title: Relationship between plasma plasminogen activator inhibitor-1 and hypertension in American Indians: findings from the Strong Heart Study.
abstract: Deficient plasminogen activator inhibitor-1 (PAI-1) prevented hypertension in mice. Plasma PAI-1 was associated with hypertension in cross-sectional analyses, but the prospective association of PAI-1 with incident hypertension in large epidemiological studies is scarce.
  
  
  
  Leveraging two longitudinal cohorts of American Indians in the Strong Heart Study (SHS, N = 1019) and the Strong Heart Family Study (SHFS, N = 1502), we examined the prospective association of plasma PAI-1 with incident hypertension by multivariate logistic regression, adjusting for age, sex, study site, smoking, drinking, dietary sodium, obesity, lipids, fasting glucose, kidney function, inflammation, and follow-up years. Family relatedness in the SHFS was accounted for using the GLIMMIX procedure. Plasma PAI-1 level at baseline was measured by immunoassay. All participants were free of hypertension, cardiovascular diseases, and chronic kidney disease at baseline.
  
  
  
  A total of 305 and 258 participants, respectively, from the SHS (57 ± 7 years) and the SHFS (33 ± 13 years) developed incident hypertension during follow-up. In the SHS, higher level of log-transformed PAI-1 was associated with 1.35-fold increased risk of hypertension [odds ratio (OR) (95% confidence interval): 1.35 (1.06-1.72)]. Analysis using categorical PAI-1 (in tertiles) showed that participants in the highest tertile (≥58 ng/ml) had 63% increased risk for hypertension [OR = 1.63 (1.12-2.37)] compared with those in the lowest tertile (<33 ng/ml). This association was confirmed in the SHFS with similar effect sizes [OR = 1.41 (1.11-1.81) for log-transformed PAI-1; OR = 1.64 (1.08-2.50) for categorical PAI-1: ≥58 vs. <33 ng/ml].
  
  
  
  A higher level of plasma PAI-1 is significantly associated with hypertension in American Indians, independent of established risk factors. The potential causality warrants further investigation.
authors.affiliation: aDepartment of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida bCenter for American Indian Health Research, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA cDepartment of Clinical and Experimental Medicine, Federico II University, Naples, Italy dEagle Butte Industries Research Inc, Timber Lake, South Dakota eMedStar Health Research Institute, Hyattsville, Maryland, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Peng
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Jinying
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000453:epidemiology*; D007198:Indians, North American / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human