Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: Methods and initial two years' experience

White, Ayla O.; Folsom, Aaron R.; Chambless, Lloyd E.; Sharret, A. Richey; Yang, Katherine; Conwill, David E.; Higgins, Millicent; Williams, O. Dale; Tyroler, Herman A.

doi:10.1016/0895-4356(95)00041-0

Cited by 622 publications

(538 citation statements)

References 20 publications

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“…Participants have been followed for >2 decades 19, 20, 21. The original ARIC Study protocol included physical examinations, medical interviews, and laboratory tests.…”

Section: Methodsmentioning

confidence: 99%

“…Trained study personnel collected data at baseline using standardized protocols with extensive quality control measures 19, 20, 21. Covariates were selected a priori to examine the independent association between OH and CVD 28, 29, 31.…”

Section: Methodsmentioning

confidence: 99%

“…Sitting SBP and DBP levels were estimated from a mean of the second and third of 3 measurements obtained after 5 minutes of seated rest with a random‐zero mercury sphygmomanometer, and hypertension was defined as an SBP ≥140 mm Hg or DBP ≥90 mm Hg (the definition of hypertension at the time of these assessments) or self‐report of use of an antihypertensive medication 21. Antihypertensive use during the preceding 2 weeks was self‐reported.…”

Section: Methodsmentioning

confidence: 99%

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Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Juraschek

Daya

Appel

et al. 2018

JAHA

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BackgroundAlthough orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial.Methods and ResultsParticipants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49).Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.

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“…Participants have been followed for >2 decades 19, 20, 21. The original ARIC Study protocol included physical examinations, medical interviews, and laboratory tests.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Juraschek

Daya

Appel

et al. 2018

JAHA

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“…Local hospital discharge records and vital records were also surveyed to detect hospitalizations and deaths of cohort participants. An incident CHD event was defined as a validated definite or probable hospitalized myocardial infarction, a definite CHD death, an unrecognized myocardial infarction defined by electrocardiographic assessment at study visits, or coronary revascularization 30. An incident stroke event was defined as a first definite or probable hospitalized stroke occurring in a participant free of a baseline history of physician‐diagnosed stroke 28.…”

Section: Methodsmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

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167

130

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Background US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.Methods and ResultsWe used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population‐wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987–1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of “428.” A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100 000 person‐years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person‐years, respectively, in whites. In contrast, a 1 mm Hg population‐wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person‐years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population‐wide and targeted interventions.ConclusionsModest population‐wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

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“…CHD was adjudicated on the basis of published criteria 19. CHD was defined as a definite or probable myocardial infarction, definite coronary death, or coronary revascularization procedure.…”

Section: Methodsmentioning

confidence: 99%

Association of High‐Density Lipoprotein‐Cholesterol Versus Apolipoprotein A‐I With Risk of Coronary Heart Disease: The European Prospective Investigation Into Cancer‐Norfolk Prospective Population Study, the Atherosclerosis Risk in Communities Study, and the Women's Health Study

Capelleveen

Bochem

Boekholdt

et al. 2017

JAHA

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BackgroundThe contribution of apolipoprotein A‐I (apoA‐I) to coronary heart disease (CHD) risk stratification over and above high‐density lipoprotein cholesterol (HDL‐C) is unclear. We studied the associations between plasma levels of HDL‐C and apoA‐I, either alone or combined, with risk of CHD events and cardiovascular risk factors among apparently healthy men and women.Methods and Results HDL‐C and apoA‐I levels were measured among 17 661 participants of the EPIC (European Prospective Investigation into Cancer)‐Norfolk prospective population study. Hazard ratios for CHD events and distributions of risk factors were calculated by quartiles of HDL‐C and apoA‐I. Results were validated using data from the ARIC (Atherosclerosis Risk in Communities) and WHS (Women's Health Study) cohorts, comprising 15 494 and 27 552 individuals, respectively. In EPIC‐Norfolk, both HDL‐C and apoA‐I quartiles were strongly and inversely associated with CHD risk. Within HDL‐C quartiles, higher apoA‐I levels were not associated with lower CHD risk; in fact, CHD risk was higher within some HDL‐C quartiles. ApoA‐I levels were associated with higher levels of CHD risk factors: higher body mass index, HbA1c, non‐HDL‐C, triglycerides, apolipoprotein B, systolic blood pressure, and C‐reactive protein, within fixed HDL‐C quartiles. In contrast, HDL‐C levels were consistently inversely associated with overall CHD risk and CHD risk factors within apoA‐I quartiles (P<0.001). These findings were validated in the ARIC and WHS cohorts.ConclusionsOur findings demonstrate that apoA‐I levels do not offer predictive information over and above HDL‐C. In fact, within some HDL‐C quartiles, higher apoA‐I levels were associated with higher risk of CHD events, possibly because of the unexpected higher prevalence of cardiovascular risk factors in association with higher apoA‐I levels.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000479.

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Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: Methods and initial two years' experience

Cited by 622 publications

References 20 publications

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle‐Aged Adults

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Association of High‐Density Lipoprotein‐Cholesterol Versus Apolipoprotein A‐I With Risk of Coronary Heart Disease: The European Prospective Investigation Into Cancer‐Norfolk Prospective Population Study, the Atherosclerosis Risk in Communities Study, and the Women's Health Study

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