title: Leukocyte Telomere Length and Risks of Incident Coronary Heart Disease and Mortality in a Racially Diverse Population of Postmenopausal Women.
abstract: OBJECTIVE
  Telomeres are regions at the ends of chromosomes that maintain chromosomal structural integrity and genomic stability. In studies of mainly older, white populations, shorter leukocyte telomere length (LTL) is associated with cardiometabolic risk factors and increased risks of mortality and coronary heart disease (CHD). On average, African Americans (AfAm) have longer LTL than whites, but the LTL-CHD relationship in AfAm is unknown. We investigated the relationship of LTL with CHD and mortality among AfAm.
  
  
  RESULTS
  Using a case-cohort design, 1525 postmenopausal women (667 AfAm and 858 whites) from the Women's Health Initiative had LTL measured in baseline blood samples by Southern blotting. CHD or mortality hazards ratios were estimated using race-stratified and risk factor-adjusted Cox proportional hazards models. There were 367 incident CHD (226 mortality) events in whites, whereas AfAm experienced 269 incident CHD (216 mortality) events during median follow-up of 13 years. Shorter LTL was associated with older age, current smoking, and white race/ethnicity. In whites, each 1 kilobase decrease in LTL was associated with 50% increased hazard of CHD, hazard ratio=1.50 (95% confidence interval, 1.08-2.10), P=0.017. There was no association between CHD and LTL in AfAm. White women with shorter LTL had higher risks of mortality. In contrast, shorter LTL was weakly associated with decreased mortality hazard in AfAm.
  
  
  CONCLUSIONS
  As one of the largest prospective studies of LTL associations with incident CHD and mortality in a racially diverse sample, our study suggests differences in LTL associations with CHD and mortality between white and AfAm postmenopausal women.
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.). ccarty@cnmc.org.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Carty
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Charles
authors.initials: C
authors.lastname: Kooperberg
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Jingmin
authors.initials: J
authors.lastname: Liu
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Megan
authors.initials: M
authors.lastname: Herndon
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Themistocles
authors.initials: T
authors.lastname: Assimes
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Lifang
authors.initials: L
authors.lastname: Hou
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kimura
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Abraham
authors.initials: A
authors.lastname: Aviv
authors.affiliation: From the Division of Biostatistics and Study Methodology, Center for Translational Science, George Washington University and Children's National Medical Center, Washington, DC (C.L.C.); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (C.K., J.L., M.H., A.P.R.); Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (T.A.); Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL (L.H.); Kaiser Permanente Division of Research, Oakland, CA (C.H.K.); Department of Epidemiology, University of California, San Diego (A.Z.L.); Center of Development and Aging, New Jersey Medical School, Rutgers State University of New Jersey, Newark (M.K., A.A.); and Department of Epidemiology, University of Washington, Seattle (A.P.R.).
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Reiner
mesh_terms: D001741:Black or African American / Q000235:genetics*; D000368:Aged; D016022:Case-Control Studies; D016001:Confidence Intervals; D003327:Coronary Disease / Q000208:ethnology* / Q000235:genetics* / Q000503:physiopathology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007962:Leukocytes; D008875:Middle Aged; D017698:Postmenopause / Q000208:ethnology / Q000235:genetics; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016615:Telomere / Q000235:genetics*; D044465:White People / Q000235:genetics
keywords: African Americans; coronary disease; mortality; risk factors; telomere; women