Cardiovascular Disease

Using data from the All of Us Research Program, this project aims to examine cardiometabolic measurements across different ethnic/racial groups in order to set a foundation for future funding for All of Us research. This project was funded by the University of Arizona Office of Research, Innovation, and Impact. 

he microbiome, the microbes - bacteria, fungi, protozoa and viruses - living inside the human intestinal track, have been shown to impact both disease and health. In the last decade, there has been considerable research demonstrating that its composition is important in the development of metabolic diseases like hypertension, obesity,  heart disease, and diabetes. At the same time, studies have also shown that gut microbes vary across different populations and the composition of the microbiome is largely shaped by cultural factors like diet, nutrition, and physical activity. Researchers have noted that not only do immigrants from different countries have different microbes in their intestines, but they also have different rates of diseases impacted by the microbiome. Research for instance, has shown that some Asian immigrants have intestinal bacteria better suited to processing carbohydrates rather than meat when they arrive in the US, but these microbes are replaced over time with bacteria more common to the general US population. At the same time, rates of cardiovascular disease and diabetes also increase. This raises the question about whether lifestyle and dietary factors among immigrants might be shaping the composition of the intestinal microbe populations and protecting them against heart disease. This pilot study will compare the intestinal microbes of recent Hispanic immigrants, 2nd generation Hispanics, and non-Hispanic whites. Since first-generation Hispanics also have been shown to have lower rates of CVD, we hope to better understand whether the bacteria in their gut might be lowering their heart disease risk. This knowledge may help us to design interventions that will lower heart disease in the general population.

There is increasing evidence suggesting that women with endometriosis may have a greater risk of cardiovascular disease. This project overcomes limitations that have challenged previous studies of endometriosis and long-term health outcomes and leverages long-term longitudinal data from an established cohort, with detailed information collected on endometriosis, stroke, type 2 diabetes, and potential confounding and intermediate factors. Understanding the relation between endometriosis and cardiometabolic conditions may increase our understanding of disease etiology, influence screening recommendations, and ultimately reduce excess morbidity and mortality among the substantial proportion of women experiencing endometriosis worldwide. More information about this projet can be found here.  This project received funding from the Endometriosis Foundation of America. Stacey Missmer, ScD., from Michigan State University is a Co-Investigator for this project. 

We are using genetics to better understand the pathophysiological intersect of type-2 diabetes and cardiovascular disease, and to better understand how and in whom statin use may lead to a higher risk of developing type-2 diabetes. This project is funded by the National Institutes of Health.  Other collaborators on this project include Alexis Frazier-Wood, Craig Stump, and Jose Ordovas. 

The NIH funded research focuses on the prevention of cardiovascular disease (CVD) and its complications among adults with diabetes in Northern Mexico. We are conducting a cluster-randomized trial among adult patients with diabetes recruited from 20 Secretaría de Salud (Secretary of Health)-operated health centers in Sonora. Ten of these health centers randomized to the intervention. Existing community health workers at the ten health centers randomized to the intervention trained on the adapted CVD prevention curriculum. To evaluate the intervention, psychosocial (e.g., knowledge, attitudes, and beliefs) and behavioral (e.g., smoking, healthy eating) risk factors for cardiovascular disease will be assessed at baseline, 3 months after, and at a 12 month follow up. Clinical risk factors (i.e., BMI, blood pressure, lipids, blood sugar) are collected at the health centers for these same time periods. Changes in the intervention clinic will be compared to changes over the same time among adult patients with diabetes in each of ten health centers randomized to the control condition, the usual standard of care.

