the SDOH domain score (White total effect HR: 1.25; 95% CI: 1.18, 1.33, indirect effect HR: 1.04; 95% CI: 1.03, 1.05, direct effect HR: 1.21; 95% CI: 1.14, 1.28 and Black total effect HR: 1.24; 95% CI: 1.18, 1.29, indirect effect HR: 1.04; 95% CI: 1.03, 1.05, direct effect HR: 1.19; 95% CI: 1.14, 1.24). There was no evidence of mediation by the health behaviors score. No significant associations were found for female caregiver/mother's or male caregiver/father's education (N = 13,209). Conclusions: In conclusion, participant education was strongly associated with cancer mortality, and this association was partially mediated by the SDOH domain score.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2352827323002112; https://doaj.org/toc/2352-8273

URL الوصول: https://doaj.org/article/53311a8348c446bf921e317c777f25fa

المؤلفون: Russell P. Sawyer, Bradford B. Worrall, Virginia J. Howard, Michael G. Crowe, George Howard, Hyacinth I. Hyacinth

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 12, Iss 17 (2023)

مصطلحات موضوعية: cerebral small vessel disease, cognitive impairment, dementia, racial disparities, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Non‐Hispanic Black adults have a higher proportion of vascular cognitive impairment and Alzheimer's disease and related dementias compared with non‐Hispanic White adults that may be due to differences in the burden of cerebral small vessel disease and risk alleles for Alzheimer's disease and related dementias. We describe here the methods of an ancillary study to the REGARDS (Reason for Geographic and and Racial Difference in Stroke) study, which will examine the role of magnetic resonance imaging markers of cerebral small vessel disease and vascular as well as genetic risk factors for Alzheimer's disease and related dementias in racial disparity in the prevalence and trajectory of vascular cognitive impairment and dementia in non‐Hispanic White and non‐Hispanic Black participants. Methods In participants with no prior history of stroke who had an incident stroke or transient ischemic attack after enrollment in the study, magnetic resonance imaging scans will be evaluated using the Standards for Reporting Vascular Changes on Neuroimaging international consensus criteria and automated analysis pipelines for quantification of cerebral small vessel disease. Participants will be genotyped for APOE ε4 and TREM2 risk alleles for Alzheimer's disease and related dementias. The 6‐item screener will define global cognitive function and be the primary cognitive outcome. Conclusions With at least 426 non‐Hispanic Black and 463 non‐Hispanic White participants who have at least 2 prior and 2 poststroke or transient ischemic attack cognitive assessments, we will have at least 80% power to detect a minimum effect size of 0.09 SD change in Z score, with correction for as many as 20 tests (ie, at P

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2047-9980

URL الوصول: https://doaj.org/article/e3398cc6dda24a56b973bb371ec1ed3f

المؤلفون: Samuel A. P. Short, Katherine Wilkinson, Janin Schulte, Miguel Arce Renteria, Katharine L. Cheung, Charles D. Nicoli, Virginia J. Howard, Mary Cushman

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 12, Iss 11 (2023)

مصطلحات موضوعية: cognitive impairment, cohort study, opioid, pro‐enkephalin, risk factor, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Cardiovascular disease is a risk factor for cognitive impairment. Evidence links both lower and higher concentration of the circulating opioid pro‐enkephalin A (PENK‐A) with stroke risk. We studied the association of plasma PENK‐A with incident cognitive impairment. Methods and Results REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a prospective cohort study of 30 239 adults enrolled from 2003 to 2007. Baseline PENK‐A was measured in a nested case–control study of 462 participants who developed cognitive impairment over 4.7 years, and 556 controls. Logistic regression and spline plots adjusted for confounders estimated odds ratios (ORs) of cognitive impairment by baseline PENK‐A. Interaction terms tested for differences in associations by age, sex, and race. Baseline PENK‐A was comparable between cases and controls. There were significant differences in the association of PENK‐A with cognitive impairment by sex and age (adjusted P=0.003 and 0.06, respectively). In women but not men, spline plots showed that higher and lower PENK‐A were associated with decreased odds of cognitive impairment (ORs for 10th and 90th percentiles versus median, 0.65 [95% CI, 0.43–0.96] and 0.64 [95% CI, 0.41–0.99]), with no difference by age. In men ≥65 years of age but not younger men, higher PENK‐A was associated with decreased odds for cognitive impairment (OR for fourth versus first quartile 0.47 [95% CI, 0.22–0.99]); this pattern was not confirmed with spline plotting. Conclusions High and low levels of circulating opioid PENK‐A were associated with decreased odds of future cognitive impairment in specific subgroups. Additional research is warranted to understand the biology underlying this association and the observed differences by sex.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2047-9980

