Minding the Gaps: Projecting the Consequences of Altering ASCVD Risk Thresholds on Type 2 Diabetes and ASCVD

While the cardioprotective effect of statins are undeniable, experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk. However, few studies have directly compared statin-associated benefits and harms or examined heterogeneity by population subgroups or assumed treatment effect. Thus, we aimed to project the benefits and harms of statin treatment in primary prevention adult populations newly eligible for statin treatment using four proposed statin treatment recommendations. First, we conducted a meta-analysis of statin-associated T2D risk among randomized controlled trials (RCTSs) and observational studies (OBSs), excluding studies conducted among secondary prevention populations. We identified 23 studies (35% RCTs) of n=4,012,555 participants. There was little evidence for publication bias (P>0.1); however, evidence of heterogeneity was observed overall and among OBSs and RCTs (PCochran=<0.05). Findings from the meta-analysis provided us with statin-associated T2D risks to be used to project the benefits and harms of statin treatment. A series of simulations were constructed using Markov models and contemporary data from biracial (African American and Caucasian), adult (aged 40-75) national population-based surveys and published meta-analyses. Statin treatment eligibility for each of four recommendations was determined by 10-year atherosclerosis cardiovascular disease (ASCVD) risk and, for one recommendation, age. This simulation framework was used to project statin-associated absolute benefit, quantified as the number needed to treat (NNT) to prevent one ASCVD event, absolute harm, quantified as number needed to harm (NNH) to incur one incident T2D, and relative benefit, quantified as the likelihood to be helped or harmed (LHH, NNH/NNT). Overall, the number of ASCVD events prevented was at least twice as large as the number of incident T2D incurred (LHH range: 2.10-2.90). However, the relative benefit of statin treatment decreased when higher statin-associated T2D RRs were assumed. Findings highlight the higher relative burden of T2D occurred among female and younger adult populations, with disparities widening as statin-associated T2D RR increased, underscoring the need for more research quantifying statin-associated benefits and harms.Doctor of Public Healt

Disparities in Early Transitions to Obesity in Contemporary Multi-Ethnic U.S. Populations

Few studies have examined weight transitions in contemporary multi-ethnic populations spanning early childhood through adulthood despite the ability of such research to inform obesity prevention, control, and disparities reduction

Longitudinal associations between objective and perceived healthy food environment and diet: The Multi-Ethnic Study of Atherosclerosis

IntroductionResearch examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity.MethodsData on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity.ResultsNet of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity.ConclusionOur findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations

Projections of incident atherosclerotic cardiovascular disease and incident type 2 diabetes across evolving statin treatment guidelines and recommendations: A modelling study

BACKGROUND: Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or examined heterogeneity by population subgroups or assumed treatment effect. Thus, we compared ASCVD risk reduction and T2D incidence increases across 3 statin treatment guidelines or recommendations among adults without a history of ASCVD or T2D who were eligible for statin treatment initiation. METHODS AND FINDINGS: Simulations were conducted using Markov models that integrated data from contemporary population-based studies of non-Hispanic African American and white adults aged 40–75 years with published meta-analyses. Statin treatment eligibility was determined by predicted 10-year ASCVD risk (5%, 7.5%, or 10%). We calculated the number needed to treat (NNT) to prevent one ASCVD event and the number needed to harm (NNH) to incur one incident case of T2D. The likelihood to be helped or harmed (LHH) was calculated as ratio of NNH to NNT. Heterogeneity in statin-associated benefit was examined by sex, age, and statin-associated T2D relative risk (RR) (range: 1.11–1.55). A total of 61,125,042 U.S. adults (58.5% female; 89.4% white; mean age = 54.7 years) composed our primary prevention population, among whom 13–28 million adults were eligible for statin initiation. Overall, the number of ASCVD events prevented was at least twice as large as the number of incident cases of T2D incurred (LHH range: 2.26–2.90). However, the number of T2D cases incurred surpassed the number of ASCVD events prevented when higher statin-associated T2D RRs were assumed (LHH range: 0.72–0.94). In addition, females (LHH range: 1.74–2.40) and adults aged 40–50 years (LHH range: 1.00–1.14) received lower absolute benefits of statin treatment compared with males (LHH range: 2.55–3.00) and adults aged 70–75 years (LHH range: 3.95–3.96). Projected differences in LHH by age and sex became more pronounced as statin-associated T2D RR increased, with a majority of scenarios projecting LHHs &lt; 1 for females and adults aged 40–50 years. This study’s primary limitation was uncertainty in estimates of statin-associated T2D risk, highlighting areas in which additional clinical and public health research is needed. CONCLUSIONS: Our projections suggest that females and younger adult populations shoulder the highest relative burden of statin-associated T2D risk

