Cardiometabolic consequences of pubertal maturation and childhood adversity in young Latino men and women

An extensive literature has linked off-time pubertal maturation to adverse health outcomes among adults. Childhood adversities are also linked to both pubertal development and cardiometabolic disease. Despite the racial and ethnic disparities in pubertal timing and cardiometabolic health in midlife, few studies have investigated if off-time pubertal maturation is associated with Latino individuals' metabolic syndrome. Furthermore, there exists limited data assessing early life risk factors affecting the association between timing of pubertal maturation and metabolic syndrome by sex and in young adults. This dissertation used a life course perspective to test developmental hypotheses of stress on reproductive strategies and cardiometabolic health to address these limitations. The three primary aims of this dissertation research were to 1) estimate the association between family dysfunction and timing of pubertal maturation in Latino boys and girls, 2) systematically review the impact of the timing of pubertal maturation on metabolic syndrome in young adults age 18-40 years, and 3) estimate the association between timing of pubertal maturation and metabolic syndrome in young adult Latino men and women. The analytic aims were explored using data from two population-based cohorts that include different age groups: the Hispanic Community Health Study/Study of Latinos (HCSH/SOL) Youth Ancillary Study (cross-sectional design) (8-16 years), and the Boricua Youth Study Health Assessment Ancillary Study (prospective design) (5-10 years and 18-23 years). The first empirical study, using HCHS/SOL Youth data, found that the presence of family dysfunction may be associated with delayed pubertal maturation in Latino children and adolescents. The systematic review highlighted the lack of diversity by sex, measurements, and racial/ethnic representation in this area of research, but also suggested that childhood BMI may account for much of the association between pubertal timing and metabolic syndrome. The second empirical study, based on the BYS HA study, did not find meaningful associations between timing of pubertal maturation and metabolic syndrome and cardiometabolic traits in young adults. These results do not support the prevailing hypotheses nor quantitative evidence linking off-time pubertal maturation to poorer cardiometabolic health. Overall, this dissertation utilized a life course perspective to advance understanding and support of the origins of adulthood cardiovascular risk that may begin in childhood. Future investigations should be designed to be longitudinal and include measures characterizing childhood body size, health behaviors, and environmental exposures. Future studies should also explore the specific mechanisms explaining the observed associations, particularly the complex interaction between hormonal and metabolic factors that appear to affect adult health among individuals with off-time pubertal maturation adversely

Influence of Childhood Adversity and Infection on Timing of Menarche in a Multiethnic Sample of Women

Childhood adversities (CAs) and infections may affect the timing of reproductive development. We examined the associations of indicators of CAs and exposure to tonsillitis and infectious mononucleosis (mono) with age at menarche. A multiethnic cohort of 400 women (ages 40–64 years) reported exposure to parental maltreatment and maladjustment during childhood and any diagnosis of tonsillitis and/or mono; infections primarily acquired in early life and adolescence, respectively. We used linear and relative risk regression models to examine the associations of indicators of CAs individually and cumulatively, and history of tonsillitis/mono with an average age at menarche and early onset of menarche (<12 years of age). In multivariable models, histories of mental illness in the household (RR = 1.44, 95% CI: 1.01–2.06), and tonsillitis diagnosis (RR = 1.67, 95% CI: 1.20–2.33) were associated with early menarche (<12 years), and with an earlier average age at menarche by 7.1 months (95% CI: −1.15, −0.02) and 8.8 months (95% CI: −1.26, −0.20), respectively. Other adversities indicators, cumulative adversities, and mono were not statistically associated with menarcheal timing. These findings provided some support for the growing evidence that early life experiences may influence the reproductive development in girls

Abstract P181: Impact of Blood Pressure on Longitudinal Patterns of Pre-Heart Failure in a Hispanic/Latino Population-Based Cohort: Results From the Echocardiographic Study of Latinos