URL الوصول: https://doaj.org/article/f4349b34a84e49b0a97ed7b6fcfcf739

المؤلفون: Emily B. Levitan, Virginia J. Howard, Mary Cushman, Suzanne E. Judd, Stephanie E. Tison, Ya Yuan, Debora Kamin Mukaz, Henry E. Wang, Nathalie Pamir, Timothy B. Plante, Stephen P. Juraschek, Monika M. Safford, Parag Goyal

المصدر: BMC Public Health, Vol 21, Iss 1, Pp 1-11 (2021)

مصطلحات موضوعية: COVID-19, Social determinants of health, Health care access, Public aspects of medicine, RA1-1270

الوصف: Abstract Background Understanding health care experiences during the COVID-19 pandemic may provide insights into patient needs and inform policy. The objective of this study was to describe health care experiences by race and social determinants of health. Methods We conducted a telephone survey (July 6, 2020-September 4, 2021) among 9492 Black and White participants in the longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, age 58–105 years, from the continental United States. Among participants with symptoms of COVID-19, outcomes were: 1. Sought care or advice for the illness; 2. Received a SARS-CoV-2 test for the illness; and 3. Tested positive. Among participants without symptoms of COVID-19, outcomes were: 1. Wanted a test; 2. Wanted and received a test; 3. Did not want but received a test; and 4. Tested positive. We examined these outcomes overall and in subgroups defined by race, household income, marital status, education, area-level poverty, rural residence, Medicaid expansion, public health infrastructure ranking, and residential segregation. Results The average age of participants was 76.8 years, 36% were Black, and 57% were female. Among participants with COVID-19 symptoms (n = 697), 74% sought care or advice for the illness, 50% received a SARS-CoV-2 test, and 25% had a positive test (50% of those tested). Among participants without potential COVID-19 symptoms (n = 8795), 29% wanted a SARS-CoV-2 test, 22% wanted and received a test, 8% did not want but received a test, and 1% tested positive; a greater percentage of participants who were Black compared to White wanted (38% vs 23%, p

وصف الملف: electronic resource

Relation: https://doaj.org/toc/1471-2458

URL الوصول: https://doaj.org/article/558cf577aeeb42f082f8d7a0e3dcdef4

المؤلفون: Kara K. Landry, Suzanne E. Judd, Dawn O. Kleindorfer, George Howard, Virginia J. Howard, Neil A. Zakai, Mary Cushman

المصدر: Research and Practice in Thrombosis and Haemostasis, Vol 4, Iss 5, Pp 893-901 (2020)

مصطلحات موضوعية: NT‐proBNP, risk factors, stroke cerebrovascular disease, Diseases of the blood and blood-forming organs, RC633-647.5

الوصف: Abstract Background N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), a commonly used clinical marker of cardiac function, is associated with the presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke, and all‐cause mortality. Few data are available on the association between NT‐proBNP levels and stroke recurrence. Objective We studied the relationship between NT‐proBNP and risk of future ischemic stroke across the continuum of preexisting cerebrovascular conditions: asymptomatic, prior stroke symptoms, prior transient ischemic attack (TIA), and prior stroke. Methods The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30,239 black and white Americans aged 45 years and older from 2003 to 2007. With 5.4 years follow‐up, baseline NT‐proBNP was measured in 892 participants who developed ischemic stroke and a 4328‐person cohort random sample. Hazard ratios of stroke by baseline NT‐proBNP were calculated in groups based on the presence of prebaseline cerebrovascular conditions. Results In the fully adjusted model, elevated NT‐proBNP was associated with stroke risk in participants without a preexisting cerebrovascular condition (hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.84‐2.94) and in participants with a history of stroke symptoms (HR, 1.67; 95% CI, 1.01‐2.78) or transient ischemic attack (HR, 2.66; 95% CI, 1.00‐7.04) but not among those with prior stroke (HR, 1.26; 95% CI, 0.71‐2.21). Conclusions These findings support the potential for NT‐proBNP testing to identify people who are at highest risk for future stroke.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2475-0379