Author Correction: Transitions from Ideal to Intermediate Cholesterol Levels may vary by Cholesterol Metric

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the pape

Fine particulate matter and incident coronary heart disease events up to 10 years of follow-up among Deepwater Horizon oil spill workers.

BACKGROUND: During the 2010 Deepwater Horizon (DWH) disaster, in-situ burning and flaring were conducted to remove oil from the water. Workers near combustion sites were potentially exposed to burning-related fine particulate matter (PM2.5). Exposure to PM2.5 has been linked to increased risk of coronary heart disease (CHD), but no study has examined the relationship among oil spill workers. OBJECTIVES: To investigate the association between estimated PM2.5 from burning/flaring of oil/gas and CHD risk among the DWH oil spill workers. METHODS: We included workers who participated in response and cleanup activities on the water during the DWH disaster (N&nbsp;=&nbsp;9091). PM2.5 exposures were estimated using a job-exposure matrix that linked modelled PM2.5 concentrations to detailed DWH spill work histories provided by participants. We ascertained CHD events as the first self-reported physician-diagnosed CHD or a fatal CHD event that occurred after each workers last day of burning exposure. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) for the associations between categories of average or cumulative daily maximum PM2.5 exposure (versus a referent category of water workers not near controlled burning) and subsequent CHD. We assessed exposure-response trends by examining continuous exposure parameters in models. RESULTS: We observed increased CHD hazard among workers with higher levels of average daily maximum exposure (low vs. referent: HR&nbsp;=&nbsp;1.26, 95% CI: 0.93, 1.70; high vs. referent: HR&nbsp;=&nbsp;2.11, 95% CI: 1.08, 4.12; per 10&nbsp;μg/m3 increase: HR&nbsp;=&nbsp;1.10, 95% CI: 1.02, 1.19). We also observed suggestively elevated HRs among workers with higher cumulative daily maximum exposure (low vs. referent: HR&nbsp;=&nbsp;1.19, 95% CI: 0.68, 2.08; medium vs. referent: HR&nbsp;=&nbsp;1.38, 95% CI: 0.88, 2.16; high vs. referent: HR&nbsp;=&nbsp;1.44, 95% CI: 0.96, 2.14; per 100 μg/m3-d increase: HR&nbsp;=&nbsp;1.03, 95% CI: 1.00, 1.05). CONCLUSIONS: Among oil spill workers, exposure to PM2.5 from flaring/burning of oil/gas was associated with increased risk of CHD

Smoothed age (2–80 years)-, race/ethnic-, and sex-specific prevalence proportions of normal weight (solid line), overweight (dashed line), and obesity (dotted line) estimated in n = 21,220 NHANES participants.

<p>Smoothed age (2–80 years)-, race/ethnic-, and sex-specific prevalence proportions of normal weight (solid line), overweight (dashed line), and obesity (dotted line) estimated in n = 21,220 NHANES participants.</p

Age (2–80 years)-, race/ethnic-, and sex-specific overweight-to-obesity net transition probabilities estimated in n = 21,220 NHANES participants.

<p>Age (2–80 years)-, race/ethnic-, and sex-specific overweight-to-obesity net transition probabilities estimated in n = 21,220 NHANES participants.</p

One-year age-specific population extrapolations of the net number of non-institutionalized African American, Caucasian, and Mexican American males and females 2–80 years of age transitioning to overweight and obesity.

<p>One-year age-specific population extrapolations of the net number of non-institutionalized African American, Caucasian, and Mexican American males and females 2–80 years of age transitioning to overweight and obesity.</p