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Bild DE, McClelland R, Kaufman JD, Blumenthal R, Burke GL, Carr JJ, Post WS, Register TC, Shea S, Szklo M. Ten-year trends in coronary calcification in individuals without clinical cardiovascular disease in the multi-ethnic study of atherosclerosis. PLoS One 2014; 9:e94916. [PMID: 24743658 PMCID: PMC3990562 DOI: 10.1371/journal.pone.0094916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background Coronary heart disease (CHD) incidence has declined significantly in the US, as have levels of major coronary risk factors, including LDL-cholesterol, hypertension and smoking, but whether trends in subclinical atherosclerosis mirror these trends is not known. Methods and Findings To describe recent secular trends in subclinical atherosclerosis as measured by serial evaluations of coronary artery calcification (CAC) prevalence in a population over 10 years, we measured CAC using computed tomography (CT) and CHD risk factors in five serial cross-sectional samples of men and women from four race/ethnic groups, aged 55–84 and without clinical cardiovascular disease, who were members of Multi-Ethnic Study of Atherosclerosis (MESA) cohort from 2000 to 2012. Sample sizes ranged from 1062 to 4837. After adjusting for age, gender, and CT scanner, the prevalence of CAC increased across exams among African Americans, whose prevalence of CAC was 52.4% in 2000–02, 50.4% in 2003–04, 60.0% is 2005–06, 57.4% in 2007–08, and 61.3% in 2010–12 (p for trend <0.001). The trend was strongest among African Americans aged 55–64 [prevalence ratio for 2010–12 vs. 2000–02, 1.59 (95% confidence interval 1.06, 2.39); p = 0.005 for trend across exams]. There were no consistent trends in any other ethnic group. Risk factors generally improved in the cohort, and adjustment for risk factors did not change trends in CAC prevalence. Conclusions There was a significant secular trend towards increased prevalence of CAC over 10 years among African Americans and no change in three other ethnic groups. Trends did not reflect concurrent general improvement in risk factors. The trend towards a higher prevalence of CAC in African Americans suggests that CHD risk in this population is not improving relative to other groups.
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Hung R, Qadi M, Shaya G, Blumenthal R, Nasir K, Schairer J, Keteyian S, Al-Mallah M, Blaha M. EXERCISE CAPACITY ATTENUATES RISK FOR MORTALITY AND ADVERSE CLINICAL OUTCOMES IN MEN AND WOMEN WITH DYSLIPIDEMIA INDEPENDENT OF STATIN THERAPY: THE FIT PROJECT. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Swiger K, Martin S, Blaha M, Toth P, Nasir K, Gerstenblith G, Blumenthal R, Jones S. ATHEROGENIC LIPID LEVELS IN 662,711 ELDERLY PERSONS: THE VERY LARGE DATABASE OF LIPIDS 10A (VLDL 10A). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bittencourt MS, Blankstein R, Patel J, Blaha M, Hulten E, Blumenthal R, Shaw L, Liu S, Eng J, Agatston A, Budoff M, Nasir K. IMPLICATIONS OF CORONARY ARTERY CALCIUM SCORE ON SAMPLE SIZE CALCULATIONS IN CARDIOVASCULAR PRIMARY PREVENTION TRIALS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Joshi P, Martin S, Blaha M, McEvoy J, Santos R, Cannon C, Blumenthal R, Jones S. SEASONAL VARIATIONS IN LIPID PROFILES FROM 2.8 MILLION US ADULTS: THE VERY LARGE DATABASE OF LIPIDS (VLDL 14). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lewis EF, Wang R, Quan S, Gottlieb D, Bhatt D, Blumenthal R, Mehra R, Punjabi N, Patel S, Weng J, Redline S. IMPACT OF TREATMENT MODALITIES ON HEALTH STATUS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quaglia LA, Freitas W, Soares AA, Santos RA, Nadruz W, Blaha M, Coelho OR, Blumenthal R, Agatston A, Nasir K, Sposito AC. C-reactive protein is independently associated with coronary atherosclerosis burden among octogenarians. Aging Clin Exp Res 2014; 26:19-23. [PMID: 23959959 DOI: 10.1007/s40520-013-0114-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/26/2022]
