Psychosocial determinants of cardiovascular events among black Americans with chronic kidney disease or associated risk factors in the Jackson heart study

Abstract

Background Individuals with chronic kidney disease (CKD), hypertension (HTN), or diabetes mellitus (DM) are at increased risk for cardiovascular disease (CVD). The extent to which psychosocial factors are associated with increased CVD risk within these individuals is unclear. Black individuals experience a high degree of psychosocial stressors due to socioeconomic factors, environment, racism, and discrimination. We examined the association between psychosocial factors and risk of CVD events among Black men and women with CKD and CKD risk factors in the Jackson Heart Study. Methods and Results We identified 1919 participants with prevalent CKD or CKD risk factors at baseline. We used rotated principal component analysis - a form of unsupervised machine learning that may identify constructs not intuitively identified by a person - to describe five groups of psychosocial components (including negative moods, religiosity, discrimination, negative outlooks, and negative coping resources) based on a battery of questionnaires. Multiple imputation by chained equation (MICE) was used to impute missing covariate data. Cox models were used to quantify the association between psychosocial components and incident CVD, defined as a fatal coronary heart disease event, myocardial infarction, cardiac procedure (angiography or revascularization procedure), or stroke. Of the 929 participants in the analysis, 67% were female, 28% were current/former smokers with mean age of 56 years and mean BMI of 33 kg/m2. Over a median follow-up of 8 years, 6% had an incident CVD event. In multivariable models, each standard deviation (SD) increase in the religiosity component was associated with an increased hazard for CVD event (hazard ratio [HR] = 1.52, 95% CI: 1.09–2.13). Conclusions Religiosity was associated with CVD among participants with prevalent CKD or CKD risk factors. Studies to better understand the mechanisms of this relationship are needed.

Genome-wide Associations, Polygenic Risk, and Mendelian Randomization Reveal Limited Interactions between John Henryism and Cynicism

“…Although our findings do not substantiate a relationship between John Henryism and cynicism, and subsequently burnout syndrome, they do suggest that there is a genetic component to both outcomes. Research among the general population has shown that hostility is an independent risk factor for cardiovascular disease (Matthews et al, 2004), which has also been reinforced with evidence in population-specific work in African Americans (Bhavsar et al, 2021). Our results suggest that a significant predisposition to hostility and cynicism, when coupled with chronic occupational stress and hostility, could lead to elevated levels of burnout and significant long-term health decline.…”

Machine learning model for cardiovascular disease prediction in patients with chronic kidney disease

“…Previous studies have explored the construction of prediction models for CVD in CKD (15)(16)(17)(18). R. Avram et al conducted a cohort study in which elastic net regression was employed to develop a proteomic risk model for predicting cardiovascular risk among 2,182 participants from a chronic kidney dysfunction cohort (19), with AUC values ranging from 0.84 to 0.89 over 1 to 10 years, yet the clinical model performed poorly, with AUCs between 0.70 and 0.73.…”

“…Previous studies have explored the construction of prediction models for CVD in CKD ( 15 – 18 ). R. Avram et al.…”

Ethnic Disparities in the Risk Factors, Morbidity, and Mortality of Cardiovascular Disease in People With Diabetes

“…The extent to which increased psychosocial stress burden contributes to clinical outcomes in African Americans with CVD is not fully understood. Carefully designed studies, with rigorous assessment of stressors and stress levels along with robust clinical outcome measures, could be illuminating [ 80 ].…”