Byline: Priscilla Duran Luciano, Albert Einstein College of Medicine, Bronx, NY; Ayana K April-Sanders, Rutgers Sch of Public Health, Piscataway, NJ; Un Jung Lee, Albert Einstein College of Medicine, Bronx, NY; Jennifer McLeod, Columbia Univ, New York, NY; Robert Kaplan, Albert Einstein College of Medicine, Bronx, NY; Barry E Hurwitz, Univ of Miami, Miami, FL; Katrina Swett, Albert Einstein College of Medicine, Bronx, NY; Martha L Daviglus, Univ of Illinois at Chicago, Chicago, IL; Martin Bilsker, Univ of Miami, Miami, FL; Daniela Sotres-Alvarez, UNC Chapel Hill, Chapel Hill, NC; Sonia Ponce, Univ of New Mexico, Albuquerque, New Mexico, NM; Mayank M Kansal, Univ of Illinois at Chicago, Chicago, IL; Jianwen Cai, UNC Chapel Hill, Chapel Hill, NC; Gregory A Talavera, San Diego State Univ, Chula Vista, CA; Carlos J Rodriguez, Albert Einstein Sch of Medicine, Bronx, NY Introduction: Hypertension (HTN) is a modifiable risk factor for heart failure (HF) and a common antecedent for pre-HF, but its effect on pre-HF is not well known. Hypothesis: Variations in blood pressure (BP) will be related to distinct patterns of pre-HF (prevalent and incident). Methods: Two echocardiograms were performed ê­4.3 years apart on 1643 adults in the Hispanic/Latino cohort ECHO SOL. Pre-HF was defined as systolic dysfunction (LVEF 15%) or diastolic dysfunction ([greater than or equal] Grade 1) or left ventricular remodeling (left ventricular mass index >115 for men, >95 for women/ relative wall thickness >0.42). At visit 1 (V1), 953 were normotensives, and 690 hypertensives [controlled and uncontrolled]. Groups were subdivided at visit 2 (V2) based on maintenance or changes from V1 BP status. Logistic regression models were used to determine the association of BP with pre-HF. All analyses were weighted due to complex survey design. Results: Higher BP at baseline (linear and by tertiles) was significantly associated with prevalent pre HF (table 1). Higher pulse pressure was significantly associated with incident pre-HF (table 1). Normotensives at V1 who later developed HTN ([greater than or equal] 130/80 mmHg) at V2 had higher odds of having prevalent (2.05 [95% CI, 1.24 - 3.39]) and incident (2.42 [95% CI, 1.07 - 5.51]) pre-HF than those who remained with BP <130/80 mmHg at V2. When defining uncontrolled HTN as BP [greater than or equal] 130/80 mmHg, we found that uncontrolled hypertensives at V1 who remained uncontrolled at V2 had higher odds (2.75 [95% CI, 1.18 - 6.41]) of having prevalent pre-HF compared to uncontrolled hypertensives who progressed to controlled HTN at V2 (<130/80 mmHg). Conclusion A significant association exists between BP and prevalent/incident pre-HF in the Hispanic/Latino population. Additionally, those who progress from normal BP to hypertension face an increased risk of developing prevalent/incident pre-HF compared to those who remain normotensives. Blood pressure control of <130/80 mmHg could result in less prevalent pre-HF.Professiona

Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study

Abstract Background Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis. Methods A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011–2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering. Results Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78–1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49–0.90). Null associations were observed among patients ≥ 64 years. Conclusions Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis

Abstract P266: Complex Patterns of Early Life Adversity Vary by Gender: Associations With Cardiometabolic Health and Pre-Heart Failure Among Hispanics/Latinos in the Midlife