URL الوصول: https://doaj.org/article/c8a5ffc240e24f8da38fdc585f346652

المؤلفون: Wenfei Zhu, Zhiwei Cheng, Virginia J. Howard, Suzanne E. Judd, Steven N. Blair, Yuliang Sun, Steven P. Hooker

المصدر: BMC Geriatrics, Vol 20, Iss 1, Pp 1-8 (2020)

مصطلحات موضوعية: Adiposity, Physical activity, Stationary time, Accelerometer, Older adults, Geriatrics, RC952-954.6

الوصف: Abstract Background Many older adults in the U.S. do not achieve the recommended amount of physical activity (PA) to fully realize a myriad of health benefits. Adiposity is one of those important correlates of PA and sedentary behaviors. However, the full extent to which adiposity is associated with PA and stationary time (STA) is uncertain. Therefore, we examined the association of adiposity with objectively measured PA and STA in black and white older adults. Methods We conducted a cross-sectional study of older adults enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003–2007 who participated in an ancillary accelerometer study 2009–2013. Assessment of body mass index (BMI) and waist circumference (WC) was completed during an in-home visit in the parent study. PA was measured by Actical™ accelerometers, which provided estimates of moderate-to-vigorous-intensity PA (MVPA), light-intensity PA (LPA), and STA for 4–7 consecutive days. Data from accelerometers were standardized to square root percentages of total wear time per day (SqrtMVPA%, SqrtLPA%, and SqrtSTA%). Interactions were tested for BMI and WC by race and sex, separately. Results Data were available for 7873 participants (69.8 ± 8.7 yr, 54.2% women, 31.5% African American). In mixed linear regression models, significant interactions existed in BMI by race and sex for the SqrtMVPA%, WC by race and sex for the SqrtMVPA% and the SqrtLPA% model(p

وصف الملف: electronic resource

Relation: http://link.springer.com/article/10.1186/s12877-020-01664-y; https://doaj.org/toc/1471-2318

URL الوصول: https://doaj.org/article/f989e82ebd04471581cbe5a59a64a7ce

المؤلفون: Babak B. Navi, George Howard, Virginia J. Howard, Hong Zhao, Suzanne E. Judd, Mitchell S. V. Elkind, Costantino Iadecola, Lisa M. DeAngelis, Hooman Kamel, Peter M. Okin, Susan Gilchrist, Elsayed Z. Soliman, Mary Cushman, Monika Safford, Paul Muntner

المصدر: Research and Practice in Thrombosis and Haemostasis, Vol 3, Iss 4, Pp 639-651 (2019)

مصطلحات موضوعية: cancer, myocardial infarction, neoplasms, stroke, thromboembolism, Diseases of the blood and blood-forming organs, RC633-647.5

الوصف: Abstract Background Retrospective studies have reported an association between cancer and arterial thromboembolic event (ATE) risk. Objectives We sought to confirm this in a prospective cohort with adjudicated outcomes. Methods We evaluated participants enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study with Medicare coverage for 365 days before their baseline visit (2003‐2007). Medicare claims were used to identify new cancer diagnoses during follow‐up. Using incidence‐density sampling, participants who developed cancer were matched by age, sex, race, and education 1:4 to control participants who had not developed cancer. Participants were prospectively followed through 2015 for an expert‐adjudicated ATE, defined as acute myocardial infarction or ischemic stroke. Cox regression was performed to evaluate the association between incident cancer and subsequent ATE. Results In this analysis, 836 REGARDS participants with incident cancer were matched to 3339 control participants without cancer. In the 30 days after cancer diagnosis, 0.60% (n = 5) of the participants had an ATE; most of these events occurred near the time of cancer diagnosis. After adjustment for demographics, geographic region, and cardiovascular risk factors, compared to the noncancer controls, participants with incident cancer had an increased risk of ATE in the first 30 days after diagnosis (hazard ratio, 5.8; 95% confidence interval, 2.1‐15.9). There was no association between cancer diagnosis and ATE beyond 30 days. Cancers with known metastases and types considered high risk for venous thromboembolism had the strongest associations with ATE. Conclusions Incident cancer is associated with an increased short‐term risk of ATE independent of vascular risk factors.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2475-0379

URL الوصول: https://doaj.org/article/61cdb9b3dc624138ba37322c5918d215

المؤلفون: Marquita S. Brooks, Aleena Bennett, Gina S. Lovasi, Philip M. Hurvitz, Natalie Colabianchi, Virginia J. Howard, Jennifer Manly, Suzanne E. Judd