Abstract
AIM OF THE STUDY In contrast to the general population, individuals with primarily persistent elevation of inflammatory activity display a significant association between inflammatory biomarkers and atherosclerotic burden. In older individuals, immunosenescence upregulates the innate response and, by this way, may hypothetically favor the presence of this association. The aim of this study was to evaluate this hypothesis in healthy octogenarians. METHODS Participants (n = 208) aged 80 years or older, asymptomatic and without medical and laboratory evidence of chronic diseases or use of anti-inflammatory treatments were included in the study. Lipid profile and plasma C-reactive protein (CRP) were measured at baseline and cardiac computed tomography was performed within 1-week interval for measuring coronary calcium score (CCS). RESULTS The median plasma CRP was 1.9 mg/L (1.0–3.4) and 33 % of the participants had elevated CRP defined as C3 mg/L. Among those with high CRP, there was an increased frequency of high CCS (C100) as compared with their counterparts (71 vs 50 %, p = 0.001). The association between CRP and CCS persisted even after adjustment for age, sex, cardiovascular risk factors and statin therapy. The area under the receiver-operating curve for CRP was 0.606 using CCS C100 as a binary outcome. The sensitivities for CCS C100 were 40 and 74 % for the cutoff points of CRP C3 or 1 mg/L, respectively. CONCLUSION The present study was able to confirm that in very elderly individuals, systemic inflammatory activity is independently associated with coronary atherosclerosis burden.
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Roberson L, Shaharyar S, Aneni E, Freitas W, Blaha M, Agatston A, Blumenthal R, Santos RD, Feiz H, Nasir K, Sposito A. The prevalence of the metabolically healthy obese phenotype in an aging population and its association with subclinical cardiovascular disease: The Brazilian study on healthy aging. Diabetol Metab Syndr 2014; 6:121. [PMID: 25411583 PMCID: PMC4236419 DOI: 10.1186/1758-5996-6-121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/29/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Current literature has elucidated a new phenotype, metabolically healthy obese (MHO), with risks of cardiovascular disease similar to that of normal weight individuals. Few studies have examined the MHO phenotype in an aging population, especially in association with subclinical CVD. RESEARCH DESIGN AND METHODS This cross sectional study population consisted of 208 octogenarians and older. Anthropometrics, biochemical, and radiological parameters were measured to assess obesity, metabolic health (assessed by the National Cholesterol Education Program -Adult Treatment Panel (NCEP-ATP III) criteria), and subclinical measures of CVD. RESULTS The prevalence of MHO was 13.5% (N = 28). No significant association with MHO was noted for age, coronary artery calcium score, cIMT, or hs-CRP > 3 mg/dl (p = NS). CONCLUSIONS Our results suggest that the MHO phenotype exists in the elderly; however, subclinical CVD measures were not different in sub-group analysis suggesting traditional metabolic risk factor algorithms may not be accurate in the very elderly.