Byline: Ayana K April-Sanders, Rutgers Sch of Public Health, Piscataway, NJ; Linda Gallo, SAN DIEGO STATE UNIVERSITY, Chula Vista, CA; Un Jung Lee, Albert Einstein College of Medicine, Bronx, NY; Barry E Hurwitz, UNIVERSITY OF MIAMI, Miami, FL; Martha L Daviglus, UNIVERSITY ILLINOIS CHICAGO, Chicago, IL; Gregory A Talavera, SAN DIEGO STATE UNIVERSITY, Chula Vista, CA; Bonnie Shook-Sa, Univ of North Carolina, Chapel Hill, NC; Carmen R Isasi, ALBERT EINSTEIN COLLEGE MEDICINE, Bronx, NY; Carlos J Rodriguez, Albert Einstein Sch of Medicine, Bronx, NY Background: Early life adversities (ELA) are known risk factors for cardiovascular disease, but less understood is how distinct configurations of ELA impart differential risks for cardiometabolic health and heart failure (HF) in adulthood. Objective: To determine distinct profiles of ELA and assess whether there are associations between the resultant profiles and multiple indicators of cardiometabolic disease and pre-HF among Hispanic/Latino adults. Methods: Data from the Hispanic Community Health Study/Study of Latinos SCAS and ECHO-SOL (N=1143, mean age 55.9Ø0.4 years, 58.2% female) were used. Latent class analysis was used to identify the optimal number of classes characterizing ELA co-occurrence overall and by gender. Prevalent pre-HF was defined as systolic dysfunction (left ventricular (LF) ejection fraction 15%) or diastolic dysfunction ([greater than or equal] Grade 1) or LV remodeling (LV mass index >115 for males, >95 for females/ relative wall thickness >0.42). Weighted multivariable logit models were used to examine associations. Results: The best fitting latent classes and characterization are shown in Figure 1. By gender, ELA profiles were associated with cardiometabolic factors. E.g., females with high adversity had greater odds of obesity than those with a low adversity (OR=2.27, 95% CI: 1.39 - 3.72). Alternatively, males experiencing household dysfunction had lower odds of high cholesterol than those with low adversity (OR=0.39, 95% CI: 0.19 - 0.80). Associations were not explained by age, childhood economic hardship, nativity, and Hispanic/Latino background. ELA profiles were not associated with pre-HF (e.g., high adversity OR=0.60, household dysfunction OR=0.75; all p>0.05). Conclusions: Distinct patterns of ELA among Hispanic/Latino adults vary by gender; females experience more complex and varied patterns of adversity. Exposure to specific patterns of ELA were associated with several cardiometabolic outcomes, but no associations were found with any measures of pre-HF.Professiona

Abstract 010: Longitudinal Impact Of Glucose Homeostasis On Cardiac Structure And Function: Results From The Echocardiographic Study Of Latinos- 2 (echo-sol-2)

Introduction: We assessed whether a longitudinal association between change in glucose homeostasis and change in cardiac structure and function was present. Methods: Data from ECHO-SOL baseline and visit 2 exams were used including 1643 Hispanic/Latino participants aged 45-74 years with serial echocardiograms obtained on average 4.3 (2.8-6.7) years apart. Glucose hoemostasis was evaluated through fasting plasma glucose levels (FGP), 2 hour oral glucose tolerance test (OGTT) and hemoglobin A1C (A1C) . Glucose homeostasis was categorized as: normal glucose tolerance (NGT) (FPG7). Linear regression models were used to examine associations between change in glucose homeostasis [worsening (NGT to PDM, NGT to DM, PDM to DM, CDM to UDM) vs unchanged] with changes in left ventricular mass (LVM), relative wall thickness (RWT), ejection fraction (EF), global longitudinal strain (GLS) and E’ velocity. All analyses were weighted to account for the complex survey design. Results: At baseline (mean age 56.4 years ±0.35; 45.4% male), glucose regulation was as follows: NGT (29.1%), PDM (51.8%), CDM (9.2%) and UDM (9.9%). At visit 2, glucose downregulation was as follows: NGT to PDM (55.9%), NGT to DM (13.4%), PDM to DM (27.4%), CDM to UCDM (33.5%). Among those with worsening glucose homeostasis the average age was 55.2 ±0.50 years, 45.7% were male, FPG was 99.4±0.90mg/dL . Change from NGT to PDM compared to remaining at NGT was associated with increase LVM (b=4.0 ±0.9, p<0.001), worsening in GLS (b=0.6 ±0.1, p<0.001) and decrease in E’ velocity (b=-1.1 ±0.1, p<0.001). Neither change from NGT to DM nor from PDM to DM was associated with significant changes in cardiac structure and function. Change from CDM to UDM was associated with increase in RWT (b=0.1 ±0.0, p<0.05), compared to those with unchanged CDM. Worsening glucose homeostasis from any group was not associated with changes in EF. Conclusions: Early stages of worsening glucose homeostasis were associated with cardiac structural and functional changes. Identification of those at risk of developing prediabetes may provide opportunities to prevent future cardiac dysfunction