المصدر: SSM: Population Health, Vol 15, Iss , Pp 100887- (2021)

مصطلحات موضوعية: Residential address, Residential history, Environmental exposure, Public aspects of medicine, RA1-1270, Social sciences (General), H1-99

الوصف: Background: Epidemiological studies utilize residential histories to assess environmental exposure risk. The validity from using commercially-sourced residential histories within national longitudinal studies remains unclear. Our study assessed predictors of non-agreement between baseline addresses from the commercially-sourced LexisNexis database and participants in the national longitudinal study, REasons for Geographic and Racial Differences in Stroke (REGARDS). Additionally, we assessed differences in stroke risk by neighborhood socioeconomic score (nSES) based on participant reported address compared to nSES from LexisNexis/REGARDS matched baseline address. Methods: From January 2003–October 2007, REGARDS enrolled 30,239 black and white adults aged 45 and older within the continental United States and collected their baseline address. ArcGIS Desktop 10.5.1 with ESRI 2016 Business Analyst Data was used to geocode baseline addresses from LexisNexis and REGARDS. Logistic regression was used to estimate the likelihood that LexisNexis address matched REGARDS baseline address for each participant. Survival analysis was used to estimate association between nSES and incident stroke. Results: Approximately 91% of REGARDS participants had a LexisNexis address. Of these geocoded addresses, 93% of REGARDS baseline addresses matched LexisNexis addresses. Odds of agreement between LexisNexis and REGARDS was higher for older-aged participants (OR = 1.02 per year, 95% CI: 1.01, 1.02), blacks compared to whites (OR = 1.16, 95% CI: 1.05, 1.29), females compared to males (OR = 1.15, 95% CI: 1.04, 1.26), participants with an income of $34k-74k compared to an income less than $20k (OR = 1.62, 95% CI: 1.39, 1.89). Odds of agreement were lower for residents in Midwest compared to residents in the south (OR = 0.82, 95% CI: 0.73, 0.94). No significant differences in nSES-stroke associations were observed between REGARDS only and LexisNexis/REGARDS matched addresses; however, differences in interactions were observed. Conclusion: Agreement between LexisNexis and REGARDS addresses varied by sociodemographic groups, potentially introducing bias in studies reliant on LexisNexis alone for residential address data.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2352827321001622; https://doaj.org/toc/2352-8273

URL الوصول: https://doaj.org/article/4f70a137cb154a2e9bce33c1c0018841

المؤلفون: Matthew J. Singleton, Ya Yuan, Farah Z. Dawood, George Howard, Suzanne E. Judd, Neil A. Zakai, Virginia J. Howard, David M. Herrington, Elsayed Z. Soliman, Mary Cushman

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 15 (2021)

مصطلحات موضوعية: atrial fibrillation, biomarkers, prospective studies, risk factors, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background Atrial fibrillation is associated with increased stroke risk; available risk prediction tools have modest accuracy. We hypothesized that circulating stroke risk biomarkers may improve stroke risk prediction in atrial fibrillation. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort study of 30 239 Black and White adults age ≥45 years. A nested study of stroke cases and a random sample of the cohort included 175 participants (63% women, 37% Black adults) with baseline atrial fibrillation and available blood biomarker data. There were 81 ischemic strokes over 5.2 years in these participants. Adjusted for demographics, stroke risk factors, and warfarin use, the following biomarkers were associated with stroke risk (hazard ratio [HR]; 95% CI for upper versus lower tertile): cystatin C (3.16; 1.04–9.58), factor VIII antigen (2.77; 1.03–7.48), interleukin‐6 (9.35; 1.95–44.78), and NT‐proBNP (N‐terminal B‐type natriuretic peptide) (4.21; 1.24–14.29). A multimarker risk score based on the number of blood biomarkers in the highest tertile was developed; adjusted HRs of stroke for 1, 2, and 3+ elevated blood biomarkers, compared with none, were 1.75 (0.57–5.40), 4.97 (1.20–20.5), and 9.51 (2.22–40.8), respectively. Incorporating the multimarker risk score to the CHA2DS2VASc score resulted in a net reclassification improvement of 0.34 (95% CI, 0.04–0.65). Conclusions Findings in this biracial cohort suggested the possibility of substantial improvement in stroke risk prediction in atrial fibrillation using blood biomarkers or a multimarker risk score.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2047-9980

URL الوصول: https://doaj.org/article/1899d020d8844bae81473999f72b4e70