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Makadia SS, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Conceicao R, Carvalho J, Nasir K, Blumenthal R, Santos RD. Relation of hepatic steatosis to atherogenic dyslipidemia. Am J Cardiol 2013; 112:1599-604. [PMID: 24012029 DOI: 10.1016/j.amjcard.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 12/31/2022]
Abstract
Hepatic steatosis is closely associated with the metabolic syndrome. We assessed for an independent association between hepatic steatosis and atherogenic dyslipidemia after adjustment for obesity, physical activity, hyperglycemia, and systemic inflammation. We studied 6,333 asymptomatic subjects without clinical cardiovascular disease undergoing a health screen in Brazil from November 2008 to July 2010. Hepatic steatosis was diagnosed by ultrasound. Atherogenic dyslipidemia was defined using 2 definitions: criteria for (1) metabolic syndrome or (2) insulin resistance (triglyceride/high-density-lipoprotein cholesterol ratio of ≥2.5 in women and ≥3.5 in men). In hierarchical multivariate regression models, we evaluated for an independent association of hepatic steatosis with atherogenic dyslipidemia. Hepatic steatosis was detected in 36% of participants (average age 43.5 years, 79% men, average body mass index 26.3 kg/m(2)). Subjects with hepatic steatosis had similar levels of low-density-lipoprotein cholesterol, with significantly lower level of high-density-lipoprotein cholesterol and higher level of triglyceride compared with those without steatosis. Hepatic steatosis remained significantly independently associated with atherogenic dyslipidemia of both definitions (metabolic syndrome [odds ratio 2.47, 95% confidence interval 2.03 to 3.02] and insulin resistance [odds ratio 2.50, 95% confidence interval 2.13 to 2.91]) after multivariate adjustment. Stratified analyses showed a persistent independent association in nonobese subjects, those without metabolic syndrome, those with normal high-sensitivity C-reactive protein, nonalcohol abusers, and those with normal liver enzymes. Hepatic steatosis was significantly associated with atherogenic dyslipidemia independent of obesity, physical activity, hyperglycemia, and systemic inflammation after multivariate adjustment. In conclusion, this adds to the growing body of evidence that hepatic steatosis may play a direct metabolic role in conferring increased cardiovascular risk.
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Blumenthal R, Changeux JP, Lefever R. Membrane excitability and dissipative instabilities. J Membr Biol 2013; 2:351-74. [PMID: 24174157 DOI: 10.1007/bf01869870] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/1970] [Indexed: 11/29/2022]
Abstract
Electrical excitation is interpreted in terms of a cooperative structural transition of membrane protomers coupled with the translocation of a permeant molecule in a non-equilibrium environment. Equations for flow of permeant and for membrane conformation are derived for the simple case of a single non-charged permeant. On the basis of a few simple physical assumptions, the theory predicts several important properties of electrically excitable membranes: the steepness of the relation between membrane conductance and potential, the presence of a negative conductance, and the occurrence of instabilities following rapid perturbations of membrane environment, giving rise to some simple cases of action potentials. Several experimental tests of the membrane with its changes of electrical properties are proposed. From a thermodynamic point of view, an electrically excitable membrane, in its resting state, lies beyond a dissipative instability and consequently is in a non-equilibrium state but with stable organization, a "dissipative structure" of Prigogine. Membrane excitation following a small perturbation of the environment would correspond to a jump from such an organization to another stable organization but close to thermodynamic equilibrium. It is shown how the cooperative molecular properties of the membrane are amplified by energy dissipation at the macroscopic level.
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Blumenthal R, Hardt W. 60 Jahre Berufsverband der Deutschen Dermatologen: Vom lokalen Hilfsverein an die Schaltstellen der Gesundheitspolitik. AKTUELLE DERMATOLOGIE 2013. [DOI: 10.1055/s-0032-1326395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Joshi P, Patel B, Blaha M, Berry J, Blankstein R, Budoff M, Wong N, Agatston A, Blumenthal R, Nasir K. CORONARY ARTERY CALCIUM PREDICTS INTERMEDIATE-TERM EVENTS IN SUBJECTS WITH A LOW LIFETIME RISK OF CARDIOVASCULAR DISEASE: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Makadia S, Blaha M, Keenan T, Ndumele C, Jones S, DeFilippis A, Martin S, Kohli P, Nasir K, Blumenthal R, Filho RS. HEPATIC STEATOSIS IS ASSOCIATED WITH ATHEROGENIC DYSLIPIDEMIA INDEPENDENT OF OBESITY, COMPONENTS OF THE METABOLIC SYNDROME, MEDICATION USE, AND SYSTEMIC INFLAMMATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aneni E, Roberson L, Blaha M, Sameer S, Agatston A, Blumenthal R, Conceicao R, Carvalho J, Nasir K, Santos R. PRE-HYPERTENSION IS STRONGLY ASSOCIATED WITH DELAYED HEART-RATE RECOVERY DURING EXERCISE STRESS TEST. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Martin SS, Blaha M, Muse E, Qasim A, Reilly M, Blumenthal R, Nasir K, Criqui M, McClelland R, Harris TB, Hughes-Austin J, Allison M. LEPTIN AND INCIDENT HEART FAILURE IN WOMEN VERSUS MEN: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rana JS, Pencina M, Blaha M, Blumenthal R, Agatston A, Min JK, Blankstein R, Wong ND, Lima J, Shaw LJ, Budoff MJ, Cushman M, Berman D, Nasir K. CORONARY ARTERY CALCIUM SCORE VERSUS A MULTIPLE BIOMARKER APPROACH FOR CORONARY HEART DISEASE RISK ASSESSMENT: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bittencourt MS, Blaha M, Blankstein R, Vargas J, Budoff M, Agatston A, Blumenthal R, Nasir K. ELIGIBILITY FOR POLYPILL THERAPY, SUBCLINICAL ATHEROSCLEROSIS, AND CARDIOVASCULAR EVENTS – NATIONAL IMPLICATIONS FOR THE APPROPRIATE USE OF PREVENTIVE PHARMACOTHERAPY: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Oni E, Sinha P, Karim A, Blumenthal R, Blaha M, Agatston A, Conceicao R, Carvalho JA, Nasir K, Santos R. STATIN USE IS NOT ASSOCIATED WITH PRESENCE OF AND SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61427-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Minder CM, Blaha M, McEvoy J, Michos E, Carvalho JAM, Conceição RD, Blumenthal R, Nasir K, Santos R. THE ASSOCIATION BETWEEN SELF-REPORTED ACTIVITY LEVEL AND CARDIORESPIRATORY FITNESS ON CARDIOVASCULAR RISK FACTORS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vranian M, Blaha M, Silverman M, Michos E, Minder C, Blumenthal R, Nasir K, de Carvalho JM, Santos R. THE INTERACTION OF FITNESS, FATNESS, AND CARDIOMETABOLIC RISK. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hamirani YS, Nasir K, Blaha M, Katz R, Blumenthal R, Kronmal R, Budoff M. ASSOCIATION BETWEEN INFLAMMATORY MARKERS AND LIVER FAT: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tison GH, Blaha M, Nasir K, Blumenthal R, Szklo M, Ding J, Budoff M. THE ASSOCIATION OF ANTHROPOMETRIC OBESITY MEASURES WITH CT-MEASURED NON-ALCOHOLIC FATTY LIVER DISEASE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martin SS, Blaha M, Brinton E, Toth P, McEvoy J, Joshi P, Kulkarni K, Mize P, Kwiterovich P, DeFilippis A, Blumenthal R, Jones S. CLINICALLY MEANINGFUL UNDERESTIMATION OF LDL-C BY FRIEDEWALD AT LEVELS BELOW 70 MG/ DL: A STUDY OF 1.3 MILLION ADULTS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Harkness J, Blaha M, Blankstein R, Lima J, Budoff M, Rivera J, Agatston A, Blumenthal R, Nasir K. DISTRIBUTION AND BURDEN OF CORONARY ARTERY CALCIUM AS PREDICTORS OF SURGICAL AND PERCUTANEOUS REVASCULARIZATION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tota-Maharaj R, Budoff MJ, Blaha MJ, Zeb I, Katz R, Blankstein R, Blumenthal R, Nasir K. ETHNIC DIFFERENCES IN LIVER FAT ON CARDIAC COMPUTED TOMOGRAPHY SCANS: THE MULTIETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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