Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study
Andrea L.C. SchneiderRita R. KalyaniSherita Hill GoldenSally C. StearnsLisa WruckHsin Chieh YehJosef CoreshElizabeth Selvin
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Abstract:
To examine the magnitude and types of hospitalizations among persons with prediabetes, undiagnosed diabetes, and diagnosed diabetes.Keywords:
Prediabetes
Atherosclerotic cardiovascular disease
Background: To guide new PCSK9 inhibitors, the AHA/ACC 2018 Cholesterol Guideline has adopted a new concept of “very high-risk” and “high-risk” for patients with atherosclerotic cardiovascular dise...
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Abstract Aims Numerous studies have shown inverse associations between serum magnesium (Mg) and risk of cardiovascular disease (CVD), but studies of dietary Mg have not been consistent. To examine the association of a Mg-rich diet score with risks of CVD, coronary heart disease (CHD), and ischaemic stroke in the Atherosclerosis Risk in Communities (ARIC) study. Methods and results There were 15 022 Black and White adults without prevalent CVD at baseline (1987–89) included in this analysis. Diet was assessed at two visits 6 years apart using an interviewer-administered 66-item food frequency questionnaire. A Mg-rich diet score was created that included servings of whole grain products, nuts, vegetables, fruit, legumes, coffee, and tea. Cox proportional hazard regression evaluated associations of incident CVD, CHD, and stroke across quintiles of Mg-rich diet score, adjusting for demographics, lifestyle factors, and clinical characteristics. Over >30 years of follow-up, there were 3531 incident CVD events (2562 CHD, 1332 ischaemic stroke). Participants who consumed more Mg-rich foods were older, female, White, had lower blood pressure, fewer were not current smokers, and more reported being physically active. A Mg-rich diet was inversely associated with incident CVD (HRQ5 vs. Q1 = 0.87, 95% CI: 0.77–0.98, Ptrend = 0.02) and CHD (HRQ5 vs. Q1 = 0.82, 95% CI: 0.71–0.95, Ptrend = 0.01); however, the diet-stroke association was null (HRQ5 vs. Q1 = 1.00, 95% CI: 0.82–1.22, Ptrend = 0.97). Conclusion Consuming a diet including Mg-rich foods, such as whole grains, nuts, vegetables, fruits, legumes, coffee, and tea, is associated with lower risk of CVD and CHD, but not ischaemic stroke.
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Background: Individuals with higher physical activity (PA) have higher 25-hydroxyvitamin D [25(OH)D] levels, but whether a dose threshold exists is unknown. Moreover, both low PA and 25(OH)D defici...
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Introduction: Blood pressure (BP) is continuously associated with atherosclerotic cardiovascular disease (ASCVD) risk, even when BP is at goal levels. Objectives: In this study, we sought to examine whether individuals at goal BP levels, who nonetheless experience ASCVD events, can be identified using multivariable risk assessment. Methods: We stratified participants (45-64 years) from the Framingham Offspring Study (exams 4-6) and Atherosclerosis Risk in Communities Study (exams 1-4) based on systolic BP levels (<120, 120-129, 130-139, 140-149, 150-159, ≥160 mm Hg). We calculated risk of an incident ASCVD event over 10 years using Cox models. We determined the number of excess ASCVD events in each BP stratum by calculating the difference between observed and expected number of events (with the ASCVD rate in SBP < 120 group used as referent). We estimated 10-year ASCVD risk at baseline for each participant using the 2013 ACC/AHA Pooled Cohort risk equations. Results: There were 14,985 participants (80% wh...
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We determined the proportion of atherosclerotic cardiovascular disease (ASCVD) events that occur across the spectrum of systolic blood pressure (SBP) and assessed whether multivariable risk assessment can identify persons who experience ASCVD events at all levels of SBP, including those with goal levels.Participants aged 45 to 64 years from the Framingham Offspring and Atherosclerosis Risk in Communities studies were stratified based on treated and untreated SBP levels (<120, 120 to 129, 130 to 139, 140 to 149, 150 to 159, ≥160 mm Hg). We determined the number of excess ASCVD events in each SBP stratum by calculating the difference between observed and expected events (ASCVD event rate in untreated SBP <120 mm Hg was used as the reference). We categorized participants into 10-year ASCVD risk groups using the Pooled Cohort risk equations. There were 18 898 participants (78% white; 22% black) who were followed for 10 years. We estimated 427 excess ASCVD events, of which 56% (109 of 197) and 50% (115 of 230), respectively, occurred among untreated and treated participants with elevated SBP who were not recommended for antihypertensive therapy. Among untreated participants, 10-year ASCVD risk ≥7.5% identified 64% of those who experienced an ASCVD at 10 years and 30% of those who did not. Multivariable risk assessment was less useful in baseline-treated participants.Half of excess ASCVD events occurred in persons with elevated SBP who were not currently recommended for antihypertensive therapy. Multivariable risk assessment may help identify those likely to benefit from further risk-reducing therapies. These findings support consideration of multivariable risk in guiding prevention across the spectrum of SBP.
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