title: Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension.
abstract: Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of multiple measurements within subjects over time. For our secondary outcome, we used administrative and National Death Index data to determine all-cause death, and univariate relationships were evaluated. Among 175 subjects, 117 were Latino (67%) and 117 were female (67%). Pulse-wave velocity and CIMT regressed over time (both P <0.001) and were highly correlated (P <0.001). Only pulse-wave velocity (P=0.002) and total cholesterol (P=0.03) were associated with CIMT in time-varying covariate analysis. At a median follow-up period of 80 months, 17 of 175 subjects had died (10%). Higher baseline CIMT and pulse-wave velocity were associated with increased mortality rates (both P <0.01). No serum inflammatory marker was significantly correlated with longitudinal changes in CIMT or death. In conclusion, both arterial stiffness and preclinical carotid atherosclerosis were associated with increased mortality rates and might be useful risk-stratification markers among this minority population.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Pflederer
authors.forename: Carlin S
authors.initials: CS
authors.lastname: Long
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.forename: Angela
authors.initials: A
authors.lastname: Keniston
authors.forename: Mori J
authors.initials: MJ
authors.lastname: Krantz
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D001808:Blood Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: Biomarkers/analysis; Hispanic Americans/ethnology; cardiovascular diseases/epidemiology/ethnology/prevention & control; models, statistical; phospholipases A2; predictive value of tests; pulse-wave analysis/methods; risk assessment; risk factors; socioeconomic factors