title: Relations between subclinical disease markers and type 2 diabetes, metabolic syndrome, and incident cardiovascular disease: the Jackson Heart Study.
abstract: OBJECTIVE
  The presence of subclinical disease measures has been directly associated with the development of cardiovascular disease (CVD) in whites. African Americans (AAs) in the U.S. are at higher risk of CVD compared with non-Hispanic whites; however, data on the prevalence of subclinical disease measures in AAs and their association to CVD remain unclear and may explain the higher CVD risk in this group.
  
  
  METHODS
  We evaluated 4,416 participants attending the first examination of the Jackson Heart Study (mean age 54 years; 64% women) with available subclinical disease measures.
  
  
  RESULTS
  There were 1,155 participants (26%) with subclinical disease, defined as the presence of one or more of the following: peripheral arterial disease, left ventricular hypertrophy, microalbuminuria, high coronary artery calcium (CAC) score, and low left ventricular ejection fraction. In cross-sectional analyses using multivariable-adjusted logistic regression, participants with metabolic syndrome (MetS) or diabetes (DM) had higher odds of subclinical disease compared with those without MetS and DM (odds ratios 1.55 [95% CI 1.30-1.85] and 2.86 [95% CI 2.32-3.53], respectively). Furthermore, the presence of a high CAC score and left ventricular hypertrophy were directly associated with the incidence of CVD (265 events) in multivariable-adjusted Cox proportional hazards regression models (P < 0.05). In prospective analyses, having MetS or DM significantly increased the hazard of incident CVD, independent of the presence of subclinical disease (P < 0.001).
  
  
  CONCLUSIONS
  In our community-based sample of AAs, we observed a moderately high prevalence of subclinical disease, which in turn translated into a greater risk of CVD, especially in people with MetS and DM.
authors.affiliation: Framingham Heart Study, Framingham, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA vanessax@bu.edu.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Xanthakis
authors.affiliation: School of Health Sciences, Jackson State University, Jackson, MS.
authors.forename: Jung Hye
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Tandaw E
authors.initials: TE
authors.lastname: Samdarshi
authors.affiliation: School of Health Sciences, Jackson State University, Jackson, MS.
authors.forename: Alethea N
authors.initials: AN
authors.lastname: Hill
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Solomon K
authors.initials: SK
authors.lastname: Musani
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Mario
authors.initials: M
authors.lastname: Sims
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Kamel A
authors.initials: KA
authors.lastname: Ghraibeh
authors.affiliation: Rush University Medical Center, Chicago, IL.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Liebson
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Herman A
authors.initials: HA
authors.lastname: Taylor
authors.affiliation: Framingham Heart Study, Framingham, MA Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Ervin R
authors.initials: ER
authors.lastname: Fox
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D003925:Diabetic Angiopathies / Q000208:ethnology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000208:ethnology; D008297:Male; D024821:Metabolic Syndrome / Q000208:ethnology*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology