title: Inflammatory Obesity Phenotypes, Gender Effects, and Subclinical Atherosclerosis in African Americans: The Jackson Heart Study.
abstract: Reasons for variations in atherosclerotic burden among individuals with similar levels of obesity are poorly understood, especially in African Americans. This study examines whether high-sensitivity C-reactive protein (hsCRP) is useful for discriminating between benign and high-risk obesity phenotypes for subclinical atherosclerosis in African Americans.
  
  
  
  Participants from the Jackson Heart Study (n=4682) were stratified into 4 phenotypes based on the presence of National Heart and Lung and Blood Institute definition of obesity or obesity-equivalent (body mass index ≥30 or body mass index 25-30 with waist circumference >102 cm in men and >88 cm in women) and inflammation by hsCRP ≥2 mg/L. Using multivariate regression models, we conducted cross-sectional analyses of the association between inflammatory obesity phenotypes and subclinical atherosclerosis determined by carotid intima-media thickness or coronary artery calcium scores. Sex-specific analyses were conducted given significant interaction for gender (P=0.03). The prevalence of obesity or equivalent was 65%, of which 30% did not have inflammation. Conversely, 37% of nonobese individuals had inflammation. Among nonobese men, hsCRP ≥2 mg/L identified a subset of individuals with higher carotid intima-media thickness (adjusted mean difference =0.05, 95% confidence interval 0.02, 0.08 mm) compared with their noninflammatory counterparts. Among obese men, hsCRP <2 mg/L identified a subset of individuals with lower coronary artery calcium compared with their inflammatory counterparts. Among women, associations between hsCRP and carotid intima-media thickness or coronary artery calcium were not found.
  
  
  
  In the largest African American population-based cohort to date, hsCRP was useful in identifying a subset of nonobese men with higher carotid intima-media thickness, but not in women. hsCRP did not identify a subset of obese individuals with less subclinical atherosclerosis.
authors.affiliation: From the Center of Innovation Long Term Services and Supports (LTSS), Veterans Affairs Hospital, Providence, RI (A.L., M.E.L., W.-C.W.); Department of Medicine, Alpert Medical School of Brown University, Providence, RI (A.L., W.-C.W.); Department of Epidemiology, School of Public Health, Brown University, Providence, RI (M.E.L., W.-C.W.); Center for Primary Care and Prevention, Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket (C.E.); and Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.).
authors.forename: Albert
authors.initials: A
authors.lastname: Lin
authors.affiliation: From the Center of Innovation Long Term Services and Supports (LTSS), Veterans Affairs Hospital, Providence, RI (A.L., M.E.L., W.-C.W.); Department of Medicine, Alpert Medical School of Brown University, Providence, RI (A.L., W.-C.W.); Department of Epidemiology, School of Public Health, Brown University, Providence, RI (M.E.L., W.-C.W.); Center for Primary Care and Prevention, Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket (C.E.); and Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.).
authors.forename: Mary E
authors.initials: ME
authors.lastname: Lacy
authors.affiliation: From the Center of Innovation Long Term Services and Supports (LTSS), Veterans Affairs Hospital, Providence, RI (A.L., M.E.L., W.-C.W.); Department of Medicine, Alpert Medical School of Brown University, Providence, RI (A.L., W.-C.W.); Department of Epidemiology, School of Public Health, Brown University, Providence, RI (M.E.L., W.-C.W.); Center for Primary Care and Prevention, Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket (C.E.); and Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.).
authors.forename: Charles
authors.initials: C
authors.lastname: Eaton
authors.affiliation: From the Center of Innovation Long Term Services and Supports (LTSS), Veterans Affairs Hospital, Providence, RI (A.L., M.E.L., W.-C.W.); Department of Medicine, Alpert Medical School of Brown University, Providence, RI (A.L., W.-C.W.); Department of Epidemiology, School of Public Health, Brown University, Providence, RI (M.E.L., W.-C.W.); Center for Primary Care and Prevention, Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket (C.E.); and Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.).
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: From the Center of Innovation Long Term Services and Supports (LTSS), Veterans Affairs Hospital, Providence, RI (A.L., M.E.L., W.-C.W.); Department of Medicine, Alpert Medical School of Brown University, Providence, RI (A.L., W.-C.W.); Department of Epidemiology, School of Public Health, Brown University, Providence, RI (M.E.L., W.-C.W.); Center for Primary Care and Prevention, Department of Family Medicine, Memorial Hospital of Rhode Island, Pawtucket (C.E.); and Department of Medicine, University of Mississippi Medical Center, Jackson (A.C.). Wen-Chih.Wu@va.gov.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000208:ethnology*; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D018836:Inflammation Mediators / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D016017:Odds Ratio; D010641:Phenotype; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D061205:Vascular Calcification / Q000097:blood / Q000000981:diagnostic imaging / Q000208:ethnology*; D055105:Waist Circumference / Q000208:ethnology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: carotid intima–media thickness; coronary artery calcium; gender; high-sensitivity C-reactive protein; inflammation; obesity; subclinical atherosclerosis