For over two decades, the Atherosclerosis Risk in Communities (ARIC) study has made many and important contributions to cardiovascular disease epidemiology. That effort will continue during the renewal. Dr. Shahar, a co-investigator on this project for over 20 years, has served on the study’s morbidity and mortality classification committee; designed and implemented ancillary studies; authored or co-authored almost 100 ARIC manuscripts; and internally reviewed ARIC manuscripts for the publication committee. Dr. Shahar has worked closely with investigators and staff at the ARIC coordinating center for many years. He will continue to support blinded endpoint classification in the ARIC cohort through a subcontract with the University of North Carolina. Subaward –University of North Carolina Chapel Hill  

Located in the Mel and Enid Zuckerman College of Public Health at the University of Arizona and funded by the state tax on tobacco products, The Arizona Smokers’ Helpline (ASHLine) is one of over 50 quitlines across the United States. Established in 1995, it is also one of the oldest and most seasoned quit lines in existence.  As a member of the North American Quitline Consortium, ASHLine is actively engaged in collaborations, research, evaluation and quality improvement to assure all Arizonans have access to high quality, evidence-based tobacco cessation services and support. Nationally, quit rates reported among North American quit lines vary, averaging around 30%.  The Arizona Smokers’ Helpline (ASHLine) has been helping people quit tobacco since its inception in 1995. We are a comprehensive quitline, offering free telephone (both reactive and proactive) and web-based quit services and four to twelve weeks Nicotine Replacement Therapy (NRT). In addition, we have fax and electronic provider referral program and provide free training and technical assistance to healthcare providers and community partners statewide. The Arizona Smokers’ Helpline (ASHLine) is a service entity well-positioned to contribute to ongoing tobacco control efforts by providing effective, evidence-based support to individuals in their effort to end tobacco use.

Residents of rural communities and Latinos continue to experience significant health disparities for chronic disease such as diabetes and cardiovascular disease.  The residents in these communities have significant disparities due to multiple social determinants of health including but not limited to a lack of access to opportunities for physical activity and other resources necessary to prevent chronic disease. Bike Ajo is a community-campus coalition with diverse membership including community health. Bike Ajo’s goal is to create a sustainable cycling hub that educates, trains, provides resources, and builds health-based partnerships within the Ajo community. The asset-based coalition includes community residents, Desert Senita Community Health Center, International Sonoran Desert Institute, Ajo Chamber of Commerce, Arizona Planning Association, Mel and Enid Zuckerman College of Public Health, UA Department of Mexican American studies, Pima County Parks & Recreation, Pima County Health Department, and Pima County Department of Transportation. The Bike Ajo works to increase access to environments promoting physical activity opportunities through the creation of the1) Bike Ajo Cycling Hub (ReaCH); and 2) expanding community-clinic linkages to chronic disease prevention resources for Desert Senita Community Health Center patients.  Successes, lessons learned, and process/implementation strategies will be shared through the Arizona REACH network as well as at local and national conferences.  Digital stories will be utilized to help community members tell their own compelling stories of the personal impact of inequities in public health. This project was funded by the National Center for Chronic Disease Prevention and Health Promotion and the Arizona Chapter of the American Planning Association. 

Honoring Your Gift is a pilot collaboration between the University of Arizona Mel and Enid Zuckerman College of Public Health, Freedoms Gate Ministries, and Ministerios Getsemani.  The project offers a program of health promotion strategies targeting specific modifiable risk factors for heart disease in multiethnic southwest Tucson. Freedoms Gate Ministries and Ministerios Getsemani will provide the supportive environment for the intervention.  This church-based intervention addresses the common heart risk factors shared by residents of this community across ethnic groups: physical inactivity, poor nutrition, diabetes, and high blood pressure.  Residents of this community will be recruited into the program, regardless of their church or religious affiliations.  Family participation will be encouraged. African American, American Indian, and Latino American ethnic groups are experiencing increasing incidence and prevalence of heart disease. Honoring Your Gift will center on the risk factors of heart disease, which is the number one cause of death for all population groups in the United States. The program, Honoring Your Gift, teaches the value of taking care of ones body and preventing heart disease through a twelve week intervention for changing eating behavior,  increasing physical activity and managing stress through health instruction, demonstrations and applications of food preparation, walking and dance, prayer and meditation. Program aims are: To conduct a baseline assessment designed to describe the health indices and health behaviors related to modifiable risk factors for heart disease among multi-ethnic study participants in a southwest Tucson church-based program. To assist program participants in achieving healthful modifications in behaviors that are associated with heart health through a culturally relevant church-based To explore changes in health indices such as blood pressure, cholesterol, blood sugar, and health behaviors (diet, physical activity, and stress management) among the Honoring Your Gift program participants.

