Racial differences in associations of blood pressure components in young adulthood with incident cardiovascular disease by middle age: Coronary Artery Risk Development in Young Adults (CARDIA) study

Yuichiro Yano, Jared P. Reis, Yacob G. Tedla, David C. Goff, David R. Jacobs, Stephen Sidney, Hongyan Ning, Kiang Liu, Philip Greenland, Donald M. Lloyd-Jones

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


IMPORTANCE: Data are sparse regarding which blood pressure (BP) components in young adulthood optimally determine cardiovascular disease (CVD) by middle age. OBJECTIVES:      To assess which BP components best determine incident CVD events in young adults and determine whether these associations vary by race and age at BP measurement. DESIGN, SETTING, AND PARTICIPANTS: Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, this study assessed the longitudinal race-stratified associations between BP and cardiovascular outcomes. CARDIA is a community-based cohort that recruited black and white individuals (age range, 18-30 years) from March 26, 1985, through June 7, 1986. CARDIA followed up participants for up to 28 years, and 94% of the surviving cohort completed at least 1 telephone interview or examination from August 2009 through August 2014. EXPOSURES: Blood pressures measubred at baseline (Y0) and 15 years later (Y15). MAIN OUTCOMES AND MEASURES: Composite CVD events, including coronary heart disease, stroke, heart failure, and other vascular diseases. RESULTS: A total of 4880 participants participated in the study (mean [SD] age, 24.9 [3.6] years at Y0 and 25.0 [3.6] years at Y15; 2223 male [45.6%] at Y0 and 1800 [44.2%] at Y15; 2657 female [54.4%] at Y0 and 2277 [55.8%] at Y0; 2473 black individuals [50.7%] at Y0 and 1994 [48.9%] at Y15; and 2407 white individuals [49.3%] at Y0 and 2083 [51.1%] at Y15). The mean SBP/DBP was 112/69 mm Hg in blacks and 109/68 mm Hg in whites at Y0 and 117/77 mm Hg in blacks and 110/72 mm Hg in whites at Y15. During a 25-year follow-up from Y0, 210 CVD events occurred (twice as many events in blacks [n = 140] compared with whites), of which 131 (87 in blacks) occurred after Y15. With adjustments for covariates, results from Cox proportional hazards models, including SBP and DBP, jointly suggested that, at Y0, SBP (hazard ratio [HR] per 1-SD increase, 1.32; 95% CI, 1.09-1.61) but not DBP (HR, 1.05; 95% CI, 0.88-1.26) was associated with CVD risk in blacks, whereas DBP (HR, 1.74; 95% CI, 1.21-2.50) but not SBP (HR, 0.82; 95% CI, 0.57-1.18) was associated with CVD risk in whites. At Y15, SBP was the strongest indicator of CVD in blacks (HR, 1.64; 95% CI, 1.25-2.16) and whites (HR, 1.67; 95% CI, 1.02-2.69). CONCLUSIONS AND RELEVANCE: This study questions the classic view that DBP is more able to identify future CVD events than SBP in all individuals younger than 50 years. In young adulthood, SBP in black individuals and DBP in white individuals were the most robust indicators of future CVD. In middle-age, SBP in both races identified risk of incident CVD.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalJAMA cardiology
Issue number4
StatePublished - Apr 2017

Bibliographical note

Funding Information:
Development in Young Adults (CARDIA) Study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C and HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and intra-agency agreement AG0005 between the NIA and NHLBI. Dr Yano is supported by the American Heart Association Strategically Focused Research Network Fellow Grant.

Publisher Copyright:
Copyright 2017 American Medical Association. All rights reserved.


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