Atherosclerosis Risk in Communities study

Atherosclerosis Risk in Communities study
Name	Atherosclerosis Risk in Communities (ARIC) study
Acronym	ARIC
Established	1985
Locations	Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; Washington County, Maryland
Participants	~15,792
Focus	Cardiovascular disease, atherosclerosis, epidemiology
Funding	National Heart, Lung, and Blood Institute

Atherosclerosis Risk in Communities study

The Atherosclerosis Risk in Communities study is a longitudinal, population-based cohort investigation begun in 1985 to characterize the determinants and outcomes of atherosclerotic cardiovascular disease across diverse Forsyth County, Jackson, Minneapolis suburbs, and Washington County populations; the study was funded by the National Heart, Lung, and Blood Institute and engaged researchers from institutions linked to Johns Hopkins University, University of Minnesota, University of Mississippi Medical Center, and Wake Forest School of Medicine. ARIC established a rich prospective dataset used by investigators associated with programs at the Centers for Disease Control and Prevention, the Framingham Heart Study, and collaborators across academic centers including Harvard University, Stanford University, University of California, San Francisco, University of Michigan, and Columbia University.

Background and Rationale

ARIC was initiated amid rising public and scientific focus on cardiovascular disease following landmark efforts such as the Framingham Heart Study, the Seven Countries Study, and national policy responses involving the National Institutes of Health and the World Health Organization; contemporaneous influences included investigators and institutions like Robert H. Williams, Daniel T. Lackland, Herbert L. Ley, Michael Stamler, T. Colin Campbell, and centers linked to Massachusetts General Hospital, Mayo Clinic, and Cleveland Clinic. Its rationale drew on prior population studies exemplified by work at Johns Hopkins Hospital, University of Chicago, Columbia-Presbyterian Medical Center, National Cancer Institute, and international cohorts related to European Society of Cardiology research, aiming to quantify risk factor associations similar to those reported by William B. Kannel, Daniel Levy, Paul Dudley White, and figures connected to the American Heart Association.

Study Design and Methods

ARIC used a prospective cohort design with repeated examinations, surveillance systems, and adjudication processes coordinated through centers including Johns Hopkins University, University of Minnesota, University of Mississippi Medical Center, and Wake Forest School of Medicine; methods incorporated standardized protocols influenced by prior trials at Harvard School of Public Health, University of North Carolina, Oxford University, Imperial College London, and analytical approaches akin to those used in studies from Uppsala University and Karolinska Institutet. Core methods included community-based sampling, biennial follow-up contacts, in-person visits, electrocardiography protocols developed in collaboration with teams at Mayo Clinic and biomarker assays performed with reference laboratories at Centers for Disease Control and Prevention and National Institutes of Health-associated facilities.

Participant Recruitment and Cohorts

ARIC enrolled approximately 15,792 men and women aged 45–64 drawn from four US communities with targeted inclusion of both black and white participants, leveraging local health systems linked to Wake Forest Baptist Medical Center, University of Mississippi Medical Center, Hennepin County Medical Center, and Meritus Health; recruitment procedures mirrored community-engaged strategies used by cohorts at Framingham Heart Study, Nurses' Health Study, Black Women's Health Study, and the Jackson Heart Study. Subcohorts and ancillary studies included specialized imaging and genetics arms collaborating with consortia including CHARGE Consortium, investigators from Broad Institute, Wellcome Trust Sanger Institute, and networks that have previously worked with datasets from European Prospective Investigation into Cancer and Nutrition and Atherosclerosis Longitudinal Study investigators.

Data Collection and Measurements

Data collection encompassed questionnaires, physical examinations, laboratory assays, carotid ultrasound, electrocardiography, and hospitalization surveillance, using standardized instruments and quality control procedures informed by teams at Mayo Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, University of Pennsylvania, and Vanderbilt University Medical Center. Biomarker measurement platforms and genetic assays were coordinated with facilities at the Broad Institute, University of Washington, Wellcome Trust, and reference laboratories affiliated with the National Heart, Lung, and Blood Institute and Centers for Disease Control and Prevention. Outcomes adjudication used committees with expertise comparable to panels convened by American College of Cardiology, European Society of Cardiology, and specialists from Brigham and Women's Hospital, Cleveland Clinic, Stanford University Medical Center, and Yale University.

Major Findings and Impact

ARIC produced influential findings on associations between traditional risk factors—hypertension, dyslipidemia, diabetes, smoking—and incident coronary heart disease, stroke, heart failure, and peripheral arterial disease, informing guidelines from the American Heart Association, American College of Cardiology, European Society of Cardiology, and public health programs at the Centers for Disease Control and Prevention and National Institutes of Health. The study contributed to risk prediction models analogous to work by William B. Kannel, Daniel Levy, and Gordon T. McInnis and to biomarker and genetic discoveries in collaboration with consortia including the CHARGE Consortium and investigators at Broad Institute, Harvard Medical School, Columbia University Medical Center, University of Pennsylvania, Johns Hopkins University, and University of Michigan. ARIC findings influenced policy and practice discussed in forums such as the American Heart Association Scientific Sessions, European Society of Cardiology Congress, and publications in journals tied to institutions like JAMA, The Lancet, New England Journal of Medicine, and Circulation.

Criticisms and Limitations

Critiques of ARIC have cited limited racial and ethnic diversity beyond black and white participants relative to national demographics, concerns about generalizability compared with studies at institutions like University of California, San Francisco, University of Texas Southwestern Medical Center, and cohorts such as the Hispanic Community Health Study/Study of Latinos; potential measurement error and survivor bias were discussed in methodological literature from Harvard School of Public Health, University of Washington, Johns Hopkins Bloomberg School of Public Health, and statistical critiques influenced by researchers at Stanford University, Columbia University, and University of Michigan. Other limitations noted include changes in medical practice since initiation affecting endpoint incidence comparable to shifts observed in datasets from Framingham Heart Study and international registries at World Health Organization partner institutions.

Ongoing Activities and Legacy

ARIC continues follow-up, ancillary studies, and data-sharing collaborations with researchers at Broad Institute, Harvard School of Public Health, University of Minnesota, Johns Hopkins University, University of Mississippi Medical Center, Wake Forest School of Medicine, and international partners including Imperial College London, Karolinska Institutet, and University College London; its legacy persists in risk prediction, biomarker discovery, genetic epidemiology, and training of investigators now affiliated with Mayo Clinic, Cleveland Clinic, Stanford University, Yale School of Medicine, Vanderbilt University Medical Center, and public health agencies such as the Centers for Disease Control and Prevention and National Institutes of Health. ARIC data remain a resource for large consortia and ongoing analyses that inform clinical practice and population health scholarship presented at meetings like the American Heart Association Scientific Sessions and in journals connected to New England Journal of Medicine, The Lancet, and Circulation.

Category:Epidemiological studies