Atherosclerosis Risk in Communities (ARIC) is a  study to investigate the etiology of atherosclerosis and its clinical sequelae and variation in cardiovascular risk factors, medical care, and disease by race, sex, place, and time. In each of four US communities--Forsyth County, North Carolina, Jackson, Mississippi, suburbs of Minneapolis, Minnesota, and Washington County, Maryland--4,000 adults aged 45-64 years will be examined twice, three years apart. ARIC has coordinating, ultrasound, pulmonary, and electrocardiographic centers and three central laboratories. Three cohorts represent the ethnic mix of their communities; the Jackson cohort, its black population. Examinations include ultrasound scanning of carotid and popliteal arteries; lipids, lipoproteins, and apolipoproteins assayed in the Lipid Laboratory; and coagulation, inhibition, and platelet and fibrinolytic activity assayed in the Hemostasis Laboratory. Surveillance for coronary heart disease will involve review of hospitalizations and deaths among community residents aged 35-74 years. ARIC aims to study atherosclerosis by direct observation of the disease and by use of modern biochemistry. This study received support through a subcontract to the University of Minnesota.

The study started in 1993 to evaluate health outcomes in aging postmenopausal women and to identify factors associated with healthy aging. Between 1993 and 1998, more than 161,000 women between 50 and 79 years of age joined the WHI. Beginning in October 2004, participants were consented for sequential 5-year WHI Extension Studies (ES). The research team continues to collect self-reported as well as medical record adjudicated health and mortality data. A team of junior investigators are engaged with data analysis in an effort to advance the dissemination of WHI research findings. Arizona research team members have published over 45 manuscripts in the past 8 years using this well-characterized and robust phenotypic information.

A subcontract to the U of MN.

The Jackson Heart Study, JHS, uses community-driven research strategies that promise impact in the near and the long term as a response to American health disparities. This research includes scientific investigations in the tradition of Framingham and other large-scale epidemiologic studies to confirm or revise our understanding of key factors in the current epidemic. The future health of the nation compels us to produce future cohorts of scientists that are prepared to sustain any gains made and to press on toward the long-term goal of eliminating CVD from all segments of American society. The dearth of scientists from the population most afflicted by CVD means that we must make the inclusion of such scientists in the scientific workforce a priority. Through programs described in this issue, the JHS is taking steps toward these goals. Ultimately, the science and the scientists produced by JHS will produce health benefits that transcend geography, ethnicity, and the current era of population research. This study was supported through a subcontract to the University of Mississippi. 

This project was funded by the Federal Emergency Management Agency. Total funding amounted to $1,000,000 for this project. 

Carotid intima-media thickness (CIMT) is a measure of the extent of atherosclerosis present in an individual, and increasing CIMT is associated with a higher likelihood of future cardiac events such as heart attacks. A higher ratio of total cholesterol (TC) over high-density lipoprotein cholesterol (HDL-C) is associated with increased CIMT. Statin therapy is generally well-tolerated and has been shown to reduce the risk of future cardiac events in individuals with cardiac risk factors, even in the absence of hypercholesterolemia (TC ≥ 240 mg/dl), and has also been shown to reduce CIMT in high-risk individuals.  However, firefighters without hypercholesterolemia rarely receive statin therapy. The goal of this project was to determine if this treatment prevents progression of CIMT in firefighters and improves other cardiovascular disease risk factors. This was done by conducting a two-year randomized interventional trial of statin therapy in firefighters with high TC/HDL-C. Phoenix area firefighters who had a TC/HDL-C ratio ≥ 5.0 and were not taking statin therapy were eligible for participation and 124 were selected. Then, half of these people were randomly assigned to receive 10 mg of rosuvastatin per day for two years and the other half were followed over this same period as a control group. CIMT and other biomarker measurements were taken at the beginning, 12-month mark, and 24-month mark of this study. This project was part of a FEMA Assistance to Firefighters Grant Program.