Abstract P024: A Multimarker Approach to Evaluate Cardiac Structure in African Americans

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Abstract

Background: Cardiac structure is an independent predictor of cardiovascular outcomes including stroke, heart attack and death. Using a multimarker approach we investigated the potential association of a group of biological pathways with cardiac mass and geometry that would suggest a role in the pathophysiology of cardiac remodeling in African Americans, a high risk group.

Objective: We examined the association of a panel of nine circulation biomarkers with cardiac structure in a community of African Americans.

Methods and Results: The study sample included participants in the Jackson Heart Study who underwent an echocardiogram and phlebotomy for a panel of biomarkers that included pathways of inflammation (C-reactive protein, CRP); neurohormonal activation (B-type natriuretic peptide, BNP); renin-angiotensin system (aldosterone and renin modeled as a ratio ARR); endothelial (homocysteine, endothelin); adiposity (adiponectin and leptin); and insulin resistance (HOMAIR) with cardiac structure. The main outcomes were left ventricular mass (LVM) and LV geometry (normal geometry [reference] vs. concentric remodeling [CR], concentric hypertrophy [CH] or eccentric hypertrophy [EH]). We used multiple linear and multinomial logistic regression models to relate the biomarker panel to LVM and LV geometry, respectively. We selected the best multiple linear regression model for LVM using Akaike Information Content and backwards elimination in a multinomial logistic regression to evaluate biomarkers associated with LV geometry. Circulating concentrations of ARR, BNP and adiponectin were associated with LVM, multiple adjusted regression coefficients [beta] and standard error [±SE] per standard deviation (SD) increase in log-biomarker were, respectively; 0.056±0.009, p=0.0067; 0.020±0.005, p<0.0001; and -0.011±0.005, p=0.0432. In terms of LV geometry, BNP concentrations was significantly associated with EH (1.38 [1.11-1.72], p=0.0045) and CH (1.34 [1.03-1.75], p=0.0314). ARR was significantly associated with EH (1.34, 95% CI [1.04-1.73] odds ratio [OR], p=0.0434) per SD increment and HOMAIR was significantly associated with CR (1.26, 95% CI [1.05-1.52], p=0.0212) and EH (1.22, 95% CI [1.00-1.48], p=0.0290).

Conclusions: In a community-based sample of African Americans there were significant and positive relation of ARR and natriuretic peptide pathway to LVM and LV geometry, a significant and positive relation of HOMAIR to LV geometry and a significant and inverse relation of adiponectin to LVM. These observations support the notion of differential influences of biological pathways on cardiac structure.

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