Pre-Heart Failure Longitudinal Change in a Hispanic/Latino Population-Based Study: Insights From the Echocardiographic Study of Latinos

Pre-heart failure (pre-HF) is an entity known to progress to symptomatic heart failure (HF). This study aimed to characterize pre-HF prevalence and incidence among Hispanics/Latinos. The Echo-SOL (Echocardiographic Study of Latinos) assessed cardiac parameters on 1,643 Hispanics/Latinos at baseline and 4.3 years later. Prevalent pre-HF was defined as the presence of any abnormal cardiac parameter (left ventricular [LV] ejection fraction 115 g/m for men, >95 g/m for women; or relative wall thickness >0.42). Incident pre-HF was defined among those without pre-HF at baseline. Sampling weights and survey statistics were used. Among this study population (mean age: 56.4 years; 56% female), HF risk factors, including prevalence of hypertension and diabetes, worsened during follow-up. Significant worsening of all cardiac parameters (except LV ejection fraction) was evidenced from baseline to follow-up (all P < 0.01). Overall, the prevalence of pre-HF was 66.7% at baseline and the incidence of pre-HF during follow-up was 66.3%. Prevalent and incident pre-HF were seen more with increasing baseline HF risk factor burden as well as with older age. In addition, increasing the number of HF risk factors increased the risk of prevalence of pre-HF and incidence of pre-HF (adjusted OR: 1.36 [95% CI: 1.16-1.58], and adjusted OR: 1.29 [95% CI: 1.00-1.68], respectively). Prevalent pre-HF was associated with incident clinical HF (HR: 10.9 [95% CI: 2.1-56.3]). Hispanics/Latinos exhibited significant worsening of pre-HF characteristics over time. Prevalence and incidence of pre-HF are high and are associated with increasing HF risk factor burden and with incidence of cardiac events

Abstract P161: Association Between Kidney Function and Pre-Heart Failure: Insights From the Echocardiographic Study of Latinos (Echo-SOL)

Abstract only Background: Impaired kidney function is an independent risk factor for heart failure (HF), but its association with pre-HF is not as well studied. We assessed kidney function in relation to pre-HF in a diverse Hispanic/Latino population in the US. Methods: Echocardiographic data from visit (V) 1 and 2 of Echo-SOL were analyzed (unweighted n=1643). Prevalent pre-HF was defined as any abnormal echocardiographic parameter at V1: left ventricular (LV) systolic dysfunction (LVSD) [ejection fraction 15%]; LV diastolic dysfunction (LVDD) >grade 1; and LV remodeling (LVR) [LV mass index >115 g/m2 in men, >95 g/m2 in women, relative wall thickness >0.42]. Incident pre-HF was defined at V2 among those without pre-HF at V1 (unweighted n=588). Kidney function was assessed by cystatin C (per 10 mg/L), eGFR (MDRD-traditional and CKD-EPI, per 5 mL/min/1.73 m2), and urine albumin creatinine ratio (UACR, per 10 units). Survey logistic regression analyses were used to examine the association of kidney function measures with prevalent and incident pre-HF and its domains (LVSD, LVDD, LVR), unadjusted and adjusted for age and sex and accounting for the complex survey design. Results: At V1 (mean age 56 years, 55% female), 66.7% had prevalent pre-HF; at V2, 66.3% had incident pre-HF. UACR was significantly associated with prevalent pre-HF and LVR in all models (Table 1-2). Higher cystatin C was significantly associated with incident pre-HF, LVDD, and LVR in all models; whereas eGFR (CKD-EPI) showed a marginal inverse relation with prevalent and incident pre-HF, LVDD and LVR, but only remained associated with LVR in adjusted models (Table 1-2). Conclusion: Declining kidney function (higher UACR and cystatin C) is associated with prevalent and incident pre-HF, diastolic dysfunction, and cardiac remodeling. Lower eGFR is also associated with cardiac remodeling in this population. Screening for kidney function could help us identify pre-HF and start protective therapies earlier to most effectively prevent overt HF